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Complementary and alternative therapies for cancer

Edzard Ernst, MD, PhD, FMEdSci, FSB, FRCP, FRCP (Edin.)
Section Editor
Paul J Hesketh, MD
Deputy Editor
Diane MF Savarese, MD


Complementary and alternative medicine (CAM) is defined by the National Center for Complementary and Alternative Medicine as a group of diverse medical and health care systems, practices, and products that are not normally considered to be conventional medicine [1]. Included in this type of therapy are herbs, acupuncture, chiropractic, and massage, among others. Use of these therapies is common in the general population.

The use of CAM is widespread. Multiple studies have found that within one year, up to 90 percent of patients with cancer used a CAM approach for at least a part of their therapy [2-10]. However, patients may not reveal the use of CAM unless specifically asked. In one study, disclosure of the use of these therapies increased from 7 to 43 percent when directed questions were added to standard history taking [11]. Unfortunately, communication between oncologists and patients about CAM is poor, infrequent, and mostly initiated by patients or their kin [12].

Users of CAM are generally not dissatisfied with conventional medicine but find alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life [13]. Factors reported to be associated with use of CAM therapies in cancer patients include:

Increased psychosocial stress (eg, anxiety, depression) [14]

Being given a less hopeful prognosis [15]


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Literature review current through: Sep 2016. | This topic last updated: Aug 15, 2016.
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  1. Engel LW, Straus SE. Development of therapeutics: opportunities within complementary and alternative medicine. Nat Rev Drug Discov 2002; 1:229.
  2. Shen J, Andersen R, Albert PS, et al. Use of complementary/alternative therapies by women with advanced-stage breast cancer. BMC Complement Altern Med 2002; 2:8.
  3. Richardson MA, Sanders T, Palmer JL, et al. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 2000; 18:2505.
  4. Navo MA, Phan J, Vaughan C, et al. An assessment of the utilization of complementary and alternative medication in women with gynecologic or breast malignancies. J Clin Oncol 2004; 22:671.
  5. Dy GK, Bekele L, Hanson LJ, et al. Complementary and alternative medicine use by patients enrolled onto phase I clinical trials. J Clin Oncol 2004; 22:4810.
  6. Lee AH, Ingraham SE, Kopp M, et al. The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital. Am J Clin Oncol 2006; 29:178.
  7. Swarup AB, Barrett W, Jazieh AR. The use of complementary and alternative medicine by cancer patients undergoing radiation therapy. Am J Clin Oncol 2006; 29:468.
  8. Vapiwala N, Mick R, Hampshire MK, et al. Patient initiation of complementary and alternative medical therapies (CAM) following cancer diagnosis. Cancer J 2006; 12:467.
  9. Gansler T, Kaw C, Crammer C, Smith T. A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer 2008; 113:1048.
  10. Hunt KJ, Ernst E. Patients' use of CAM: results from the Health Survey for England 2005. Focus Alt Compl Ther 2010; 15:101.
  11. Metz JM, Jones H, Devine P, et al. Cancer patients use unconventional medical therapies far more frequently than standard history and physical examination suggest. Cancer J 2001; 7:149.
  12. Schofield PE, Juraskova I, Butow PN. How oncologists discuss complementary therapy use with their patients: an audio-tape audit. Support Care Cancer 2003; 11:348.
  13. Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998; 279:1548.
  14. Burstein HJ, Gelber S, Guadagnoli E, Weeks JC. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 1999; 340:1733.
  15. Risberg T, Kaasa S, Wist E, Melsom H. Why are cancer patients using non-proven complementary therapies? A cross-sectional multicentre study in Norway. Eur J Cancer 1997; 33:575.
  16. Danielson KJ, Stewart DE, Lippert GP. Unconventional cancer remedies. CMAJ 1988; 138:1005.
  17. Boon H, Stewart M, Kennard MA, et al. Use of complementary/alternative medicine by breast cancer survivors in Ontario: prevalence and perceptions. J Clin Oncol 2000; 18:2515.
  18. Newell S, Sanson-Fisher RW. Australian oncologists' self-reported knowledge and attitudes about non-traditional therapies used by cancer patients. Med J Aust 2000; 172:110.
  19. Lee RT, Barbo A, Lopez G, et al. National survey of US oncologists' knowledge, attitudes, and practice patterns regarding herb and supplement use by patients with cancer. J Clin Oncol 2014; 32:4095.
  20. Gray RE, Greenberg M, Fitch M, et al. Perspectives of cancer survivors interested in unconventional therapies. J Psychosoc Oncology 1997; 15:149.
  21. Risberg T, Vickers A, Bremnes RM, et al. Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003; 39:372.
  22. Lagnado L. Laetrile makes a comeback on the web: Long deemed illegal by the FDA, it's selling briskly again to desperate patients online. The Wall Street Journal, April 22, 2000.
