Health Studies 301 Complementary and Alternative Therapies

Study Guide: Unit 14

Cancer Therapy

Whole body hyperthermia therapy as a treatment for cancer. Peter Wolf, 2012, CC BY-SA 3.0.

There are today more than 80 CAM therapies used in the treatment of cancer. They range from diet and nutrition to mind–body techniques. Approximately half of all cancer patients seek some type of CAM therapy. This unit focuses on the more common CAM therapies often used by persons with cancer.

Learning Objectives

Upon completion of Unit 14, you should be able to

• discuss the nature of CAM cancer therapies.
• determine the effectiveness of CAM cancer therapies by analyzing the available research.
• identify trends and issues related to CAM cancer therapies.

Learning Activities

Study Questions

As you complete the activities for Unit 14, keep the following questions in mind. You may want to use the Personal Learning Space wiki on the course home page, and answer these questions as a way of keeping notes to focus your learning.

1. Why do people seek alternative cancer therapies?
2. What kinds of CAM are used to treat cancers?
3. What kind of evidence has been presented for the efficacy of CAM cancer therapies?
4. What are the risks involved in using these therapies for cancer?
5. What is the difference between alterative and complementary cancer therapies?

Unit 14 Discussion Forum

When you have completed the other activities for this unit, answer at least one of the questions in the Unit 14 Discussion Forum and respond to at least one post by a fellow learner.

The more questions you answer, the better prepared you will be for the final exam!

Complementary and Alternative Medicine and Cancer

Conventional cancer treatment is painful and debilitating, and is often unsuccessful. It is not surprising, therefore, that many cancer patients seek CAM therapies in an attempt to improve their quality of life and prolong their life. This is especially the case with patients who have been told that their disease is untreatable.

Complementary and alternative therapies can be classified into two broad groups. One group includes alternative therapies. Here the intention is to achieve an anti-cancer action. Therapies of this type include diet and nutrition, pharmacological and biologic treatments, and herbal medicines. The other group includes CAM therapies that are complementary and are intended to support the patient while he or she undergoes conventional treatment. Examples are music therapy, massage therapy, and mind–body techniques. The dividing line between the two groups is often fuzzy.

Practice

Over the past century many novel treatments for cancer have been developed and presented to the world. Here we look at a selection of them.

Diet and Nutrition

Individuals with cancer often use anti-cancer diets and nutritional supplements as part of their overall treatment. There has been a great deal of speculation that various dietary regimens or dietary supplements may be of value in the treatment of cancer. However, no dietary intervention has ever been proven to cure cancer, although some diets have had a positive effect on the quality of life of a person with cancer.

Among the more popular diets used are the following:

• Macrobiotic diet. This diet was mentioned in Unit 11 in the section on vegetarian diets. Traditional oriental concepts of yin and yang are the basis of this diet. It is mainly vegetarian with a large content of whole grain cereals. It may also have a high content of vegetables and soybean products. There is no good evidence that the diet is of any value for persons with cancer (Weiger et al., 2002). Unless carefully formulated, the diet may be low in several nutrients and therefore potentially harmful for poorly nourished cancer patients.

• Gerson therapy. This treatment was developed by Max Gerson, a doctor in the United States, based on his previous work in Germany. The therapy has several features that resemble naturopathy. An important component is coffee enemas that are intended to remove “toxins” from the body. The patient is placed on a low-fat diet, with fruit and vegetable juices given hourly. The patient is also given numerous other medicines and dietary supplements, including thyroid treatment and potassium supplements, while salt is restricted.

  A study was made on 153 patients treated for melanoma at a hospital in Tijuana, Mexico (Hildenbrand, Hildenbrand, Bradford, & Cavin, 1995). This was not a randomized study. Instead, the progress of the patients was compared with that of similar patients reported in the medical literature. The conclusion from the study is that “The 5-year survival rates reported here are considerably higher than those reported elsewhere.” This study has several features that must make one very hesitant to accept the findings at face value.

  First, the patients were treated at a clinic in Tijuana. As discussed later in this unit, this city is considered by some to be the epicentre of suspect cancer treatment. Second, the study was done by an organization called the Gerson Research Organization, based in San Diego, California. This suggests the very real risk of bias in the conduct and evaluation of the research. Third, the method used, of comparing patients treated by different doctors at different clinics, is prone to serious errors.

