Complementary, Alternative, and Unproven Therapies



Complementary, Alternative, and Unproven Therapies


Joanne Finley

Susan Sartorius-Mergenthaler



I. History:

Complementary, alternative, and unproven therapies have been around for thousands of years, particularly in Chinese medicine. However, these therapies seem “new” because of the public’s recent, renewed interest. The public was the force behind the federal government’s decision to establish a National Center for Complementary and Alternative Medicine (NCCAM) in 1999, previously called the Office of Alternative Medicine from 1991 to 1999. Complementary and Alternative Medicine (CAM) is a diverse group of therapies not considered to be part of mainstream medicine, due to questions about efficacy and safety.


II. Definitions

A. Conventional Medicine: Accepted practice with a scientific basis.

B. Complementary Therapies: Used with conventional medicine.

C. Alternative Therapies: Used instead of conventional medicine.

D. Integrative Therapies: Combination of conventional medicine and complementary therapies.

E. Unproven Therapies: Therapies under investigation or with little or no scientific basis.


III. Rationale for Use

A. Incidence: The incidence of CAM use ranges from 30% to 80%, and it is on the rise. CAM users are typically female, educated, younger, and of a higher socioeconomic level. The therapies most commonly used are spirituality, vitamins/minerals/herbs, support groups, relaxation, imagery, and exercise. Most users also continue conventional therapy (Jordan & Delunas, 2001; Richardson, Sander, Palmer, Greisinger & Singletary., 2000; Sparber et al., 2000).

B. Goals: The overall goal of CAM is to create a healing environment for one’s own internal healing to occur. The specific goals of CAM include:

1. Prevention of illness.

2. Promotion of wellness.

3. Prevention or reduction of side effects of treatment.

4. Improvement of immune system function.

5. Active participation in treatment.

6. Improvement in quality of life.


IV. Biology of Therapy Based on NCCAM Classification System (NCCAM, 2002).

Tables 7-1, 7-2, 7-3, 7-4 and 7-5 describe the risks, benefits, and scientific evidence for the various types of CAM therapies.









TABLE 7-1 Alternative Medical Systems























Intervention


Description


Potential Risk/Cancer Benefit


Ayurveda
Knowledge of Life


An ancient integrated medical system from India. Uses multiple modalities to maintain spiritual, physical, and mental harmony. The combination of modalities used varies depending on the diagnosis of the patient. Diagnosis is based on critical observation, history, and physical assessment, and how the individual is connected to the cosmic universe. The treatment plan is complex and takes into account the whole person, such as diet, relationships, lifestyle, seasons, and color. Modalities include massage, yoga, guided imagery, blood letting, intestinal cleansing, dietary modifications, and herbal remedies.


Risks: Some aspects are harmful. Consult a health care provider before using any form.
Benefits: No scientific evidence. Some research has been done on its use for prevention and treatment of some cancers. No conclusions can be made at this time.


Homeopathy


The use of minute amounts of plant extracts, minerals, or chemicals that are diluted in water or alcohol. Believed to aid many health problems. Solutions are carefully mixed and diluted based on individual symptoms.


Risks: Considered safe because of the small amounts of product.
Benefits: No scientific evidence.


Holistic medicine


Belief system based on philosophy that the disease plus other aspects of the person should be treated as a whole to achieve a high level of wellness. Practitioners take into account the spiritual, emotional, physical, and mental attitudes of the individual. Various forms of complementary therapies are included so the individual may gain a sense of control over the disease.


Risks: Consult practitioner related to domain of treatment (yoga, massage, acupuncture) or for dietary changes and supplements.
Benefits: No scientific evidence. Some aspects are recognized as complementary support during cancer treatment.


Native American healing


Basic belief that disease is caused by spiritual problems. The goal of healing is to restore an individual to a state of wholeness. To achieve spiritual balance and harmony, several techniques and rituals are used: herbal medicine, religion, shamanism, and ceremonial practices. Proponents believe that disease can be cured by these approaches.


Risks: Consult physician about dietary changes and purification rituals.
Benefits: No scientific evidence. The supportive community and interventions may improve quality of life. Prayer may reduce stress.













