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> CAM - Complementary & Alternative
Medicine
Last Update: 03/14/2008 |
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Chamomile
(Kamillosan oral rinse)
|
 CAM
stands for Complementary and Alternative medicine. It's an umbrella term for interventions and practices that are not in the mainstream of medicine as practiced today in the United States and many countries.
Complementary (Integrative) Medicine
are practices that are integrated into mainstream medical care for
improvement of general health, and relief of symptoms, such as pain or
stress.
Alternative medicine are practices that
are used to replace mainstream medical care that are not based on evidence
from clinical trials in human subjects.
Here
we provide evidence-based, lymphoma-specific information about
natural compounds, supplements, diet, and other CAM practices with an
emphasis on levels of evidence and links to credible (unbiased) sources of
information. This area of
study is in its infancy and there are few controlled clinical studies to guide us.
For this and other reasons described below, the
information we provide should be considered a starting point
for discussions with your doctor.
Recommended: Discussing CAM with your doctor scienceblogs.com:80/terrasig
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On Levels of Evidence |
Credible Resources |
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Tools |
Studies |
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Drug/Supplement
Interaction Checker drugreax.epnet
This tool
doesn't include every possible interaction or account for
individual responses to medicines. |
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Complementary
and Alternative Medicine Online Continuing Education Series Video
Lectures |
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To
avoid potential adverse interactions, be
sure to let your health care provider know
if you use supplements when receiving therapy.
Given the limitations
described, it would be beneficial to find reliable data and conduct
additional research to determine how specific supplements and some life style
practices might do the following:
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Enhance or inhibit drug
efficacy.
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| Reduce or increase side effects and
damage to normal cells during treatment, or when monitoring disease. Towards
this goal we provide the following:
Radio-protective?
- practices that may or may not reduce treatment side effects or reduce risks
associated with repeated x-ray imaging. Chemo-protective
& enhancement? - practices that may
or may not reduce treatment side effects and/or
enhance treatment efficacy.
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Increase or decrease drug accumulation
or drug resistance.
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Help restore health
to patients after receiving chemotherapy or radiotherapy.
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| Inhibit or promote tumor growth for
individuals in watchful waiting status. |
BC Cancer Agency: Guidance on unconventional
therapies .bccancer.bc.cam
For unconventional therapies that are taken by
mouth or put into the body: Do not take any of these during
chemotherapy, hormonal therapy or immunotherapy. Do not take any
of them in conjunction with any other medications without checking with
the BCCA Patient Education Pharmacist about possible drug
interactions.
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Tell your oncologist about supplements and
alternative therapies
you may be using.
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When you use herbs, do so only for short periods,
and in
moderation.
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Do not use alternative therapies to replace
prescribed treatment.
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Purchase from established and reputable
suppliers.
Some herbs and supplements have been found to contain toxins, such as heavy metals. Ask about what you are buying: Are the Latin names of herbs, the quantities and uses listed?
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Do not give children under age two herbal teas.
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Be cautious in using very concentrated oils and
teas.
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Dietary Supplements in Patients With Cancer: Risks and Key Concepts
Laura Boehnke Michaud; Julie Phillips Karpinski; Kellie L. Jones; Janet Espirito
Am J Health-Syst Pharm. 2007;64(4):369-381. ©2007 American Society of Health-System Pharmacists
Purpose: The risks and key concepts regarding the use of dietary supplements in patients with cancer are described.
Summary: There are six common characteristics of dietary supplements that must be addressed when used by patients with cancer.
Clinicians must establish if the supplement:
is an antioxidant
is an anticoagulant or procoagulant
has immunosuppressive or
immunomodulating properties
has hormonal properties
has known safety issues
and has known or theoretical drug interactions
These six characteristics of the dietary supplements commonly used by patients with cancer are reviewed to aid in the analysis of the scientific data and communication of the results with the patient or family members.
A framework upon which clinicians can adequately help patients make informed decisions regarding the use of complimentary and alternative medicine and dietary supplements is also described.
