Complementary and Alternative Cancer Medicine
By Barrie R. Cassileth
C OMPLEMENTARY AND alternative therapies today
include a large assortment of unrelated modalities,
ranging from unproved or disproved cancer ‘‘cures’’ to
helpful adjunctive regimens. These dissimilar therapies
often are known by the same terms: complementary medi-
cine, alternative medicine, or complementary and alternative
medicine (CAM). Using the same words for vastly different
remedies may result in dismissing or accepting them all.
Such cases of mistaken understanding can have unfortunate
clinical implications.
In my opinion, a distinction between ‘‘alternative’’ and
‘‘complementary’’ is essential. Alternatives may be per-
ceived literally as such; they include any unproved therapy
that is promoted as a cancer treatment or cure or promoted as
a treatment to be used instead of mainstream oncology care.
Complementary therapies, in contrast, are used as adjuncts
to mainstream cancer medicine for symptom management
and to enhance quality of life.
The importance of this useful distinction was validated by
the National Institutes of Health (NIH) nomenclature shift
(the Office of Alternative Medicine was renamed the Center
for Complementary and Alternative Medicine) and by
results of a recent survey, the largest ever conducted to
determine public use of unconventional therapies.1 The
survey found that all but 2% of those who used unconven-
tional therapies did so to complement rather than replace
mainstream treatment.
In cancer medicine, alternative therapies are claimed to be
superior to surgery, chemotherapy, and radiation. Typically
invasive and biologically active, alternative regimens are, by
definition, unproved. They are also potentially harmful,
either directly through biologic activity or indirectly when
patients postpone mainstream care. Examples of alternative
therapies in cancer medicine include the metabolic therapies
that are available in Tijuana, Mexico, and elsewhere, shark
cartilage, high-dose vitamins and other products that are
sold over the counter and delivered intravenously in alterna-
tive clinics, electromagnetic cures, and many other products
and regimens.
From the Memorial Sloan-Kettering Cancer Center, New York, NY.
Address reprint requests to Barrie R. Cassileth, PhD, Memorial
Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021;
email cassileth@mskcc.org.
r 1999 by American Society of Clinical Oncology.
0732-183X/99/1711-0044
44 Journal of Clinical Oncology, Vol 17, No 11s (November Supplement), 1999: pp 44-52
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Although research evidence is scanty,2 approximately 8%
to 10% of cancer patients seek alternative care after tissue-
biopsy diagnosis. The great majority of cancer patients who
use CAM pursue complementary therapies, not alternative
therapies. Specific complementary and alternative therapies
are reviewed below.
THE IMPACT OF CAM ON THE HEALTH CARE SYSTEM
With the advent of managed care and advances in
biotechnology, the entry of unconventional therapies into
dominant medical arenas had a marked impact on health
care in the 1990s and was among the significant changes of
that decade. The popularity of alternative and complemen-
tary medicine has affected every component of the health
care system and all specialties of medicine, including
oncology. It has influenced the thinking and practice of
physicians and other health professionals and broadened
patients’ involvement and influence in their own care.
Unconventional cancer medicine today, unlike the covert
practices of prior decades, is highly visible and widely
available to the general public. It is a multibillion dollar
business in the United States and has equivalent impact and
importance throughout the developed world.
THE PREVALENCE OF COMPLEMENTARY AND
ALTERNATIVE CANCER THERAPIES
Internationally as well as in North America, the use of
CAM for cancer is widespread. A systematic review3 located
26 surveys of cancer patients from 13 countries. Five were
conducted in the United States. The average prevalence
across all studies was 31%. Therapies most commonly used
around the world included dietary treatments, herbs, home-
opathy, hypnotherapy, imagery or visualization, meditation,
megavitamins, relaxation, and spiritual healing. New inves-
tigations substantiate these results.4-6
In the United States surveys, patients used Laetrile,
metabolic therapies, diets, spiritual healing, megavitamins,
imagery, and ‘‘immune system stimulants.’’3 The prevalence
of CAM use in the United States ranged from 7% to 50%.
Additional surveys involving members of the United States
general public (not cancer patients) uncovered prevalence
rates of one third in a representative sample of 1,539 adults
as reported in 1993.7 In 1997, prevalence rates of 50% of 113
family practice patients8 and 42% of 1,500 members of the
general public9 were reported. A 1998 study found that 42%
of 2,055 people surveyed used CAM.10 The previously noted
COMPLEMENTARY AND ALTERNATIVE CANCER MEDICINE 45

