What Terms Are Used to Describe Cancer Treatment?

Proven Treatments

New medical treatments are assumed to be ineffective until they are proved to be useful. The vast majority of new drugs made in research labs turn out to be useless for treating cancer in humans. That's why doctors focus on results of carefully conducted clinical studies. They don’t prescribe drugs just because a drug company claims they're useful. Treatments must be proven in studies that are supervised and reviewed by leading experts in cancer treatment. Patient anecdotes (success stories), marketing brochures, and testimonials aren’t convincing evidence.

Proven treatment refers to treatments that have been tested following this strict set of guidelines and found to be safe and useful. The results of such studies have been published in peer-reviewed journals. Peer-reviewed journals are those in which the articles are studied by other doctors or scientists in the field to be sure that they meet certain standards before being published. Treatments that are tested in these ways are sometimes called evidence-based approaches. They are generally adopted by doctors as part of mainstream medicine. Mainstream medicine (the usual type of treatment you get from a medical doctor) may also be called standard treatment, conventional medicine, allopathic medicine, and Western medicine.

The treatments generally used in mainstream medicine have been approved by the Food and Drug Administration.

Research and Investigational Treatments

Research or investigational treatments are therapies being studied in a clinical trial. Clinical trials are research projects to find out whether a new treatment works and is safe for patients. Before a drug or other treatment can be used regularly to treat patients, it is studied and tested carefully, first in the laboratory, and then in animals. After these studies are finished, if the therapy is found safe and promising, it is tested to see if it helps people. If careful testing with patients shows that the drug or other treatment is safe and effective, the Food and Drug Administration may approve it for regular use. (See the American Cancer Society document, Clinical Trials: What You Need to Know, for more information.) Only then does the treatment become part of the standard group of proven therapies used to treat disease in human beings.

Complementary Therapy

Complementary therapy is used along with standard or mainstream medical treatment. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of cancer therapy, or improve a patient's sense of well-being. Examples might include meditation to reduce stress, peppermint tea for nausea, and acupuncture for chronic back pain. Some of the methods, such as massage therapy, relaxation, and meditation that are now called complementary have actually been referred to as supportive care in the past.

The American Cancer Society urges patients who are thinking about using any complementary or non-mainstream treatments to discuss this with their health care team.

Integrative Therapy

Integrative therapy is a term that refers to treatment that uses both mainstream and complementary methods. Some cancer treatment centers and clinics now offer this option for patients who might benefit from complementary methods.

Alternative Therapy

Alternative therapy refers to an unproven therapy that is used instead of standard or proven therapy. Some alternative therapies have dangerous or even life-threatening side effects. With others, the main danger is that the patient may lose the chance to benefit from standard therapy. The American Cancer Society urges patients who are thinking about the use of any alternative or complementary therapy to discuss this with their health care team.

Treatments Not Supported by Evidence

Disproven is a term that is not often used, but it may be used to describe a type of treatment that has been studied enough to find out that it does not work for a given condition. More often, however, such a treatment is described by saying that studies do not support claims that the treatment helps a certain type of cancer or a certain condition.

Quackery and Fraud

Quackery refers to the promotion of methods that claim to prevent, diagnose, or cure cancers that are known to be false, or which are unproven. These methods are sometimes based on the use of patient stories to convince future buyers of its usefulness and safety. Often the person or company promoting the treatment or product claims it works in other diseases as well as cancer.

Some unproven or untested treatments may be promoted by people whose main intent is to make money. Some of these methods have been tested and found not to be effective. Some are known to be harmful. Others have not been tested, but the seller claims that they can help you.

If the promoted treatment is a dietary supplement, the Federal Trade Commission is responsible for enforcing the laws about how it is advertised. For companies or people offering other types of fraudulent treatments or services, other enforcement bodies may be involved. However, many of these fraud-selling companies move offshore to other countries, where they sometimes find it easier to evade the authorities.

If you suspect fraud in any kind of health treatment, you can contact the US Food and Drug Administration (FDA). The FDA is listed in the blue pages of the phone book under "US Government." Look under the heading, "Health and Human Services." Or visit their Web site at http://www.fda.gov.

Other Terms

Other words used to describe treatments that are not used in mainstream medicine are unconventional, non-conventional, and non-traditional. These terms may be used to describe any complementary or alternative therapy. Sometimes the term "questionable" is used to describe therapy which is thought to be worthless or fraudulent.

What Makes Complementary or Alternative Treatments Harder to Evaluate?

