What is complementary alternative cancer treatment?

Introduction

Cancer is the second leading cause of death in the United
States (after heart disease), and its insidious nature gives it a special
terror. Most diseases give warning in the form of escalating symptoms, while
others strike suddenly. Cancer follows a different, stealthier path. A person who
feels perfectly well may come back from the doctor’s office with a diagnosis of
potentially fatal cancer and plenty of time to fear what comes next.

Conventional treatments for cancer also have frightening qualities to them,
including disfiguring surgery, arduous chemotherapy, and treatment with
invisible radiation. In many cases, when cancer is found early enough,
conventional treatment can lead to a permanent cure. Often, though, the prognosis
is given in statistics (a percentage chance of survival) or, worse, in months
remaining to live.

Some alternative therapies for cancer may truly work, even if they have not been proven. Most studies of alternative therapies for cancer have involved adding a natural treatment to a standard cancer regimen; alternatively, they enrolled persons who have already failed to respond to existing methods. These latter circumstances could potentially hide the benefits of an effective natural therapy. If a treatment only worked in the absence of chemotherapy, for example (as some alternative cancer therapy proponents claim about their methods) or could only cure early cases of cancer, these ethical obstacles would prevent researchers from finding out.

The relatively small amount of information that is known from a scientific perspective about alternative treatments for cancer is discussed here, as are natural options that may reduce side effects of standard cancer therapies. Possible interactions between herbs and supplements and drugs are also discussed.

Proposed Natural Treatments

Various natural supplements have shown some promise for improving the effectiveness of conventional cancer therapy (specifically surgery, chemotherapy, and radiation) or reducing its side effects. In most cases, however, the supporting evidence remains weak, and the most rigorous studies have often failed to find benefit. Persons receiving cancer treatment should not use any herbs or supplements except under the supervision of a physician.

Improving Effectiveness of Conventional Treatment

Numerous natural therapies have been proposed for enhancing the cancer-fighting effects of standard therapies. However, most of the supporting research falls short of the necessary standard for proof: a double-blind, placebo-controlled study.

Cancer survivors can find comfort by participating in support groups and events such as the cancer walk. (AP/Wide World Photos)

Shark cartilage. Based on the belief that sharks do not get
cancer, shark cartilage has been heavily marketed as a cure for cancer. While this
is a myth (sharks do get cancer), shark cartilage has shown some promise. Shark
cartilage tends to inhibit the growth of new blood vessels, a process called
angiogenesis. Because cancerous tumors must build new blood
vessels to feed themselves, this effect might be beneficial.

Shark cartilage also inhibits substances called matrix metalloproteases (MMPs). These little-understood enzymes affect the extracellular matrix, the framework of substances that lie between cells in the body. MMPs are thought to play a role in diseases of the cornea, gums, skin, blood vessels, and joints, and in cancer and illnesses that involve excessive fibrous tissue.

A number of test-tube experiments have found that shark cartilage extracts prevent new blood vessels from forming in chick embryos and other test systems. These findings have led to other test-tube experiments, animal studies, and preliminary human trials to investigate the possible anticancer effects of shark cartilage. The results appeared to suggest that a particular liquid shark cartilage extract might be useful in the treatment of various cancers, including lung, prostate, and breast cancer. However, the two most recent and best designed of these studies have failed to find benefit.

Social support and other psychological factors. Cancer treatment
puts tremendous stress, both physical and emotional, on those who undergo it.
Several studies have examined the potential benefits of social support for women
with breast
cancer. According to most studies, such support improves
survival and enhances quality of life. In one well-known study of women with
advanced breast cancer, participants who attended a support group twice weekly
doubled their survival time compared to study participants who did not attend the
group.

It is also commonly said that certain psychological coping styles (for example, fighting spirit versus helpless acceptance) can lead to longer life in people with cancer. However, a review of the evidence found that there is little to no evidence that psychological attitude makes much of a difference. People with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence, the study’s authors concluded.

Relaxation therapies. One study evaluated guided imagery and
relaxation
therapy following surgery for colon cancer. The results
indicated no more than a short-term, mood-elevating benefit; those receiving the
treatment did not recover more quickly.

