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Key Points
- Complementary and alternative medicine (CAM) is a group of diverse
medical and health care systems, practices, and products that are not
part of conventional medicine.
- The same scientific evaluation that is used to assess conventional cancer treatments should be used to assess CAM therapies.
- The National Center for Complementary and Alternative Medicine
(NCCAM) is sponsoring a number of clinical trials (research studies in
people) to study CAM therapies for cancer.
- To ensure a safe and coordinated course of care, people with cancer
should inform their health care providers about any CAM therapy that
they are currently using or considering.
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1. What is complementary and alternative medicine?
Complementary and alternative medicine is a group of diverse medical
and health care systems, practices, and products that are not part of
conventional (standard) medicine. Conventional medicine is medicine as
practiced by holders of M.D. (medical doctor) or D.O. (doctor of
osteopathy) degrees and by their allied health professionals, such as
nurses, physical therapists, and dietitians.
- Complementary medicine is used along with conventional medicine.
- Alternative medicine is used instead of conventional medicine.
- Integrative medicine combines standard medicine with CAM practices that have been shown to be effective.
This fact sheet answers some frequently asked questions about the
use of CAM therapies and the way that CAM approaches are evaluated, and
suggests resources for further information (see "For More Information").
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2. Is CAM widely used?
According to the most recent comprehensive survey on Americans' use
of CAM, 36 percent of U.S. adults are using some form of CAM. When
megavitamin therapy and prayer for health reasons are included in the
definition of CAM, that percentage rises to 62 percent. These results
are based on the 2002 National Health Interview Survey, which was
supported by NCCAM and the National Center for Health Statistics (part
of the Centers for Disease Control and Prevention). The survey found
that rates of CAM use are especially high among patients with serious
illnesses such as cancer.
Several smaller studies of CAM use by cancer patients have been
conducted. A study of CAM use in patients with cancer in the July 2000
issue of the Journal of Clinical Oncology found that 69 percent
of 453 cancer patients had used at least one CAM therapy as part of
their cancer treatment. A study published in the December 2004 issue of
the Journal of Clinical Oncology reported that 88 percent of
102 people with cancer who were enrolled in phase I clinical trials
(research studies in people) at the Mayo Comprehensive Cancer Center
had used at least one CAM therapy. Of those, 93 percent had used
supplements (such as vitamins or minerals), 53 percent had used
nonsupplement forms of CAM (such as prayer/spiritual practices or
chiropractic care), and almost 47 percent had used both.
A review article in the March 2005 issue of the Southern Medical Journal
reported that cancer patients take supplements to reduce side effects
and organ toxicity, to protect and stimulate their immune systems, or
to prevent further cancers or recurrences. Patients frequently see
using supplements as a way to take control over their health and
increase their quality of life.
Additional information about CAM use among cancer patients can be found in a review article published in Seminars in Oncology in December 2002.
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3. How are CAM approaches evaluated?
The same rigorous scientific evaluation used to assess conventional
cancer treatments should be used for CAM therapies. NCCAM is funding a
number of clinical trials to evaluate CAM therapies for cancer.
Conventional cancer treatments are studied for safety and
effectiveness through a rigorous scientific process that includes
laboratory research and clinical trials with large numbers of patients.
Less is known about the safety and effectiveness of complementary and
alternative methods to treat cancer, although some CAM therapies have
undergone rigorous evaluation.
A small number of CAM therapies, which were originally considered to
be purely alternative approaches, are finding a place in cancer
treatment--not as cures, but as complementary therapies that may help
patients feel better and recover faster. One example is acupuncture. In
1997, a panel of experts at the National Institutes of Health (NIH)
Consensus Conference found acupuncture to be effective in managing
chemotherapy-associated nausea and vomiting and in controlling pain
associated with surgery. In contrast, some approaches, such as the use
of laetrile, have been studied and found ineffective or potentially
harmful.
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4. Is NCCAM sponsoring clinical trials on CAM for cancer?
NCCAM is sponsoring a number of clinical trials to study
complementary and alternative treatments for cancer. Some of these
trials study the effects of complementary approaches used in addition
to conventional treatments, while others compare alternative therapies
with conventional treatments. Recent trials include the following:
- Acupuncture to relieve neck and shoulder pain following surgery for head or neck cancer
- Ginger as a treatment for nausea and vomiting caused by chemotherapy
- Massage for the treatment of cancer pain
- Mistletoe extract combined with chemotherapy for the treatment of solid tumors
Patients who are interested in taking part in these or any other clinical trials should talk with their health care provider.
