Getting The Most of Complementary Therapies
Assess the risks vs. the benefits
There was a time that if you mentioned an interest in complementary or alternative therapies for your cancer, your doctor might look at you like you were a little crazy, and proceed to warn you about the dangers of such therapies. Even family and friends might have questioned your thinking.
But interest in therapies outside the range of standard medical treatments has increased substantially in recent years — not just among the general public but in the medical community as well. In a government-funded survey, almost 40 percent of adults interviewed reported using some form of complementary or alternative medicine, including natural and herbal products and therapies such as deep breathing, meditation, chiropractic care, yoga and massage, among others. Doctors and scientists also are taking a keener interest in studying the safety and potential benefits of non-traditional therapies and a number of rigorous research studies are underway.
Among women with breast cancer, the use of complementary or alternative medicine is even higher. Studies report that up to 80 percent of women with breast cancer use at least one type of complementary or alternative therapy. People with cancer or chronic illness turn to complementary and alternative therapies for a host of reasons, including relieving physical distress, achieving emotional well-being and controlling symptoms such as pain. Surveys of women with breast cancer cite motivations such as:
≈≈≈≈≈≈≈
The terminology used for health care methods and practices that generally fall outside mainstream medicine has evolved quite a bit over the last several decades. It can be confusing to hear different people using different terms for what seem like the same things.
Once labeled as “unconventional” or “natural” medicine in the early 90s, dietary supplements and therapies such as yoga and hypnosis eventually came to be known as complementary and alternative medicine (CAM), an umbrella term that’s still widely used today.
There’s an important distinction, however, between complementary and alternative methods. Complementary therapies generally refer to treatments used in conjunction with conventional medicine, such as acupuncture for chemotherapy-induced nausea. In contrast, alternative medicine includes treatments used in place of traditional medicine. This might include seeing a homeopath or naturopath instead of your regular doctor. Among the general public, this distinction isn’t always so clear. Many people use the term alternative medicine as a catchall phrase to refer to both — therapies used in addition to conventional care and those used in place of it.
Add to the picture another term. Integrative medicine is a fairly new concept that describes a growing movement in many health care institutions — integrating complementary therapies with conventional medicine in an effort to treat the whole person, not just the disease or condition. The treatments promoted through integrative medicine programs aren’t substitutes for conventional medical care. They’re used in concert with medical treatment to help alleviate stress, reduce pain and anxiety, manage symptoms, maintain strength and flexibility, and promote a sense of well-being.
It’s the types of therapies being studied and practiced in a number of medical institutions, such as Mayo Clinic, that are discussed in this chapter.
≈≈≈≈≈≈≈
After learning that you have cancer or that you’re at high-risk, your natural response is to want to do everything that you can to heal yourself and to live well. That may include use of complementary and alternative healing approaches.
Keep in mind, though, that no alternative or complementary therapy is known to cure cancer. If a claim for a type of therapy sounds too good to be true, chances are it is. You also don’t want to pass up conventional medical treatment, such as surgery or chemotherapy, that’s has been shown to help treat cancer or prolong survival, in favor of an unproven alternative approach. The best use of complementary and alternative medicine is to “complement” standard medical care.
This chapter focuses primarily on therapies that might complement your prescribed cancer treatment. These therapies are known to be generally safe and they may help improve the quality of your life by relieving symptoms, reducing stress or anxiety, or minimizing the side effects of conventional treatment.
The best approach is to learn all that you can about your options and the potential benefits and risks of each therapy that you’re considering. It’s also important that you talk to members of your medical team about the complementary approaches you feel may help you. Team members can assist you in making sure that you’re pursuing the best therapies for your particular situation.
In the Additional Resources section of this book, you’ll find a listing of reliable institutions and organizations to help you in your quest.
One of the key differences between complementary therapies and conventional medicine is that conventional medicine, particularly in the United States, generally results from clinical trials that rigorously test medicines and other therapies on many people. A medicine or therapy is approved by the U.S. Food and Drug Administration, when it has been found to be safe and effective for people who meet the criteria for taking it and who take it as instructed.
