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Complementary Medicine in Cancer Therapy. Patricia L. Judson, MD Associate Professor Gynecologic Oncology University of Minnesota. Categories of Methods. Mind, Body, Spirit Manual Healing and Physical Touch Herb, Vitamin and Mineral Diet and Nutrition Pharmacological and Biological.

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complementary medicine in cancer therapy

Complementary Medicine in Cancer Therapy

Patricia L. Judson, MD

Associate Professor

Gynecologic Oncology

University of Minnesota

categories of methods
Categories of Methods
  • Mind, Body, Spirit
  • Manual Healing and Physical Touch
  • Herb, Vitamin and Mineral
  • Diet and Nutrition
  • Pharmacological and Biological
mind body spirit
Aromatherapy

Art Therapy

Ayurveda

Bioenergetics

Biofeedback

Breathwork

Crystals

Curanderismo

Cymatic Therapy

Dance Therapy

Faith Healing

Feng Shui

Holistic Medicine

Humor Therapy

Hypnosis

Imagery

Kirlian Photography

Labyrinth Walking

Meditation

Music Therapy

Native American Healing

Naturopathic Medicine

Neuro-linguistic Programming

Psychotherapy

Qigong

Samanism

Spirituality and Prayer

Support Groups

Tai Chi

Yoga

Mind, Body, Spirit
manual healing and physical touch
Acupuncture

Applied Kinesiology

Biological Dentistry

Bodywork

Cancer Salves

Castor Oil

Chirpractic

Cold Laser Therapy

Colon Therapy

Craniosacral Therapy

Cupping

Electroacupuncture

Electrodermal Screening

Electromagnetic Therapy

Heat Therapy

Hydrotherapy

Hyperbaric Oxygen Therapy

Light Therapy

Magnetic Therapy

Massage

Moxibustion

Myofascial release

Myotherapy

Neural therapy

Ohashiatsu

Osteopathy

Polarity Therapy

Psychic Surgery

Reflexology

Reiki

Rosen Method

Rubenfeld Synergy Method

Sonopuncture

Therapeutic Touch

Transcutaneous Electrical Nerve Stimulation

Tui-Na

Watsu

Manual Healing and Physical Touch
herbs vitamins and minerals
Aconite

Aloe

Alsihum

Arnica

Astragalus

Aveloz

Beta Carotene

Betulinic Acid

Black Cohosh

Black Walnut

Bromelain

Calcium

Capsicum

Cat’s Claw

Celandine

Centella

Cesium Chloride

Chamomile

Chaparral

Chinese Herbal Medicine

Chlorella

Cloves

Comfrey

Copper

Echinacea

Essiac Tea

Evening Primrose

Flaxseed

Flower Remedies

Folic Acid

Fu Zhen Therapy

Germanium

Ginger

Ginkgo

Ginseng

Goldenseal

Green tea

Hansi

Hoxsey Herbal treatment

Indian Snakeroot

Kampo

Kava

Larch

Licorice

Herbs, Vitamins and Minerals
  • Marijuana
  • Milk Thistle
  • Mistletoe
  • Molybdenum
  • Mugwort
  • Oleander Leaf
  • Orthomolecular medicine
  • Pau D’Arco
  • PC-SPES
  • Peppermint
  • Phytochemicals
  • Pokeweed
  • Potassium
  • Psyllium
  • Pycnogenol
  • Rabdosia Rubescens
  • Red Clover
  • Saw Palmetto
  • Selenium
  • Siberian Ginseng
  • Six Flavor Tea
  • St. John’s Wort
diet and nutrition
Acidophilus

