Integrative medicine: complementary therapies and ... - Nature

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Integrative medicine: complementary therapies and supplements Barrie R. Cassileth, Jyothirmai Gubili and K. Simon Yeung Abstract | Many patients with cancer or other urologic disorders use complementary therapies in an effort to control symptoms and to prevent and treat disease. Complementary modalities are adjuncts to mainstream treatment. These safe, evidence-based therapies reduce symptoms associated with treatment of urologic cancers and other illnesses. They are to be distinguished from ‘alternative therapies’, which are unproven, potentially harmful, and often promoted as substitutes for mainstream medical care. Accumulating evidence supports the beneficial impact of complementary therapies, such as acupuncture, yoga, meditation and physical activity, on physical and emotional symptoms associated with cancer treatment, for which there are few effective standard interventions. Herbs and other dietary supplements are unlikely to be beneficial, and might be problematic or dangerous when taken during cancer treatment. Cassileth, B. R. et al. Nat. Rev. Urol. 6, 228–233 (2009); doi:10.1038/nrurol.2009.41

Introduction

Treatment of urologic cancers has become increasingly effective, generating substantial numbers of patients who are free of disease 5 years or more after completion of treat­ ment. In the US alone, 11 million people fall into this ‘survivorship’ category. These effective treatments, however, are associ­ ated with persistent adverse effects that impair function and diminish quality of life, both during treatment and for often months or years thereafter. As a result, substantial numbers of patients are drawn to complementary therapies, and concomi­ tant scientific interest has produced a large and growing body of data that support their use. PubMed elicits more than 380 ‘hits’ in response to a query about use of comple­ mentary therapies among cancer patients; examples of a few hits relevant to prostate cancer are cited here.1–3 The convenience of the acronym ‘CAM’, for complementary and alternative medi­ cine, is outweighed by important distinc­ tions between the two. Complementary therapies are adjuncts to mainstream treat­ ment that control symptoms and enhance wellbeing. Alternative therapies, however, Competing interests The authors declared no competing interests.

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are often promoted as surrogates for main­ stream care. They are unproven, expensive and potentially dangerous, especially when patients postpone conventional treat­ ment to try alternatives, and fail to receive the care needed in a timely fashion. No viable “alternatives” to mainstream cancer treatment are available. To avoid confu­ sion and disassociate from specious inter­ ventions, the terms ‘Integrative Medicine’ and ‘Integrative Oncology’ are increas­ ingly applied inter­n ationally to mean complementary medicine.4 Some complementary therapies are passive (such as acupuncture and massage therapies), whereas others require patient effort (such as meditation and yoga). In this article, we review the evidence base for many complementary therapies, as well as current data on herbs and other dietary supplements. Most complementary thera­ pies are helpful to patients across oncologic diagnostic categories. Over-the-counter remedies to be taken by mouth are more commonly oriented toward a particular cancer diagnosis, and these remedies are also noted. Men with prostate cancer commonly seek helpful complementary modalities as well as dietary supplements.5,6 Data in this manuscript are presented in two main sections, ‘Complementary

therapies’ and ‘Herbs and other dietary supplements’. The complementary thera­ pies discussed are commonly available in cancer departments and hospitals. Space constraints preclude a section on massage therapy, a very useful, muscle-relaxing, stress-reducing therapy.7,8

Complementary therapies Acupuncture An important component of traditional Chinese medicine, acupuncture is the stimulation of one or more predetermined points on the body with needles, some­ times with the application of heat, pressure or electricity to enhance therapeutic effect. The ancient theoretical underpinnings assume that ‘qi’ (pronounced ‘chee’), or ‘life energy’, flows through ‘meridians’, which were conceptualized as vertical energy channels thought to connect body organs. According to traditional Chinese medi­ cine philosophy, disease occurs when the meridians become blocked. Acupuncture was thought to relieve these blockages and enable the normal flow of ‘qi’, thereby restoring health. Some acupuncture points coincide with ‘trigger points,’ which are anatomic sites of enriched innervation.9,10 Biophysiologic and imaging research indicates that acupuncture triggers the release of neuro­transmitters and other endogenous substances, and activates the central nervous system. Full under­ standing of the mechanisms underlying these phenomena requires further study, but data from investigations, summarized below, support the utility of acupuncture in alleviating urologic symptoms. In a single-arm study of men with non­ inflammatory chronic pelvic pain syn­ drome and intrapelvic venous congestion, acupuncture alleviated pain (P