Complementary and Alternative Medicine
CAM Applications to Ovarian Cancer
Not all CAM therapies are directly applicable to women with ovarian cancer. In the following sections we have summarized some of the therapies that our patients have found to be most helpful in relieving symptoms and improving the quality of life by reducing side effects of conventional treatments or by providing psychological benefits. We also present a brief summary of some of the more commonly encountered herbs and dietary supplements; however, we reiterate that these should not be used as alternatives to conventional treatments to fight cancer.
Mind, Body, and Spirit Methods
Aromatherapy is the use of essential oils (fragrant substances distilled from plants) to alter mood or improve health. Essential oils are highly concentrated aromatic substances that can either be inhaled or applied as oils during therapeutic massage. For inhalation, steaming water, diffusers, or humidifiers are used to spread a combination of the steam and a few drops of the essential oil throughout the room. For skin application, essential oils are usually mixed with vegetable oil and massaged directly into the skin.
Aromatherapy can be used to enhance the quality of life as a complementary treatment through reducing stress, pain, and depression and by producing a feeling of well-being. Although there are over 40 different essential oils, the most commonly used are lavender, eucalyptus, rosemary, jasmine, chamomile, peppermint, and geranium. Lavender oil is promoted to reduce stress, anxiety, insomnia, and muscle tension. Inhaled peppermint and ginger oil may help to reduce chemotherapy-related nausea, although these reports have not been scientifically proven.
Aromatherapy may be self-administered or practiced by an aromatherapist. Many aromatherapists are also trained as massage therapists, psychologists, chiropractors, or social workers. It may be advisable to seek a consultation from someone experienced in aromatherapy before starting treatment, particularly when applying essential oil directly to the skin. Essential oils should never be taken internally, as many are poisonous if ingested, or applied for prolonged periods of time. There is no scientific evidence to support aromatherapy as a means of preventing or treating cancer.
Art therapy uses creative activities to express emotions and provides a way for people to increase self-awareness, express unspoken concerns about their disease, or come to terms with emotional conflicts. A trained art therapist usually serves as a facilitator as patients work individually or in groups to express themselves through their art and discuss emotions and concerns as they relate to their creations. Many cancer centers or support groups will be able to provide access to a trained art therapist.
The complementary therapy of imagery uses visualization techniques and mental exercises to enable the mind to influence the health and well-being of the body. While imagery does not appear to directly affect cancer growth, the techniques can help reduce anxiety, improve depression, create feelings of being in control, and may be helpful in reducing pain. For cancer patients, imagery has been promoted as a way to alleviate the nausea caused by chemotherapy and reduce the stress associated with having cancer. Guided imagery is one technique that entails visualizing a specific goal to be achieved and imagining achieving that goal, much as an athlete would prior to competition. Imagery techniques should be guided by a trained health care provider, at least at the start of therapy, and are best used as a complementary therapy to conventional treatments.
Meditation is a relaxation method that can be useful as a complementary therapy for treating chronic pain, insomnia, and improving the overall quality of life. There is no evidence that meditation is effective in directly treating cancer, however. There are different types of meditation that use concentration or reflection to relax the body and calm the mind to create a sense of well-being. Meditation can be self-directed or guided by a health care professional. In self-directed meditation, one sits or rests in a quiet place free from noise and distraction, trying to achieve a feeling of peace. A relaxed yet alert state is created by concentrating on a pleasant idea or thought, chanting a special phrase or sound, or focusing on the sound of one’s breathing. A mental separation from the outside world is the goal of meditation, which is promoted as a way of reducing stress on both the mind and body.
Tai chi is a mind-body, self-healing system that is an ancient Chinese form of martial arts that uses movement, meditation, and breathing to improve health and well-being. Tai chi is based on the theory of yin and yang (the interaction of opposite forces) and is thought to balance the flow of vital energy or life force (called chi) to improve general health and extend life. It incorporates slow, graceful movements with rhythmic breathing to relax the body as well as the mind and reduce stress. The deep breathing and physical movements are a good source of exercise and are associated with improved posture, flexibility, agility, balance, and circulation. Meditative concentration focuses on a point just below the navel, from which it is thought that chi radiates throughout the body, as a series of gentle, deliberate movements called forms are performed. Each form consists of 20 to 100 individual movements and derives its name from nature (e.g. “Wave hands like a cloud”). Tai chi can be a useful adjunct to conventional therapy, especially as part of a physical rehabilitation program after surgery; however, there is no evidence that it can cure of prevent cancer.
