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NEWS & VIEWS

GROWING INTEREST IN COMPLEMENTARY AND ALTERNATIVE CANCER THERAPIES

This abundance of information reflects the enormous public interest in complementary and alternative methods (CAM) for cancer treatment. Despite this volume of Web site content, clinicians have sparse evidence upon which to base recommendations for or against many of these therapies.

"I would guess that over 80% of cancer patients use... some form of complementary or alternative therapies," says Barrie Cassileth, PhD, Chief of the Integrative Medicine Center at Memorial Sloan-Kettering Cancer Center in New York. "Patients often can’t distinguish which are good and which are harmful, and we’ve got to help them do that."

To that end, experts from around the country have collaborated to form the Society for Integrative Oncology (http://www.integrativeonc.org). This new professional group is a joint effort of three major cancer centers with strong CAM programs—Memorial Sloan-Kettering, MD Anderson Cancer Center in Houston, and Boston’s Dana-Faber Cancer Institute—as well as other cancer-related organizations, including the American Cancer Society. The new group holds its first conference November 17–19, 2004, in New York.

Its goal, said Cassileth, who is the society’s president, is to promote high-level research of CAM and get reliable information to doctors so they can guide their patients.

For instance, some complementary therapies—those which patients use in conjunction with conventional cancer treatment modalities—can be very helpful, Cassileth said.

Doctors also need to know which therapies are bogus and potentially dangerous—treatments typically considered "alternative" because patients may use them instead of traditional treatments. An article earlier this year in CA: A Cancer Journal for Clinicians (2004;54:110–118) reviewed the evidence for nearly a dozen alternative cancer therapies and found that they don’t hold up under scrutiny.

Such therapies should no longer be considered "unproven," wrote author Andrew Vickers, PhD, of Memorial Sloan-Kettering. Rather, "it is time to assert that many alternative therapies have been ‘disproven,’" he said.

Then there are treatments that fall somewhere in between the "proven" and the "disproven"—herbs, for instance.

"Botanicals have tremendous potential," Cassileth said, "but... at this point, patients only have access to what’s available over the counter in the form of supplements, but those... should be avoided [during treatment] because of their potential to interact negatively with traditional therapy."

Research is being conducted, she said, but the process is slow.

Despite the unknowns, herbal supplements are popular among cancer patients. As many as 63% use these remedies, according to some studies.

A study of women being treated for breast and gynecologic cancers at MD Anderson found that 48% used some type of herbal or vitamin supplement (Journal of Clinical Oncology 2004;22:671–677). Yet only 53% of these women told their doctor about it.

Said co-author Judith Smith, PharmD, BCOP, "We kind of knew that patients weren’t telling physicians about CAM use; most of them don’t even consider it medication."

Indeed, less than a third of the women in the study said they thought of herbal products and vitamins as medication. Botanicals aren’t necessarily benign, though.

An article by National Cancer Institute researchers in the Journal of Clinical Oncology (2004;22:2489–2503) reviews evidence on pharmacokinetic interactions between common herbal products and drugs used in cancer therapy.

The review focused on the top-selling herbal preparations in the US. Among these, garlic, gingko, echinacea, ginseng, St. John’s wort, valerian, evening primrose, kava, and grape seed raised concern regarding documented or potential interactions with the membrane transporters responsible for drug absorption and elimination, and the enzymes that metabolize many anticancer drugs.

Much of this research has been performed with in vitro systems or laboratory animals, lead author Alex Sparreboom, PhD, emphasized; clinical evidence is scarce.

Nevertheless, patients and doctors should use caution, experts say, and keep the lines of communication open.

"I think the best thing to do is to be aware that patients are likely taking [herbal supplements] and be aware they might not tell you about it," said William Figg, PharmD, coauthor of the herbal review.

Doctors should question cancer patients about CAM use and monitor them for unusual symptoms or reactions that might be caused by the CAM, he said. Sparreboom suggested doctors keep a list of potentially troublesome compounds, such as those noted in his review, to ask patients about.

Smith agreed that doctors need to take an active role in talking to patients about CAM. In her study, most of the women who didn’t talk to their doctor about CAM use said it was because the doctor never asked about it.

As use of nontraditional cancer therapies surges, so do worries and research.

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