Complementary therapies, on the other hand, have been used and practiced for much longer than conventional medicines, but they didn’t originate in a lab or a study, and many lack good research. Thus, scientists today are playing catch-up in the sense that they are just now testing many unconventional therapies on a large scale to make sure that they truly are safe and effective.
Since not all of the evidence is there to tell you what works and what doesn’t, it’s important to use common sense when considering a therapy that you think might complement your cancer treatment or help you manage treatment side effects.
Discuss your options
Talk with your doctor or another member of your health care team about the therapy you’re considering. Many people who use unconventional therapies don’t discuss them with their doctors. They assume their doctors will either be indifferent or opposed to their use of such therapies. But not sharing information with your doctor about all of the therapies you’re using could prove dangerous. For instance, some dietary supplements and herbs can interfere with conventional medications (see the chart Herbal Products That Don’t Mix).
When considering a complementary or alternative therapy, talk with your doctor first. He or she may be able to provide resources to help you evaluate your options or show you studies indicating potential risks or benefits.
Whether or not your doctor agrees with your decision, it’s important that he or she knows what you’re doing so that you receive the best possible care and avoid dangerous interactions.
Assess the risks vs. the benefits
Some therapies pose little risk while offering some obvious benefits. For example, meditation is unlikely to cause you harm, is easy to learn, is accessible at any time, and can help you relax and reduce stress.
To the contrary, buying an herbal supplement marketed online as a cancer cure could pose multiple risks. You don’t know exactly where it came from or even exactly what’s in it. Recent FDA regulations are improving the quality of most dietary supplements sold in the United States, but online products may be of suspect quality and purity. You also don’t know how it will affect you personally. It may interact with your conventional treatment and, depending on the supplement, it may even increase your cancer risk. So, as you research unconventional therapies, use reputable sources and providers.
Evaluate treatment providers
If you decide on a particular treatment that requires a provider, such as acupuncture or massage, find a qualified and experienced practitioner who offers it. Ask for a referral from your doctor or another trusted health care professional. A number of teaching hospitals now have integrative health programs that offer a holistic, evidence-based approach to health care.
If you’re given a referral from a friend, do your homework first before making an appointment. You can check your state government listings for agencies that regulate and license health care providers. Contact professional organizations, such as the American Academy of Medical Acupuncture, for the names of certified practitioners in your area. Keep in mind, though, that for many unconventional therapies, there are no licensure or certification standards.
Consider the costs
Your health insurance may not cover the complementary treatment that you’re considering. Check with your insurance company. If you have to pay for the treatment out of pocket, find out how much it will cost. If possible, get the cost estimate in writing before you start your treatment.
Take a middle road
Regard complementary therapies with an open but objective mind. Stay open to possibilities, but fully evaluate any treatment you’re considering.
Many different forms of complementary medicine are available, each designed to work in a different way to improve your health and quality of life. In this section we discuss some commonly used therapies that seem to have the most support from conventional practitioners.
Mind-body techniques
People have long believed that your state of mind influences your physical body. And there is, in fact, a substantial amount of scientific evidence that sustained stress can have a negative impact on your overall health. Stress can affect your emotions, your behaviors and even some of your physiologic responses.
Therefore, decreasing stress is widely thought to be beneficial. This is why mind-body techniques typically top the list of complementary therapies that doctors think are helpful.
The techniques discussed here can help reduce your vulnerability to stress and its harmful effects. They can help lessen the impact of treatment side effects, help you sleep better and feel better, lessen your sensitive to pain and contribute to your overall sense of well-being.
You can learn to do most of these techniques yourself, and many of them are inexpensive or free. To get the full benefit, though, you need to practice mind-body therapies regularly.
Meditation
Meditation techniques, which have been around for thousands of years and practiced by people of varied backgrounds, help you enter a deep, restful state that reduces your body’s stress response.
Today, many people meditate for spiritual reasons, but meditation may have health benefits as well. Meditating regularly can help relax your breathing, slow your brain waves, and decrease muscle tension and your heart rate. You can teach yourself the art of meditation.