Another study on relaxation therapy involved 126 hospitalized persons with cancer pain. Researchers found that those who listened to relaxing music for thirty minutes and received pain medication had more relief than the group who received only the medication.

Vitamin C. Cancer treatment is one of the more controversial
proposed uses of vitamin C. An early study tested vitamin C in eleven hundred
terminally ill persons with cancer. One hundred persons received 10,000 milligrams
(mg) daily of vitamin C, while the other one thousand persons (the control group)
did not receive vitamin C. Those taking the vitamin C survived more than four
times longer on average (210 days) than those in the control group (50 days). A
large (1,826 subjects) follow-up study by the same researchers found a nearly
doubled survival rate (343 days versus 180 days) in vitamin C-treated persons
whose cancers were deemed incurable, compared to people not treated with vitamin
C. Benefits were also seen in a similarly designed Japanese study.

However, while these results seem promising and almost miraculous, they show next to nothing because they lacked a placebo group. When proper double-blind, placebo-controlled studies were performed on vitamin C for cancer, they failed to find any benefit. Vitamin C proponents have criticized these trials on various grounds, but the fact remains that there is no reliable positive evidence for vitamin C in cancer.

PC-SPES for prostate cancer. PC-SPES is a formulation of eight natural substances: seven are plants and one is a fungus. The name is derived from the common abbreviation for prostate cancer (PC) and the Latin word spes, meaning “hope.”

After its commercial launch in 1996, PC-SPES received increasing interest
from the general public and prostate cancer researchers. Preliminary evidence
suggested that it has significant effects on prostate cancer cells, perhaps
because of its estrogen-like action.

However, chemical analysis reported in 2002 showed that PC-SPES is not truly a
purely herbal product; samples of the product dating to 1996 have been found to
contain a form of pharmaceutical estrogen, diethylstilbestrol (DES), as well as indomethacin (an
anti-inflammatory medication in the ibuprofen family) and warfarin (a strong blood
thinner). Samples subsequent to 1999 contain less DES; but they also have shown
less effectiveness in treating prostate cancer.

There is little doubt that DES is active against prostate
cancer, but it presents a variety of risks, including blood
clots in the legs. The other two pharmaceutical contaminants might actually reduce
the risk of blood clots (which may be why they were covertly added), but present
various risks all on their own. For these reasons, PC-SPES use is not
recommended.

Other natural treatments. Hundreds of herbs and supplements have been shown in test-tube studies to fight cancer cells. However, it is a long way from a test tube to a human body, and such findings are not meaningful.

Several natural supplements that have received at least preliminary study in humans are discussed here. None of the positive studies cited here reached the level of rigor required to truly show a treatment effective. (Most lacked a control group, for example.) In contrast, several properly designed studies failed to find benefit.

A double-blind study of fifty-three people undergoing cancer treatment found equivocal evidence that treatment with a special form of Panax ginseng (modified to contain higher levels of certain constituents) could improve general well-being of people with cancer. Another study investigating the effects of P. ginseng on survival of persons being treated for lung cancer showed no additional benefit. One study provides indirect but promising evidence that a mixture of the supplements coenzyme Q10 (100 mg daily), riboflavin (10 mg daily), and niacin (50 mg daily) might help reduce the chance of breast cancer metastasis, or recurrence.

According to most of the highly preliminary trials, extracts of the fungus
Coriolus versicolor may enhance the effectiveness of various
forms of standard cancer therapy. Coriolus is thought to work by
stimulating the immune system. The fungi products active hexose correlated
compound and shiitake are also advocated for this purpose.

The supplement docosahexaenoic acid, a constituent of fish oil, has
shown promise for enhancing the effects of the cancer chemotherapy drug
doxorubicin. The herb Ginkgo biloba is thought to increase blood
flow. An uncontrolled study evaluated combination therapy with ginkgo extract and
the chemotherapy drug 5-FU for the treatment of pancreatic
cancer, on the theory that ginkgo might enhance blood flow to
the tumor and thereby help 5-FU penetrate better. The results were promising.
Scant preliminary evidence suggests that American ginseng may increase the
effectiveness of treatment for breast cancer and that Siberian ginseng (properly
known as Eleutherococcus senticosus) may be useful in the
treatment of breast cancer and other forms of cancer.