Treatments Are Assumed To Be Safe

Many people choose complementary or alternative therapies because they think there are no harmful side effects from them. This is not always a reliable assumption. In addition to the delay in mainstream treatment that can allow the cancer to grow and spread to other parts of the body, some complementary and alternative treatments have been reported to cause serious problems or even deaths. Even so, most of these problems are not reported to the FDA by the patient or family, so that no one else knows about them. Sometimes, if the patient was treated by a doctor who wrote up the problem for a medical journal, there may be reports of some of the more serious effects of these treatments. But it is clearly impossible to be sure that all of them are there.

Certain vitamins and minerals can increase the risk of cancer or other illnesses, especially if too much is taken. When it happens to one person, it is very easy to miss any link between the illness and the supplement. Large groups of people must be studied to find out about a small increase in risk.

Some companies do not follow FDA's requirements about making claims and labeling supplements properly. In many cases, these companies know that they are operating illegally and will move to a country where regulations are more lax than the United States.

Finally, if a company does not carefully control the manufacturing process, it is possible for harmful contaminants to get into dietary supplements. Serious illnesses and even deaths have resulted from these problems.

If you have experienced a serious side effect from a dietary supplement, you can report it to the FDA's Medwatch program. (See information in the "Additional Resources" section.)

Some Treatments Are Assumed To Be Effective

There are those who think that treatments derived from folk remedies that have been used for "thousands of years" must work. It is important to keep in mind that just because a treatment method has been used a long time does not mean that it works. Still, it is very common for people who want you to try these methods to remind you of their long history.

When scientific studies are not done, it is hard to tell what is caused by the illness and what is caused by the treatment. Herbal treatments that are given for illnesses that go away on their own may be given credit for curing the person. Or the treatment might make the person feel better for a short time but have no effect in the long run.

The Expectation Effect

It is quite common for people to feel better after almost any kind of treatment that they expect to help them. There is a name for this: It is called the placebo effect, which is one form of the expectation effect. The placebo effect means that if the person expects the treatment to help, he or she may feel better after getting it even if the treatment does nothing for the underlying problem. This effect usually lasts only a short time, and seems to have something to do with the body's own chemical ability to relieve pain or certain symptoms for a short time.

The expectation effect can also work in a less pleasant way; that is, a person who expects a strong treatment or side effects may notice a headache, fatigue, nausea, or other symptom even though he or she got a sham (inactive) treatment. This has been named the nocebo effect. This effect is one reason why, in scientific studies, side effects are listed for the placebo group as well as the treatment group.

Clearly, when there is no scientific study (or when there is a study with no control group), it is impossible to separate these expectation effects from some of the short-term treatment effects. The placebo effect may explain one of the reasons that people continue to use certain types of complementary or methods that have no actual effect on the disease. If they feel better for a few hours, it may be worthwhile to them to continue using the method as long as it does not hurt them. It does not mean that it will have the same effect on everyone who tries it, though.

Testing Is Not Required

The US FDA does not require proof that dietary supplements be tested before they are sold, even though certain health claims may be allowed. Dietary supplements are regulated by the FDA just the opposite of the way medicines are treated. Even drugs sold over the counter must be carefully tested to find out about their risks and side effects before they can be sold. They also must be proven effective. Dietary supplements, on the other hand, are assumed safe until proven otherwise.

Other methods, such as massage therapy, acupuncture, and meditation came into wide use with no requirement for testing.

Good Research Studies Take Time

It is difficult for some people to believe that the treatments their family and friends recommend have no proof that they work. They may hear convincing stories of a person who was told they had cancer. Then, after using this treatment, the patient became well and healthy again.

Everyone wants to believe these hopeful stories. However, stories about amazing cures cannot be considered as evidence that a treatment works. Most of the time, there is no way to be sure the stories are true. And if such a story is true, it is not possible to know which treatment helped the person or whether he or she got sick again later. These are questions that can be answered by controlled studies called clinical trials.

Some of the clinical trials that are done on complementary methods are done differently than those on drugs and other mainstream treatments. The study may not have a control group, or there may not be enough people in the study to show any effect. Sometimes even when there is a control group, the studies aren't blinded, meaning that the researchers know who is getting placebo or standard treatment. Knowing this information can lead to biased results. In studying some methods (for example, acupuncture and some other hands-on methods), it is almost impossible to come up with a good placebo method for the control group.

It takes time and money to get careful clinical trials done. How long a clinical trial takes depends partly on what it is being tested; for instance, it may take several years to show that a treatment helps survival, but only a few months to show that it helps nausea related to chemotherapy. Since the companies that produce supplements or offer complementary treatments often do not carefully test them before selling them, it is left to other researchers to look into their claims. Because there are many types of complementary treatments, it may be a long time after the treatment is first offered before studies are published that can show that any one treatment does or does not help. This can be frustrating when a person wants information to make a decision right now.

