Sei sulla pagina 1di 11

11/9/2014 www.medscape.

com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 1/11
www.medscape.com
September02,2014
Overthepastdecade,complementaryandalternativemedicine(CAM)hasgrownintoamultibilliondollarindustryin
theUnitedStates,withtheuseofCAMinterventionsbecomingincreasinglypopularamongcancerpatients.
Studiesestimatethatatleasthalfofcancerpatientsusesometypeofcomplementaryintervention,
[1]
thoughthe
reportedrangevariesfromlessthan10%tomorethan60%.
[2]
Thenumberofpatientswhoseekoutalternative
therapiesisquitelow,withexpertsestimatingthatthepercentagefallsinthesingledigits.
Althoughtheterm"CAM"combinescomplementaryandalternativemedicine,distinguishingthetwoisimportant.
Complementaryinterventionsareonlyintendedtosupplementmainstreamcareandareusedprimarilytocontrol
symptomsandbolsterphysicalandemotionalwellbeingthroughouttreatment.
"Althoughwecan'trelyoncomplementarytherapiestoshrinkatumor,ifgiventogetherwithchemotherapyorradiation
therapy,suchinterventionsmayimprovequalityoflifeandpossiblysurvivalaswell,"saidGaryDeng,MD,PhD,interim
ChiefofIntegrativeMedicineatMemorialSloanKetteringCancerCenterinNewYorkCity."It'sacommon
misconceptionthatcancertreatmentisallaboutshrinkingthetumor.Reducinganxietyorpaincanmakeanenormous
impactonapatient'sdaytodayqualityoflife."
Alternativetherapies,however,aremeantasasubstituteformainstreamcare.Bothsupportersandskepticsof
complementarytreatmentsagreethatalternativemodalitiesarenotviablesubstitutesformainstreamcareandthat
usinganyinlieuofconventionalmedicineisdangerous.
"Wediscourageourpatientsfromusingalternativeinterventionsinsteadofmainstreamtherapiesbecausetheywillmiss
theopportunityforpropercare,"saidDr.Deng."Eventhebestchemotherapydoesnotcurecancer.Surgeryistheonly
cure."
DavidRosenthal,MD,MedicalDirectorofIntegrativeTherapiesatDanaFarberCancerInstituteandaprofessorinthe
DepartmentofMedicineatHarvardMedicalSchool,agreesabouttheharmsofalternativemedicine."Amajorproblemis
therearestillquacksclaimingalternativecures,"hesaid.
Thatiswhyagrowingnumberofoncologistsandpolicymakerswanttoabandontheterm"CAM"infavorof"integrative
oncology,"whichfocusessolelyoncombiningmainstreamandcomplementarycare.
Theseintegrativeservicesfacilitatecommunicationbetweenoncologistsandpatients,providinganenvironmentwhere
patientscansharetheirconcernsanddiscloseanycomplementaryinterventionstheyalreadyuseorwouldliketotry.
Disclosingthisinformationisparticularlyimportantbecausesomecomplementarymodalitiescaninteractwith
chemotherapydrugs."Manypatientsdon'trealizethatherbsandsupplementsoneofthemostcommon
complementaryinterventionsaredrugs,andthatsomehavebeenshowntointeractwithchemotherapyandcanbe
harmfultopatients,"saidStevenNovella,MD,aneurologistandassistantprofessoratYaleUniversitySchoolof
MedicinewhoisexecutiveeditoroftheblogScienceBasedMedicine.
Still,manypatientsdon'tinformtheirdoctorsabouttheirCAMuse.Onestudyfoundthatonly58%ofmenwithprostate
cancerhadtoldtheirphysicianaboutusingCAMinterventions,andevenfeweraskedtheirfamilyphysician(15%)or
oncologist(7%)forguidanceregardingCAMuse.
[3]
Whenitcomestotreatingcancer,"therearenomagicbullets,"Dr.Rosenthalsaid.Patientsneedproper,evidence
Mythbusters:ComplementaryandAlternativeTreatmentsin
Cancer
VictoriaStern,MA
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 2/11
basedguidancetogetthebestpossiblecareandtoavoidriskytreatments.
Inthiscolumn,Medscapewilldelveintothescientificvalidityofpopularcomplementaryinterventions,fromacupuncture
toReiki,exploringcommonmythsaboutthesemodalitiesandexaminingwhatthescientificliteratureandexpertsinthe
fieldsayabouttheirsafetyandeffectiveness.
Exercise
Proposition:Engaginginphysicalactivity,suchaswalking,runningorrecreationalsports,canimprovecancersurvival.
Whatthesciencesays:Thebenefitsofexerciseforbothmentalandphysicalhealthcannotbedenied.Since1996,the
CentersforDiseaseControlandPreventionhasrecommendedthatadultsengageinmoderateintensityactivities,such
asabriskwalkorjog,foratleast30minutes5daysaweek.
[4]
In2008,theAmericanCancerSociety(ACS)reiterated
theserecommendations,providingawealthofnewevidencetosupporttheroleofexerciseincancerpreventionandfor
promotingoverallhealth.
[5]
Agrowingbodyofresearchnowsuggeststhatexercisemaynotonlyhelpprotectpeoplefromdevelopingcancerbut
alsomayincreasesurvivalinthosealreadydiagnosed.
[6]
A2005prospective,observationalstudy,whichfollowed
almost3000womendiagnosedwithnonmetastaticbreastcancer,foundthatthosewhoengagedinmoderatephysical
activityequivalenttowalking35hourseachweekatamodestpacesignificantlyloweredtheirriskofdyingfrom
breastcancercomparedwiththeirmoresedentarypeers.