• Megadose vitamin C. The section on dietary supplements in Unit 11 discussed the use of megadoses of vitamin C to prevent cancer and the common cold. Clinical studies indicate that this treatment is of no value for patients with cancer (Weiger et al., 2002).

Pharmacologic and Biologic Treatments

The more common treatments in this category are as follows:

• Antineoplastons. These are based on a “discovery” made by Dr. Stanislaw Burzynski while a graduate student in Poland. He later emigrated to the United States where he developed his treatment. He operates the Burzynski Clinic and the Burzynski Research Institute. The treatment consists of peptides, amino acids, and other simple organic substances that are said to promote the body’s natural defences against cancer. The therapy has been attacked numerous times by the U.S. Food and Drug Administration (FDA) and medical researchers on the grounds that there is an absence of any supporting evidence (Vickers, 2004; “Burzynski Clinic,” n.d.).

• Shark cartilage. Some years ago a book was published with the title Sharks Don’t Get Cancer. This resulted in shark cartilage becoming a popular treatment of cancer. Here is how experts summed up the subject:

  The promotion of crude shark cartilage extracts as a cure for cancer has contributed to at least two significant negative outcomes: a dramatic decline in shark populations and a diversion of patients from effective cancer treatments. An alleged lack of cancer in sharks constitutes a key justification for its use.… Scientific evidence to date supports neither the efficacy of crude cartilage extracts nor the ability of effective components to reach and eradicate cancer cells. The fact that people think shark cartilage consumption can cure cancer illustrates the serious potential impacts of pseudoscience (Ostrander, Cheng, Wolf, & Wolfe, 2004).

• Laetrile. This is one of the most publicized alternative cancer therapies. Laetrile is a substance found in the seeds of particular fruits and nuts. It produces cyanide when broken down in the body. It has been claimed that the cyanide selectively poisons cancer cells, but no supporting evidence has been produced (Vickers, 2004). Over the last 40 years, thousands of cancer sufferers have paid millions of dollars for treatment, often at clinics in Mexico.

• Di Bella Multitherapy. This is a multi-drug, customized, medical treatment developed by Luigi Di Bella, an Italian physician who has reportedly administered it on a private outpatient basis for many years (Traversa et al., 1999). The drug cocktail consists of several main ingredients: the hormone drugs somatostatin and melatonin, and a mixture of vitamins A, D, and E. Di Bella claims it is effective in blocking, if not curing, most cancers. Extensive trials done by an Italian Study Group found that the treatment was of little or no benefit (Italian Study Group, 1999; Buiatti, Arniani, Verdecchia, & Tomatis, 1999).

  The treatment attracted much media interest in many countries, including Canada. As a result, in 1998, the Government of Canada sent four Canadian doctors to Italy to investigate the treatment. In their report, they recommended that Canada not introduce the treatment or subject it to clinical trials, as it is scientifically unfounded (Gray, 1998).

Herbal Medicines

Unit 10 discussed herbal medicine. Herbal remedies are employed for a wide variety of medical conditions, including cancer. Herbal treatments usually have a prominent place in traditional medical systems.

Most herbal medicines are of unproven value (Miller, Stagl, Wallerstedt, Ryan, & Mansky, 2008). However, we need to bear in mind that many of today’s drugs were originally used as herbal treatments. It is therefore quite possible that some herbal treatments may be of therapeutic value for cancer.

• Hoxsey treatment. This was developed more than a century ago by Harry Hoxsey. He dispensed the treatment through his clinics in the United States. The preparation is a mixture of herbs and other substances. One of the herbs is pokeweed root, which is poisonous and can be fatal. The treatment has never been properly tested.
• Essiac. This is a herbal mixture, apparently of Native American origin. An Ontario nurse, Renee Caisse, believed that the concoction could treat cancer. She named it Essiac (Caisse spelled backwards). In 1922 she set up a clinic where she treated thousands of cancer patients. The treatment is still used today. Overall, the evidence is weak that this therapy is effective (Ulbricht et al., 2009).
• Mistletoe. An extract of mistletoe, known as iscador, has been used as a cancer treatment for decades. Much research has been carried out into this treatment, often with apparently positive results on survival and quality of life (Büssing, Raak, & Ostermann, 2012; Ostermann, Raak, & Büssing, 2009). A point stressed by the investigators who reviewed this subject is that definitive conclusions cannot be made because many of the studies were of poor methodological quality.

