Complementary and alternative therapies for cancer symptoms
Complementary and alternative therapies for cancer symptoms
Running Time: 0:09:07
Welcome to Mayo Clinic podcast. I'm your host, Rich Dietman. In today's podcast we're talking about complementary and alternative medicine therapies that can be used to help relieve some symptoms of cancer and chemotherapy.
Complementary and alternative therapies have been used for some time now to treat cancer symptoms and the side effects of chemotherapy. Here to talk about some of those therapies is Mayo Clinic's Dr. Brent Bauer. Dr. Bauer practices in the Division of General Internal Medicine at Mayo Clinic in Rochester, Minnesota, and he's also director of the Complementary and Integrative Medicine Program at Mayo Clinic. Dr. Bauer, thanks for being with us today.
Dr. Bauer: Well, thanks for having me here.
Rich Dietman: Cancer and cancer treatment can cause a variety of symptoms and side effects, ranging from nausea and vomiting to fatigue, poor sleep and stress. Give us a brief overview of some of the complementary and alternative treatments that are being used to help these problems.
Dr. Bauer: It turns out there's a lot of things in this realm of what people call complementary and alternative medicine that actually can have some beneficial effects, and these range from acupuncture, massage therapy, some of the dietary supplements, guided imagery. A lot of these are very simple techniques; a lot of them are things you can do for yourself — for example, meditation. You can learn a meditation program and use that as you go through the experience of cancer; both the cancer itself as well as the treatments.
Rich Dietman: Exercise has been reported to have provided some help in reducing fatigue in people with cancer. Is that true, and doesn't it seem to run sort of counter to the symptom? In other words, if I'm fatigued, shouldn't I rest rather than work out?
Dr. Bauer: It's one of the most common problems for patients with cancer. Whether they're being treated for cancer, whether they're a cancer survivor, a lot of people will tell you that the fatigue is one of the worst symptoms they had to deal with. And it does turn out, and it may be a little counterintuitive, if you think about it, when you're going through all these treatments there's a lot of stress. Plus you're usually off your usual game plan. You may not have your usual exercise program. So on top of all the things that are going on with the treatment, there is some deconditioning, there's a lot of stress. And it turns out that by incorporating a gentle, graded approach to aerobic exercise, that we actually see pretty significant improvement in fatigue for a lot of patients. It doesn't mean going out and running marathons. But it does mean maybe if you were walking beforehand and you were walking a mile a day, maybe to start back up with just a half-mile a day and then gradually build up. Where if you were biking before, cut the distance but keep going so that there's something there each day that gets you out and gets the heart rate up and moves those muscles.
Rich Dietman: What about ginseng and fatigue? Is there some truth to that to being some use in terms of reducing or alleviating fatigue?
Dr. Bauer: Well, we'd like to think so, since we did the study here a couple years ago. We looked at a group of cancer patients and half were given ginseng — oh actually one-half, or one-fourth, were given a placebo. One-fourth were given a small dose of ginseng and then two groups got larger and larger doses. And it turned out in the two groups that had the larger doses of ginseng, they actually did seem to reduce their fatigue. They felt better. Overall they just had a better quality of life. That was a relatively small study. We're actually repeating that study now with a more focused group of patients with cancer, to see if we can validate those results. The results were positive enough that I think that we said yes, there's something there. But the trick, of course, is that it doesn't mean that every ginseng on the shelf has the same effects as what we used. We worked with the Ginseng Growers' Association in Wisconsin. We had them harvest a specific batch; we managed how it was harvested, how it was processed; we analyzed the number of ginsenosides at the start and the number of ginsenosides at the end. Those would be what we think would be the active ingredients, so we had a very good control of the quality and nature of the product. And so, using that same formula, we might see the same effects but, of course, when we go to the shelf we know that the quality there can sometimes be of varying degrees of quality.
Rich Dietman: Can certain herbs and supplements interfere with cancer treatments?
