Complementary Medicine in Cancer Therapy

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Complementary Medicine in Cancer Therapy

• Patricia L. Judson, MD
• Associate Professor
• Gynecologic Oncology
• University of Minnesota

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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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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

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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

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Herbs, Vitamins and Minerals

• Marijuana
• Milk Thistle
• Mistletoe
• Molybdenum
• Mugwort
• Oleander Leaf
• Orthomolecular medicine
• Pau DArco
• PC-SPES
• Peppermint
• Phytochemicals
• Pokeweed
• Potassium
• Psyllium
• Pycnogenol
• Rabdosia Rubescens
• Red Clover
• Saw Palmetto
• Selenium

• Aconite
• Aloe
• Alsihum
• Arnica
• Astragalus
• Aveloz
• Beta Carotene
• Betulinic Acid
• Black Cohosh
• Black Walnut
• Bromelain
• Calcium
• Capsicum
• Cats Claw
• Celandine
• Centella
• Cesium Chloride
• Chamomile
• Chaparral

• 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

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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

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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
• Revicis Guided Chemotherapy
• Sea Cucumber
• Shark Cartilage
• Shark Liver Oil
• Urotherapy
• 714-X

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Tonight

• My CAM research trial
• Acupuncture
• Botanicals, Vitamins, Minerals

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Outcomes in Ovarian Cancer PatientsUsing
Complementary Alternative Medicine
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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
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Clinical Hypnosis
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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.

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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.

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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.

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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.

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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 (ppain relief.
• Related to decreased nausea and vomiting post
  chemotherapy, with decreases persisting after
  training visits with the therapist ended.

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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

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Massage Therapy

• Manipulation, rubbing and kneading of the bodys
  muscle and soft tissue.

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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

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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.

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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.

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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 (preduction in their state of anxiety according to
  a comparison of pre- and post-test means on the
  State Anxiety Inventory

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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.

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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.

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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

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Questions?
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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

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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.

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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.

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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

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Botanicals, Vitamins, Minerals
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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
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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
200698(3)249-259
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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 198818(6)681-6. 2.
  Ogoshi K. et al. Cancer Invest
• 199513(4)363-9. 3.Torisu M. et al. Cancer
  Immunol Immunother 199031(5)261-8
• 4-10 Available upon request

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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 200018(21)3595-603.
  
• Pfeifer BL et al. BJU Int 200085(4)481-5.
• Oh WK et al. Urology 200157(1)122-26.
• Oh WK et al. J Clin Oncol 200422(18)3705-12
• 5. Sun AS et al. Nutr Cancer 199934(1)62-69

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Herbal Products with Serious Side Effects
Food and Drug Administration
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Herbal Products with Serious Side Effects

• Astragalus can reverse the effects of
  cyclophosphamide.
• Soy isoflavones may antagonize tamoxifen breast
  cancer prevention.

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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

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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
  9169(3)294-304.

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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. 200860(6)710-9

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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. 200817(4)889-94

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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.

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Thank You!