Complementary and Alternative Medicine for Cancer

• Complementary and alternative medicine provides a wide variety of treatments including botanicals and dietary supplements to relaxation and spiritual healing; complementary medicine is treatment used along with standard medical treatments that itself is not considered standard by current medical experts while alternative medicine is treatment that is used instead of standard treatments.
• Please note that most physicians urge patients to discuss complementary and alternative medicine treatments before using them with their individual doctors and/or medical team; some of the treatments are not proved to be effective, others are not available and some could be harmful.
• Botanicals and herbs used in complementary/alternative treatment for cancer; some propose uses:
  • Black Cohosh - hot flashes
  • Cannabis and Cannabinoids (marijuana) - antiemetic effects, pain relief, appetite stimulation and others
  • Essiac/Flor Essence - immune system augmentation, detoxification
  • Flaxseed - cancer prevention, hot flashes and a source for omega-3 fatty acids
  • Ginger - nausea, vomiting
  • Ginseng – fatigue
  • L – carnitine - fatigue, anti-inflammatory
  • Medicinal mushrooms - pulmonary diseases, cancer and infections
  • Milk thistle - liver and bile disorders, antioxidant, detoxification, augmentation of chemotherapy
  • mistletoe extracts - used in Europe as an injectable prescription drug for cancer
  • PC-SPES - herbs for anti-inflammatory, antioxidant and anticancer use (no longer manufactured)
  • St. John’s wort – depression (may interact negatively with other drugs)
  • Selected vegetables/Sun’s Soup - mixtures of vegetables and herbs for anticancer and immune system augmentation
• Acupuncture for complementary/alternative cancer treatment has been used in China for thousands of years to clinically manage many problems with symptom management such as nausea, vomiting, weight loss, anxiety, depression, insomnia, poor appetite, constipation and/or diarrhea.
• Mind – body therapies and massage for alternative/complementary cancer treatment:
  • Aromatherapy and essential oils – volatile oils from plants to improve physical, emotional and spiritual well-being
  • Cognitive – behavioral therapy (CBT) - psychotherapy that helps patients change behavior and used to treat anticipatory nausea and vomiting and insomnia
  • Hypnosis - a trancelike state where the patient becomes more focused and open to suggestions about thoughts, feelings and/or sensations
  • Qigong - a combination of movement meditation and control breathing to improve quality of life and reduce fatigue utilized by traditional Chinese medicine
  • Spirituality - spirituality and religion utilized to increase the patient’s quality of life
  • Tai chi - improve quality of life and reduce fatigue in cancer patients
  • Yoga - meditation control breathing and emotional control to relieve stress, fatigue, inflammation and insomnia
• Nutritional therapies as complementary/alternative treatment for cancer are as follows:
  • Antioxidants - protect cells damage from unstable molecules
  • Coenzyme Q10 - antioxidant, immune system stimulation, protection of the heart due to chemotherapy
  • Dietary supplements - vitamins, supplements such as specific foods used to complement standard therapy for cancer
  • Gerson therapy - method of treating cancer patients based on diet and nutrient intake
  • Glutamine - reduction of toxicity due to chemotherapy and radiation therapy causes mucositis and diarrhea
  • Gonzales regimen - limited availability; use of specific diets, vitamins and mineral supplements along with extracts from animal organs and coffee enemas tailored to individual patients
  • Lycopene – antioxidant used in some treatments of chronic diseases such as cardiovascular disease and cancer
  • Melatonin - a hormone used to fight cancer in conjunction with chemotherapy and radiation therapy
  • Modified citrus pectin (MCP) - a polysaccharide that may have protective effects against colon, lung and prostate cancer
  • Pomegranate - plant with multiple compounds that may slow proliferation of human prostate cancer cells
  • Probiotics - various nutritional supplements used to treat diarrhea, gut-barrier dysfunctions and inflammation
  • Selenium - essential trace mineral involved in enzyme regulation, immune function and gene expression
  • Soy - may be used for the prevention of cancer, hot flashes and osteoporosis
  • Tea - may have protective effect against cardiovascular disease and/or cancer
  • Vitamin C, high – dose - treatment for various types of cancers
  • Vitamin D - promotion of good health
  • Vitamin E - immune system boosting, reduces blood clot formation and has antioxidant effects
• Medications as complementary/alternative treatments for cancer:
  • 714-X - chemically modified camphor compound that is claimed to protect and stabilize the immune system and restores his ability to fight cancer
  • Antineoplastons - limited availability, chemical compounds that are naturally present in urine and blood that are currently experimental and available only to patients of their developer
  • Cancell/Cantron/Potocel - a liquid whose exact composition is not known and is not effective in treating any type of cancer
  • Cartilage (Bovine and Shark) - inhibitors of angiogenesis
  • Hydrazine sulfate - chemical claimed to limit the ability of tumors to utilize glucose
  • Laetrile/Amygdalin - component that may contain cyanide as the main anticancer agent; no anticancer activity in human clinical trials
  • Newcastle disease virus (NDV) - a paramyxovirus that reproduces better in human cancer cells than in normal human cells
• Again, patients need to discuss any of the above-mentioned complimentary/alternative treatments with their medical caregivers before using them.