1999 survey of more than 24,000 individuals found that 8% health issues abounds. In 1999, the United States Federal
of the study population used CAM with or without main- Trade Commission (FTC) announced that it had identified
stream care.1 hundreds of web sites selling bogus cures for cancer and
Prevalence rates from all CAM studies internationally other serious illnesses among the estimated total of approxi-
vary from less than 10% to more than 50%. This broad mately 17,000 health-related web sites.12
range, with its apparent discrepancies, is attributable to It is all but impossible for most patients to distinguish
variable understandings and definitions of CAM. Often between reputable sources of information and those backed
CAM is not defined in surveys, or it is defined so broadly as by vested interests. Some promotional materials and books
to include lifestyle activities such as weight loss efforts, are written by medical doctors and seem to present legiti-
exercise, church attendance, and support activities (such as mate information.
group counseling), which results in overblown figures for
CAM use.
Herbal medicines were used by 3% of respondents. In NIH AND MEDICAL ESTABLISHMENT ACTIVITY
contrast, the 1997 general public survey revealed the most
In addition to its acceptance by the public, CAM also has
common CAM therapies to be herbal remedies, used by 17%
infiltrated mainstream medicine in an unprecedented fash-
of respondents, and chiropractic, used by 16% of those
ion. An Office of Alternative Medicine (OAM) was estab-
surveyed.9
lished at the NIH by congressional mandate in 1992; its
The 1994 legislation allowing herbal medicines and other
stated purpose was to investigate unconventional medical
food supplements to be sold over the counter without review
practices.13 In 1998, Congress elevated the OAM to the
by the United States Food and Drug Administration (FDA)
National Center for Complementary and Alternative Medi-
has profoundly influenced public behavior. This is evident in
cine (CCAM) and increased its funding to $50 million.
the increased use of herbal remedies from 3% in 19917 to
CCAM now supports 10 CAM Research Centers. Most,
17% in 19979 to more than 20% in 1999.1 It is estimated that
including the Center for Alternative Medicine Research in
sales of dietary supplements have more than doubled since
Cancer at the University of Texas Health Science Center in
passage of the 1994 law. Expanding insurance coverage of
Houston, TX,14 are university-based. Research is funded
chiropractic care during this same time period may account
cooperatively by the relevant NIH institute and CCAM.
for similar growth in its utilization. Homeopathy, acupunc-
Mainstream interest in CAM is displayed also in the
ture, folk remedies, and the like were used by a maximum of
emergence and growth of medical school courses that cover
only 2% of respondents in the studies noted above.
complementary and alternative medicine. Elective courses
Virtually all studies conducted to date of cancer patients
in CAM were taught in 75 medical schools in the United
and of the general public internationally show that those
States in 1997,15 and the number seems to have increased
who use CAM tend to be female, better educated, of higher
since that time.16
socioeconomic status, and younger than those who do not.
In addition, numerous hospitals, medical centers, and
They tend to be more health conscious and use more
cancer centers have developed research and clinical service
mainstream medical services than do people who do not use
programs in CAM. These programs differ by departmental
CAM. It seems that CAM use by cancer patients has
base, types of clients served (inpatients, outpatients, commu-
increased in recent years,3,11 which probably reflects in-
nity), access (physician or self-referral), administrative staff
creases in over-the-counter remedies and broader availabil-
(physician, nurse, CAM expert), and services provided.
ity of complementary therapies in mainstream cancer pro-
Services range from mind-body sessions only, to massage
grams.
and exercise, to the provision of herbs and food supple-
It is important to note that patients who receive alternative
ments, to remedies that are even more removed from
cancer therapies exclusively are not reflected in CAM
mainstream care, such as colonic irrigation and homeopathy.
surveys, because, with one exception,2 all such surveys were
Some clinical CAM programs are repackaged support
conducted in mainstream clinics or hospitals.
services that were previously offered as spiritual care,
counseling, art therapy, nutritional guidance, and so on.
A final marker of mainstream interest to be noted here is
PUBLIC ACCESS TO CAM INFORMATION the publication of research articles about CAM in major
Information about CAM varies widely in its accuracy. mainstream medical journals. The Journal of the American
Many web sites and publications that seem to be objective Medical Association, the New England Journal of Medicine,
actually are sponsored by commercial enterprises that pro- The Lancet, the British Medical Journal, and specialty
mote and sell the products they report. Misinformation about journals such as the Journal of Clinical Oncology and

