Q&A: Complementary and Alternative Medicine and Cancer

Cancer.Net Q&A Forum
Complementary and Alternative Medicine and Cancer with Patrick Mansky, MD, and Barrie Cassileth, PhD
Questions posted November 3, 2005
Questions posted November 11, 2005
Questions posted November 14, 2005
Questions posted November 22, 2005

Cancer.Net Q&A forums are month-long events on a specific topic. During the month, guests may submit questions to leading cancer experts. Each week, answers are posted on Cancer.Net. Cancer.Net Q&A forums are free of charge, anonymous, and preregistration is not required.

Please keep in mind that Dr. Mansky and Dr. Cassileth are unable to give individual medical advice in this setting, nor are they able to address questions that include information specific to one person's medical profile. Questions are answered as time permits.

The information presented here is for informational and educational purposes only and is not intended to substitute the professional medical advice or treatment recommendations provided by your doctor.

This forum is neither intended nor appropriate to serve as a means of obtaining a second opinion on cancer diagnosis or treatment. In response to questions about specific drugs, comments will focus only on the state of current research and clinical trials.

It is advised that you do not delay seeking professional medical advice based on any information contained in this Q&A forum.

This forum is governed by all terms and conditions of the Cancer.Net website. Participation in this Q&A forum means that you fully understand and agree to abide by the terms and conditions of the Cancer.Net website.

Patrick Mansky, MD, is currently a staff clinician and clinical investigator in the Division of Intramural Research at the National Center for Complementary and Alternative Medicine, National Institutes of Health (NIH). His area of research is complementary and alternative medicine in cancer, with special emphasis on botanical/drug interactions, cancer symptom management, and mind-body interventions.

Barrie Cassileth, PhD, is currently the Laurance S. Rockefeller Chair of Integrative Medicine and Chief of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center. She has published extensively on alternative and complementary (integrative) medicine and the psychosocial aspect of cancer care, and is an associate editor or advisory board member of eleven medical journals. Dr. Cassileth was also a founding member of the Advisory Council to the National Institutes of Health Office of Alternative Medicine and is a previous member of the National Board of Directors of the American Cancer Society.

SAVE THE DATE: Please join Cancer.Net for a live chat about Coping With Cancer on Thursday, December 8, 2005, from 2:00 – 3:00 PM ET.

The featured expert is Lidia Schapira, MD, of Massachusetts General Hospital.

Questions posted November 3, 2005

Question 1: I heard that vitamin A and beta-carotene could make lung cancer worse. If beta-carotene is not harmful to those with lung cancer, do you recommend synthetic beta-carotene or carrot juice?

Dr. Cassileth: Excessive amounts of beta-carotene in supplement form were found to increase the risk of lung cancer in two large studies of smokers. The thinking is that the high-dose vitamin supplements cannot distinguish between healthy cells and cancer cells, so they strengthen both. It's always best to get your vitamins not from supplements but from diet. A United States Department of Agriculture (USDA)-level multivitamin is fine.

Question 2: My doctors are recommending chemotherapy and radiation therapy simultaneously. I am very afraid of chemotherapy. Is there anything that you can suggest to use that may prevent or reduce the side effects of radiation therapy and chemotherapy?

Dr. Cassileth: I suspect you are afraid of chemotherapy because you heard stories years ago, before excellent antiemetics were developed and used along with the chemotherapy infusion. Nauseais rare these days. Everyone's body is different, and many people have few or no side effects. Many people continue to work and participate in other regular activities. Hair loss is more likely than any other side effect, and there are beautiful wigs to make up for that! Hair grows back; it is a temporary problem. For more information see Cancer.Net Feature: Side Effects of Radiation Therapy, Cancer.Net Feature: Part I: Understanding Radiation Therapy, and Part II: Radiation Therapy--Your Personal Experience

Question 3: My 28-year-old son has advanced colon cancer, which has spread to his liver. He is taking fluorouracil (5-FU) with oxaliplatin (Eloxatin) and tomorrow will be starting bevacizumab (Avastin). Can he take active hexose correlate compound (AHCC)?

