Complementary and Alternative Therapy

Life doesn’t stop happening to you even when you get cancer,”

Suzanne Guerrero says, and she ought to know. The 40-year-old Boise, Idaho, resident is currently undergoing treatment for stage I invasive breast cancer.

“Even during cancer treatment, your car still breaks down, you still go through a divorce, or a death in the family, or whatever. You’re not able to just focus on your disease; you still have to manage the rest of your life,” she continues.

But, how do you manage the rest of your life when you’re faced with cancer and the side effects of treatment? Most cancer patients can attest to the fact that the disease, treatment and side effects quickly become their main focus. At the same time, increasing numbers of doctors and patients are coming to recognize the importance of the whole patient and of maintaining optimal quality of life during cancer treatment.

The side effects of cancer treatment are no secret. In fact, the mere mention of chemotherapy often invokes fear of its more well-known side effects: nausea, vomiting and hair loss, which can drastically affect quality of life. For that reason, the first reaction upon hearing a cancer diagnosis can often be instant fear of treatment.

“In the beginning, I didn’t want to do anything,” Guerrero recalls, remembering how she felt after her diagnosis. “I was so afraid of conventional treatment. The more I read about it and all of the things it could do, I was just very afraid and immobilized for a while.”

Guerrero isn’t alone. Many patients fear cancer treatment even more than they fear their cancer. In fact, sometimes the worst side effect of cancer treatment becomes the anxiety about side effects. It is this fear that often leads patients to search for alternatives to standard treatments. But alternatives are not always the answer. In fact, “alternative” is not a very welcome word in the oncology field.

A growing community of complementary and alternative (CAM) practitioners are stepping in to answer the call of patients like Guerrero who want the benefits of standard therapy but are seeking relief from the side effects that the treatments deliver.

Naomi Jankowitz, Licensed Acupuncturist, sees the benefit of supporting cancer patients during conventional cancer treatment: “Western medicine really is the best treatment when there is a cancer, and you really need it, but it throws the body off. I think it’s best to use the Western medicine to fight the cancer and use Chinese medicine to treat the side effects of that treatment.”

Joan Haynes, ND, a naturopathic doctor who specializes in working with cancer patients agrees, “When you’re looking at conventional treatment and natural treatments, it’s not either or, it’s both; it’s using everything together.” Haynes continues, describing her role in conjunction with standard therapy: “My role in cancer is not that of cure, but really of support during their conventional treatment.”

CAM practitioners like Haynes and Jankowitz offer a welcome addition to what doctors refer to as “supportive care”—providing care for patients during treatment to maintain their health and improve their quality of life—and patients and doctors are increasingly recognizing their value during cancer treatment.

What is CAM?

CAM describes medical therapies practiced outside “mainstream” or conventional Western medicine. CAM includes a variety of healing philosophies and medical practices that are not currently accepted or used by conventional medicine, such as acupuncture, aromatherapy, biofeedback, herbal remedies and more.

The distinction between complementary and alternative medicine is an important one. Complementary medicine refers to therapies that are used in addition to conventional medical treatments, whereas alternative medicine refers to therapies that are used instead of conventional treatment (these can be the same therapies as those used in complementary medicine, but they are used alone).

Complementary medicine is quickly becoming more mainstream and well-accepted in the oncology field; however, mention alternative medicine and most oncologists will shudder. Alternative medicine is a risky proposition because there is no alternative medicine that has been scientifically proven to cure cancer. The use of alternative medicine usually delays conventional treatment and allows the disease to progress, often to the point where conventional treatment can no longer help.

Patients who utilize complementary medicine, on the other hand, are using conventional treatment and CAM concurrently. They use well-researched conventional treatment to fight their cancer, while utilizing complementary treatment to reduce stress, enhance the immune system and/or reduce the side effects of conventional treatment. Using complementary medicine and conventional treatment is a way of integrating the best of what both types of medicine have to offer.

From Complementary to Integrative

Integrative medicine is the new evolution of CAM and represents a paradigm shift from treating the cancer to treating the patient. Integrative medicine focuses on the whole patient, combining conventional treatments and complementary therapies in order to fight cancer and promote health and healing.

While historically conventional treatment and CAM have been pitted against each other, the new trend is to integrate the two and bring the best of both worlds together.

Dr. David S. Rosenthal, Medical Director of Zakim Center for Integrated Therapies at Dana Farber Cancer Institute in Boston reports that the field of CAM is evolving. “What is happening in this country, and gradually in major cancer centers, is the appearance of integrative medicine—combining preventive services alongside conventional treatment…The field is evolving.”

The Zakim Center for Integrative Therapies is one of many new integrative centers that are popping up in cancer centers across the country. At the Zakim Center, Rosenthal consults with patients and works closely with a team of practitioners to offer patients support through many modalities, including acupuncture and massage. Their main goal is to improve quality of life by reducing symptoms related to the disease or the treatment of the disease.

A unique and crucial aspect of the success at the Zakim Center is that all of the practitioners have access to patient records and are in direct communication with the treating doctors, making it a truly integrative approach. For example, if a patient’s platelet count falls below 50,000, then the acupuncturist knows to hold off on placing any needles until that number rises.