  23. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 1998; 83:777.
  24. Ernst E, Boddy K. CAM cancer diets. Focus Altern Complement Ther 2006; 11:91.
  25. Hildenbrand GL, Hildenbrand LC, Bradford K, Cavin SW. Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review. Altern Ther Health Med 1995; 1:29.
  26. Carter JP, Saxe GP, Newbold V, et al. Hypothesis: dietary management may improve survival from nutritionally linked cancers based on analysis of representative cases. J Am Coll Nutr 1993; 12:209.
  27. Downer SM, Cody MM, McCluskey P, et al. Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. BMJ 1994; 309:86.
  28. Gonzalez NJ, Isaacs LL. Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with nutrition and detoxification support. Nutr Cancer 1999; 33:117.
  29. Richardson MA, Straus SE. Complementary and alternative medicine: opportunities and challenges for cancer management and research. Semin Oncol 2002; 29:531.
  30. Sun AS, Ostadal O, Ryznar V, et al. Phase I/II study of stage III and IV non-small cell lung cancer patients taking a specific dietary supplement. Nutr Cancer 1999; 34:62.
  31. Sun AS, Yeh HC, Wang LH, et al. Pilot study of a specific dietary supplement in tumor-bearing mice and in stage IIIB and IV non-small cell lung cancer patients. Nutr Cancer 2001; 39:85.
  32. Mok TS, Yeo W, Johnson PJ, et al. A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Ann Oncol 2007; 18:768.
  33. Gan T, Wu Z, Tian L, Wang Y. Chinese herbal medicines for induction of remission in advanced or late gastric cancer. Cochrane Database Syst Rev 2010; :CD005096.
  34. Yang J, Zhu L, Wu Z, Wang Y. Chinese herbal medicines for induction of remission in advanced or late gastric cancer. Cochrane Database Syst Rev 2013; :CD005096.
  35. Rui D, Xiaoyan C, Taixiang W, Guanjian L. Elemene for the treatment of lung cancer. Cochrane Database Syst Rev 2007; :CD006054.
  36. Xu M, Deng PX, Qi C, et al. Adjuvant phytotherapy in the treatment of cervical cancer: a systematic review and meta-analysis. J Altern Complement Med 2009; 15:1347.
  37. Chen X, Deng L, Jiang X, Wu T. Chinese herbal medicine for oesophageal cancer. Cochrane Database Syst Rev 2016; :CD004520.
  38. Meng Z, Garrett CR, Shen Y, et al. Prospective randomised evaluation of traditional Chinese medicine combined with chemotherapy: a randomised phase II study of wild toad extract plus gemcitabine in patients with advanced pancreatic adenocarcinomas. Br J Cancer 2012; 107:411.
  39. Bernstein BJ, Grasso T. Prevalence of complementary and alternative medicine use in cancer patients. Oncology (Williston Park) 2001; 15:1267.
  40. Hussain T, Gupta S, Adhami VM, Mukhtar H. Green tea constituent epigallocatechin-3-gallate selectively inhibits COX-2 without affecting COX-1 expression in human prostate carcinoma cells. Int J Cancer 2005; 113:660.
  41. Mei Y, Qian F, Wei D, Liu J. Reversal of cancer multidrug resistance by green tea polyphenols. J Pharm Pharmacol 2004; 56:1307.
  42. Adhami VM, Siddiqui IA, Ahmad N, et al. Oral consumption of green tea polyphenols inhibits insulin-like growth factor-I-induced signaling in an autochthonous mouse model of prostate cancer. Cancer Res 2004; 64:8715.
  43. Jian L, Xie LP, Lee AH, Binns CW. Protective effect of green tea against prostate cancer: a case-control study in southeast China. Int J Cancer 2004; 108:130.
  44. Kikuchi N, Ohmori K, Shimazu T, et al. No association between green tea and prostate cancer risk in Japanese men: the Ohsaki Cohort Study. Br J Cancer 2006; 95:371.
  45. Sonoda T, Nagata Y, Mori M, et al. A case-control study of diet and prostate cancer in Japan: possible protective effect of traditional Japanese diet. Cancer Sci 2004; 95:238.
  46. Laurie SA, Miller VA, Grant SC, et al. Phase I study of green tea extract in patients with advanced lung cancer. Cancer Chemother Pharmacol 2005; 55:33.
  47. Jatoi A, Ellison N, Burch PA, et al. A phase II trial of green tea in the treatment of patients with androgen independent metastatic prostate carcinoma. Cancer 2003; 97:1442.
  48. Zhang M, Lee AH, Binns CW, Xie X. Green tea consumption enhances survival of epithelial ovarian cancer. Int J Cancer 2004; 112:465.
  49. Golden EB, Lam PY, Kardosh A, et al. Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid-based proteasome inhibitors. Blood 2009; 113:5927.
  50. Tamayo C, Richardson MA, Diamond S, Skoda I. The chemistry and biological activity of herbs used in Flor-Essence herbal tonic and Essiac. Phytother Res 2000; 14:1.
  51. Kaegi E. Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 1998; 158:897.
  52. Kaegi E. Unconventional therapies for cancer: 3. Iscador. Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ 1998; 158:1157.
  53. Pae HO, Seo WG, Oh GS, et al. Potentiation of tumor necrosis factor-alpha-induced apoptosis by mistletoe lectin. Immunopharmacol Immunotoxicol 2000; 22:697.
  54. Schumacher U, Feldhaus S, Mengs U. Recombinant mistletoe lectin (rML) is successful in treating human ovarian cancer cells transplanted into severe combined immunodeficient (SCID) mice. Cancer Lett 2000; 150:171.
  55. Steuer-Vogt MK, Bonkowsky V, Ambrosch P, et al. The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: a randomised controlled clinical trial. Eur J Cancer 2001; 37:23.
  56. Semiglazov VF, Stepula VV, Dudov A, et al. Quality of life is improved in breast cancer patients by Standardised Mistletoe Extract PS76A2 during chemotherapy and follow-up: a randomised, placebo-controlled, double-blind, multicentre clinical trial. Anticancer Res 2006; 26:1519.
  57. Lenartz D, Dott U, Menzel J, et al. Survival of glioma patients after complementary treatment with galactoside-specific lectin from mistletoe. Anticancer Res 2000; 20:2073.
  58. Kleeberg UR, Suciu S, Bröcker EB, et al. Final results of the EORTC 18871/DKG 80-1 randomised phase III trial. rIFN-alpha2b versus rIFN-gamma versus ISCADOR M versus observation after surgery in melanoma patients with either high-risk primary (thickness >3 mm) or regional lymph node metastasis. Eur J Cancer 2004; 40:390.
  59. Ernst E, Schmidt K, Steuer-Vogt MK. Mistletoe for cancer? A systematic review of randomised clinical trials. Int J Cancer 2003; 107:262.
  60. Kienle GS, Kiene H. Complementary cancer therapy: a systematic review of prospective clinical trials on anthroposophic mistletoe extracts. Eur J Med Res 2007; 12:103.
  61. Ostermann T, Raak C, Büssing A. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review. BMC Cancer 2009; 9:451.
  62. Stein GM, Berg PA. Adverse effects during therapy with mistletoe extracts. In: Mistletoe: The Genus Viscum, Büssig A (Ed), Hardwood Academic Publishers, Amsterdam 2000. p.195.
  63. Büssing A, Raak C, Ostermann T. Quality of life and related dimensions in cancer patients treated with mistletoe extract (iscador): a meta-analysis. Evid Based Complement Alternat Med 2012; 2012:219402.
  64. Kienle GS, Kiene H. Review article: Influence of Viscum album L (European mistletoe) extracts on quality of life in cancer patients: a systematic review of controlled clinical studies. Integr Cancer Ther 2010; 9:142.
  65. Fan S, Wang X. Herbal composition for treating prostate cancer. PC-SPES. Pending United States patent number 08/697920.
  66. Weinrobe MC, Montgomery B. Acquired bleeding diathesis in a patient taking PC-SPES. N Engl J Med 2001; 345:1213.
  67. Shimizu I. Sho-saiko-to: Japanese herbal medicine for protection against hepatic fibrosis and carcinoma. J Gastroenterol Hepatol 2000; 15 Suppl:D84.
  68. Oka H, Yamamoto S, Kuroki T, et al. Prospective study of chemoprevention of hepatocellular carcinoma with Sho-saiko-to (TJ-9). Cancer 1995; 76:743.
  69. Delaey E, Vandenbogaerde A, Merlevede W, de Witte P. Photocytotoxicity of hypericin in normoxic and hypoxic conditions. J Photochem Photobiol B 2000; 56:19.
  70. Chen B, de Witte PA. Photodynamic therapy efficacy and tissue distribution of hypericin in a mouse P388 lymphoma tumor model. Cancer Lett 2000; 150:111.
  71. Kamuhabwa AR, Agostinis P, D'Hallewin MA, et al. Photodynamic activity of hypericin in human urinary bladder carcinoma cells. Anticancer Res 2000; 20:2579.
  72. Liu CD, Kwan D, Saxton RE, McFadden DW. Hypericin and photodynamic therapy decreases human pancreatic cancer in vitro and in vivo. J Surg Res 2000; 93:137.
  73. Chung PS, Rhee CK, Kim KH, et al. Intratumoral hypericin and KTP laser therapy for transplanted squamous cell carcinoma. Laryngoscope 2000; 110:1312.