[7]
Exercisemayalsoenhancesurvivalforthosediagnosedwithnonmetastaticcolorectalcancer.
[8]
Inoneobservational
studywhichfollowed573womendiagnosedwithstageI,II,orIIIcolorectalcancer,thosewhowerephysicallyactive
aftertheirdiagnosis,regardlessoftheirprediagnosisexerciseregimen,werelesslikelytodiefromcanceroringeneral.
Andthemoreexercisetheydid,thebettertheiroddsbecame:Thosewhoengagedin6ormorehoursofmoderate
exerciseeachweek,includingwalking,bicycling,swimming,andrunning,reducedtheirriskofdyingfromcancerby
abouthalfcomparedwiththeirpeerswhoexercisedlessthan1hourperweek.
Formenwithprostatecancer,thedataalsolookpromising.Inaprospectivestudy,whichfollowed47,620meninthe
UnitedStatesover14years,researchersfromHarvardSchoolofPublicHealthanalyzedtherelationshipbetween
cancerincidenceandreportedphysicalactivitylevels.
[9]
Althoughtheresearchersdidnotfindanassociationbetween
exerciseandsurvivalinyoungermen,inmen65yearsandolder,regularvigorousactivitydidappeartoslowthe
progressionofbothadvancedandfatalprostatecancer.Theauthorsconcludedthat"regularvigorousactivitycouldslow
theprogressionofprostatecancerandmightberecommendedtoreducemortalityfromprostatecancer."
Encouragingresultsfroma2014prospectivecohortstudyshowedanassociationbetweenexerciseandsurvivalinmen
diagnosedwitharangeofcancers.
[10]
Thestudyfollowed1021mendiagnosedwithcancerfor2decades,inwhichtime
themencompletedquestionnairesabouttheirlevelofphysicalactivity.Thosewhoengagedinmorefrequentand
vigorousexercise,measuredbytheirestimatedweeklycalorieburn,hadthelowestriskofdyingfromcancer.Thebest
survivaladvantageoccurredinmenwhoburnedover3000caloriesperweek,whichisequivalenttoabout45minutesto
anhourofhikingorjogging5daysaweekforatypical150to200lbman.
Whattheexpertsays:AccordingtoDr.Deng,"Physicalactivityistheonlyintegrativeoncologytherapywithasurvival
advantage."
CherylL.Rock,PhD,RD,aprofessorintheDepartmentofFamilyandPreventiveMedicineattheUniversityof
California,SanDiego,added,"Exercisingnotonlylowersaperson'sriskofdevelopingcancerandmakesitlesslikely
theywillhavearecurrence,butitalsoincreasestheoddsofcancersurvival.Forpatientsdiagnosedwithcancer,
exerciseenhancesqualityoflifeandcanchangehowthebodymetabolizesfood,whichmaypromoteimportanthealing
processes."
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 3/11
Asanoncologistwhopracticesintegrativeoncology,Dr.Rosenthaltriestogetpatientstoincreasetheiractivitylevelsto
atleast30minutesaday,5daysaweek."Althoughthespecifictypeofexercisemayvary,patientsdoneedtogettheir
heartrateup,sotheexerciseshouldbehigherimpact,suchasjogging,asopposedtostretchingoryoga.Evenona
badday,doingjust510minutescouldhavepreventativeandrehabilitativeeffects,"hesaid.Infact,Dr.Rosenthal
noted,"attheDanaFarberCancerCenter,wegivechemotherapytosomepatientswhiletheywalkonatreadmill."
Theevidencesupportingexerciseincancercareissocompellingthatmostexpertsconsiderphysicalactivitytobepart
ofmainstream,notcomplementary,treatment."Atthispoint,exerciseanddietregimenscaneasilybeconsidered
conventionalmedicine,"saidDavidGorski,MD,PhD,asurgicaloncologistattheBarbaraAnnKarmanosCancer
InstituteinDetroitwhospecializesinbreastcancersurgery.
Despitetheclearbenefitsofphysicalactivity,Dr.Dengcautioned,"Wecan'tgivepatientsgenericadviceabout
exercisingaftertheyarediagnosedwithcancer.Therearemanynuancestodevelopinganappropriateexercise
programthatistailoredtopatients'individualconditionandneedsonethattakesintoaccounttheirpersonal
preferences,whethertheyareoverweightorunderweight,theircurrentdiet,theirtypeandseverityofcancer."
Verdict:Confirmed.Theevidenceshowingthatregularmoderatetovigorousexerciseimprovessurvivalformenand
womendiagnosedwitharangeofcancersiscompelling.
Acupuncture
Proposition:Acupuncturereducesnausea,vomiting,andpainfromcancer.
Whatthesciencesays:AcupunctureisanancientChinesetechniqueinwhichpractitionersinsertneedlesintospecific
pointsonthebody,calledacupoints,tostimulatenervesandreleasethebody'snaturalenergyflow,calledQi.Cancer
patientsuseacupunctureprimarilytohelprelievepainandreducenauseaandvomiting,withonestudyestimatingits
prevalenceamongcancerpatientstobeabout5%.
[11]
Despitehundredsofstudiesevaluatingacupuncture,itsbenefitstocancerpatientsremainunclear.Themajorityof
studiescannotdistinguishbetweenthegenuinepainrelievingeffectsofacupunctureanditsrobustplaceboeffect.
