Complementary alternative cancer treatment

DEFINITION: The use of herbs, supplements, and alternative therapies to complement conventional cancer treatment.

• PROPOSED NATURAL TREATMENTS:
• HERBS AND SUPPLEMENTS TO USE ONLY WITH CAUTION: Alfalfa, androstenedione, beta-carotene, black cohosh, boron, dong quai, estriol, folate, genistein, hops, licorice, Panax ginseng, red clover, resveratrol, St. John’s wort, soy, vitamin C, vitamin E

Introduction

Cancer is the second leading cause of death in the United States (after heart disease), and its insidious nature gives it a special terror. Most diseases give warning in the form of escalating symptoms, while others strike suddenly. Cancer follows a different, stealthier path. A person who feels perfectly well may come back from the doctor’s office with a diagnosis of potentially fatal cancer and plenty of time to fear what comes next.

In many cases, when cancer is found early enough, conventional treatment can lead to a permanent cure. Often, though, the prognosis is given in statistics (a percentage chance of survival) or, worse, in months remaining to live. Conventional treatments for cancer can also have frightening qualities to them, including disfiguring surgery, arduous chemotherapy, and treatment with invisible radiation.

Many alternative therapies have been proposed for cancer treatment, but none have definitively been shown to be effective. Therefore, while medical professionals may support various complementary therapies, these are used in addition to standard treatment. Often, they focus on alleviating the negative side effects of conventional therapies. The complete approach combining complementary and alternative medicine (CAM) with standard medicine is referred to as integrative medicine. Still, some alternative therapies for cancer may truly have benefits, even if they have not been proven. Most studies of alternative therapies for cancer have involved adding a natural treatment to a standard cancer regimen. Alternatively, they enrolled persons who have already failed to respond to existing methods. These latter circumstances could potentially hide the benefits of an effective natural therapy. If a treatment only worked in the absence of chemotherapy, for example (as some alternative cancer therapy proponents claim about their methods) or could only cure early cases of cancer, these ethical obstacles would prevent researchers from finding out.

The methodological and ethical challenges in studying alternative cancer treatments contribute to a relative lack of strong research on the subject. The relatively small amount of information that is known from a scientific perspective about complementary and alternative treatments for cancer is discussed here, as are natural options that may reduce side effects of standard cancer therapies. Possible interactions between herbs and supplements and drugs are also discussed.

Proposed Natural Treatments

Various natural supplements have shown some promise for improving the effectiveness of conventional cancer therapy—specifically surgery, chemotherapy, and radiation—or reducing its side effects. In most cases, however, the supporting evidence remains weak, and the most rigorous studies have often failed to find benefit. Persons receiving cancer treatment should not use any herbs or supplements except under the supervision of a physician.

Improving Effectiveness of Conventional Treatment

Numerous natural therapies have been proposed for enhancing the cancer-fighting effects of standard therapies. However, most of the supporting research falls short of the necessary standard for proof: a double-blind, placebo-controlled study.

Shark cartilage. Based on the belief that sharks do not get cancer, shark cartilage has been heavily marketed as a cure for cancer. While this is a myth (sharks do get cancer), shark cartilage showed some initial promise. Shark cartilage tends to inhibit the growth of new blood vessels, a process called angiogenesis. Because cancerous tumors must build new blood vessels to feed themselves, this effect might be beneficial. Shark cartilage also inhibits substances called matrix metalloproteases (MMPs). These little-understood enzymes affect the extracellular matrix, the framework of substances that lie between cells in the body. MMPs are thought to play a role in diseases of the cornea, gums, skin, blood vessels, and joints, and in cancer and illnesses that involve excessive fibrous tissue.

Several test-tube experiments have found that shark cartilage extracts prevent new blood vessels from forming in chick embryos and other test systems. These findings have led to other test-tube experiments, animal studies, and preliminary human trials to investigate the possible anticancer effects of shark cartilage. The results appeared to suggest that a particular liquid shark cartilage extract might be useful in the treatment of various cancers, including lung, prostate, and breast cancer. However, later and better-designed studies have failed to find benefit, and results remain mixed. Additionally, using shark cartildge products have shown to cause many side effects, including hypoglycemia, fever, jaundice, nausea, vomiting, and constipation. These products are avaliable under the names Carticin, Cartilade, BeneFin, and Neovastat (Æ-941).