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46
Cancer have published reports of CAM research in recent
years. In 1996 and 1997, the National Library of Medicine
added many new CAM search terms to its medical subject
headings and began to cover alternative medicine journals
that were previously not reviewed for inclusion in MEDLINE.
Not everyone is happy about CAM. The professional
oncology community is hardly unanimous in its approval,
and many mainstream scientists are displeased with the
integration of CAM into mainstream medicine and are
particularly unhappy about the existence of a separate NIH
research entity for alternative medicine.17-19 Vigorous oppo-
sition to parts of CAM as ‘‘pseudo science’’ based on
‘‘absurd beliefs’’ has been voiced. The deviation from basic
scientific principles, which is implicit in homeopathy and
therapeutic touch, for example, is decried. The very exis-
tence of CCAM as an entity apart from existing NIH
research institutes, many claim, supports a separate, inferior
level of research and an antiscience bias. Alternative medi-
cine is a quintessential example of the sociopolitical force
behind medical change.
That force continues in congressional efforts to ensure
broad availability of CAM. In 1999, hearings were held by
the House of Representatives Committee on Government
Reform to improve availability of CAM to women with
breast and gynecologic cancers.20 The committee expressed
special concern about policies of the United States Health
Care Financing Administration, Medicare, and Medicaid,
and other federal institutions.
INSURANCE COVERAGE AND
OUT-OF-POCKET PAYMENT
Health insurance programs increasingly cover CAM ser-
vices and providers.21 More than 30 major insurers, one half
of them Blue Cross plans, cover more than one alternative
method.22 Increased coverage of complementary and alterna-
tive therapies reflects managed care efforts to control costs
as well as consumer demand.23 However, public willingness
to pay out-of-pocket is evident in the 73% growth of
pharmacy sales of natural remedies and supplements from
1991 to 1995; prescription drug sales during this same
period increased by 31%.24
POPULAR CAM CANCER THERAPIES
Currently favored unproved cancer therapies, or treat-
ments that are promoted as actual alternatives to mainstream
cancer care, are noted briefly here. Although there is no
evidence that these treatments impede the progression of
malignant diseases, they remain popular and are used by
large numbers of patients. (Helpful complementary/adjunc-
tive therapies are listed in the Appendix.)
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BARRIE R. CASSILETH
Diet and Nutrition Cures
Advocates of dietary cancer treatments tend to extend
mainstream assumptions about the ability of some diets to
reduce cancer risk to the idea that foods or vitamins can cure
cancer. Proponents make their claims in dozens of popular
books and on the Internet.
The macrobiotic diet ranks among the more enduring and
still popular dietary ‘‘treatments’’ for cancer. Developed in
the 1930s by George Ohsawa, a Japanese philosopher, the
macrobiotic diet was an effort to integrate traditional Asian
medicine, Christian teachings, and aspects of Western medi-
cine.25 Macrobiotic concepts of human physiology and
disease and of diagnosing disease with iridology and similar
techniques are fanciful and incorrect. Moreover, versions of
this diet are nutritionally deficient and can cause weight loss
in cancer patients.
Some patients and alternative practitioners believe that
large doses of vitamins, such as hundreds of pills a day or
intravenous infusions of high-dose vitamin C, can cure
disease. In 1968, Nobel Laureate Linus Pauling coined the
term ‘‘orthomolecular’’ to describe the treatment of disease
with large quantities of nutrients. His claims that massive
doses of vitamin C could cure cancer were disproved in
clinical trials,26,27 but megavitamin and orthomolecular
