Complementary treatments

In recent years, increasing numbers of people with cancer have chosen to try one or more types of ‘complementary’ or ‘alternative’ treatments in addition to what may be called conventional, orthodox or ‘mainstream’ medical care. Many of these people say that they have benefited from complementary medicine as far as their emotions, general sense of well-being and some symptoms are concerned, but there is very little evidence of an impact on long term cancer control or cure. A great number of seemingly persuasive claims have been made for many treatments, but unfortunately most do not stand up to careful scrutiny.

 

Many different treatments may be offered under the complementary medicine umbrella, and most have been developed outside mainstream medicine. You normally have to pay for them although some, such as aromatherapy massage, are offered free in some hospitals and hospices.

 

Types of complementary therapy

 

Acupuncture

 

An ancient form of Chinese medicine in which fine needles are inserted at specific points. A wide variety of techniques is available, ranging from a traditional Chinese approach to Western adaptations. There is some evidence that acupuncture may help in pain control although this has not been scientifically proven. It may also help with hot flushes. There is good evidence that acupuncture at a point just above the wrist can help in reducing nausea and vomiting from chemotherapy.

 

Homoeopathy

 

Based on the principle that ‘like cures like’, homoeopathic remedies contain infinitesimal quantities of substances which it is believed would in larger amounts produce similar symptoms to the illness being treated. Practitioners believe that these help the body to heal itself. However, there is no scientific evidence of benefit from homoeopathy as an anti-cancer treatment.

 

Hypnotherapy

 

Several clinical trials of hypnosis in cancer care have now been conducted. There is encouraging evidence that it is helpful in controlling anxiety, pain, nausea and vomiting.

 

Massage (including aromatherapy and reflexology)

 

Gentle massage can help patients to relax and may help relieve muscular pain and stiffness. It can be a pleasurable physical experience, leading to a feeling of improved well-being. Aromatherapy involves oils with pleasant aromatic scents from a wide range of plants being massaged gently into the skin. Reflexology is a type of foot massage, and there is evidence from clinical trials that it can help in reducing stress. Massage directly over a cancer which can be felt near the surface is probably best avoided.

Meditation

 

This involves calm contemplation, controlling or directing your thoughts and emotions by using one of a range of techniques to shut out distraction. This can help some individuals achieve a sense of inner peace and relief of anxiety, and possibly some relief of pain also.

 

Relaxation

 

A number of techniques are available, including breathing exercises, muscle relaxation and imagery (see visualisation), all designed to encourage a sense of physical and mental calm and to combat anxiety and tension. There is some evidence that relaxation therapy can help in pain control.

 

Spiritual healing

 

Healers may have differing spiritual or religious beliefs, but all claim to transfer some form of healing energy. Healing is usually considered to come from a divine origin, through prayer and meditation. Healing may or may not involve touch and some healers actually work from a distance. Those receiving healing may experience relaxation and a feeling of inner peace.

 

Visualisation

 

This involves using the imagination to conjure up images that the individual may find helpful as an aid to relaxation, meditation or symptom control. Some people find it helpful to imagine their immune system fighting their cancer.

 

Diets and vitamins

 

The need to try to maintain an adequate and balanced nutritional intake, and to avoid obesity, is discussed elsewhere. A great number of widely differing alternative diets have been advocated over the years by complementary medicine practitioners. ‘Gerson’ and ‘macrobiotic’ diets are but two examples. Large amounts of vitamins have been quite a common feature. However, although special diets may sound a good idea, there is no convincing evidence that they can influence the chance of cure or help keep a cancer under control.

 

Some people feel that by going on special diets they are being constructively involved in the fight against their cancer and that this helps them psychologically. Unfortunately, others find their diet unpleasant and difficult to stick to, difficult and time consuming to prepare and expensive.

 

Carrots often feature prominently in special diets. They are rich in beta-carotene, which is converted to vitamin A in the digestive tract. There is some evidence suggesting that low dietary levels of vitamin A or beta-carotene may lead to an increased risk of cancer, and there are studies in progress looking at whether supplements of beta-carotene or related substances known as retinoids can reduce cancer incidence. So far there is no good evidence that they can and, surprisingly, long-term high-dose beta carotene supplements may even increase the risk of lung cancer among current and former smokers.

 

Retinoids have been shown to have some efficacy in the treatment of some human tumours but, like high doses of natural vitamin A, they can cause side effects, including nausea, vomiting, headache, skin changes and psychiatric disturbance. There is no good evidence that they can improve the chance of cure, apart from being used in combination with chemotherapy to treat a rare type of leukaemia. Consuming large amounts of carotene-containing foods can sometimes cause the skin to turn yellow.