  74. Colasanti A, Kisslinger A, Liuzzi R, et al. Hypericin photosensitization of tumor and metastatic cell lines of human prostate. J Photochem Photobiol B 2000; 54:103.
  75. Alecu M, Ursaciuc C, Hãlãlãu F, et al. Photodynamic treatment of basal cell carcinoma and squamous cell carcinoma with hypericin. Anticancer Res 1998; 18:4651.
  76. McCulloch M, See C, Shu XJ, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. J Clin Oncol 2006; 24:419.
  77. Jacobson JS, Workman SB, Kronenberg F. Research on complementary/alternative medicine for patients with breast cancer: a review of the biomedical literature. J Clin Oncol 2000; 18:668.
  78. Lissoni P, Barni S, Ardizzoia A, et al. A randomized study with the pineal hormone melatonin versus supportive care alone in patients with brain metastases due to solid neoplasms. Cancer 1994; 73:699.
  79. Berk L, Berkey B, Rich T, et al. Randomized phase II trial of high-dose melatonin and radiation therapy for RPA class 2 patients with brain metastases (RTOG 0119). Int J Radiat Oncol Biol Phys 2007; 68:852.
  80. Lissoni P, Giani L, Zerbini S, et al. Biotherapy with the pineal immunomodulating hormone melatonin versus melatonin plus aloe vera in untreatable advanced solid neoplasms. Nat Immun 1998; 16:27.
  81. Sheu JR, Fu CC, Tsai ML, Chung WJ. Effect of U-995, a potent shark cartilage-derived angiogenesis inhibitor, on anti-angiogenesis and anti-tumor activities. Anticancer Res 1998; 18:4435.
  82. Liu N, Lapcevich RK, Underhill CB, et al. Metastatin: a hyaluronan-binding complex from cartilage that inhibits tumor growth. Cancer Res 2001; 61:1022.
  83. Lu C, Lee JJ, Komaki R, et al. Chemoradiotherapy with or without AE-941 in stage III non-small cell lung cancer: a randomized phase III trial. J Natl Cancer Inst 2010; 102:859.
  84. Loprinzi CL, Levitt R, Barton DL, et al. Evaluation of shark cartilage in patients with advanced cancer: a North Central Cancer Treatment Group trial. Cancer 2005; 104:176.
  85. Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfate influence on nutritional status and survival in non-small-cell lung cancer. J Clin Oncol 1990; 8:9.
  86. Kosty MP, Fleishman SB, Herndon JE 2nd, et al. Cisplatin, vinblastine, and hydrazine sulfate in advanced, non-small-cell lung cancer: a randomized placebo-controlled, double-blind phase III study of the Cancer and Leukemia Group B. J Clin Oncol 1994; 12:1113.
  87. Loprinzi CL, Goldberg RM, Su JQ, et al. Placebo-controlled trial of hydrazine sulfate in patients with newly diagnosed non-small-cell lung cancer. J Clin Oncol 1994; 12:1126.
  88. Loprinzi CL, Kuross SA, O'Fallon JR, et al. Randomized placebo-controlled evaluation of hydrazine sulfate in patients with advanced colorectal cancer. J Clin Oncol 1994; 12:1121.
  89. Roffe L, Schmidt K, Ernst E. Efficacy of coenzyme Q10 for improved tolerability of cancer treatments: a systematic review. J Clin Oncol 2004; 22:4418.
  90. Lesser GJ, Case D, Stark N, et al. A randomized, double-blind, placebo-controlled study of oral coenzyme Q10 to relieve self-reported treatment-related fatigue in newly diagnosed patients with breast cancer. J Support Oncol 2013; 11:31.
  91. Takimoto M, Sakurai T, Kodama K, et al. [Protective effect of CoQ 10 administration on cardial toxicity in FAC therapy]. Gan To Kagaku Ryoho 1982; 9:116.
  92. Lucarelli G, Angelucci C, Giardini G, et al. Ubidecarenone and toxic cardiopathy from antiblastic therapy with daunoblastine. Boll Chim Farm 1986; 125:S34.
  93. Okuma K, Furuta I, Ota K. [Protective effect of coenzyme Q10 in cardiotoxicity induced by adriamycin]. Gan To Kagaku Ryoho 1984; 11:502.
  94. Spigset O. Reduced effect of warfarin caused by ubidecarenone. Lancet 1994; 344:1372.
  95. Ben-Efraim S, Keisari Y, Ophir R, et al. Immunopotentiating and immunotherapeutic effects of thymic hormones and factors with special emphasis on thymic humoral factor THF-gamma2. Crit Rev Immunol 1999; 19:261.