A small unblinded study using a no-treatment control group found indications
that the use of a standardized tomato extract containing the supplement
lycopene might slow the growth of prostate cancer. In a
small, double-blind, placebo-controlled study, a combination of soy, isoflavones,
lycopene, silymarin (from milk thistle), and antioxidants
showed some potential benefit for preventing recurrence of prostate cancer after
prostate cancer surgery. Another study enrolled men with rising PSA levels (a
symptom of worsening cancer) and found that the use of lycopene helped stabilize
these levels. Because this study failed to include a placebo control group, its
results fail to indicate that lycopene lowers PSA levels and therefore, by
inference, slows prostate cancer. However, researchers did compare lycopene alone
with lycopene plus isoflavones and found that the combined treatment seemed to be
less effective, as if the isoflavones somehow antagonized the effects of
lycopene.

Preliminary studies, including unblinded-controlled trials, suggest that the
hormone melatonin may enhance the effectiveness of standard therapy
for breast cancer, prostate cancer, brain glioblastomas, non-small-cell lung
cancer, and other forms of cancer. However, no double-blind studies have been
reported. Melatonin may also help decrease cancer chemotherapy side effects.

Mistletoe extract (Iscador) taken by injection has been evaluated as a cancer
treatment in a number of studies, including double-blind,
placebo-controlled trials. In general, though, these studies
failed to attain adequate levels of scientific rigor or clinical relevance. The
best studies found benefit; more rigorous studies found no improvement in survival
time, survival rate, or quality of life. A review of forty-one studies found
mistletoe use was associated with improved survival in persons with cancer. An
analysis of these studies limited to randomized trials showed no effect. The
safety of mistletoe is not established, and one report suggests that it can damage
the liver.

An uncontrolled study found that the use of a special spleen extract (spleen
peptide preparation) somewhat reduced side effects of chemotherapy for
head and neck
cancer. In a double-blind, placebo-controlled trial, neither
vitamin
A nor N-acetylcysteine proved helpful for enhancing survival
in head and neck cancer or lung cancer. Vitamin D may decrease
bone pain and increase muscle strength in men with prostate cancer.

Traditional
Chinese medicine has been evaluated in a number of studies in
persons being treated for cancer. In one such study, acupuncture
has shown some promise for reducing the sense of fatigue that commonly occurs in
cancer. Similarly, medical qigong (two ninety-minute sessions
weekly) was associated with improved quality of life, fatigue, and mood
disturbance in another study. A review of fifteen mostly poor-quality trials
involving 862 persons receiving chemotherapy for non-small-cell lung cancer
suggested that Chinese herbal medicine might improve quality of life. A 2010
review of seven studies, however, found insufficient evidence to conclude whether
or not Tai
Chi improves quality of life or psychological or physical
outcomes in persons with breast cancer. One study tested whether a diet very high
in vegetables, fruit, and fiber, and low in fat could enhance survival or reduce
recurrence rates in women diagnosed with breast cancer; no benefits were seen.

Reducing Side Effects of Chemotherapy

Various herbs and supplements have shown promise for reducing the side effects of chemotherapy. Many chemotherapy drugs work by interfering with rapidly dividing cells. Cancer cells, however, are not the only cells that divide rapidly. The intestinal tract constantly rebuilds its lining, and chemotherapy may interfere with that process. The result is gastrointestinal side effects, such as mouth sores, nausea, loss of appetite, and diarrhea. Several herbs and supplements have shown promise for alleviating these conditions, although none have been definitively proven effective.

Diarrhea and other gastrointestinal side effects. A
well-designed, double-blind, placebo-controlled trial of seventy participants
undergoing cancer chemotherapy with the drug 5-FU evaluated the potential benefits
of the supplement glutamine for reducing chemotherapy-induced diarrhea. The
results suggest that the use of glutamine at a dose of 18 grams daily may reduce
intestinal damage and diminish symptoms of diarrhea. These promising findings
indicate a need for larger trials to accurately determine the extent of
benefit.