Amino Acids

Broccoli

Cassava

Coriolus Versicolor

Ellagic Acid

Fasting

Garlic

Gerson Therapy

Grapes

Inositol Hexaphosphate

Juicing

Kombucha Tea

Lycopene

Macrobiotic Diet

Maitake Mushroom

Metabolic Therapy

Modified Citrus Pectin

Noni Plant

Omega-3 Fatty Acids

Selected Vegetable Soup

Shiitake Mushroom

Soybean

Vegetarianism

Wheat Grass

Willard Water

Diet and Nutrition
pharmacological biological
Antineoplaston Therapy

Apitherapy

Bovine Cartilage

Cancell

Cell Therapy

Chelation Therapy

Coenzyme Q10

Coley Toxins

DHEADi Bella Therapy

DMSOEnzyme Therapy

Gamma Linolenic Acid

Glucarate

Greek Cancer Cure

Homeopathy

Hydrazine Sulfate

Hydrogen Peroxide Therapy

Immuno-Augmentive Therapy

Inosine Pranobex

Krebiozen

Laetrile

Lipoic Acid

Live Flush

Livingston-Wheeler Therapy

Lyprinol

Melatonin

Oxygen Therapy

Poly-MVA

Pregnenolone

Revici’s Guided Chemotherapy

Sea Cucumber

Shark Cartilage

Shark Liver Oil

Urotherapy

714-X

Pharmacological / Biological
tonight
Tonight
  • My CAM research trial
  • Acupuncture
  • Botanicals, Vitamins, Minerals
slide10

Newly diagnosed patients with ovarian & primary peritoneal cancer requiring chemotherapy

Eligibility criteria satisfied and consent process

Randomized

Administer QOL instruments, cycles 1, 3, 6

Labs, cycles 1-6

Chart review / interview record complications

Administer QOL six months post treatment

clinical hypnosis12
Clinical Hypnosis

Hypnosis has been defined as an altered state of consciousness resulting from the selective deployment of attention onto a focal goal and away from stimuli perceived as peripheral.

clinical hypnosis13
Clinical Hypnosis
  • As a therapeutic tool, hypnosis is intentionally induced
    • either by a therapist = hetero-hypnosis
    • or by the patient alone = self-hypnosis
  • Individuals retain control of themselves and their behavior while under hypnosis.
clinical hypnosis14
Clinical Hypnosis
  • Hypnosis has been associated with
    • positive changes in patient immunity
    • decreases in distress
    • decreased frequency and severity of treatment-related side effects
  • Prospective, randomized, controlled trials
    • psychological intervention, including hypnosis, can enhance the quality of life of patients with cancer
  • Hypnosis can enhance the immune response and increase T and B cell counts.
clinical hypnosis15
Clinical Hypnosis
  • Meta-analysis found that relaxation training and hypnosis with immune suggestions produced reliable, medium-sized increases in total salivary IgA concentrations.
  • Relaxation was unrelated to T cell and NK cell counts; these outcome data were not measured in the hypnosis studies.
clinical hypnosis16
Clinical Hypnosis
  • Women with breast or gynecological cancers
    • effectively reduce pain
    • decrease depression and anxiety
    • ameliorates chemotherapy side effects such as nausea and vomiting.
  • Self-hypnosis training for breast cancer survivors was associated with statistically significant (p<0.05) enhancements in perceived pain relief.
  • Related to decreased nausea and vomiting post chemotherapy, with decreases persisting after training visits with the therapist ended.
clinical hypnosis17
Clinical Hypnosis
  • Used to reduce anticipatory nausea in cancer patients
  • Although the data consistently find a positive relationship between hypnosis and outcomes, methodological shortcomings, particularly small sample sizes, lack of appropriate controls, lack of randomization, and failure to report outcome effect sizes support the need for further research
massage therapy
Massage Therapy
  • Manipulation, rubbing and kneading of the body’s muscle and soft tissue.
massage therapy19
Massage Therapy
  • Studies have shown cellular changes in immune function following massage therapy.
    • 100% experienced reduced levels of anxiety
    • 56% experienced a substantial increase in white blood cell counts and natural killer T cells
  • Salivary IgA concentration significantly increased in an experimental group receiving a back massage compared to the control group
  • Bone marrow transplant patients receiving massage therapy compared to controls showed significantly larger reductions in distress, fatigue, nausea and anxiety, as measured by the State Anxiety Inventory
healing touch
Healing Touch
  • Healing touch is a biofield therapy that is a holistic energy-based approach to health and healing.
  • It uses gentle, non-invasive

touch to influence the human

energy system, specifically

the energy field that surrounds

the body, and the energy

centers that control the flow

from the energy field to

the physical body.

healing touch21
Healing Touch
  • The healing touch practitioner utilizes their hands to clear, energize, and balance the human energy fields.
  • The goal is to restore harmony and balance in the energy system supporting the patient in the self-healing process.
  • Healing touch complements conventional health

care and is used in

collaboration with

other approaches to

health and healing.

