The Role of Complementary and Alternative Therapies in Cancer

Complementary Therapies for Cancer-Related Symptoms

Conventional cancer treatments such as chemotherapy, radiation therapy, and surgery are often associated with severe side-effects that can significantly impact the patient's quality of life and interfere with routine activities of daily living. In general, side-effects of conventional cancer treatments may include nausea/vomiting, fatigue, anxiety, depression, pain, sleep disturbances, loss of appetite, dry mouth, gastrointestinal disturbances, and peripheral neuropathy. Conventional treatments may not always be completely effective in relieving cancer-related symptoms and, in some cases, the treatments themselves may cause additional side-effects. Complementary therapies, when used in conjunction with conventional mainstream treatments can help patients better cope with cancer-related symptoms and side-effects and also improve physical and emotional well-being and overall quality of life.

Psychological Stress

The diagnosis of cancer is a life-altering event that may evoke feelings of anxiety, fear, depression, hopelessness, and severe psychological stress in many patients. Studies have shown that about 25% of cancer patients suffer from depression. Conventional treatments for anxiety, stress, and depression may involve the administration of anti-anxiety medications or antidepressants which may cause undesirable side-effects in some patients. Studies have shown that a variety of CAM therapies are useful for controlling anxiety and other mood disturbances when used in conjunction with conventional treatments. These include:

  • Mind-body interventions - relaxation techniques, guided-imagery, meditation, hypnosis
  • Acupuncture
  • Massage therapy
  • Music therapy

In general, patients with severe mood disturbances (e.g., panic attacks; suicide ideation) require immediate psychological evaluation and treatment to stabilize their acute condition before CAM therapies may be considered. For most patients with mild to moderate anxiety and mood disturbances, CAM therapies are a useful adjunct to conventional treatments for managing psychological distress. Techniques such as mind-body interventions, acupuncture, and music therapy are generally safe when performed by qualified, experienced practitioners and can help cancer patients better cope with feelings of anxiety, fear, hopelessness, and depression. Although some herbs and dietary supplements (e.g., Kava Kava; St. John's Wort; Passionflower) have been reported to relieve anxiety and mood disturbances, some experts have discouraged the use of these products in cancer patients because they may interfere with drugs used to treat cancer (chemotherapeutic agents) and/or other medications that patients may be taking. Patients should discuss the risks and benefits of using any herbal medications/dietary supplements with their oncologist before taking any of these products, particularly if they are undergoing chemotherapy, radiation therapy, or surgery.

Cancer-Related Pain

Pain is a common symptom that can affect many cancer patients. Most often, the source of the pain is the tumor itself. Cancer-related pain may be caused by spread of the tumor to other tissues and organs or may result from compression of the tumor on a nerve or the spinal cord. In general, acute cancer-related pain is most responsive to conventional mainstream treatments which may involve medications (e.g., narcotic analgesics; steroids) or, in severe cases, (e.g., tumor causing spinal cord compression; tumor associated with abdominal obstruction), emergent surgery may be required to relieve the acute pain.

As a general rule, CAM therapies are usually not considered as a viable treatment option for the management of acute cancer-related pain. Once the acute pain has been brought under control by conventional treatment modalities, CAM therapies may be considered in the management of chronic cancer-related pain. A potential benefit of using CAM therapies in conjunction with conventional treatments for the management of chronic cancer-related pain is that they may reduce the dosage of conventional pain medications that may be required to achieve chronic pain control and, therefore, also potentially reduce the side-effects that may be associated with conventional pain medications.

A variety of CAM therapies, when used in conjunction with conventional treatments, may be beneficial for the management of cancer-related pain, including:

  • Meditation
  • Guided imagery
  • Hypnosis
  • Relaxation techniques
  • Massage therapy
  • Reflexology
  • Acupuncture
  • Yoga
  • Aromatherapy

Some procedures that may be used for the diagnosis and treatment of some types of cancers may also be associated with pain. Examples include:

  • Biopsy - a piece of tissue is removed from the tumor and is examined under a microscope to determine if it is malignant or benign.
  • Placement of a central line catheter that is used to administer chemotherapeutic agents and/or other medications
  • Bone marrow aspiration
  • Lumbar puncture

A variety of CAM therapies, particularly mind-body techniques, have been found to be beneficial for controlling pain associated with cancer-related procedures (both diagnostic and therapeutic), especially in children with cancer, although they appear to be useful in adults as well.

Some cancer patients who undergo surgery to remove a tumor develop persistent neuropathic pain due to injury of nerves during the surgical procedure. In general, severe neuropathic pain may be difficult to control with conventional pain management treatment modalities. There is some evidence that acupuncture, when used in conjunction with conventional pain management strategies, may be effective for the management of persistent neuropathic pain that may develop in some patients after cancer surgery.

Nausea and Vomiting

Nausea and vomiting are relatively common side-effects in patients undergoing cancer chemotherapy. When used in conjunction with standard treatments, CAM therapies may offer patients additional relief from chemotherapy-induced nausea and vomiting. A 1998 National Institutes of Health (NIH) Consensus Conference concluded that there is clear evidence supporting the efficacy of acupuncture for controlling nausea and vomiting associated with cancer chemotherapy. Other CAM therapies that may help cancer patients better cope with chemotherapy-induced nausea and vomiting include:

  • Acupressure
  • Aromatherapy
  • Hypnosis
  • Guided imagery
  • Music therapy
  • Massage therapy

Other Cancer-Related Symptoms

There is a limited amount of evidence which suggests that CAM therapies may be useful for helping patients to better cope with a variety of other common cancer-related symptoms including:

  • Fatigue - A study published in 2004 in the Journal of Clinical Oncology (Vol. 22, Issue 9; pp. 1731-1735) reported that acupuncture reduced chemotherapy-related fatigue by 31% after 6 weeks of acupuncture treatment.

  • Dry Mouth (xerostomia) - Several studies suggest that acupuncture may be useful in the management of dry mouth that occurs in some patients undergoing radiation therapy to the head and neck.

  • Hot Flashes - Some women with breast cancer who are treated with a drug called tamoxifen may experience hot flashes that can be very uncomfortable. A study published in 2002 in the journal Tumori (Volume 88, Issue 2; pp. 128-130) reported that acupuncture may relieve menopause-related symptoms, including hot flashes, in women taking tamoxifen.

  • Lymphedema - A study published in 2002 in the European Journal of Cancer Care (Volume 11; Issue 4, pp. 254-261) reported that a specific type of massage therapy known as manual lymphatic drainage (MLD) was beneficial for the treatment of breast cancer related lymphedema and also improved overall quality of life.

  • Insomnia - A variety of mind-body therapies (e.g., relaxation techniques; meditation; biofeedback) may help to improve the quality of sleep of cancer patients who experience insomnia.