Social support and other psychological factors. Cancer treatment puts tremendous stress, both physical and emotional, on those who undergo it. Several studies have examined the potential benefits of social support for women with breast cancer. According to most studies, such support improves survival and enhances quality of life. In one well-known study of women with advanced breast cancer, participants who attended a support group twice weekly doubled their survival time compared to study participants who did not attend the group.

It is also commonly said that certain psychological coping styles (for example, fighting spirit versus helpless acceptance) can lead to longer life in people with cancer. However, a review of the evidence found that there is little to no evidence that psychological attitude makes much of a difference. People with cancer should not feel pressured into adopting particular coping styles to improve survival or reduce the risk of recurrence, the study’s authors concluded.

Relaxation therapies. One study evaluated guided imagery and relaxation therapy following surgery for colon cancer. The results indicated no more than a short-term, mood-elevating benefit; those receiving the treatment did not recover more quickly.

Another study on relaxation therapy involved 126 hospitalized persons with cancer pain. Researchers found that those who listened to relaxing music for thirty minutes and received pain medication had more relief than the group who received only the medication. In another study, a statistically significant decrease in anxiety was observed among cancer patients who participated in relaxation therapies, particularly progressive muscle relaxation therapy. While these therapies do not cure the disease, they offer an outlet for an improved quality of life during treatment.

Vitamin C. Cancer treatment is one of the more controversial proposed uses of vitamin C. An early study tested vitamin C in eleven hundred terminally ill persons with cancer. One hundred persons received 10,000 milligrams (mg) daily of vitamin C, while the other one thousand persons (the control group) did not receive vitamin C. Those taking vitamin C survived more than four times longer on average (210 days) than those in the control group (50 days). A large (1,826 subjects) follow-up study by the same researchers found a nearly doubled survival rate (343 days versus 180 days) in vitamin C-treated persons whose cancers were deemed incurable, compared to people not treated with vitamin C. Benefits were also seen in a similarly designed Japanese study.

However, while these results seem promising and almost miraculous, they show next to nothing because they lacked a placebo group. When proper double-blind, placebo-controlled studies were performed on vitamin C for cancer, they failed to find any benefit. Vitamin C proponents have criticized these trials on various grounds, but the fact remains that there is little reliable positive evidence for vitamin C in cancer.

Other natural treatments. Hundreds of herbs and supplements have been shown in test-tube studies to fight cancer cells. However, it is a long way from a test tube to a human body, and such findings are not meaningful.

Several natural supplements that have received at least preliminary study in humans are discussed here. None of the positive studies cited here reached the level of rigor required to truly show a treatment effective. (Most lacked a control group, for example.) In contrast, several properly designed studies failed to find benefit.

A double-blind study of fifty-three people undergoing cancer treatment found equivocal evidence that treatment with a special form of Panax ginseng (modified to contain higher levels of certain constituents) could improve the general well-being of people with cancer. Another study investigating the effects of P. ginseng on the survival of persons being treated for lung cancer showed no additional benefit. One study provided indirect but promising evidence that a mixture of the supplements coenzyme Q₁₀ (100 mg daily), riboflavin (10 mg daily), and niacin (50 mg daily) might help reduce the chance of breast cancer metastasis or recurrence.

According to some highly preliminary trials, extracts of the fungus Coriolus versicolor may enhance the effectiveness of various forms of standard cancer therapy. Coriolus is thought to work by stimulating the immune system. The fungi products active hexose correlated compound and shiitake are also advocated for this purpose.

