By Catherine Grillo

In a hospital room in New York City‚ a 53–year–old woman lies recovering from surgery for lung cancer. As a staff reflexologist applies pressure to the soles of her feet‚ the woman feels a wave of relief sweep over her as the pain in her chest subsides.

In an operating room in California‚ a 60–year–old man lies on an operating table‚ his ears cupped by headphones‚ as surgeons insert radioactive seeds into his prostate. Although numb from the waist down‚ he is awake and aware through the entire three–hour procedure‚ kept calm and relaxed by the soothing voice coming through the headphones.

These two patients on opposite ends of the continent are part of a quiet revolution in the world of cancer treatment. In hospitals and cancer centers across the country‚ once–esoteric therapies such as hypnosis‚ reflexology‚ yoga‚ and acupuncture are being offered alongside conventional treatments. And although some medical professionals have yet to embrace these techniques‚ others see such “complementary medicine” programs as part of the natural evolution of cancer care.

“Complementary medicine is really just an extension of supportive care‚ which we’ve had in oncology for many decades‚” points out Barrie Cassileth‚ PhD‚ chief of the Integrative Medicine Service at Memorial Sloan–Kettering Cancer Center. “But some physicians are just not aware of the very good research that is behind many of these interventions.”

The world of complementary and alternative medicine—or CAM—has always held a unique appeal for patients dealing with cancer.

Walter F. Baile‚ MD‚ medical director of the M. D. Anderson Cancer Center’s complementary medicine center‚ “Place of Wellness” in Houston‚ says that although the data indicate more than 60% of cancer patients use some form of complementary or alternative treatment‚ he thinks it is probably more like 80%.
Unfortunately‚ many of these patients never talk to their physicians about their experiments with CAM. Those who do‚ often meet indifference or resistance‚ which further impedes communication.

“Patients may try these therapies to gain more mastery over their illness‚ or because they’re particularly anxious about their disease‚ or because other aspects of the therapy have not been working very well‚” points out Dr. Baile. “Physicians need to address the motivations of people who turn to CAM‚ not dismiss it outright. That’s a major mistake.”

Although complementary and alternative techniques are often lumped together (as evidenced by the CAM acronym) oncology professionals stress that the two terms are not synonymous.

Alternative therapies—as the word implies—are touted as substitutes or replacements for conventional cancer treatment‚ often with promises of a cure

Complementary treatments‚ on the other hand‚ are meant to complement standard treatment modalities‚ and enhance patients’ well–being and overall quality of life.

“There are no cures associated with the complementary therapies‚” explains Dr. Cassileth. “Complementary therapies reduce symptoms. They help patients deal with very difficult problems associated with cancer and its treatment.”
This does not mean that complementary therapies don’t yield some physical benefits. “It’s possible that in an indirect way these therapies strengthen people’s bodies and minds and enable them to get through some very difficult treatments‚” says Dr. Cassileth.

“We certainly hear this all the time from patients‚ and that’s wonderful. But unfortunately‚ these interventions do not cure disease.”

Because these treatments have not been shown to have any concrete effect on cure or survival rates‚ experts such as Drs. Baile and Cassileth find it alarming when therapies that should be complementary are promoted as alternatives. “The problem is that some people make claims that have to do with physical healing that are unproven‚” explains Dr. Baile.

“When therapies that are useful in a complementary mode are offered as literal alternatives‚ they are more harmful than helpful‚ because frequently they keep patients from receiving needed care in a timely fashion‚” agrees Dr. Cassileth.
Patients who utilize complementary therapies find them most helpful not as cure‚ but as tools for getting through the harsh physical and emotional realities of cancer treatment.

“I think the complementary cancer clinic gave me a sense of control‚ a sense that there was something I could do about this pretty uncontrollable disease‚” recalls Nancy L. Mau‚ who was diagnosed with breast cancer in May 2000. The retired flight attendant attends the Cancer Supportive Care Program at the Stanford Center for Integrative Medicine‚ Stanford‚ California.

“I started with a restorative yoga class as soon as I was finished with chemotherapy‚ and that was just huge‚” says Mau. “Not only was it something that made me feel I was helping myself rather than just sitting around waiting for cancer to come back‚ but it was something that I could take with me to the doctor’s office. It was a way of meditating‚ of relaxing‚ of getting in touch with my body.”

The Big 10
Prior to her breast cancer diagnosis in July 2001‚ Elaine S. Costello of San Mateo‚ California‚ knew little about complementary medicine. Her first inkling came when she chanced across a flier from Stanford’s Cancer Supportive Care Program. “It was called ‘Enhance Your Chemotherapy Experience‚’ which is I think a little more optimistic than it should be‚” says Costello with a laugh. “But I figured anything that could enhance this would be good.” She calls the first session a revelation.

“They said there are many ways to adapt to the experience of cancer‚ and that you can make a big difference in how the experience is for you. You can be an active participant‚” recalls Costello. “And I thought that was so much healthier than anything else I had heard.”

Perhaps most importantly‚ the staff at Stanford gave her alternatives beyond cure. “The concept of cure can be a little overwhelming‚ because it’s an all or nothing kind of thing—either you’re going to be cured or you’re going to die‚” explains Costello. “The complementary care program basically said it’s great if you’re cured‚ but that’s not the only alternative. You can also deal with your cancer as a chronic disease and learn to manage your therapy without being overwhelmed by it. And I just found that really useful.”

