Much of cancer treatment involves managing cancer symptoms, including pain and the side effects of cancer treatment. The latter may include fatigue; problems related to nutrition and eating (e.g., loss of appetite, nausea and vomiting); hair loss; neurotoxicity (e.g., damage to nerve cells, causing numbness or tingling in hands and feet); loss of concentration; psychological distress; sexual problems; and infertility. Some effects of cancer treatment are short-lived (e.g., hair loss, nausea), but others are permanent (e.g., increased susceptibility to infection after removal of the spleen, infertility after certain chemotherapy drugs). Likewise, some treatment side effects are immediate (e.g., hair loss), whereas others may arise only after a substantial delay (e.g., congestive heart failure many years after anthracycline chemotherapy, leukemia secondary to alkylating agents or radiation therapy). Information about the long-term side effects of treatment on important organs, such as the heart and lungs, is becoming more available.

Cancer patients in the United States have long been interested in treatments not traditionally offered as part of mainstream medicine. The incorporation of some alternative or complementary approaches as adjuncts to conventional treatments is a direct result of patients' desires for better cancer treatment, both curative and palliative, and generally for treatment that leaves them with a better quality of life than they might otherwise expect (Box 2.1).

BOX 2.1 Alternative or Complementary Cancer Treatments

Certain approaches to pain relief and coping (e.g., guided imagery, acupuncture, therapeutic touch) are increasingly being offered in mainstream cancer centers alongside conventional treatment. Other alternative approaches such as combinations of unknown drugs and chemicals given with the promise of cure fall squarely outside what mainstream medicine accepts, and patients may go to clinics inside and outside the United States to obtain them.

Among the more popular alternative or complementary approaches are the following:

  • dietary, ranging from low-fat "conventional" or vegetarian diets to a strict "macrobiotic" diet (which supporters believe to be curative);
  • spiritual approaches based on Western and Eastern religions, as well as Native American belief systems;
  • mind-body techniques such as hypnosis, relaxation, meditation, yoga, and guided Imagery;
  • physical approaches such as massage and therapeutic touch; and
  • Chinese medicine of various types.

Patients may use mind-body approaches, in particular, throughout the course of cancer treatment (and survivorship)—for example, to alleviate the side effects of chemotherapy, to improve their psychological state, and to increase their energy levels. Some of these techniques have been studied and have been shown objectively to benefit patients, although this cannot be said for each approach or claim of benefit.

At present, there is little evidence available for judging which, if any, alternative treatments are actually beneficial, particularly in terms of improved survival and, in some cases, safety. It is reasonable to assume, however, that patient interest will continue to maintain a focus on these treatments and that the government will continue its modest efforts to foster reliable evaluations of them.



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