Ask Dr. Block: Which integrative treatments are right for me?

Are all integrative treatments evidence based? How do we know which is right for our situation?

 
The evidence base for integrative treatments varies for different treatments. Some integrative therapies, such as St John’s Wort for mild to moderate depression, or hypnosis for easing the surgical experience, have been tested in randomized controlled trials. Some, on the other hand, have only laboratory testing to back up their claims; for example, some facets of traditional Chinese medicine and most, if not all, “alternative” interventions. I strongly advise patients work with a clinician who knows the state of research on many different therapies. In addition, using therapies with the highest level of evidence (clinical-based versus laboratory based) is generally advised. 

However, there are therapies with relatively little research that may offer a lot to certain cancer patients, particularly those with advanced disease who have few conventional treatment options available to them. With any treatment option a patient may be considering, I recommend researching what is known about that specific treatment. The first questions should always be “how safe is it?” A treatment doesn’t need as much proof of efficacy if the approach being considered has little to no known risks, toxicity or side effects. Nonetheless, the next question should be “is there meaningful scientific data that demonstrates that the treatment actually works?” Related to this question, one should ask “what level of research was performed to determine the effectiveness of the treatment?” Since few alternative and even some integrative treatments have high level evidence to demonstrate efficacy, one should get input from an integrative physician and carefully examine the rationale of any treatment option before initiating care. And then there is the feasibility for the patient to do the therapy, evaluating concerns such as cost, travel, inconvenience, etc. 

I would also like to mention that there are also a number of internet databases that offer assessments of different integrative cancer therapies, including MedlinePlus of the National Library of Medicine, and the PDQ® Cancer Information Summaries: Complementary and Alternative Medicine, sponsored by the National Cancer Institute (by way of disclosure, I am a member of the committee responsible for working with the NCI on this patient and practitioner resource).

For more information on The Block Center for Integrative Cancer Treatment, visit BlockMD.com.

Comments

[Janet Cook]

Please clarify what Dr. Block meant in his blog when he referenced aspects of Chinese Medicine that had not been researched beyond laboratories. Based upon rigorous studies, MD Anderson, a leading center for cancer research and treatment, trains acupuncturists to treat patients with cancer. MDA recommends acupuncture for many conditions, including boosting the immune system as well as treating pain, uncontrolled nausea or vomiting, side effects from treatment or medications, and failed symptom control by conventional treatment. Physicians are also encouraged to consider acupuncture for a number of other conditions related to cancer treatment or cancer, e.g., chemo-related peripheral neuropathy. A recent study by MDA found that qigong improves overall quality of life during breast radiotherapy.

[The Block Center]

We agree, Janet, there’s been substantial progress with research on acupuncture. Some of the conditions mentioned are ones in which the clinical trial data have been very encouraging. We would suggest, for example, that patients having pain should consider acupuncture. It is specifically in the area of Chinese herbal medicine, though, that Dr. Block feels that much of the most meaningful research is still being conducted in the laboratory, rather than the clinic. Though there has been a strong effort to research Chinese herbal medicine in the clinic; many of the trials that have been done in this area are less convincing in design than acupuncture trials. This makes it more difficult to offer patients evidence-based information. However, this doesn't mean that Chinese herbs don't work; in fact, we think that many Chinese herbal formulas are likely to be extremely effective. They just don't have a fully adequate base in scientific evidence yet. Areas in particular need of research are quality control, herb-drug interactions and preclinical studies of mechanisms of action. We are pleased to note that China is now investing heavily in herbal medicine research, and we hope to see a more secure scientific evidence base for this area in the future.