Patients, family members, and health professionals can use the following Web resources to find out about CAM clinical trials:
- The NCCAM Clinical Trials
Web page. Describes current clinical trials for cancer and other health
conditions. Information on clinical trials is also available through
the NCCAM Clearinghouse (see "For More Information").
- The National Cancer Institute (NCI) PDQ Clinical Trials Database.
Includes studies of CAM and conventional medicine for cancer. This
information is also available through NCI's Cancer Information Service
(see "For More Information" for contact information).
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5. What should patients do when using or considering CAM therapies?
Cancer patients who are using or considering CAM should discuss this
decision with their health care provider, as they would any therapy.
Some complementary and alternative therapies may interfere with
standard treatment or may be harmful when used along with standard
treatment. The booklet "Thinking About Complementary and Alternative
Medicine: A Guide for People with Cancer" discusses choices that people
face in making decisions about cancer treatment and includes
suggestions on how to talk with health care providers about these
choices (see "For More Information").
As with any medicine or treatment, it is a good idea to learn about
the therapy, including whether the results of scientific studies
support the claims that are made for it. Some resources for this
information are provided in the "For More Information" section.
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6. When considering CAM, what questions should patients ask their health care providers?
- What benefits can be expected from this therapy?
- What are the risks associated with this therapy?
- Do the known benefits outweigh the risks?
- What are the potential side effects?
- Will the therapy interfere with conventional treatment?
- Is this therapy part of a clinical trial? If so, who is sponsoring the trial?
- Will the therapy be covered by health insurance?
Further information on evaluating CAM therapies, selecting
practitioners, and considering financial issues for CAM treatment is
available from NCCAM (see "For More Information").
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References
Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
Dy GK, Bekele L, Hanson LJ, et al. Complementary and alternative medicine use by patients enrolled onto phase I clinical trials. Journal of Clinical Oncology. 2004;22(23):4810-4815.
Frenkel M, Ben-Arye E, Baldwin C, et al. Approach to communicating with patients about the use of nutritional supplements in cancer care. Southern Medical Journal. 2005;98(3):289-294.
National Cancer Institute. PDQ Cancer Information Summary: Laetrile/Amygdalin. National Cancer Institute Web site. Accessed on August 11, 2005.
National Institutes of Health. Acupuncture: NIH Consensus Statement. National Institutes of Health Office of Disease Prevention Web site. Accessed on August 30, 2005.
Richardson MA, Sanders T, Palmer JL, et al. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. Journal of Clinical Oncology. 2000;18(13):2505-2514.
Richardson MA, Straus SE. Complementary and alternative medicine: opportunities and challenges for cancer management and research. Seminars in Oncology. 2002;29(6):531-545.
Sparber A, Wooton JC. Surveys of complementary and alternative medicine: Part II. Use of alternative and complementary cancer therapies. Journal of Alternative and Complementary Medicine. 2001;7(3):281-287.
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For More Information
NCCAM Clearinghouse
The NCCAM Clearinghouse provides information on CAM and on NCCAM,
including publications and results of searches of Federal databases of
scientific and medical literature. The Clearinghouse does not provide
medical advice, treatment recommendations, or referrals to
practitioners. Publications include:
Toll-free in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
National Cancer Institute's Cancer Information Service
The National Cancer Institute (NCI) is the lead Federal Government
agency for cancer research. NCI's Cancer Information Service can
provide answers to questions about cancer, help with quitting smoking,
informational materials, and help in using the NCI Web site.
Toll-free in the U.S.: 1-800-4-CANCER (1-800-422-6237)
Web site: www.cancer.gov
E-mail: cancer.gov_staff@mail.nih.gov
PubMed
A service of the National Library of Medicine (NLM), PubMed contains
publication information and (in most cases) abstracts of articles from
medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is
a subset of NLM's PubMed system and focuses on the topic of CAM.
Web site: www.ncbi.nlm.nih.gov/entrez
CAM on PubMed: www.nlm.nih.gov/nccam/camonpubmed.html
NCCAM has provided this material for your information. It is not
intended to substitute for the medical expertise and advice of your
primary health care provider. We encourage you to discuss any decisions
about treatment or care with your health care provider. The mention of
any product, service, or therapy in this information is not an
endorsement by NCCAM.
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NCCAM, National Institutes of Health
9000 Rockville Pike
Bethesda, Maryland 20892 USA
