Hypnosis
A small percentage of patients may experience dizziness, nausea, or headache. These symptoms usually result from patients being brought out of trances by inexperienced hypnotherapists.
Massage Therapy
Serious adverse events are rare and associated with exotic types of massage or untrained practitioners. In work with cancer patients, the application of deep or intense pressure should be avoided, especially near lesions or anatomic distortions such as postoperative changes. Patients with bleeding tendencies should receive only gentle, light-touch massage.
Acupuncture
The most common minor adverse events included local bleeding and needling pain, both in 0.05% of patients. It is prudent to avoid acupuncture at the site of tumor or metastasis, limbs with lymphedema, areas with considerable anatomic distortion attributable to surgery, and in patients with thrombocytopenia, coagulopathy, or neutropenia. Cancer patients require certified practitioners who are experienced in treating patients with malignant diseases.
Herbs and Botanical Products
Because botanicals contain biologically active constituents, they carry health risks if not used properly. The botanical kava kava, for example, proved more effective than placebo in treating anxiety, stress, and insomnia, and it was considered a viable alternative to benzodiazepines because of its benefits and absence of dependency and addiction. However, later reports associate this herbal remedy with severe hepatotoxicity resulting in death.
Herbs may attenuate or lessen the effect of a drug either by direct action on its target or by altering its pharmacokinetics. Herbs such as feverfew, garlic, ginger, and ginkgo have anticoagulant effects and should be avoided by patients using warfarin, heparin, aspirin, and related agents. Red clover, Dong quai, and licorice, because of their phytoestrogen components, should not be used by patients using tamoxifen or aromatase inhibitors. St. John's wort was a popular product for depression, at least equivalent in efficacy to tricyclics and selective serotonin reuptake inhibitors in mild to moderate depression and with a side effect profile superior to both. It was found, however, that St. John's wort induces cytochrome P450 CYP3A4. Reduced plasma levels of SN38, an active metabolite of irinotecan, have been reported after simultaneous use. Such metabolic interactions preclude St. John's wort for patients on medications metabolized by CYP3A4.
Although not an herb, grapefruit juice was found to significantly change the plasma level of many prescription drugs. Further study found that furanocoumarin derivatives inhibit intestinal CYP3A4, which consequently increases the bioavailability of drugs that are substrate to first-pass metabolism by this enzyme.