Popularity of CAM Therapies

Surveys consistently show that large numbers of cancer patients use CAM therapies. A survey in Canada carried out in 2005 found that that more than 80% of all women with breast cancer report using CAM (41% in a specific attempt to manage their breast cancer) (Boon, Olatunde, & Zick, 2007). The most commonly used foods or supplements taken for symptoms associated with the cancer were green tea, vitamins C and E, flaxseed, and specialty foods/diets. Each was used by about 10% to 13% of the women. Lesser numbers used essiac and shark cartilage. The most commonly used types of CAM for symptoms associated with breast cancer were, in decreasing order, massage therapy (10%), nutrition, reiki, naturopathy, homeopathy, and therapeutic touch (3.6%).

Complementary and alternative therapies for cancer are available from a variety of sources. A survey of naturopaths in the United States and Canada found that the CAM therapies most commonly used by these practitioners were dietary counselling (94%), herbal medicines (88%), antioxidants (84%), and supplemental nutrition (84%). The most common specific treatments were vitamin C (39%), coenzyme Q10 (34%), and Hoxsey formula (29%) (Standish, Greene, Greenlee, Kim, & Grosshans 2002).

Hazards of CAM, Possible Benefits, and Patient Motivation

To evaluate the possible hazards and benefits of CAM therapies, we need to distinguish between those therapies that are alternative (used with the intention that the therapy will have an anti-cancer action) and those that are complementary (intended to support the patient while he or she undergoes conventional treatment).

Alternative cancer therapies can carry a high degree of risk. This is because patients may use ineffective CAM therapies rather than an effective conventional treatment. A study of breast cancer patients who refused or delayed standard treatments in favour of alternative therapies concluded that there was a higher likelihood of disease progression and increased risk of recurrence and death (Han, Johnson, DelaMelena, Glissmeyer, & Steinbock, 2011).

Ernst and colleagues (2007) reviewed the research evidence supporting various CAM therapies. Research has been mostly negative for therapies where herbs or diet supplements are given. These are mostly alternative therapies. However, some positive findings have been reported for gingko, ginseng, and coenzyme Q10.

By contrast, there is quite good evidence showing the value of several types of complementary therapies that provide comfort for the patient. These include aromatherapy/massage, music therapy, relaxation, and spiritual healing. Similar conclusions were reached in another review, namely that the CAM therapies that have the strongest benefit for effectively and safely reducing physical and emotional symptoms are massage therapy, music, and mind–body therapies (Wesa, Gubili, & Cassileth, 2008).

It can make good sense for cancer patients to use those complementary therapies that help relieve symptoms. It is likely that a patient’s belief in the efficacy of treatment can relieve pain, anxiety, and other functional disorders that accompany cancer.

With respect to mind–body techniques, it has often been claimed that these types of therapy provide benefits that go much beyond the area of physical and emotional symptoms and that they can influence the course of the cancer. Bernie Siegel and Deepak Chopra are two well-known authors who have asserted that changing mental state can affect the course of cancer. In best-selling books aimed at the general public, these authors make claims such as that patients can control the course of cancer using thoughts. This whole area is highly controversial, and nothing has been firmly established.

Why do many patients use alternative therapies that lack credible supporting evidence? Insight into this came from a study in which interviews were carried out on 60 breast cancer patients who used CAM therapies (Citrin, Bloom, Grutsch, Mortensen, & Lis, 2012). The investigators observed that key factors in the decision to reject potentially life-prolonging conventional therapy were negative first experiences with “uncaring, insensitive, and unnecessarily harsh” oncologists, fear of side effects, and belief in the efficacy of alternative therapies. Patients who rejected conventional treatment tend to believe that chemotherapy and radiotherapy are risky and not beneficial. Moreover, they often believe that they can cure themselves from cancer with simple methods like raw fruits, vegetables, and supplements. These findings are not really surprising, as the message from CAM therapists is frequently a good deal more positive (and dishonest) than that given by oncologists.