Ina2012systematicreview,researchersidentified15randomizedcontrolledtrials(RCTs)evaluatingtheefficacyof
acupunctureforreducingcancerpainaloneorincombinationwithanalgesics.
[12]
Althoughacupuncturewasnomore
effectiveatrelievingpainthandrugtherapy,patientswhoreceivedacupuncturealongsideapainmedicationreported
significantlylessdiscomfortcomparedwiththosewhoonlyreceivedanalgesics.Still,theauthorscouldnotdrawfirm
conclusionsaboutthepainrelievingbenefitsofacupuncture,giventhatmostofthetrialswerepoorlydesigned.
A2006review,whichincluded11RCTs,evaluatedwhetheravarietyofacupuncturemethodscouldreduce
chemotherapyinducednauseaandvomitingcomparedwithshamacupuncture.Theanalysisrevealedthat,overall,
acupuncturereducedtheincidenceofvomitingbutnotnauseaseverity,exceptinpatientswhounderwentacupressure.
[13]
Preliminarydataalsosuggestthatacupuncturemayhelprelieveaslewofothersymptoms,includinghotflashes,
fatigue,anddepressionandanxiety.
[1416]
Additionally,acupuncturemayreducethequantityofopioidspatientsneedto
controltheirpainaftersurgery.Onesystematicreviewfoundthatindividualsrequiredfewerpainmedicationspost
surgerywhentheyunderwentrealacupuncturecomparedwithshamacupuncture.
[17]
Whattheexpertssay:AccordingtoDr.Rosenthal,"acupunctureisevidencebasedforreducingchemotherapyinduced
nausea,vomiting,andfatigue,andalmost70%ofusersareacupunctureresponders.Althoughnotyetproven,
acupuncturemayalsobehelpfulforrelievingneuropathy,hotflashes,insomnia,anddecreasinganxietyandstress.
Overall,acupunctureappearstobeasafetechniquethatcanhelptreatsomesideeffectsofcancerandimprovequality
oflife."
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 4/11
HarrietHall,MD,aretiredfamilyphysicianandAirForceflightsurgeonwhowritestheSkepDoccolumninSkeptic
magazine,ismuchmorecautiousaboutthebenefitsofacupuncture."Thepublishedevidenceonacupunctureindicates
thatitmightbehelpfulforpainandpossiblyforpostoperativenauseaandvomiting,butnotforanyotherindications.
Therearestudiesshowingthatacupuncturemayhelpwithsubjectivesymptomslikefatigueandchemotherapyrelated
nauseaincancerpatients,butitisdifficulttodesignstudiesthatcontroladequatelyfornonspecificeffectsandbias,and
theentirebodyofresearchisconsistentwithjustwhatwouldbeexpectedfromatreatmentthathasnospecificeffects
butactsonlyasatheatricalplacebo.Someacupunctureproponentsarguethatthetechniquecausesendorphinrelease
inthebrain,butsodoestakingasugarpill.Endorphinreleaseismerelyanindicationthataplaceboeffectisatwork."
Dr.Hallalsostressed,"Thereisnoevidencethatacupunctureprolongssurvivalorslowsthecourseofthediseasein
anyway.Anyclaimsthatacupuncturecancurecancermustbedisregarded."
Dr.Gorskiagreed,notingthat"ifyouhaveaninterventionthatclaimstotreateverythingfrominfertility,headaches,back
pain,anddrymouthfromradiation,itismorelikelyatreatmentthatisgoodfornothingandsimplyreliesonplacebo
effects.Inmyopinion,theevidenceforacupunctureisweak,atbest."
Inregardtoprevalenceoftheplaceboeffect,Dr.Rosenthal'sresponseis,"Sowhat?Ifaninterventionismakingyou
feelbetterandit'ssafe,thenwhatistheharm?Themaindisadvantagetoacupunctureismakingitmorewidely
availableandgettinginsurancecompaniestocoverit."
Verdict:Plausibleforpain,nausea,andvomiting.Althoughtheevidenceconflicts,itappearsthatacupuncturedoes
reducepain,nausea,andvomitingforsomecancerpatients.Withalowriskinterventionsuchasacupuncture,some
expertsbelievethattheimportanceofaperceivedbenefitmaytrumpclinicalbenefit.
Massage
Proposition:Massagetherapyreducescancerpatients'painandanxiety.
Whatthesciencesays:Massage,definedasthesystematicmanipulationofsofttissues,isincreasinglybeing
incorporatedintointegrativeoncologyprogramsasawaytoreducecancerrelatedstressandpain.Morethan20%of
patientswithcancerusemassagealongsidetheirmainstreamcare.
[18]
Theevidenceinsupportofthispractice,however,ismixed.Manystudiesreportthatmassagealleviatesarangeof
symptoms,includingpain,nausea,anxiety,depression,andstress,butoftenthestudymethodologyisflawed,makingit
difficulttoprovidedefinitiverecommendations.
Inonemetaanalysis,EdzardErnst,MD,EmeritusProfessorofComplementaryMedicineattheUniversityofExeter,
evaluatedevidencefrom14RCTsexaminingtheextenttowhichclassicmassage(alsoknownasSwedishmassage)
therapyimprovedcancerpatients'qualityoflife.
[19]
Themostrobuststudy,whichcomparedclassicmassagetolight
touchin380advancedcancerpatientswithmoderatetoseverepain,foundthatbothgroupsreportedreductionsinpain,
butthoseintheclassicmassagegroupreportedsignificantlygreaterrelief.