TABLE 7-2 Mind-Body Interventions















































































Intervention


Description


Potential Risk/Cancer Benefit


Aromatherapy


Use of fragrant essential oils inhaled by way of humidifiers or during application of massage. Believed to enhance quality of life, help with coping, and produce feelings of well-being.


Risks: Poisonous. Do not take oils internally.
Benefit: No scientific evidence. May reduce anxiety, tension, pain.


Art therapy


Use of art to encourage release of emotional conflicts and express unconscious concerns/conflicts.


Risk: Should be monitored by therapist. Uncomfortable feelings could occur.
Benefit: No scientific evidence. May reduce anxiety.


Breathwork


General term used to describe various forms of deep breathing exercises.


Risk: Unknown.
Benefit: No scientific evidence. May aid in relaxation and the reduction of stress.


Crystals


Used to restore energy flow, promote healing, balancing. Thought to have reenergizing effects on body’s energy fields.


Risk: Considered safe.
Benefit: No scientific evidence. May aid in relaxation and the reduction of stress.


Dance therapy


Use of movement to increase mobility, improve self-awareness, reduce muscle tension.


Risk: May have restricted movement; involves use of the joints, muscles.
Benefit: No scientific evidence. May improve self-concept, reduce stress, pain, body tension.


Faith healing


A strong belief in a supreme being or place that has the ability to cure disease. May involve prayer; laying on of hands; visit to a church, shrine, or another kind of healing monument.


Risk: No curative effect, which may lead to feelings of guilt, failure, hopelessness.
Benefit: No scientific evidence. May produce placebo effect, which may evoke peacefulness.


Feng Shui “wind and water”


Chinese philosophy that placing objects, furniture, rooms in a particular arrangement will promote the flow of vital energy, qi, thereby promoting healing.


Risk: Unknown.
Benefit: No scientific evidence.


Humor therapy


Use of laughter to promote relief from physical illness and emotional complexities.


Risk: Considered safe.
Benefit: No scientific evidence. May enhance quality of life, reduce stress, anxiety.


Hypnosis


Relaxation technique used to guide a person into a trancelike state.
Person enters a state of restful alertness and becomes open to suggestion.


Risk: Considered safe under the care of a trained hypnotherapist.
Benefit: No scientific evidence. Approved by National Institutes of Health for treatment of chronic pain. May aid in the reduction of blood pressure, anxiety, fear. May control nausea/vomiting.


Imagery


A “mind-over-matter” methodology in which a person will concentrate on a specific problem and visualize positive outcomes to be achieved. Methods include: guided imagery, Simonton method.


Risk: Considered safe under the care of a trained health professional.
Benefit: No scientific evidence. May decrease pain, nausea/vomiting, depression, stress, and may enhance immune system.


Labyrinth walking


Meditative walking along a continuous pathway that has a directed beginning and end. During the walk, a person may pray, let the mind wander, reflect on a specific problem.


Risk: Considered safe.
Benefit: No scientific evidence. May reduce stress, promote relaxation, enhance spirituality.


Meditation


Relaxation technique achieved by closing the eyes or chanting a sound and concentrating on a pleasant theme to create a sense of well-being and separating self from the outside world. A self-directed or guided method for relaxing the mind and calming the body. Methods include: tai chi, aikido, Zen Buddhism.


Risk: Complications are rare. A person may become disoriented or experience uncomfortable feelings.
Benefit: No scientific evidence. Approved by National Institutes of Health for the treatment of chronic pain and insomnia. May improve quality of life.


Music therapy


Use of music to soothe and promote healing.


Risk: Considered safe.
Benefit: No scientific evidence. Clinical trials have shown a reduction in nausea, pain, anxiety, blood pressure, depression, insomnia. May promote social interaction, enhance quality of life.


Psychotherapy


Widely supported mind-body approach in which a person discusses the emotional difficulties of an illness. Methods include: behavior modification, cognitive therapy, group therapy, psychodynamic therapy, client-centered therapy.


Risk: Considered safe. May experience uncomfortable feeling. Person should be under the care of a trained therapist.
Benefit: Research has shown a decrease in depression and anxiety, and quality of life improvement. May benefit coping skills and overall enjoyment of life, or aid in communication with health care workers.