Dr. Cassileth: AHCC is an extract made from several species of Basidiomycete mushrooms, including shiitake. Unlike herbal supplements, which should be avoided during cancer treatment, medicinal mushrooms are fine to use during chemotherapy and radiation therapy. For more information, see http://www.mskcc.org/aboutherbs.

Question 4: What are some alternative treatments to radiation therapy and chemotherapy for lung cancer, such as homeopathic remedies, natural foods, etc.?

Dr. Cassileth: There are no viable alternative treatments for any cancer diagnosis. Homeopathic remedies have no place in health care. (They are expensive placebos.) Eating healthfully is important. The American Cancer Society's recent book, Eating Well, Staying Well, During and After Cancer, is one of many excellent resources.

Question 5: What are your recommendations for a prophylaxis against prostate cancer?

Dr. Cassileth: Maintain proper weight and strength (exercise and good nutrition). Eat a diet low in fat and high in fruits and vegetables. Vitamin E and/or selenium are under study for their ability to reduce prostate cancer risk, and you should consider taking these supplements.

Question 6: Does drinking milk while on tamoxifen (Nolvadex) interfere with its treatment?

Dr. Cassileth: No, milk will not interfere with tamoxifen. It's important to drink low-fat or nonfat milk and milk products rather than full-fat milk.

Question 7: I have early stage breast cancer and currently take a multivitamin, 500mg of vitamin C, 1200mg of a garlic supplement, and calcium with vitamin D (600 mg). Do you have any suggestions as to other supplements I should be taking or suggestions on dosages for what I am currently taking on daily basis?

Dr. Cassileth: That sounds like a good plan. A medicinal mushroom supplement is safe and may help enhance immune function (studies are underway), but I would not recommend additional supplements.

Question 8: I am undergoing chemotherapy for breast cancer, and I am using chemotherapy drugs, such as cyclophosphamide (Cytoxan, Neosar), methotrexate (MTX, Amethopterin), and fluorouracil. A doctor, not my oncologist, suggested that I use Iscador (a drug made from mistletoe extracts) for complementary treatment in breast cancer, as my white blood cell count seems to be particularly sensitive to the chemotherapy. Is there any information on whether Iscador could have a negative effect? Is it safe to use under a doctor's supervision, having informed the oncologist, while undergoing chemotherapy?

Dr. Cassileth: Iscador is not likely to have an additional benefit. We can assume that any positive effect is pretty weak. In my view, possible side effects outweigh potential benefit. (You may want to tell your doctor to check it out on http://www.mskcc.org/aboutherbs.) If you are thinking of Iscador as a means of boosting immune cells, probably the best supplement is a medicinal mushroom extract. As noted in response to Question 7, medicinal mushroom extracts when produced at a pharmaceutical grade are safe, can be used concurrently with prescription medications including chemotherapy, and may help enhance immune function. Studies are underway.

Question 9: Can you tell me more about natural cancer control pills? I have heard about some that are distributed by Flu-Fighter Laboratories in Boca Raton, Florida and would like to know more.

Dr. Cassileth: These are neither natural nor effective. Furthermore, their claims are not backed by any research. There are so many baseless product claims out there; don't let them fool you.

Questions posted November 11, 2005

Question 1: What do you recommend as alternative therapies for insomnia due to chemotherapy and radiation therapy?

Dr. Cassileth: There are several complementary therapies that work well, including self-hypnosis, progressive relaxation, meditation, and other relaxation techniques. Mind-body professionals, often psychologists or psychiatrists, teach these techniques, and you can also find books and CDs that explain what to do. It is not safe to take herbal preparations, as they may interfere biologically with the chemotherapy. Also, caffein-free tea is soothing and helps many people fall asleep.