*Facts section by Charles Patrick Davis, MD, PhD

Complementary and alternative medicine (CAM) covers a wide variety of therapies, botanicals, and dietary supplements. Complementary medicine is treatment that is used along with standard treatments but is not considered standard. Alternative medicine is treatment that is used instead of standard treatments. Less research has been done for most types of complementary and alternative medicine than for standard treatments. Integrative therapy is a total approach to medical care that combines standard care with CAM practices.

The 2007 National Health Interview Survey reports that about four out of ten adults use a CAM therapy, with the most commonly used treatments being natural products and deep breathing exercises.

One large survey of cancer survivors reported on the use of complementary therapies. The therapies used most often were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31% to 84% of children with cancer, both
inside and outside of clinical trials. CAM therapies have been used in the management of side effects caused by cancer or cancer treatment. Some cancer patients have chosen alternative medicine over conventional treatment, but with a greater risk of death.[5] In Asian countries, traditional Chinese medical therapies are
frequently used along with conventional medicine.

One study showed that when CAM was discussed in an oncology visit, it was most often brought up by the patient; and that having such discussions was associated with greater satisfaction with the visit by both patient and physician.

Black Cohosh

Black cohosh is a substance obtained from the root of a perennial herb used in some cultures to treat a number of medical problems. Black cohosh has been studied for reducing hot flashes. Clinical trials of black cohosh that have been well designed with a randomized placebo-controlled arm have also found that black cohosh is no better than a placebo in reducing hot flashes.

Cannabis and Cannabinoids (Also Known as Marijuana)

Cannabis originated in Central Asia but is grown worldwide today. In the United States, it is a controlled substance and is classified as a Schedule I agent (a drug with increased potential for abuse and no known medical use). The Cannabis plant produces a resin containing psychoactive compounds called cannabinoids. The potential benefits of medicinal Cannabis for people living with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep.

Essiac/Flor Essence

Essiac and Flor Essence are herbal tea mixtures originally developed in Canada. They are marketed worldwide as dietary supplements. Proponents have claimed that Essiac and Flor Essence can help detoxify the body, strengthen the immune system, and fight cancer. No controlled data are available from human studies to suggest that Essiac or Flor Essence can be effective in the treatment of patients with cancer.

Flaxseed

Flaxseed comes from the seed of the flax plant and is a rich source of omega-3 fatty acid, fiber, and compounds called lignans. It is being studied in the prevention of several types of cancer. Flaxseed has also been studied for its effect on hot flashes.

Ginger

The roots of the ginger plant have been used in cooking and by some cultures to treat nausea, vomiting, and certain other medical conditions. The plant has been studied for reducing nausea in cancer patients.

Ginseng

Ginseng, another popular supplement used to treat fatigue, was studied in patients with cancer who were either undergoing anticancer treatment or had completed treatment. There was a significant and clinically meaningful difference favoring the ginseng group over the placebo group.

L-carnitine

L-carnitine is a dietary supplement believed to be helpful for the treatment of cancer-related fatigue because of its role in cellular energy metabolism and its ability to decrease proinflammatory cytokines.

Medicinal Mushrooms

Medicinal mushrooms have been used for hundreds of years, mainly in Asian countries, for the treatment of infections. More recently, medicinal mushrooms have also been used in the treatment of pulmonary diseases and cancer.

Milk Thistle

Milk thistle is a plant whose fruits have been used for more than 2,000 years as a treatment for liver and biliary disorders. The active substance in milk thistle is silymarin. Laboratory studies demonstrate that silymarin functions as an antioxidant, stabilizes cellular membranes, stimulates detoxification pathways, stimulates regeneration of liver tissue, inhibits the growth of certain cancer cell lines, exerts direct cytotoxic activity toward certain cancer cell lines, and may increase the efficacy of certain chemotherapy agents.

Mistletoe Extracts

Mistletoe is a semiparasitic plant that has been used for centuries to treat numerous human ailments. It is used commonly in Europe, where a variety of different extracts are manufactured and marketed as injectable prescription drugs. These injectable drugs are not available commercially in the United States and are not approved as a treatment for people with cancer.

PC-SPES

PC-SPES is a patented mixture of eight herbs. Each herb used in PC-SPES has been reported to have antiinflammatory, antioxidant, or anticarcinogenic properties. PC-SPES was recalled and withdrawn from the market because certain batches were contaminated with Food and Drug Administration–controlled prescription drugs. The manufacturer is no longer in operation, and PC-SPES is no longer being made.

St. John’s wort

One popular herbal agent that has been used to treat depression is St. John's wort, a plant with Greek origins. The major active constituents in St. John's wort are hypothesized to be melatonin, hypericin, hyperforin, and adhyperforin, although hypericin may not reach sufficient concentrations in humans to have biologic activity. Hypericin is thought to be a monoamine oxidase inhibitor, while hyperforin and adhyperforin are believed to inhibit the reuptake of serotonin, dopamine, and norepinephrine. These mechanisms of action provide the rationale for evaluating St. John's wort for depression management.

It is important that a physician knows what drugs a patient is already using before that patient begins taking St. John's wort, which decreases the effectiveness of other concomitantly administered drugs. There are two important cautions when the use of St. John's wort for depression is being considered:

1. As an herb, St. John's wort is regulated by the U.S. Food and Drug Administration (FDA) as a food/dietary supplement. Although the FDA issued a final rule establishing regulations to require manufacturers of dietary supplements to prove good manufacturing processes and to correctly label their ingredients, the standardization of products such as St. John's wort with respect to the desired amount of potentially active ingredients is not required by the FDA, but nevertheless carried out by some manufacturers. Therefore, if hyperforin is the desired ingredient, the amount of hyperforin in any formulation of St. John's wort could differ substantially among brands.
2. St. John's wort is metabolized within the cytochrome P450 system and has effects inhibiting as well as inducing various metabolic enzymes. The enzymes affected by St. John's wort are CYP3A4, CYP2C9, and CYP2D6. In one study in humans, effects on systemic concentrations of drugs via the CYP3A4 pathway were evident in as few as 14 days. Clinically, this means that the concomitant use of St. John's wort with other drugs could cause lower concentrations of drugs that are needed to have therapeutic effects. With respect to cancer and its treatment, St. John's wort has been shown to decrease concentrations of irinotecan in patients receiving treatment and, in vitro, is suspected of reducing concentrations of docetaxel. Additionally, St. John's wort has been found to affect concentrations of cyclosporin A and tacrolimus, both important for transplant engraftment, as well as concentrations of indinavir for the treatment of the human immunodeficiency virus.

Trials have compared St. John’s wort with placebo, with antidepressants, and sometimes with both placebo and antidepressants. A wide range of results have emerged, from finding no differences between arms, to finding St. John's wort improving outcomes over placebo for moderate depression, to finding St. John's wort preferable to placebo in general, to finding St. John's wort equal to antidepressants in alleviating depressive symptoms.

