Lung Cancer

Complementary Therapies and Integrative Oncology in Lung Cancer
ACCP Evidence-Based Clinical Practice Guidelines
June 2007 - American College of chest Physicians (chestjournal.org)

NCHS, of 31000 adults surveyed, 75% used some form of CAM
CAM users typically younger, more educated and more affluent

Complementary therapies - used as adjuncts to mainstream care, supportive measures that help control symptoms, enhance well-being, and contribute to overall patient care.

Alternative Therapies - unproved or disproved, promoted for use instead of mainstream treatment.  Especially problematic as it can delay treatment and diminish the possibility of remission and cure.

Mind-body modalities are strongly recommended to reduce anxiety, mood disturbance, chronic pain. (meditation, guided imagery, relaxation techniques, yoga)

Massage therapy (by qualified practitioners - deep or intense pressure should be avoided near cancer lesions or anatomic distortions such as surgery sites; light/gentle massage only in those with bleeding tendencies.)  Reduces tension, pain, improves circulation, encourages relaxation.  May help anxiety, fatigue.  Reflexology (foot massage)
Use of aromatic oils in massage - mixed results.

Acupuncture strongly recommended as a complementary approach to pain control.  Also for nausea and vomiting associated with chemotherapy.  No support for acupuncture in treating nicotine addiction, dyspnea, or fatigue - but for tobacco cessation, could trial if all other measures fail. Could also trial for fatigue, mixed results.  Possibly could be used for chemotherapy induced neuropathy (early positive results) and xerostomia.

Acupressure wristbands render continuous stimulation of PC6 point and may reduce N/V on day of chemo; no significant difference for delayed N/V.  Do not use electrostimulation wristbands.

Manipulation of bioenergy fields not recommended.  Also not recommended - use of bioelectromagnetic-based therapy (use of electromagnetic fields)

Diet:  A specific diet (ie: macrobiotic, alkaline) is not supported by clinical studies.  But lifestyle changes toward a healthy diet is encouraged.

Dietary supplements:

• B12 and folic acid required for pemetrexed treatment
• Supplementation of beta-carotene may increase risk of lung cancer in those who currently smoke or who have recently quit smoking.
• High dose antioxidants or complex botanical agents can interact/interfere with treatment.
• Some botanicals have antiplatelet activity - may interact with corticosteroids and CNS depressant drugs, may produce GI effects, hepatotoxicity and nephrotoxicity, can produce additive effects when used with opiods.
• Quality control in supplements an additional issue.
• Feverfew, garlic, ginger, ginkgo should be avoided by those taking blood-thinning medications.
• Red clover, Dong Quai, licorice (phytoestrogen components) should not be used by patients taking tamoifen or aromatase inhibitors.
• St John Wort - metabolized by P450 CYP3A4; has been shown to make irinotecan less effective.
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