by Lise Alschuler, ND, and Karolyn A. Gazella
Evaluating Your Options and Choosing Integrative Treatment
It may seem that we have a long way to go before most people have access to truly integrative cancer treatment. Academic medical centers have not yet sufficiently integrated CAM services into their conventional care models. According to research by Dr. David Eisenberg and his colleagues at the Harvard Medical School Osher Institute, none of the 39 randomly selected academic medical centers that integrate complementary and alternative medicine services into conventional care had written policies concerning credentialing practices or malpractice liability for CAM therapies, and only 10 reported a written policy governing use of dietary supplements.
The good news is that just a few years ago, very few academic medical centers were even considering an integrative medical model. Today, several integrative cancer clinics and hospitals exist in the United States. These facilities offer conventional treatments such as radiation, chemotherapy, and surgery, but they also offer nutritional support, including supplements, as well as other CAM therapies such as naturopathic medicine, acupuncture, Reiki, massage, and meditation. This comprehensive care model uses best of both worlds to treat cancer, offset side effects, and enhance quality of life for the cancer patient.
The key to determining the best integrative cancer treatment approach is understanding how to evaluate all of your options -- conventional and native. Having lots of choices can be positive, but it can also be overwhelming. For some people, black-and-white decisions are much easier; they to avoid the gray areas. When faced with a cancer diagnosis, avoiding the gray is nearly impossible. Evaluating your options is like navigating foggy seas at night. The only way to reach your destination is to be guided by the right information. Authoritative resources, knowledgeable health-care providers, and skilled researchers are lighthouses that can help you navigate the foggy sea of cancer diagnosis and treatment.
Complicating the cancer treatment evaluation process is the pressure to choose sides. Will it be conventional or complementary? It can be difficult to overcome this either-or dilemma and its attendant stress. If you, your loved ones, or your doctors have this sort of polarized view, remember that seldom is the situation with cancer black and white. It's perfectly fine to combine treatment approaches. Avoid painting yourself into a corner. As long as you're working with a knowledgeable health-care practitioner and both of you are armed with trusted information about the pros and cons of each treatment, you can choose to utilize conventional and complementary treatments simultaneously, or you can alternate between them. You are a unique individual, and as such your cancer treatment should be individualized. Remember, these are ultimately your decisions to make.
Another difficulty that cancer patients and their families sometimes face is the desire to loyally or even blindly follow the advice of a single doctor. Most doctors will admit that at times even they are unsure what course is best. Cancer treatment is riddled with ambiguity, and oncology is one of the most emotionally and intellectually challenging specialties in medicine. Cancer doctors seldom have definitive answers; they're just doing their best to provide you with the information you need to make informed decisions. Don't be afraid to ask questions, and don't be afraid to leave the protective cocoon of your main cancer doctor. Most doctors are familiar with and even encourage second opinions. Relying on multiple sources to help you navigate will provide you with more perspective. And the more perspective you have, the better.
Gathering Information
Some skepticism of both conventional and alternative treatment options is healthy. Suspicion can be particularly helpful when evaluating Internet information. Beware of the charlatan -- the person, company, or organization aggressively trying to sell or promote the next "cancer cure." If you search the Internet for "cancer" and "cure," Google will quickly deliver more than a million websites! Some of them are reputable, but some clearly are not. That's why it is important to get other opinions when evaluating information -- particularly when you find extraordinary claims that may indicate self-serving websites or commercial interests. And that's why it is important to listen to your own voice of doubt, no matter how weak or strong.
That said, there is an immense amount of useful information available online. PubMed, an online library of peer-reviewed and scientifically credible medical journals sponsored by the Library of Congress, contains a vast store of articles that provide helpful and trustworthy information. Though these are usually fairly technical, they can help you better understand various treatment options. Respected integrative cancer centers have websites, as do various nonprofit organizations. Many health-related government agencies have information about cancer on their websites, and it's encouraging to note how many of these have added information on CAM therapies in recent years. There's a great deal of information available on the Internet that isn't directly tied to product sales. We'll show you how to successfully navigate this terrain while avoiding the muck that inevitably surfaces. In addition, we have provided a resource listing at the back of the book with specific websites we recommend, including the PubMed online library.