[20]
Still,Dr.Ernstnoted,twoofthestudies
didnotshowasignificantbenefittomassageinrelationtopain,anxiety,depression,andsleepquality,whilethe
remaining11werefraughtwithweaknesses,includingsmallsamplesizesandlackofacontrolgroup.Despitethese
flaws,Dr.Ernstconcludedthatoverallthedatasuggestthatmassagecanhelpreducecancerrelatedpain,nausea,and
anxiety.
Anothersystematicreviewassessingthepotentialbenefitsofmassageincancerpatientscametoasimilarconclusion.
[21]
Amongthe10RCTsevaluated,theauthorsreportedthatmassageoraromatherapymassagemayreducecancer
patients'anxiety,pain,andnauseaintheshortterm,but"thelackofrigorousresearchevidenceprecludesdrawing
definitiveconclusions."
Partofthedifficultyisseparatingoutthebenefitsofmassagetherapyandsimpletouch.
[20]
Additionally,someexperts
haveraisedconcernsoverpotentialadverseeffectsofmassage.Ina2005review,LisaCorbin,MD,fromtheCenterfor
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 5/11
IntegrativeMedicineattheUniversityofColoradoHospital,foundpotentialharmfuleffectsofmassage,rangingfrom
bruisingtointernalhemorrhaging,fracture,andincreasedpainorinfection.
[18]
Althoughrare,thesetypesofadverse
eventsbecomemorelikelywhenapersonisinadequatelytrainedorisusingamoreforcefultechnique,suchasshiatsu
orRolfing.
[22]
Generally,theevidencepointstomassagebeinganeffectivetactictocontrolsymptomsandimprovequalityoflife,but
inordertominimizeriskforinjury,massagemustbeshapedtotheneedsofeachpatient.
Whattheexpertsays:AccordingtoDr.Gorski,"Massageisperfectlyfineforpatientswhoenjoyit,andifmassage
makescancerpatientsfeelbetterandimprovestheirqualityoflife,thenitisworthwhile."But,henoted,"Itakeissue
whenmassageiscooptedandturnsintomassagetherapy.Medicalizingthethingswedonormallytofeelgoodcan
leadtoexaggeratedorfalseclaimsabouttheirbenefits."
Verdict:Plausible.
SugarFreeDiet
Proposition:Cuttingsugaroutofone'sdietwillstopatumorfromgrowing.
Whatthesciencesays:Afteracancerdiagnosis,patientsfrequentlyasktheironcologistaboutthefoodstheyshould
andshouldn'teat.Aparticularlycommonqueryiswhethereliminatingsugarwillhelpstarvetumorgrowth.
Ataglance,theevidenceappearsquitecompelling.Consumingcopiousamountsofsugarisassociatedwithaslewof
poorhealthoutcomes,includingdiabetes,obesity,andcardiovasculardisease.Andstudieshaveconsistentlyshowna
linkbetweenexcessconsumptionofrefinedsugarsandgreatercancerriskaswellasaratherrobustrelationship
betweenbeingoverweightorobeseandanincreasedlikelihoodofdevelopingcancer.
[5,23]
Onecomprehensivereviewpublishedin2011lookedatwhetherreducingglucoseconsumptioncouldhelppreventor
treatcancer.
[24]
Studiesshowedthatwhenstarvedofglucose,tumorcellscommitcellsuicideinvitro,andthathigh
glucoseconcentrationsmayaltergeneexpressioninwaysthatpromotecellgrowthintumorcellsstudiedinvitro.Still,
therearenoRCTsinhumansthathaveevaluatedwhethersugarfuelscancergrowth.
"Itistruethatwhenacellbecomesacancercell,itchangesitscellularmetabolism,andinacellculturedish,acancer
cellpreferssugar,"saidDr.Rock."Butinthecontextofthehumanbody,cancercellsdon'tbehavethesameway,sowe
can'textrapolatefromthecellculturetohumans."
Accordingtothe2012ACSguidelinesonnutritionandphysicalactivityforcancerprevention,thebestdietadviceisto
consumemostlyfruits,vegetables,leanmeats,lowfatdairyproducts,andwholegrainsandtolimittheconsumptionof
redandprocessedmeatsandalcoholaswellashighfat,highcaloriefoodsthatmaypromoteweightgain.
[5]
Onestudy
foundthatadheringtotheACSdietaryguidelineswasassociatedwithlowermortalityfromcancer,cardiovascular
diseases,andanycause.
[25]
Thisprospectivestudyevaluatedtheeffectsofdietarypatternsontheriskfor
cardiovascular,cancer,andallcausemortalityamong72,113healthywomen.Afterfollowingthesewomenfor18years,
theresearchersdeterminedthatthosewhoconsumedadiethighinredandprocessedmeats,refinedgrains,and
dessertshada16%greaterriskofdyingfromcanceranda21%greaterriskofdyingfromanycausecomparedwith
thosewhofollowedahealthfuldietofmostlyvegetables,fruit,fish,poultry,andwholegrains.Althoughthestudydidnot
separateouttheeffectsofdifferentfoodsoncancermortality,itcontributestoagrowingbodyofliteraturethat
demonstratesthatmaintainingagenerallyhealthydietcandecreasetheriskofdevelopinganddyingfromcancer.
