The Need for Complementary Alternative Cancer Therapies
Mainstream medical treatment of cancer revolves around surgery,
chemotherapy, and radiation therapy, used either alone or in
combination (Isobe T et al 2005; Ostoros G et al 2005). Chemotherapy
and radiation therapy cannot discriminate between cancer cells and
healthy cells; thus, they damage both types of cells and cause serious
and often debilitating side effects, frequently forcing patients to
abandon treatment (Ettinger DS 2005; Giraud P et al 2004; Munden RF et
al 2005). Therefore, it is not surprising that many cancer patients now
opt to complement conventional treatments with alternative therapies
that may not only temper the adverse side effects of conventional
cancer therapy, but also improve its effectiveness via independent
anti-cancer effects.
What Are Complementary Alternative Therapies?
Complementary alternative medical therapies (CAM) is a collective
term for an array of remedies that lie outside what is traditionally
considered conventional medical treatment for cancer. These include the
use of herbal, vitamin, and nutritional supplements, as well as
physical and psychological interventions such as exercise, relaxation,
massage, prayer, hypnotherapy, and acupuncture (Deng G et al 2005; Hann
D et al 2005; Molassiotis A et al 2005). The use of CAM as a component
of integrated cancer treatment regimens may help patients reduce the
side effects associated with conventional cancer treatments, alleviate
symptoms, enhance immune function, and provide greater quality of (and
control over) life (Deng G et al 2004, 2005).
The use of CAM is popular among cancer patients undergoing
conventional treatment (Hann D et al 2005; Molassiotis A et al 2005).
Over 72 million patients used complementary alternative therapies in
the past year (Tindle HA et al 2005) to help control their disease. In
the United States, 91 percent of cancer patients implemented at least
one form of CAM in addition to undergoing conventional cancer treatment
(Yates JS et al 2005). The most popular forms of CAM were exercise,
relaxation, and prayer (Yates JS et al 2005).
Although most physicians acknowledge the benefits of physical and
psychological CAM therapies, the role of nutritional and mineral
supplements, particularly when used in conjunction with chemotherapy
and radiation therapy, is an issue of considerable controversy.
Cancer Patient Nutrition: The Use of Dietary Supplements/Antioxidants During Conventional Treatment
In the following section, we summarize key findings from published
studies demonstrating that dietary supplements influence clinical
outcomes and long-term survival, as opposed to showing only a
short-term benefit:
- Encouraging results from a clinical study have shown that the use
of antioxidants during chemotherapy treatment does not compromise the
treatment. In this study of lung cancer patients, supplementation with
vitamin C, vitamin E, and beta-carotene did not interfere with the
effectiveness of chemotherapy (Pathak AK et al 2005). In fact,
recipients of chemotherapy who took antioxidants had better response
rates and overall survival than those who received chemotherapy alone;
however, these differences did not reach statistical significance
(Drisko JA et al 2003; Pathak AK et al 2005).
- In a study of non-small cell lung cancer patients over 60
years of age who had undergone surgery to remove their primary
tumor(s), doctors compared survival in vitamin users to nonusers and
measured blood folate levels as an indicator of folic acid intake. The
average survival of nonusers was only 11 months, compared to 41 months
for vitamin users; in other words, supplement users survived almost
four times longer than did nonusers. Patients with higher blood folate
levels also had improved long term survival (Jatoi A et al 1998). The
Mayo Clinic researchers who conducted this study have conducted further
studies with larger patient samples, and their results consistently
show improved survival and quality of life in non-small cell lung
cancer patients who use vitamin and mineral supplements (Jatoi A et al
2005a; Jatoi A et al 2005b).
- Another study examined a group of transitional cell bladder
cancer patients. One group was given BCG (a tuberculosis vaccine)
immune-augmentation therapy plus the recommended daily allowance (RDA)
of vitamins. The second BCG-treated group (the mega-dose group)
received the RDA plus 40,000 IU of vitamin A, 2000 mg of vitamin C, 400
IU of vitamin E, 100 mg of vitamin B6, and 90 mg of zinc. After five
years, cancer recurrence rates were 91 percent in the group that
received the low-potency RDA vitamins, but only 41 percent in the
mega-dose group. In this study, large doses of vitamins resulted in a
55 percent reduction in cancer recurrence (Lamm DL et al 1994).
