Complementary and Alternative Medicine and Cancer: What You Should Know

Transcript: Complementary and Alternative Medicine and Cancer:
What You Should Know
October 7, 2003, 2:00 – 3:00 PM ET

Moderator: On behalf of the American Society of Clinical Oncology (ASCO), and in collaboration with the National Center for Complementary and Alternative Medicine (NCCAM) and CancerCare, welcome to the Cancer.Net chat on complementary and alternative medicine and cancer, a live question-and-answer session hosted by Stephen E. Straus, MD.

During this hour, Dr. Straus will answer as many questions as time permits. Some questions may be adapted so that Dr. Straus' answers can help as many people as possible.

Dr. Straus will take questions from 2:00 to 3:00 PM ET. As you prepare your questions, please keep in mind that he is unable to give individual medical advice in this setting.

In answering questions about specific methods, his comments will focus on the state of current research and clinical trials.

The chat is governed by all terms and conditions of the Cancer.Net website.

Good afternoon and welcome. Thank you for joining us. Dr. Straus will now begin taking questions.

Dr. Straus is Director of NCCAM and an internationally recognized expert in clinical research and clinical trials. NCCAM is currently funding several studies on complementary and alternative medicine for cancer prevention and treatment.

A component of the National Institutes of Health, Department of Health and Human Services, NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training complementary and alternative medicine researchers, and disseminating authoritative information to the public and professionals.

CancerCare is dedicated to helping people face the many challenges of a cancer diagnosis and provides free professional support services including counseling, education, financial assistance, and practical help to people across the country.

Dr. Straus, thank you for taking the time to join us today. Do you have any opening remarks you would like to make?

Dr. Straus: I'm delighted to have an opportunity to chat with you all today. Dr. Patrick Mansky, an oncologist and researcher on our NCCAM staff, who will assist in answering many of your questions, also joins me. In this chat, we will review some of the more popular CAM practices that people with cancer use. We will discuss available research on what is most safe and proven most effective. And we will review where you can find reliable information and what issues you should be aware of when considering CAM.

Guest252: Are there clinical trials that evaluate CAM approaches? How can a patient become a participant?

Dr. Straus: Yes, investigators in major institutions all over the United States are studying CAM approaches for patients with cancer. A good place to look is the website www.clinicaltrials.gov. This website lists all of the National Institutes of Health (NIH) studies for cancer including those addressing CAM approaches.

Guest304: Dr. Straus, are there any alternative medicines that shrink tumors?

Dr. Straus: There are many alternative medicines that claim to shrink tumors but none have been proven to shrink tumors. It's important to realize that complementary and alternative medicine may be more helpful in relieving symptoms and side effects of treatments then in actually shrinking tumors.

Guest201: What are the warning signs that may indicate a complementary or alternative medicine approach is fraudulent?

Dr. Straus: This is a very important issue. The conventional treatments that are prescribed by physicians are treatments whose safety and benefits have been proven. The difficulty with CAM treatments is that they are just now beginning to be studied in a formal way. Patients may see advertisements and claims that are not yet supported by careful scientific studies. I would urge that all possible approaches be discussed with your oncologist. Remember, if it sounds too good to be true, it probably is.

mandy: I am having acupuncture treatments weekly while having chemotherapy for lymphoma. Are there any studies that show the effectiveness of acupuncture while undergoing chemotherapy?

Dr. Straus: There have been a number of studies showing that acupuncture can relieve pain, which may be a very big problem in people with cancer. Acupuncture can relieve nausea caused by chemotherapy drugs. I would have no reluctance to try acupuncture while receiving chemotherapy for those purposes.

Guest220: I hear lots of terms "complementary therapy," "alternative therapy," and "integrative medicine." Is there a difference?

Dr. Straus: This is an important question. There are so many different terms; it's good that somebody asked for some definitions. Complementary treatments are ones that we use in addition to the treatments prescribed by our physicians. One example is acupuncture used to relieve nausea from chemotherapy drugs. Alternative treatments are ones we might chose instead of standard treatments, and we do so at the risk of neglecting some treatments that have been proven to work. The term integrative medicine is a new concept that suggests the possibility of incorporating into conventional medicine other approaches that may be beneficial.

kt: What are some of the most effective complementary therapies currently used for pain?

Dr. Straus: Pain is a huge problem with some kinds of cancer. There are many conventional treatments for pain but even some of them don't work for everybody. So people try anything they can imagine to relieve their pain. CAM approaches worth trying include acupuncture, hypnosis, and various forms of relaxation and meditation. But I will add that none of these have been proven yet, although they're not likely to hurt. Talk to your doctor.

Guest951: I would like the doctor to comment on uses of CAM to mitigate toxicity and side effects of tamoxifen.

Dr. Straus: Tamoxifen is a useful and long-term treatment that helps to prevent breast cancer recurrence. One of the main side effects is hot flashes. A number of CAM approaches have been tried to relieve hot flashes in women with breast cancer taking tamoxifen. At this point, research does not support the use of soy protein supplements to relieve hot flashes in women after menopause.

Guest379: Can you speak to the current controversies regarding high-dose vitamin C?