  96. Wolf E, Milazzo S, Boehm K, et al. Thymic peptides for treatment of cancer patients. Cochrane Database Syst Rev 2011; :CD003993.
  97. Chang R. Functional properties of edible mushrooms. Nutr Rev 1996; 54:S91.
  98. Borchers AT, Stern JS, Hackman RM, et al. Mushrooms, tumors, and immunity. Proc Soc Exp Biol Med 1999; 221:281.
  99. deVere White RW, Hackman RM, Soares SE, et al. Effects of a mushroom mycelium extract on the treatment of prostate cancer. Urology 2002; 60:640.
  100. Jin X, Ruiz Beguerie J, Sze DM, Chan GC. Ganoderma lucidum (Reishi mushroom) for cancer treatment. Cochrane Database Syst Rev 2016; 4:CD007731.
  101. Giovannucci E. Tomato products, lycopene, and prostate cancer: a review of the epidemiological literature. J Nutr 2005; 135:2030S.
  102. Jatoi A, Burch P, Hillman D, et al. A tomato-based, lycopene-containing intervention for androgen-independent prostate cancer: results of a Phase II study from the North Central Cancer Treatment Group. Urology 2007; 69:289.
  103. Kavanaugh CJ, Trumbo PR, Ellwood KC. The U.S. Food and Drug Administration's evidence-based review for qualified health claims: tomatoes, lycopene, and cancer. J Natl Cancer Inst 2007; 99:1074.
  104. Greenlee H, Gammon MD, Abrahamson PE, et al. Prevalence and predictors of antioxidant supplement use during breast cancer treatment: the Long Island Breast Cancer Study Project. Cancer 2009; 115:3271.
  105. Creagan ET, Moertel CG, O'Fallon JR, et al. Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer. A controlled trial. N Engl J Med 1979; 301:687.
  106. Moertel CG, Fleming TR, Creagan ET, et al. High-dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. A randomized double-blind comparison. N Engl J Med 1985; 312:137.
  107. Padayatty SJ, Sun AY, Chen Q, et al. Vitamin C: intravenous use by complementary and alternative medicine practitioners and adverse effects. PLoS One 2010; 5:e11414.
  108. Stephenson CM, Levin RD, Spector T, Lis CG. Phase I clinical trial to evaluate the safety, tolerability, and pharmacokinetics of high-dose intravenous ascorbic acid in patients with advanced cancer. Cancer Chemother Pharmacol 2013; 72:139.
  109. Hoffer LJ, Levine M, Assouline S, et al. Phase I clinical trial of i.v. ascorbic acid in advanced malignancy. Ann Oncol 2008; 19:1969.
  110. Riordan HD, Casciari JJ, González MJ, et al. A pilot clinical study of continuous intravenous ascorbate in terminal cancer patients. P R Health Sci J 2005; 24:269.
  111. Monti DA, Mitchell E, Bazzan AJ, et al. Phase I evaluation of intravenous ascorbic acid in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. PLoS One 2012; 7:e29794.
  112. Heaney ML, Gardner JR, Karasavvas N, et al. Vitamin C antagonizes the cytotoxic effects of antineoplastic drugs. Cancer Res 2008; 68:8031.
  113. Perrone G, Hideshima T, Ikeda H, et al. Ascorbic acid inhibits antitumor activity of bortezomib in vivo. Leukemia 2009; 23:1679.
  114. Nangia-Makker P, Hogan V, Honjo Y, et al. Inhibition of human cancer cell growth and metastasis in nude mice by oral intake of modified citrus pectin. J Natl Cancer Inst 2002; 94:1854.
  115. Pienta KJ, Naik H, Akhtar A, et al. Inhibition of spontaneous metastasis in a rat prostate cancer model by oral administration of modified citrus pectin. J Natl Cancer Inst 1995; 87:348.
  116. Platt D, Raz A. Modulation of the lung colonization of B16-F1 melanoma cells by citrus pectin. J Natl Cancer Inst 1992; 84:438.
  117. Guess BW, Scholz MC, Strum SB, et al. Modified citrus pectin (MCP) increases the prostate-specific antigen doubling time in men with prostate cancer: a phase II pilot study. Prostate Cancer Prostatic Dis 2003; 6:301.
  118. Garcia MK, McQuade J, Haddad R, et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol 2013; 31:952.
  119. Ezzo J, Vickers A, Richardson MA, et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. J Clin Oncol 2005; 23:7188.
  120. Roscoe JA, Bushunow P, Jean-Pierre P, et al. Acupressure bands are effective in reducing radiation therapy-related nausea. J Pain Symptom Manage 2009; 38:381.
  121. Streitberger K, Friedrich-Rust M, Bardenheuer H, et al. Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Clin Cancer Res 2003; 9:2538.
  122. Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 2000; 284:2755.