Question 2: My mother-in-law, who has stage III colon cancer, is talking about stopping chemotherapy (because of the side effects) and using only vitamins and herbs to treat the cancer. What information can we give her to convince her not to stop her regular treatments?

Dr. Cassileth: What a difficult situation for you. You can explain that vitamins and herbs strengthen cells, including cancer cells; no vitamins or herbs cure cancer; and finally, her very best chance of doing well is to keep up with the chemotherapy. At the same time, she should receive better supportive care to deal with the symptoms. If nausea or pain is a problem, acupuncture works well, and of course, there are good medications for these and other symptoms. Check with her oncologist about why she is having so much difficulty.

Question 3: How does someone find a good doctor or medical professional that treats cancer with alternative therapies?

Dr. Cassileth: There are no viable alternatives to mainstream cancer treatment. It is because of gold-standard care with surgery, chemotherapy, and radiation therapy that we have a 64% cancer cure rate in this country. Undeveloped countries, which do not have these treatments and rely on herbs, etc. to treat cancer, have a 20% cure rate.

Question 4: How effective are those diets that are supposed to cure cancer by removing toxins from the body? Does this work?

Dr. Cassileth: No. Eating healthfully and maintaining the right weight are very important, but no diet has ever been shown to cure cancer. "Removing toxins" is what your digestive track does. Please don't be fooled by bogus claims.

Question 5: How are complementary and alternative medicine (CAM) therapies studied? Are there clinical trials using CAM techniques? Where can I find out more information?

Dr. Cassileth: Complementary therapies are properly studied exactly the same way any cancer therapies are studied, and there is indeed a great deal of laboratory and clinical trials research. In my department, for example, we have multiple clinical trials on acupuncture, massage therapy, herbal therapies, etc. The National Institutes of Health Center for Complementary and Alternative Medicine and the National Cancer Institute Office of Complementary and Alternative Medicine have information about this. The National Library of Medicine's PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) lists most published research on everything in medicine and science around the world. To get specific information about published clinical trials data, you can inquire about the particular problem (for example, "breast cancer") and the particular complementary modality of interest (for example, "acupuncture" or "exercise").

Question 6: What are some of the more common and effective complementary/alternative therapies for pain?

Dr. Cassileth: Acupuncture is probably the most effective against pain, but massage therapy works well, too.

Questions posted November 14, 2005

Question 1: I have been diagnosed with breast cancer. My mother, who also had breast cancer back in 1981, said she used to take vitamin B17 as part of her cancer treatment. Is this something I should consider now?

Dr. Cassileth: Your mother did not receive vitamin B17 from an accredited cancer program, as it was banned by the U.S. Food and Drug Administration (FDA) after two major clinical trials showed it was not effective. B17 is not a real vitamin. The prompters of this product, which is also called laetrile, amygdalen, and a few other names, made up B17.

Question 2: I have early stage prostate cancer, and my wife wants me to eat only a macrobiotic diet. She says it will help prevent my cancer from growing. What do you recommend?

Dr. Cassileth: No diet prevents cancer from growing. A healthy, low-fat, plant-based diet, along with exercise, will keep your body strong. You should consider and ask your oncologist about supplements of selenium and vitamin E, which are now under study in the "SELECT" trial sponsored by the National Cancer Institute.

Question 3: I have heard that powdered shark cartilage has been used successfully to stop the development of new blood vessels that cancerous tumors need to grow. Can you comment on this therapy?

Dr. Cassileth: The powdered shark cartilage available over-the-counter as a supplement has been studied carefully and found not to work. There is now some research underway to look at specific isolated ingredients of shark cartilage that may have benefit, but the powdered shark cartilage supplement does not have benefit. Efforts to find ways to successfully starve tumors of their blood supply, without which they will die, is a major area of intense scientific effort around the world.

Question 4: I've heard that patients with cancer should not get deep tissue massage, as it can cause cancer cells to spread. What do you think?

