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Talking to your Doctor about Complementary and Alternative Medicine

Talking to your Doctor about Complementary and Alternative Medicine

2017 - 07 - 24 | Author: Laurel Felsenfeld, RN, BSN, CRRN, CCM

Doctor Talking to PatientIn a 2012 study of over 65,000 cancer patients in 18 countries, the prevalence of complementary and alternative medicine (CAM) use was over 40% for all studies, with the highest use in the United States -- and that use has increased considerably over the past few years.1 Many cancer patients will seek or will be approached by others suggesting use of alternative and complementary therapies to improve quality of life, particularly when conventional therapies cause distressing side effects they cannot tolerate, when conventional treatments are no longer effective, or when no clinical trials exist or the patient does not meet trial criteria.2

Theoretically, when CAM is utilized only after conventional therapies are exhausted, that is when CAM is least likely to be effective. In advanced disease tumor burden is at its greatest, healthy cells have been under prolonged assault by chemicals and radiation, the stress of treatment and anxiety over relapse have raised stress hormone levels to a sustained peak, and the blood and immune systems have bottomed out. Implementing CAM soon after diagnosis, particularly prior to initiation of chemotherapy, during “breaks” between treatment cycles, and when in remission, has the greatest potential for positive effect while minimizing oncologists’ concerns over interference with conventional therapy.

Safety Concerns Relating to Nutritional Supplements

There are many types of CAM therapies, many of which are extremely effective. Those that oncologists tend to be most uncomfortable with are nutritional supplements. Oncologists’ concerns for the safety of ingested and injected supplements and herbs are valid. Even relatively harmless supplements such as vitamin C can have additive, potentially toxic effects with certain chemotherapy agents, and other supplements have been found to reduce effectiveness of some chemotherapy regimens. There are rarely controlled research studies, no standards for potency, and, unlike prescription drugs, little information on recommended dosage. Supplements and nutritional products are not approved to treat any medical condition and are not regulated by the U.S. Food and Drug Administration in the same way as prescription drugs and food.

Under the Dietary Supplement Health and Education Act (DSHEA) of 1994, supplements have to meet their advertising claims and manufacturing standards, but they do not have to meet the premarket efficacy and safety standards that all pharmaceuticals must comply with. Worse still, herbal and plant preparations are not subject to DSHEA regulations. 51% of all US Food and Drug Administration (FDA) Class I recalls from 2004-2012 involved supplements.3,4 Products that are manufactured overseas, for example, have been found to be contaminated with prescription drugs, toxic heavy metals, and even proteins from endangered and protected animal species. 

How to Minimize Risk

To minimize the risk of contaminated products, strive to use products from reputable U.S. based companies whose factories are USP (US Pharmacopeial Convention) or ISO (International Standards Organization) certified. The Institute for Safe Medication Practices recommends that for safe use of ingested supplements and remedies you educate yourself thoroughly about the products you are considering and consult a trustworthy source about potential risks and side effects. Such sources include www.mskcc.org/aboutherbs, http://www.nlm.nih.gov/medlineplus/herbalmedicine.html, http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplements-guide, and https://nccih.nih.gov/. The latter is the website for the National Center for Complementary and Integrative Health (NCCIH), previously the National Center for Complementary and Alternative Medicine, which is the federal government's lead agency for research on products not generally considered conventional medicine. Don't assume more is better. Avoid taking mega-doses of any herbal or supplement, including vitamins, and always inform your healthcare providers of what you are taking. 5

Working with Your Oncologist

Broaching the subject of CAM with physicians is challenging. Most physicians are unfamiliar with CAM, and therefore fearful of liability in appearing to support or dissuade its use. 4 Knowing that their concerns may be based more on fear and ignorance than on confidence and knowledge, a helpful approach is informing and acknowledging---informing of what you are considering or using, rather than seeking approval or advice, and anticipating, acknowledging, and responding to concerns by bringing information. Do your homework before your initial appointment; search for research studies published in recognized medical journals such as through the NCCIH’s database and PubMed. Research the manufacturer to determine what quality and safety certifications and controls are in place. Share the physician’s skepticism about overstated testimonials of “cures” and his or her concern over allegations that the only reason the product isn’t widely known or accepted is due to a “conspiracy of the medical establishment”; these are red flags of quackery.5

A suggested dialogue is “I am informing you of my use of ___ and I appreciate that you may have concerns about how this may affect my condition and treatment. I have brought some articles about ___. Be assured I will not use anything that may interfere with treatment during active treatment cycles, I will always seek out reputable sources for the product(s), and I will stop use at the first indication of any problem. I would appreciate your cooperation in ordering blood work periodically to monitor kidney and liver function for any adverse effects.”

If your doctor will not partner with you in using CAM, consider contacting an integrative oncology physician through the Society for Integrative Oncology (www.integrativeonc.org) to prescribe and monitor your CAM program and blood work. Your oncologist may be more receptive to your use of CAM knowing that you have oversight by a licensed healthcare provider. Your finances should also be taken into account in choosing CAM. CAM products and services are not covered by health insurance, and in the absence of proven effectiveness, one must consider if the cost will cause financial stress that would negate the potential benefits.

More Options

A cancer remission-promoting nutrition program such as that advocated by Beat Cancer.org and the use of stress reduction modalities such as yoga, tai-chireikiacupuncture, massage, and meditation are all well known, less controversial, and relatively low cost CAM options that have no known adverse effects, and studies suggest they improve quality of lifeduring treatment2. Stress reduction activities and mindfulness training programs are available at hospital cancer centers and through cancer support programs such as the Cancer Support Community (formerly Gilda’s Club) at www.cancersupportcommunity.org and the American Cancer Society at www.cancer.org/treatment/support-programs-and-services. Also check out the University of Massachusetts Medical School Center for Mindfulness at http://www.umassmed.edu/cfm/ and their teacher search section at http://w3.umassmed.edu/CFMInstructorSearch/#/index/search to find certified mindfulness-based stress reduction providers in your area.

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References:

[1] Horneber, M. Bueschel, G. et al. (2012). How Many Cancer Patients Use Complementary and Alternative Medicine: A Systematic Review and Metaanalysis; 2012 Integrative Cancer Therapies 11(3) 187–203

[2] Mobed, Ketty PhD and Liu,Raymond MD, et al. (2009) Quality of Life and Patterns of Use of Complementary and Alternative Medicines Among Glioma Patients J Support Oncol. 2009 Nov-Dec; 7(6): W23–W31

[3] Page, Leigh. (2013). What to Do When a Patient Wants 'Alternative' Medicine - Medscape - Jun 12, 2013. http://www.medscape.com/viewarticle/805545_3

[4] The Institute for Safe Medication Practices (ISMP http://www.consumermedsafety.org/medication-safety-articles/item/771-liver-injuries-from-herbals-and-dietary-supplements-have-led-to-death-and-liver-transplants)

[5] https://www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/complementary-and-alternative-methods-and-cancer/using-cam-safely.html

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