- Uveal melanoma is a rare form of melanoma that occurs in the
iris of the eye (Tallberg T et al 2000). Nine random high-risk patients
with uveal melanoma had standard conventional therapy to eradicate
their primary tumors. The patients were then put on a nutritional
supplement regimen consisting of folic acid, trace minerals, amino
acids, and fatty acids. After 80 months of follow-up, none of the nine
patients experienced recurrent disease, compared to a similar group of
patients who did not receive these supplements. Given that 100 percent
of these high-risk patients were free of disease after almost seven
years, the results provide further evidence of the potential value of
nutritional supplementation for cancer patients (Tallberg T et al
2000).
- Studies of breast cancer patients have shown that patients
using antioxidants are less likely to suffer a recurrence or die from
their cancer (Fleischauer AT et al 2003).
- The effectiveness of 5-fluorouracil (5-FU), a chemotherapy
agent used to treat breast cancer, was improved when it was
administered in combination with folic acid (Kreienberg R 1998). 5-FU
is also commonly used in colon, liver, and pancreatic cancers, but has
not shown a high degree of efficacy (Christopoulou A 2004). A
randomized trial of patients with metastatic colorectal carcinoma
compared the effects of 5-FU administered alone and in combination with
folic acid. Compared to the group receiving 5-FU alone, the patients
receiving 5-FU plus folic acid experienced a 76 percent overall tumor
reduction. Survival in the group receiving 5-FU plus folic acid was 47
percent greater than in the group receiving 5-FU alone. The addition of
folic acid to this chemotherapy drug regimen resulted in an improved
therapeutic profile and significantly prolonged survival time (Loffler
TM et al 1992). These results are summarized in Table 1 below.
Table 1: Effect of folic acid on the effectiveness of 5-FU chemotherapy
|
|
5-FU |
Folic Acid and 5-FU |
Difference |
|
Complete or partial remission |
9% |
16% |
7% |
|
Arrest of tumor growth |
20% |
60% |
40% |
|
Progression |
71% |
24% |
47% |
- Advanced cancer patients exhibit a range of defects in their
immune capacity that likely contribute to an increased susceptibility
to infections and disease progression (Campbell MJ et al 2005). A study
of 12 advanced colorectal cancer patients sought to determine whether
supplementation with vitamin E could enhance immune function. The
patients received a daily dose of 750 mg (<1200 IU) of vitamin E
beginning two weeks prior to intervention with chemotherapy or
radiation treatment. Short-term supplementation with vitamin E led to
increased white blood cell (lymphocyte) counts (CD4:CD8 ratios) and
enhanced the lymphocytes’ ability to produce interleukin-2 and
IFN-gamma, which are required for the immune system to destroy cancer
cells (Malmberg KJ et al 2002).
While all the studies mentioned above (and many others) showed the
benefit of dietary supplements for cancer patients simultaneously
undergoing conventional medical treatment, some studies have failed to
show any benefit or have shown mixed effects from taking nutritional
supplements (Lesperance ML et al 2002). In one study, high levels of
folic acid supplementation were associated with greater reductions in
neutrophils (a type of white blood cell); however, the same study
showed that low neutrophil levels caused by chemotherapy could be
improved by vitamin E supplements (Branda RF et al 2004). A
preponderance of evidence supports the use of antioxidants with
conventional cancer treatments (Moss RW 2006). However, cancer patients
are advised to consult physicians who are experienced in both
conventional cancer treatments and nutritional oncology.