healing touch22
Healing Touch
  • Found to enhance the immune system and decrease anxiety
  • In one study, participants who received healing touch had significantly increased levels of IgA and IgM; CD25 and IgG levels were also increased in the healing touch group, but the differences were not statistically significant.
  • Healing touch has been shown to decrease anxiety levels in hospitalized patients. Patients who received the intervention by healing touch experienced a highly significant (p< .001) reduction in their state of anxiety according to a comparison of pre- and post-test means on the State Anxiety Inventory
research objective
Research Objective
  • To determine whether combined modality CAM used in ovarian or primary peritoneal cancer patients will change their QOL, immune status, use of anti-emetics, or hospitalizations while undergoing primary chemotherapy.
research objective24
Research Objective
  • Primary Objective
    • Quality of Life: To determine whether QOL, as measured by the FACT-O and MHI total scores, is improved in patients receiving combined modality CAM as compared to patients receiving chemotherapy alone.
research objective25
Research Objective
  • Secondary Objectives
    • To determine whether immunological changes in natural killer (NK) cells can be detected in patients undergoing primary chemotherapy with combined modality alternative therapies.
    • Evaluate for additional immunological response markers, chemotherapy side effects and complication rates change during combined modality alternative therapies treatment as determined by:
      • WBC with differential T and B panel (T helper cells, CD4, CD8)
      • Salivary IgA
      • Delays in chemotherapy protocol
      • Use of anti-emetics
      • Infection rate
      • Re-hospitalization rate
acupuncture
Acupuncture
  • Penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.
  • Aims to restore and maintain health through the stimulation of specific points on the body
acupuncture28
Acupuncture
  • According to TCM, health is achieved by maintaining the body in a "balanced state"; disease is due to an internal imbalance of yin and yang.
  • This imbalance leads to blockage in the flow of qi along pathways known as meridians.
  • Qi can be unblocked by using

acupuncture at certain points on

the body that connect with these

meridians.

acupuncture29
Acupuncture
  • No scientific evidence that acupuncture is effective as a treatment for cancer.
  • Relieves symptoms related to cancer and cancer therapies.
  • Effective for nausea caused by chemotherapy and anesthesia.
  • Effective for treating pain.
acupuncture for hot flashes
Acupuncture for hot flashes
  • 27 women electrostimulated acupuncture for 12 weeks – two 30 min sessions/wk for 2 wks then once weekly for the next 10
  • Hot Flashes:
    • Baseline: 9.6 / 24hr
    • 12 weeks: 4.3 / 24hr
    • 1 year: 4.9 / 24hrs
    • 2 years: 2.1 / 24hr
  • 18 women HT for 24 months
  • Hot Flashes:
    • Baseline: 6.6 / 24hr
    • 12 weeks: 0
botanicals vitamins minerals32
Botanicals, Vitamins, Minerals
  • 38 million, 12% of Americans use botanicals*.
  • Among cancer patients in the US, up to 60% use herbal supplements.
  • Symptom control, quality of life, and cancer recurrence.
  • Research has expanded.

*2002 National Health Interview Survey Centers for Disease Control and Prevention

popular botanical agents
Popular Botanical Agents
  • Essiac: burdock, turkey rhubarb, sorrel, and slippery elm. No anticancer effects. Stimulates the growth of human breast cancer cells1
  • Iscador: a derivative of mistletoe. Many studies, no definitive benefit in cancer therapy.

1. Kulp KS et al. Breast Cancer Res Treat 2006;98(3):249-259

popular botanical agents34
Popular Botanical Agents
  • Mushroom derived compounds:
    • Polysaccharide kureha (PSK), an extract of the mushroom Coriolus versicolor, or schizoplyllan.
      • Phase III trial of chemotherapy & radiotherapy +/- PSK found superior survival with PSK compared to controls in esophageal, gastric1-3 & colorectal cancers. 4-5
      • Used after therapy in colorectal cancer prolonged survival by 1 year.6-7
    • Results less encouraging for breast cancer & leukemia.8-10
  • Niimoto M. et al. Jpn J Surg 1988;18(6)681-6. 2. Ogoshi K. et al. Cancer Invest
  • 1995;13(4)363-9. 3.Torisu M. et al. Cancer Immunol Immunother 1990;31(5)261-8
  • 4-10 Available upon request
popular botanical agents35
Popular Botanical Agents
  • PC-SPES: eight herbs from Chinese medicine. Reduce PSA, and improve QOL in men with advanced prostate cancer.1-4
  • SV Soup – 19 vegetables from traditional Chinese medicine. NSCLC – enhanced survival by 11 months and improved QOL.5
  • Small EJ et al. J Clin Oncol 2000;18(21):3595-603.
  • Pfeifer BL et al. BJU Int 2000;85(4):481-5.
  • Oh WK et al. Urology 2001;57(1):122-26.
  • Oh WK et al. J Clin Oncol 2004;22(18):3705-12
  • 5. Sun AS et al. Nutr Cancer 1999;34(1)62-69
herbal products with serious side effects
Herbal Products with Serious Side Effects*