When evaluating the appropriateness of a supplement for use by a patient with cancer, clinicians must conduct a safety review (evaluate the six characteristics). If the supplement is considered safe, an efficacy review must be conducted, after which the clinicians can recommend the supplement’s use, accept the patient’s decision to use the supplement if no or inconclusive evidence exists, or discourage use if there is conclusive evidence supporting inefficacy.
Available resources for locating information regarding dietary supplements are also discussed.
Conclusion: Counseling patients with cancer about dietary supplements requires a systematic thought process that considers the available theories and data, as well as the patients’ views about the agents.
I: www.medscape.com/viewarticle/553692_print
II: www.medscape.com/viewarticle/553699_print
Caveats of Supplements Use
Doses: Information
about effective doses and bioavailablity of natural products
is rarely
known or provided.
Survival evidence?
There is little
evidence that alternative or complementary medicine, natural compounds,
vitamins or supplements can alter survival, and if so how significant
the influence might be. This is not to say that there are no potential benefits .. or risks.
Mixed and unexpected effects: A natural compound may have both positive and/or negative effects. For example, Vitamin D-3 might induce apoptosis in lymphoma cells in culture, but it may also inhibit maturation of dendritic cells, which might be needed to optimize immunotherapies, such as antibody or vaccine therapy.
When to use? The
potential benefits and risks of taking herbs might relate to whether you are, or are not, receiving treatment, and if so, the kind of treatment.
An herb
that has the potential to inhibit lymphoma growth, such as fish oil, might also inhibit
immune therapies, or put you at risk of developing an infection.
Mouse (murine) studies as
evidence? "A mouse is not a man (or woman). The behavior of a drug in a mouse need not be the same as in a human. Meaning, the drug may distribute differently, proportional differences per blood and organs and tumor, in mouse
vs. man. Drug exposures ( the amount of drug and for how long) in different body parts, including tumor, may be quite different
... " Full text
Petri dish (in-vitro/cell
culture) experiments as evidence?
To have clinical effects the active
ingredients must get to the cells you want to influence in sufficient
concentrations. Often, natural products are promoted based on cell culture
activity that fail to take into account how the compound is affected by
digestion, and other metabolic processes - so called
bioavailability.
Limitations of in vitro
evidence:
In vitro evidence refers to experiments on cells that are done outside the
body in test tubes or cell cultures. It's known that cancer cells
are changed significantly when removed from
the host environment - often they die spontaneously.
Background wikipedia.org
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Why Petri dish studies don't always translate into benefit
for patients -
Part I: scienceblogs.com
| Part II: scienceblogs.com
"To understand the translation of cell culture studies
to the whole person, we must first consider all of the systems
operating in the human body that are not present when human cells are
grown in plastic Petri dishes. ....
(1) drug absorption, (2) distribution,
(3) metabolism, and (4) excretion"
It is rare for a herbal or dietary supplement company to conduct, much
less publish, the results of the bioavailability of their products.
For dietary supplements, these studies are not required by the US Food
and Drug Administration or by any federal regulatory authority in the
world.
By "bioavailability," we mean a study as to what
fraction of a given oral dose actually makes it into the bloodstream.
While measuring bioavailability, scientists also conduct more
sophisticated calculations to determine the peak blood concentrations,
when they occur, and how quickly the body clears the substance.
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Drug
interactions: uptake and lack of standards:
Supplements may
interfere with treatment or with how a drug is metabolized. Therefore, we
believe it's prudent to avoid taking any supplements the same day you are receiving
treatment medications.
Purity?
Since so-called natural products and supplements are not regulated by an
independent agency, and the risk or ingesting inferior or contaminated
herbal products is significant and well documented.
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NEWS:
Final Rule Promotes Safe Use of Dietary Supplements fda.gov
Under the final rule, manufacturers are required to evaluate the
identity, purity, quality, strength, and composition of dietary
supplements. |
Natural does not mean not
toxic: It's common
to associate "natural" with safety. But many plants and
animals produce poisons in order to avoid being eaten by animals and
insects, or to kill off competing plants. Consider how many common house plants are toxic to
our pets.
See Herbs or Natural Products That May Cause Cancer and Harm Part Four of a Four-Part Series Muriel J.