The supplement docosahexaenoic acid, a constituent of fish oil, has shown promise for enhancing the effects of the cancer chemotherapy drug doxorubicin. The herb Ginkgo biloba is thought to increase blood flow. An uncontrolled study evaluated combination therapy with ginkgo extract and the chemotherapy drug 5-FU (Fluorouracil) for the treatment of pancreatic cancer, on the theory that ginkgo might enhance blood flow to the tumor and thereby help 5-FU penetrate better. The results were promising. Scant preliminary evidence suggests that American ginseng may increase the effectiveness of treatment for breast cancer and that Siberian ginseng (properly known as Eleutherococcus senticosus) may be useful in the treatment of breast cancer and other forms of cancer.

A small, unblinded study using a no-treatment control group found indications that the use of a standardized tomato extract containing the supplement lycopene might slow the growth of prostate cancer. In a small, double-blind, placebo-controlled study, a combination of soy, isoflavones, lycopene, silymarin (from milk thistle), and antioxidants showed some potential benefit for preventing recurrence of prostate cancer after prostate cancer surgery. Another study enrolled men with rising PSA levels (a symptom of worsening cancer) and found that the use of lycopene helped stabilize these levels. Because this study failed to include a placebo control group, its results fail to indicate that lycopene lowers PSA levels and, therefore, by inference, slows prostate cancer. However, researchers did compare lycopene alone with lycopene plus isoflavones and found that the combined treatment seemed to be less effective, as if the isoflavones somehow antagonized the effects of lycopene.

Preliminary studies, including unblinded-controlled trials, suggest that the hormone melatonin may enhance the effectiveness of standard therapy for breast cancer, prostate cancer, brain glioblastomas, non-small-cell lung cancer, and other forms of cancer. However, no double-blind studies have been reported. Melatonin may also help decrease cancer chemotherapy side effects.

Mistletoe extract (Iscador) taken by injection has been evaluated as a cancer treatment in several studies, including double-blind, placebo-controlled trials. In general, though, these studies failed to attain adequate levels of scientific rigor or clinical relevance. The best studies found benefit; more rigorous studies found no improvement in survival time, survival rate, or quality of life. A review of forty-one studies found mistletoe use was associated with improved survival in persons with cancer. An analysis of these studies limited to randomized trials showed no effect. The safety of mistletoe is not established, and some reports suggest that it can damage the liver.

An uncontrolled study found that the use of a special spleen extract (spleen peptide preparation) somewhat reduced side effects of chemotherapy for head and neck cancer. In a double-blind, placebo-controlled trial, neither vitamin A nor N-acetylcysteine proved helpful for enhancing survival in head and neck cancer or lung cancer. Vitamin D may decrease bone pain and increase muscle strength in men with prostate cancer.

Traditional Chinese medicine has been evaluated in many studies in persons being treated for cancer. In one such study, acupuncture has shown some promise for reducing the sense of fatigue that commonly occurs in cancer. Similarly, medical qigong (two ninety-minute sessions weekly) was associated with improved quality of life, fatigue, and mood disturbance in another study. A review of fifteen mostly poor-quality trials involving 862 persons receiving chemotherapy for non-small-cell lung cancer suggested that Chinese herbal medicine might improve quality of life. A review of seven studies, however, found insufficient evidence to conclude whether Tai Chi improves quality of life or psychological or physical outcomes in persons with breast cancer. One study tested whether a diet very high in vegetables, fruit, and fiber, and low in fat could enhance survival or reduce recurrence rates in women diagnosed with breast cancer; no benefits were seen.

Reducing Side Effects of Chemotherapy

Various herbs and supplements have shown promise for reducing the side effects of chemotherapy. Many chemotherapy drugs work by interfering with rapidly dividing cells. Cancer cells, however, are not the only cells that divide rapidly. The intestinal tract constantly rebuilds its lining, and chemotherapy may interfere with that process. The result is gastrointestinal side effects, such as mouth sores, nausea, loss of appetite, and diarrhea. Several herbs and supplements have shown promise for alleviating these conditions, although none have been definitively proven effective.

Diarrhea and other gastrointestinal side effects. A well-designed, double-blind, placebo-controlled trial of seventy participants undergoing cancer chemotherapy with the drug 5-FU evaluated the potential benefits of the supplement glutamine for reducing chemotherapy-induced diarrhea. The results suggest that the use of glutamine at a dose of eighteen grams daily may reduce intestinal damage and diminish symptoms of diarrhea. These promising findings indicate a need for larger trials to accurately determine the extent of benefit.