The good news is that more and more doctors and scientists are now studying complementary methods with the same careful methods used to study drugs. Results from many of these studies have been published in reliable, mainstream medical journals. As more of these studies are completed, patients and healthcare professionals will be able to make better decisions about these treatments.

Judging for Yourself

All of these factors mean that it is common to find much less high-quality, objective information available about complementary and alternative methods than is available about mainstream medicines. This is one of the reasons that it is sometimes impossible to say much about whether a complementary method is likely to help you, or even how safe it might be. That is why you will want to learn as much as you can about a treatment before you try it. Even if some information isn't available, you can find out the limitations of what is known about it to help you make your decision.

Can I Safely Use an Alternative or Complementary Cancer Treatment?

Many people with cancer use one or more kinds of alternative or complementary therapies. Often they do not tell their doctors about their decision. The best approach is to look carefully at your choices. Talk to your doctor about any method you are considering. There are many complementary methods you can safely use along with standard treatment to help relieve symptoms or side effects, to ease pain, and to help you enjoy life more. Even if they are not fully tested, you can choose methods that don't usually cause harm or interfere with your cancer treatment. Here is a partial list of some complementary methods that some people have found helpful when used along with medical treatment.

Complementary Approaches That May Be Used With Cancer Treatment

• acupuncture: Acupuncture is a technique in which very thin needles are inserted through the skin to treat a variety of conditions. It may be helpful with mild pain and some types of nausea. (See the American Cancer Society document Acupuncture.) 
• aromatherapy: Aromatherapy is the use of fragrant substances, called essential oils, distilled from plants to alter mood or improve symptoms such as stress or nausea. (See the American Cancer Society document Aromatherapy.) 
• art therapy: Art therapy is used to help people with physical and emotional problems by using creative activities to express emotions. This is done by mainstream therapists with specialized training. (See the American Cancer Society document Art Therapy.) 
• biofeedback: Biofeedback is a treatment method that uses monitoring devices to help people consciously control physical processes such as heart rate, blood pressure, temperature, sweating, and muscle tension that are usually controlled automatically. (See the American Cancer Society document Biofeedback.) 
• labyrinth walking: Involves a meditative walk along a set circular pathway that goes to the center and comes back out. Labyrinths can also be "walked" online or on a grooved board following the curved path with a finger. (See the American Cancer Society document Labyrinth Walking.) 
• massage therapy: Massage involves manipulation, rubbing, and kneading of the body's muscle and soft tissue. Some studies suggest massage can decrease stress, anxiety, depression, and pain and increase alertness. (See the American Cancer Society document Massage Therapy.) 
• meditation: Meditation is a mind-body process in which a person uses concentration or reflection to relax the body and calm the mind. (See the American Cancer Society document Meditation.) 
• music therapy: Music therapy is offered by a group of established healthcare professionals who use music in order to promote healing and enhance quality of life. (See the American Cancer Society document Music Therapy.) 
• prayer and spirituality: Spirituality is generally described as an awareness of something greater than the individual self. It is often expressed through religion and/or prayer, although there are many other paths of spiritual pursuit and expression. (See the American Cancer Society document Spirituality and Prayer.) 
• tai chi: Tai chi is an ancient Chinese martial art. It is a mind-body system that uses movement, meditation, and breathing to improve health and well being. It can improve strength and balance in some people. (See the American Cancer Society document Tai Chi.) 
• yoga: Yoga is a form of non-aerobic exercise that involves a program of precise posture and breathing activities. In ancient Sanskrit, the word yoga means "union." (See the American Cancer Society document Yoga.)

In addition to these, the American Cancer Society has information on many other types of alternative and complementary treatments. You can call us (1-800-ACS-2345) or visit our Web site (www.cancer.org) any time to find more information on these methods.

The American Cancer Society recommends discussing all types of complementary or alternative treatments with your cancer treatment doctor (oncologist) and health care team. See the American Cancer Society document Guidelines for Using Complementary and Alternative Therapy for more information on how to go about this.

If you are thinking about using any other method instead of evidence-based medical treatment, you may also want to look at the questions below.

