Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies and questions such as whether they are safe and whether they work for the diseases or medical conditions for which they are used.
The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care, and as new approaches to health care emerge.
Though grouped together, complementary and alternative medicines are different from each other. Complementary medicine is used together with conventional medicine. An example of complementary therapy is the use of aromatherapy to help lessen a patient's discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional health care practitioner.
The National Center for Complementary and Alternative Medicine (NCCAM) has classified CAM therapies into five groups or domains:
- alternative medical systems (for example, homeopathic medicine and traditional Chinese medicine);
- mind-body interventions (for example, visualizations and relaxation);
- manipulative and body-based methods (for example, chiropractic and massage);
- biologically based therapies (for example, vitamins and herbal products); and
- energy therapies (for example, qi gong and therapeutic touch).
Evaluation of Complementary and Alternative Approaches
It is important that the same scientific evaluation which is used to assess conventional approaches be used to evaluate complementary and alternative therapies. A number of medical centers are evaluating complementary and alternative therapies by developing clinical trials (research studies with people) to test them.
Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process, including clinical trials with large numbers of patients. Often, less is known about the safety and effectiveness of complementary and alternative methods. Some of these complementary and alternative therapies have not undergone rigorous evaluation. Others, once considered unorthodox, are finding a place in cancer treatment--not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. Some approaches, such as laetrile, have been studied and found ineffective or potentially harmful.
Best Case Series Program
The Best Case Series Program, which was started by the NCI in 1991, is one way CAM approaches that are being used in practice are being evaluated. The program is overseen by the NCI's Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer CAM services submit their patients' medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops followup research strategies for approaches that have therapeutic potential.
- Acupuncture to reduce the symptoms of advanced colorectal cancer.
- Combination chemotherapy plus radiation therapy with or without shark cartilage in the treatment of patients who have non-small cell lung cancer that cannot be removed by surgery.
- Hyperbaric oxygen therapy with laryngectomy patients (people who have had an operation to remove all or part of the larynx [voice box]).
- Massage therapy for cancer-related fatigue.
- Chemotherapy compared with pancreatic enzyme therapy plus specialized diet for the treatment of pancreatic cancer.
- Mistletoe extract and chemotherapy for the treatment of solid tumors
Patients who are interested in taking part in these or any clinical trials should talk with their doctor.
NCI, NCCAM, and OCCAM clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching the following:
- NCI's PDQ Clinical Trials Database,which can be searched by using criteria such as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI's Cancer Information Service (1-800-4-CANCER [1-800-422-6237]; TTY: 1-800-332-8615).
- The NCCAM Clinical Trials Web page, which can be searched by the type of treatment or disease.
- The OCCAM Clinical Trials Web page, which provides links to NCI's PDQ Clinical Trials Database.
Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. Some resources for this information are provided in the section "Where to Learn More" below.
Questions patients should ask their health care provider:
- What benefits can be expected from this therapy?
- What are the risks associated with this therapy?
- Do the known benefits outweigh the risks?
- What side effects can be expected?
- Will the therapy interfere with conventional treatment?
- Is this therapy part of a clinical trial? If so, who is sponsoring the trial?
- Will the therapy be covered by health insurance?
Further information on evaluating CAM therapies and practitioners is available from NCCAM (see below).
Where to Learn More
Patients, their families, and their health care providers can learn about CAM therapies from the following Government agencies and resources:
The NCCAM Clearinghouse is the Federal Government's lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.
The NCCAM Clearinghouse provides information on NCCAM and on CAM, including fact sheets, other publications, and searches of Federal databases of scientific and medical literature. Publications include:
- 'Are You Considering Using Complementary and Alternative Medicine (CAM)?' (http://nccam.nih.gov/health/decisions)
- 'Selecting a Complementary and Alternative Medicine Practitioner' (http://nccam.nih.gov/health/decisions/practitioner.htm)
- 'Consumer Financial Issues in Complementary and Alternative Medicine' (http://nccam.nih.gov/health/)
The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
Post Office Box 7923
Gaithersburg, MD 20898-7923
Toll-free in the United States: 1-888-644-6226
TTY (for deaf and hard of hearing callers): 1-866-464-3615
Fax-on-Demand service: 1-888-644-6226
Web site: http://nccam.nih.gov
The NCI's Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine. OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via http://www.cancer.gov/cam/ on the Internet.
The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective. This agency provides a number of publications for consumers, including information about dietary supplements.
Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
Telephone: 1-888-463-6332 (toll free)
Web site: http://www.fda.gov/
FDA's Dietary Supplements Web page: http://www.fda.gov/food/dietarysupplements/default.htm
The Federal Trade Commission (FTC) enforces consumer protection laws and offers publications to guide consumers. The FTC also collects information about fraudulent claims. Consumer Response Center
Federal Trade Commission
Washington, DC 20580
Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)
TTY (for deaf and hard of hearing callers): 202-326-2502
Web site: http://www.ftc.gov/
CAM on PubMed, a database accessible via the Internet, was developed jointly by NCCAM and the NIH National Library of Medicine. It contains bibliographic citations (from 1966 to the present) to articles in scientifically based, peer-reviewed journals on CAM. These citations are a subset of the NLM's PubMed system, which contains over 11 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to many publisher Web sites, which may offer the full text of articles. To access CAM on PubMed, go to http://nccam.nih.gov/research/camonpubmed/ on the Internet.
NCI Online Internet Use http://www.cancer.gov to reach NCI's Web site.
Cancer Information Specialists offer online assistance through the LiveHelp link on the NCI's Web site.
NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for cancer. Some of these trials study the effects of complementary approaches used in addition to conventional treatments, while others compare alternative therapies with conventional treatments.