Use of nutritional and botanical medicines during cancer treatment is controversial within both the allopathic and the naturopathic medical communities. Most conventional oncologists strongly dissuade patients from taking herbs and supplements. They do so because they are largely under-informed about nutrition and botanical medicine, and feel they must err on the side of caution. Their stated fear is that supplements may interfere with the efficacy of conventional treatment.
Some conventionally trained physicians take a neutral stance, and a minority advocates supplementation. Within the naturopathic profession, where knowledge of natural products is deep, the situation is reversed. Most naturopaths recommend supplementation during conventional cancer treatment and only a small minority raise concerns about combined therapy.
I believe there are three main reasons for such divergent opinions: 1) The long-standing attitude of caution in the oncology profession regarding chemo-protective and radio-protective therapies and the demand that these be supported by reliable evidence; 2) A mistaken impression that evidence for botanical and nutritional products is wholly or mostly lacking; 3) Different interpretations of the evidence that does exist.
The American Society of Clinical Oncology (ASCO), the largest conventional oncology organization, has published clinical guidelines for currently available conventional protective therapies (Schuchter LM, et al. J Clin Oncol. 2002; 20:2895–903). However, few nutrients or botanical compounds are officially recognized in this document.
The truth is, these are complex questions, without simple answers. There is provocative evidence on all sides of the question. For example, some studies have shown antioxidant vitamins can reduce adverse effects of conventional therapies and even improve outcomes; others show deleterious effects. The December 2004 issue of Integrative Cancer Therapies is entirely devoted to the topic of antioxidants during cancer therapy and the reader is referred there for details on the state of this controversy. Other interesting articles on this topic include: Labriola D, Livingston R. Oncology (Huntington). 1999; 13:1003–08; Lamson DW, Brignall MS. Altern Med Rev. 1999; 4:304–29; Prasad KN, et al. Cancer Treat Rev. 2002; 28:78–91).
Beyond antioxidants, naturopathic doctors and integrative MDs often use nutrients and botanicals to increase efficacy and tolerability of conventional treatment. These include: curcumin, quercetin, green tea, modified citrus pectin, melatonin, fish oil, and L-glutamine. My review of existing evidence has led me to the conclusion that the scale is tipping in favor of an integrated approach, and my clinical experience has definitely confirmed this. The days when patients had to dread the awful adverse effects of chemotherapy and radiation are, in my opinion, quickly passing. My patients, and those of my naturopathic colleagues, are able to tolerate treatment with minimal adverse effects and disruption to their well-being and quality of life. The age of humane, integrative oncology is thankfully arriving.
No doubt, there are specific circumstances in which there is strong evidence to contraindicate specific herbs and nutrients in combination with certain chemotherapeutic agents. But on the whole, most patients will benefit from judicious use of natural therapies to strengthen their immune systems, reduce chemotherapy side-effects, and improve overall nutritional status. This is not to diminish the need to recognize potential risk inherent in the use of natural agents and to further clarify their physiologic effects. As the adage goes, “just because something is natural doesn’t mean that it’s always good for you.”
However, the fact is, a vast number of cancer patients experiment with natural products, whether we want them to or not. One study put the estimate at roughly 63% (Richardson MA, et al. J Clin Oncol. 2000; 18:2505–14), and most were doing so without the knowledge of their oncologists.
Patients find huge amounts of information online, much of which is inaccurate and unreliable. Do they use this information? In many cases, yes. Do they know what they’re doing? In most cases, probably not. More importantly, do WE, as physicians, know what we’re doing? I would have to say we are at the very beginning of understanding the complex dynamics of botanical and nutritional compounds when used during conventional cancer treatment.
I often wonder how much evidence we’ll need in support of herbs and nutrients as adjuvant cancer therapies before we can expect acceptance from conventional oncology. Clearly, in vitro and animal studies are insufficient. Yet, funding is not readily available for the sort of large randomized trials we need.
Looking into my crystal ball, I expect that in a few years, research will ultimately vindicate skeptics and advocates of integrative cancer care. We are increasingly recognizing that natural agents are not simple, risk-free “cures” for cancer: some are proverbial two-edged swords, acting in an anti-cancer mode and improving outcomes under certain conditions, while promoting cancer growth or hindering conventional treatment in others. I predict that both wanton enthusiasm and categorical dismissal of natural medicines will ultimately be dashed on the rocks of good evidence.
Last fall, the American Association of Naturopathic Physicians recognized the Oncology Academy of Naturopathic Physicians (OncANP) as an affiliate organization. OncANP’s vision is enhanced survival and quality of life for people living with cancer through the integration of naturopathic oncology into cancer care. The Academy’s goals are to:
- Provide board certification in naturopathic oncology.
- Develop and maintain a repository of information and knowledge regarding naturopathic oncology.
- Promote clinical research in naturopathic oncology.
- Provide advanced and continuing education in naturopathic oncology.
- Facilitate the standardization of instruction in oncology at naturopathic medical schools.
- Provide a forum for enhanced communication between healthcare providers regarding naturopathic oncology.
- Foster integration of naturopathic oncology into the healthcare system.
As one of OncANP’s founding members, I hope that our ongoing work will help provide the evidence we need to optimize the use of nutrition, botanical medicine and other naturopathic modalities for the treatment of cancer. Find out more about OncANP at www.oncanp.org.
Michael Traub, ND, is immediate past-president of the American Association of Naturopathic Physicians. He practices in Kailua-Kona, Hawaii, and is on staff at North Hawaii Community Hospital.