  123. Roscoe JA, Morrow GR, Bushunow P, et al. Acustimulation wristbands for the relief of chemotherapy-induced nausea. Altern Ther Health Med 2002; 8:56.
  124. Treish I, Shord S, Valgus J, et al. Randomized double-blind study of the Reliefband as an adjunct to standard antiemetics in patients receiving moderately-high to highly emetogenic chemotherapy. Support Care Cancer 2003; 11:516.
  125. Pearl ML, Fischer M, McCauley DL, et al. Transcutaneous electrical nerve stimulation as an adjunct for controlling chemotherapy-induced nausea and vomiting in gynecologic oncology patients. Cancer Nurs 1999; 22:307.
  126. Roscoe JA, Morrow GR, Hickok JT, et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 2003; 26:731.
  127. Lee EJ, Frazier SK. The efficacy of acupressure for symptom management: a systematic review. J Pain Symptom Manage 2011; 42:589.
  128. Molassiotis A, Russell W, Hughes J, et al. The effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: a randomized controlled trial. J Pain Symptom Manage 2014; 47:12.
  129. Yang Y, Zhang Y, Jing NC, et al.. Electroacupuncture at Zusanli (ST 36) for treatment of nausea and vomiting caused by chemotherapy of the malignant tumor. A multicentral randomized controlled trial (in Chinese). Zhonghua Zhenjiu 2009; 29:955.
  130. Enblom A, Johnsson A, Hammar M, et al. Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea--a randomized controlled study. Ann Oncol 2012; 23:1353.
  131. Paley CA, Johnson MI, Tashani OA, Bagnall AM. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev 2011; :CD007753.
  132. Pfister DG, Cassileth BR, Deng GE, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol 2010; 28:2565.
  133. Cho JH, Chung WK, Kang W, et al. Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. J Altern Complement Med 2008; 14:523.
  134. Simcock R, Fallowfield L, Monson K, et al. ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 2013; 24:776.
  135. Wong RK, Deshmukh S, Wyatt G, et al. Acupuncture-Like Transcutaneous Electrical Nerve Stimulation Versus Pilocarpine in Treating Radiation-Induced Xerostomia: Results of RTOG 0537 Phase 3 Study. Int J Radiat Oncol Biol Phys 2015; 92:220.
  136. Meng Z, Garcia MK, Hu C, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer 2012; 118:3337.
  137. Meng Z, Kay Garcia M, Hu C, et al. Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer 2012; 48:1692.
  138. Hammar M, Frisk J, Grimås O, et al. Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: a pilot study. J Urol 1999; 161:853.
  139. Redd WH, Montgomery GH, DuHamel KN. Behavioral intervention for cancer treatment side effects. J Natl Cancer Inst 2001; 93:810.
  140. Richardson J, Smith JE, McCall G, Pilkington K. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions. J Pain Symptom Manage 2006; 31:70.
  141. Stalpers LJ, da Costa HC, Merbis MA, et al. Hypnotherapy in radiotherapy patients: a randomized trial. Int J Radiat Oncol Biol Phys 2005; 61:499.
  142. Genuis ML. The use of hypnosis in helping cancer patients control anxiety, pain, and emesis: a review of recent empirical studies. Am J Clin Hypn 1995; 37:316.
  143. Lotfi-Jam K, Carey M, Jefford M, et al. Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review. J Clin Oncol 2008; 26:5618.
  144. Rummans TA, Clark MM, Sloan JA, et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. J Clin Oncol 2006; 24:635.
  145. Hoffman CJ, Ersser SJ, Hopkinson JB, et al. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol 2012; 30:1335.
  146. Sloman R, Brown P, Aldana E, Chee E. The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer. Contemp Nurse 1994; 3:6.
  147. Walker LG, Walker MB, Ogston K, et al. Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer 1999; 80:262.
  148. Syrjala KL, Cummings C, Donaldson GW. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial. Pain 1992; 48:137.
  149. Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a major cancer center. J Pain Symptom Manage 2004; 28:244.
  150. Sims S. Slow stroke back massage for cancer patients. Nurs Times 1986; 82:47.
  151. Ahles TA, Tope DM, Pinkson B, et al. Massage therapy for patients undergoing autologous bone marrow transplantation. J Pain Symptom Manage 1999; 18:157.
  152. Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med 2008; 149:369.
  153. Bradt J, Dileo C, Grocke D, Magill L. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst Rev 2011; :CD006911.
  154. Nainis N, Paice JA, Ratner J, et al. Relieving symptoms in cancer: innovative use of art therapy. J Pain Symptom Manage 2006; 31:162.
  155. Moadel AB, Shah C, Wylie-Rosett J, et al. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 2007; 25:4387.
  156. Mustian KM, Palesh O, Sprod L, et al. Effect of YOCAS yoga on sleep, fatigue, and quality of life: a URCC CCOP randomized controlled clinical trial among 410 cancer survivors (abstract 9013). J Clin Oncol 2010; 28:639s.