A double-blind, placebo-controlled study of 150 people undergoing chemotherapy with 5-FU found some evidence that a probiotic (friendly bacterium) called Lactobacillus rhamnosus can reduce the diarrhea that is a common complication of this treatment. Another, more unusual probiotic, a special, nonpathogenic form of Escherichia coli, has also shown promise. Preliminary evidence hints that the supplement active hexose correlated compound and colostrum might help reduce chemotherapy-induced gastrointestinal side effects. In one study, the use of the supplement creatine failed to help maintain muscle mass in people undergoing chemotherapy for colon cancer.

Mouth sores. In an uncontrolled study, the use of the herb chamomile as a mouthwash appeared to help prevent mouth sores in people undergoing various forms of chemotherapy. However, uncontrolled studies prove nothing. A rigorous, double-blind, placebo-controlled trial of 164 people did not find chamomile mouthwash effective for treating the mouth sores caused by the chemotherapy drug 5-FU. Beta-carotene and vitamin E have also shown some promise for preventing mouth sores (caused by various forms of cancer treatment) in preliminary studies, but rigorous studies of adequate size have not been reported.

Nausea. A preliminary trial hints that ginger may reduce nausea caused by the chemotherapy drug 8-MOP. However, another study failed to find ginger helpful for nausea in people using the drug cisplatin. In a third trial, ginger did not add to the effectiveness of standard medications to treat chemotherapy-induced nausea and vomiting.

Massage has shown some benefit for reducing nausea caused by
chemotherapy. Psychological methods such as hypnosis and
relaxation therapy have also shown promise for nausea. One study found that the
use of aromatherapy massage (combined massage therapy and the use of fragrant
essential oils) reduced symptoms of anxiety or depression (or both) in people
undergoing treatment for cancer, at least for the short-term. However, the authors
of a review of ten massage therapy studies were unable to
draw firm conclusions about its benefits for a wide range of symptoms in persons
undergoing treatment for cancer. Studies of acupressure
or acupuncture for reducing nausea in people undergoing chemotherapy have reached
contradictory results, though on balance, there may be some benefit.

A double-blind study performed in Hong Kong evaluated the potential benefits in
cancer chemotherapy of personalized herbal formulas designed according to the
principles of traditional Chinese herbal medicine. In this study, 120
people undergoing chemotherapy for early-stage breast or colon cancer were given
either a personalized formula or placebo. Researchers evaluated numerous possible
effects of the treatment but found benefits in only one: reduction of nausea. Even
this single result is less meaningful than it may seem; it is statistically
questionable to use a multiplicity of outcome measures.

Other side effects of chemotherapy. In highly preliminary trials, the supplement N-acetylcysteine has shown promise for reducing various side effects of the drug ifosfamide. An animal study suggests that a constituent of fish oil called docosahexaenoic acid might decrease side effects caused by the drug irenotecan. The hormone melatonin has shown some promise for reducing the side effects of various chemotherapy drugs.

In preliminary studies, various antioxidants have shown promise for preventing
heart damage and other side effects of the drug doxorubicin.
One animal study hints that the herb milk thistle might protect against kidney
damage caused by the drug cisplatin. In addition, there is some
evidence that acetyl-L-carnitine, glutamine, and vitamin E supplementation might
each reduce peripheral neuropathy (painful damage to nerves outside the spinal
column) symptoms in persons receiving cisplatin or paclitaxel.

Sea buckthorn berry has been advocated for reducing side effects of chemotherapy, but the evidence that it works is far too preliminary to be relied upon. A review of thirty-three studies supports the view that antioxidants in general (with the exception of vitamin A) may reduce the toxic effects of chemotherapy. However, because of inconsistencies among these studies, it is unclear what antioxidants are best for this purpose.

Reducing Side Effects of Radiation Therapy

Although the symptoms are generally less intense than with chemotherapy,
radiation
therapy can also cause problems, such as diarrhea, skin
damage, and fatigue. Certain supplements and alternative therapies may offer
benefit.

Two double-blind, placebo-controlled studies enrolling a total of almost seven
hundred people undergoing radiation therapy found that the use of probiotics
significantly improved diarrhea. However, of eighty-five women receiving pelvic
radiation for cervical or uterine cancer, those who consumed a probiotic-enriched
yogurt had no less diarrhea than those who took a placebo drink.