Yoga is a form of non-aerobic exercise based on a program of precise posture and breathing techniques. Yoga is thought to cultivate prana, which means vital energy or life force and is similar to chi in traditional Chinese medicine. As a way of life, yoga is based on Hindu traditions that combine physical exercise, meditation, dietary guidelines, and ethical standards to create a union of mind, body, and spirit. Similar to tai chi, yoga can provide a good source of exercise and serve to increase strength and reduce stress.
There are different variations of yoga, but the more common types incorporate physical movement, breathing exercises, and meditation to achieve a connection between the mind, body, and spirit. A typical yoga session may include guided imagery or visualization, in addition to gentle movements and breathing, and may last between 20 minutes and 1 hour. Yoga can be practiced at home without an instructor, but for beginners it is recommended to start with an educational class or classes at a yoga center, local community center or health club. Although yoga can provide an improved level of fitness, reduce stress, and increase feelings of relaxation and well-being, there is no evidence that it is effective in treating or preventing cancer.
Manual Healing and Physical Touch Methods
Acupuncture is a CAM therapy in which very thin needles are inserted through the skin at various locations called acupoints. In Chinese medicine, acupuncture is used as an anesthetic during surgery, relieve the symptoms of a variety of conditions, and is believed to have the power to cure certain diseases. It is thought that acupoints lie along invisible meridians, which are channels for the flow of vital energy of life force (called chi). Needles are inserted just beneaththe skin at specific acupoints and are thought to restore balance and a healthy energy flow to the body. Skilled acupuncturists cause virtually no pain. Although there is no scientific evidence that acupuncture can cure cancer, an expert panel from the National Institutes of Health concluded that acupuncture is an effective treatment for nausea caused by chemotherapy drugs and may lessen the need for conventional pain-relieving medications. Acupuncture is generally considered safe, as long as it is performed by a trained professional. When performed improperly, acupuncture can cause fainting, bleeding, nerve damage, and pose a risk for infection. For these reasons, you should always talk with your doctor or nurse beforehand, especially if you may have low white blood cells counts or thrombocytopenia from chemotherapy, to make sure that acupuncture can be performed in the safest manner possible. Acupressure is a variation of acupuncture in which the therapist presses on acupoints with their fingers rather than using needles.
In massage therapy, the therapist uses their hands or instruments (such as rollers) to manipulate, rub, and knead the body’s muscles and soft tissue. Massage can be a useful adjunct to conventional medical treatments. Massage therapy can decrease stress, anxiety, depression, and pain while providing a temporary feeling of well-being and relaxation. Massage therapy may also be useful for relieving joint pain and stiffness, increase mobility, rehabilitate injured muscles, stimulate nerves, increase blood flow, and help the circulation of the lymph system. Massage therapy should be conducted by a trained and licensed professional. You should always consult with your doctor or nurse before undergoing any type of therapy, particularly if you have a chronic condition such as arthritis or heart disease, to make sure that it is safe.
Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation (or TENS) is a CAM therapy used for pain relief in which a device transmits electrical impulses through electrodes to an area of the body. A TENS system consists of an electrical generator connected to pair of electrodes, which are attached to the skin near the area of pain and carry a mild electric current. A treatment session may last between 5 and 15 minutes, and treatments can be applied as often as necessary. TENS may be administered by a physical therapist or applied at home using a portable TENS system. Although TENS has been advocated for relief of both acute and chronic pain, most evidence indicates that it is most appropriate for short-term pain relief. Some cancer patients with mild pain related to nerve damage may benefit from TENS for brief periods of time. However, TENS will not cure the underlying causes of pain. Electrodes should not be placed over the eyes, heart, or brain, and people with heart problems should not use TENS.
There are several kinds of Echinacea (aka Kansas Snakeroot, Black Sampson, Purple Cone Flower) that are believed to provide immune enhancement and improve resistance to flu-like illnesses and colds. However, there is little evidence that it helps to boost the immune system or increase resistance to cancer. Echinacea is an herb that grows primarily in the Great Plains and eastern North America as well as Europe. Echinacea can be associated with allergic reaction, so women with a history of asthma or allergic rhinitis should exercise caution. It may also cause liver damage, so if you are taking medications that have liver toxicity (e.g. amiodarone [used for heart rhythm problems], anabolic steroids, methotrexate, or ketoconazole) Echinacea should be avoided. When taken for long periods, Echinacea may actually suppress the immune system, so women with autoimmune disorders (HIV disease, multiple sclerosis) or those undergoing surgery should not take this preparation.