 

It has been suggested that vitamin C can render normal tissues less susceptible to destruction by chemicals released by cancer cells. It was reported in one study that patients given high doses of vitamin C lived longer than expected, but subsequent randomised trials have provided no evidence of benefit.

 

There is evidence to suggest that antioxidants like vitamins A, C and E, co-enzyme Q10 and selenium might reduce the effectiveness of some chemotherapy drugs and radiotherapy. It seems sensible to avoid taking such supplements whilst receiving conventional cancer treatment.

 

Herbal medicine and other preparations

 

It should not be forgotten that various anti-cancer drugs of proven efficacy used in mainstream medicine originate from plants. Herbal medicines have considerable appeal to some, stemming particularly from their being thought of as ‘natural’.

 

Outside orthodox oncology, several herbal preparations have been claimed to have particular benefit for cancer patients. One example is iscador, a fermented mistletoe extract given by injection. It is claimed that it exerts its beneficial effects both by killing cancer cells and by beneficially altering the body’s immune system. Although there have been anecdotal claims of efficacy, there is no evidence to support this from properly conducted clinical trials. Patients receiving iscador in one trial fared less well than those not receiving it.

 

Another example is laetrile, which has sometimes been described, incorrectly, as ‘vitamin B17’.  The principal ingredient of this substance is amygdalin, found in apricot stones and almonds. It has been suggested that laetrile causes toxic hydrogen cyanide to be released selectively within cancer cells. There is no scientific justification for this hypothesis and unfortunately careful clinical study has again produced no evidence of efficacy. Several cases of cyanide poisoning have been linked to laetrile therapy. The herbal mixture Essiac and shark cartilage both have their supporters, but again there is no consistent objective evidence that either is effective.

 

Di Bella therapy, a mixture of natural and synthetic substances, had a strong following after many anecdotal claims of efficacy. However, in 11 studies of almost 400 patients only 3 patients showed any evidence of benefit and their responses were only partial. Another study of over 300 patients showed that overall patients receiving Di Bella therapy had a worse survival compared with other patients.

 

While there seems to be a paucity of good evidence for the anti-cancer efficacy of complementary herbal treatments, a recent trial has demonstrated at least a short term improvement in cancer related fatigue from taking American ginseng.

 

It seems inevitable that useful anti-cancer effects will be found for other herbal and other natural substances, but proving benefit depends on careful scientific evaluation, not anecdotal claims. Once the evidence is sufficiently convincing such medications will inevitably become part of orthodox treatment. Some substances certainly seem worthy of further study. For example, in China and Japan there have been a number of studies which appear to demonstrate immune system stimulation and some improved anti-cancer treatment results from preparations derived from certain mushrooms.

 

The importance of the mind

 

There is quite a common belief among complementary therapists that a person’s psychological make-up is relevant to the development and subsequent course of their cancer. It has been suggested that some people are cancer prone by virtue of their personality, but there is no good scientific evidence to support this. Nor is there conclusive evidence that the psyche influences survival chances for cancer patients. There is some evidence that it can, and quite a few mainstream oncologists believe that it does, but even if psychological factors do exert some influence on outcome this is not necessarily of any help in practice.

 

There is good evidence that psychological stress can reduce resistance to infection. Some complementary therapists believe that psychological stress can encourage the development of cancer, and that it is possible to enable people with the disease to fight it more effectively by changing their frame of mind. The role of stress in causation remains a controversial issue, with different studies arriving at different conclusions, but a recent comprehensive study has reassuringly shown no relationship between work related stress and the risk of a variety of common cancers. Neither is there any good evidence that stressful events increase the risk of relapse.

 

There have been numerous reports on the part played by a person’s innate psychological characteristics, sometimes suggesting that those who are freely able to express emotion or distress tend to survive longer than those who suppress or deny their emotional feelings. One study of women with breast cancer who underwent psychological assessment at diagnosis found that those who had reacted to cancer by denial or who had a ‘fighting spirit’ did rather better than those who had responded with stoic acceptance or feelings of helplessness or hopelessness. However, other studies have failed to show a relationship between such psychological factors and outcome. .

 

So far there is inconclusive evidence to support any benefit from psychological therapy over and above that of improving psychological well-being, which is of course very important in itself. One study on breast cancer patients suggested that regular psychologist-led sessions aimed at reducing distress and improving mood following surgery improved long term survival. But the sessions also covered diet, exercise and smoking cessation and it is not certain which component(s) may have contributed to the apparently improved outcomes. Another study reported that women with closer social ties and better emotional support had fewer recurrences of breast cancer, but yet another reported that psychosocial factors, including friendships, marital history and job satisfaction had no influence on outcome.

