Alternative and Complementary Medicine

Advising patients who seek complementary and alternative medical therapies for cancer. Annals of Internal Medicine

137(11): 889-903, December 3 2002
W A Weiger, M Smith, H Boon, M A Richardson, T J Kaptchuk, D M Eisenberg

Study purpose: In addition to treatments overseen by medical doctors, many cancer patients turn to alternative and complementary therapies. Physicians need information on these “holistic” therapies to advise these patients. This review evaluates the usefulness of selected alternative therapies used by people with cancer. It rates the therapies in terms of their efficacy and safety, and develops a guide that physicians can use to provide patients with responsible evidence-based advice and care.

Study description: Alternative therapies reviewed included dietary modification and supplementation, herbal products and biological agents, acupuncture, massage, exercise, and psychological and mind-body therapies. Two categories of evidence on the effectiveness of these therapies were considered — first, their possibly beneficial effects on worsening cancer and ability to lengthen cancer patients’ lives, and, second, their possible beneficial effects on pain management. In evaluating safety issues, two types of risk were considered: bad reactions caused by the alternative therapy, and complementary treatments that interact badly with conventional medical therapies.

Findings: After being evaluated for efficacy and safety, each of the selected alternative therapies was assigned to one of three categories designed to advise physicians: “recommended” (an endorsement of the use of the alternative therapy), “accepted” (use tolerated but not encouraged), and “discouraged” (the alternative therapy is potentially harmful and any use should be discontinued). For example, the use of Vitamin E supplements and soy food products by men with prostate cancer falls within the “recommended” category, while the reduction of dietary fats by well-nourished patients with prostate cancer is in the “accepted” category. However, alternative therapies such as herbal products and biological agents used by men with prostate cancer consistently end up in the “discouraged” category. The authors counsel physicians to warn prostate cancer patients to avoid these products because of their potential for harm.

Conclusions: The authors believe that their study’s rating of each selected alternative therapy as “recommended,” “accepted,” or “discouraged” is a useful guide for physicians who want to provide responsible, evidence-based advice to persons with cancer seeking additional treatments outside a doctor’s care. The authors state there is a need for further guidelines on cancer patients’ usage of complementary/alternative therapies.

Note: The use of two alternative health products analyzed by the study, shark cartilage and “PC-SPES” (a combination of eight herbs), is “strongly discouraged” for men with prostate cancer.