Alternative Medicine and Cancer: Why Don’t Oncologists Get On Board?
Dr. Richard Frank—
"Doctor, do you believe in alternative medicine to treat cancer?" As a medical oncologist, this is a question I am frequently asked by cancer patients.
I totally understand why someone affected by cancer asks this question. The main reasons seem to be:
- A desire to do "all that they can" to fight cancer successfully.
- A desire to prevent the side effects ("protect the healthy cells") caused by cancer treatments, such as chemotherapy and radiation.
- To support the immune system during cancer treatment.
- The belief that non-prescription herbs, supplements and vitamins are natural and, therefore, without the potential to cause harm.
Complementary and Alternative Cancer Therapies
I wish to better define the term "alternative medicine." Technically speaking, alternative medicine is the use of non-FDA (Food and Drug Administration of the US Government) approved medicines or treatments instead of conventional (FDA-approved) therapies to treat diseases and ailments. Because most people use alternative therapies along with conventional treatments, the recommended term is Complementary and Alternative Medicine or CAM. Another commonly used term is Integrative Medicine.
(For an accessible review of CAM and cancer, visit the medical resource UpToDate)
As it relates to cancer, CAM includes:
- Alternative cancer treatments, such as:
- special diets (macrobiotic, Gonzalez regimen, others)
- herbal supplements (Chinese herbal medicines, curcumin, green tea, mistletoe, others)
- non-herbal supplements (melatonin, shark cartilage, lycopene, vitamins/minerals, others)
- Complementary therapies, such as:
- massage, Reiki, exercise
- music, art, yoga, reflexology
- prayer, support groups
There are also alternative medical systems, such as homeopathy and ayurvedic medicine. For an overview of these, consult the book After Cancer Treatment by Julie Silver, MD.
Today, most oncologists and cancer centers embrace complementary therapies and offer an array of them. These therapies help to provide a more holistic approach to patient care and promote a person's overall sense of well-being. As I discuss in Chapter 8 of my book, not enough cancer patients avail themselves of the programs and support groups that could help them and their families better cope with the many emotional challenges wrought by cancer.
- I encourage every cancer patient to have at least one session with an oncology-trained counselor (usually a social worker, nurse, or family therapist) to at least acknowledge the psychological effects of a cancer diagnosis on them and their loved ones.
The Crux of the Problem
Whereas complementary programs are universally accepted, many cancer patients find that their physicians and hospitals are not up to their expectations in the area of alternative cancer treatments. Many individuals take vitamins on a regular basis and continue to take them during cancer treatment; others hear of possibly helpful supplements and immune-boosters and start taking these. Although many patients do not disclose to their oncologists what they are taking, many appropriately do.
I have found that the vast majority of cancer patients want their oncologists to be familiar with the alternative medicines they may be taking or have heard about. They want their oncologists to work with their naturopaths, if they have one, or to recommend the best of conventional and alternative medicine and to know when there may be a negative interaction (for example, St. John's wort can reduce the levels of many chemotherapy drugs in the bloodstream, resulting in their diminished effectiveness). But even the most highly regarded oncologists usually only recommend conventional cancer treatments and prescription drugs to counteract their side effects. (I like to define the best oncologists as those offering skilled, dedicated, compassionate patient care and clinical trials from the National Cancer Institute that test the cancer treatments of tomorrow).
Although many oncologist may suggest alternative medicines to counteract a treatment related side effect, such as nausea (ginger) and peripheral neuropathy (vitamin B6, glutamine, alpha-lipoic acid), most do not routinely recommend an entire regimen of herbal supplements and vitamins to go along with standard therapies. Why is this? Are oncologists ignorant or biased as some claim? Or are we cautious, perhaps overly-so, concerned that "what we don't know CAN hurt us (our patients)?"
With all the exciting information on the web, in books and on TV about alternative cancer medicines for the treatment and prevention of cancer, why don't oncologists get on board?
In Search of Evidence
As an oncologist/hematologist, I deal with very serious illnesses and see people through the most difficult times in their lives. I realize that when the diagnosis is an incurable cancer, there is an urgent need to do all that is possible to live. I get it. Yet, I have a solemn responsibility to do what is best for each patient I care for and a legal responsibility to practice according to accepted standards of care. As physicians, my colleagues and I are bound by oath and conscience to be very mindful of what we prescribe and to base our medical recommendations on evidence that what we prescribe will do more good than harm. Trust me, as a patient, you do not want it any other way.
