Beyond pharmaceuticals

With cancer, the complicated combination of chemotherapy and surgeries plus side effects lead patients to seek alternative medicine more often than people with other afflictions.

Sixty-five percent of cancer survivors have used complementary and alternative medicine, a 2011 study in the Journal of Cancer Survivorship found, compared with 52 percent of those who haven't had cancer.

Yet these largely unregulated treatments are often unproven and can lead patients down a health-care rabbit hole unless they have guidance.

People use them to help regain control of their treatment. And the sickest cancer patients are willing to take more risks when it comes to alternative care, said Diljeet Singh, who directs gynecologic oncology at the Banner MD Anderson Cancer Center in Gilbert, Ariz.

Singh, who also heads integrative medicine and cancer prevention at the center, recently shared some tips for navigating these less-conventional options in Philadelphia at the eighth annual Joining FORCEs Conference, which supports people affected by hereditary breast and ovarian cancer.

She concluded her 80-minute talk with this advice: "Be as careful [with alternative treatments] as you would about finding a physician."

Cancer patients should use complementary and alternative medicine to deal with symptoms, such as fatigue and stress - not the cancer itself. Such treatments range from herbal supplements to mind-body techniques including yoga and meditation.

For example, soy supplements are popular among patients who have undergone a hysterectomy to treat or prevent ovarian cancer, according to Singh. Soy may relieve menopausal symptoms such as hot flashes.

But it can also have complicated effects in the body, including altered estrogen levels and interactions with other drugs.

Instead of soy products for hot flashes, Singh prefers black cohosh - her "go-to herb" - because it doesn't influence estrogen. She reports good results from the oral supplement Remifemin, sold by Enzymatic Therapy Inc. of Wisconsin.

A class of herbs known as adaptogens, including ginseng and astragalus, can help with symptoms such as cancer-related fatigue, which has proved difficult for conventional medicine to alleviate.

"In the world of cancer-related fatigue, we don't have great drugs," Singh said.

Adaptogens support the body's ability to adapt to stress, but scientists don't yet understand how they work, Singh said.

Acupuncture has been shown to reduce nausea, Singh said. The National Cancer Institute has a Web page citing its effectiveness on nausea and vomiting. This type of traditional Chinese medicine may also help prevent peripheral neuropathy, the numbness and pain in fingertips and toes that often results from chemotherapy, she said. A 2013 review article found some evidence for acupuncture's positive effects on neuropathy, but concluded that more rigorous research was needed. Acupuncture treatment generally must be intensive - at least two sessions a week - in order to work, Singh said.

Patients commonly use herbal supplements in the form of pills or powdered additives, but those products may not contain what their labels say. Though supplements are much less regulated than pharmaceuticals, Singh steers her patients to the Nature's Way Products Inc. of Utah and Gaia Herbs, based in North Carolina. (She says she has no financial ties to them.)

Herbs are particularly hard to study, Singh said. Scientists typically try using chemical analyses to isolate the part of an herb that provides benefits. But data derived from that approach can be misleading, as herbs ordinarily are ingested in their whole form.

Singh's first recommendation is still conventional medicine, because of its efficacy and better regulation of safety.

"If I have an equivalent that's tried and true, and I know what's in it, I tend to go with the standard pharmaceutical," she said.

Singh also warns against trying too many unconventional treatments at the same time. This "polypharmacy" mistake distorts the individual effect of each drug. Instead, she tells her patients to try one herb at a time and see what works.

It's important to tell your doctor about any alternative treatments, even at the risk of getting a lecture. Only about 22 percent of complementary and alternative-medicine use among cancer survivors is reported to mainstream health-care providers, according to a 2011 study led by Jun Mao, associate professor of family medicine and community health at the University of Pennsylvania.

Patients may think their doctors won't approve of alternative treatments or don't know enough about them to provide guidance, Mao said. But he thinks working with an oncologist to integrate these treatments into cancer care is crucial.

Singh agreed and called it a red flag when an alternative-medicine provider won't cooperate with an oncologist.

If a patient mentions doing yoga for stress management, a doctor can make more recommendations for handling stress, including prescribing conventional drugs.

Perhaps the best prescription isn't even for medicine. A change in lifestyle might be helpful.

"I absolutely push people to exercise," Singh said. Even small aerobic activities, such as a 30-minute walk, can help patients manage stress, she said.

Sleep matters, too. Disrupted sleep patterns can increase the risk of ovarian, breast, and prostate cancers, Singh said.

Patients can also bolster their health with the right diet, including whole foods in their natural form. That, as opposed to taking supplements or juicing, is the best way to get the nutrients you need.

"You have to be committed," Singh said. "It's all about what's important for you."