Cancer patients finally get alternative advice

Acupuncture might help with pain or nausea, but herbal treatments show little benefit for lung cancer patients, new guidelines say.

Every day, cancer patients walk into their doctors' offices and neglect to mention the other treatment they are pursuing on the side: the herbal supplements, the hypnosis, the trip to the acupuncturist. And doctors, with little information to offer on such therapies, often don't ask.

New guidelines on lung cancer, published last week as a supplement to the medical journal Chest, aim to help change that. In a sweeping set of recommendations that also advise against using CT scans to screen patients for lung cancer, the American College of Chest Physicians offers what it says is a comprehensive look at the use of alternative and complementary medicine in lung cancer.

Many of the report's recommendations on prevention and treatment jibe with more widely known guidelines from other medical groups such as the American Society of Clinical Oncology and the American Cancer Society. But these groups haven't offered guidelines for complementary therapies.

Half of all Americans have used complementary and alternative therapies, according to a federal survey. And cancer patients are especially likely to do so, according to Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center and lead author of the complementary-therapy guidelines. So she and her colleagues surveyed the landscape of published research, examining more than 100 studies on treatments ranging from acupuncture to herbal remedies. The aim was to offer useful guidance for doctors and patients on which therapies may be helpful and which may not.

"Doctors aren't comfortable discussing these subjects with their patients," says Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, who wasn't involved in the guidelines. The new report "gives you that anchor you need as a professional to have a conversation with your patient."

Among the recommendations, the ACCP report notes that some herbal supplements may interfere with chemotherapy or radiation. But other therapies, such as acupuncture, may help some patients deal with pain and other symptoms.

The report also makes clear that any benefits of these therapies are limited to treating the often debilitating effects of cancer and cancer treatment, and not the disease itself. So patients shouldn't forgo standard treatment in favor of alternative therapies. But guidelines may apply beyond lung cancer, because many symptoms are common to many kinds of cancer, Dr. Cassileth says.

Among the alternative therapies that are recommended, acupuncture for pain relief was found to be helpful when drugs aren't enough, or when the side effects of pain medications become a problem and the patient wants to reduce the dose. Acupuncture is also recommended to control nausea and vomiting associated with chemotherapy, when symptoms aren't well-controlled with drugs. Patients who are likely to bleed excessively should be cautious in seeking acupuncture, the report says, and should be treated only by a practitioner qualified to treat cancer patients.

Several "mind-body" approaches are endorsed as well. Meditation may reduce stress; yoga and relaxation techniques may improve sleep; hypnosis may alleviate pain and anxiety. Massage given by a therapist trained in treating cancer patients can reduce anxiety, pain, fatigue and distress, but the "application of deep or intense pressure" isn't recommended in patients with a greater-than-normal tendency to bleed.

The guidelines generally don't recommend the use of herbal supplements. For the most part, there is little clear evidence that they help, Dr. Cassileth says. And in some cases, supplements may even interfere with chemotherapy and other mainstream cancer treatments.

But some dietary supplements are appropriate in certain circumstances, the researchers note. For example, patients receiving the chemo drug pemetrexed should take vitamin B12 and folic-acid supplements. In general, supplements should be "evaluated for side effects and potential interaction with other drugs," the researchers say.

Many experts note that the body of research on complementary therapies is limited, which can make it difficult to draw firm conclusions. Nancy Davidson, a Johns Hopkins oncologist and the president of ASCO, said her group doesn't have complementary therapy guidelines because its experts believe there isn't enough rigorous evidence on the subject.