Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) is defined as interventions that are neither taught widely in medical schools, nor traditionally available in US Hospitals. CAM can be broken down into two broad categories I) those that are ingested or injected and II) those that require a practitioner or therapist. Herbals, vitamins, organics, chemicals and diet are examples of the first group and meditation, massage, chiropractic, acupuncture, body-mind therapy, and prayer are examples of the second.

The use of complementary and alternative medicine (CAM) has become the norm for many cancer patients, the majority of whom use it along with conventional therapy. Data published in the Journal of the American Medical Association (JAMA 280(18):1569-75) from a 1997 United States survey of alternative medicine use demonstrated that 42% of the general population uses some form of CAM. More recent surveys of cancer patients demonstrate approximately two-thirds are engaged in a least one form of CAM therapy.

As a group, physicians remain somewhat oblivious to their patients' use of CAM therapies. In multiple surveys, only about one-half of patients using CAM have indicated that their doctors are aware. The primary reason patients cite for not informing their practitioner is that the physician never asked. Studies also indicate that the great majority of patients using CAM do so in conjunction with standard cancer therapies, and not to the exclusion of oncologic treatments that are physician-endorsed.

Most oncologists are comfortable with their patients' use of CAM. Overall there is little clinical evidence to suggest that complementary therapies cause harm or interact unfavorably with regular medications. However, physicians are concerned that ingested or injected CAM might pose risks to some patients (See Table 1). Some might biochemically interfere with the effect of the chemotherapy or radiation therapy either negating or intensifying its action. In addition, although often taken to decrease the side effects and toxicity of conventional therapy, CAM may sometimes have unwarranted side effects of their own. For example, they may worsen other medical conditions a patient has such as high blood pressure. Lastly, because CAM therapies do not require FDA approval they are not subject to the same manufacturing and purity standards as regulated pharmaceuticals. This has led to production batches containing impurities (such as the case with Tryptophan causing eosinophilic myalgia syndrome) or high levels of lead in supplements given to children.

As a patient, it is always a good idea to discuss the use of CAM with your oncologist. Not only will it make them aware of other therapies you are using, but also the reasons that you may need them such as insomnia, pain, depression, anxiety, etc. Bringing along any data or literature you may have will be helpful to your doctor. As well, there are multiple Internet websites available for you to research CAM. Try looking at several, from a variety of different groups (manufacturers, support groups, medical) before starting complementary therapies. The National Center for Complementary and Alternative Medicine (NCCAM) website is a good starting place - http://nccam.nih.gov.

The medical community recognizes the growing use of CAM and the need to investigate these medicines and their side effects. The National Institutes of Health (NIH) is presently putting forth a research initiative through the NCCAM to study complementary and alternative therapies.

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