Some people prefer moving meditation to sitting meditation. Walking meditation, yoga and tai chi, a Chinese martial arts form that combines gentle movement with deep breathing, are examples of moving meditation.
≈≈≈≈≈≈≈
One of the best things about meditation, other than its value as a stress reducer, is that anyone can do it. Here’s how:
≈≈≈≈≈≈≈
Yoga
Yoga involves moving through a series of body postures while practicing controlled breathing exercises. It’s an excellent way to counteract stress and anxiety. Its quiet, precise movements focus your mind less on your stressors and more on the moment as you move your body through poses that required balance and concentration.
Practicing yoga regularly can improve posture, flexibility, strength and range of motion. Recent evidence also indicates that yoga can improve vigor and lessen persistent fatigue in women who’ve gone through breast cancer treatment. The women involved in one of the larger studies took a 90-minute yoga class twice a week for 12 weeks. Not only did they feel less fatigued, they also felt more confident in their ability to manage their fatigue and lessen its impact on their lives.
Yoga is an activity that you can do alone or in a group and it doesn’t require a big investment to get started. You might begin by taking a class and then after you become adept at the postures and breathing continue the practice at home on your own.
Progressive relaxation
This is a method by which you learn to relax your body a little bit at a time. For instance, you might start by tightening the muscles in your toes and releasing them, then working your way up your body to the top of your head, tightening and releasing muscles as you go. Progressive relaxation teaches you to identify muscle tension and release it. Practicing it can help ease anxiety and distress.
Hypnosis
Hypnosis induces a state of deep relaxation while allowing your mind to remain narrowly focused and open to suggestion. Studies indicate that hypnosis can help reduce pain, anxiety, phobias, nausea and vomiting.
The success of hypnosis depends on the expertise of the practitioner and your willingness to try it. Some people eventually can be taught to hypnotize themselves. Contrary to ideas about hypnosis made popular by the film industry, while hypnotized you can’t be made to do something against your will.
Biofeedback
During a biofeedback session, a trained therapist applies electrodes and sensors to various parts of your body to help you identify how your body responds to certain stimuli. Using this information, you can learn how to control certain body responses, such as decreasing muscle tension and lowering your heart rate and skin temperature, all signs of relaxation. You can receive biofeedback treatments at physical therapy clinics, medical centers and hospitals. Computer-assisted biofeedback programs can be used at home.
Guided imagery
During guided imagery, you relax by following instructions — either from a recorded voice or by someone leading you — to create a pleasant mental picture. In your mind’s eye, for example, you might see yourself lying on a beach on a warm summer day listening to gentle, rhythmic waves lapping against the shore. Sometimes, guided imagery is used with progressive relaxation, to increase the relaxation effect.
Music therapy
Music has been used to supplement healing for centuries, and it’s still used today to improve quality of life for people with cancer. Listening to or playing music has many potential benefits. Music therapy may help reduce pain and, with the help of anti-nausea drugs, ease the symptoms of nausea and vomiting. It can also promote awareness and communication of your emotions and help you better manage your stress. More research is needed on the potential benefits of music therapy, but there’s certainly no downside to its use.
More than just listening to soothing music, music therapy may involve working with a music therapist, who designs a program involving vocal or instrumental music, based on your needs.
To learn more about music therapy or to find a certified music therapist, ask a member of your health care team or check with the American Music Therapy Association (see Additional Resources for more information).
Massage
From birth, the warm touch of other human beings provides comfort and pleasure. So it seems reasonable to assume that massage and other therapies like it can contribute to improved quality of life for women with cancer.
Benefits of massage therapy include relaxation and decreased muscle tension. Studies indicate that massage therapy can help improve symptoms such as anxiety, pain, fatigue and distress. Types of massage therapy common in cancer care include Swedish massage, aromatherapy massage, foot or hand massage (reflexology) and application of light pressure at specific points on the body (acupressure). One type of massage, called manual lymph drainage, uses precise light rhythmic motions to reduce swelling of the arm after a mastectomy. This therapy has become a standard part of physical therapy after mastectomy.