Physical and Psychological Supportive CAM Therapies
Rehabilitation programs for cancer patients involve
a combination of physical and psychological interventions that improve
the patient’s physical comfort and ability to function (Pandey M et al
2001; Santiago-Palma J et al 2001). These are thought to alleviate the
emotional distress caused by the patient’s loss of mobility and need
for self-care (Cheville AL 2005; Fialka-Moser V et al 2003).
Acupuncture improves cancer symptoms and
treatment-related side effects such as nausea, pain, hot flashes, and
breathlessness (Samuels N 2002). Indeed, the American Cancer Society
recommends the use of acupuncture in cancer patients (Samuels N 2002).
In a study of the use of acupuncture in cancer patients, as many as 60
percent of patients showed an improvement in their symptoms (Johnstone
PA et al 2002).
Hypnosis improves the symptom of hot flashes
(Elkins G et al 2004) and overall quality of life by reducing anxiety
and insomnia in breast cancer patients (Elkins G et al 2004). Hypnosis
is also recommended as an integral part of palliative care (symptom
relief) for cancer patients, with a view to reducing pain and shortness
of breath (Marcus J et al 2003). In addition, hypnosis improves mental
health and overall well-being in cancer patients treated with radiation
therapy (Stalpers LJ et al 2005).
Breathing Exercises. A study of cancer patients
recovering from stem cell transplantation showed that following a
breathing exercise program for six weeks reduced levels of fatigue (Kim
SD et al 2005).
Massage and Aromatherapy improve the general
psychological health of cancer patients and, in particular, reduce
anxiety levels, pain, and nausea (Fellowes D et al 2004). Breast cancer
sufferers receiving massage therapy have improved immune system
function and feel less depressed and angry about their circumstances
(Hernandez-Reif M et al 2005). A combination of aromatherapy, foot
soaking, and reflexology improves the fatigue that is often experienced
by cancer patients (Kohara H et al 2004).
Yoga Meditation. Kundalini yoga involves a variety
of meditation techniques that are effective in alleviating anxiety,
fear, anger, and depression (Shannahoff-Khalsa DS 2005). Indeed, this
type of yoga helped breast and prostate cancer patients think
positively about their cancers (Shannahoff-Khalsa DS 2005).
Humor. Laughing has always been recognized as a
good relaxation and coping strategy. Scientific studies have now
demonstrated that laughter is able to reduce anxiety and physical
discomfort in cancer patients (Christie W et al 2005). Laughter has a
beneficial effect on the immune system and improves the function of
natural killer cells, which play an important role in counteracting
cancer (Bennett MP et al 2003; Berk LS et al 2001; Christie W et al
2005; Takahashi K et al 2001). Laughter is also known to improve pain
threshold in cancer patients and to reduce levels of stress hormones
(Christie W et al 2005).
Positive Visualization. Adoption of hope-inspiring
interventions by cancer care providers is associated with an
improvement in patients’ ability to cope with the fear and anxiety
associated with a cancer diagnosis (Felder BE 2004; Watts S et al 2004).
Exercise. Various forms of exercise, including Tai
Chi Chuan, improve the quality of life of cancer patients (Jones LW et
al 2004; Mustian KM et al 2004) recovering from surgery or undergoing
treatment. Exercise alleviated fatigue and improved heart and lung
function and overall physical well-being (Dimeo FC et al 2004; Kendall
AR et al 2005; Mock V et al 2005; Stevinson C et al 2004; Thorsen L et
al 2005).
Hydration. Many cancer patients, particularly those
with terminal disease, suffer from low levels of body fluids, or
dehydration (Dalal S et al 2004). Artificial hydration in these
patients improves dehydration symptoms (Bruera E et al 2005) and is
also useful in treating chemotherapy-related diarrhea and kidney
disease (Polycarpe E et al 2004; Saltz LB 2003). However, artificial
hydration should be approached with caution and used according to each
patient’s medical condition, as it can also aggravate symptoms
associated with water retention, such as edema (Morita T et al 2004;
Morita T et al 2005).
