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Part III of a Series
By Adriane Fugh-Berman, MD
Patients who ask about alternative cancer therapies clearly trust their doctors. However, physicians have difficulty providing counsel in this area, since they must walk the line between supporting their patients while endorsing only proven therapies.
There is a difference between using alternative therapies as adjuncts to conventional treatment and using alternative therapies as anticancer treatments (often instead of conventional treatment). In terms of adjunctive treatments, adequate evidence exists to support the use of certain alternative treatments, including hypnosis or acupressure bracelets for chemo-associated nausea and vomiting; massage for post-mastectomy lymphedema; and topical vitamin E for chemo-induced mucositis.
And it’s common sense that cancer patients can benefit from a balanced diet, exercise, relaxation, social support, and stress reduction (whether by massage, meditation, yoga, or seeing more movies). In fact, everyone could benefit from these measures.
It is difficult to counsel patients about alternative cancer treatments because there is little evidence of benefit in this area. However, physicians should ensure that cancer patients know all their options by describing the known benefits or risks for specific cancer therapies (conventional or alternative); informing patients of the option to participate in clinical trials; avoiding recommendation of therapies (conventional or alternative) for which no clinical trial data exist; and remaining supportive of patients even when they make decisions against their physician’s advice.
For conventional treatments, the National Cancer Institute (NCI) provides an invaluable resource called "CancerFax" that gives consumers and physicians frequently updated information about prognoses and treatments of choice for all kinds of cancer. To access this service, call (301) 402-5874 from any fax machine, and follow the commands to get a list of cancers and their codes. After identifying the appropriate code, call back and key in the code. Up-to-date information will be sent back to the caller’s fax machine. Or visit NCI’s website at http://www.nci.nih.gov.
NCI’s telephone information service, (800) 4-CANCER, provides information in English and Spanish; people with TTY equipment should call (800) 332-8615.
For a current list of clinical trials, consult the PDQ database, which is accessible at medical and many other libraries, or at http://www.cancernet.nci.nih.gov/pdq.htm. This site also provides links to other clinical trials sites.
For patients whose cancers have high cure rates through conventional treatment, physicians have an ethical obligation to recommend against choosing alternative treatments (adjunctive treatments are fine). For example, early cervical cancer, endometrial cancer, and Hodgkin’s lymphoma have very high cure rates when treated conventionally; it does not make sense for patients to eschew curative treatment when it does exist.
There is nothing to be gained by discouraging patients with poor prognoses or those who want to use alternative cancer treatments in conjunction with conventional treatments. Whether or not they agree with their patients’ choices, physicians still play an important role in monitoring and supporting their patients. Descriptions of alternative cancer therapies can be found in several books; Michael Lerner’s Choices in Healing is the best among them. It bears emphasizing that no large clinical trials have been completed on any alternative cancer therapies, and patients should be told that.
Many alternative cancer therapies are very expensive. Providers of alternative cancer treatments range from the sincere to the unscrupulous. Several services charge patients hundreds of dollars for referrals to alternative practitioners; many of these referral services are staffed by people who are not health care professionals.
If patients are determined to try alternative cancer clinics, physicians can help them weed out the worst by providing the following list of questions to ask alternative cancer therapy providers:
Are all patients treated, or is there a selection process?
Be wary of clinics that accept all patients and/or claim that their therapy cures all cancers.
What’s the success rate with my cancer?
High numbers or slick answers should arouse suspicion.
What does "success" mean?
Some clinics use their own unvalidated tests to mark cancer progression, prognosis, or the "success" of their therapy.
Can this therapy be used with conventional treatment or other alternative treatments?
It’s a bad sign when someone states that their therapy must be used alone. There is a case to be made that the immunosuppressive effects of chemotherapy should not be combined with an immunostimulating therapy, but a blanket statement that surgery, radiation, or any other conventional therapy would "interfere" with a treatment should not be trusted unless backed by data. Patients should also ask about potential side effects.
Can I talk to some patients who have received this treatment (preferably patients who have had the same cancer as mine?)
This is a good question to test the level of suspicion or paranoia manifested by a clinic, and whether they actually can identify patients happy with their treatment. Some clinics that refuse may invoke patient confidentiality, but a responsible clinic should be able to contact a patient or two and ask whether they would be willing to be called by a potential patient. And obviously a place that gives out former patients’ names and numbers without their permission does not care about patient confidentiality.
How much does it cost, and what does that fee include?
Some programs require extended stays, and lodging may add thousands of dollars to expenses.
Is the clinic staff willing to speak to my regular physician?
This is a good question to ask to help determine the clinic’s level of paranoia. Willingness to talk to a patient’s regular physician is a good sign.
Are records kept on how the treatment affects various patients?
Obviously, this is a minimal requirement.
Is there any long-term follow-up on patients?
A clinic that claims a high success rate but does not track patients after they leave the clinic is not trustworthy.
Regardless of whether patients decide to use conventional and/or alternative therapies, primary care practitioners should stay in regular contact with patients after a cancer diagnosis. Even when you are not making the decisions on chemotherapy regimens, you still can be a very important support to them during their health crisis. It may be a good idea to request that patients make regular appointments so they can discuss their experiences with a physician who knew them before their cancer diagnoses. Even when you "only" listen and provide comfort, your patients will appreciate your support immensely.