Whattheexpertssay:"Thesugarinyourdietwon'tpromotecancergrowth,andtherearenostudiestodatethatshow
thatavoidingsugarwillshrinkatumor,"saidDr.Rock."Still,nooncologistornutritionistwouldrecommendahighsugar
dietbecausepatientswouldbemissingoutonthebeneficialnutrients."
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 6/11
But,Dr.Rockadded,"Whenpatientsgothroughchemoorradiationtherapy,theirtastesoftenchangeandtheymay
loseweight.Ifputtingsugarinfoodhelpssomepatientsgetthevitaminsandmineralstheyneed,theneatingsugaris
notsuchabadthing.Overall,though,it'sbestnottoconsumefoodswithaddedsugarorfat."
AccordingtoDr.Deng,eatingtoomuchsugarisbadforusnotjustfromacancerstandpointbutformanyotherhealth
reasons."Althoughwedon'thaveevidencethateliminatingrefinedsugarwillshrinktumorandprolongsurvival,doingso
isalowrisklifestylechangeandwillcertainlynotharmpatients.Wearenottalkingaboutgivingpeopleatoxicdrug,so
thereisverylittledownside."Still,Dr.Dengcautioned,"Noneoftheradicalanticancerdietsthatemployrestrictive
regimenshavebeenshowntoimprovesurvival.Thedownsidetosuchrestrictivedietsisthatpatientsruntheriskof
deprivingthemselvesofessentialnutrients."
Verdict:Unconfirmedforapotentialanticancereffectofeliminatingsugar,butit'simportanttominimizeexcesssugar
intakeaspartofmaintainingagenerallyhealthydiet.
Antioxidants
DietarySupplements
Proposition:Consumingantioxidantrichsupplementsmayprotectagainstcancerandpreventtumorgrowth.
Whatthesciencesays:Dietarysupplementusehasbecomeparticularlyprevalentamongcancerpatients.Onereview
foundthat64%to81%ofcancersurvivorstakevitaminandmineralsupplementsand14%to32%ofpatientsbegin
usingsupplementsafterthey'rediagnosed.
[26]
Antioxidantsinparticularhavegarnerednotorietyfortheirpotentialtoheal.Hypeoverthetherapeuticpropertiesof
antioxidantsbegantoemergeafterresearchrevealedthatconsumingfruitsandvegetables,whicharerichin
antioxidants,maylowertheincidenceofcancerandheartdiseaseandprolonglife.
[27]
Antioxidantsdoparticipateinanessentialbiologicalbalancingact:Thehumanbodynaturallyproducesantioxidantsto
neutralizetheeffectsofoxidation.Duringoxidation,thebodygeneratesfreeradicalsunstablemoleculesthatcan
damagecellsbytearingawaytheirelectronsandanoverabundanceoffreeradicalshasbeenlinkedtoanincreased
riskforcancer.
Butwhenresearchersbeganexaminingtherolethatantioxidantsupplementationmightplayincancerprevention,the
evidencewaslargelydisappointing.Thebulkofstudiesfoundthatantioxidantsupplementsdonotreducetheriskfor
cancerorpreventtumorgrowth,andthatantioxidantsupplementationmayactuallyincreasepeople'slikelihoodofdying
fromcancer.
Ina2004metaanalysisfromtheLancet,researchersevaluated14RCTsthatcomparedtheeffectsofantioxidant
supplementationwithaplaceboontheincidenceofesophageal,gastric,colorectal,pancreatic,andlivercancers.
[27]
TheyfoundthatconsumingvitaminsA,C,andEandbetacaroteneandseleniumsupplementsactuallyincreased
overallmortality.A2009RCTinJAMA,whichexploredtheeffectsofseleniumandvitaminEsupplementationon
prostatecancerriskin35,533healthymen,failedtofindevidencethatselenium,vitaminE,orbothsupplements
reducedparticipants'riskforprostatecancer.
[28]
Infact,thestudyuncoveredanincreasedriskforprostatecancerin
participantswhoconsumedvitaminE.Afollowuptothistrial,alsopublishedinJAMA,revealedthatvitaminE
supplementsincreasedtheriskforprostatecancerinhealthymen.
[29]
Forcancerpatientsreceivingradiationtherapy,antioxidantsupplementsmaybeharmful.A2006RCTof540patients
withheadandneckcancerwhowereundergoingradiationtreatmentfoundthatpatientswhoconsumedvitaminEand
betacarotenesupplementseachdayhadasignificantlyincreasedlikelihoodofdyingcomparedwiththosewhotooka
placebo.
[30]
Whattheexpertssay:AccordingtoDr.Rock,"Consumingantioxidantsthroughfruitsandvegetablesisthebestoption
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 7/11
forcancerpatients.Whenwegetourantioxidantsfromfood,ourbodycanregulatehowmuchcellsareactuallyexposed
to,whereassupplementsmayshockthebodywithhighdosesofasubstance.Infact,antioxidantsderivedfrom
supplementsmayinteractwithchemotherapyandradiationtherapyandthusbepotentiallydangerous.Chemotherapy
createsoxidativestressthatkillscancercells,sotakingantioxidantsmayinterferewiththatprocess,makingitmore
likelythatthetherapywon'twork."
Yale'sDr.Novellaalsostressedthatalthoughvitaminsandherbsmayseemharmless,"theycanhavepotent
pharmacologicactivity,whichmaycounteractchemotherapy.Anotherproblemwithsupplementsisthattheyarepoorly
regulated,sousersdon'treallyknowwhatthey'regettingintermsofdoseorpurity."
Verdict:"Busted"forsupplements,thoughitisplausiblethatantioxidantsfromfoodmaybebeneficial.