Dr. Cassileth: This is what's known as an old wives tale. It is not correct. Massage therapy is offered in many major oncology centers, including Memorial Sloan-Kettering Cancer Center (MSKCC). You want to select a licensed, certified massage therapist, preferably one that has special training in working with patients with cancer. (We have a two-day certificate course at MSKCC for licensed massage therapists, and programs elsewhere may also provide similar training).

Question 5: Could you suggest any complementary therapies to treat anxiety? My mother just finished adjuvant chemotherapy for colon cancer, and it seems like she is in emotional distress.

Dr. Cassileth: Temporary anxiety is not alarming, and she may find relief with massage therapy, any of the psychologist-offered relaxation therapies, or through meditation. If her anxiety persists for more than a few weeks, she should call her doctor and get professional help. There are good medications for anxiety and no one should suffer when it can be well-treated.

Question 6: Why are doctors so cautious about recommending herbal treatments for patients with cancer? What are the real risks?

Dr. Cassileth: The risks are very real. Herbs are active biologic agents and, just as they can be beneficial under some circumstances, they can also be harmful. Many herbal preparations are contaminated, and many do not contain what the label says they do. Perhaps of greatest concern for patients with cancer is that they can cause serious side effects. They may interfere with coagulation of the blood, and they may interfere with prescription medication. See www.mskcc.org/aboutherbs for accurate, free, up-to-date information.

Questions posted November 22, 2005

Question 1: What is the best way to find a medical doctor (MD) who treats melanoma using complementary and alternative therapies in the eastern part of the United States?

Dr. Mansky: Selecting a health-care practitioner of conventional or complementary and alternative medicine (CAM) is an important decision and can be key to ensuring that you are receiving the best health care. The National Center for Complementary and Alternative Medicine (NCCAM) has developed a fact sheet to answer frequently asked questions about selecting a CAM practitioner, such as issues to consider when making your decision and important questions to ask the practitioner you select. You may access this fact sheet at http://nccam.nih.gov/health/practitioner/index.htm.

In addition, NCCAM and the National Cancer Institute (NCI) have produced a new booklet, "Thinking about Complementary and Alternative Medicine: A Guide for People with Cancer." This booklet addresses making decisions about using CAM and considerations for finding a practitioner. You may access this booklet at http://www.cancer.gov/cancertopics/thinking-about-CAM.

Question 2: What methods besides massage are used when treating a patient with cancer, specifically leiomyosarcoma, who is suffering from lymphatic swelling in the legs and pelvic area? I have heard about the Lymph Star Pro? What do you think about it?

Dr. Mansky: Elevation, T.E.D. hose (tight-fitting, anti-embolism stockings), and lymph drainage massage are interventions that have been shown to be beneficial in cancer-related lymphatic swelling. If new swelling occurs, talk with your doctor about safe and effective management of this problem. The NCI has information on lymphedema at http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/patient. For more information, read Cancer.Net's Managing Side Effects: Fluid in the Arms or Legs (Lymphedema).

Question 3: A registered dietitian (RD) suggested taking indole-3-carbinol (I3C) while on tamoxifen (Nolvadex). I will be starting tamoxifen in two weeks. What are your thoughts on this?

Dr. Mansky: I3C, a major component of cruciferous vegetables, has been shown to prevent cancer in a number of animal models and is being evaluated as a potential agent to prevent breast cancer in healthy women. In some models, long-term intake of I3C promoted cancers. I3C administration to rats causes marked shift in the metabolic profile of drugs, such as nicotine and tamoxifen. Such an effect could lead to adverse drug reactions in humans. I3C should therefore not be used while taking tamoxifen. While I3C is being studied as a cancer prevention treatment, it should not be used as a substitute for tamoxifen, a drug with known benefit in the treatment and prevention of breast cancer. Further information about clinical trials on I3C can be found at http://www.cancer.gov/clinical trials.