Spirituality and prayer


Method of communicating to a higher power to decrease the negative effects of illness. Can be self-directed, done in groups or by individuals for a “sick” person in any place or at any time. Often takes place in religious facilities.


Risk: Considered safe.
Benefit: Research has demonstrated quality-of-life benefits. May psychologically reduce stress and anxiety, and strengthen will.


Support groups


Education-based and behavioral supportive group to share feelings and experiences related to illness. By sharing these experiences, the person will develop a better understanding of the illness, receive emotional support, reduce stress, and form positive coping skills.


Risk: Considered safe. May provoke uncomfortable feelings. Caution when using online chat rooms because of the lack of information regarding confidentiality issues and verification of training/qualifications.
Benefit: A clinical trial has shown benefits in the reduction of anxiety, fear, fatigue, and confusion. May increase treatment compliance, and enhance quality of life.


Tai-chi


Chinese form of martial arts. Believed to balance the life force, qi. Form of relaxation using deep breathing methods and physical movements to prevent illness and improve health and extend life. Considered self-healing.


Risk: Moderately safe, but a physician should be consulted before undergoing a program because it is considered a form of exercise.
Benefit: Research has demonstrated benefits in stress reduction; decreased blood pressure; reduction of heart disease; improvement in posture, flexibility, balance, muscle mass. Recommended for older adults to improve wellbeing.


Yoga


Hindu philosophy used to create a union of mind, body, spirit. Believed to cultivate the life force, prana. Thought to consulted before undergoing a program because lead to a state of relaxation, peace, harmony, and happiness. Form of exercise that requires exact postures and breathing techniques.


Risk: Moderately safe, but a physician should be some yoga positions may be physically difficult to achieve.
Benefit: National Institutes of Health suggest benefits may provide cancer symptom relief. Research has shown control of blood pressure, respiration, heart rate, body temperature.

















TABLE 7-3 Biology-Based Therapies















































































































































Intervention


Description


Potential Risk/Cancer Benefit


Chlorella


Freshwater alga containing high levels of chlorophyll. Used extensively in Japan. Believed to have cleansing effect on the body by ridding the body of toxins. Contains antioxidants. Stimulates the production of macrophages. May be taken in many forms: liquid extracts, powder, and tablet.


Risks: Considered safe. No adverse effect data available in humans.
Benefits: No scientific evidence. Animal and laboratory research testing the extract suggests possible anticancer properties.


Copper


Controversial trace element found in foods. May aid the immune system and rid toxins from the body. Controversial beliefs regarding its cancer protectant and cancer-promoting effects. Available as a natural element in vegetables and fruits and as a vitamin supplement.


Risks: Vitamin supplements are considered safe. Do not take if diabetic (may affect glucose levels) or with Wilson’s disease.
Benefits: No scientific evidence. Laboratory studies suggest it may contain antioxidants.


Ellagic acid


Compound believed to prevent carcinogens from binding to DNA by causing apoptosis. Found naturally in fruits and nuts but especially strawberries, raspberries, and pomegranates. Available as a liquid, capsule, or powder.


Risks: No information available.
Benefits: Currently under investigation. Animal studies have shown that it may inhibit tumor growth in some cancers.


Essiac tea (slippery elm bark, Turkish rhubarb, burdock root, sheep sorrel, blessed thistle, red clover, watercress, and kelp)


Mixture of eight herbs that, when infused together, is used as a tea. Strengthens the immune system, promotes cell repair, and shrinks tumors.


Risks: Considered safe. When taken with food, may cause diarrhea, nausea, vomiting, and headache.
Benefits: No scientific evidence. Many testimonials. Laboratory research suggests that some of the herbs in the tea may have anticancer activity.


Evening primrose


North American fragrant flowering plant that blooms at night. Oil is extracted from the seeds containing essential fatty acids, gamma linolenic acid and omega-3 fatty acid, that are believed to have anticancer properties. Available for administration as a tea, capsules, and gelcaps.