therapy—the latter adds minerals and other nutrients—
remain popular among cancer patients. There is no evidence
that megavitamin or orthomolecular therapy is effective in
treating any disorder.
Metabolic therapies continue to draw patients from North
America to the many clinics in Tijuana, Mexico, that
specialize in practitioner-specific combinations of diet plus
vitamins, minerals, enzymes, and ‘‘detoxification.’’ These
therapies are based on the belief that toxic products of cancer
cells accumulate in the liver, leading to liver failure and
death. The Gerson regimen, for example, counteracts such
liver damage with a low-salt and high-potassium diet, coffee
enemas, and consumption of a gallon of fruit and vegetable
juice daily.28
Detoxification is thought to be necessary for the body to
heal itself. Cancer and other illnesses are seen as symptoms
of the accumulation of toxins. This nonphysiologic concept
originated in ancient Egyptian, Ayurvedic, and other early
efforts to understand illness and death, which were believed
to be caused by the putrefaction of food in the colon. Decay
and purging were major themes in early cultures’ therapeutic
regimens. Neither the toxins nor the benefit of eliminating
them has been documented.
Modern drinkable cleansing formulas, which are said to
detoxify and rejuvenate the body, are also available in health
COMPLEMENTARY AND ALTERNATIVE CANCER MEDICINE
food stores, books, and on the Internet. A mixture of liquid
clay, psyllium seed husks, and fruit juice, for example, is
said to remove harmful food chemicals and air pollutants.29
These products are major laxatives, potentially dangerous
when taken on a regular basis as recommended by promot-
ers, and of special concern for cancer patients.
Mind-Body Techniques
The potential to influence health with our minds affirms
the power of the individual and remains an extremely
appealing concept in the United States.30 Some mind-body
interventions have moved from the category of alternative or
unconventional into mainstream medicine. Good documen-
tation exists, for example, for the effectiveness of medita-
tion, biofeedback, and yoga in stress reduction and the
control of physiologic reactions.31,32
Some argue that patients can use mental attributes and
mind-body work to prevent or cure cancer. Although they
may involve small numbers of patients or remain unrepli-
cated, research suggesting that psychologic factors or thera-
pies influence cancer are widely publicized.33 Prospective
versions of this study have failed to replicate the 1989
results.34
Bernie Siegel, MD, former surgical oncologist and best-
selling author, is a proponent of the idea that attitudes,
assumption of responsibility for one’s own health, and
understanding why patients ‘‘need’’ their cancers can help
correct unhealthy emotional patterns, thereby affecting can-
cer remission or cure. A study coauthored by Siegel,
however, found no difference in length of survival for his
support group patients versus controls, where patients in
both groups had completed standard mainstream therapy for
breast cancer.35
Attending to the psychologic health of cancer patients is a
fundamental component of good cancer care. Support groups,
good doctor-patient relationships, and the emotional and
instrumental help of family and friends are vital. However,
the idea that patients can influence the course of their disease
through mental or emotional work is not substantiated and
can evoke feelings of guilt and inadequacy when disease
continues to advance despite patients’ best spiritual or
mental efforts.30
Traditional Chinese Medicine
This ancient approach continues to draw Western patients,
although it is based on the unproved principle that a vital
energy courses throughout the body and that blockages to
the flow of this energy cause disease. Called ‘‘chi’’ in
Chinese medicine and ‘‘prana’’ in ancient Ayurvedic (In-
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47
dian) medicine, this energy can be unblocked or smoothed