The Importance of Nutrition During Cancer Treatment
The nutritional status of cancer patients is often compromised as a
symptom of the cancer or as a side effect of conventional treatment
(Usharani K et al 2004). Indeed, a significant number of patients
recovering from cancer are malnourished (Guo Y et al 2005) or have
suffered considerable weight loss (Colasanto JM et al 2005). The
nutritional status of cancer patients has an impact on a variety of
important factors, including:
- Treatment tolerance
- Survival and overall outcome
- Immune function
- Cancer development and progression.
Nutritional intervention as an integral part of cancer treatment can
be implemented by eating healthy foods and taking supplements or by
administration of enriched formulas through a feeding tube directly
into the gastrointestinal tract (enteral) or injection into the veins
(parenteral) (Hyltander A et al 2005). Enteral nutrition is always the
preferred method of feeding cancer patients when the gastrointestinal
tract is functional but the oral route is compromised; parenteral
nutrition should be provided only to selected patients, as it is of
little benefit to most cancer patients.
However, parenteral nutrition can be administered in the comfort of
the patient’s home and improves the long-term survival of patients with
incurable advanced disease (Hoda D et al 2005). In particular, this
type of artificial feeding can be useful in gynecological and colon
cancer patients who often suffer from intestinal tract obstruction
(McKinlay AW 2004). In a recent study comparing the different types of
nutritional intervention during cancer treatment, normal oral nutrition
was superior to enteral and parenteral feeding only when it was
supported by nutritional counseling from a dietician (Hyltander A et al
2005).
Treatment Tolerance. Nutritional intervention
during cancer treatment may help patients to better tolerate cancer
treatment, with less frequent adverse side effects (Bahl M et al 2004;
Capra S et al 2001; Read JA et al 2004). In particular, patients with
nasopharyngeal cancer, when artificially fed through a tube before
treatment, had less weight loss and superior recovery compared to
patients who had the nutritional intervention only after treatment
(Bahl M et al 2004).
Survival and Overall Outcome. Malnourished cancer
patients are more likely to have longer periods of hospitalization,
lower survival rates, and a higher frequency of medical complications
(Colasanto JM et al 2005; Guo Y et al 2005). A study of stomach cancer
patients recently showed that nutritional status affected the patients’
quality of life, and the authors recommended increasing the number of
high-protein, high-calorie meals consumed each day as a way to improve
nutritional status (Tian J et al 2005).
Studies of colorectal and head and neck cancer patients have shown
the beneficial effect of nutrition on survival and quality of life
(Ravasco P et al 2005b; Ravasco P et al 2005a). These studies have also
highlighted the importance of cancer patients having access to
counseling and guidance from a dietician. In fact, these studies showed
that regular foods supported by dietary counseling were more beneficial
than enriched nutritional supplements taken in the absence of qualified
guidance (Ravasco P et al 2005b; Ravasco P et al 2005a).
Immune Function. Impaired nutritional status in
cancer patients is associated with reduced numbers of white blood cells
(most often neutropenia) and low red blood cell counts, or anemia
(Usharani K et al 2004). Administration of a specialized formula
enriched with nutrients (including arginine and omega-3 fatty acids) to
cancer patients before surgery reduced the occurrence of infections and
time spent in the hospital (Moskovitz DN et al 2004). Because of its
immunomodulatory properties, arginine helps to restore immune system
balance in cancer patients after surgery (Ates E et al 2004); however,
further research is necessary to define its role in the nutritional
care of cancer patients
Delays in the healing of surgical wounds—or a complete failure of
the wounds to heal—often complicates the rehabilitation of malnourished
cancer patients after surgery (Farreras N et al 2005). Artificial
nutrition of gastric cancer patients after surgery with a formula
designed to boost the immune system improves wound healing and recovery
(Farreras N et al 2005).
Cancer Development and Progression. A study of
patients with high levels of prostate-specific antigen (PSA), a widely
accepted indicator of the risk of developing prostate cancer, showed
that a diet of low fat and high soybean protein content induced a
significant, though temporary, reduction in PSA levels (Tsutsumi M et
al 2004).
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