Should integrative medicine be used in patients with cancer?
Stress management may reduce cancer risk.
There are sufficient clinical data in terms of patient, family and even health care provider satisfaction when integrative medicine is used. Nobody questions the quality-of-life benefits, and quality of life is very important, especially in patients with cancer.
There is a tremendous amount of evidence showing that the nervous system regulates the immune system through many roots, including the brains hormonal stress response. The autonomic nervous system regulates the immune system at regional levels and in immune organs, such as lymph nodes. Similarly, the peripheral nervous system regulates the immune system at local sites of inflammation. So, we have a firm basis for understanding how something as abstract as an emotion can regulate something as concrete as a disease.
Given that stress can make some cancers worse, it is not a far leap to say stress management should be able to attenuate negative effects and possibly prevent the worsening of certain cancers.
Integrative medicine approaches, like meditation, Tai Chi and lifestyle changes, have been shown to enhance positive emotion, reduce activation of the stress response and shift the brain toward the calming and relaxation response.
These approaches should not be used instead of cancer chemotherapy, however. Integrative medicine combines mind/body approaches with state-of-the-art cancer therapies. When these methods are used together, the body has the best chance to heal.
Esther M. Sternberg, MD, is chief of the section on neuroendocrine immunology and behavior, and senior investigator at the NIH, Bethesda, Md.
Do not give patients false hope.
I know of no compelling data that indicate that integrative medicine can change major clinical outcomes and survival rates for life-threatening malignancies.
I am sure, however, that for certain patients, using measures other than scientific medicine, such as yoga or Tai Chi, may increase comfort and quality of life.
I have patients who have spent a fortune on therapies that are scientifically unproven. At times, they have endangered their clinical course through untoward interactions with active medicines or by causing potentially life-threatening delays.
When practitioners promise patients things that they have no right to promise, that is when integrative medicine may approach quackery.
For example, I find it unacceptable to assure patients that swallowing parts of a shark, a homeopathic pill, or an incredibly expensive vitamin will make the difference between life and death.
On the other hand, a massage, a warm touch or a caring word may help someone feel better, and I am all for having people feel better. But, it is not appropriate to assure patients that will change the number of days they will live.
It is very important to offer patients hope, and if hope is offered through integrative medicine, that is terrific. But hope is different from a promise or false assurance, and too often people step over that line.
Tom Delbanco, MD, is Richard and Florence Koplow-James Tullis Professor of General Medicine and Primary Care, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston.