Complementary and Alternative Medicine

“Integrative health care” describes care that includes both conventional treatments and complementary approaches. Conventional treatment refers to mainstream Western medicine. Complementary approaches are practices used alongside conventional treatment. These approaches may include:¹

• Mind-body practices: yoga, meditation and relaxation techniques, massage, chiropractic manipulation, acupuncture, hypnotherapy
• Natural products: herbs, vitamins, minerals, probiotics, other dietary supplements
• Traditional healing practices and alternative medical systems: traditional Chinese medicine, Ayurvedic medicine, homeopathy, and naturopathy

Some people use the term alternative medicine to describe these practices. Alternative medicine is when non-mainstream treatments are used in place of conventional medicine. This is fairly uncommon.

Home remedies are also a form of alternative medicine, but it's important to understand the associated risks.

Who uses complementary practices? And why?

More than 30% of adults use complementary health approaches.² Cancer survivors are more likely than non-cancer survivors to use complementary approaches.³ In a survey of people with melanoma, more than 40% reported using complementary approaches.⁴

People choose complementary practices for many reasons. Some people use them to relieve symptoms of cancer treatment. Others find they reduce stress related to treatment or procedures. People with melanoma being treated with Yervoy® (ipilimumab) reported using complementary approaches to “boost the immune system” or “strengthen the body.”⁵

Many complementary approaches can be used safely by most people. Some can be dangerous, particularly when combined with medications.

What are the benefits of complementary practices?

Many complementary practices are safe to use with conventional treatment. These practices may control symptoms. They may improve quality of life. For example:^6,7

• Acupuncture may relieve mild pain or nausea and improve dry mouth.
• Massage therapy may decrease fatigue, anxiety, nausea, and pain.
• Meditation may help you be relaxed and calm during stressful procedures or treatments.
• Reiki is an energy therapy that may reduce anxiety and improve well-being.
• Hypnotherapy may reduce vomiting, pain, and fatigue.
• Spirituality and prayer may help with better coping, improved health, reduced anxiety and depression.

It is hard to design scientifically rigorous studies of complementary practices. The highest-quality studies are blinded, randomized, placebo-controlled trials. This means that some people get the treatment and others get a fake treatment (placebo). The groups are picked at random. No one knows which treatment she or he got.

Of course, you know if you got a massage - and it may have made you feel better. Do you feel better because of the massage? Or because you expected it to help? Feeling better simply because you got treatment, even if the treatment you got could not possibly help, is called the “placebo effect.” Without blinding and comparison with an untreated comparison group, it is hard to tell if a treatment is working or if you just think it is working.

On a practical level, it may not matter. If a complementary therapy poses little risk and it seems to be helping, that may be all you need to know.

What are the risks of complementary practices?

Among people with melanoma who use complementary medicine, nearly two-thirds use supplements or herbs. Herbal medicines or dietary supplements may interact with conventional medications. They may make medication less effective. They may increase side effects. One analysis indicated that 85% of people who use supplements or herbal medicines may be at risk of a drug-supplement interaction.⁴ Unfortunately, many of these interactions are not well studied or understood.

Dietary supplements are not regulated by the US Food and Drug Administration. These products are not routinely tested, so you cannot be certain what is in them. Manufacturers are not required to conduct studies that prove the supplements are safe and effective.

If you choose to use dietary supplements, please discuss them with your doctor. Write down all the dietary supplements that you are taking and the doses. Review this list with your doctor or pharmacist.

Alternative practices can be dangerous if they delay effective treatment. Delaying effective treatment for skin cancer can lead to worse outcomes. One risk of using a possibly ineffective therapy is that it gives the cancer time to grow. Melanoma is the most likely to invade and spread (metastasize) if it is not treated early.⁸ Aggressive squamous cell carcinoma and basal cell carcinoma are less common. However, metastatic non-melanoma skin cancer can be hard to treat.⁹

Should I talk with my doctor about complementary medicine?

Friends and family are often the main source of information about complementary medicine.⁵ Your doctor may not discuss these approaches, and you may be reluctant to bring it up. Although it may be hard to start the discussion, there are good reasons to have this conversation:⁷

• You probably have researched the alternative treatment and learned what other respected sources have to say about it. Asking for your doctor’s thoughts is part of your own research about this treatment. This discussion is part of developing a treatment plan that both you and your doctor can agree upon.
• Dietary supplements can have harmful interactions with conventional medications. To avoid harmful effects, patients should review all medications (prescription and over-the-counter), herbal supplements, and vitamins they are taking, or are considering taking, with their doctor or pharmacist.
• By discussing your concerns with your doctor, you may learn that there are mainstream ways to manage bothersome side effects or symptoms.

Please talk with your doctor if you are thinking of stopping or delaying conventional treatment. Ultimately, the choice to start or continue treatment is yours. However, together with your doctor, you may be able to modify treatment to make it more acceptable. You may learn that there are different treatment options with proven benefits.