The advantage to such an innovative and integrative approach is that doctors and practitioners can work collaboratively to meet the needs of the patients, which takes the mystery out of the equation. “We would rather have patients discuss with us what they’re doing than not know,” Rosenthal says, noting that it can be a major concern for doctors when patients do not inform them of complementary therapies they are using.

In fact, the biggest concern regarding complementary therapies has always been lack of communication between the patient and the doctor. While the trend is shifting and more doctors and cancer centers are embracing integrative medicine, there is still a gap in communication. Some complementary therapies can interfere with conventional treatment; therefore, it’s important that patients communicate with their doctors should they decide to use any form of complementary therapy.

Safety First

Rosenthal says that safety and efficacy are two of their primary concerns. “Safety is such an important issue,” he says. “There are drug-drug interactions, drug-herb interactions, drug-botanical interactions; sometimes antioxidants are good and sometimes they’re bad.”

These safety concerns have led to more studies designed to measure outcomes in integrative therapies. “It’s a new field.” Rosenthal continues, “Measuring outcomes is very important.”

Evidence-based research in the field of integrative medicine is growing. In fact, the Society for Integrative Oncology was established in 2003 in order to promote research in complementary therapies for cancer patients.

“There is a growing body of data and information on these therapies. For example, we know that laetrile is unsafe and toxic and there are scores of evidence to show it’s ineffective. However, we know that acupuncture is safe. There are no adverse reactions and there is evidence from randomized clinical trials that it reduces cancer pain and chemotherapy-induced nausea and vomiting,” Rosenthal reports.

Safety is truly the biggest concern among doctors treating patients who are interested in complementary therapies. It’s important to remember that complementary therapies are not evaluated and approved by the FDA. The larger cancer centers that have embraced integrative medicine are paving the way with research in the new field; however, until this information trickles down, patients will need to take care to choose their complementary therapies carefully and communicate with their physician regarding their choices.

If You Want to Integrate

There is almost no limit to the variety of therapies available to cancer patients. Therapies that were once considered alternative at best, or “hocus-pocus” at worst, have now entered the mainstream. Some of these therapies are offered on an individual basis, whereas others are offered in a group setting. Patients can attend lectures or meditation groups; they can practice yoga or tai chi; or they might receive nutritional counseling or healing touch. All of these modalities have the same goal: to improve quality of life and reduce symptoms related to the disease and its treatment.

Cancer patients looking for extra support during treatment might benefit from one of the therapies listed below:

Acupuncture: Acupuncture is a safe, painless and effective form of Chinese medicine that involves the placement of tiny needles on different points throughout the body in order to stimulate energy. Acupuncture can be used to reduce anxiety, promote relaxation, improve energy level, reduce pain, improve appetite and reduce nausea and vomiting. Weidong Lu, a Licensed Acupuncturist at the Zakim Center notices marked improvement in her patients: “It improves their energy level. These patients are very, very tired due to fatigue from treatment and acupuncture improves stamina so they can handle treatment much better.”

Aromatherapy: Aromatherapy involves the skilled and controlled use of essential oils for physical and emotional health and well-being. These oils can be applied either directly to the skin or through inhalation. The oils are very strong, so they are best inhaled by placing a few drops on a tissue or 10 to15 drops into 4 ounces of distilled water for a room spray. Kamron Keep, an oncology nurse and certified aromatherapist advises patients to find a good source of high-quality essential oils or to work with a professional aromatherapist. “I think aromatherapy can offer a lot to cancer patients because our sense of smell is very important to our emotional health and wellbeing and is something that we often take for granted.” While cancer patients may need to use caution in using essential oils directly on the skin, they can benefit from inhaling the aroma of certain oils. For example, placing a few drops of peppermint, ginger or lemon on a tissue may help to reduce nausea. Patients with fatigue might benefit from basil, rosemary or grapefruit.

Massage: During a massage session, a therapist kneads muscles in order to relieve muscle tension, stimulate circulation and promote relaxation. Massage can help cancer patients with pain and muscle tension that results from awkward positions, stress or side effects of treatment. In addition, massage can reduce anxiety and stress associated with cancer and its treatment. “After massage, patients feel calmer, able to receive their treatments without that anxiety often associated with it and able to deal with the day with better spirits,” notes Bambi Mathay, a massage therapist at the Zakim Center.

Music Therapy: Music therapy uses music to promote a general sense of well-being. Michael Richardson, a music therapist with Place of Wellness at M.D. Anderson Cancer Center in Houston describes his technique with patients: “I use music to work on other-than-musical goals. In other words, the music is just the vehicle. I might be working on self-expression, socialization, or stimulation. Sometimes people are depressed and they need something to get them motivated to get up.”

This is by no means a comprehensive list of therapies available to patients. Patients interested in using complementary therapies should consult with their physician. Remember, integrative medicine embraces conventional treatment and attempts to combine the best of both worlds, but in order for the approach to be truly integrative, patients will need to communicate and work with their doctors and practitioners to create the optimal healthcare situation.