Complementary Medicine

in
Cancer Therapy

Patricia L. Judson, MD
Associate Professor
Gynecologic Oncology
University of Minnesota
 Categories of Methods

• Mind, Body, Spirit

• Manual Healing and Physical Touch
• Herb, Vitamin and Mineral
• Diet and Nutrition
• Pharmacological and Biological
 Mind, Body, Spirit
• Aromatherapy • Imagery
• Art Therapy • Kirlian Photography
• Ayurveda • Labyrinth Walking
• Bioenergetics • Meditation
• Biofeedback • Music Therapy
• Breathwork • Native American Healing
• Crystals • Naturopathic Medicine
• Curanderismo • Neuro-linguistic Programming
• Cymatic Therapy • Psychotherapy
• Dance Therapy • Qigong
• Faith Healing • Samanism
• Feng Shui • Spirituality and Prayer
• Holistic Medicine • Support Groups
• Humor Therapy • Tai Chi
• Hypnosis • Yoga
 Manual Healing and Physical Touch
• Acupuncture • Massage
• Applied Kinesiology • Moxibustion
• Biological Dentistry • Myofascial release
• Bodywork • Myotherapy
• Cancer Salves • Neural therapy
• Castor Oil • Ohashiatsu
• Chirpractic • Osteopathy
• Cold Laser Therapy • Polarity Therapy
• Colon Therapy • Psychic Surgery
• Craniosacral Therapy • Reflexology
• Cupping • Reiki
• Electroacupuncture • Rosen Method
• Electrodermal Screening • Rubenfeld Synergy Method
• Electromagnetic Therapy • Sonopuncture
• Heat Therapy • Therapeutic Touch
• Hydrotherapy • Transcutaneous Electrical Nerve
• Hyperbaric Oxygen Therapy Stimulation
• Light Therapy • Tui-Na
• Magnetic Therapy • Watsu
 Herbs, Vitamins and Minerals
• Aconite • Comfrey •Marijuana
• Aloe • Copper •Milk Thistle
• Alsihum • Echinacea •Mistletoe
• Arnica • Essiac Tea •Molybdenum
• Astragalus • Evening Primrose •Mugwort
• Aveloz • Flaxseed •Oleander Leaf
• Beta Carotene • Flower Remedies •Orthomolecular medicine
• Betulinic Acid • Folic Acid •Pau D’Arco
• Black Cohosh • Fu Zhen Therapy •PC-SPES
• Black Walnut • Germanium •Peppermint
• Bromelain • Ginger •Phytochemicals
• Calcium • Ginkgo •Pokeweed
• Capsicum • Ginseng •Potassium
• Cat’s Claw • Goldenseal •Psyllium
• Celandine • Green tea •Pycnogenol
• Centella • Hansi •Rabdosia Rubescens
• Cesium Chloride • Hoxsey Herbal treatment •Red Clover
• Chamomile • Indian Snakeroot •Saw Palmetto
• Chaparral • Kampo •Selenium
• Chinese Herbal Medicine • Kava •Siberian Ginseng
• Chlorella • Larch •Six Flavor Tea
• Cloves • Licorice •St. John’s Wort
 Diet and Nutrition
• Acidophilus • Lycopene
• Amino Acids • Macrobiotic Diet
• Broccoli • Maitake Mushroom
• Cassava • Metabolic Therapy
• Coriolus Versicolor • Modified Citrus Pectin
• Ellagic Acid • Noni Plant
• Fasting • Omega-3 Fatty Acids
• Garlic • Selected Vegetable Soup
• Gerson Therapy • Shiitake Mushroom
• Grapes • Soybean
• Inositol Hexaphosphate • Vegetarianism
• Juicing • Wheat Grass
• Kombucha Tea • Willard Water
 Pharmacological / Biological
• Antineoplaston Therapy • Inosine Pranobex
• Apitherapy • Krebiozen
• Bovine Cartilage • Laetrile
• Cancell • Lipoic Acid
• Cell Therapy
• Live Flush
• Chelation Therapy
• Livingston-Wheeler Therapy
• Coenzyme Q10
• Coley Toxins • Lyprinol
• DHEA • Melatonin
Di Bella Therapy • Oxygen Therapy
• DMSO • Poly-MVA
Enzyme Therapy • Pregnenolone
• Gamma Linolenic Acid
• Revici’s Guided Chemotherapy
• Glucarate
• Sea Cucumber
• Greek Cancer Cure
• Homeopathy • Shark Cartilage
• Hydrazine Sulfate • Shark Liver Oil
• Hydrogen Peroxide Therapy • Urotherapy
• Immuno-Augmentive Therapy • 714-X
 Tonight
• My CAM research trial
• Acupuncture
• Botanicals, Vitamins, Minerals
Outcomes in Ovarian Cancer Patients
Using
Complementary Alternative Medicine
 Newly diagnosed patients with ovarian & primary peritoneal
cancer requiring chemotherapy

