Banking on Supplements
By Carol Sorgen
When cancer strikes, most people will try anything to win the battle. One place most people with cancer are turning is complementary or alternative medicine. And while most cancer patients feel that this treatment definitely benefits them, recent findings cast doubt on the safety of this decision.
People diagnosed with cancer are at a "frightful" time in their life, says B. Jay Brooks Jr., MD, chairman of the department of hematology/oncology at the Ochsner Clinic in Baton Rouge. "When they hear what we have to offer them, they often look to explore other ways to help themselves."
In fact, in a study of 356 cancer patients at the Fred Hutchinson Cancer Research Center in Seattle, 70% of those surveyed had used some form of alternative medicine during the previous year -- either receiving care from an alternative healthcare provider or taking at least one alternative supplement (other than a daily multivitamin). In addition, almost all said they noticed a significant improvement in their well-being.
That doesn't mean that if you're suffering from cancer you should join them.
"A lot of people take supplemental medicines," says Brooks. "Unfortunately, these products are totally unregulated by the FDA and we don't really know what's in them."
One such supplement was PC-SPES, a popular alternative treatment for prostate cancer. In recent months, however, the product was found to contain various prescription medications such as the hormone DES, the blood thinner warfarin, and the arthritis drug indomethacin. "In effect, the 'herbal' ingredients appeared to be a camouflage for the prescription ingredients, allowing the product to be sold as a supplement and avoiding the scrutiny of the FDA," says Tod Cooperman, MD, president of ConsumerLab.com Cooperman. PC-SPES was voluntarily recalled by the company following these reports.
"Patients don't like to hear this," says Brooks. "But people are spending enormous amounts of money on things that can hurt them."
Some of these supplements in and of themselves are not harmful, Brooks says, but when taken by people with certain cancers, or those undergoing certain treatments, they can be dangerous. High doses of vitamin C, for example, can be detrimental for those with head and neck cancer; St. John's wort and milk thistle can interfere with the body's metabolism of certain chemotherapy agents; and natural estrogens and soy products can increase the chance of having a heart attack, stroke, and breast cancer.
Tim Birdsall, ND, national director of naturopathic medicine for Cancer Treatment Centers of America, says hardly a week goes by without a new "natural" therapy being touted as a way to treat cancer. "Patients come in with grocery bags full of supplements," he says. Some of the supplements -- like melatonin -- may actually be beneficial in slowing the growth of tumors, says Birdsall (although he cautions that it should not be taken without medical supervision). Others, like shark cartilage, essiac, noni juice, and saw palmetto, aren't harmful, but they haven't been shown to be effective either.
"People need information and they need to understand that these supplements aren't 100% benign," Birdsall cautions. "That doesn't mean you necessarily have to avoid them (St. John's wort, for example, can be helpful for people suffering from mild to moderate depression, but it should only be taken at a certain point during the chemotherapy cycle). But you need to talk to your doctor about what you'd like to take.
Which is something not many patients are willing to do. Forty to 60 percent of patients will not tell their medical doctors that they are taking so-called natural supplements, says Birdsall. Why? Because they're afraid of the doctor's negative reaction, Birdsall says, and because they assume that if the doctor didn't bring it up, it's not important.
Terri Ades, MS, director of quality of life/health promotion strategy and health content products for the American Cancer Society, says it's important to distinguish between alternative and complementary therapies.
Alternative medicine is generally thought to be any therapy used instead of the current standard treatment. "Laetril [vitamin B-17], for example, used alone as the only cancer treatment would be considered an alternative," says Ades.
Complementary therapies, on the other hand, are used along with standard cancer treatment, and are typically used to improve the quality of life and not to treat the cancer. Relaxation, guided imagery, massage, tai chi, music, and art therapy are examples.
As more and more people learn about complementary therapies and their benefits, says Ades, and understand that alternatives haven't been proven to be effective, there will very likely be a change in current trends, and it may have begun already.
"We can see that people are turning more to complementary therapies to improve their quality of life," says Ades. "Cancer centers are adding integrative medicine programs that offer complementary therapies to their services. And researchers are realizing that these alternatives need to be studied so we know either that they are or aren't effective. We need these answers."
According to Ades, those who typically turn to alternative (as opposed to complementary) therapies, are those who have limited or no standard treatment for their cancer or those who fear the effects of cancer treatment. "Most people want to know that something can be done and if it means turning to an alternative, some will make this choice. They are willing to try an alternative even knowing that it hasn't been through the appropriate clinical trials to prove its safety and effectiveness."
Birdsall won't give his patients a blanket veto when it comes to herbal supplements. But he does want them to know that each individual case is different. "You have to look at the individual parameters," he says. "Breast cancer is different from ovarian cancer which is different from colon cancer which is different from prostate cancer." Even chemotherapy regimens differ from cancer to cancer, from patient to patient.
"What I tell patients varies with what type of cancer they have and what kind of treatment they're undergoing," he says.
And what Brooks tells all cancer patients is, "Be aware that with many of these alternatives, there is no scientific evidence that they can help, and that in some instances, they can actually harm. Talk to your doctor and show him what you're taking -- before you take it."
Originally published Oct. 4, 2002.
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