A double-blind, placebo-controlled study of 150 people undergoing chemotherapy with 5-FU found some evidence that a probiotic (friendly bacterium) called Lactobacillus rhamnosus can reduce diarrhea, which is a common complication of this treatment. Another, more unusual probiotic, a special, nonpathogenic form of Escherichia coli, has also shown promise. Preliminary evidence hints that the supplement active hexose correlated compound and colostrum might help reduce chemotherapy-induced gastrointestinal side effects. In one study, the use of the supplement creatine failed to help maintain muscle mass in people undergoing chemotherapy for colon cancer.

Mouth sores. In an uncontrolled study, the use of the herb chamomile as a mouthwash appeared to help prevent mouth sores in people undergoing various forms of chemotherapy. However, uncontrolled studies prove nothing. A rigorous, double-blind, placebo-controlled trial of 164 people did not find chamomile mouthwash effective for treating the mouth sores caused by the chemotherapy drug 5-FU. Beta-carotene and vitamin E have also shown some promise for preventing mouth sores (caused by various forms of cancer treatment) in preliminary studies, but rigorous studies of adequate size have not been reported.

Nausea. A preliminary trial hints that ginger may reduce nausea caused by the chemotherapy drug 8-MOP (methoxsalen). However, another study failed to find ginger helpful for nausea in people using the drug cisplatin. In a third trial, ginger did not add to the effectiveness of standard medications to treat chemotherapy-induced nausea and vomiting.

Massage has shown some benefit for reducing nausea caused by chemotherapy. Psychological methods, such as hypnosis and relaxation therapy, have also shown promise for nausea. One study found that the use of aromatherapy massage (combined massage therapy and the use of fragrant essential oils) reduced symptoms of anxiety or depression (or both) in people undergoing treatment for cancer, at least for the short-term. However, the authors of a review of ten massage therapy studies were unable to draw firm conclusions about its benefits for a wide range of symptoms in persons undergoing treatment for cancer. Studies of acupressure or acupuncture for reducing nausea in people undergoing chemotherapy have reached contradictory results, though on balance, there may be some benefit.

A double-blind study performed in Hong Kong evaluated the potential benefits in cancer chemotherapy of personalized herbal formulas designed according to the principles of traditional Chinese herbal medicine. In this study, 120 people undergoing chemotherapy for early-stage breast or colon cancer were given either a personalized formula or placebo. Researchers evaluated numerous possible effects of the treatment but found benefits in only one: reduction of nausea. Even this single result is less meaningful than it may seem because it is statistically questionable to use a multiplicity of outcome measures.

Other side effects of chemotherapy. In highly preliminary trials, the supplement N-acetylcysteine has shown promise for reducing various side effects of the drug irinotecan. An animal study suggests that a constituent of fish oil called docosahexaenoic acid might decrease side effects caused by the drug irinotecan. The hormone melatonin has shown some promise for reducing the side effects of various chemotherapy drugs.

In preliminary studies, various antioxidants have shown promise for preventing heart damage and other side effects of the drug doxorubicin. One animal study hints that the herb milk thistle might protect against kidney damage caused by the drug cisplatin. In addition, there is some evidence that acetyl-L-carnitine, glutamine, and vitamin E supplementation might each reduce peripheral neuropathy (painful damage to nerves outside the spinal column) symptoms in persons receiving cisplatin or paclitaxel.

Sea buckthorn berry has been advocated for reducing side effects of chemotherapy, but the evidence that it works is far too preliminary to be relied upon. A review of thirty-three studies supports the view that antioxidants in general (except for vitamin A) may reduce the toxic effects of chemotherapy. However, because of inconsistencies among these studies, it is unclear what antioxidants are best for this purpose.

Reducing Side Effects of Radiation Therapy

Although symptoms are generally less intense than with chemotherapy, radiation therapy can also cause problems, such as diarrhea, skin damage, and fatigue. Certain supplements and alternative therapies may offer benefits.

