Acupuncture News
News Archive
7-15-03
Researchers Evaluate Evidence and Suggest Guidelines for Use of Complementary and Alternative Medicine Therapies
Source: 411Cancer.com "Cancer Experts leading the way to optimal cancer care."
A recent article published in the Journal
of the National Cancer Institute reviewed CAM therapies and evaluation
criteria guidelines suggested by several researchers for complementary and
alternative medicine (CAM).
CAM use by cancer patients has steadily increased throughout the past ten
years. While research on CAM has also begun to increase, little is known
about the safety and efficacy of most CAM therapies. This creates a dilemma
for physicians, who have difficulty acquiring authoritative information on
CAM. Several leading researchers recommending guidelines for evaluating CAM
were interviewed in this article.
Researchers at the Osher Institute of Harvard Medical School in Boston
recently published a review of CAM therapies in the December 3rd, 2003
Annals of Internal Medicine. This team summarized the scientific evidence on
a wide array of CAM most commonly used by cancer patients, focusing on the
safety (based on side effects or interactions with other drugs/treatments)
and/or effectiveness of individual CAM therapies. As a result, CAM
treatments were classified in one of three categories: reasonably
recommended, accepted (with some caveats) or discouraged. Overall, more CAM
therapies appear to alleviate symptoms, of cancer or cancer treatment, than
to treat cancer itself. The only therapy the authors tentatively recommended
as a potential treatment for cancer was Vitamin E for latent prostate cancer
.
The Osher Institute researchers advised physicians to accept, monitor and
consider recommending vitamin use for some patients. They do not discourage
a CAM therapy unless there are major safety concerns or two or more
randomized clinical trials have been performed, two-thirds of which suggest
the therapy does not work. However, they note that certain subpopulations of
patients may be at increased risk from a CAM therapy. Examples include deep
massage and acupuncture for patients with higher risk of bleeding and the
use of antioxidants for patients undergoing chemotherapy and radiation
treatment. Theoretically, antioxidants may block the cancer-killing effects
of chemotherapy or radiation treatments because the free radicals generated
by these conventional therapies are partially responsible for their
anticancer effects. A few studies have reviewed this issue, but have
produced mixed results.
Barrie Cassileth, Ph.D., chief of the Integrative Medicine Service at
Memorial Sloan-Kettering Cancer Center (MSKCC) in New York and author of The
Alternative Medicine Handbook, reports that 8% to 10% of cancer patients
utilize CAM treatments prior to, or instead of, conventional treatment. This
delay may result in a cancer with good prognosis developing into a more
widespread and higher grade cancer. Cassileth is also concerned about
adulteration, misbranding and lack of regulation of dietary supplements
available in the United States. MSKCC does not use dietary supplements
available in U.S. health food stores for its clinical trials. They import
Japanese supplements, which are regulated as drugs, or raw substances from
China which undergo testing for contamination, consistency and stability.
Andrew Vickers, Ph.D., a research methodologist and biostatistician at MSKCC
Integrative Medicine Service and author of several articles on CAM,
recommends that physicians discourage the use of CAM therapies that are
unproven and have high risk of adverse side effects or interactions. He also
advises against treatments that are used instead of conventional treatment
(rather than those which can be used in addition to it) or that require
travel or financial cost. He suggests that physical, economic and emotional
harm may result from extreme measures such as traveling to Mexico in the
last weeks of life for an unproven therapy.
The following CAM therapies were included in the Annals of Internal Medicine
review article authored by the Osher Institute. They may be reasonably
accepted and, in some cases, considered for recommendation:
