Overview of CAM and Dietary Supplement Use in Cancer Patients
Mary Ann
Richardson, DrPH, Program Director
National Center for Complementary and
Alternative Medicine (NCCAM)
National Institutes of Health, Bethesda, MD
Presented at the American Dietetic Association
Food & Nutrition Conference & Exhibit 2002
October 19-22, 2002, Philadelphia, PA
Complementary
and alternative medical (CAM) practices are those healthcare practices that are
not currently an integral part of conventional medicine, but many of these
approaches are being integrated into comprehensive cancer care. The National
Center for Complementary and Alternative Medicine (NCCAM) has grouped CAM into
five major domains: alternative medical systems such as traditional oriental
medicine and homeopathy; mind–body interventions including meditation, prayer,
and mental healing; biologically based treatments such as melatonin, herbs,
shark cartilage, and high-dose vitamins; manipulative and body-based methods
including chiropractic manipulation, massage, and other hands-on techniques;
and energy therapies of which therapeutic touch, Reiki, and Qi gong are a few.1 By some estimates, use of CAM by the general population rose, from 34%
in 1990 to 42% in 1995. Visits to CAM practitioners jumped from 427 million to
629 million visits;2,3 however, the 1999 National
Health Interview Survey of 30,000 adults in the United States recently reported
CAM use at 29%.4
An estimated 30-75% of cancer patients worldwide use
CAM therapies including dietary approaches, herbals, and other biologically
based treatments (ie, melatonin, mushrooms, cartilage, and vitamins). Cancer
patients commonly use CAM to prevent, palliate, and treat their disease. Among CAM users, dietary supplements
and antioxidants are the most widely used CAM product with estimates ranging
from 60% in outpatients at a comprehensive cancer center;5 26.6% (8.2% megavitamins)
among breast cancer survivors of four ethnic groups in San Francisco,6 50% in breast cancer
survivors in Canada,7 25% in breast cancer patients
in a Midwest University center,8 and 25% in advanced-stage
breast cancer patients;9 10% to 46% in gynecologic
cancer patients;10,11 34% to 65% in prostate cancer patients;12,13 10% in hematology oncology patients;14and 36% in a pediatric
oncology population.15 Supplements are used often in combination with conventional
oncology treatment and often while patients are participating in clinical
trials. For example, 55% of colorectal cancer survivors reported
using vitamins, minerals, or nutritional supplements while participating in a
chemoprevention trial. 16
The possible impact of antioxidants on the efficacy
of conventional treatment, amelioration of side effects or toxicity of
conventional treatment, recurrence, and survival are as yet unevaluated by
compelling, well controlled studies, either in preclinical models or in cancer
patients. To date, studies are too few
and too fragmentary to enable conclusions about efficacy, make definite
recommendations for patients, or develop guidelines for health
professionals. As the body of research evolves to confirm which dietary supplements are
harmful or beneficial, which will not hurt but might help, physicians will be
able to effectively advise patients. In
the interim, the phenomenon of CAM use warrants a more proactive approach with
screening of patients at the beginning of treatment and monitoring throughout
treatment, improved patient–provider communication about CAM, even in the
absence of definitive data.
1. The
National Center for Complementary and Alternative Medicine. Expanding Horizons
of Healthcare: The Five-Year NCCAM
Strategic Plan 2001-2005.
Http://Nccam.Nih.Gov/Nccam/Strategic/. accessed January 10, 2002.
2. Eisenberg D, Davis R, Ettner S, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569-1575.
3. Eisenberg D, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalance, costs, and patterns of use. N Eng J Med. 1993;328:246-252.
4. Hanyu N, Simile C, Hardy A. Utilization of complementary and alternative medicine by United States adults. Med Care. 2002;40:353-358.
5. Richardson MA, Ramirez T, Palmer JL, Greisinger A, Singletary SE. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol. 2000;18:2505-2514.
6. Lee MM, Lin SS, Wrensch MR, Adler SR, Eisenberg D. Alternative therapies used by women with breast cancer in four ethnic populations. JNCI. 2000;92(1):42-47.
7. Boon H, Stewart M, Kennard M, et al. Use of Complementary/Alternative Medicine by Breast Cancer Survivors in Ontario: Prevalence and Perceptions . J Clin Oncol. 2000;18:2515-2521.
8. VandeCreek L, Rogers E, Lester J. use of alternative therapies among breast cancer outpatients compared with the general population. Altern Ther Health Med. 1999;5(1):71-76.
9. Shen J, Andersen R, Albert P, et al. Use of complementary/alternative therapies by women with advanced-stage breast cancer. BioMed Central. 2002.
10. Von Gruenigen V, White L, Kirven M, Showalter A, Hopkins M. A comparison of complementary and alternative medicine use by gynecology and gynecologic onocology patients. Int J Gynecol Cancer. 2000;11:205-209.
11. Swisher E, Cohn D, Goff B, et al. Use of complementary and alternative medicine among women with gynecologic cancers. Gynecol Oncol. 2002.
12. Lippert M, McClain R, Boyd J, Theodorescu D. Alternative medicine use in patients with localized prostate carcinoma treated with curative intent. Cancer. 1999;86(12):2642-2648.
13. Jones H, Metz J, Devine P, Hahn S, Whittington R. Rates of unconventional medical therapy use in patietns with prostate cancer: standard history versus directed questions. Urology. 2002;59:272-276.
14. Paltiel O, Avitzour M, Peretz T, et al. Determinants of the use of complementayr therapies by patients with cancer. J Clin Oncol. 2001;19(1):2439-2448.
15. Kelly K, Jacobson J, Kennedy D, Braudt S, Mallick M, Weiner M . Use of unconventional therapies by children with cancer at an urban medical center. J Pediatr Hematol Oncol . 2000;22(5):412-426.
16. Sandler R, Halabi S, Kaplan E, Baron J, Paskett E, Petrelli N. Use of vitamins, minerals, and nutritional supplements by participants in a chemoprevention trial. Cancer. 2001;91:1040-1045.