Curcumin
Proposition:Curcuminsupplementscanhelpshrinktumors.
Whatthesciencesays:Curcumin,amainingredientintheIndianspiceturmeric,hasbeenshowntoexhibitanticancer
activityagainstcolorectalcancerincellcultures.
[31]
Severalstudieshavealsorevealedpotentialanticanceractivityin
cancerpatientsreceivingcurcuminalongsidechemotherapy.Inonestudy,generalsurgeonsfromChinareportedthat
patientswithcolorectalcancerwhoreceivedcurcuminsupplementspriortosurgeryappearedtoexhibitenhanced
anticanceractivityaswellasimprovedgeneralhealth.
[32]
Inaphase2trial,researchersatMDAndersonCancerCenter
studiedtheeffectsof8gofcurcumindailyon21patientswithadvancedpancreaticcancer,andfoundnocurcumin
relatedtoxiceffects.
[33]
Twopatientsevenshowedimprovementsindiseaseprogression.
Still,noRCTshaveexaminedtheanticancereffectsofcurcumin,andsomestudieshavefoundthatcurcuminmay
interactwithcertainchemotherapyagents.
[34]
Otherlimitationstocurcuminsupplementationarethatthebodyexcretes
mostofthecompound,andthatit'sunclearwhethercurcumininisolationorturmericconsumedincombinationwith
otherspicesprovidesthegreatestbenefit.
[35]
Whattheexpertssay:AccordingtoDr.Rock,"Curcumindoeshavebiologicalactivity,butwedon'tknowhowthebody
reactstocurcuminsupplements,whichprovideveryhighconcentrationsofthecompound.Whenweeatfoodslike
curry,wedon'tabsorbverymuchofthecurcumin,whichishowyourbodyprotectsitself."
Dr.Rosenthalcautionedthat"inpharmacologicdoses,curcuminmayinterferewithsomechemotherapyagents.Ithink
weputtoomuchonusonherbs,botanicals,andsupplementsbeforeweknowtheirtruesafetyandeffectiveness.I
believeweshouldfocusongettingthebulkofournutrientsfromfood."
Verdict:Unconfirmed.
Reiki
Proposition:Reikicandiminishcancerpainandstress.
Whatthesciencesays:TheACS,CancerResearchUK,andtheNationalCenterforComplementaryandAlternative
MedicineagreethatthereisnoclinicalorscientificevidencetosuggestthatReikicaneffectivelytreatanycondition,
includingcancer.
SomestudiesdosuggestthatthisancientJapaneseformofspiritualhealing,whichpurportedlyworksthroughthe
transferofspiritualenergy,orQi,fromthepractitionertothepatient,mayhelprelievestressandreducepain,butmost
ofthesestudiesarepoorlydesigned.
Onesystematicreviewanalyzeddatafrom9RCTsexploringtheeffectsofReikionarangeofconditions,including
depression,pain,anxiety,andstress,andfoundmixedresults.
[36]
SeveralRCTsreportedgreaterpainreliefandlower
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 8/11
anxietyinthetrueReikigroupcomparedwiththeshamcontrol,butothersfoundnodifferencesinanxietyorpain.A
2014literaturereview,whichlookedat7RCTs,4ofwhichstudiedcancerpatients,foundsomeevidencetosuggestthat
Reikitherapymayhelprelievepainandanxiety,butitconcludedthatfurtherstudywasrequiredtoreachadefinitive
conclusion.
[37]
OnerecentRCT,whichlookedatwhetherReikitherapycouldimprovepatients'wellbeing,cametoarathercompelling
conclusion.
[38]
Inthestudy,189patientsundergoingchemotherapyinanoutpatientcenterwererandomlyassignedto
receiveReikitherapy,shamReikiplacebotherapy,andstandardcare.PatientsinboththeReikitherapyandsham
groupsreportedsignificantimprovementsintheircomfortandwellbeingafteratherapysession.Theauthorsfoundthat
itwastheoneononesupportduringchemotherapythatwasthekeytotheirenhancedqualityoflife,regardlessof
whetherReikiwasused.
Whattheexpertsays:AccordingtoDr.Gorski,"TheevidencefortheefficacyofReiki,andenergybasedmedicinein
general,isweaktononexistent.Trainingyourselftorelax,ontheotherhand,canbeevidencebased,butalotofother
modalitiesgetthrownintothemindbodywastebasket.TheclaimthatReikipractitionerscanmanipulatepatient'senergy
fieldisnonsense."
Verdict:Plausibleforreducinganxietyandimprovingrelaxation,thoughtheeffectsarenotnecessarilybetterthanany
otherrelaxationtechnique."Busted"fortheclaimthatReikireducespainandanxietybychannelingaperson'senergy
field.
Meditation
Proposition:Meditationdiminishesanxiety,stress,anddepressionincancerpatients.
Whatthesciencesays:Meditationasacomplementtocancertreatmentdoesappeartoimprovepatients'qualityoflife
andreduceanxietyandpain.Studiesconsistentlyshowthathighlevelsofstresscanboostinflammation,whichmay
increasetheriskofdevelopingcancer,havingarecurrence,ordyingfromthedisease.
[39]
Alternatively,meditationor
otherrelaxationtechniqueshavebeenshowntoalleviateanxiety,depression,andstressandevenenhanceimmune
function.
[40]
Onerecentmetaanalysisthatincluded9studies,2ofwhichwereRCTs,foundthatvariousmindfulnessbasedstress
reductiontechniquesdecreasedstress,depression,andanxietyinbreastcancerpatients.