Kava (aka Kava Kava, Kavalactones) is a member of the pepper family that grows as a large shrub and is native to many islands in the South Pacific. Kava is promoted for relief of nervousness, anxiety, stress, and insomnia. Kava has no direct impact on cancer growth; however, its ability to ease anxiety may improve the quality of life. Kava is available in capsules, tablets, powder, and cream. A safe dose has not been determined, although 100mg to 200mg per day is commonly recommended. Kava should not be taken for longer than 3 months, and there are several precautions that need to be observed. Kava may reduce motor reflexes and judgment when driving and may cause extreme drowsiness when taken with antianxiety medications or alcohol. It has the potential to interact with anesthetics, and therefore should not be taken if you are to undergo surgery. Heavy or long-term use may result in liver damage, so women with a history of liver disease should not use Kava. Rarely, Kava may cause a rash, decreased urination, numbness of the mouth, or gastrointestinal discomfort.
Ginko (aka Ginko Biloba) is an extract from the gingko tree from China, Japan, and Korea. It is promoted for tinnitus (ringing in the ears), dizziness, motion sickness, and is believed to improve memory. While some herbalists have suggested that a compound in Ginko, called gingkolide B, may counteract body chemicals thought to promote cancer growth, there is no scientific evidence to support this claim. Ginko can be administered in pill or liquid form, with a recommended dose of 120mg to 240mg per day for up to 3 months. Ginko may interfere with normal blood clotting and therefore should not be taken if you are undergoing surgery or taking certain medications (aspirin, non-steriodal anti-inflammatory drugs, or anticoagulants). Mild side effects that may be associated with Ginko include stomach upset, headache, and allergic skin reactions.
Ginseng is a perennial plant that grows in China, Korea, Japan, Russia, and the United States. The dried root is promoted as a remedy to provide energy to people who are fatigued and improve concentration. It has also believed by some to prevent cancer, although this claim is not supported by solid scientific evidence. Ginseng can be taken as a powder, capsule, or tea. Ginseng can cause restlessness, insomnia, headaches, and hypertension. Because of its estrogen-like effects, Ginseng may have adverse effects in women with breast cancer or ovarian cancer. You should discuss these issues with your doctor or nurse before taking this preparation. In addition, Ginseng can also alter normal blood clotting and should not be used if you are undergoing surgery or taking anticoagulants.
St. John’s Wort
St. John’s Wort (aka Goatweed, Amber, Klamath Weed, Kira) is a shrub-like plant native to Asia, northern Africa, and Europe and is also cultivated in the United States. The bright yellow flowers of this plant are parts used in herbal remedies. St. John’s Wort is commonly used to treat mild to moderate depression, anxiety, and sleep disorders. An average dose is 300mg taken three times a day for up to 6 weeks. Side effects are not common but may include dizziness, fatigue, gastrointestinal pain, a rash, and hypersensitivity to sunlight. St. John’s Wort may interfere with conventional medications including coumadin, digoxin (a heart medicine), antidepressants, anticoagulants, anesthesia, and certain types of chemotherapy (e.g. etoposide). You should consult with your doctor or nurse before taking St. John’s Wort, especially if you are taking any prescription medications or other herbal preparations.
Vitamin C (aka ascorbic acid) is an essential vitamin that is found in citrus fruits (oranges, grapefruits, lemons), strawberries, green leafy vegetables, potatoes, bell peppers, and broccoli. Vitamin C is an antioxidant, which means that it blocks the action of activated oxygen molecules (called free radicals), which can damage cells. Many scientific studies have shown a connection between consuming a diet high in fruits and vegetables and reducing the risks of certain cancers. However, it is unclear whether consuming Vitamin C supplements can also reduce cancer risk. Other claims about Vitamin C that are under investigation include whether it can: enhance the immune system, prevent cancer from spreading, and help the body heal after cancer surgery. The recommended daily allowance of Vitamin C is 75mg per day. The upper limit is 2000mg per day, with dosages over this amount possibly causing nausea, diarrhea, stomach cramps, and headaches. Vitamin C doses over 1000mg per day should probably be avoided during cancer treatments.