So, what is the evidence that alternative medicines can diminish the side effects of chemotherapy and radiation, boost the immune-system, improve survivals and do no harm? Let's look at some examples.
Chinese Herbal Medicine (CHM)
The belief that CHM reduces chemotherapy induced side effects is prevalent, especially in Asia where CHM use is widespread. In order to put the belief in CHM to the acid test, chinese physicians and researchers from Hong Kong studied breast and colon cancer patients undergoing adjuvant chemotherapy (given after all the cancer has been removed surgically, explained in Chapter 6 of my book). 125 patients were randomly assigned to one of three licensed, university trained herbalists who were allowed to treat each patient according to their own practices. 225 types of commonly used herbs were available and stocked in packaged form. Half of the patients received packages with the prescribed herbs, whereas the other half received packs of placebo containing tea/bean paste/sugar and coloring and flavoring that mimicked herbal preparations. Neither patient nor practitioner knew what was in the packages (called a "double-blind, placebo-controlled randomized study," the gold standard in proving if a new treatment works). The patients were followed to determine if CHM could prevent the lowering of blood counts, hair loss, loss of appetite, constipation/diarrhea, fatigue, rash, dizziness, headache, insomnia, nausea/vomiting, pain, altered liver function or mouth sores.
The result? CHM fared no better than placebo in diminishing any chemotherapy side-effect except for a mild improvement in nausea. Given the many excellent medicines we have to control nausea today (such as zofran, anzemet, emend, others), CHM would hardly seem worth it. To read more about this study, click on Annals of Oncology 2007.
While this study says nothing about the thousands of other herbal and non-herbal products touted to prevent chemotherapy side effects, it does give us pause. When someone recommends a natural product to "protect the healthy cells of the body" you should ask: "What is the data? Has a randomized trial been run to prove that it works?" It is also worth inquiring if those promoting a product are profiting from it.
Recommendation: In most cases, it is up to the individual to decide if taking a product with "claims" of effectiveness, without good science to back them up, is worth it. If a product is not thought to interfere with treatment (ask the oncologist and check out the resources listed below) and may help, it may be worth a try. But be objective in determining if it is helping so that you don't continue to pay for and put faith in something that has not been proven.
Ridding the Body of Toxins: Proteolytic Enzyme Therapy to Treat Pancreatic Cancer
Pancreatic cancer is one of the most difficult to treat cancers. It is a biologically aggressive cancer that spreads (metastasizes) early in its development and responds to only a few chemotherapy drugs. For many years, there were claims made by some doctors that an intriguing alternative medicine regimen, called proteolytic enzyme therapy or the "Gonzalez regimen," of orally ingested proteolytic enzymes, nutritional supplements, detoxification (including coffee enemas and liver flush) and an organic diet that required at least 70% of the food to be raw or minimally cooked, led to superior outcomes compared with chemotherapy treatments. Growing enthusiasm and patient testimonials for this approach led the National Cancer Institute to sponsor a clinical trial to compare the Gonzalez regimen with chemotherapy for patients with pancreatic cancer.
The result was reported in 2009 in the Journal of Clinical Oncology and was indeed striking: those who received chemotherapy lived for an average of 14 months whereas those who were treated with the enzyme therapy lived for only 4 months; quality of life was also better with chemotherapy.
Take Home Points: This study shows once again that any promising new therapy for cancer must be put to the acid test before it can be regarded as effective; patient testimonials cannot replace hard evidence.
Boosting the Immune System Naturally
Of all the claims made about CAM therapies for cancer, this is the biggest attraction. Wouldn't it be wonderful if a person with cancer could take a natural herb or supplement and boost their immune system to better fight the disease? If only it were that easy.
Our immune system is exceedingly complex. It consists of dozens of distinct cells (such as T- and B-cells, dendritic cells, neutrophils, macrophages) that communicate via hundreds of secreted chemicals (such as the interleukins and interferons) and molecules on their surfaces; many aspects of these interactions are yet to be discovered. Scientists do not understand why the immune system turns against the body in autoimmune diseases such as lupus and multiple sclerosis. And they are far from understanding how cancer cells can evade the immune response by inducing "immune tolerance." Immune tolerance makes cancer cells essentially invisible and unrecognizable by the immune system.
