NCCAM seeks scientific answers on CAM for cancer: complementary and alternative medicine at the NIH
This year, over 1.3 million Americans will find out that they have cancer. A major public health concern, cancer was the second-leading cause of death in the United States in 2001. Cancer cost Americans $171.6 billion in medical bills and time lost from work in 2002, according to the National Institutes of Health (NIH).
Many cancer patients and their caregivers use complementary and alternative medicine (CAM). One survey places the percentage of adult cancer patients who use CAM at 83%. The NCCAM Clearinghouse (see below), which responds to inquiries about CAM from the public, receives more questions about CAM for cancer that for any other medical condition.
NCCAM Director Stephen E. Straus, MD, observes, "For millions of Americans, cancer prevention and treatment concerns are not being adequately addressed through conventional medicine. Many are turning outside the medical mainstream to CAM approaches that are affordable and accessible, but largely untested."
A few of the CAM approaches used by cancer patients include prayer, meditation, and other forms of spiritual practice; vitamins, herbs, and special diets; exercise and other movement therapies; imagery (1) and other relaxation techniques; and Traditional Chinese Medicine.
NCCAM is funding rigorous studies on CAM for cancer prevention and treatment (including whether CAM therapies may interfere with or enhance conventional therapies). It does so through grants to researchers at leading centers around the country and in its own Division of Intramural Research. In fiscal year 2002, NCCAM's expenditures for cancer research totaled $14,253,000, or 16% of its research portfolio. In addition, NCCAM collaborates with other NIH Institutes and Centers, especially the National Cancer Institute (NCI).
A network of specialized centers of research is an integral part of NCCAM's research portfolio (read more at nccam. nih.gov/training/centers). Currently, two of these centers are focused on cancer research, and two others are conducting projects on CAM and cancer:
* The Johns Hopkins Center for Cancer Complementary Medicine is studying fish oil for pancreatic cancer and the antioxidant effects of herbs in cancer cells.
* The Specialized Center of Research in Hyperbaric Oxygen Therapy at the University of Pennsylvania is conducting four projects on the mechanisms of action, safety, and effectiveness of hyperbaric oxygen therapy (2) for head and neck tumors.
* The Botanical Center for Age-Related Diseases at Purdue University is studying whether polyphenols--chemical compounds found in some plants, such as soy, grapes, Ginkgo biloba, and berries--reduce the risk of developing cancer.
* The UCLA Center for Dietary Supplements Research on Botanicals is studying green tea and other botanicals--such as curcumin (a spice) and ganoderma mushrooms--for insights into their actions on tumor angiogenesis (3); Chinese red yeast rice and its possible implications for cancer prevention; and multiple Chinese herbs for possible benefit in prostate cancer.
Clinical trials (research studies in people) are also underway. Some of these trials are investigating:
* Acupuncture and whether it reduces anxiety and improves quality of life in patients with advanced colorectal cancer
* Shark cartilage for its safety and effectiveness as a treatment in patients with advanced colorectal or breast cancer
* An alternative diet (the macrobiotic diet) and flaxseed, to see if they help decrease the risk of developing breast cancer or uterine cancer.
* Noni, a CAM therapy originating from Asia and Pacific Islands, and its possible usefulness in treatment and symptom management for cancer patients
* The vitamin L-carnitine and whether it reduces fatigue in cancer patients
* Massage therapy, to find out whether it eases swelling of the arms and legs related to treatment for breast cancer.
The NCCAM Division of Intramural Research's Oncology Program is investigating selected CAM therapies for cancer. Currently, the Division is conducting studies of:
* Electroacupuncture, for delayed nausea and vomiting from chemotherapy in pediatric patients with osteosarcoma. While existing data suggest that nausea and vomiting in the first 24 hours after chemotherapy can be effectively treated with conventional medicine, delayed symptoms (occurring from 24 hours to 5 days after chemotherapy) are harder to manage. Electroacupuncture, a variation of traditional acupuncture, (4) involves placing needles on selected points on the body and pulsing them with electric current to stimulate the points.
* The herb mistletoe, combine with the chemotherapy drug gemcitabine, for patients with pancreatic, colorectal, lung, or breast cancer. Data from early studies suggest that mistletoe, either alone or in combination with chemotherapy, may stimulate the immune system and help cancer patients to feel better overall.
More information on NCCAM-sponsored clinical trials is available at nccam.nih.gov/clinicaltrials.
NCCAM collaborates with NCI in a number of areas, including cosponsoring research; jointly producing information for the public; and, through NCI's Best Case Series (BCS) Program, offering an avenue for learning of potentially promising new CAM approaches. Through the BCS Program, CAM practitioners can submit specific types of evidence--such as medical records, medical imaging (e.g., X-ray or ultrasound films), and pathology reports--that they believe support a CAM treatment's therapeutic effect on a group of cancer patients. The data are evaluated using a panel approach. Currently, NCCAM plans to perform these reviews through a working group of its National Advisory Council on Complementary and Alternative Medicine (NACCAM). This will continue the work of the Cancer Advisory Panel for Complementary and Alternative Medicine (CAPCAM), whose charter was withdrawn in 2002 during a Federal reduction of chartered advisory committees. The BCS Website is www3.cancer.gov/occam/bestcase.html.
"NCCAM is committed to exploring promising alternative approaches to treating cancer," Dr. Straus noted. "Supporting researchers who are using cutting-edge scientific tools to study CAM for cancer, one of America's greatest public health challenges, is a vital part of our work."
Complementary and Alternative Medicine at the NIH is published by the National Center for Complementary and Alternative Medicine (NCCAM), NIH, 6707 Democracy Blvd., Suit 401, Bethesda, Maryland 20892-5475 USA. The newsletter is available by mail, on NCCAM's website (nccam.nih.gov), or via e-mail by contacting the NCCAM Clearinghouse.
NCCAM Clearinghouse: For information about NCCAM or any aspect of complementary and alternative medicine, contact the NCCAM Clearinghouse
P.O. Box 7923
Gaithersburg, Maryland 20898 USA
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Our Mission: NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training complementary and alternative medicine researchers, and disseminating authoritative information to the public and professionals. This publication is not copyrighted. Please give credit to Complementary and Alternative Medicine at NIH.
Arias E, Smith B. Deaths: Preliminary Data for 2001. National Center for Health Statistics Website. Accessed at http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_05.pdf on August 8, 2003.
American Cancer Society. Facts & Figures 2003. American Cancer Society Website. Accessed at http://www.cancer.org/downloads/stt/caff2003pwsecured.pdf on August 8, 2003.
Richardson MA, Straus S. Complementary and alternative medicine: opportunities and challenges for cancer management and research. Seminars in Oncology. 2002;29(6);531-545.
Sparber A, Wootton J, Surveys of complementary and alternative medicine: Part II. Use of alternative and complementary cancer therapies. Journal of Alternative and Complementary Medicine. 2001;73:281-287.
1. In imagery (also known as guided imagery or visualization), the patient imagines a calming or soothing image or experience, such as a favorite place. Focusing on all the sensory details of this experience helps the brain and body to relax.
2. Hyperbaric oxygen therapy is the use of oxygen at pressures greater than those found in the atmosphere to treat a variety of disorders.
3. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor.
4. To find out more, see the NCCAM fact sheet "Acupuncture."