Massage therapy, when provided by a massage therapist who’s received additional training in massage techniques for people with cancer, has very few risks. If your cancer has spread to your bones, too much pressure applied during massage could lead to fracture. Vigorous massage may cause further harm to tissue that has already been damaged by surgery or radiation therapy if it’s not applied carefully. Concerns about the possibility of massage increasing the risk of cancer spread appear unwarranted. Still, it’s recommended massage not be applied directly to a tumor or enlarged lymph nodes.
If you have a massage, make sure the massage therapist uses care in areas of your body undergoing cancer treatment or that previously received treatment. Talk with your doctor about whether massage is safe for you and what areas of your body, if any, the massage therapist should avoid. Be sure your massage therapist graduated from an accredited program and meets state licensure requirements.
Dietary supplements
People with cancer will sometimes turn to dietary supplements, including vitamins and herbal preparations, to aid in their care. According to the American Cancer Society, about 40 percent of people with cancer report using vitamins or a nutritional supplement. Other surveys report even higher numbers. Breast cancer survivors report the highest use of any vitamin or mineral use, more than 80 percent in some surveys.
Although dietary supplements are popular among people with cancer, these therapies also have the least amount of evidence to indicate they aid cancer treatment or reduce side effects. Studies of botanicals and other biologically based products tend to be promising when performed in test tubes and in animals, but they fail to meet expectations when studied in humans. Herbs are composed of hundreds of different components and the key ingredients can be difficult to isolate, making it hard to create a standardized, one-size-fits-all supplement. In some cases, it may be the synergy between multiple parts of an herb that make it effective.
In addition, people tend to think of products derived from plants and herbs as “natural” and, therefore, safe. Unfortunately, that’s not necessarily true. Some dietary supplements may be harmful. In addition, they aren’t regulated the way medications are and generally aren’t put through rigorous testing procedures. The good news is the FDA now requires all herbs and dietary supplements sold in the United States to meet Good Manufacturing Practices. This means manufacturers are required to ensure what’s on the label matches what’s in the bottle.
Still, research, for the most part, hasn’t established the effectiveness of most dietary supplements, or established guidelines concerning side effects or how much of a preparation is necessary to meet a specific claim.
A major problem with dietary supplements concerns their potential interactions with medications. For example, St. John’s wort, an herbal preparation used to combat mild depression, can alter the action of a number of drugs, which is a serious concern if you’re receiving anti-cancer medications. High doses of vitamins can pose risks, as well. So do your homework if you’re considering taking a dietary supplement. Find out all that you can about any preparation you want to try, and discuss the information with your doctor before trying anything. The chart Herbal Products That Don’t Mix lists supplements that may interact with chemotherapy drugs and cause harm.
Still, researchers continue to study certain plants, herbs and other biologically based substances to see if they might have beneficial properties, particularly for managing the side effects of breast cancer and its treatment. Following are some of the more popular dietary supplements taken by women who have or are at risk of breast cancer, as well as some of the more promising supplements being studied.
Green tea
Drinking green tea is one of the most common ways that women with breast cancer try to enhance their health. Although evidence for its usefulness is mixed when it comes to protecting against cancer, drinking a cup of green tea a day is unlikely to hurt you. However, be cautious about drinking large quantities of green tea if you’re taking chemotherapy medications. The interaction may have harmful effects.
Vitamin C
Many people with cancer take high-dose vitamin C as a supplemental therapy in the belief that the antioxidant will enhance their body’s ability to get rid of toxic free radicals. Unfortunately, there’s little evidence that vitamin C helps prevent cancer. Large doses of the vitamin aren’t necessarily dangerous because the excess is flushed away in your urine, but some research has raised concerns that vitamin C could interfere with the effectiveness of certain chemotherapy drugs.
Flax seed
Studies in mice have shown that components of flax seed and flax seed oil may inhibit the growth of breast tumors and enhance the effects of the anticancer drug tamoxifen. But more research is needed in humans to see if this holds true for women with breast cancer.
Vitamin E
Research is ongoing regarding vitamin E’s role in preventing breast cancer. As of yet, there’s not enough evidence to recommend it as a supplementary therapy for breast cancer. And, as with other antioxidants, high doses might interfere with the effectiveness of chemotherapy.
