Communicating Complementary Therapies

The U.S. Department of Agriculture recently released a study of 71 types of broccoli—yes 71 types—to assess their levels of glucoraphanin, a compound believed to aid in preventing some types of cancer. Surprisingly, they found a 30-fold difference in glucoraphanin amounts between the plants; some had virtually none of it.

(Unfortunately for consumers, it is difficult to tell the difference without a laboratory testing the produce.)

The Agriculture Department hopes their broccoli research will soon lead to new broccoli hybrids that are richer in glucoraphanin. But in the interim, they say, there are plenty of other fruits and vegetables that also appear to have cancer-fighting benefits.

One great example—tomatoes. Tomatoes contain an antioxidant called lycopene that attacks roaming oxygen molecules known as free radicals, which are suspected of triggering cancer. (Interestingly, the hotter the weather, the more lycopene tomatoes produce. Processing also increases lycopene levels further.)

The Agriculture Department study, published in the Journal of the American Society for Horticultural Science, is only the most recent example of a subtle shift in research toward complementary and alternative approaches for battling cancer and other diseases. And such studies are long overdue.

Paradigm Shift

Without a doubt, cancer patients—and many simply wanting to minimize their risk for the disease—are turning to so-called "complementary and alternative therapies" in extraordinary numbers. Yet while some refer to these supplemental treatments as "complementary," and others as "alternative," and still others as "complementary and alternative," there actually is a difference.

Simply put, a therapy is generally called "complementary" when it is used in addition to conventional treatments; it is referred to as "alternative" when it is intended for use instead of conventional treatments. Together, complementary and alternative therapies include a broad range of healing philosophies and approaches.

Complementary methods are not intended to cure disease, but rather to help control symptoms and improve well being. For example, a patient may drink peppermint tea to help with nausea, practice meditation to reduce stress, or undergo acupuncture for chronic pain. Other complementary methods that are sometimes used along with standard treatments include: aromatherapy, art therapy, biofeedback, massage therapy, t’ai chi, and yoga.

Alternative therapies refer to treatments that are sometimes promoted as cancer cures. There is considerably more risk to the patient when traditional medical treatments are abandoned in favor of unproven or untested alternative therapies. Furthermore, when patients mix and match treatments the use of alternative therapies may counteract the benefits of standard medicines, skew lab test results, or even cause direct harm. Examples of alternative therapies include mega-doses of a particular vitamin or mineral, extreme diets, or products such as shark cartilage that are touted as cancer cures.

A Sign of Coping

In an intriguing article published in the journal Cancer, Dr. Wolfgang Sollner and colleagues from University Hospital in Innsbruck, Austria wrote that the use of complementary and alternative medicine is actually a positive sign that patients are actively coping with their disease, rather than a signal of their frustration with conventional care.

In a survey of 172 patients undergoing traditional surgical, radiation and chemotherapy treatments for their cancers, the researchers found that patients using complementary or alternative therapies were more "information-seeking and problem-solving" toward the treatment of their disease, and they received high marks for their compliance with standard treatment regimens.

Surprisingly, in spite of their use of complementary and alternative therapies, these same patients also said they "maintained a high trust" in conventional medicine.

The researchers noted that many oncologists still fear that the use of non-conventional treatments may lead patients to abandon standard medical care. On the contrary, Sollner asserted, their findings "suggest that cancer patients consider complementary and alternative therapies supplementary to standard medical methods and one way of avoiding passivity and of coping with feelings of hopelessness.

Communication Issues

Nonetheless, many cancer patients are using complementary and alternative therapies without telling their doctors.

In a study published in the Journal of Clinical Oncology, researchers from the University of Texas found that 99.3 percent of outpatient cancer patients at the school’s M.D. Anderson Cancer Center had heard of complementary and alternative medicine, and 83.3 percent had tried at least one approach.

However, about 60 percent of these patients said they did not discuss complementary and alternative therapies with their doctor, although when interviewed in more detail about individual therapies, this rate dropped to a lower—but still significant—38.2 percent.

Richardson and her colleagues interviewed 453 patients undergoing cancer treatments at one of eight clinics at M.D. Anderson. When they excluded psychotherapy and spiritual practices, they found that more than two-thirds (68.7 percent) of the patients reported using at least one unconventional therapy. Of these, more than a third had used herbs like essiac tea, mistletoe and ayurveda, while 60 percent had used vitamins, including melatonin and shark or bovine cartilage.

Richardson’s team found that users of complementary and alternative therapies tended to be female, younger, and with more advanced disease. Reasons cited for their use of such therapies included a desire to improve quality of life, to boost the immune system and to prolong life. More than a third (37.5 percent) said they had turned to these therapies as a cure for their cancer.

In a presentation at a recent meeting of the American Society for Clinical Oncology in New Orleans, Dr. James Metz of the University of Pennsylvania Cancer Center found that cancer patients who use unconventional medical treatments only tell their doctor when specifically prompted to do so.

Of the 196 cancer patients interviewed in the study, only 13 percent revealed their use of unconventional medicines—defined as those not proven in the eyes of the medical profession—when asked about over-the-counter and prescription drugs. But when given specific questions about the use of vitamins, herbal supplements, shark cartilage and therapies such as guided imagery music or medication, a total of 92 percent admitted they did.

Metz expressed concern that many of these treatments could interfere with conventional therapies that are being prescribed. For example, vitamin A has been linked to an increased risk of stomach cancer, and concerns have been raised about the interaction of St. John’s Wort with certain medicines. Vitamins C and E are antioxidants that could interfere with or inhibit radiation treatment. And many supplements can skew the results of laboratory tests.

Physician’s Share the Blame

Many doctors are surprisingly unaware of the use of complementary and alternative treatments by their patients. In one study of prostate cancer patients by Dr. Gary Kao of the Hospital of the University of Pennsylvania and Pamela Devine of the Department of Veterans Affairs Medical Center in Philadelphia, 37 percent of the patients were found to be using at least one complementary health practice. However, the physicians estimated that only 4 percent of their patients used such therapies.

Writing in the journal Cancer, Kao and Devine said that the danger of such a wide communication gap is that many patients are making their own conclusions regarding how the complementary treatment would interact with conventional medicines in the absence of specific instructions by their healthcare provider.

Interestingly, in a report published in The Journal of Alternative and Complementary Medicine, Dr. Ira Wilson of the New England Medical Center in Boston noted that two-thirds of physicians say they believe that complementary and alternative therapies may help some patients. In addition, 36 percent reported that they personally had used such therapies.

SOURCES:

Journal of the American Society of Horticultural Science, 2000; 125(4): 482-488
U.S. Department of Agriculture, Agricultural Research Service (http://www.ars.usda.gov)
Cancer, August 15, 2000; 89:873-880
Journal of Clinical Oncology, July 2000; 18:2505-2521
Abstracts from the Annual Meeting of the American Society of Clinical Oncology, May 23, 2000, New Orleans, LA 
The Journal of Alternative and Complementary Medicine, October 1999; 5; 447-456
Cancer, February 1, 2000; 88:615-619

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