by the hands of healers. Despite claims, these efforts do not
cure cancer. However, ‘‘tai chi,’’ a gentle exercise technique
based on the same precepts, is a well-documented, effective
means of improving balance and preventing falls among
elderly persons.36-38
In addition to acupuncture and acupressure, traditional
Chinese medicine also includes a full herbal pharmacopoeia
with remedies for cancer and most other illnesses.39 Chinese
herbal teas and relaxation techniques are soothing to many
patients with cancer, who use them as complementary
therapies (see Appendix). The potential anticancer benefits
of Chinese green tea and other herbal remedies are under
investigation.40-42
Pharmacologic and Biologic Treatments
These alternative treatments are invasive and biologically
active. Among today’s best-known pharmacologic treat-
ments is antineoplastons, developed by Stanislaw Burzyn-
ski, MD, PhD.43 Promising anecdotal reports encouraged a
clinical trial for pediatric brain tumor patients, but a joint
research effort by the OAM and the National Cancer
Institute failed to accrue patients. Further research at the
Burzynski Research Institute in Houston, TX, was permitted
under an Investigational New Drug Application, but prelimi-
nary data were criticized as uninterpretable and the therapy
as useless and toxic by respected mainstream scientists.44
Interest in shark cartilage as a cancer therapy began in
1992 with a book by I. William Lane, PhD, entitled Sharks
Don’t Get Cancer. Advocates base their support of shark
cartilage on its supposed antiangiogenic properties,45 but
shark cartilage protein molecules are too large to be
absorbed by the gut and are excreted. A recent phase I-II trial
of shark cartilage found no clinical benefit.46
Cancell is said to return cancer cells to a ‘‘primitive state’’
from which they are rendered inert. FDA laboratory studies,
which showed Cancell to be composed of common chemi-
cals including nitric acid, sodium sulfite, potassium hydrox-
ide, sulfuric acid, and catechol, found no basis for proponent
claims of Cancell’s effectiveness against cancer.47
Manual Healing Methods
There are numerous healing approaches that involve
touch and manipulation techniques. Hands-on massage, with
well-documented physiologic and emotional benefits,48 is an
important complementary therapy. Chiropractic treatment of
low back pain was supported by an NIH consensus confer-
ence,49 but its value is widely disputed by mainstream
physicians.50
48
One of the most popular manual healing methods is
therapeutic touch (TT), which, despite its name, involves no
direct contact. Instead, healers move their hands a few
inches above a patient’s body and sweep away ‘‘blockages’’
to the patient’s energy field. Although a study in the Journal
of the American Medical Association showed that experi-
enced TT practitioners could not detect the investigator’s
‘‘energy field,’’51 and despite scientists’ rejection of its
fundamental premises, TT is taught in North American
nursing schools and is widely practiced by nurses in North
America and other countries.52
Related therapies involve use of an individual’s special
energy gifts. Healing of this type has remained popular over
the centuries in less developed areas of the world53,54 and has
become increasingly popular in the United States. Healers in
many areas of the United States claim to have the ability to
cure people of cancer.55 Many patients are sufficiently
convinced of healers’ abilities that they decline to have
tumors removed surgically.
Herbal Remedies for Cancer
Herbal remedies encompass traditional and folk-healing
methods with long histories of use throughout the world and
across all cultures historically. Although many herbal rem-
edies are claimed to have anticancer effects, only a few
remain in common use as alternative cancer therapies. For
decades, Essiac has been one of the most popular herbal
cancer alternatives in North America. The treatment com-