Eligibility criteria satisfied and consent process

Randomized

Chemotherapy Alone Chemotherapy plus CAM

Administer QOL instruments, cycles 1, 3, 6

Labs, cycles 1-6
Chart review / interview record complications
No CAM therapy Three CAM Therapies
•30 min Clinical hypnosis, cycles 1,2,4
30 min Massage therapy, cycles 1-6
30 min Healing touch, cycles 1-6
Administer QOL six months post treatment
Clinical Hypnosis
 Clinical Hypnosis

Hypnosis has been defined as an altered state of

consciousness resulting from the selective
deployment of attention onto a focal goal and
away from stimuli perceived as peripheral.
 Clinical Hypnosis

• As a therapeutic tool, hypnosis is intentionally

induced
– either by a therapist = hetero-hypnosis
– or by the patient alone = self-hypnosis
• Individuals retain control of themselves and their
behavior while under hypnosis.
 Clinical Hypnosis

• Hypnosis has been associated with

– positive changes in patient immunity
– decreases in distress
– decreased frequency and severity of treatment-related side
effects
• Prospective, randomized, controlled trials
– psychological intervention, including hypnosis, can
enhance the quality of life of patients with cancer
• Hypnosis can enhance the immune response and
increase T and B cell counts.
 Clinical Hypnosis

• Meta-analysis found that relaxation training and

hypnosis with immune suggestions produced
reliable, medium-sized increases in total salivary
IgA concentrations.
• Relaxation was unrelated to T cell and NK cell
counts; these outcome data were not measured
in the hypnosis studies.
 Clinical Hypnosis

• Women with breast or gynecological cancers

– effectively reduce pain
– decrease depression and anxiety
– ameliorates chemotherapy side effects such as nausea
and vomiting.
• Self-hypnosis training for breast cancer survivors
was associated with statistically significant (p<0.05)
enhancements in perceived pain relief.
• Related to decreased nausea and vomiting post
chemotherapy, with decreases persisting after
training visits with the therapist ended.
 Clinical Hypnosis

• Used to reduce anticipatory nausea in cancer

patients
• Although the data consistently find a positive
relationship between hypnosis and outcomes,
methodological shortcomings, particularly small
sample sizes, lack of appropriate controls, lack of
randomization, and failure to report outcome effect
sizes support the need for further research
 Massage Therapy

• Manipulation, rubbing
and kneading of the
body’s muscle and soft
tissue.
 Massage Therapy
• Studies have shown cellular changes in immune
function following massage therapy.
– 100% experienced reduced levels of anxiety
– 56% experienced a substantial increase in white blood cell
counts and natural killer T cells
• Salivary IgA concentration significantly increased in
an experimental group receiving a back massage
compared to the control group
• Bone marrow transplant patients receiving massage
therapy compared to controls showed significantly
larger reductions in distress, fatigue, nausea and
anxiety, as measured by the State Anxiety Inventory
 Healing Touch
• Healing touch is a biofield therapy that is a holistic
energy-based approach to health and healing.
• It uses gentle, non-invasive
touch to influence the human
energy system, specifically
the energy field that surrounds
the body, and the energy
centers that control the flow
from the energy field to
the physical body.
 Healing Touch
• The healing touch practitioner utilizes their hands to
clear, energize, and balance the human energy
fields.
• The goal is to restore harmony and balance in the
energy system supporting the patient in the self-
healing process.
• Healing touch complements conventional health
care and is used in
collaboration with
other approaches to
health and healing.
 Healing Touch
• Found to enhance the immune system and decrease
anxiety
• In one study, participants who received healing touch
had significantly increased levels of IgA and IgM;
CD25 and IgG levels were also increased in the
healing touch group, but the differences were not
statistically significant.
• Healing touch has been shown to decrease anxiety
levels in hospitalized patients. Patients who received
the intervention by healing touch experienced a
highly significant (p< .001) reduction in their state of
anxiety according to a comparison of pre- and post-
test means on the State Anxiety Inventory
 Research Objective

