What works, what doesn’t…and how to tell the difference
Complementary Therapies for Cancer
Professor Shaun Holt
Use of CAM by people with cancer
quackery
unproven
unorthodox
unconventional

National Centre for Complementary & Alternative Medicine (NCCAM)...


Alternative medical systems - 

Homeopathy
Acupuncture
Ayurvedic Medicine
Traditional Chinese Medicine 
Manipulative and body based systems - 

Chiropractic
Osteopathy
Acupressure
Alexander Technique
Reflexology
Feldenkrais Technique
Colonic irrigation
Therapeutic Touch
Craniosacral massage
Ear candling
Iridology
Massage Therapy
Cupping
Hyperbaric oxygen
Mind body interventions - 

Meditation
Yoga
Tai Chi
Hypnosis
Hypnotherpy
Art Therapy
Music Therapy
Spiritual Healers
Biofeedback
Aromatherapy
Reiki
Psychic Surgery
Qi gong
Shiatsu            
Biologically based therapies - 

Herbal medicines
Vitamins
Supplements
Special diets
Food and drinks
Energy Therapies - 

Magnetic therapy 
Crystal healing
TENS        
complementary
alternative
integrative oncology
CAM use in US cancer patients
1990 - 34% 
1997 -  42% 
Number of CAM therapies used by people with cancer...
1 - 13%
2 - 20%
3 - 15%
4 - 10%
5 - 8%
6 - 9%
7+ - 25%




RCT eliminates...

Placebo effect 
Natural History
Additional measures  
Why Research Is Important
What works...
Nausea & vomiting due to chemotherapy
Hot flashes 
Pain 
Dry mouth 
Fatigue after chemotherapy
Joint problems caused by breast cancer drugs  

Anxiety 
Pain
Nausea
Sleep
Overall quality of life

Anxiety
Depression
Tension
Pain
Nausea
Blood pressure
Coping ability
Painful procedures 
Distress
Hyperventilation
Anxiety
Chronic pain 
Incontinence 
Muscle injuries
Sleep problems
Quality of life
Chronic pain
Anxiety
High blood pressure
Immune response to viruses
Post traumatic stress disorder 
Insomnia
Chronic pain
Fear and anxiety
Headaches
Phobias 
Stop smoking or overeating
Painful procedures
Nausea & vomiting

Insomnia
Joint pain
Stress
Blood pressure
Depression
Hot flashes
Quality of life
Bone remodelling
Quality of life 
Whole white blood cell profile
Aerobic capacity
Muscle strength
Pain
Quality of life
Well-being and relaxation
Nausea & vomiting 
Wounds
Burns
Cough
Pain relief 
Mouth sores 
? slow growth of prostate cancer cells

Nausea & vomiting
0.5g per day, ¼ teasp. ground ginger 
s/e: can cause bleeding
Premenstrual symptoms
Menopause symptoms
Hot flashes

Depression
Anxiety
Sleep problems 
Anxiety
Tension
Insomnia
Muscle spasms
Nausea & vomiting
Appetite
Pain 
Psychological benefits

Pain
Esp arms, legs, abdomen 
What does NOT work...
Levels of Evidence
Level 1   Large RCT or meta-analysis 
Level 2   Small RCT

Level 3   Non-randomised trials, cohorts, case series, case-control 
Level 4   Expert authority opinion
Level 5   Expert opinion
"The plural of anecdote is not data"
Why do people think products work...when they don't?