Older studies comparing St. John's wort with antidepressant therapy tended to use low doses of antidepressants, and the doses of antidepressants did not titrate up by response to the usual doses used for managing depression. The best overview of the research in this area is provided in a meta-analysis of randomized controlled trials.[10] Conclusions from this meta-analysis, which includes 37 trials, are that St. John's wort does not have a clinically important effect on major depressive disorder and that for milder depression, it may have some effect (but the effect is not large).

Side effects reported in studies of St. John's wort are minimal. One study that compared St. John's wort with sertraline and placebo found that the side effects of St. John's wort, which were significantly different from those of placebo, included anorgasmia, frequent urination, and swelling. According to a metaanalysis of randomized controlled trials, fewer patients treated with St. John's wort withdrew from trials because of adverse effects than did those treated with antidepressants.

The bottom line regarding the use of St. John's wort for the management of depression is that, despite a more tolerable side effect profile, there is some, but currently no unambiguous evidence demonstrating an advantage to using this herbal agent over approved antidepressant therapy. The data do not support a strong effect on major depressive disorder or even on mild to moderate depression. This fact, combined with concerns about drug interactions and lack of uniformity in standardization, limits the evidence which supports St. John's wort as being effective for depression management specifically in cancer patients.

Selected Vegetables/Sun's Soup

“Selected Vegetables” and “Sun’s Soup” are names given to several different mixtures of vegetables and herbs that have been studied as treatments for cancer. These mixtures were developed by a single individual. Two formulations of Selected Vegetables/Sun’s Soup are marketed in the United States as dietary supplements. The vegetables and herbs in Selected Vegetables/Sun’s Soup are thought to have anticancer and/or immunesystem–stimulating properties. Existing data supporting the effectiveness of Selected Vegetables/Sun’s Soup as a treatment for cancer are limited and weak.

Acupuncture is a part of traditional Chinese medicine practiced in China and Asia for thousands of years. It has been used clinically to manage cancer-related symptoms, treat side effects induced by chemotherapy or radiation therapy, boost blood cell count, and enhance lymphocyte and natural killer cell activity. In cancer treatment, the primary use of acupuncture is symptom management; commonly treated symptoms are cancer pain, chemotherapy-induced nausea and vomiting, and other symptoms that affect a patient’s quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, and gastrointestinal symptoms (constipation and diarrhea).

Aromatherapy and Essential Oils

Aromatherapy is the therapeutic use of essential oils (also known as volatile oils) from plants (flowers, herbs, or trees) for the improvement of physical, emotional, and spiritual well-being. Aromatherapy is used by cancer patients primarily as supportive care for general well-being, and with other complementary treatments (e.g., massage and acupuncture) and standard treatment.

Cognitive-Behavioral Therapy (CBT)

CBT is a type of psychotherapy that helps patients change behavior by changing the way they think and feel about certain things. It is used to treat mental, emotional, personality, and behavioral disorders. The efficacy of CBT has been studied for insomnia. Relaxation therapy and imagery have been used to treat anticipatory nausea and vomiting.

Cognitive-behavioral psychotherapy has been used to treat depression and has been offered in a variety of forms. Most interventions have been offered in both individual and small-group formats and have included a structured educational component about cancer or a specific relaxation component.

Hypnosis

Hypnosis is a trance-like state in which one becomes more aware and focused and is more open to suggestion. Under hypnosis, a person can concentrate more clearly on a specific thought, feeling, or sensation without becoming distracted.

Qigong

Qigong is a component of traditional Chinese medicine that combines movement, meditation, and controlled breathing. The intent is to improve blood flow and the flow of qi. Some trials, mostly with small sample sizes, have indicated that qigong may improve quality of life and fatigue in cancer patients.

Spirituality

Spirituality and religion are important to most individuals in the general population, according to national surveys. In health care, concerns about spiritual or religious well-being have sometimes been viewed as an aspect of complementary and alternative medicine, but this perception may be more characteristic of providers than of patients.

Tai Chi

Some trials, mostly with small sample sizes, have indicated that tai chi may improve quality of life and fatigue in cancer patients.