Stanford‚ like most cancer centers‚ offers a range of options to help patients manage their therapy‚ all chosen based on sound scientific evidence. “I personally would call much of what we do rather mainstream‚” says Holly Gautier‚ RN‚ associate director of the Cancer Supportive Care Program. “Many of these modalities‚ including massage and acupuncture‚ are now being covered by some insurance.”

“One of our bottom lines is‚ show me the data‚” says Dr. Baile‚ who designed the program at M. D. Anderson.

“We don’t use magic‚” agrees Dr. Cassileth. “The therapies we use have good data behind them. Therapies that are rational and consistent with current understanding of human physiology and disease. For example‚ our use of acupuncture isn’t based on 3‚000–year–old traditional Chinese medical theories. It’s based on what’s known scientifically‚ and the fact is that we’ve had a lot of success with acupuncture.”

While each complementary care program is slightly different‚ some of the most frequently offered therapies include:

Acupuncture: This 3‚000–year–old technique uses very thin needles inserted through the skin to treat a variety of ills. Although the precise mechanisms of acupuncture’s effects are still unclear‚ it has proved effective for relieving chemotherapy–induced nausea and many types of pain.

Art Therapy: Painting‚ sculpture‚ and other creative activities help cancer patients express difficult emotions and come to terms with feelings about their disease. Little research has been done on the effect of art therapy on cancer patients‚ but studies in children and adults with other disorders indicate art therapy can have significant emotional benefits (see CURE past issues‚ Fall 2002).

Biofeedback: Biofeedback uses various monitoring devices to help patients gain control over normally automatic physical responses such as blood pressure‚ heart rate‚ temperature‚ and muscle tension. To date‚ biofeedback has proved effective at reducing the side effects of chemotherapy‚ helping patients regain bowel and urinary control after surgery‚ and relieving various types of pain.

Guided Imagery: This relaxation technique involves visualizing a particular image or goal and then imagining achievement of that goal. One popular technique‚ the Simonton method‚ has patients imagine cancer cells being destroyed by chemotherapy or their bodies’ natural defenses. Dozens of studies have shown that guided imagery is an effective technique for managing stress‚ anxiety‚ and depression‚ and can also relieve high blood pressure‚ pain‚ and the side effects of chemotherapy.

Hypnosis: During hypnosis‚ patients enter a state of relaxed‚ highly focused attention in which external stimuli are largely ignored. Research has shown that hypnosis is a very effective way to reduce stress‚ anxiety‚ and pain‚ and can also help relieve the nausea and vomiting caused by chemotherapy.
Massage/Reflexology: The “touch therapies” of massage and reflexology (application of pressure to specific areas of the feet) are among the most comforting and effective complementary therapies for cancer. Several small studies have documented positive effects on pain‚ anxiety‚ and depression.
Meditation: Meditation involves achieving a state of deep relaxation through various techniques. The goal is to temporarily “tune out” the outside world and enter a state of calm well–being. Numerous studies have shown that regular meditation can mitigate the effects of chronic stress‚ relieve anxiety‚ lower blood pressure‚ and help ease pain.

Music Therapy: Music therapy can involve everything from simply listening to music to songwriting‚ performance‚ musical improvisation‚ and discussion of lyrics. Several studies have found that music therapy‚ when combined with antinausea drugs‚ can significantly relieve nausea and vomiting in patients receiving high–dose chemotherapy‚ and it enhances the effect of pain–relieving drugs.

Qigong: This 7‚000–year–old Chinese discipline combines meditation‚ physical movements‚ and breathing exercises to enhance the flow of “qi‚” the body’s vital energy. Although one small–scale study found that qigong helped reduce pain and stress in cancer patients‚ there is little hard scientific evidence on the beneficial effects of qigong.

Yoga: Yoga seeks to achieve a synthesis of body‚ mind‚ and spirit through controlled movements combined with breathing exercises and meditation. Numerous studies have shown that yoga can help patients control a range of physiological functions‚ including blood pressure‚ body temperature‚ heart rate‚ and other functions. The National Institutes of Health has stated that yoga may be appropriate as a complementary therapy to relieve symptoms associated with cancer.

Many programs also offer nutritional guidance and advice‚ but most steer clear of advocating specific diets or dietary supplements. “There are many diets or ways of eating that are beneficial in terms of reducing the risk of some cancers‚ but after a diagnosis of cancer is made there is no curative magical diet‚” says Dr. Cassileth. “Eating properly will make you healthier and keep your body as strong as possible‚ but it won’t cure cancer.” In addition‚ inappropriate use of nutritional supplements has been shown to alter the effects of chemotherapy and increase the risk of some side effects.

The Future of CAM
“Every patient should have the opportunity to avail themselves of things that help them cope with their disease‚” asserts Dr. Baile‚ and as more and more patients seek out complementary therapies‚ it is likely that more and more cancer centers will add complementary therapies to their treatment rosters.
“A lot of the interest in complementary medicine has been driven by the patients’ requests for improved quality of life‚” says Gautier. “When I came on two years ago we had about 60 to 90 patient visits a month. Today we serve anywhere from 450 to 600 a month. The program has been so successful because patients feel an improvement pretty quickly‚ so it’s something very tangible for them.”

Mau would certainly agree. When she compares notes with cancer patients who have not availed themselves of complementary care‚ she is often struck by the difference in their treatment experience. “My experience has been so much more positive‚” she says. “I feel like I’m nurturing myself and taking care of myself and taking control of this cancer. I think other people feel a little more like a feather in the wind or a little more of a victim.”