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Complementary and Alternative Medicine in
Cancer Treatment

What is complementary and alternative medicine?

Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.

This fact sheet answers some frequently asked questions about the use of CAM therapies among the general public, and about how CAM approaches are evaluated, and suggests sources for further information.

Are complementary and alternative therapies widely used?
The results of studies of CAM use have been inconsistent. One large-scale study published in the November 11, 1998, issue of the Journal of the American Medical Association found that CAM use among the general public increased from 33.8 percent in 1990 to 42.1 percent in 1997. However, an analysis of data from the 1999 National Health Interview Survey indicated that only 28.9 percent of U.S. adults (age 18 and over) had used at least one CAM therapy in the past year. These results were published in the journal Medical Care in 2002.

Several surveys of CAM use by cancer patients have been conducted with small numbers of patients. One study published in the February 2000 issue of the journal Cancer reported that 37 percent of 46 patients with prostate cancer used one or more CAM therapies as part of their cancer treatment. These therapies included herbal remedies, vitamins, and special diets.

A larger study of CAM use in patients with different types of cancer was published in the July 2000 issue of the Journal of Clinical Oncology. This study found that 69 percent of 453 cancer patients had used at least one CAM therapy as part of their cancer treatment. Additional information about CAM use among cancer patients can be found in a review article published in Seminars in Oncology in December 2002.

How are CAM approaches evaluated?
It is important that the same rigorous scientific evaluation used to assess conventional approaches be used to evaluate CAM therapies. The National Cancer Institute (NCI) and NCCAM are funding a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer.

Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Some CAM therapies have undergone rigorous evaluation. A small number of CAM therapies originally considered to be purely alternative approaches are finding a place in cancer treatment-not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or potentially harmful.

What is the Best Case Series Program?
The Best Case Series Program, which was started by the NCI in 1991, is one way CAM approaches that are being used in practice are being evaluated. The program is overseen by the NCI's Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer CAM services submit their patients' medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops followup research strategies for approaches that have therapeutic potential.

Are the NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine?
The NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for cancer. Some of these trials study the effects of complementary approaches used in addition to conventional treatments, while others compare alternative therapies with conventional treatments. Current trials include the following:

acupuncture to reduce the symptoms of advanced colorectal cancer,
combination chemotherapy plus radiation therapy with or without shark cartilage in the treatment of patients who have non-small cell lung cancer that cannot be removed by surgery,
hyperbaric oxygen therapy with laryngectomy patients (people who have had an operation to remove all or part of the larynx (voice box)),
massage therapy for cancer-related fatigue,
chemotherapy compared with pancreatic enzyme therapy plus specialized diet for the treatment of pancreatic cancer, and
mistletoe extract and chemotherapy for the treatment of solid tumors.
Patients who are interested in taking part in these or any clinical trials should talk with their doctor.

The NCI, NCCAM, and OCCAM clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching:

The NCI's PDQ® Clinical Trials Database-The PDQ Clinical Trials database can be searched at using such criteria as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI's Cancer Information Service (see below).
The NCCAM Clinical Trials Web page-Clinical trials can be searched by type of treatment or disease at on the Internet.
The OCCAM Clinical Trials Web page-Links are provided to the NCI's clinical trials databases at on the Internet.

What should patients do when using or considering complementary and alternative therapies?
Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it.


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