prises four herbs: burdock, Turkey rhubarb, sorrel, and
slippery elm. Researchers at the National Cancer Institute
and elsewhere found that it has no anticancer effect. Iscador,
a derivative of mistletoe, is a prevalent cancer remedy in
Europe, where it is used in many mainstream cancer clinics.
No definitive data support its efficacy.
Pau d’arco tea, an old Incan remedy for cancer and other
illnesses, is made from the bark of an indigenous South
American evergreen tree. Its active ingredient, lapachol,
displayed antitumor activity in animal studies conducted in
the 1970s. However, it does not seem to affect human
malignancies. Nonetheless, pau d’arco tea is sold as a cancer
remedy in health food stores, through mail order, and on the
Internet.
Asian herbal remedies show greater promise. Several
mushroom-derived compounds are approved for use as
cancer treatments in Japan. PC-SPES (PC for prostate
cancer; SPES is Latin for ‘‘hope’’), which is a combination
of eight herbs, all but two from traditional Chinese medi-
cine, reduced prostate-specific antigen levels in men with
advanced prostate cancer.56 Its mechanism of action may
relate to its phytoestrogen effects.
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BARRIE R. CASSILETH
A study developed by researchers at the University of
California at San Francisco Breast Cancer Center involves
patients from that institution and from the Memorial Sloan-
Kettering Cancer Center. Women with advanced metastatic
breast cancer who are receiving a Tibetan herbal formula are
being studied for clinical outcome, including survival.
Historic herbal cancer remedies, when pretested to ensure
purity and consistency of product and when studied care-
fully, may produce potentially useful and nontoxic cancer
treatments. The difficulty is that they are rarely tested for
purity, examined for consistency, or studied carefully. They
are, nonetheless, in common use. Herb sales in drugstores
and food stores increased 35% from 1993 to 1994, totaling
$106.7 million for the year.57
Herbal Medicine
Some herbal remedies help cancer patients (see Appen-
dix), but others are toxic or may interact with other
medications. Because neither the FDA nor any other govern-
ment agency examines herbal remedies for safety and
effectiveness, few have been formally tested for side effects,
quality control, or efficacy.58 Many patients apparently are
unaware that herbs are dilute natural drugs containing scores
of different chemicals, most of which remain undocu-
mented. Their effects are not always predictable.
The potential for herb-drug interaction is sufficiently
strong that patients on chemotherapy should not simulta-
neously use herbal remedies. Similar cautions are necessary
for patients who undergo radiation therapy, as some herbs
photosensitize the skin and cause severe reactions. Before
surgery, herbal remedies should be discontinued because
some herbs produce dangerous blood pressure swings and
other unwanted interactions with anesthetics.59 Herbs such
as feverfew, garlic, ginger, and ginkgo have anticoagulant
effects and should be avoided by patients on warfarin,
heparin, aspirin, and related agents. The risk of herb-drug
interactions seems to be greatest for patients with kidney or
liver problems.
Regulatory and safety issues remain serious concerns so
long as governmental agencies are precluded from assessing
the safety and efficacy of dietary supplements. These
supplements, which include vitamins and minerals, homeo-
pathic remedies, herbal treatments, antioxidants, and other
over-the-counter products, are commonly purchased by
cancer patients as well as by the public generally. According
to the Nutrition Business Journal, 1998 sales of supplements
sold over the Internet alone reached $40 million, an increase
from $12 million in 1997. The Nutrition Business Journal
estimates that sales of food supplements will reach $160
million in 1999 and $500 million in 2001.
COMPLEMENTARY AND ALTERNATIVE CANCER MEDICINE 49