 

A trial on a small number of women with advanced breast cancer demonstrated increased survival in those randomised to participate in weekly supportive group therapy and self-hypnosis for pain control. Another small study demonstrated increased survival in people with melanoma skin cancer who had received ‘psycho-educational intervention’ including stress management, enhancement of coping skills and supportive group psychotherapy.

 

Such results are very interesting but other similar studies have failed to show that such additional psychological support makes people live longer. More research needs to be done before we have conclusive results, but there does not appear to be any evidence that cancer patients benefit in terms of survival from having less social interaction or emotional support. The weight of the evidence is perhaps now beginning to suggest that at least for some patients with some cancers their chances of long term survival may possibly be enhanced slightly by additional measures aimed at improving psychological well-being. For people experiencing anxiety or other emotional distress achieving the latter will of course at least have an immediate impact on their quality of life. It may also help them to communicate better with those treating their cancer, and to adhere to their anti-cancer treatment.

 

Considering complementary treatment

 

There are more things in heaven and earth than are currently dreamed of by practitioners of mainstream medicine. However, it should not be forgotten that most of the progress that has been made in the fight against cancer has been as a result of critical scientific evaluation.

 

Most complementary treatments have not been exposed to or have not withstood the rigours of scientific testing. Nevertheless, there is no doubt that many people say that they feel better as a result of complementary therapy. The extent to which this is actually the result of the treatment itself remains controversial and it seems likely that there may be other less tangible factors at work. Much of the benefit may be as a result of the promotion of relaxation.

 

Also a complementary therapist is often willing and able to give you as much time and personal attention as you want – something that is not always possible for your doctors, however well intentioned they may be. This may be conducive to patients deriving ‘placebo effect’ benefit. The placebo effect, whereby patients derive symptomatic benefit merely as a result of their belief that they are receiving an active treatment, is potentially important in both complementary and conventional medicine.

 

It’s also true that many people simply feel better for trying to do something to help themselves, especially when conventional medicine may have little to offer them. They may feel more in control through availing themselves of some form of complementary treatment, rather than continuing merely to accept passively what is on offer from mainstream medicine. It also seems likely that, if for whatever reason patients feel better in themselves, they may then be able to cope better with the demands and side effects of their conventional treatment.

 

Whether or not complementary treatments can influence the outcome as far as the cancer is concerned is obviously a very important issue. Many of those offering and receiving them believe that the chance of survival will be improved, but there is little evidence to support this. There is understandable concern about people with cancer having their hopes raised unrealistically. There is in particular a great amount of misleading information accessible on the internet, including fraudulent claims for so-called ‘miracle cures’.

 

Complementary treatments are often considered as part of a ‘holistic’ or ‘whole person’ approach to care, implying that conventional medicine is more concerned with the disease than with the patient. The pressures on the service and the resulting constraints on time may quite often result in patients getting this impression, but most doctors would maintain that good conventional medicine has always been holistic.

 

Most complementary treatments for people with cancer in Britain are offered in good faith. However, you also need to be aware of the possibility of being exploited commercially by the unscrupulous. Marketing strategies for non-orthodox treatments include both giving complex pseudo-scientific rationales and making superficially attractive conceptual claims, neither of which stand up to close inspection. Non-conventional methods may be hailed as ‘natural’ and much may be made of the toxicity of some conventional treatments, but some alternative treatments can themselves be toxic or unpleasant.

 

If you are thinking about some kind of complementary therapy, it is worth mentioning this to your doctor, who may be able to give you some useful advice. In any case, your doctor should know about any treatment you are having in order to take it into account when assessing your progress, or possibly when faced with new symptoms or other changes in your condition. There is growing evidence that several complementary treatments can interact detrimentally with conventional anti-cancer treatments and with other medications such as anti-coagulants, either by reducing their effectiveness, or increasing toxicity.

 

You should be wary of any therapist who says or implies that their treatment can cure you or shrink the cancer, and you should make sure that you are clear in your own mind about what you expect the treatment to do for you. You should establish at the outset how much the treatment will cost, how long it will take, and how soon you can reasonably expect to feel any benefits. Do not stop taking any conventional treatment without first discussing it with your doctor.

 

KEY POINTS

• People often feel better psychologically after having complementary therapy

• Complementary therapies have not been proved to be of benefit in improving survival or the chance of cure

• Some complementary treatments can interact harmfully with conventional treatments

• Most complementary medicine is offered in good faith, but you should be wary of being exploited by unscrupulous practitioners while you are at your most vulnerable