Key
Points
- Complementary
and alternative medicine (CAM) is a group of diverse medical
and health care systems, practices, and products that are
not presently considered to be part of conventional medicine
--Medicine as practiced by holders of M.D. (medical
doctor) or D.O. (doctor of osteopathy) degrees and by their
allied health professionals such as physical therapists, psychologists,
and registered nurses..
- The same
scientific evaluation that is used to assess conventional
cancer treatments should be used to assess CAM therapies.
- The National
Center for Complementary and Alternative Medicine (NCCAM)
is sponsoring a number of clinical trials (research studies
in people) to study CAM therapies for cancer.
- Tell
your health care providers about any complementary and alternative
practices you use. Give them a full picture of what you do
to manage your health. This will help ensure coordinated and
safe care.
1.
What is complementary and alternative medicine?
Complementary
and alternative medicine is a group of diverse medical and health
care systems, practices, and products that are not presently
considered to be part of conventional medicine. Conventional
medicine is medicine as practiced by holders of M.D. (medical
doctor) or D.O. (doctor of osteopathy) degrees and by their
allied health professionals, such as physical therapists, psychologists,
and registered nurses. Some health care providers practice both
CAM and conventional medicine.
- Complementary
medicine is used together with conventional medicine.
- Alternative
medicine is used in place of conventional medicine.
- Integrative
medicine combines treatments from conventional medicine and
CAM for which there is some high-quality evidence of safety
and effectiveness. It is also called integrated medicine --An
approach to medicine that combines treatments from conventional
medicine and CAM for which there is some high-quality scientific
evidence of safety and effectiveness..
This fact
sheet answers some frequently asked questions about the use
of CAM therapies and the way that CAM approaches are evaluated.
To find out more about topics and resources mentioned in this
fact sheet, see "For More Information."
2.
Is CAM widely used?
According
to a comprehensive survey on Americans' use of CAM, 36 percent
of U.S. adults are using some form of CAM. When megavitamin
therapy and prayer for health reasons are included in the definition
of CAM, that percentage rises to 62 percent. These results are
based on the 2002 National Health Interview Survey, which was
supported by NCCAM and the National Center for Health Statistics
(part of the Centers for Disease Control and Prevention). The
survey found that rates of CAM use are especially high among
patients with serious illnesses such as cancer.
Several
smaller studies of CAM use by cancer patients have been conducted.
A study of CAM use in patients with cancer in the July 2000
issue of the Journal of Clinical Oncology found that
69 percent of 453 cancer patients had used at least one CAM
therapy as part of their cancer treatment. A study published
in the December 2004 issue of the Journal of Clinical Oncology
reported that 88 percent of 102 people with cancer who were
enrolled in phase I clinical trials (research studies in people)
at the Mayo Comprehensive Cancer Center had used at least one
CAM therapy. Of those, 93 percent had used supplements (such
as vitamins or minerals), 53 percent had used nonsupplement
forms of CAM (such as prayer/spiritual practices or chiropractic
care), and almost 47 percent had used both.
A review
article in the March 2005 issue of the Southern Medical Journal
reported that cancer patients take supplements to reduce side
effects and organ toxicity, to protect and stimulate their immune
systems, or to prevent further cancers or recurrences. Patients
frequently see using supplements as a way to take control over
their health and increase their quality of life.
Additional
information about CAM use among cancer patients can be found
in a review article published in Seminars in Oncology
in December 2002.
3.
How are CAM approaches evaluated?
The same
rigorous scientific evaluation used to assess conventional cancer
treatments should be used for CAM therapies. NCCAM is funding
a number of clinical trials to evaluate CAM therapies for cancer.
Conventional
cancer treatments are studied for safety and effectiveness through
a rigorous scientific process that includes laboratory research
and clinical trials with large numbers of patients. Less is
known about the safety and effectiveness of complementary and
alternative methods to treat cancer, although some CAM therapies
have undergone rigorous evaluation.
A small
number of CAM therapies, which were originally considered to
be purely alternative approaches, are finding a place in cancer
treatment--not as cures, but as complementary therapies that
may help patients feel better and recover faster. One example
is acupuncture --family of procedures that originated
in traditional Chinese medicine. Acupuncture is the stimulation
of specific points on the body by a variety of techniques, including
the insertion of thin metal needles though the skin. It is intended
to remove blockages in the flow of qi and restore and maintain
health.. In 1997, a panel of experts at the National
Institutes of Health (NIH) Consensus Conference found acupuncture
to be effective in managing chemotherapy-associated nausea and
vomiting and in controlling pain associated with surgery. In
contrast, some approaches, such as the use of laetrile, have
been studied and found ineffective or potentially harmful.
4.
Is NCCAM sponsoring clinical trials on CAM for cancer?