  157. Oh B, Butow P, Mullan B, et al. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial. Ann Oncol 2010; 21:608.
  158. Chen Z, Meng Z, Milbury K, et al. Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer 2013; 119:1690.
  159. Klein PJ, Schneider R, Rhoads CJ. Qigong in cancer care: a systematic review and construct analysis of effective Qigong therapy. Support Care Cancer 2016; 24:3209.
  160. Zhang LL, Wang SZ, Chen HL, Yuan AZ. Tai Chi Exercise for Cancer-Related Fatigue in Patients With Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial. J Pain Symptom Manage 2016; 51:504.
  161. Chen YW, Hunt MA, Campbell KL, et al. The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses. Br J Sports Med 2016; 50:397.
  162. Sharp DM, Walker MB, Chaturvedi A, et al. A randomised, controlled trial of the psychological effects of reflexology in early breast cancer. Eur J Cancer 2010; 46:312.
  163. Stephenson NL, Weinrich SP, Tavakoli AS. The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncol Nurs Forum 2000; 27:67.
  164. Fenlon DR, Corner JL, Haviland JS. A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer. J Pain Symptom Manage 2008; 35:397.
  165. Puetz TW, Morley CA, Herring MP. Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer. JAMA Intern Med 2013; 173:960.
  166. Shin ES, Seo KH, Lee SH, et al. Massage with or without aromatherapy for symptom relief in people with cancer. Cochrane Database Syst Rev 2016; :CD009873.
  167. Samarel N, Fawcett J, Davis MM, Ryan FM. Effects of dialogue and therapeutic touch on preoperative and postoperative experiences of breast cancer surgery: an exploratory study. Oncol Nurs Forum 1998; 25:1369.
  168. Tsang KL, Carlson LE, Olson K. Pilot crossover trial of Reiki versus rest for treating cancer-related fatigue. Integr Cancer Ther 2007; 6:25.
  169. Catlin A, Taylor-Ford RL. Investigation of standard care versus sham Reiki placebo versus actual Reiki therapy to enhance comfort and well-being in a chemotherapy infusion center. Oncol Nurs Forum 2011; 38:E212.
  170. Agdal R, von B Hjelmborg J, Johannessen H. Energy healing for cancer: a critical review. Forsch Komplementmed 2011; 18:146.
  171. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989; 2:888.
  172. Fawzy FI, Fawzy NW, Hyun CS, et al. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 1993; 50:681.
  173. Kuchler T, Henne-Bruns D, Rappat S, et al. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. Hepatogastroenterology 1999; 46:322.
  174. Küchler T, Bestmann B, Rappat S, et al. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial. J Clin Oncol 2007; 25:2702.
  175. Cunningham AJ, Edmonds CV, Jenkins GP, et al. A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psychooncology 1998; 7:508.
  176. Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 2001; 345:1719.
  177. Edelman S, Lemon J, Bell DR, Kidman AD. Effects of group CBT on the survival time of patients with metastatic breast cancer. Psychooncology 1999; 8:474.
  178. Kissane DW, Love A, Hatton A, et al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol 2004; 22:4255.
  179. Smedslund G, Ringdal GI. Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients. J Psychosom Res 2004; 57:123.
  180. Spiegel D, Butler LD, Giese-Davis J, et al. Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial. Cancer 2007; 110:1130.
  181. Boesen EH, Boesen SH, Frederiksen K, et al. Survival after a psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol 2007; 25:5698.
  182. de Oliveira Campos MP, Riechelmann R, Martins LC, et al. Guarana (Paullinia cupana) improves fatigue in breast cancer patients undergoing systemic chemotherapy. J Altern Complement Med 2011; 17:505.
  183. Bruera E, Strasser F, Palmer JL, et al. Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. J Clin Oncol 2003; 21:129.
  184. Markman M. Safety issues in using complementary and alternative medicine. J Clin Oncol 2002; 20:39S.
  185. Ben-Arye E, Samuels N, Goldstein LH, et al. Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals. Cancer 2016; 122:598.
  186. Murch SJ, KrishnaRaj S, Saxena PK. Phytopharmaceuticals: problems, limitations, and solutions. Scientific Rev Alternative Med 2000; 4:33.
  187. Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med 2000; 342:1686.
  188. Lord GM, Cook T, Arlt VM, et al. Urothelial malignant disease and Chinese herbal nephropathy. Lancet 2001; 358:1515.
  189. Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med 2002; 136:42.
  190. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000; 343:1833.