Risks: No side effects identified. Gamma linolenic acid may lower the seizure threshold.
Benefits: No scientific evidence. Laboratory tests in animal tumors suggest that it may slow cancer growth in breast and skin cancer cells.


Flaxseed


The seed and oil from the flaxseed plant are thought to have anticancer properties. The oil is high in omega-3 fatty acids and alpha linolenic acid. Flaxseed contains lignans, a compound that functions as an antioxidant and has antiestrogen effects. Flaxseed oil is available in gel capsules and as a liquid. Flaxseed is also found in meal, flour, breads, cereals.


Risks: Needs to be refrigerated. Must not be used by people with inflammatory disease. Immature pod is poisonous.
Benefits: No scientific evidence. Currently being studied in animals. One study suggests that flaxseed and low-fat diet may decrease testosterone levels and slow tumor growth in men with prostate cancer.


Folic acid


Naturally occurring B-complex compound found in many foods. It promotes development of blood cells and aids in metabolism of DNA. Available as an oral vitamin supplement and in fruit, vegetables, liver, and grains.


Risks: Considered safe. In high levels, may interfere with methotrexate.
Benefits: Low levels of folic acid linked to cancer. Thought to be related to decreased immune surveillance or DNA structure changes due to low levels.


Garlic


Allyl sulfur is one of several compounds from the lily family to have anticancer and enhanced immune surveillance activities. Available in natural plant form (eaten cooked or raw) extracts, powders, capsules, and oils.


Risks: Large quantities may cause GI distress. Has anticoagulant properties.
Benefits: No scientific evidence. Studies suggest it may lower the risk for some type of cancers or reduce tumor growth.


Ginger


Root of this native Asian plant is often used in herbal remedies for nausea, vomiting, and motion sickness. Available as root (fresh/dried), capsules, tablets, and tea.


Risks: May interfere with blood clotting, and enhance bleeding risk.
Benefits: No scientific evidence. Believed to relieve therapy-induced nausea and vomiting.


Ginkgo


Leaf from the ginkgo tree native to Asia that may promote cancer growth. Available in multiple oral forms.


Risks: Considered safe. May enhance bleeding risk.
Benefits: No scientific evidence of anticancer or cancer-causing effects.


Ginseng


The root of an Asian Perennial plant that may have cancer-protective effects. Available in multiple oral forms.


Risks: May interact with anticoagulants or antidepressants. May cause high blood pressure, insomnia, headaches, vaginal bleeding, swollen breasts, and, some believe, recurrence of breast cancer.
Benefits: No scientific evidence. Research has demonstrated potential anticancer effects.


Goldenseal


Native to the United States, the root is used for many conditions. Available for administration in multiple oral forms, douches, eyedrops, eardrops, and powder forms.


Risks: Multiple serious adverse effects: depression, tachycardia, diarrhea, nervousness, respiratory problems, death. Long-term use may lead to hallucinations and vitamin D deficiency. Consult physician before taking.
Benefits: No scientific evidence. May activate the immune system. Has been studied for cardiacstimulating properties and anticoagulant potential.


Green tea


Comes from the leaves of the native shrub plant from Asia called Camellia sineses. A popular tea used for many conditions including the prevention of cancer. Contains an element called epigallocatechin-3-gallate, which may inhibit the blood supply to tumor cells (antiangiogenesis properties). Usually found in tea form, but may also be administered as an extract.


Benefits: Mixed results from laboratory/animal studies. Some studies do show potential cancerprotecting benefit.


Inositol hexaphosphate (IP6)


Chemical found in foods that are high in fiber. Believed to inhibit or slow growth in some cancers and have antioxidant properties. Called the “natural cancer fighter.” Available in many food sources and in pill form.


Risks: Believed to be safe.
Benefits: Studies have shown potential reduction of lung cancers and possibly a relationship between cancer and high cholesterol.


Kampo


Popular Japanese medicine containing 210 different herbs. Formula is often individualized to each patient based on visual and auditory interpretations of the concept sho. Proponents claim that Kampo enhances macrophages and boosts natural killer cells.


Risks: Very little is known about safety.
Benefits: No scientific evidence.


