Complementary and Alternative Medicine: An Introduction for Patients

Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 15, 2014

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Defining the Terms

What is complementary and alternative medicine ( CAM)? What is integrative therapy? You may hear these terms used by your cancer care team and wonder how CAM or Integrative Therapies can help patients with cancer? This article will help you better understand what these terms mean and how to safely explore CAM therapies.

  • Conventional cancer therapies: cancer treatments that are widely practiced and have been proven beneficial in clinical research trials. These are often called standard care and may include surgery, chemotherapy, radiation therapy, and/or hormonal therapy.
  • Complementary and alternative medicines and practices (CAM): not considered standard treatments, though many can be beneficial to cancer patients. Often, these therapies are not routinely taught in medical schools and your physician or nurse may not be familiar with them.
    • CAM therapies fall into two categories: complementary and alternative.
      • Complementary medicines: cancer therapies used in conjunction with conventional medical treatments. For example, acupuncture and guided imagery may be used to manage nausea caused by chemotherapy.
      • Alternative medicine: therapies that are used instead of conventional medical therapies. For example, receiving vitamin infusions to treat the cancer, instead of a standard therapy prescribed by an oncologist.
  • Integrative Medicine: is an approach to cancer care that incorporates promising complementary therapies to support the whole patient: mind, body and spirit. Many cancer centers have integrative medicine programs that offer complementary therapies on-site.

What is considered CAM?

CAM therapies may be called "natural", but it is important to remember that natural does not mean no risk or imply safety. CAM therapies are broken down into 5 categories:

  • Mind-Body Therapies – including meditation, guided imagery, hypnosis, yoga and even creative outlets such as dance and music.
  • Biologically Based Therapies – including dietary supplements, herbal therapies and specialized diets.
  • Manipulative and Body-Based Practices – including massage, chiropractic care and reflexology.
  • Energy Medicine – including Tai Chi, Reiki, Quigong and therapeutic touch.
  • Whole Medical Systems – including Chinese Medicine (includes acupuncture), Ayurveda, naturopathic medicine.

Talking to Your Healthcare Provider About CAM or Integrative Therapies

If you are considering CAM or Integrative therapies, it is very important that you discuss them with your oncology providers before using these therapies. Although many of these can be helpful, others have been proven ineffective or can interact with your body or your standard cancer treatments. In recent years, oncology providers have become more aware of promising CAM therapies and are usually willing to support their patients in using CAMs that are safe. Ask your providers about which CAM therapies may be helpful in managing your specific side effects. Ask if they can suggest a practitioner for this CAM.

Many studies have shown that providers are not aware that patients are using CAMs because they do not specifically ask about them. Be sure to speak up about your use of CAMs!

Safety Considerations

Many CAM therapies are helpful in relieving side effects and supporting a patient's mental well-being. Unfortunately, for many CAM therapies, we are not certain what risks, if any, they pose and for others the risks are well known. CAM therapies that are taken by mouth or given through an IV may interfere with standard cancer treatments (either negating or intensifying its action) or cause certain blood test results to be inaccurate, so it is important to discuss those with your providers. In addition, CAM may have side effects of their own. For example, they may worsen other medical conditions a patient has, such as high blood pressure.

CAM therapies do not require FDA approval and they are not subject to the same manufacturing and purity standards as regulated pharmaceuticals. This has led to production batches containing impurities or not containing what the label states they contain. One way to safeguard against this is to buy from reputable manufacturers or those that are verified by USP (United States Pharmacopeial Convention). USP is a non-profit organization that tests vitamins and supplements for purity and assures that the products contain what the label says they contain. Verified vitamins and supplements will have a "USP verified" seal on the packaging.

There can also be safety concerns for some mind-body and body-based practices, depending on your situation. For example, deep tissue massage is typically not recommended for areas affected by lymphedema and acupuncture could increase infection risk in patients with a low white blood cell count. This underscores the importance of discussing CAM therapies with your providers.

Practical Considerations

Once you decide to use a CAM, there are some practical considerations. Where is the therapy is available – this may not be at the cancer center. What does it cost – these therapies may not be covered by insurance, but perhaps your cancer center has a program to offer a CAM at low or no cost. CAM is not always on the top of your practitioner's minds, so be sure to ask what is offered at the cancer center.

Learning More

There are a number of reliable websites that you can reference to learn more about CAM in general or a specific therapy.

National Center for Complementary and Alternative Medicine (NCCAM)

Office of Cancer Complementary and Alternative Medicin (OCCAM)

USP (United States Pharmacopeial Convention)

I Wish You Knew

Complementary & Alternative Medicine

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