Montbriand, PhD, RN ons.org
Data Sources: Natural Medicines Comprehensive Database
and Lawrence Review of Natural Products–Monograph System.
Information about these herbs has been found in evidence-based
studies cited in the references.
So why with the uncertainties
stated here should we provide information about CAM? The
answer is that patients are using vitamins and herbs
and therefore need reputable and objective sources of information on this
topic. Please note that the
data here is definitely not complete, but we are making an
honest effort to provide this information in a balanced way - by avoiding
commercial sources and seeking information from published scientific
papers when possible.
-KarlS
Anonymous & Confidential
4-question CAM SURVEY
for lymphoma survivors or caregivers
 Purpose:
To better meet needs by understanding the community we serve details
After you complete the survey you
will see a list of what you selected.
When you return to this
form, you are done.
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Evidence-based?
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Evaluating medical claims and data Lymphomation.org
Spontaneous Remission and the Placebo Effect,
Stephen Barrett, M.D. quackwatch.org
Recovery from illness, whether it follows self-medication,
treatment by a scientific practitioner, or treatment by an
unscientific practitioner, may lead individuals to conclude that
the treatment received was the cause of the return to good health.
Alternative Therapies for Curing Cancer: What Do
Patients Want? What Do Patients Need?
Wendy S. Harpham, MD (NHL survivor) amcancersoc.org
"Patients who don’t understand the difference
between information based on theory, anecdote, historical
analysis, or double-blind placebo controlled studies are making
ill-informed decisions, believing alternative therapies are safer
or more effective when they are not. Even patients who presume
that alternative therapies are ineffective may use them. Why?
When faced with a life-threatening disease requiring highly toxic
treatments with no guarantees, or when dying because there are no
effective conventional treatments, it takes guts to reject
something or someone claiming to be able to save you, just in
case you might be wrong."
Debunking cancer myths: An interview with a Mayo Clinic specialist
mayoclinic.com
Medical myths not only mislead but also may hamper proper treatment.
Find out why these common cancer myths are wrong. Highly recommended
reading.
Consumer Health Digest ncahf.org
"NCAHF is a private nonprofit, voluntary
health agency that focuses upon health misinformation, fraud, and quackery
as public health problems. Our positions are based upon the principles of
science that underlie consumer protection law. We advocate: (a) adequate
disclosure in labeling and other warranties to enable consumers to make
truly informed choices; (b) premarketing proof of safety and effectiveness
for products and services claimed to prevent, alleviate, or cure any health
problem; and, (c) accountability for those who violate the law."
2006
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Subscribe to CH Digest | NCAHF
Home Page | Search All
of Our Affiliated Sites
Caring (Really) for Patients Who Use Alternative Therapies
for Cancer jco.org
"The reasons why people seek alternative therapies
for cancer are broad. Many seek out alternative therapy when
options for conventional therapy have been exhausted. There is
also the recognition that, for some tumor systems, conventional
therapy is of limited effectiveness and that the side effects of
chemotherapy, surgery, and radiation are feared. For some tumor
systems, no conventional therapy exists and the standard therapy
is participation in phase I or phase II trials. Many patients
perceive that the conventional approach is emotionally or
spiritually empty and provides neither comfort nor solace."
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Other Resources & Research
News
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| BC Cancer Agency: Guidance on unconventional
therapies bccancer.bc.cam
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Ethical considerations of complementary and
alternative medical therapies
in conventional medical settings.
Ann Intern Med. 2002 Oct 15;137(8):660-4. PMID: 12379066 PubMed
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| Facts About Dietary Supplement NIH
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| Facts and
Myths about Attitude and Cancer cansa.co.za
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| Integrating Complementary and Alternative Therapies
for Cancer Patients
A Cancer Patient’s Guide to Complementary and Alternative Medicine
Heather L. Morein University of California San Diego School of
Medicine
Independent Study Project, April 2002 (Large 168 pg document) PDF
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Use of Complementary/Integrative Nutritional Therapies During
Cancer Treatment: Implications in Clinical Practice Medscape
2002 H. Lee Moffitt Cancer Center and Research Institute, Inc.
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