Andrew J Vickers and Barrie Cassileth

Complementary and alternative medicine (CAM) is a general term used to describe techniques as diverse as chiropractic and yoga, iridology and meditation, colonic irrigation and spiritual healing. As such, it resists simple definition. Most published definitions describe CAM simply as practices outside of mainstream care.1 A more fundamental issue concerns the difference between complementary and alternative approaches. Alternative therapies are used in place of mainstream care. Conversely, complementary therapies are used as adjuncts to mainstream care for symptom management and to enhance quality of life. This distinction is especially important in oncology, where treatment choices can be literally a matter of life and death.

CAM is widely used by the general public in the United States2,3 and in other industrialized countries.4-7 CAM use is markedly prevalent among cancer patients: a systematic review located 26 surveys of cancer patients from 13 countries, including 5 from the United States. The average prevalence across all studies was 31%, with prevalence rates as high as 64% in published reports.8 Research published subsequent to the systematic review showed similar or slightly increased rates of CAM use.9-15 Particularly popular today among cancer patients is the use of herbs, vitamins, and other dietary supplements. For example, more than one in four prostate cancer patients at a Canadian cancer clinic16 and at a veterans' affairs medical center17 used supplements or herbal treatments. A review of several studies reporting CAM product use in breast cancer patients found rates as high as 50% for herbs and 60% for other supplements.18

Given such widespread use, the first principle of CAM for cancer is that health professionals should ask patients about their use of CAM. This information helps to complete the clinical picture and to alert clinicians to potentially harmful interactions with conventional therapy. Keeping an open dialogue with patients is also likely to reduce the risk that they abandon conventional care to pursue unproven alternative cures.

In this chapter, we review data on alternative cancer treatments, botanical (herbal) anticancer agents, and interactions between CAM therapies and conventional oncologic care. We then review the evidence supporting the use of complementary therapies for symptom control.

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