Two double-blind, placebo-controlled studies enrolling a total of almost seven hundred people undergoing radiation therapy found that the use of probiotics significantly improved diarrhea. However, of eighty-five women receiving pelvic radiation for cervical or uterine cancer, those who consumed a probiotic-enriched yogurt had no less diarrhea than those who took a placebo drink.

An unblinded-controlled study of seventy-five people receiving radiation therapy for various forms of cancer found some evidence that soap enriched with aloe vera gel can help protect the skin from radiation damage. However, researchers had to use questionable statistical methods to find evidence of benefit, making the results less than fully reliable. A double-blind, placebo-controlled study that evaluated the effects of aloe gel in 225 women undergoing radiation therapy for breast cancer failed to find benefit. Another study failed to find aloe vera beneficial for reducing side effects of radiation therapy for head and neck cancer.

One study compared cream made from calendula flowers with the standard treatment trolamine for protecting the skin during radiation therapy and found calendula more effective. However, it is not known whether trolamine is beneficial, neutral, or harmful when used for this purpose, and for this reason, it is not possible to draw firm conclusions from the study. Cream made from chamomile has also been tried for protecting the skin from damage caused by radiation therapy, but the one controlled trial on the subject failed to find benefit.

One study failed to find oligomeric proanthocyanidins from grape seed helpful for reducing the local side effects of radiation therapy for breast cancer. Radiation treatment in the vicinity of the mouth may cause alterations in taste sensation. In a small, double-blind, placebo-controlled trial, the use of zinc supplements tended to counter this symptom. However, a larger follow-up study failed to find this benefit. Another study did find that the use of zinc could modestly decrease inflammation of the mucous membranes and skin caused by radiation therapy.

Radiation treatment to the pelvic area can cause nausea, vomiting, and fatigue. A double-blind, placebo-controlled trial with fifty-six participants evaluated the potential effectiveness of proteolytic enzymes for reducing these symptoms. No benefits were seen. Another study failed to find proteolytic enzymes helpful for reducing mouth sores or other symptoms that occur during radiation therapy of head and neck cancers.

In a double-blind study of forty people undergoing radiation therapy for breast cancer, the use of a standard multivitamin preparation failed to reduce fatigue compared with placebo. People in the placebo group may have done somewhat better than those given the vitamin.

A large study failed to find aromatherapy more helpful than placebo for reducing psychological distress among people undergoing radiation therapy for cancer. A small randomized trial found that effleurage massage, a common massage technique, had no significant effect on anxiety, depression, or quality of life among twenty-two women undergoing radiation therapy for breast cancer.

As with chemotherapy, sea buckthorn berry has been advocated for reducing side effects of radiation therapy, but again, reliable evidence is lacking. The use of antioxidants during radiation therapy is controversial. One study found that the use of antioxidants decreased radiation therapy side effects but also may have decreased radiation therapy effectiveness. In a small trial, persons who wore acupressure bands for up to seven days following radiation therapy reported less nausea than persons who received only usual care.

Treating Side Effects Caused by Breast Cancer Surgery

Many women experience lymphedema (chronic arm swelling caused by damage to the lymph drainage system) following breast cancer surgery. Natural treatments for this condition include oxerutins, citrus bioflavonoids, and oligomeric proanthocyanidins. Another small randomized trial of seventy persons found that acupuncture may decrease dry mouth and pain after removing lymph nodes in the neck for cancer treatment.

Hot flashes after mastectomy. Women who have had breast cancer surgery frequently experience annoying hot flashes. Estrogen treatment is not an option, as it might increase the risk of cancer recurrence.

In a two-month double-blind trial, eighty-five women who had undergone treatment for breast cancer received either the herb black cohosh or placebo. The results were not encouraging: Black cohosh did not reduce overall hot-flash symptoms. Four double-blind, placebo-controlled trials evaluated soy isoflavones as a treatment for hot flashes, but these also failed to find benefit.

