Table 61 Some Experts Recommendations on CAM Therapies

All cancer survivors should avoid High-dose vitamin A and C supplements

Some cancer survivors should avoid

Antioxidants (anyone actively undergoing chemotherapy or radiation) Soy (phytoestrogens) (women with breast or endometrial cancer) Acupuncture (sometimes not advisable in people with a low platelet count or people receiving anticoagulant therapy) Deep tissue massage (sometimes not advisable in people with a low platelet count or severe osteoporosis or people receiving anticoagulant therapy)

St. John's wort (anyone taking medications that may be altered by this supplement)

Restrictive dietary regimens (often not advisable for people with poor nutritional status)

Some cancer survivors may benefit from

Certain dietary regimens (such as reduced fat for people with breast and prostate cancers)

Cruciferous vegetables (broccoli, cauliflower, collards, bok choy, kale, mustard greens, turnips, brussels sprouts) Flavonoids (cranberries, bilberries, blueberries, onions, green beans, lettuce, rhubarb) Lycopene (tomatoes, apricots, watermelon, papaya) Omega-3 fatty acids (flaxseed, salmon, halibut, cod, tuna, shark, sardines, herring, mackerel)* Vitamin E supplementation Soy supplementation (men with prostate cancer) Shark cartilage (studies are inconclusive) Acupuncture

Massage (people who are anxious or have lymphedema or nausea) Moderate exercise (see Chapter 7 for details on this topic) Psychological and mind-body therapies

Source: Adapted from W. A. Weiger et al., "Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer," Annals of Internal Medicine 137 (2002): 889-903.

*Use with caution if you are taking anticoagulants or aspirin.

improve sleep, relieve pain, and diminish symptoms of anxiety or depression. Some CAM therapies can help with treatment-related side effects, such as nausea or hot flashes. In some instances, they may also improve immune function. For example, studies have shown benefit from hypnosis for cancer pain and nausea; from relaxation therapy, music therapy, and massage for anxiety; and from acupuncture for nausea and pain.

Cancer patients most commonly try special dietary regimens, herbs, homeopathy, hypnosis, imagery, meditation, megadoses of vitamins, relaxation, and spiritual healing. Progressive muscle relaxation, imagery, hypnosis, prayer, and meditation are all reasonable to try. They may help reduce stress and pain and have essentially no side effects. Some treatments, such as massage and acupuncture, are usually fine to try, though in rare instances your doctor may not want you to use them. For example, if your immune system has been suppressed by cancer treatment or if you are taking anticoagulants, then both massage and acupuncture may be unwise (not always; check with your doctor). If you have extremely brittle bones from osteoporosis, then deep-tissue massage might not be the best treatment for you to try. Some doctors also recommend that you not have massage over an area where you had or have a tumor. Yoga is usually well tolerated unless extreme positions are used. Check with your doctor before beginning any exercise program.

Joseph Audette (another doctor in my department) and I wrote a chapter containing information about the healing effects of acupuncture in a book titled Rehabilitation of Sports Injuries. Here is an excerpt:

The use of acupuncture by athletes to treat acute injuries is very common in Asia and Eastern Europe and is increasingly becoming an option in many Western nations. At the Winter Olympics in Japan in 1998, international exposure came when the acupuncturist in Nagano offered free treatments to Olympic athletes and officials, emphasizing that it is a drug-free way to treat injuries. Even more stunning was the near miraculous recovery in response to acupuncture by the Austrian, Hermann Maier. Maier won gold medals in the giant slalom and super G, 3 days following a dramatic fall and injury that occurred during the downhill competition. Maier mentioned to the press that the use of acupuncture to treat his shoulder and knee injuries following the fall helped him to recover so quickly.

As I indicated earlier, acupuncture, once considered a CAM therapy, is more often now accepted as a mainstream treatment for musculo-skeletal conditions due to its pain-relieving (analgesic) effects and its effects on the immune system. The use of acupuncture in cancer patients may help with chemotherapy-related side effects such as nausea, vomiting, and pain. Acupuncture can also be tried in the post-treatment phase for residual surgical pain or other pain as well as to help heal musculoskeletal injuries. For example, one of my patients is a woman who had a mastectomy and developed significant lymphedema, a condition involving arm swelling that may occur after surgical exploration of the underarm lymph nodes. Because my patient was trying to protect the arm that had lymphedema, she overused her other arm and developed a common musculoskeletal overuse injury called lateral epicondylitis (also known as "tennis elbow"). Acupuncture may be helpful for lateral epicondylitis and is a reasonable remedy to prescribe.

Medical doctors are most concerned about patients who ingest herbal products or megadoses of vitamins or other supplements that are not regulated as drugs and therefore have not undergone vigorous scientific testing. These products can be purchased at drugstores and health stores. In some instances, they might harm someone recovering from cancer treatment. Moreover, what these products actually contain and the quality of the preparation is variable (as demonstrated by the study on the heavy metal content of Ayurvedic herbal medicine products). Extreme dietary regimens can also be hazardous to one's health and may inhibit healing.

Another problem with CAM treatments is that the people who are offering advice may have little or no training. For example, some states do not require any training or licensure to perform acupuncture. In a 2003 study titled "Health Food Store Recommendations: Implications for Breast Cancer Patients," the authors investigated the advice given to women with breast cancer who visited thirty-four health food stores in a major Canadian city. Employees at the stores that were studied gave out quite a bit of advice—most of which was misleading and some of which was wrong and potentially very harmful. For example, the vast majority of consumers were not asked whether they were on any prescription medications, yet the employees felt confident in recommending products to be ingested. There was no consistency in which products were suggested, and none of them had proven therapeutic value. Two employees suggested a possible cure with one of their products, and another employee told one woman to stop taking tamoxifen (a mainstream and proven treatment to help prevent breast cancer recurrence). These employees also offered advice on other "experts" to consult and suggested books for further reading. The authors of the health food store study noted: "This study also highlights the vulnerability of patients with breast cancer to potentially misleading information from health food employees. Advice presented by health food employees was authoritative and could be misconstrued by patients as evidence-based, particularly when books are consulted or literature is provided on the products."

Of course it is not just advice from health food store employees that one should be wary of. Well-meaning friends, neighbors, co-workers, and others often give advice about CAM treatments because they truly want to reach out to someone who is ill. As these therapies are further studied, much more information will be generated about which treatments will help people who have been diagnosed with cancer. Dr. Christine Horner, in her book Waking the Warrior Goddess, writes of a future in which conventional medicine and CAM are both optimally utilized. She suggests, "An integrated system of medicine—one that combines the best technologies of Western medicine with those of ancient holistic systems of medicine—will serve us best. Imagine a system of medicine that uses all of the best knowledge and techniques of health from every culture in the world, where rapidly advancing sophisticated technology is built on a base that includes everything we have learned about our bodies and health over thousands of years since the beginning of recorded time."

Indeed an integrated health care approach is ideal, especially if we are able to use the best of all medical practices. Medical doctor Paul Brenner has an appreciation for many medical systems, and although he is an advocate of "holistic" medicine, he writes in Buddha in the

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