This meeting was the third on the subject of Complementary and Alternative Medicine in the last four years. As before, the symposium, held the day before the full meeting began, was cosponsored by the American Cancer Society. Co-chairs: Maurie Markman, MD (Cleveland Clinic Foundation) and David S. Rosenthal, MD (Harvard University Health Services). In his introductory remarks, Dr. Rosenthal stated that just a few years ago, studies found that over 600,000,000 annual visits were made to CAM practitioners compared to 400,000,000 to primary care physicians .(Eisenberg et al., JAMA 280:1559-1575, 1998) Most cancer patients use CAM to "improve QOL, self esteem, and some in hopes to cure cancer". Herbs and vitamins were found to be the primary CAM used in cancer patients. The first speaker was Eric Winer, MD (Dana-Farber Cancer Institute) who spoke on "Complementary Therapy in Women with Breast Cancer". He said that he was a 'traditional' oncologist who takes care of many women with breast cancer, conducts clinical research in breast cancer, including pyschosocial/QOL research and that he has NOT done research in complementary therapies. But he said: "interest in complementary therapies is great, traditional treatment is imperfect, and discussion is important." He then showed a copy of a letter from a NYC-based 'integrative physician' whom one of his patients had visited. The letter outlined the herbs and vitamins suggested for the patient as she underwent adjuvant therapy. Suggestions included: high soy diet until the patient went on Tamoxifen, CoQ10, Vitamin E mixed tocopherols and tocotrienols, N-acetyl cystein and Ganoderma (mushroom). The doctor included some references at the bottom of this letter. Winer then made several important statements. He suggested that when a therapy becomes accepted by the medical profession, it is no longer CAM. This acknowledges, of course, that some treatments have crossed over in the past. He also pointed out that the prevalence of CAM use depends on the breadth of the definition, i.e. including yoga, meditation, etc. He listed some types of CAM therapies including: Vitamins/Herbs: (vitamin supplements, melatonin, herbal therapy, mistletoe, shark cartilage, soy, tea) Special diet:(vegan-no meat,dairy eggs), macrobiotic Physical: (acupuncture, yoga, massage, Tai Chi or Chi Gong, chiropractic) Mind/Body: (imagery, hypnosis, meditation, biofeedback, energy healing, spiritual healing) Not CAM (in his view)--Psychotherapy, Support Groups, Exercise Dr. Winer told the audience that CAM services were often not reimbursed and nearly 2/3 of a recent sample paid $100-$1000 yearly for cancer-related CAM. (Morris, et al, Am J Surg179:407-411,2000) He reiterated some of the stats that Dr. Rosenthal had presented. He suggested that characteristics that in general predict CAM use included women, younger age, higher income and education levels. He did point out that there were multiple studies from different geographic venues that have looked at descriptions of CAM, reasons for use and psychosocial correlates. Ann's NOTE: a question from the audience elicited the information that CAM use is widespread throughout the patient population regardless of age, gender, or income/education levels. Many of the studies done on patient populations are listed on this website. They have come from many diverse states and institutions as Dr. Winer acknowledged. A study from 2000 by Morris, Am J Surg 2000 demonstrated that breast cancer patients use more CAM interventions than any other cancer patients. (Prostate patients are probably second.) He touched upon the San Francisco phone study that interviewed African American women (45% use of CAM), Chinese American women (42%), Latinas (52%) and White (54%). (Lee et al. JNCI 2000;92:42). Winer then demonstrated that the cultural variations had predictors such as younger age, more education, non-smokers, exercise, advanced breast cancer stage, private insurance, use of counseling, and a cultural cohort. He then discussed CAM use among 254 women enrolled in a Genetic Testing Program. These women were exploring their risk for breast/ovarian cancer susceptibility. Their baseline enrollment questionnaires showed: Low smoking rates (8%) Little alcohol use (15% more or less five days a week) 50% consumed 5+ daily servings of fruits/vegetables (Ann's NOTE: This is a huge number, most studies looking at vegetable and fruit consumption can only measure in terms of weeks or months since MOST Americans do not eat enough of these foods.) 66% used sunscreen regularly 77% performed routine BSE 31% regularly saw a dermatologist for cancer prevention (sic) Ann's NOTE: More likely to be earliest possible detection than actual prevention!) DiGianni....Garber., manuscript submitted, 2002) CAM was used by 54% of this overall cohort. Cancer survivors reported significantly more CAM use than unaffected women (63% vs. 42%). A 1999 study Burstein et al: NEJM 1999 showed that 10.6% of women used CAM before a Stage I or II breast cancer diagnosis, but 28.1% began immediately after. In general the CAM therapies were used in conjunction with conventional treatments, not in lieu of it. Not for the first time, presentation of the idea that women who use CAM are 'distressed' was brought up (more later from Jimmie Holland, MD). "Breast cancer CAM users completing standard treatments more psychologically distressed and weaker sense of personal control, compared to non-users". And "poorer emotional health scores were found among 49% of a cohort of breast cancer survivors reporting use of various herbal treatments". (Ganz, et al.JNCI:39-42, 2002). Ann's NOTE: We contend that this 'distress' is a way for the woman to get what she needs, is a sign of discomfort with therapies offered, perhaps a marker for more awareness, more information, more choices. Makes sense that there is more 'distress'. Winer then discussed the fact that the high prevalence of CAM use was due to physicians not asking their patients about it. But the good news is that 50% of cancer survivors recently reported CAM use to their docs. Open communication is critical to: Promote solid patient-provider relationships Promote education and minimize misconceptions Minimize risk of untoward 'side' effects A study by Richardson et al, JCO 2000 showed that 63% of women were using vitamins/herbs and 80% using spiritual healings. 13% of patients used at least one method, with 20% using two and 24% using seven or more. The main reasons cited for use: To feel hopeful-73% Non-toxicity of approach-49% More control over medical decision-making-44% Their expectations included: Improved QOL-76% Boosted immune system-71% Prolonged life-62% Relieve symptoms-44% Cure disease-37% Dr. Winer then quoted from Jacobson et al, JCO 18:668-683, 2000 which reviewed CAM research in patients with breast cancer. 12 databases were examined finding over 1000 citations. The quality of the methodology was variable and only 51 studies were found to be 'acceptable', 4 Phase I, 23 Phase II, 17 Phase III, and 7 cohort studies. The endpoints examined included disease progression, disease symptoms, immune function and 'side' effects. So where do patients get recommendations since studies have not been forthcoming (or as Dr. Winer stated, "rigorous research is lacking"). Sources include: friends and family, the Internet, non-conventional practitioners, Traditional practitioners, advertising. He then explained that there are current trials looking at: shark cartilage in patients with advanced colorectal or breast cancer; soy protein supplements to treat hot flashes in post-menopausal women taking Tamoxifen after breast cancer; macrobiotic diet and flax seed looking at effects on estrogen, phytoestrogen and fibrinolytic factors; soy isoflavone compared with no treatment before surgery for breast cancer; and herbal therapy to treat metastatic breast cancer in women. All of the above were sponsored by the National Center for Complementary and Alternative Medicine (NCCAM). Dr. Winer finished by stating that "we all need to put aside our biases". He suggested that collaborations between clinicians, scientists, patients and advocates will be important. And he urged practitioners to run studies that can be used to increase our knowledge. Eric J. Small, MD, University of California, San Francisco Maurice Markman, MD (Cleveland Clinic Foundation) Michael J. Hawkins, MD Washington Cancer Institute Norman R. Farnsworth, PhD University of Illinois Jimmie Holland, MD Memorial Sloan Kettering Ralph Moss' take on ASCO CAM, 2002 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.