Many complementary (adjunctive) therapies are well
studied. Most alternatives (unproved therapies) are not.
Overall, CAM today represents a medical, social, and
economic phenomenon that cannot be ignored and that
remains in need of proper research. Some CAM proponents
argue that research is unnecessary to determine the effective-
ness of alternative therapies for cancer; others claim that
CAM therapies are too individualized to study with usual
scientific methods. In fact, there is no unconventional
therapy that cannot be properly evaluated.60-62 CAM thera-
pies require standard, scientific research. The most difficult
problem may lie in the ability of science, the public, and the
true believers to accept the results of rigorous inquiries, no
matter what they reveal.

APPENDIX

For Patients: Complementary Therapies to Smooth the Way During Cancer Treatment and Recovery62

Anxiety and Stress

Acupressure: Use the fingers of one hand to press inside the wrist of the other hand. Press for a minute or two approximately 1 inch above the hand
crease. Pressing this acupoint relieves nausea as well as anxiety and stress.
Aromatherapy: Put a few drops of essential oil of rosemary, lavender, or camomile (available in health food stores and pharmacies) in the bath, or
light a scented candle while relaxing. The fragrance is luxurious and calming.
Meditation and other relaxation techniques: These are opportunities for mini emotional vacations. Close your eyes and see yourself in a pleasant,
peaceful place. Breathe deeply and slowly. Or lie down, eyes closed. Start at the toes and gradually move up the body as you consciously relax each
body part. Your body and mind will relax accordingly.
Music therapy: Music has important physiologic as well as emotional benefits. It calms, distracts, and soothes at a very fundamental level of being.
Therapeutic massage: Visit a licensed, certified massage therapist who is experienced with people undergoing cancer therapy, or arrange for that
person to visit you. Or have a friend or family member gently massage your neck and shoulders, hands and feet. Weekly therapeutic massages will
keep you feeling well. Patients with lymphatic cancers should avoid touch massage.
Valerian: Make a tea from 1 to 2 teaspoons of the dried root from this herb. You may prefer capsules because the tea doesn’t have a pleasant odor
(health food stores and pharmacies have both). It is safe and nonaddictive, and it effectively reduces anxiety and brings about sleep.
Yoga: Take a class, rent a videotape, borrow a book, and practice postures along with deep breathing techniques. Anyone can do yoga, even while
bedridden. It is said to bring mind, body, and spirit together in a peaceful union. Regardless of the way in which it works, yoga relaxes.

Backache or Muscle Ache

Capsicum cream: Hot red peppers contain a powerful pain-relieving chemical called ‘‘capsaicin.’’ It is the active ingredient in many rub-on
pharmaceutical pain relievers. Blend or mash a red pepper. Add some of the mashed red pepper to white body lotion or cold cream until the lotion
turns pink. Rub it on the sore spots. Or spend a few dollars on a cream that contains capsaicin.
Hydrotherapy: A warm bath or Jacuzzi should help relieve muscle aches.
Massage: Try a professional massage by a licensed, certified massage therapist or a careful muscle massage by a friend or relative. Patients with
lymphatic cancers should avoid touch massage.
Willow tea: The bark of the willow tree contains salicin, the active ingredient in aspirin. (Avoid this herb if aspirin causes upset stomach or if your
doctor told you to use an aspirin substitute.)

Colds and Influenza (Flu)

Garlic: Eat raw or cooked garlic, or try deodorized garlic capsules.
Echinacea: Take this herb when you feel a cold coming on, and you may reduce its duration. It also relieves symptoms. Echinacea works as a tea or
capsule. Avoid if you have allergies to ragweed, daisy, or sunflower.
Eucalyptus or peppermint oil: Place in a steam vaporizer and inhale.
Ginger: Make a large cup of tea with 2 tablespoons of shaved ginger and boiling water. It’s an effective way to relieve cold symptoms, and it tastes
good too. Add some chopped ginger to this or any other tea for its special benefits as an expectorant and cough suppressant.
Iceland moss and plantain: Tea from these herbs soothes sore throats and helps calm colds and flu.
Watercress tea: Tea made with watercress or fresh watercress helps treat cough and running nose.
Zinc lozenges: Studies show they may reduce the duration of a cold or flu.

Constipation
Cascara: Fluid extracts or capsules of cascara or buckthorn bark, a related herb, work well. Over-the-counter laxatives often contain chemicals
from one of these herbs.
Plantago seed: Also called psyllium seed, this is an effective herbal laxative. Take it with plenty of water.
Pureed rhubarb: Flavored with apple juice, lemon, and honey, pureed rhubarb is a delicious way to solve the problem.
Water and fiber: Water (six to eight glasses a day) and fiber (fruit, bran cereal, prunes) consumed regularly should keep this problem away, and
regular exercise is also helpful.

