In Managed Healthcare Executive’s 2018 Cancer Management Trends Survey, a majority of respondents indicated support for the selected use of complementary and alternative medicine (CAM). Where do things stand in what some consider a promising treatment area?
Jonathan Stegall, MD, an integrative oncologist and medical director at the Center for Advanced Medicine in Alpharetta, Georgia, says those complementary and alternative therapies which currently have the most evidence for their use are nutrition, exercise, mistletoe, and mind-body medicine.
He notes that studies show that a mostly plant-based diet, focusing on fruits, vegetables, legumes, and grains, is best for cancer prevention and cancer treatment. Similarly, those who exercise have much lower rates of cancer development and have fewer side effects from cancer treatment and generally better outcomes.
While the use of mistletoe might seem an unlikely treatment option, a number of studies have shown its potential to improve survival rates and also reduce side effects from conventional cancer treatment.
In the area of mind-body medicine, stress-reduction/mindfulness strategies such as prayer, meditation, and guided imagery have brought positive results. Other promising natural and alternative therapies include acupuncture, intravenous vitamin C, and supplements including curcumin, melatonin, and berberine.
The biggest challenge
The challenge with these and other therapies falling under the CAM umbrella, according to Stegall, is that definitive research is lacking. While large-scale trials are required to support a therapy's efficacy, the money needed to fund such trials is hard to come by.
“My approach is to be an open-minded skeptic,” he says. “This means being open to any potential therapy which has some evidence for its use, which we feel is safe as well as compatible with other therapies, but balance this with a healthy level of skepticism.”
In fact, the skeptical approach seems dominant in the oncology community. Stegall notes that most physicians were not trained in these therapies, and they are not discussed at most oncology conferences and in most oncology journals. In addition, physicians are already limited in the amount of time they can spend with patients, and most CAM therapies are not covered by insurance or Medicare/Medicaid.
At the same time, many physicians are willing to include at least some CAM alternatives among treatment options. For example, integrative pain management is another approach garnering attention in treatment of a variety of diseases, including cancer, says Steven Vasilev, MD, gynecologic oncologist and medical director of Integrative Gynecologic Oncology at Providence Saint John's Health Center and professor at John Wayne Cancer Institute in Santa Monica, California. He says that in addition to acupuncture, non-pharmacologic options include electrotherapy, meditation, mindfulness, tai-chi, and anti-inflammatory botanicals and herbals like curcumin, Boswellia, and ginger.
One development worth watching is that employers seem to be giving more credence to CAM in their health plans, according to Jeff Levin-Scherz, MD, co-leader of the North American Health Management practice at global broker and adviser Willis Towers Watson.
“We’re seeing many employers strongly considering offering their health plan members access to complementary medical therapies,” he says. Along with chiropractic care and massage therapy, this also includes support for alternative approaches such as acupuncture for oncology patients, including chemotherapy-induced nausea and cancer-related pain.
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“It’s a trend that appears to be growing,” Levin-Scherz says. “With the labor market tighter, employers are more interested in offering insurance that covers complementary and alternative traditional care coverage.”
No doubt the future will also continue to hold a variety of questionable approaches that will never gain acceptance, whether in the treatment of cancer or other diseases. And their very existence may cast a shadow on more valid alternatives, slowing progress in their acceptance. But at least for some options, chances seem good for an expanded role for complementary and alternative medicine in cancer treatment.