Kombucha tea


Tea made from a mushroom culture and sugar. Proponents believe that it detoxifies and promotes tissue-restoring balance to the body. Proponents also encourage the removal of all chemicals from the diet while taking the tea.


Risks: FDA warning to consumers that it may cause acidosis and death. Do not use if immunocompromised.
Benefits: No scientific evidence.


Lycopene


Natural compound found in tomatoes, watermelon, papaya, and other fruits. Believed to protect enzymes, cellular lipids, DNA, and have antioxidant properties. Available as a natural resource and capsule form.


Risks: None found.
Benefits: Believed to reduce cancer growth in many cancers. Research has been focused on prostate cancer.


Macrobiotic diet


Dietary way of life based on elements of Buddhism and belief that food is sacred. A process of eating/chewing food until it is liquid. A precise way of preparing and cooking the food in a peaceful setting. Diet consists of organic whole grains, cooked vegetables, and cereals.


Risks: May cause vitamin and other nutritional deficiencies. Deaths have been reported.
Benefits: No scientific evidence.


Maitake mushroom


D-Fraction, a polysaccharide, is an extract found in the Maitake mushroom that may slow tumor growth and boost the immune system. It is an edible mushroom and available in capsule, pill, tablet, and liquid forms.


Risks: Considered safe.
Benefits: No scientific evidence. Studies in mice using injectable extract have shown some evidence of tumor inhibition.


Marijuana


Leaves and buds of Cannabis sativa grow in warm tropical regions. Delta-9-tetrahydro-cannabinol (THC) is one of 66 active biologic ingredients found in marijuana that is believed to help manage symptoms of patients who have cancer, AIDS, and glaucoma. THC is available as a pill or suppository by prescription. The raw plant may be smoked or eaten and is illegal in the United States.


Risks: Side effects of THC are similar to the natural plant leaves when smoked or eaten. May cause tachycardia, low blood pressure, memory loss, increased anxiety, or altered time perception. May decrease immune function. The plant material does contain carcinogens, which may increase risk of oral cancers and respiratory disease.
Benefits: Prescription THC has been studied in patients with chemotherapy-induced nausea and vomiting. THC is used to reduce anxiety, stimulate appetite, and may have sedative effects. More studies need to be done to evaluate the effectiveness as compared to standard medications.


Modified citrus pectin (MCP)


Carbohydrate found in many fruits. Believed to slow the growth of prostate and melanoma cancers. May enhance “killer T cell” abilities. Available as a natural product, powder, and capsules.


Risks: Side effects are rare. Considered safe.
Benefits: Animal research has demonstrated reduction of lung metastasis in prostate and melanoma cancers.


Noni plant


Juice from the fruit of the Noni plant, a large evergreen tree native to the Pacific Islands, is used as an herbal remedy for many conditions and is available in many forms.


Risks: No information available.
Benefits: Hawaiian researchers found that mice treated with Noni juice had a longer survival time.


Omega-3 fatty acids


Nutrient source found in oils from cold water fish, flaxseed, and beans. Believed to stop the spread of some hormone-based cancers. Available as oil supplements and in diet.


Risks: Do not take with anticoagulants. May increase anemia in women while menstruating or may cause abdominal bloating.
Benefits: No scientific evidence. Preliminary studies are inconclusive.


PC-SPES (PC-prostate cancer; SPES-Latin for hope)


Combination of eight herbs: chrysanthemum, licorice, saw palmetto, Rabdosia, skull cap, ginseng, isatis, and Ganoderma lucidum. Collectively, they contain plant chemicals and trace minerals such as copper, zinc, and calcium. PC-SPES shows promise in slowing tumor growth in prostate cancer. Proponents believe it may also stimulate the immune system. Available in oral form, but the drug is not regulated and the formula may vary.


Risks: Side effects are similar to estrogenlike compounds. May increase risk of thromboembolism.
Benefits: Clinical trials have been established to study the effectiveness in men with prostate cancer who have not responded to hormonal treatment. In 2002, the drug was recalled due to contamination. Future studies are planned.


Peppermint


Widely known and cultivated plant. Oil is extracted from the flowers and leaves and used for GI and respiratory disorders. May be administered in capsule, inhaled, tea, and oil forms.


