Cancer, Unproven Therapies, and Magic

In this issue of Oncology, Dr. Wein presents a thoughtful discussion on the use of unproven therapies by cancer patients. He attempts to explain the rationale and motives behind such use, and the challenges faced by oncologists when encountering patients who embrace them. This commentary further highlights important issues, and provides alternative viewpoints. Although no set of terms is ideal, we feel that it is important to use a defined vocabulary when discussing unconventional medical therapies (UMT). The term “unconventional medical therapy” includes “alternative” and “complementary” therapies, which have important nuances in definition. The same modality might be considered alternative if used in lieu of a conventional medical therapy, yet complementary if used as a supplement to a conventional therapy. Unconventional medical therapies typically include modalities that are not traditionally part of allopathic medicine—eg, herbal or other supplements, meditation, biofeedback, acupuncture, and homeopathic tinctures—but may include nostrums and other hoaxes. A conventional therapy used out of its accepted context, on the other hand, might become a UMT—for example, the use of penicillin for Parkinson’s disease. Are UMTs Becoming the Norm? In recent years, unconventional medical therapies have infiltrated the mainstream of medical practice. The Dietary Supplement and Health Education Act of 1994 prevents the US Food and Drug Administration (FDA) from regulating nutritional supplements. Although specific therapeutic claims are not permissible, it is common for media advertisements to promote a supplement, typically as “natural,” in the context of promoting the general health or well-being of a specific organ. Popular slogans, such as “Increase your libido with this safe, natural, scientifically proven supplement” or “This herbal preparation is clinically proven to benefit [insert body part] health,” can be heard on many radio stations. Use of UMTs in the general population skyrocketed in the 1990s, and it is estimated that 42% of the general US population use UMTs to promote well-being.[1] This figure is likely higher for those diagnosed with cancer. Dr. Wein emphasizes that physicians must ask patients about the use of UMTs because of the magnitude of their use and the potential for direct harm or interaction with conventional therapies. Questionnaire studies estimate that 9% to 64% of cancer patients use UMTs; these surveys suggest that patients are reluctant to discuss UMT use with physicians.[2-7] A study at the Hospital of the University of Pennsylvania revealed that the disclosure of UMT use by cancer patients increased from 7% with standard history-taking to 43% with the addition of directed questions.[8] Hazards/Benefits of UMTs While UMTs are frequently promoted as “natural” and, therefore, safer than conventional therapies, there are potential dangers. It must be remembered that medications such as atropine, digoxin, and paclitaxel (Taxol), are natural plant derivatives. Various UMTs have been shown to cause liver or renal impairment, electrolyte imbalances, interactions with prescription medications, or carcinogenesis.[9,10] Shark cartilage may cause an elevation in transaminases, possibly leading to hepatitis.[11] In addition to this warning, patients should be cautioned not to use shark cartilage enemas if they are at risk for neutropenia. Although the deleterious effects of particular UMTs are becoming evident, it is also clear that others may be salutary, especially when used as complements to conventional therapies. For example, acupuncture has been shown to reduce chemotherapy-induced nausea and emesis, pain perception, and possibly even radiation-induced xerostomia.[12-14] Biofeedback with relaxation training can decrease chemotherapy-induced nausea.[15] Lycopene may lower prostate-specific antigen levels,