WHEN BETSY GLOSIK ​​was diagnosed with estrogen receptor-​positive, stage II breast cancer in October 2007, she suspected the treatment would be rough on her. Her doctor recommended three types of chemotherapy—docetaxel, doxorubicin and cyclophosphamide—a combination of drugs that carry a risk of severe side effects, including diarrhea, fatigue and neuropathy.

Glosik, who lives in Brecksville, Ohio, a suburb of Cleveland, was then 49 years old. She frequently had unusual reactions to medications, even over-the-counter ones, so she asked her oncologist if a less toxic approach might be just as effective.

“He looked at me with a blank face and said, ‘You have no choice.’” The response rubbed her the wrong way. “In the back of my head, I knew I had a choice. I could choose not to be treated.”

Glosik contacted an oncologist who had treated her for localized melanoma four years earlier, who referred her to another oncologist for a second opinion. The doctor reviewed her case and felt confident that omitting doxorubicin would not significantly affect her chance of survival.

After a life-threatening allergic reaction to the pared-down regimen, Glosik eventually finished three rounds of another drug, Abraxane (paclitaxel), in addition to radiation therapy. She went on to take tamoxifen for 6 1/2 years to decrease the risk of the cancer coming back. To this day, she believes the toxicity of the three-drug combination would have killed her.

Glosik wanted to know what more she could do to manage treatment side effects. “I was looking for something else that wasn’t going to be another drug that was going to tear my body down,” she says. She started with exercise, which had always helped her relieve stress. After chemotherapy treatments, she would nap and then head to the gym.

But the treatment side effects, especially pain and fatigue, became more intense. She met with an oncology social worker, who recommended meditation and reiki, a technique in which practitioners place their hands on or near a person’s body. How reiki works isn’t well understood, but practitioners say the technique stimulates a person’s healing mechanism. Glosik researched reiki online and decided to go ahead with it while she was undergoing chemotherapy.

The effects were immediate, relieving both her pain and fatigue. “I walked into the practitioner’s room feeling like I got hit by a bus, and I walked out and floated for two days,” she says.

Glosik is among a growing number of people diagnosed with cancer who are looking to include nontraditional therapies ​as a complement to their conventional treatment regimens. These approaches can include massage, acupuncture or reiki; movement activities like yoga​ or tai chi; and botanical or nutritional supplements.

A review of 61 studies, published in the May 2019 Complementary Therapies in Clinical Practice​, found that 51% of more than 20,000 people in the studies, all of whom had been diagnosed with cancer in the previous decade and were undergoing treatment, reported using therapies that would qualify as complementary. In contrast, studies conducted on cancer patients in the 1970s and 1980s found that only about a quarter of people with cancer reported using such approaches.

This growing use has given rise to an inter-disciplinary, patient-centered field called integrative oncology, which aims to incorporate complementary therapies grounded in evidence with conventional cancer treatments to help patients improve their quality of life and manage side effects.

“We’re seeing more and more patients picking up things like meditation, movement therapies and music therapy,” says integrative oncologist Donald Abrams of the University of California, San Francisco Osher Center for Integrative Medicine. “A lot of these activities are about improving quality of life and coping with the distress that can come with a cancer diagnosis.”

Sources You Can Trust

Learn more about complementary medicine​.

Evidence-Based Therapies

The rise in popularity of complementary therapies presents challenges. Interested patients may find themselves overwhelmed by choices, not all of them good. There is solid evidence showing that some complementary therapies can safely and effectively ease cancer-related symptoms. Acupuncture, for example, may relieve pain, fatigue and nausea in adults and children undergoing treatment, according to multiple studies.

Yoga has similarly been examined: A review published in the International Journal of Yoga​ in January 2018 included data from more than 10,000 patients with a variety of cancer types. Most studies reported that yoga, meditation and breathing exercises helped reduce anxiety, sleeplessness and fatigue. (Patients with bone metastases should first consult with their oncologists to avoid yoga positions that could lead to fractures.)

Using dietary and herbal supplements, especially during treatment, is more controversial. Unlike prescription and over-the-counter drugs, which must be approved by the U.S. Food and Drug Administration before they can be used on patients, supplements have less restrictive requirements. They do not need to be proven safe and effective before they hit the store shelves. In addition, they can be expensive and may interfere with how the body metabolizes drugs used in chemotherapy, potentially making the drugs more toxic or less effective. Investigations have shown that many supplements don’t contain​ the mix of ingredients listed on their labels.

Hundreds of clinical trials have focused on the anticancer effects of supplements, including green tea, mistletoe, pomegranate, selenium and resveratrol, which is found in red wine. Most of these studies have found no survival benefits, and some supplements may increase a person’s risk of a cancer diagnosis or mortality. (For example, while selenium may reduce the risk of lung and gastric cancer in people with low selenium levels, it increases the risk of gastric cancer for everyone else.) So far, there’s no reason to believe that an herb or other supplement can help treat cancer.

