Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer

Many patients with cancer use complementary and alternative medical (CAM) therapies. Physicians need authoritative information on CAM therapies to responsibly advise patients who seek these interventions. This article summarizes current evidence on the efficacy and safety of selected CAM therapies that are commonly used by patients with cancer. The following major categories of interventions are covered: dietary modification and supplementation, herbal products and other biological agents, acupuncture, massage, exercise, and psychological and mind–body therapies. Two categories of evidence on efficacy are considered: possible effects on disease progression and survival and possible palliative effects. In evaluating evidence on safety, two types of risk are considered: the risk for direct adverse effects and the risk for interactions with conventional treatments. For each therapy, the current balance of evidence on efficacy and safety points to whether the therapy may be reasonably recommended, accepted (for example, dietary fat reduction in well-nourished patients with breast or prostate cancer), or discouraged (for example, high-dose vitamin A supplementation). This strategy allows the development of an approach for providing responsible, evidence-based, patient-centered advice to persons with cancer who seek CAM therapies.

Author and Article Information

From Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; Canadian College of Naturopathic Medicine and University of Toronto, Toronto, Ontario, Canada; and National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland.

Grant Support: In part by grant U24 AR 43441 from the National Institutes of Health, Bethesda, Maryland; the John E. Fetzer Institute, Kalamazoo, Michigan; American Specialty Health Plans, San Diego, California; the Bernard Osher Foundation, San Francisco, California; and the Kevin Kelly Fund, Boston, Massachusetts.

Potential Financial Conflicts of Interest: Consultancies: H. Boon; Honararia: M. Smith, D.M. Eisenberg; Stock ownership or options (other than mutual funds): H. Boon, M. Smith, D.M. Eisenberg.

Requests for Single Reprints: Wendy A. Weiger, MD, PhD, Osher Institute, Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, The Landmark Center, 2nd Floor West, Suite 22A, 401 Park Drive, Boston, MA 02215; e-mail, wendy_weiger@hms.harvard.edu.

Current Author Addresses: Drs. Weiger, Kaptchuk, and Eisenberg: Osher Institute, Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, The Landmark Center, 2nd Floor West, Suite 22A, 401 Park Drive, Boston, MA 02215.

Dr. Smith: Canadian College of Naturopathic Medicine, 1255 Sheppard Avenue, East, North York, Ontario M2K 1E2, Canada.

Dr. Boon: Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, Ontario M5S 2S2, Canada.

Dr. Richardson: National Center for Complementary and Alternative Medicine, National Institutes of Health, 6707 Democracy Boulevard #406, Bethesda, MD 20892.