Questions to Ask About Alternative and Complementary Therapies

• What claims are made for the treatment? Is it expected to cure the cancer or to help the medical treatment to work better? Is it supposed to relieve symptoms or side effects? 
• What are the qualifications of those supporting the treatment? Are they recognized experts in cancer treatment? 
• Have scientific studies or clinical trials been done to find out whether this treatment works? Have any side effects been reported? Have the findings been published in trustworthy journals? 
• How is the method promoted? Is it promoted only in the mass media, such as books, magazines, the Internet, TV, infomercials, and radio talk shows rather than in scientific journals? 
• What are the costs of the therapy? 
• Is the method widely available for use within the health-care community, or is it controlled with access to its use limited? 
• If used in place of standard therapies or clinical trials, will it delay any chances for cure or make the cancer worse?

Signs of Treatments to Avoid

Use the checklist below to spot potential treatments that might be open to question. If you are not sure, talk to your doctor or nurse before moving ahead.

• Is the treatment based on an unproven theory? 
• Does the treatment promise a cure for all cancers? 
• Are you told not to use the recommended medical treatment? 
• Does the treatment offer benefits but claim to have no side effects? 
• Is the treatment or drug a "secret" that only certain providers can give? 
• Is the treatment or drug only offered by 1 person or clinic? 
• Does the treatment require you to travel to another country? 
• Do the promoters attack the medical or scientific community?

Additional Resources

More Information From Your American Cancer Society

The following information on complementary and alternative therapies may also be helpful to you. These materials may be found on our Web site (www.cancer.org) or ordered from our toll-free number (1-800-ACS-2345).

Guidelines for Using Complementary and Alternative Methods

How to Know What Is Safe: Choosing and Using Dietary Supplements

American Cancer Society Operational Statement on Complementary and Alternative Methods of Cancer Management

Clinical Trials: What You Need to Know

In addition to the above, information on many different types of complementary and alternative treatments are available at no cost to you from the American Cancer Society. You can find them on our Web site or order from our toll-free number as noted above.

National Organizations and Web Sites*

There is a great deal of interest today in complementary and alternative therapies. Mass communication, especially the Internet, makes it possible for people to share ideas and information very quickly. But too often information on the Internet is written by promoters of useless treatments. In addition to the American Cancer Society, the following is a partial list of Web sites and phone numbers of reputable groups that provide information on complementary and alternative therapies:

National Cancer Institute
Telephone: 1-800-4-CANCER (1-800-422-6237); TTY: 1-800-332-8615
Internet Address: http://www.cancer.gov

National Center for Complementary and Alternative Medicine (NCCAM)
Telephone: Telephone: 1-888-644-6226; TTY: 1-866-464-3615
Internet Address: http://nccam.nih.gov

Memorial Sloan Kettering Cancer Center
About Herbs and Botanicals
Internet Address: http://www.mskcc.org/mskcc/html/11570.cfm

The University of Texas MD Anderson Center
Complementary/Integrative Medicine Therapies
Internet Address: http://www.mdanderson.org/cimer

United States Department of Agriculture, Food and Nutrition Information Center
Telephone: 1-888-INFO-FDA (1-888-463-6332)
Internet Address: http://fnic.nal.usda.gov
Choose "Dietary Supplements" from the left menu bar

United States Food and Drug Administration
Internet Address: http://vm.cfsan.fda.gov/%7Edms/supplmnt.html
To report side effects or other adverse events from a dietary supplement, call Medwatch at 1-800-FDA-1088.

National Council Against Health Fraud
Internet Address: http://www.ncahf.org

Quackwatch
Internet Address: http://www.quackwatch.org

*Inclusion on this list does not imply endorsement by the American Cancer Society.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-ACS-2345 or visit www.cancer.org.

References

Beyerstein BL. Distinguishing science from pseudoscience. 1995. Victoria, B.C.: The Centre for Curriculum and Professional Development. Available at: http://www.sfu.ca/~beyerste/research/articles/02SciencevsPseudoscience.pdf. Accessed November 8, 2007.

Link J, Haggard R, Kelly K, Forrer D. Placebo/nocebo symptom reporting in a sham herbal supplement trial. Eval Health Prof. 2006;29:394-406.

US Food and Drug Administration. An FDA Guide to Dietary Supplements. Available at: http://www.fda.gov/fdac/features/1998/598_guid.html. Accessed November 13, 2007.

US Food and Drug Administration, Center for Food Safety and Applied Nutrition. Dietary Supplement Health and Education Act of 1994. December 1, 1995. Available at: http://www.cfsan.fda.gov/~dms/dietsupp.html. Accessed November 13, 2007.

US Food and Drug Administration. Dietary Supplement Enforcement Report. Available online at: http://www.fda.gov/oc/nutritioninitiative/report.html. Accessed November 13, 2007.

Revised: 12/12/2007