In 2016, Glosik began working as a patient advocate with the Society for Integrative Oncology (SIO), a nonprofit professional organization for health care providers, researchers and patient advocates who are interested in advancing evidence-based ways to combine complementary therapy with standard treatments to help cancer patients and their families. She notes that many cancer patients are unaware that these options can help manage side effects.

This may be in part because many doctors don’t discuss integrative options wit​h their patients. For a small study published in May 2019 in the Oncologist, for example, researchers reviewed 529 recorded conversations between doctors and patients at two cancer centers, one in Michigan and the other in Southern California. Only 12% of the conversations included some discussion of integrative therapy. Results of a survey published in the May 2019 issue of JAMA Oncology​ suggest that about 30% of patients who use complementary medicines don’t tell their health care providers.

Not having conversations about these treatments is a missed opportunity because many patients are unaware of options that could help them manage side effects, says Lynda Balneaves, a nurse researcher at the University of Manitoba in Winnipeg, Canada, and SIO president. Patients seeking information may rely instead on internet searches and advertisements, which often publicize overblown claims. “It’s distressing and concerning that patients might be getting misinformation and making those choices,” she says.​

Placing Myth Over Medicine

Using alternative medicine in place​ of standard treatment is associated with shorter survival.​

What Patients Can Do

Walela Nehanda learned firsthand about assessing the new information that comes with a cancer diagnosis. In 2017, at the age of 23, Nehanda was diagnosed with phase III chronic myeloid leukemia and started taking a daily capsule of the drug Tasigna (nilotinib). The daily dose has exacted a heavy toll: Two years into treatment, the Los Angeles-based community organizer and poet still experiences insomnia, nausea and severe infections. Taking the drug also triggered the onset of pulmonary hypertension.

Nehanda, who identifies as nonbinary, manages side effects with a suite of complementary medicines. “Acupuncture has been a real lifesaver” for stress relief, nausea and gastrointestinal discomfort, says Nehanda, who also uses some cannabis-derived products, including gummy candies that contain cannabidiol (CBD) to help with sleep. Clinical trials focused on CBD, a nonintoxicating compound in cannabis, have found it to be safe for cancer patients, though they haven’t shown evidence of it treating or curing the disease.

Pharmacists and journal studies found online provide reliable information for Nehanda, who knows firsthand what misinformation looks like. Right after diagnosis, Nehanda was deluged with advice, mostly from commenters in online discussions, about supplements and natural cures. Almost all of it was bogus. “People were like, take garlic and you’re cured,” says Nehanda, “but I found that garlic can interfere with Tasigna.”

Nehanda learned to be vigilant and skeptical, but the onslaught of advice became irritating. “I found it to be infantilizing,” Nehanda says. “You really didn’t think I decided to look it up?”

Cannabis and Cancer Patients

People with cancer are using marijuana with the intention of alleviating side effects​.

An Integrated Future

Twelve years ago, when Glosik was being treated for her cancers, she thought oncologists were suspicious of complementary treatments. Since then, clinical trials have provided more information on ways to integrate approaches like acupuncture and meditation while patients undergo conventional treat​ment. For example, the Sept. 1, 2018, issue of the Journal of Clinical Oncology included integrative oncology guidelines developed by the SIO for oncologists treating breast cancer patients.

The guidelines, based on the outcomes of recent studies, recommend treatments like yoga and meditation for stress; yoga, massage and music therapy for depression; and acupuncture and acupressure for reducing nausea and vomiting caused by chemotherapy. They advise against using a supplement called acetyl-L-carnitine because it can increase nerve pain from chemotherapy, and they report finding a lack of strong evidence for using dietary supplements to manage adverse effects related to treatment.

Glosik sees the guidelines as a step toward fully integrative cancer care. Other efforts suggest integrative oncology is reaching more patients. Many major cancer centers now have integrative medicine centers that steer patients toward safe, evidence-based ways to use complementary therapies.

Patient interest in integrative approaches is so high that Abrams, at UCSF, started organizing group sessions with patients to present information and field questions about nutrition, supplements and other complementary methods.

Balneaves, at SIO, thinks the recent shift to patient-centered care has helped smooth the path for patients seeking integrative care and for providers to become more open to these discussions with patients. “There’s been so much progress in many of these therapies with strong evidence,” she says.

Still, Nehanda, in Los Angeles, thinks it’s nearly impossible for some people to navigate the tricky world of complementary medicine, drug interactions and evidence on their own, which is why it makes sense to consult with experts before trying anything new. Maximizing the benefits of these treatments “requires us to do a lot of self-research and double-checking our sources,” Nehanda says. “Let your care team and caregivers help you with that process.”

Stephen Ornes, a contributing writer for Cancer Today, lives in Nashville, Tennessee.