Question 4: I am a breast cancer survivor, age 63, diagnosed in 2003. What is your view of the use of bioidentical hormone creams by menopausal women with hormone positive breast cancer?

Dr. Mansky: There is little information suggesting that estrogenic vaginal creams result in significantly increased systemic estrogen exposure in excess of what dietary phytoestrogens would represent. However, any hormonal therapy should be discussed with your doctor.

Question 5: Is there a noncatabolic alternative to dexamethasone (Decadron) to manage side effects of whole-brain radiation? What about the herb, Boswellia?

Dr. Mansky: Boswellic acids have been shown to have anticancer activity in preclinical studies. However, information based on controlled clinical trials in humans is lacking. Decadron is used to reduce brain swelling caused by radiation, not as an anticancer therapy. If the treating oncologist has suggested the use of dexamethasone, it should not be stopped in favor of an herbal preparation without discussion, as this may result in life-threatening complications from radiation therapy.

Question 6: What are your thoughts on taking evening primrose oil as a supplement while undergoing cancer treatment? How does evening primrose oil compare with mistletoe supplements?

Dr. Mansky: Primrose oil components have been shown to have anticancer activity in laboratory studies. However, no controlled clinical trials have been conducted to study the safety or efficacy of this agent in the treatment of cancer. Primrose and mistletoe have not been compared in a controlled clinical trial for the treatment of cancer. NCCAM is conducting a study of mistletoe in people with solid tumors. More information on mistletoe and this study may be found at http://nccam.nih.gov/mistletoe/.

Question 7: What are the best supplements/herbs for treating or preventing a recurrence of melanoma? Are there any other alternative treatments for melanoma? How would I find information regarding the effectiveness of treatments for melanoma?

Dr. Mansky: There are no data based on controlled clinical trials in humans suggesting effective alternative treatments for melanoma. Read more about melanoma treatment.

Question 8: What recommendations do you have for taking soy after a breast cancer diagnosis? When I asked my oncologist about consuming soy products post-breast cancer treatment for estrogen receptor-positive cancer, he said, "We don't know." Is there any further news as to whether consuming soy products has a positive effect on breast cancer elimination/prevention?

Dr. Mansky: The effect of soy on breast cancer recurrence or prevention in women with estrogen receptor-positive breast cancer remains controversial. There is some epidemiologic evidence that increased soy intake during adolescence reduces the risk for breast cancer. Increased fresh fruit and vegetable intake may have a greater effect on breast cancer prevention than soy intake according to epidemiologic data from Asia.

An in-depth review of the effects of soy on health can be found at http://www.ahrq.gov/clinic/epcsums/soysum.htm.

Question 9: Are there any studies on whether acupuncture is proven to boost immunity, and would it be helpful for cancer survivors? I completed several sessions of acupuncture when I was being treated for stage I breast cancer and found it effective in preventing nausea. Do you recommend acupuncture for prevention of cancer recurrence?

Dr. Mansky: There are no controlled clinical trials published that would suggest that acupuncture reduces cancer recurrence. There are data from laboratory studies and case series in humans suggesting that acupuncture may stimulate the immune system. Whether and how that may be beneficial for the treatment of cancer remains to be shown. The best evidence for efficacy of acupuncture exists for the treatment of dental pain and chemotherapy-induced, acute nausea and vomiting.

Question 10: I am a three-year survivor of ductal and lobular cancer. I have read that massages, hot tubs, and saunas are not recommended for those with cancer. Is this true?

Dr. Mansky: There is no evidence based on clinical trials that massage, hot tub, or sauna would increase the likelihood of the cancer to return. Patients should talk with their treating oncologist before considering manipulation or local treatment of any existing site of tumor growth or prior cancer surgery.

Please check back next week for more answered questions. In addition, feel free to post a question.

More Information

Complementary and Alternative Medicine (CAM)

Last Updated: November 03, 2005