Ginseng
The root of the American ginseng plant is being studied for its potential effects in improving cancer-related fatigue. A persistent feeling of tiredness is one of the most common unmanaged symptoms in people with cancer. Studies of ginseng support that it helps relieve some fatigue. A water-based extracted product is recommended instead of an alcohol-based one, which can produce unwanted estrogen-like effects.
Black cohosh
Hot flashes can be a bothersome side effect of menopause. Scientists are investigating whether black cohosh, an herb that has effects similar to the female hormone estrogen, might help alleviate hot flashes. Most studies, to date, haven’t found the herb beneficial.
Vitamin D
Vitamin D supplementation is often recommended to improve or maintain bone health and prevent osteoporosis. Preliminary evidence also suggests that vitamin D may have protective effects against breast cancer. Studies to define vitamin D’s role in reducing breast cancer risk or recurrence are ongoing.
In the meantime, experts recommend women with breast cancer get at least enough vitamin D to optimize their bone health. The current recommended daily intake is 600 IU for women under 70 years of age and 800 IU for those over age 70. The upper limit is 4,000 IU daily.
≈≈≈≈≈≈≈
Available evidence indicates that the following herbal preparations may interfere with the strength or effectiveness of some chemotherapy or hormone therapy medications if the herbs are taken at the same time as the medications. Some of these products could possibly even work to stimulate tumor growth. The bottom line is that before taking any herbal preparation it’s best to talk to your doctor.
| Garlic | Ginkgo | Echinacea |
| Soy | Ginseng (alcohol-extracted) | St. John's wort |
| Valerian | Kava | Grape seed |
≈≈≈≈≈≈≈
Natural energy restoration
The theory of natural energy centers on the traditional Chinese belief that humans contain a vital life energy, called qi, which runs along pathways within the body. Illness results when there’s a blockage or disturbance of the free flow of energy along these pathways. According to this theory, restoring natural energy flow restores health.
Acupuncture falls into this category. Although not every acupuncture practitioner ascribes to the energy theory, the method is a proven treatment for many forms of pain, including cancer-related pain. Acupuncture is also noted for its potential to relieve nausea and vomiting associated with chemotherapy treatment.
Other energy therapies such as therapeutic touch and reiki are also known to be safe, although the evidence as to their effectiveness is limited. Research suggests that these practices primarily have a calming, relaxing effect, but they may also help relieve pain.
Acupuncture
Acupuncture is one of the most researched and accepted forms of unconventional medicine. It involves inserting from one to 20 or more hair-thin needles into the skin. The needles usually are left in place for 15 to 30 minutes. The practitioner may move the needles by hand or stimulate them with an electrical current.
It’s possible that acupuncture may work, in part, because inserting needles into a person’s skin releases endorphins, the body’s natural painkillers, and other central nervous system chemicals. Other studies suggest that acupuncture may improve pain control by increasing the number of opioid receptors in the brain.
Acupuncture may provide relief of chronic pain associated with cancer or its treatments, as well as reduced nausea and vomiting that can accompany chemotherapy. Acupuncture has also been shown to improve dry mouth resulting from some forms of radiation treatment.
You should feel little or no pain from the insertion of the needles. Significant pain is a sign that the procedure isn’t being performed properly. Adverse side effects are rare, but they do occur, usually as a result of a practitioner’s lack of medical knowledge or inadequate training. Concerns about the risk of infection from acupuncture have largely disappeared as use of disposable needles has become a standard practice.
If you undergo acupuncture, you’ll probably have several sessions. If you don’t get relief after six or eight sessions, the procedure may not work for you.
≈≈≈≈≈≈≈
Some health care practices are very different from conventional medicine. These include practices such as homeopathy, ayurveda and naturopathy. There’s no evidence that any of these practices can cure cancer, and they may be harmful if they prevent an individual from receiving conventional medical treatment. However, the healthy lifestyle components of some of these practices may be beneficial if used in conjunction with conventional treatment.