Yoga

Yoga is an ancient system of practices used to balance the mind and body through movement, meditation (focusing thoughts), and control of breathing and emotions. Yoga is being studied as a way to relieve stress and poor sleep in cancer patients. One study revealed lower levels of fatigue and inflammation in breast cancer survivors participating in a yoga program.

Antioxidants and Cancer Prevention

Antioxidants are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Free radical damage may lead to cancer. Antioxidants interact with and stabilize free radicals and may prevent some of the damage free radicals might otherwise cause. There has been some concern about whether antioxidants may decrease the effectiveness of chemotherapy and radiation therapy.

Coenzyme Q10

Coenzyme Q10 is made naturally by the human body. Coenzyme Q10 helps cells to produce energy, and it acts as an antioxidant. Coenzyme Q10 has shown an ability to stimulate the immune system and to protect the heart from damage caused by certain chemotherapy drugs. No report of a randomized clinical trial of coenzyme Q10 as a treatment for cancer has been published in a peer-reviewed scientific journal.

Dietary Supplements

Many studies suggest that the use of complementary and alternative medicine is common among many cancer patients, and the use of vitamins, supplements, and specific foods is frequently reported by prostate cancer patients.

Gerson Therapy

The Gerson therapy is advocated by its supporters as a method of treating cancer patients based on changes in diet and nutrient intake. An organic vegetarian diet plus nutritional and biological supplements, pancreatic enzymes, and coffee or other types of enemas are the main features of the Gerson therapy. Few clinical studies of the Gerson therapy are found in the medical literature. Refer to the PDQ summary on the Gerson Therapy for more information.

Glutamine

Glutamine is an amino acid that is important for gastrointestinal (GI) mucosal cells and their replication. These cells are often damaged by chemotherapy and radiation therapy, causing mucositis and diarrhea, which can lead to treatment delays, dose reductions, and severely affect quality of life. Some evidence suggests that oral glutamine can reduce both of those toxicities by aiding in faster healing of the mucosal cells and the entire GI tract.

Gonzalez Regimen

The Gonzalez regimen is a complex cancer treatment that is tailored by the practitioner for each specific patient and is currently available only to the patients of its developer. Pancreatic enzymes taken orally are the primary agents in the regimen thought to have direct antitumor effects. The regimen also includes specific diets, vitamin and mineral supplements, extracts of animal organs, and coffee enemas.

Lycopene

Lycopene is a carotenoid found in a number of fruits and vegetables, including apricots, guava, and watermelon, but most of the lycopene consumed in the United States comes from tomato-based products. When ingested, lycopene is broken down into a number of metabolites and is thought to have various biological functions, including antioxidant capabilities. Lycopene has been investigated for its role in chronic diseases, including cardiovascular disease and cancer.

Melatonin

Melatonin is a hormone produced by the pineal gland during the hours of darkness, plays a major role in the sleep-wake cycle, and is linked to the circadian rhythm. Clinical studies in renal, breast, colon, lung, and brain cancer suggest that melatonin exerts anticancer effects in conjunction with chemotherapy and radiation therapy; however, evidence remains inconclusive.

Modified Citrus Pectin (MCP)

Citrus pectin is a complex polysaccharide found in the peel and pulp of citrus fruit and can be modified by treatment with high pH and temperature. MCP may have effects on cancer growth and metastasis through multiple potential mechanisms, as suggested in preclinical research. Some research suggests that MCP may be protective against various types of cancer, including colon, lung, and prostate cancer.

Pomegranate

The pomegranate (Punica granatum L.) plant is native to Asia and cultivated widely throughout the world. Various components of the pomegranate fruit contain bioactive compounds, including phenolics, flavonoids, and anthocyanins, some of which have antioxidant activity. Pomegranate extracts have been shown to inhibit the proliferation of human prostate cancer cells in vitro.

Probiotics

Probiotics are nutritional supplements that contain a defined amount of viable microorganisms. The use of probiotic functional foods (beneficial live microorganisms) to modify gut microflora has been suggested for clinical conditions associated with diarrhea, gut-barrier dysfunction, and inflammatory response.

Selenium

Selenium is an essential trace mineral involved in a number of biological processes, including enzyme regulation, gene expression, and immune function. Selenium is being studied for its role in cancer.