NCCAM is
sponsoring a number of clinical trials to study complementary
and alternative treatments for cancer. Some of these trials
study the effects of complementary approaches used in addition
to conventional treatments, while others compare alternative
therapies with conventional treatments. Recent trials include
the following:
- Acupuncture
to relieve neck and shoulder pain following surgery for head
or neck cancer
- Ginger
as a treatment for nausea and vomiting caused by chemotherapy
- Massage
for the treatment of cancer pain
- Mistletoe
extract combined with chemotherapy for the treatment of solid
tumors
Patients
who are interested in taking part in these or any other clinical
trials should talk with their health care provider.
Patients,
family members, and health professionals can use the following
Web resources to find out about CAM clinical trials:
- The NCCAM
Clinical Trials Web page. Describes current clinical trials
for cancer and other health conditions. Information on clinical
trials is also available through the NCCAM Clearinghouse.
- The National
Cancer Institute (NCI) PDQ Clinical Trials Database.
Includes studies of CAM and conventional medicine for cancer.
This information is also available through NCI's Cancer Information
Service.
5.
What should patients do when using or considering CAM therapies?
Cancer patients
who are using or considering CAM should discuss this decision
with their health care provider, as they would any therapy.
Some complementary and alternative therapies may interfere with
standard treatment or may be harmful when used along with standard
treatment. The booklet "Thinking About Complementary and Alternative
Medicine: A Guide for People with Cancer" discusses choices
that people face in making decisions about cancer treatment
and includes suggestions on how to talk with health care providers
about these choices.
As with
any medicine or treatment, it is a good idea to learn about
the therapy, including whether the results of scientific studies
support the claims that are made for it.
6.
When considering CAM, what questions should patients ask their
health care providers?
- What
benefits can be expected from this therapy?
- What
are the risks associated with this therapy?
- Do the
known benefits outweigh the risks?
- What
are the potential side effects?
- Will
the therapy interfere with conventional treatment?
- Is this
therapy part of a clinical trial? If so, who is sponsoring
the trial?
- Will
the therapy be covered by health insurance?
These fact
sheets contain further information on evaluating CAM therapies,
selecting practitioners, and considering financial issues for
CAM treatment:
References
Barnes PM,
Powell-Griner E, McFann K, Nahin RL. Complementary
and alternative medicine use among adults: United States, 2002.
CDC Advance Data Report #343. 2004.
Dy GK, Bekele
L, Hanson LJ, et al. Complementary
and alternative medicine use by patients enrolled onto phase
I clinical trials. Journal of Clinical Oncology.
2004;22(23):4810-4815.
Frenkel
M, Ben-Arye E, Baldwin C, et al. Approach
to communicating with patients about the use of nutritional
supplements in cancer care. Southern Medical Journal.
2005;98(3):289-294.
National
Cancer Institute. PDQ
Cancer Information Summary: Laetrile/Amygdalin. National
Cancer Institute Web site. Accessed on August 11, 2005.
National
Institutes of Health. Acupuncture: NIH
Consensus Statement. National Institutes of Health Office
of Disease Prevention Web site. Accessed on August 30, 2005.
Richardson
MA, Sanders T, Palmer JL, et al. Complementary/alternative
medicine use in a comprehensive cancer center and the implications
for oncology. Journal of Clinical Oncology. 2000;18(13):2505-2514.
Richardson
MA, Straus SE. Complementary
and alternative medicine: opportunities and challenges for cancer
management and research. Seminars in Oncology.
2002;29(6):531-545.
Sparber
A, Wooton JC. Surveys
of complementary and alternative medicine: Part II. Use of alternative
and complementary cancer therapies. Journal of Alternative
and Complementary Medicine. 2001;7(3):281-287.
For
More Information
NCCAM
Clearinghouse
The NCCAM
Clearinghouse provides information on CAM and NCCAM, including
publications and searches of Federal databases of scientific
and medical literature. The Clearinghouse does not provide medical
advice, treatment recommendations, or referrals to practitioners.
Toll-free
in the U.S.: 1-888-644-6226
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
Web site: nccam.nih.gov
E-mail: info@nccam.nih.gov
National
Cancer Institute's Cancer Information Service
The National
Cancer Institute (NCI) is the lead Federal Government agency
for cancer research. NCI's Cancer Information Service can provide
answers to questions about cancer, help with quitting smoking,
informational materials, and help in using the NCI Web site.
Toll-free
in the U.S.: 1-800-4-CANCER (1-800-422-6237)
Web site: http://www.cancer.gov/
E-mail: cancergovstaff@mail.nih.gov
PubMed
A service
of the National Library of Medicine (NLM), PubMed contains publication
information and (in most cases) brief summaries of articles
from scientific and medical journals. CAM on PubMed, developed
jointly by NCCAM and NLM, is a subset of the PubMed system and
focuses on the topic of CAM.
Web site:
www.ncbi.nlm.nih.gov/entrez
CAM on PubMed: nccam.nih.gov/camonpubmed/
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