An unblinded-controlled study of seventy-five people receiving radiation therapy for various forms of cancer found some evidence that soap enriched with aloe vera gel can help protect the skin from radiation damage. However, researchers had to use questionable statistical methods to find evidence of benefit, making the results less than fully reliable. A double-blind, placebo-controlled study that evaluated the effects of aloe gel in 225 women undergoing radiation therapy for breast cancer failed to find benefit. Another study failed to find aloe vera beneficial for reducing side effects of radiation therapy for head and neck cancer.

One study compared cream made from calendula flowers with the standard treatment trolamine for protecting the skin during radiation therapy and found calendula more effective. However, it is not known whether trolamine is beneficial, neutral, or harmful when used for this purpose, and for this reason it is not possible to draw firm conclusions from the study. Cream made from chamomile has also been tried for protecting the skin from damage caused by radiation therapy, but the one controlled trial on the subject failed to find benefit.

One study failed to find oligomeric proanthocyanidins from grape seed helpful for reducing the local side effects of radiation therapy for breast cancer. Radiation treatment in the vicinity of the mouth may cause alterations in taste sensation. In a small, double-blind, placebo-controlled trial, the use of zinc supplements tended to counter this symptom. However, a larger follow-up study failed to find this benefit. Another study did find that the use of zinc could modestly decrease inflammation of the mucous membranes and skin caused by radiation therapy.

Radiation treatment to the pelvic area can cause nausea, vomiting, and fatigue. A double-blind, placebo-controlled trial with fifty-six participants evaluated the potential effectiveness of proteolytic enzymes for reducing these symptoms. No benefits were seen. Another study failed to find proteolytic enzymes helpful for reducing mouth sores or other symptoms that occur during radiation therapy of head and neck cancers.

In a double-blind study of forty people undergoing radiation therapy for breast cancer, the use of a standard multivitamin preparation failed to reduce fatigue compared with placebo. People in the placebo group may have done somewhat better than those given the vitamin.

A large study failed to find aromatherapy more helpful than placebo
for reducing psychological distress among people undergoing radiation therapy for
cancer. A small randomized trial found that effleurage massage, a common massage
technique, had no significant effect on anxiety, depression,
or quality of
life among twenty-two women undergoing radiation therapy for
breast cancer.

As with chemotherapy, sea buckthorn berry has been advocated for reducing side effects of radiation therapy, but again, reliable evidence is lacking. The use of antioxidants during radiation therapy is controversial. One study found that the use of antioxidants decreased radiation therapy side effects but also may have decreased radiation therapy effectiveness. In a small trial, persons who wore acupressure bands for up to seven days following radiation therapy reported less nausea than persons who received only usual care.

Treating Side Effects Caused by Breast Cancer Surgery

Many women experience lymphedema (chronic arm swelling caused
by damage to the lymph drainage system) following breast cancer surgery. Natural
treatments for this condition include oxerutins, citrus bioflavonoids, and
oligomeric proanthocyanidins. Another small randomized trial of seventy persons
found that acupuncture may decrease dry mouth and pain after removing lymph nodes
in the neck for cancer treatment.

Hot flashes after mastectomy. Women who have had breast cancer surgery frequently experience annoying hot flashes. Estrogen treatment is not an option, as it might increase the risk of cancer recurrence.

In a two-month double-blind trial, eighty-five women who had undergone treatment for breast cancer received either the herb black cohosh or placebo. The results were not encouraging: Black cohosh did not reduce overall hot-flash symptoms. Four double-blind, placebo-controlled trials evaluated soy isoflavones as a treatment for hot flashes, but these also failed to find benefit.

A trial involving seventy-two women with breast cancer failed to find real acupuncture significantly more effective than sham acupuncture for treatment of hot flashes. A 2008 review of all existing studies on the subject concluded that the evidence does not support a beneficial effect for acupuncture in women with breast cancer who also have hot flashes. In a small randomized trial, hypnosis appeared to reduce hot flashes and improve mood and sleep among fifty-one breast cancer survivors.

Treating side effects caused by chemotherapy. In a small randomized trial of forty-three persons with breast cancer, six weeks of acupuncture twice weekly reduced joint pain attributed to aromatase-inhibitor therapy.