  191. MacGregor FB, Abernethy VE, Dahabra S, et al. Hepatotoxicity of herbal remedies. BMJ 1989; 299:1156.
  192. Moertel CG, Fleming TR, Rubin J, et al. A clinical trial of amygdalin (Laetrile) in the treatment of human cancer. N Engl J Med 1982; 306:201.
  193. Miller DR, Anderson GT, Stark JJ, et al. Phase I/II trial of the safety and efficacy of shark cartilage in the treatment of advanced cancer. J Clin Oncol 1998; 16:3649.
  194. Ashar B, Vargo E. Shark cartilage-induced hepatitis. Ann Intern Med 1996; 125:780.
  195. Buckner JC, Malkin MG, Reed E, et al. Phase II study of antineoplastons A10 (NSC 648539) and AS2-1 (NSC 620261) in patients with recurrent glioma. Mayo Clin Proc 1999; 74:137.
  196. Hainer MI, Tsai N, Komura ST, Chiu CL. Fatal hepatorenal failure associated with hydrazine sulfate. Ann Intern Med 2000; 133:877.
  197. Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002; 136:374.
  198. Trotter JF. Hepatic hematoma after deep tissue massage. N Engl J Med 1999; 341:2019.
  199. Mikhail A, Reidy JF, Taylor PR, Scoble JE. Renal artery embolization after back massage in a patient with aortic occlusion. Nephrol Dial Transplant 1997; 12:797.
  200. Kerr HD. Ureteral stent displacement associated with deep massage. WMJ 1997; 96:57.
  201. Markman M. Medical complications of "alternative" cancer therapy. N Engl J Med 1985; 312:1640.
  202. Green S. A critique of the rationale for cancer treatment with coffee enemas and diet. JAMA 1992; 268:3224.
  203. Questionable methods of cancer management: 'nutritional' therapies. CA Cancer J Clin 1993; 43:309.
  204. Sparreboom A, Cox MC, Acharya MR, Figg WD. Herbal remedies in the United States: potential adverse interactions with anticancer agents. J Clin Oncol 2004; 22:2489.
  205. Shi S, Klotz U. Drug interactions with herbal medicines. Clin Pharmacokinet 2012; 51:77.
  206. Zeller T, Muenstedt K, Stoll C, et al. Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center. J Cancer Res Clin Oncol 2013; 139:357.
  207. Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998; 158:2200.
  208. Goey AK, Beijnen JH, Schellens JH. Herb-drug interactions in oncology. Clin Pharmacol Ther 2014; 95:354.
  209. Goey AK, Mooiman KD, Beijnen JH, et al. Relevance of in vitro and clinical data for predicting CYP3A4-mediated herb-drug interactions in cancer patients. Cancer Treat Rev 2013; 39:773.
  210. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000; 7:273.
  211. Zuber R, Modrianský M, Dvorák Z, et al. Effect of silybin and its congeners on human liver microsomal cytochrome P450 activities. Phytother Res 2002; 16:632.
  212. Werneke U, Earl J, Seydel C, et al. Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer 2004; 90:408.
  213. Kivistö KT, Kroemer HK, Eichelbaum M. The role of human cytochrome P450 enzymes in the metabolism of anticancer agents: implications for drug interactions. Br J Clin Pharmacol 1995; 40:523.
  214. Lin HL, Liu TY, Wu CW, Chi CW. Berberine modulates expression of mdr1 gene product and the responses of digestive track cancer cells to Paclitaxel. Br J Cancer 1999; 81:416.
  215. Arslan D, Tural D, Akar E. Herbal administration and interaction of cancer treatment. J Palliat Med 2013; 16:1466.
  216. Ernst E. Intangible risks of complementary and alternative medicine. J Clin Oncol 2001; 19:2365.
  217. Coppes MJ, Anderson RA, Egeler RM, Wolff JE. Alternative therapies for the treatment of childhood cancer. N Engl J Med 1998; 339:846.
  218. Brienza RS, Stein MD, Fagan MJ. Delay in obtaining conventional healthcare by female internal medicine patients who use herbal therapies. J Womens Health Gend Based Med 2002; 11:79.
  219. Davis GE, Bryson CL, Yueh B, et al. Treatment delay associated with alternative medicine use among veterans with head and neck cancer. Head Neck 2006; 28:926.
  220. Han E, Johnson N, DelaMelena T, et al. Alternative therapy used as primary treatment for breast cancer negatively impacts outcomes. Ann Surg Oncol 2011; 18:912.
  221. Friedrich U. Homöopathische Krebsbehandlung. Erfahrungsheilk 2000; 4:221.
  222. Ernst E. Unconventional cancer therapies : what We need is rigorous research, not closed minds. Chest 2000; 117:307.
  223. Boddy K, Ernst E. Review of reliable information sources related to integrative oncology. Hematol Oncol Clin North Am 2008; 22:619.
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