A trial involving seventy-two women with breast cancer failed to find real acupuncture significantly more effective than sham acupuncture for treatment of hot flashes. A review of studies on the subject concluded that the evidence does not support a beneficial effect for acupuncture in women with breast cancer who also have hot flashes. In a small randomized trial, hypnosis appeared to reduce hot flashes and improve mood and sleep among fifty-one breast cancer survivors.

Treating side effects caused by chemotherapy. In a small randomized trial of forty-three persons with breast cancer, six weeks of acupuncture twice weekly reduced joint pain attributed to aromatase-inhibitor therapy. Other suggestions include techniques to reduce stress, such as meditation and deep breathing exercise, as well as exercise. However, the impact of any of these changes is subject to the individual's body and needs.

Treating Weight Loss Caused by Cancer or Cancer Treatment

Cancer can cause a condition called tumor-induced weight loss, in which symptoms of starvation occur despite adequate nutrition. The cause is thought to be a particular form of inflammation caused by the cancer. Cancer chemotherapy can also cause weight loss.

Cancer Cures

Numerous herbs, including bloodroot, burdock, cat’s claw, flaxseed (based on lignan content), lapacho, maitake, noni, Oregon grape, pokeroot, red clover, and reishi, have been claimed effective for the treatment of cancer. However, there is no reliable evidence to indicate that these herbs help, and one, pokeroot, is actively toxic.

Various herbal combinations have also been promoted for the treatment of cancer, including the Hoxsey cancer cure, Essiac, and Jason Winter’s cancer-cure tea. Again, however, there is no reliable evidence that they really work. Similarly, various dietary approaches that have been claimed to help treat cancer, such as macrobiotics and raw foods, lack meaningful supporting evidence.

Herbs and Supplements to Use Only with Caution

Various herbs and supplements may interact adversely with drugs used to treat cancer. It is strongly recommended that persons under treatment for cancer not use any herb or supplement except under a physician’s supervision.

The herb St. John’s wort interacts with many medications, including various chemotherapy drugs. The drug methotrexate causes the body to become deficient in folate. For this reason, people who take methotrexate for rheumatoid arthritis, juvenile rheumatoid arthritis, or psoriasis are sometimes advised to take folate supplements. Studies indicate that in those conditions, the use of folate does not impair the action of the drug. However, no studies have established that folate supplements are safe to take with methotrexate when it is used to treat cancer. The citrus bioflavonoid tangeretin may interact with the breast cancer drug tamoxifen. One highly preliminary study found that black cohosh might interfere with the action of the chemotherapy drug cisplatin.

The antioxidant controversy. Heated disagreement exists regarding whether it is safe or appropriate to combine antioxidants (such as vitamin E, vitamin C, and beta-carotene) with standard chemotherapy drugs. The reasoning behind the concern is that some chemotherapy drugs may work in part by creating free radicals that destroy cancer cells, and antioxidants might interfere with this beneficial effect.

There is little reliable evidence, though, that antioxidants interfere with chemotherapy drugs. Additionally, there is some evidence that antioxidants may not cause harm and, in certain cases, may offer benefits. However, the effects are likely to vary with the specific situation (for example, type and stage of cancer and kind of treatment used), and there is far more research to be done. Therefore, it is strongly recommended that one not take antioxidants (or any other supplements) while undergoing cancer chemotherapy, except on the advice of a physician.

A similar situation exists regarding radiation therapy. One study found that the use of antioxidants decreased radiation therapy side effects but also may have decreased radiation therapy effectiveness. Another study found some evidence that people who smoked cigarettes and used antioxidants while undergoing radiation therapy for head and neck cancer had an increased risk of treatment failure compared to smokers who did not use antioxidants.

After reviewing much of the research on this controversial topic, one group of researchers published an article in the Journal of the National Cancer Institute which concluded that antioxidants should be discouraged during either chemotherapy or radiation therapy because of their potential to reduce the effectiveness of these treatments.

Herbs that may increase breast cancer recurrence risk. Women who have had breast cancer are at high risk for a recurrence. The use of estrogen promotes the development of breast cancer, and for this reason, it is “off limits.” However, certain natural products may present a similar risk. Numerous herbs and supplements have estrogen-like properties, including alfalfa, genistein, hops, licorice, red clover, resveratrol, and soy. Contrary to popular belief, black cohosh is probably not estrogenic.