Treating Weight Loss Caused by Cancer or Cancer Treatment

Cancer can cause a condition called tumor-induced weight loss, in which symptoms of starvation occur despite apparently adequate nutrition. The cause is thought to be a particular form of inflammation caused by the cancer. Cancer chemotherapy can also cause weight loss.

Cancer Cures

Numerous herbs, including bloodroot, burdock, cat’s claw, flaxseed (based on lignan content), lapacho, maitake, noni, Oregon grape, pokeroot, red clover, and reishi, have been claimed effective for the treatment of cancer. However, there is no reliable evidence to indicate that these herbs actually help, and one, pokeroot, is actively toxic.

Various herbal combinations have also been promoted for the treatment of cancer, including the Hoxsey cancer cure, Essiac, and Jason Winter’s cancer-cure tea. Again, however, there is no reliable evidence that they really work. Similarly, various dietary approaches that have been claimed to help treat cancer, such as macrobiotics and raw foods, lack meaningful supporting evidence.

Herbs and Supplements to Use Only with Caution

Various herbs and supplements may interact adversely with drugs used to treat cancer. It is strongly recommend that persons under treatment for cancer not use any herb or supplement except under a physician’s supervision.

The herb St. John’s wort interacts with many medications, including various
chemotherapy drugs. The drug methotrexate causes the body to become
deficient in folate. For this reason, people who take methotrexate for rheumatoid
arthritis, juvenile rheumatoid arthritis, or psoriasis are sometimes advised to
take folate supplements. Studies indicate that in those conditions, the use of
folate does not impair the action of the drug. However, no studies have
established that folate supplements are safe to take with methotrexate when it is
used to treat cancer. The citrus bioflavonoid tangeretin may interact with the
breast cancer drug tamoxifen. One highly preliminary study found that black cohosh
might interfere with the action of the chemotherapy drug cisplatin.

The antioxidant controversy. Heated disagreement exists regarding
whether it is safe or appropriate to combine antioxidants (such as vitamin E,
vitamin C, and beta-carotene) with standard chemotherapy drugs. The reasoning
behind the concern is that some chemotherapy drugs may work in part by creating
free
radicals that destroy cancer cells, and antioxidants might
interfere with this beneficial effect.

There is little reliable evidence, though, that antioxidants interfere with chemotherapy drugs. Additionally, there is growing evidence that antioxidants may not cause harm and, in certain cases, may offer benefits. However, the effects are likely to vary with the specific situation (for example, type and stage of cancer and kind of treatment used), and there is far more research to be done. Therefore, it is strongly recommend that one not take antioxidants (or any other supplements) while undergoing cancer chemotherapy, except on the advice of a physician.

A similar situation exists regarding radiation therapy. One study found that the use of antioxidants decreased radiation therapy side effects but also may have decreased radiation therapy effectiveness. Another study found some evidence that people who both smoked cigarettes and used antioxidants while undergoing radiation therapy for head and neck cancer had increased risk of treatment failure compared to smokers who did not use antioxidants.

After reviewing much of the research on this controversial topic, one group of researchers published an article in the Journal of the National Cancer Institute, in which they conclude that antioxidants should be discouraged during either chemotherapy or radiation therapy because of their potential to reduce the effectiveness of these treatments.

Herbs that may increase breast cancer recurrence risk. Women who have had breast cancer are at high risk for a recurrence. The use of estrogen promotes the development of breast cancer, and for this reason it is “off limits.” However, certain natural products may present a similar risk. Numerous herbs and supplements have estrogen-like properties, including alfalfa, genistein, hops, licorice, red clover, resveratrol, and soy. Contrary to popular belief, black cohosh is probably not estrogenic.

Other supplements, such as androstenedione and boron, may raise estrogen levels in the body. Finally, although the herbs dong quai and P. ginseng do not appear to act in an estrogen-like manner, they may nonetheless stimulate the growth of breast cancer cells. Women who have undergone breast cancer surgery should use these herbs and supplements only under the advice of a physician.

The weak estrogen estriol is sometimes advocated by alternative practitioners as a safer choice than standard estrogen. However, test-tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen.

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