We believe in integrative medicine and helping people with cancer find scientifically sound information to help them make decisions regarding all treatment methods. We are disappointed in the individuals, manufacturers, and organizations that irresponsibly push "natural alternatives" as cures for cancer for their own gain -- and sometimes we find ourselves disgusted by the depths of their crassness. They do a great disservice to people with cancer, who face enough challenges without also having to wade through false claims and unsubstantiated hype. Their claims are also bad for integrative medicine, which can provide great benefit to people with cancer, and to people in general. Read on as we guide you in discovering the genuine wisdom in the world of natural health.
Healthy Exploration
It's important to learn to separate the wheat from the chaff. Although many "new" miracle products and novel theories are bogus, creative and innovative thinking has been the impetus for some of the most exciting and effective medical advances of our time. At some point, we have to trust the momentum and take a chance. Reverend Pam Roberts, executive director of Samaritan Counseling and Education Center and a cancer survivor, tells her clients to listen to their "inner eye" -- that "gut instinct" sitting at the center of all of us. Learn to rely on your intuition and the intuition of the people you love and trust, then try to validate that intuition with scientific information.
We understand the desperation that can come with a cancer diagnosis. And we understand the need to sometimes take a chance or a leap of faith. If you are considering taking such a leap, we hope you're tethered to solid science, sound advice, and a logical and effective evaluation of all of the information you receive. After you gather all the details, open your "inner eye" to take one last look before you make your decision.
Understanding Our Evaluation
The maze of information about complementary and alternative medicine can be so confusing it can become maddening. Sometimes it seems impossible to find the right path -- the healing path. From this point forward, we will provide you with information about specific integrative cancer treatment options. We have based our conclusions on the following:
- Scientific, credible sources
- A combination of conventional gold standard research, case reports, traditional wisdom, and historical use information
- Practical risk-to-benefit ratios
- Safety, side effects, and contraindications
- Types of studies available
- Input from our respected editorial board and other experts
We provide evidence-based advice along a continuum ranging from "highly recommended" to "recommended with caution" to "not recommended." We evaluate treatments based on their ability to halt disease progression, enhance quality of life, and ease side effects of the disease or from conventional treatments. Cancer can be a life-threatening illness, and we understand that it may not be prudent to wait for unequivocal scientific assurance of the effectiveness of a drug or therapy. Our goal is that our rating system, will help you make some of your treatment decisions more easily, more safely, and with greater confidence.
Within conventional medicine, a treatment is typically not determined to be effective and safe until it has been demonstrated in at least three separate, successful, well-designed human clinical trials. This is the standard, for example, that Medicare uses to authorize coverage for a treatment. The randomized controlled trial is often considered the gold standard of medical evaluation because it reduces research errors and more clearly identifies whether the intervention being tested is effective by comparing it to a placebo (an inert substance).
Applying this gold standard to complementary and alternative treatments is not always possible. Randomized controlled trials are designed to study isolated pharmaceutical ingredients or single interventions rather than a multitreatment, integrative approach that may include combinations of herbs, nutrients, diet, and lifestyle changes. Although randomized trials have studied some complementary and alternative therapies, the majority of CAM therapies are not substantiated by definitive human clinical data.
Fortunately, there are many other types of research that can provide validation for complementary and alternative therapies and an integrative approach. Thus, we can still apply high research standards to the evaluation of integrative medicine. Using findings from in vitro tests (those using cells and tissue samples), in vivo animal tests, and clinical data (vast population studies, small clinical trials, observational trials, randomized clinical trials, and so on), we can piece together a picture of the evidence for the effectiveness of a particular CAM therapy. It's always important to consider not just results of a study, but the type of study as well. For example, studying a substance in a test tube provides a less convincing case than studying it in animals or humans. Furthermore, a human trial of 10 individuals is less compelling than a trial of 100 individuals who have been compared to a control group. This is the criteria we use throughout the book.
Copyright © 2007 DEFINITIVE GUIDE TO CANCER: AN INTEGRATED APPROACH FOR TREATMENT AND HEALING by Lisa Alschuler and Karolyn A. Gazella, published by Celestial Arts; www.tenspeed.com.