• To determine whether combined modality CAM

used in ovarian or primary peritoneal cancer
patients will change their QOL, immune status,
use of anti-emetics, or hospitalizations while
undergoing primary chemotherapy.
 Research Objective

• Primary Objective
– Quality of Life: To determine whether QOL, as measured by
the FACT-O and MHI total scores, is improved in patients
receiving combined modality CAM as compared to patients
receiving chemotherapy alone.
 Research Objective
• Secondary Objectives
– To determine whether immunological changes in natural
killer (NK) cells can be detected in patients undergoing
primary chemotherapy with combined modality alternative
therapies.
– Evaluate for additional immunological response markers,
chemotherapy side effects and complication rates change
during combined modality alternative therapies treatment
as determined by:
• WBC with differential T and B panel (T helper cells, CD4, CD8)
• Salivary IgA
• Delays in chemotherapy protocol
• Use of anti-emetics
• Infection rate
• Re-hospitalization rate
Questions?
 Acupuncture
• Penetrating the skin with
thin, solid, metallic needles
that are manipulated by the
hands or by electrical
stimulation.
• Aims to restore and
maintain health through the
stimulation of specific
points on the body
 Acupuncture
• According to TCM, health is achieved by
maintaining the body in a "balanced state"; disease
is due to an internal imbalance of yin and yang.
• This imbalance leads to blockage in the flow of qi
along pathways known as meridians.
• Qi can be unblocked by using
acupuncture at certain points on
the body that connect with these
meridians.
 Acupuncture
• No scientific evidence that acupuncture is
effective as a treatment for cancer.
• Relieves symptoms related to cancer and cancer
therapies.
• Effective for nausea caused by chemotherapy and
anesthesia.
• Effective for treating pain.
 Acupuncture for hot flashes
• 27 women • 18 women HT for 24
electrostimulated months
acupuncture for 12 weeks • Hot Flashes:
– two 30 min sessions/wk for 2 – Baseline: 6.6 / 24hr
wks then once weekly for the
– 12 weeks: 0
next 10
• Hot Flashes:
– Baseline: 9.6 / 24hr
– 12 weeks: 4.3 / 24hr
– 1 year: 4.9 / 24hrs
– 2 years: 2.1 / 24hr
Botanicals, Vitamins, Minerals
 Botanicals, Vitamins, Minerals
• 38 million, 12% of Americans
use botanicals*.
• Among cancer patients in the
US, up to 60% use herbal
supplements.
• Symptom control, quality of
life, and cancer recurrence.
• Research has expanded.

*2002 National Health Interview Survey Centers for Disease Control and Prevention
 Popular Botanical Agents

• Essiac: burdock, turkey rhubarb, sorrel, and

slippery elm. No anticancer effects. Stimulates
the growth of human breast cancer cells1
• Iscador: a derivative of mistletoe. Many studies,
no definitive benefit in cancer therapy.

1. Kulp KS et al. Breast Cancer Res Treat 2006;98(3):249-259

 Popular Botanical Agents
• Mushroom derived compounds:
– Polysaccharide kureha (PSK), an extract of the mushroom
Coriolus versicolor, or schizoplyllan.
• Phase III trial of chemotherapy & radiotherapy +/- PSK found
superior survival with PSK compared to controls in esophageal,
gastric1-3 & colorectal cancers. 4-5
• Used after therapy in colorectal cancer prolonged survival by 1
year.6-7
– Results less encouraging for breast cancer & leukemia.8-10

1. Niimoto M. et al. Jpn J Surg 1988;18(6)681-6. 2. Ogoshi K. et al. Cancer Invest

1995;13(4)363-9. 3.Torisu M. et al. Cancer Immunol Immunother 1990;31(5)261-8
4-10 Available upon request
 Popular Botanical Agents

• PC-SPES: eight herbs from Chinese medicine.

Reduce PSA, and improve QOL in men with
advanced prostate cancer.1-4
• SV Soup – 19 vegetables from traditional
Chinese medicine. NSCLC – enhanced survival
by 11 months and improved QOL.5