Other supplements, such as androstenedione and boron, may raise estrogen levels in the body. Finally, although the herbs dong quai and P. ginseng do not appear to act in an estrogen-like manner, they may nonetheless stimulate the growth of breast cancer cells. Women who have undergone breast cancer surgery should use these herbs and supplements only under the advice of a physician.

The weak estrogen estriol is sometimes advocated by alternative practitioners as a safer choice than standard estrogen. However, test-tube studies suggest that estriol is just as likely to cause breast cancer as any other form of estrogen.

Bibliography

"Alternative Cancer Treatments: 10 Options to Consider." Mayo Clinic, 5 Jan. 2024, www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-treatment/art-20047246. Accessed 2 Nov. 2024.

Billhult, A., et al. “Massage Relieves Nausea in Women with Breast Cancer Who Are Undergoing Chemotherapy.” Journal of Alternative and Complementary Medicine, vol. 13, 2007, pp. 53-58.

Block, Keith I., et al. “Impact of Antioxidant Supplementation on Chemotherapeutic Toxicity: A Systematic Review of the Evidence from Randomized Controlled Trials.” International Journal of Cancer, vol. 123, no. 6, 2008, pp. 1227–39, doi.org/10.1002/ijc.23754. Accessed 2 Nov. 2024.

"Cancer Alternative Therapies." MedlinePlus, 9 June 2020, medlineplus.gov/canceralternativetherapies.html. Accessed 25 Aug. 2023.

"Complementary and Alternative Methods and Cancer." American Cancer Society, 25 Aug. 2021, www.cancer.org/treatment/treatments-and-side-effects/complementary-and-alternative-medicine/complementary-and-alternative-methods-and-cancer.html. Accessed 25 Aug. 2023.

"Complementary and Integrative Methods." American Society of Clinical Oncology, www.cancer.org/cancer/managing-cancer/treatment-types/complementary-and-integrative-medicine/complementary-and-alternative-methods-and-cancer.html. Accessed 2 Nov. 2024.

Crew, Katherine D., et al. “Randomized, Blinded, Sham-Controlled Trial of Acupuncture for the Management of Aromatase Inhibitor-Associated Joint Symptoms in Women with Early-Stage Breast Cancer.” Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, vol. 28, no. 7, 2010, pp. 1154–60, doi.org/10.1200/JCO.2009.23.4708. Accessed 2 Nov. 2024.

Elkins, G., et al. “Randomized Trial of a Hypnosis Intervention for Treatment of Hot Flashes among Breast Cancer Survivors.” Journal of Clinical Oncology, vol. 26, 2008, pp. 5022-26.

Huang, Shih-Tzu, et al. “The Effectiveness of Music in Relieving Pain in Cancer Patients: A Randomized Controlled Trial.” International Journal of Nursing Studies, vol. 47, no. 11, 2010, pp. 1354–62, doi.org/10.1016/j.ijnurstu.2010.03.008. Accessed 2 Nov. 2024.

Lee, Myeong Soo, et al. “Tai Chi for Breast Cancer Patients: A Systematic Review.” Breast Cancer Research and Treatment, vol. 120, no. 2, 2010, pp. 309–16, doi.org/10.1007/s10549-010-0741-2. Accessed 2 Nov. 2024.

Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, US National Institutes of Health, cam.cancer.gov. Accessed 25 Aug. 2023.

Oh, B., et al. “Impact of Medical Qigong on Quality of Life, Fatigue, Mood, and Inflammation in Cancer Patients.” Annals of Oncology, vol. 21, 2010, pp. 608-14.

Pradhan, Jhunilata, et al. "Progressive Muscle Relaxation Therapy on Anxiety among Hospitalized Cancer Patients." European Journal of Molecular & Clinical Medicine, vol. 7, no. 8, 2020, pp. 1485-88.

Wilkinson, S., et al. “Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients with Cancer.” Journal of Clinical Oncology, vol. 25, 2007, pp. 532-39.