Dr. Straus: Vitamin C is very important for health, but we do not know whether taking large doses of vitamin C provides any added benefit. The average amount of vitamin C a person should take is about 1/10 gram/day. Many people have tried taking doses 10 to 100 times that amount without any clear benefit. There seems to be no harm in taking high doses, in general, but very high doses of antioxidant chemicals such as vitamin C could interfere with radiation treatment. You need to discuss this with your doctor.

Guest1071: I have just completed six treatments of paclitaxel (Taxol)/carboplatin (Paraplatin) for epithelial ovarian cancer. Is there something I can do now to improve my white blood cell count and immune system function, such as a particular diet, herbs, or exercise?

Dr. Straus: Chemotherapeutic drugs are known to temporarily damage the immune system—in part by lowering the white blood cell count. There are standard medications to help restore white blood cells and these should be considered first. But there is no question that a healthy diet and exercise may help a person return to normal strength. We don't know whether it will make an important difference in their immune system. There are many herbal medicines that claim to boost immunity, however, none have been proven to do this in a meaningful way. What we do know is that some of these herbs can interfere with the action of cancer drugs, so it is important to not start taking herbs until you review the choices with your doctor.

Guest98 What information can you provide about IPT therapy, or the use of insulin with chemotherapy?

Dr. Straus: There have been a very small number of cases that suggest that insulin may increase the effectiveness of chemotherapy. To date, this has never been seriously tested. One should be concerned that insulin is a powerful drug by itself, and should only be used with medical supervision.

Moderator: Transcripts of today's chat will be available on Cancer.Net tomorrow by 12:00 PM ET. More information about receiving transcripts will be provided at the end of the chat.

Guest1010: What needs to be disclosed to my oncologist regarding my use of CAM? What if he or she disagrees with my usage?

Dr. Straus: This is an important issue about CAM. Patients are often concerned that their physician will dismiss them and not care for them properly if he or she feels that the patient is doing unreasonable things that might interfere with treatment. Fortunately, oncologists are increasingly aware that most cancer patients try CAM approaches sooner or later. My personal advice is to tell your doctor what you're doing or thinking about doing.

mandy: Are there any studies that show the effectiveness of Qigong or yoga while undergoing cancer treatment?

Dr. Straus: There are many studies now looking at yoga as a good form of exercise and way to reduce stress. People with cancer report feeling better while doing yoga, but we have no idea whether it actually improves their response to their cancer treatment. Qigong is a Chinese form of exercise and meditation that aims to harness the body's healing energy. It is very popular in Asia and has not been tested in cancer.

Guest10: I have heard conflicting advice concerning the use of flax seed for men with prostate cancer. One study indicates using ground flax seeds daily, in combination with a low-fat diet is beneficial. However, another prostate doctor has said that flax seed and other vegetable sources of omega 3 will increase prostate tumor growth. Can you give me any more definitive advice about this?

Dr. Straus: Some studies suggest that flax seed oil may have a chemopreventive role in cancer, in part due to one of its group of constituents called lignans. At this point, there are no data based on clinical trials available that would suggest a benefit from taking flax seed oils for prostate cancer.

betsy: Does NCCAM collaborate internationally on CAM developments? What sorts of clinical trials is NCCAM now conducting?

Dr. Straus: Yes. NCCAM has a new office of international health research headed by an oncologist. He is building research collaborations in many countries, especially in Asia, Africa, and Europe. Please visit this website for more information: nccam.nih.gov/clinicaltrials.

Joelle: Is it ok to get a professional massage while undergoing chemotherapy/radiation therapy for breast cancer with lymph node involvement post-mastectomy? I get mixed messages from my health-care providers.

Dr. Straus: I would be concerned that the tissues have not yet healed enough to tolerate a massage. Once your physician feels the healing is complete, massage may be a good idea. It may be soothing, it may relieve discomfort, and massage of the arm on the side of the mastectomy may help lymph fluid return more easily, relieving swelling.

Guest835: Has the use of Barley Green been considered in research for cancer patients?

Dr. Straus: I'm not aware of any research on Barley Green for cancer.

mhavrile: Is alternative and complementary treatment an option to prevent a cancer recurrence?

Dr. Straus: Yes. Patients who have had cancer are the most prepared to engage in better diet, more regular exercise, and a better lifestyle, in general. I would recommend that for anyone who has had cancer. Now, the question is whether you could actually prevent the recurrence—that's an answer we don't have. There are data to suggest that some vitamins and minerals may help prevent cancers, but we don't know how well or whether they can prevent recurrences. Studies in China show that selenium and vitamins reduced the risk of cancers of the stomach. The National Cancer Institute and NCCAM are funding a study of selenium and vitamins for prevention of prostate cancer. So, vitamins might be good, but we know from other studies that high doses of vitamins can be unhealthy. A study in Europe showed that high doses of zinc are associated with prostate cancer. And high doses of vitamin E are associated with lung cancer in smokers.

ZDC: What are some of the most dangerous/untested CAM methods regarding cancer?