Soy

Soy comes from a plant of Asian origin that produces beans used in many food products. Soy foods (e.g., soy milk, miso, tofu, and soy flour) contain phytochemicals that may have health benefits and, among these, soy isoflavones have been the focus of most of the research. Soy is being studied for the prevention of cancer, hot flashes that occur with menopause, and osteoporosis (loss of bone density).

Tea

Tea has long been regarded as an aid to good health, and many believe it can help reduce the risk of cancer. Tea originates from the plant Camellia sinensis, and contains polyphenol compounds, particularly catechins, which are antioxidants and whose biological activities may be relevant to cancer prevention.

Some observational and interventional studies suggest that green tea may have a protective effect against cardiovascular disease, and there is evidence that green tea may protect against various forms of cancer.

Vitamin C, High-Dose

Vitamin C (ascorbic acid) is an essential nutrient that has antioxidant functions, is a cofactor for several enzymes, and plays an important role in the synthesis of collagen. High-dose vitamin C has been studied as a treatment for cancer patients.

Vitamin D

Vitamin D is involved in a number of processes that are essential for good health. Vitamin D is produced by the body in response to sunlight exposure. It can also be obtained through the diet, but very few foods naturally contain vitamin D. These foods include fatty fish, fish liver oil, and eggs.

Vitamin E

Vitamin E is a nutrient that the body needs in small amounts to stay healthy and work the way it should. It is fatsoluble (can dissolve in fats and oils) and is found in seeds, nuts, leafy green vegetables, and vegetable oils. Vitamin E boosts the immune system and helps keep blood clots from forming. It also helps prevent cell damage caused by free radicals (highly reactive chemicals). Vitamin E is being studied in the prevention and treatment of some types of cancer. It is a type of antioxidant, also called alpha-tocopherol.

714-X

714-X is naturally derived camphor that is chemically modified by the introduction of a nitrogen atom. It is claimed that 714-X protects and stabilizes the immune system and restores its ability to fight cancer. No study of 714-X has been published in a peer-reviewed scientific journal to show its safety or effectiveness in treating cancer.

Antineoplastons

Antineoplastons are drugs composed of chemical compounds that are naturally present in the urine and blood. They are an experimental cancer therapy that is purported to provide a natural biochemical substance that is excreted and therefore lacking in people with cancer. Antineoplastons therapy for cancer patients is currently available only in the United States and only to the patients of its developer.

Cancell/Cantron/Protocel

Cancell/Cantron/Protocel—also known by the names Sheridan’s Formula, Jim’s Juice, JS-114, JS-101, 126-F, and the "Cancell-like" products Cantron and Protocel—is a liquid that has been produced in various forms principally by two manufacturers since the late 1930s. The exact composition of Cancell/Cantron/Protocel is unknown and not effective in treating any type of cancer.

Cartilage (Bovine and Shark)

Bovine (cow) cartilage and shark cartilage have been studied as treatments for people with cancer and other medical conditions for more than 30 years. At least three different inhibitors of angiogenesis have been identified in bovine cartilage, and two angiogenesis inhibitors have been purified from shark cartilage.

Hydrazine Sulfate

Hydrazine sulfate is a chemical that has been studied as a treatment for cancer and as a treatment for the body wasting (i.e., cachexia) associated with this disease. It has been claimed that hydrazine sulfate limits the ability of tumors to obtain glucose, which is a type of sugar used by cells to create energy.

Laetrile/Amygdalin

Laetrile is another name for the chemical amygdalin, which is found in the pits of many fruits and in numerous plants. Cyanide is thought to be the main anticancer component of laetrile. Laetrile has shown little anticancer activity in animal studies and no anticancer activity in human clinical trials.

Newcastle Disease Virus (NDV)

NDV is a paramyxovirus that causes Newcastle disease in a wide variety of birds (most notably, in chickens). Although NDV causes a potentially fatal, noncancerous disease (Newcastle disease) in birds, it causes only minor illness in humans. NDV appears to replicate (i.e., reproduce) substantially better in human cancer cells than it does in most normal human cells.