Vitamin A is obtained in the diet from animal sources and from beta carotene in plant foods and is essential for normal growth, bone development, maintenance of healthy skin and mucous membranes, and protection against infections of the respiratory, gastrointestinal, and urinary tract. Vitamin A has not been shown to prevent cancer from developing, although some studies suggest that certain closely related molecules, called retinoids, may inhibit cancer development. The best way to get Vitamin A is to eat a well balanced diet of fruits, vegetables, dairy products, and animal fats. The recommended daily allowance of Vitamin A is 4000IU (2.4mg) per day. High doses of Vitamin A can cause nausea, diarrhea, loss of appetite, fatigue, and headaches.
Vitamin E is essential to the body in forming normal cells and healthy red blood cells. It is an antioxidant, and some proponents claim that Vitamin E can protect the body against cancer by strengthening the immune system. Others believe that high doses may interfere with the effectiveness of radiation therapy or chemotherapy. Vitamin E may protect against colorectal and prostate cancers; however, there is no evidence that it can significantly affect cancers that have already developed. The main dietary sources of Vitamin E are vegetable oils, green leafy vegetables, nuts, cereals, whole wheat products, and egg yolks. The recommended daily allowance of Vitamin E from food is 15mg per day, which should be able to be obtained from a balanced diet. The upper limit from supplements is 1000mg per day. Excessive doses of Vitamin E taken for long periods can cause stomach pain, nausea, and diarrhea. High doses of Vitamin E can also the body’s absorption of Vitamins A, D, and K and should be avoided if you are taking coumadin, as supplements may counteract its’ blood thinning effect.
Folic acid (aka Folate, Folacin, Vitamin B Complex) is B-complex vitamin found in vegetables, beans, fruits, and whole grains that helps in cell metabolism and is important for the development of blood cells. Scientific studies have shown a connection between lower levels of Folic Acid and colorectal cancer and possibly cancers of the breast, lung, and stomach; however, the amount needed to lower this risk is unknown. The recommended daily allowance of Folic Acid is 400micrograms per day, which can be obtained from supplements or a diet rich in dark green leafy vegetables, citrus fruits, and fortified grain-based cereals. If taken in extremely high doses, Folic Acid can be associated with nausea, flatuelence, decreased appetite, and increased seizure activity in persons with a seizure disorder. In addition, high doses of folate can interfere with the effectiveness of certain chemotherapy drugs (e.g. methotrexate).
Selenium is an essential mineral nutrient that shows promise for preventing the development and progression of cancer; however, additional research is needed to confirm these claims. Selenium is also thought to improve elasticity of body tissues, improve blood flow to the heart, and prevent abnormal blood clotting. Dietary sources of Selenium include seafood, whole grains, cereals, and Brazil nuts. The human body needs only a very small amount of Selnium (the recommended intake is 5.5micrograms per day), and excessive doses can be toxic. Signs of Selenium poisoning include vomiting, fatigue, and loss of hair, teeth and nails.
Coenzyme Q10 (aka CoQ10) is an enzyme that regulates chemical reactions in the body and is believed to be an antioxidant. Coenzyme Q10 has been promoted as a treatment for cancer and immune deficiencies, but these claims have yet to be proven conclusively. Some research indicates that Coenzyme Q10 may have some protective effects against heart damage related to chemotherapy (e.g. doxorubicin). Coenzyme Q10 can be obtained from a number of foods including mackerel, sardines, beef, soybeans, peanuts, and spinach. Coenzyme Q10 can also be obtained in supplemental form as tablets or capsules with a usual dosage of 90 to 400mg per day. There are few side effects from Coenzyme Q10 but may include headache, fatigue, diarrhea, and skin reactions.
In the preceding sections we have tried to provide a brief summary of some of the more commonly encountered complementary and alternative therapies. From a practical perspective, the complementary methods of mind, body, and spirit methods, as well as the physical healing and manual touch methods, are most helpful when used in addition to conventional treatments to lessen side effects from ovarian caner treatment or provide a sense of overall well being. We would again caution against the use of herbal remedies or dietary supplements as alternatives to conventional treatment for ovarian cancer, as most of these methods have not been shown to have cancer-fighting effects in rigorous scientific studies.