*Food and Drug Administration

herbal products with serious side effects37
Herbal Products with Serious Side Effects
  • Astragalus – can reverse the effects of cyclophosphamide.
  • Soy isoflavones may antagonize tamoxifen breast cancer prevention.
slide38

Long-term Use of Beta-Carotene, Retinol, Lycopene, and Lutein Supplements and Lung Cancer Risk: Results From the VITamins And Lifestyle (VITAL) Study.

  • 77,126 completed a detailed questionnaire about supplement use (duration, frequency, dose) during the previous 10 years.
  • 521 developed lung cancer
  • Longer duration of use of individual beta-carotene, retinol, & lutein supplements was associated with statistically significantly elevated risk of lung cancer
  • Little evidence for effect modification by gender or smoking status.
  • Conclusion: Long-term use of individual beta-carotene, retinol, and lutein supplements should not be recommended for lung cancer prevention, particularly among smokers.

Satia JA, et al. Am J Epidemiol. 2009

multivitamin use and risk of cancer and cardiovascular disease in the whi cohorts
Multivitamin use and risk of cancer and cardiovascular disease in the WHI cohorts.
  • 161,808 participants from the Women's Health Initiative
  • Detailed data were collected on multivitamin use at baseline and follow-up time points over a median of 8 years.
  • Documented cancers of the breast, colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality.
  • Results
    • 41.5% of the participants used multivitamins
    • 9619 cases of cancer, 8751 CVD events, 9865 deaths
    • Multivariate-adjusted analyses revealed no association of multivitamin use with risk of cancer.Ovarian Cancer: HR 1.07and 95% CI, 0.88-1.29
  • Conclusion: multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in PMP women.

Neuhouser ML, et al. Arch Intern Med. 2009 Feb 9;169(3):294-304.

the role of antioxidants and vitamin a in ovarian cancer results from the women s health initiative
The role of antioxidants and vitamin A in ovarian cancer: results from the Women's Health Initiative
  • Examined the relationship between intake of dietary and supplemental antioxidant nutrients including vitamins C, E, and selenium as well as carotenoids and vitamin A and ovarian cancer
  • 133,614 postmenopausal women enrolled in the WHI study.
  • Dietary intake was assessed using a food frequency questionnaire, and ovarian cancer endpoints were centrally adjudicated.
  • 451 cases of invasive ovarian cancer were diagnosed over 8.3 yr of follow-up.
  • Results: Dietary intake at baseline was not significantly different for cases vs. controls. No significant relationships among dietary factors and ovarian cancer risk.
  • Conclusion: intake of dietary antioxidants, carotenoids, and vitamin A are not associated with a reduction in ovarian cancer risk.

Thomson CA, et al. Nutr Cancer. 2008;60(6):710-9

serum levels of vitamin d metabolites and breast cancer risk in the plco screening trial
Serum levels of vitamin D metabolites and breast cancer risk in the PLCO screening trial
  • Experimental and epidemiologic studies suggest that vitamin D metabolites (1,25-dihydroxyvitamin D and its precursor 25-hydroxyvitamin D) may reduce breast cancer risk.
  • Examined breast cancer risk related to serum levels of these metabolites.
  • Women ages 55 - 74 years, who donated blood at baseline in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
  • 1,005 breast cancer cases during follow-up and 1,005 noncases were matched based on age and year of entry
  • Conclusion: In this prospective study of postmenopausal women, we did not observe an inverse association between circulating 25(OH)D or 1,25(OH)(2)D and breast cancer risk.

Freedman DM, et al. Cancer Epidemiol Biomarkers Prev. 2008;17(4):889-94

conclusion
Conclusion
  • The use of botanicals, vitamins, and minerals with cancer treatment is concerning.
  • Few studies have addressed dose levels, mechanism of action, safety or efficacy.