Dr. Straus: The most dangerous approach is to neglect proven treatments, whether it's surgery, chemotherapy, or radiation therapy. Patients with cancer often turn to the Internet to find supplements or herbs that promise to cure their cancer. Some of these herbs have side effects. Some of them interfere with the function of drugs. And none have been proven to cure cancer. Be an informed and skeptical consumer. For specific information, call the toll-free NCCAM Clearinghouse at 1-888-644-6226.

prai: Can you talk more specifically about studies regarding how acupuncture helps relieve nausea/vomiting during chemotherapy?

Dr. Straus: There are several studies showing that acupuncture can relieve nausea and relieve episodes of vomiting caused by chemotherapy. A good place to find summaries of those scientific studies is on our website or by calling the NCCAM Clearinghouse at 1-888-644-6226. You might look at the study conducted by Dr. Shen, published in the Journal of the American Medical Association in 2001.

S74: Once a CAM treatment has been proven to work for treatment through a clinical trial, is it still considered a CAM therapy, or standard therapy?

Dr. Straus: Excellent question. My personal belief is that once an approach is proven, many people will want to use it, and it will become part of mainstream practice—no longer considered complementary or alternative. I'll give some examples of approaches that were once considered unconventional and doubted by many physicians: diet and exercise for diabetes, support groups for breast cancer, and biofeedback for headache.

Guest820: I had a brain tumor removed last month. It was a glioblastoma. I need someone's opinion on Laetrile/B-17.

Dr. Straus: Laetrile is an extract of apricot pits. It was very popular in the 1970s. Two good studies showed that it does not work. Yet people desperate for relief continue to try it. We do not recommend it. You can find a whole fact sheet on Laetrile on our website.

isarose: How would I find someone in my area who is practicing safe and high-quality CAM right now?

Dr. Straus: It's a very good question. It's hard to find good doctors in general. We never know what kind of background check to do. A good place to start is look at our fact sheet on Selecting a CAM Practitioner because licensing and credentialing varies from state to state.

Guest34: Dr. Straus, with widespread misinformation available on numerous CAM approaches, where can I find reliable information?

Dr. Straus: Look at our website, call the NCCAM Clearinghouse at 1-888-644-6226, and contact the National Cancer Institute at 1-800-4-CANCER, the U.S. Food and Drug Administration (FDA), the Federal Trade Commission (FTC), CancerCare, and Cancer.Net (Cancer.Net).

Guest46: Dr. Straus, what is the most promising area of research in CAM and cancer care so far?

Dr. Straus: CAM approaches in cancer address a wide range of needs, such as helping with cancer-related symptoms, improving quality of life, coping with side effects, and relieving cancer-related stress. In each of these areas, there are a number of research activities that show promise.

yottavia: I am a medical oncologist and have many patients receiving chemotherapy who want to take vitamins/naturopathic remedies along with conventional chemotherapy. We know little of how they interact. Are there specific things they MUST avoid that you know of (vitamin C, vitamin A, etc.), or is there a window between chemotherapy treatments that patients can take whatever supplements they wish?

Dr. Straus: I'm glad to see that both physicians and patients are participating in this web chat and have questions about communication with each other. I would think that during chemotherapy treatment is not a good time to be exploring all sorts of new herbal products. And as I said earlier, even simple vitamins might interfere with cancer treatment. A good example is the popular herb St. John's Wort, commonly used by cancer patients to improve their mood. Studies published in the past two years show that St. John's Wort interferes with the metabolism of nearly 50% of nearly all classes of prescription drugs, including the cancer drug, irinotecan.

Moderator: Dr. Straus, would you like to add any concluding remarks?

Dr. Straus: It has been a pleasure to chat with you today. Thank you for your very insightful questions. Also, thanks to ASCO and Cancer.Net as well as CancerCare for their collaboration so that we could discuss a topic of great importance to all of us. For more information about CAM, please visit the NCCAM website or call the NCCAM Clearinghouse at 1-888-644-6226.

Moderator:The chat is now ending. Thank you for your thoughtful questions. We hope this discussion has been valuable, and we regret not being able to answer every question. We want to thank Dr. Straus for lending us his time and expertise.

TRANSCRIPTS: The full text of today's chat will be available on Cancer.Net (www.cancer.net) tomorrow by 12:00 PM ET. To receive a copy of the transcript by e-mail, please send a message to contactus@cancer.net.

SAVE THE DATE: In observance of National Breast Cancer Awareness Month, please join Cancer.Net for a live chat about Breast Cancer on October 16 from 2:00 to 3:00 PM ET, with featured expert Lynn Schuchter, MD.

Dr. Schuchter is an oncologist at the Abramson Cancer Center of the University of Pennsylvania and an Associate Professor at the School of Medicine. Her clinical research interests include skin and breast cancers, with an emphasis on targeted therapies and vaccine clinical trials.

Dr. Schuchter is a board member of Living Beyond Breast Cancer, a Philadelphia-based education and support organization for women affected by breast cancer. She is the chair of ASCO's Public Issues Committee and a member of the Cancer Education and Scientific Programs Committees, as well as past chair of the Cancer Communications Committee. Dr. Schuchter is the recipient of numerous awards and honors and has edited and published more than 60-peer-reviewed textbooks and articles.

The chat room is now closed. Thanks again for joining us.