Homeopathy
Homeopathy is based on two beliefs — the law of similars and the law of infinitesimals. The law of similars: A substance that causes certain symptoms in a healthy person can, when taken in tiny doses, cure someone with similar symptoms who is ill. The law of infinitesimals: The more dilute the substance, the more potent the medicine. Because this concept runs counter to most of conventional medicine, many doctors are skeptical of this therapy. Substances are prepared by a series of shakings, called succession, and are made from tiny amounts of plant, mineral or animal products or chemicals diluted in water or alcohol solutions. Although some of these ingredients are toxic, the amount used is typically too small to present any danger. There’s no scientific evidence that homeopathic remedies are effective in treating cancer.
Ayurveda
Possibly the oldest system of medicine still practiced today, ayurveda begins with the premise that people differ from one another physically and psychologically, so treatments must take those differences into account. According to ayurveda, people are made up of three types of energy (doshas) — fire, water and air. In most people, one dosha is dominant, and different combinations cause different metabolic types. Disease is caused by energy imbalances and disharmony with nature. The system uses a variety of therapies, including healthy eating, herbs, exercise, intestinal cleansing, meditation, massage, and breathing exercises to promote health and cure disease. Although most of the techniques promote a healthy lifestyle, some of them, such as intestinal cleansing preparations, might be harmful.
Naturopathy
Based on the healing power of nature and the body, this holistic system uses a combination of approaches, including nutrition, herbs, acupuncture and massage. Practitioners also incorporate techniques from homeopathy, ayurveda, Chinese medicine and conventional medicine. Although some of the techniques may be harmful to someone with cancer, including certain herbal preparations and excessive dietary restrictions, most of the techniques are geared to promoting a healthy lifestyle.
≈≈≈≈≈≈≈
Therapeutic touch
Proponents of therapeutic touch believe that the human body has an energy field and that blockages or disturbances in that field can be “fixed” with energy provided by a therapeutic touch practitioner.
During therapeutic touch, also known as healing touch, the practitioner moves his or her hands two to four inches above your body to survey your body’s energy field, looking for areas of congestion. If a spot is found, the practitioner will use light touch or sweeping hand motions above your skin to assess and balance the energy in and around your body. A typical session lasts approximately 20 to 30 minutes.
Therapeutic touch hasn’t been rigorously studied, but evidence so far indicates that it may promote a deep relaxation response, reduction of pain and anxiety, and faster wound healing. Some people have also found it helps to reduce certain side effects of cancer treatment, such as nausea and fatigue.
Reiki
Reiki practitioners channel healing energy by placing their hands just above or lightly on you when you’re receiving treatment. The goal is to access your healing energy and use it to facilitate your own healing. During a reiki session, the practitioner uses a series of 12 to 15 different hand positions that are related to energy centers in your body. Each position is held for two to five minutes or until the practitioner feels the flow of energy slow or stop.
Similar to healing touch, the benefits from reiki may come from its ability to promote relaxation. It’s not unusual to experience a relaxing tingling or warmness during the procedure. Reiki is most often used to restore a state of relaxation, balance and well-being.
Knowledge can be a powerful tool in your effort to treat your illness. There’s no shortage of books, articles and websites that provide health information. But when it comes to alternative and complementary medicine, hype abounds. How do you know the information you’re getting is accurate?
There may be no way to know for sure, but you can use certain safeguards. Here are some guidelines:
Even if you follow these guidelines, remember that there are no guarantees. Always verify the information you get, check more than one source, and talk with your doctor or other members of your health care team.
When it comes to use of unconventional practices, try to steer a middle course between uncritical acceptance and outright rejection. Learn to be open-minded and skeptical at the same time. Stay open to various treatments but evaluate them carefully. Also remember that the field is changing: What’s unconventional today may well be accepted — or discredited — tomorrow.
≈≈≈≈≈≈≈
The Food and Drug Administration and the National Council Against Health Fraud recommend that you watch for the following claims or practices. These are often warning signs of potentially fraudulent dietary supplements or other so-called “natural” treatments that don’t work.
≈≈≈≈≈≈≈