Cont’d

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50 BARRIE R. CASSILETH

APPENDIX

For Patients: Complementary Therapies to Smooth the Way During Cancer Treatment and Recovery62 (Cont’d)

Depression
Hypericum: Also known as St. John’s wort, hypericum is a common herb that blooms around the time of St. John’s birthday, hence its name. It is a
proven antidepressant for mild or moderate problems. It probably does not work as well for more serious depression, which requires pharmaceuticals,
but that issue is under study. Capsules are readily available over the counter. St. John’s wort has few if any side effects. Do not take with any
prescription medication for depression.
Licorice: Black licorice contains monoamine oxidase inhibitors. These are the same antidepressant chemicals found in prescription pharmaceutical
products such as phenelzine and tranylcypromine. Licorice is powerful medicine. As with any monoamine oxidase inhibitor, avoid smoked foods and
aged cheeses, alcohol, narcotics, and cold and allergy remedies, and do not take it if you are on any prescription medication for depression or if you
have an adrenal disorder. Add some to an herbal tea that has its own antidepressant properties, such as tea made with ginger, purslane, or rosemary.
Light therapy: These are bright-light boxes that are placed at eye level on a desk or table. Light boxes are made specifically to reduce depression,
and they are especially effective in northern parts of the world where sunlight is rare or during winter months in the northern hemisphere. Light boxes
are used in mainstream medicine and recommended by psychiatrists to treat seasonal affective disorder.
Meditation and yoga: These are very helpful for depression as well as anxiety (see Anxiety and Stress).
Tai chi: This gentle exercise program is practiced daily by millions of older Chinese. Follow the slow motions, which typically mimic animal
movements, as displayed in books, videos, and classes. Research shows that tai chi not only lifts depressed mood, but that it also improves bodily
balance, reduces falls, and increases physical strength.

Diarrhea
Relieve diarrhea with agrimony or peppermint tea; applesauce or cooked carrots; dried blackberry, blueberry, or raspberry leaves; dried blueberry
fruit; or up to two teaspoons of pulverized seeds from the herb fenugreek.

Headache
Acupressure: Press the acupoint between your eyebrows or in the hollows at the base of the skull on both sides of the spine.
Evening primrose tea: sunflower seeds, garlic, and onion relieve headaches, too.
Feverfew: Make tea (steep six to eight leaves in boiling water; avoid further boiling because it will break down the active chemicals) or take
capsules of fresh or freeze-dried leaf. Add bay leaves to feverfew tea to increase effectiveness against headaches, including migraines.
Progressive relaxation or massage: See Anxiety and Stress.

Heartburn
Herb teas: Especially ginger, camomile, and licorice.
Salad items: Including lettuce, onion, garlic, and olives. Walnuts, in addition to fennel or anise tea, also help.

Indigestion
Peppermint or chamomile tea.

Nausea
Acupressure: Press inside of wrist with fingers of other hand. (See Anxiety and Stress).
Cinnamon or peppermint tea.
Ginger: Use tea, capsules, or candy. Add fresh shaved gingerroot to boiled water to make tea, or add sugar and gelatin to the boiled ginger water and
let it cool. Cut into cubes and eat as candy. Ginger ale or cookies, if made with real ginger and not flavoring, work too.

Chronic Pain
Acupuncture: Consult the yellow pages in your local telephone directory for a licensed, accredited acupuncture doctor. Properly trained
acupuncturists use disposable stainless steel needles and do a virtually painless job.
Biofeedback: This requires equipment and a trained biofeedback therapist. Check the telephone book. Many pain clinics and pain management
experts in hospitals use biofeedback or can make referrals.
Useful herbs: External capsicum (see Backache or Muscle Ache), sunflower seeds (eat them or grind them with some oil or water and apply to skin),
willow bark (‘‘natural aspirin’’) tea (avoid if you have been instructed to not take aspirin), mountain mint leaf tea (apply the cooked leaves to the skin).
Hypnotherapy: Some people can eliminate chronic pain, or reduce it substantially, with hypnosis. Pain clinics, the telephone book, and your nurse
or doctor are good referral sources for certified hypnotherapists.
Massage: See Anxiety and Stress.

Sleep Problems
Relax in a warm bath scented with lavender oil, drink lemon balm herb tea, or try massage or meditation. Make tea of fresh or dried passionflower
herbs, valerian root, or chamomile.

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COMPLEMENTARY AND ALTERNATIVE CANCER MEDICINE
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