For over a century, researchers have been earnestly trying to crack the immune response/cancer problem. Many millions of dollars have been spent and continue to be spent (righly so) on solving this problem: get a person's immune system to recognize their cancer and voila!, the cancer is gone. So far, exciting studies with cancer vaccines, lymphocyte activated killer cells, stem-cell transplants and other immunologic approaches using the most sophisticated molecular science have not succeeded. Even a vaccine uniquely created (with great science and at great expense) against an individual's lymphoma failed to make an impact on the cancer in recently completed studies. So, to me, it seems very unlikely that something off the shelf in CVS or out of a catalog or promoted by a celebrity or businessman claiming miracle cures is going to do the job.
This is not to say that some herbal supplements do not affect the immune system, because many actually do. For example, a recent study presented at the Society for Integrative Oncology reported that Grifola frondosa (Maitake extract) caused both immune stimulation and depression in cancer patients; no effects on cancer recurrences were reported. More encouraging are studies with Viscum album or white-berry mistletoe (Iscador), which has been used for many years in Europe to treat cancer patients. In a recent overview of clinical studies published on Iscador use to prevent cancer recurrences, researchers from Germany concluded that although many of the studies were not of high quality, there did seem to be accumulating evidence that Iscador can improve survival. They called for definitive studies to determine the true benefit of this approach. Currently, the National Institutes of Health is sponsoring a study of Iscador and the chemotherapy gemcitabine to treat pancreatic cancer.
Take home points: Some herbal products affect the immune system, often in ways that are poorly understood and sometimes in ways that may be harmful. Many have been shown to have positive effects against cancer cells in a petri dish or in a laboratory animal, articfical situations which often don't carry over when given to humans. As of today, none have been clearly shown to improve survival. Use them with caution. Consult reputable websites (see below) for research updates.
Does "Natural" Mean Safe?
Most herbal products in the US are considered dietary supplements, not medicines. Therefore, they are not required to meet the standards for drugs specified by the Federal Food, Drug, and Cosmetic Act; they may be produced without the same manufacturing standards as drugs; and they may be marketed without prior approval of their effectiveness and safety by the Food and Drug Administration (FDA). Because of this, there are numerous reports of herbal products containing adulterants and contaminants, such as microorganisms, pesticides and heavy metals, which can damage the heart, liver, kidneys or nervous system. For example, kava has been linked to severe liver damage.
Furthermore, there are also many possiblelinteractions between herbs and conventional drugs, including chemotherapy medicines, as discussed in the resources below. The strong anti-oxidant properties of many herbal products may interfere with the cell killing activity of chemotherapy.
According to a review from The Hague published in The New England Journal of Medicine, "Contrary to popular belief, the use of herbal remedies can pose serious health risks."
Recommendation: Most herbal products are being tested as cancer prevention agents, not as treatments. Use herbal remedies with chemotherapy with great caution and only after discussion with your oncologist.
We should no longer live in an "us" versus "them" world, in which oncologists prescribe clinically tested treatments and herbalists offer less tested alternative medicines. Whatever works or could work should be properly studied and, when proven, recommended by any health care provider who truly cares about the person in front of them, often searching for hope. I realize that many cancer patients will take alternative medicines as well as standard cancer therapies and decide for themselves what works for them. I do support each individual's right to decide what to put into their own bodies.
Salespeople touting alternative cancer cures often claim that the "mainstream" cancer community is not interested in natural products. Nothing could be further from the truth. In fact, as discussed in my book, many chemotherapy drugs in use today are derived from plants, bacteria and marine life (such as Taxol from the yew tree, Adriamycin from bacteria and Yondelis from soft coral). Many other herbs and natural products are being intensively studied today in research centers across the nation. Once the active compounds in these products are isolated, studied and shown in clinical trials to help fight cancer, oncologists will jump right on board to prescribe them. Until that time, don't believe the hype about any cancer cure, always ask for study results in cancer patients (not personal anectodes/testimonials or laboratory findings) and never forego standard cancer treatments.
Recommended On-line Resources
Richard C. Frank, M.D., is director of cancer research at the Whittingham Cancer Center of Norwalk Hospital, medical director of Mid-Fairfield Hospice, and Clinical Assistant Attending at Weill Cornell Medical College. He has been appointed cancer expert for WebMD and was named a “Top Doc” in the New York Metro area by Castle and Connelly.