Dr. Bauer: So another good question, and one of the reasons I think it's so important that places like Mayo are doing studies in this regard. Because the answer is, of course, yes. Any herb that's strong enough to have a beneficial effect in your body obviously has the potential to interfere with chemotherapy or other things that are going on in your body while you're fighting cancer. And a good example of this concern centers on the use of antioxidants. We know that antioxidants, for the most part, are really good and that they may actually have some beneficial effects in helping your body fight some of the side effects of chemotherapy. So one of the studies we're actually doing right now is something with ginkgo, to see if it can prevent some of the long-term changes in brain function that sometimes happens after chemotherapy. The concern, of course, is that if we take an antioxidant at the time we're using chemotherapy, it might, yes, blunt some of those side effects of the chemotherapy — a good thing. But could it also do a bad thing — blunt some of the effects of the chemotherapy? There's a lot of debate about that right now. But the only way to answer that question is to do good, controlled studies where half the group takes the antioxidant, half does not, and then we'll be able to tease out from that study — which is ongoing right now — whether or not we saw the benefit or the harm.
Rich Dietman: Nausea is a common symptom for people undergoing chemotherapy, and acupuncture has proved to be of some help in some of these cases. How does it work, and what should a person consider when they're having these symptoms and considering acupuncture?
Dr. Bauer: Well, it's interesting. The NIH actually came out with a consensus statement back in 1994, highlighting what they thought the evidence supported in terms of the use of acupuncture. One of the things they identified was nausea related to chemotherapy. So that's been recognized for a long period of time. And a number of studies since that have all suggested that there's a beneficial effect. But I think we still don't fully understand is how it works. There's certainly the traditional Chinese medicine view, and that is that we have within our system or our body 13 channels of energy, what they will call chi. And how that chi flows determines whether you're sick or not. And so the acupuncture needles are thought to stimulate the flow of chi, or change a block in the chi, that would be the traditional Chinese medicine approach to why it might work with nausea. More typically on the Western side, researchers tend to think more about the effect of a needle going into the skin might release substance P or release chemicals in the brain that might have some impact on pain or nausea. At the end of the day, it doesn't really matter which of those theories is correct. It seems to work, it's relatively safe in competent hands, and that's why we're using it for those kinds of indications.
Rich Dietman: While we're talking about reducing nausea, talk about music therapy and what role that has played or may play in treating that symptom.
Dr. Bauer: So there's two kinds of broad aspects under music, one of which is just music. What if I play music in the background while I'm getting my chemotherapy, or what if I listen to peaceful music or nature sounds? Then the other aspect is: What if I use a music therapist? If I work with somebody who actually has a degree and certification as a therapist, who comes in and works with me and then either plays music with me or sings with me or has me play instruments. So there's really two levels, one of which is music, which is very common, and then less common — but I think increasing on a regular basis — the concept of the music therapist. Both have been studied. A study just last year looking at the role of a music therapist in patients getting chemotherapy found that working with the music therapist reduced nausea, reduced stress levels, heart rate came down — a very nice effect. Other studies have shown just even simply playing music of choice — you know, if you like country western, if you like classical — allowing that type of music to be played in the background can have a huge impact on your stress level, even to some degree nausea. I think we underestimate the power of music, and we probably could get many more benefits from it. And not only cancer, but in almost everything we do in the hospital that's stressful. Whether you're going for an endoscopy or a procedure of any type, having music be part of that experience seems to help most people fairly significantly.
Rich Dietman: And speaking of stress, it's been suggested that yoga can help reduce stress for people who are undergoing treatment for a chronic disease, including cancer. Talk about that.
Dr. Bauer: So yoga's kind of cool because it certainly brings in not only the postures, which a lot of people are familiar with, but there's clearly a component of breathing. And we know that slowing your breathing, doing some of the deep breathing that yoga encourages, actually has a pretty profound impact on the autonomic nervous system — the part of the nervous system that controls how fast the heart beats, and the blood pressure and all those kinds of things. So we have a series of postures, we have breathing, and then there's a meditative quality — something where we get our mind to kind of settle down and come to a point of reflection. Putting all three of those components together under yoga tends to have a very profound impact on our stress levels. A lot of people benefit in terms of the flexibility from the postures. Other people find it's just a nice respite, a change of pace — takes me out of my day-to-day, rush-rush world. So for a lot of those reasons, we're seeing more and more interest in yoga, more and more studies coming out suggesting that, in fact, it can be a very effective stress-relieving modality.
Rich Dietman: Thanks very much, Dr. Bauer. We've been talking with Dr. Brent Bauer, a physician in the Division of General Internal Medicine at Mayo Clinic, Rochester, Minnesota. Dr. Bauer is also director of the Complementary and Integrative Medicine Program at Mayo. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.
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Last Updated: 2008-12-12
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