[41]
Anothermetaanalysis,
whichevaluated3RCTs,foundthatmindfulnessbasedstressreduction,whichincludedmeditationandyoga,reduced
depressionandanxietyinbreastcancerpatientsreceivingmainstreamtreatmentssignificantlymorethanthosewhojust
receivedconventionalcare.
[42]
Whattheexpertssay:"Althoughthereisnoevidencethatmeditationreducescancerrecurrenceorincreasessurvival
incancerpatients,itmayenhancerelaxationandoverallqualityoflife,"saidDr.Rock.
AccordingtoDr.Deng,whenitcomestointegratingmindbodyinterventions,suchasmeditation,intomainstreamcare,
theburdenofproofdoesn'tneedtobehigh."Withchemotherapy,wehavetobeverycertainthatitwillhelppatients
becauseitisahighrisktreatmentthatneedstobetailoredtoapatient'sparticularpathologyandgenome.Meditation,
however,won'thurtpatientssotherequirementfortryingitisquitelow.Researchshowsthatmindfulnessmeditation,
yoga,andotherrelaxationtechniquesreducestressandimprovequalityoflife.Whetherapatientchoosestodo
meditation,yoga,ortaichitorelaxisachoicethatdependsonaperson'sbeliefsystem,personality,cultural
background,andgenerallikesanddislikes.Mindbodytechniquesareessentiallydifferenttoolsthatservethesame
purpose,soitisamootpointtocomparetheireffectiveness.It'smoreaboutwhatworksforeachperson."
Verdict:Confirmedfordiminishingstress,depression,andanxiety.
References
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 9/11
1. SeelyDM,WeeksLC,YoungS.Asystematicreviewofintegrativeoncologyprograms.CurrOncol.
201219:e436e461.Abstract
2. CassilethBR.Complementaryandalternativetherapiesforcancer.TheOncologist.20049:8089.Abstract
3. EngJ,RamsumD,VerhoefM,GunsE,DavisonJ,GallagherR.Apopulationbasedsurveyofcomplementary
andalternativemedicineuseinmenrecentlydiagnosedwithprostatecancer.IntegrCancerTher.20032:212
216.Abstract
4. NationalCenterforChronicDiseasePreventionandHealthPromotionandCentersforDiseaseControland
Prevention.PhysicalActivityandHealth:AReportoftheSurgeonGeneral1996.
5. KushiLH,DoyleC,McCulloughM,RockCL,DemarkWahnefriedW,BanderaEV.AmericanCancerSociety
guidelinesonnutritionandphysicalactivityforcancerprevention.CACancerJClin.201262:3067.
6. LemanneD,CassilethB,GubiliJ.Theroleofphysicalactivityincancerprevention,treatment,recovery,and
survivorship.Oncology(WillistonPark).201327:580585.Abstract
7. HolmesMD,ChenWY,FeskanichD,KroenkeCH,ColditzGA.Physicalactivityandsurvivalafterbreastcancer
diagnosis.JAMA.2005293:24792486.Abstract
8. MeyerhardtJA,GiovannucciEL,HolmesMD,ChanAT,ChanJA,ColditzGA.Physicalactivityandsurvivalafter
colorectalcancerdiagnosis.JClinOncol.200624:35273534.Abstract
9. GiovannucciEL,LiuY,LeitzmannMF,StampferMJ,WillettWC.Aprospectivestudyofphysicalactivityand
incidentandfatalprostatecancer.ArchInternMed.2005165:10051010.Abstract
10. LeeIM,WolinKY,FreemanSE,SattlemairJ,SessoHD.Physicalactivityandsurvivalaftercancerdiagnosisin
men.JPhysActHealth.201411:8590.
11. CuiY1,ShuXO,GaoY,etal.UseofcomplementaryandalternativemedicinebyChinesewomenwithbreast
cancer.BreastCancerResTreat.200485:263270.Abstract
12. ChoiTY,LeeMS,KimTH,ZaslawskiC,ErnstE.Acupunctureforthetreatmentofcancerpain:asystematic
reviewofrandomisedclinicaltrials.SupportCareCancer.201220:11471158.Abstract
13. EzzoJM,RichardsonMA,VickersA.Acupuncturepointstimulationforchemotherapyinducednauseaor
vomiting.CochraneDatabaseSystRev.20062:CD002285.
14. DengG,VickersA,YeungS,CassilethB.Randomized,controlledtrialofacupunctureforthetreatmentofhot
flashesinbreastcancerpatients.JClinOncol.200725:55845590.Abstract
15. VickersAJ,StrausDJ,FearonB,CassilethBR.Acupunctureforpostchemotherapyfatigue:aphaseIIstudy.J
ClinOncol.200422:17311735.Abstract
16. MehlingWE,JacobsB,AcreeM.Symptommanagementwithmassageandacupunctureinpostoperativecancer
patients:arandomizedcontrolledtrial.JPainSymptomManage.200733:258266.Abstract
17. SunY,GanTJ,DuboseJW,HabibAS.Acupunctureandrelatedtechniquesforpostoperativepain:asystematic
reviewofrandomizedcontrolledtrials.BrJAnaesth.2008101:151160.Abstract
18. CorbinL.Safetyandefficacyofmassagetherapyforpatientswithcancer.CancerControl.200512:158164.
Abstract
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 10/11
19. ErnstE.Massagetherapyforcancerpalliationandsupportivecare:asystematicreviewofrandomisedclinical
trials.SupportCareCancer.200917:333337.Abstract
20. KutnerJS,SmithMC,CorbinL,HemphillL,BentonK,MellisBK.Massagetherapyversussimpletouchto
improvepainandmoodinpatientswithadvancedcancer:arandomizedtrial.AnnInternMed.2008149:369379.