The study also suggested how oncologists could make patients more receptive to the best treatment options (Citrin et al., 2012). The breast cancer patients stated that a compassionate approach to cancer care, educating patients about their options, and allowing them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.

Complementary and Alternative Therapies and Research Challenges

It has been stressed numerous times in this course that carrying out research in the area of CAM therapies poses many challenges. This is especially true with unconventional cancer therapies. Anyone who finds a cure for cancer will gain great rewards, such as celebrity status in the media and perhaps a great deal of money, either by selling the patent or by treating cancer patients. They may also win a Nobel Prize. Even a modest advance in treatment may be richly rewarded. For these reasons, someone who believes they have found an effective new treatment for cancer has a very strong motivation to present the discovery in the best possible light.

The focus here is on those new cancer treatments that are purported to treat the actual cancer and not merely relieve symptoms. In the great majority of cases, these claims have two key features: First, they are based on an unproven theory regarding the cause of cancer and how it can be effectively treated. Second, the clinical evidence showing that the treatment actually works is of low methodological quality. What we often see is a series of cases where the claim is made that many patients had a partial, or even total, remission of the cancer. For multiple reasons, such evidence can be highly misleading.

As with all other areas of CAM therapies, the type of evidence that is truly reliable is that coming from randomized controlled trials (RCTs). With some of the treatments discussed here, no RCTs have ever been carried out. In other cases, RCTs have generated negative findings, thereby contradicting the earlier (apparently) very positive findings. However, there are a few instances where RCTs have given apparently positive results. Most often, such RCTs have included only a small number of patients and have been short term. Much hesitation is therefore required before taking the results at face value: confirmation is required, especially from larger studies with longer follow-up.

Cost of CAM Therapies

The amount of money spent on CAM therapies is enormously variable. A study was carried out in the United States on cancer patients who used both conventional treatment and CAM therapies (Lafferty, Tyree, Devlin, Andersen, & Diehr, 2008). The CAM therapies used by these patients, such as chiropractic, massage therapy, and acupuncture, were no more than 1% of the cost of conventional treatment.

But an altogether different story emerges when we look at treatments at clinics that specialize in unconventional cancer therapies. Reference was made earlier to a cancer treatment based on antineoplastons. There is no credible evidence that it is effective; nevertheless, according to some reports, patients may be charged from $7000 to $9500 per month or more for treatment (“Burzynski Clinic,” n.d.).

Sarah Macdonald is a journalist who carried out an undercover investigation of cancer clinics operating in Tijuana, Mexico. Her report was aired in 2012 on the TV network Al Jazeera (Macdonald, 2012). She stated that “The facilities promote their services through glossy brochures and online video testimonials. . . . The clinics often claim survival rates that far outweigh anything a conventional oncologist could offer—a complete cure when all else has failed.” Several clinics required an up-front payment of $50,000.

There is no doubt that many thousands of people have been sold false hope that a cure is available, often for an extortionate amount of money. As a result, a great many families have endured a double tragedy: not only have they lost a loved one, but they have become financially ruined in the process.

Summary

Cancer patients seeking alternative treatment have a number of different therapies to choose from. Although studies on some therapies have shown promising results, no clinical trials have proven that any alternative cancer therapy can prolong life or cure cancer. Alternative cancer treatments may cause severe morbidity or even death, either directly (due to toxicity) or indirectly by preventing the patient from seeking appropriate medical care.

Any person considering using an alternative therapy for the treatment of cancer should consider three facts:

1. Although purveyors of alternative therapies often make grandiose claims, the hard evidence to support such claims is meagre at best. Indeed, no convincing evidence has yet emerged from RCTs that any alternative therapy can significantly improve the odds of survival.
2. In many cases, persons who supply alternative therapies profit from the enterprise.
3. Persons who advocate alternative therapies often rationalize the treatment based on unscientific arguments.

An altogether different picture emerges when we look at CAM therapies intended for alleviating physical and emotional symptoms. Examples include massage therapy, music, and mind–body therapies. Here we have good evidence that many patients with cancer find that they gain benefit from these therapies.

Learning Activity

Self-test Quiz

Do the self-test quiz for Unit 14 as many times as you wish to check your recall of the unit’s main points. You will get a slightly different version of the quiz each time you try it. (This quiz does not count toward your final grade).

If you have trouble understanding the material, please contact your Academic Expert.

References