Risks: Considered safe. May be a skin irritant.
Benefits: No scientific evidence. May be useful in patients with chemotherapy-induced nausea and vomiting.


Pokeweed


Berries and root of this native North American shrub are used to treat many conditions. Proponents believe it has anticancer and antiviral properties. Available as an extract, powder, and tincture.


Risks: Pokeweed is poisonous. Do not take with antidepressants or oral contraceptives.
Benefits: Animal research suggests that it may have anticancer effects and may stimulate the immune system.


Saw palmetto


Berries of this palm tree are promoted as a treatment for several prostate conditions. Available in oral forms.


Risks: Side effects may include nausea, vomiting, headache, dizziness, and insomnia. Safety of long-term use is not known. May interfere with PSA levels.
Benefits: May improve symptoms associated with benign prostate hyperplasia (BPH), but not estab lished for use with prostate cancer.


Shitake mushroom


Compound lentinan is found in this native Asian fungus. Believed to have antitumor effects. Available as an edible mushroom or in extract form.


Risks: Considered safe. Allergic reactions have been noted.
Benefits: Early studies have proven lentinan has antiviral properties and may also be effective against stomach and colorectal cancers.


Soybean


Isoflavones, also called phytoestrogen, are found in this high-protein Asian plant. Believed to be effective against many cancers. Available in many dietary sources: tofu, soybean extract or powder, protein bars, milk, and other dairy products.


Risks: Considered safe. Women taking hormonal supplements should refrain from large amounts of soy products. May cause GI distress.
Benefits: It is uncertain how the isoflavone affects estrogen-receptor growth in breast cancers, although thought to have protective properties for breast and prostate cancers.


Turmeric


Root of this native plant of India and Asia is used as a spice in foods. The active ingredient curcumin is used for antiinflammatory conditions. Proponents believe it has antioxidant properties, which may slow growth of cancers. Available as a powder, tablet, and ointment.


Risks: Considered safe when used as a spice. Do not take with anticoagulants, nonsteroidals, or immunosuppressants.
Benefits: No scientific evidence. Research in the laboratory and animals has been focused on antioxidant properties.


Venus flytrap


Native plant of the southeastern United States that has the unique ability to eat and trap insects. Carnivora is extracted from the plant and is felt to have anticancer effects and to stimulate the immune system. It is commercially available in liquid form and may be taken either by mouth, inhaled, or injected. Another extract from the plant is plumbagin.


Risks: No toxic effects reported. May cause nausea and vomiting when injected.
Benefits: No scientific evidence. Both carnivora and plumbagin have inconclusive laboratory evidence.


Phytochemicals (Ascorbic acid, beta-carotene, flavonoids, carotenoids, sulfides, vitamins A, C, E)


Group of over 4,000 compounds found in fruits, beans, grains, and vegetables that have antioxidant and hormonelike properties. Promoted as a preventive and treatment for various health conditions. Believed to block carcinogens from their target organ. Available as a food source and in numerous oral supplemental forms.


Risks: Do not take with benzodiazepines. May be toxic in large doses.
Benefits: Most studies have been focused on diets high in this classification of food derivative. Research suggests that, by eating foods high in phytochemicals, the risk of some cancers can be reduced. Studies indicate that the collective whole might have more benefit than select supplements.


Vitamin B complex


Dietary essential nutrient needed to maintain adequate enzyme activity in the body. Available as a food source and as oral supplement.


Risks: Considered safe. High doses may be toxic. Folic acid may interfere with methotrexate.
Benefits: Research is focused on the relationship of vitamin B and the prevention of some cancers. It may lower the risk of colorectal cancer.


Zinc


Dietary mineral that the body needs to build DNA, and to regulate the immune system and cell metabolism. Believed to protect against some cancers. Available in the diet, as a spray and oral supplement.


Risks: High-level exposure to zinc is a prostate cancer risk.
Benefits: Research has shown that patients with head and neck cancers, melanoma, and some forms of leukemia have low serum zinc levels.

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Sep 16, 2016 | Posted by in NURSING | Comments Off on Complementary, Alternative, and Unproven Therapies

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