Abstract
21. WilkinsonS,BarnesK,StoreyL.Massageforsymptomreliefinpatientswithcancer:systematicreview.JAdv
Nurs.200863:430439.Abstract
22. ErnstE.Thesafetyofmassagetherapy.Rheumatology(Oxford).200342:11011106.Abstract
23. PortAM,RuthMR,IstfanNW.Fructoseconsumptionandcancer:isthereaconnection?CurrOpinEndocrinol
DiabetesObes.201219:367374.
24. KlementRJ,KmmererU.Istherearoleforcarbohydraterestrictioninthetreatmentandpreventionofcancer?
NutrMetab(Lond).20118:75.
25. HeidemannC,SchulzeMB,FrancoOH,vanDam,MantzorosCS,HuFB.Dietarypatternsandriskofmortality
fromcardiovasculardisease,cancer,andallcausesinaprospectivecohortofwomen.Circulation.
2008118:230237Abstract
26. VelicerCM,UlrichCM.VitaminandmineralsupplementuseamongUSadultsaftercancerdiagnosis:a
systematicreview.JClinOncol.200826:665673.Abstract
27. BjelakovicG,NikolovaD,SimonettiRG,GluudC.Antioxidantsupplementsforpreventionofgastrointestinal
cancers:asystematicreviewandmetaanalysis.Lancet.2004364:12191228.Abstract
28. LippmanSM,KleinEA,GoodmanPJ.EffectofseleniumandvitaminEonriskofprostatecancerandother
cancers:theseleniumandvitaminEcancerpreventiontrial(SELECT).JAMA.2009301:3951.Abstract
29. KleinEA,ThompsonIM,TangenCM,CrowleyJJ,LuciaMS,GoodmanPJ.VitaminEandtheriskofprostate
cancer:theseleniumandvitaminEcancerpreventiontrial(SELECT).JAMA.2011306:15491556.Abstract
30. BairatiI,MeyerF,JobinE,GlinasM,FortinA,NabidA.Antioxidantvitaminssupplementationandmortality:a
randomizedtrialinheadandneckcancerpatients.IntJCancer.2006119:22212224.Abstract
31. 31ChauhanDP.Chemotherapeuticpotentialofcurcuminforcolorectalcancer.CurrPharmDes.20028:1695
1706.Abstract
32. HeZY,ShiCB,WenH,LiFL,WangBL,WangJ.Upregulationofp53expressioninpatientswithcolorectal
cancerbyadministrationofcurcumin.CancerInvest.201129:208213.Abstract
33. DhillonN,AggarwalBB,NewmanRA,WolffRA,KunnumakkaraAB,AbbruzzeseJL.PhaseIItrialofcurcuminin
patientswithadvancedpancreaticcancerClinCancerRes.200814:44914499.
34. SomasundaramS,EdmundNA,MooreDT,SmallGW,ShiYY,OrlowskiRZ.Dietarycurcumininhibits
chemotherapyinducedapoptosisinmodelsofhumanbreastcancer.CancerRes.200262:38683875.Abstract
35. AggarwalB,PrasadS,SungB,KrishnanS,GuhaS.Preventionandtreatmentofcolorectalcancerbynatural
agentsfrommothernature.CurrColorectalCancerRep.20139:3756.
36. LeeMS,PittlerMH,ErnstE.EffectsofReikiinclinicalpractice:asystematicreviewofrandomizedclinicaltrials.
11/9/2014 www.medscape.com/viewarticle/830552_print
http://www.medscape.com/viewarticle/830552_print 11/11
MedscapeOncology2014WebMD,LLC
Citethisarticle:Mythbusters:ComplementaryandAlternativeTreatmentsinCancer.Medscape.Sep02,2014.
IntJClinPract.200862:947954.Abstract
37. ThraneS,CohenSM.EffectofReikitherapyonpainandanxietyinadults:anindepthliteraturereviewof
randomizedtrialswitheffectsizecalculations.PainManagNurs.2014S15249042(13)000805.
38. CatlinA,TaylorFordRL.InvestigationofstandardcareversusshamReikiplaceboversusactualReikitherapyto
enhancecomfortandwellbeinginachemotherapyinfusioncenter.OncolNursForum.201138:E212E220.
Abstract
39. EllsworthRE,ValenteAL,ShriverCD,BittmanB,EllsworthDL.Impactoflifestylefactorsonprognosisamong
breastcancersurvivorsintheUSA.ExpertRevPharmacoeconomicsOutcomesRes.201212:451464.
40. ShennanC,PayneS,FenlonD.Whatistheevidencefortheuseofmindfulnessbasedinterventionsincancer
care?Areview.Psychooncology.201120:681697.Abstract
41. ZainalNZ,BoothS,HuppertFA.Theefficacyofmindfulnessbasedstressreductiononmentalhealthofbreast
cancerpatients:Ametaanalysis.Psychooncology.201322:14571465.Abstract
42. CramerH,LaucheR,PaulA,DobosG.Mindfulnessbasedstressreductionforbreastcancerasystematic
reviewandmetaanalysis.CurrOncol.201219:e343e352.Abstract