1. Small EJ et al. J Clin Oncol 2000;18(21):3595-603.

2. Pfeifer BL et al. BJU Int 2000;85(4):481-5.
3. Oh WK et al. Urology 2001;57(1):122-26.
4. Oh WK et al. J Clin Oncol 2004;22(18):3705-12
5. 5. Sun AS et al. Nutr Cancer 1999;34(1)62-69
 Herbal Products with Serious
Side Effects*
Product (responsible constituent) Adverse Effects
Aristolochia, Bragantia, or Asarum Renal toxicity renal failure
species (aristolochic acid)
Common comfrey, prickley comfrey, Hepatic toxicity, veno-occlusive disease
Russian comfrey (pyrrolizidine
alkaloids)
Ephedra, Ma huang (ephedrine Hypertension, tachycardia, increased
alkaloids) risk for stroke, heart attack and heart
failure.
Products containing androstenedione, Androgenic and estrogenic effects
or “andro”
Kava Hepatic toxicity
St. John’s Wort Potent cytochrome p450 3A4 inducer,
altered metabolism of many drugs
*Food and Drug Administration
 Herbal Products with Serious
Side Effects
• Astragalus – can reverse the effects of
cyclophosphamide.
• Soy isoflavones may antagonize tamoxifen
breast cancer prevention.
 Long-term Use of Beta-Carotene, Retinol,
Lycopene, and Lutein Supplements and
Lung Cancer Risk: Results From the
VITamins And Lifestyle (VITAL) Study.
• 77,126 completed a detailed questionnaire about supplement
use (duration, frequency, dose) during the previous 10 years.
• 521 developed lung cancer
• Longer duration of use of individual beta-carotene, retinol, &
lutein supplements was associated with statistically
significantly elevated risk of lung cancer
• Little evidence for effect modification by gender or smoking
status.
• Conclusion: Long-term use of individual beta-carotene,
retinol, and lutein supplements should not be recommended
for lung cancer prevention, particularly among smokers.
Satia JA, et al. Am J Epidemiol. 2009
 Multivitamin use and risk of cancer and
cardiovascular disease in the WHI cohorts.
• 161,808 participants from the Women's Health Initiative
• Detailed data were collected on multivitamin use at baseline
and follow-up time points over a median of 8 years.
• Documented cancers of the breast, colon/rectum, endometrium,
kidney, bladder, stomach, ovary, and lung; CVD (myocardial
infarction, stroke, and venous thromboembolism); and total
mortality.
• Results
– 41.5% of the participants used multivitamins
– 9619 cases of cancer, 8751 CVD events, 9865 deaths
– Multivariate-adjusted analyses revealed no association of
multivitamin use with risk of cancer.Ovarian Cancer: HR 1.07and
95% CI, 0.88-1.29
• Conclusion: multivitamin use has little or no influence on the
risk of common cancers, CVD, or total mortality in PMP women.
Neuhouser ML, et al. Arch Intern Med. 2009 Feb 9;169(3):294-304.
 The role of antioxidants and vitamin A in ovarian
cancer: results from the Women's Health Initiative
• Examined the relationship between intake of dietary and
supplemental antioxidant nutrients including vitamins C, E,
and selenium as well as carotenoids and vitamin A and
ovarian cancer
• 133,614 postmenopausal women enrolled in the WHI study.
• Dietary intake was assessed using a food frequency
questionnaire, and ovarian cancer endpoints were centrally
adjudicated.
• 451 cases of invasive ovarian cancer were diagnosed over 8.3
yr of follow-up.
• Results: Dietary intake at baseline was not significantly
different for cases vs. controls. No significant relationships
among dietary factors and ovarian cancer risk.
• Conclusion: intake of dietary antioxidants, carotenoids, and
vitamin A are not associated with a reduction in ovarian cancer
risk.
Thomson CA, et al. Nutr Cancer. 2008;60(6):710-9
 Serum levels of vitamin D metabolites and
breast cancer risk in the PLCO screening trial
• Experimental and epidemiologic studies suggest that vitamin
D metabolites (1,25-dihydroxyvitamin D and its precursor 25-
hydroxyvitamin D) may reduce breast cancer risk.
• Examined breast cancer risk related to serum levels of these
metabolites.
• Women ages 55 - 74 years, who donated blood at baseline in
the Prostate, Lung, Colorectal, and Ovarian Cancer
Screening Trial
• 1,005 breast cancer cases during follow-up and 1,005
noncases were matched based on age and year of entry
• Conclusion: In this prospective study of postmenopausal
women, we did not observe an inverse association between
circulating 25(OH)D or 1,25(OH)(2)D and breast cancer risk.
Freedman DM, et al. Cancer Epidemiol Biomarkers Prev. 2008;17(4):889-94
 Conclusion
• The use of botanicals, vitamins, and
minerals with cancer treatment is
concerning.
• Few studies have addressed dose levels,
mechanism of action, safety or efficacy.
Thank You!