Complimentary Medicine

Complementary and alternative medicine (CAM) is a term used to describe any intervention or therapy that is not considered part of standard, Western, medical care. CAM therapies include a wide variety of interventions focused on combining mental, physical, and spiritual aspects of care. Some CAM therapies have shown to improve symptom management and quality of life for patients receiving conventional cancer care like chemotherapy. Leading cancer centers are recognizing this benefit and integrating evidence-based complementary medicine into conventional cancer care to create a plan that addresses the needs of the whole person during cancer therapy. Many examples of CAM therapies are discussed in detail on this webpage.

If you are exploring different CAM therapies online, you will likely see the words “complementary”, “alternative”, and “integrative” used frequently. Though they are often used together, they all have very different meanings:

• Complementary medicine is the use of any non-conventional therapy along with evidence-based, conventional medical interventions.
• Alternative medicine is the use of any non-conventional therapy in place of evidence-based, conventional medical interventions.
• Integrative medicine is the careful coordination of evidence-based complementary medicine and standard Western medical care.

When considering CAM, it is important to understand that there are risks and benefits to every therapy just like in standard medical care. Some resources may describe a therapy as “natural” to make it seem safe. However, not all “natural” products are safe, and some interact in harmful ways with other medications you may be taking. It is important to discuss any intervention you are considering with your physician to make sure it is safe and fits into your current care plan.

Sensory Complementary Medicine:

Sensory complementary medicine therapies are therapies that work in conjunction with the five senses: smell, site, taste, sound and touch, as well as the body's overall energy.

Aromatherapy:(https://my.clevelandclinic.org/health/treatments/16883-complementary-therapy) The theory of Aromatherapy is that essential oils are absorbed into the body either through the pores of the skin during massage, or by inhalation through the nose. The scents released by the oil act on the hypothalamus, a part of the brain that influences the hormonal system. Thus, in theory, a smell might affect mood, metabolism, stress levels, and libido. Clinical research into claims for the effects of essential oils on medical conditions is not extensive, but the psychological effects of smell have been studied more.

Some common essential oils used are chamomile, lavender, peppermint, rosemary, sandalwood and tea tree. There are conflicting reports regarding the properties and uses for oils, and responses to smells are highly personal.

Landscape Therapy(https://my.clevelandclinic.org/health/treatments/16883-complementary-therapy) is the showing of peaceful, relaxing landscapes to patients, scenes that evoke calm and tranquility. They may be shown in a darkened room via a slide show or video screen, or they may be shown in the form of art books or actual artwork. Landscape therapy is often used as a distraction technique to help manage pain and anxiety that results from cancer treatment.

Music Therapy (https://my.clevelandclinic.org/health/treatments/8817-music-therapy) is the clinical and evidence-based use of music interventions to support cancer patients’ needs by promoting physical, emotional, mental, spiritual, and social well-being. Interventions may include listening to, playing, creating, or composing music. Music therapists are board certified professionals who are educated to assess and implement interventions within the context of a therapeutic relationship, helping patients express emotion, cope with treatment, reduce anxiety or pain, and promote relaxation.

Massage Therapy is a form of complementary medicine in which the therapist manipulates the body’s soft tissues to reduce pain, tension, and stress. There are many types of massage, but the most common are Swedish massage, myofascial release, deep tissue, and trigger point therapy. Massage therapists frequently employ aromatherapy as part of a session as well.

There are many benefits to massage therapy for patients undergoing treatment for cancer. Studies show that massage can reduce anxiety, stress, and pain, and can be helpful in managing nausea and fatigue. Massage can also be used to manage discomfort from scar tissue following surgery. Patients experiencing lymphedema may benefit from a manual lymphatic drainage massage (this type of massage should only be performed by a certified MLD therapist).

There are certain risks involved in massage therapy for patients with cancer. The most common contraindications are low platelet count, blood clots, bone metastases, and lymphedema. Massage therapy should not be performed directly over a tumor, over a port, or in an area receiving radiation therapy. Patients should consult their physician before engaging in massage therapy to identify any risk factors and precautions to take. Patients should also seek out a massage therapist that is certified in oncology massage. Deep tissue massage is not recommended for patients actively receiving cancer treatment.

When seeking out a massage therapist it is recommended that information regarding the therapist's education and credentials be reviewed. The following are criteria that are recommended in a massage therapist:

• Graduated from an accredited program, which meets the standards set by the Commission on Massage Therapy and Accreditation.
• Holds a current state license in massage therapy, if applicable; and/or, is certified by the National Certification Board for Therapeutic Massage and Bodywork
• Is a member of a professional association, such as the American Massage Therapy Association
• Has received special training in massage of patients undergoing cancer treatment.

Massage therapy can be very beneficial to a person undergoing cancer treatment. However, be sure to discuss with your health care provider so this therapy can be used safely.

Therapeutic Touch is a complementary medicine modality that postulates people have individual "energy fields" that interact with one another and with the external environment as part of a universal energy field. These fields are thought of in scientific terms, rather than in mystical terms. In the late 1960’s, Dr. Dolores Krieger, Professor of Nursing at New York University, learned the technique of "laying on of hands" from a healer, Dora Kunz. Krieger began to teach what she called Therapeutic Touch to her students.

In a Therapeutic Touch (TT) session, the practitioner attunes their energy fields with the patient so that disturbances in the "energy flow" are balanced and the body's healing powers can work freely. Hands are placed inches above the body and gently moved over it to assess any changes or blockages in the energy field. Using sweeping movements, the practitioner will try to treat the area of imbalance, perhaps by visualizing healing energy directed from her body to the patient. A session may last 30 minutes. TT is used to treat stress-related conditions, such as fatigue and headaches. It is also used for pain relief, especially from muscle strain and following surgery. It also has been used to promote wound healing, and for lymphatic and circulation disorders.

Reiki: (https://my.clevelandclinic.org/health/treatments/21080-reiki-self-treatment) Reiki is a Japanese spiritual healing and physical stress reduction and relaxation modality. This complementary medicine technique has its foundation in ancient Chinese Medicine, which was apparently forgotten until its rediscovery in the late 19th century by Dr. Mikao Usui in Japan. The aim of Reiki therapy is to promote health, maintain well-being, and in some cases it helps people attain a higher consciousness. Practitioners draw on “Reiki energy," channeling it to areas of need in themselves and their patients. Much like Therapeutic Touch, Reiki works to balance the patient’s body, mental, and emotional energies.

A Reiki treatment session lasts about 30-45 minutes, during which the practitioner channels Reiki energy through his/her hands to the patient. The patient lies clothed on a Reiki treatment table or in seated a chair, and the practitioner’s hands are placed on or over the body in 12 basic positions for about 3-5 minutes each. Reiki promotes balance in the body's energy centers or "chakras." Most patients feel relaxed after treatment, while others feel invigorated or energized.

International Association of Reiki Professionals: https://iarp.org/

Reiki information and search engine to locate Reiki practitioners

International Center for Reiki Research: https://www.centerforreikiresearch.org/

Reiki research study findings, including in healthcare.

Reflexology: Through the application of pressure on particular areas of the hands or feet, Reflexology is said to:

• Support homeostasis (optimal balance of the body’s systems) which can improve the healing process throughout the body.
• Calm the central nervous system, promoting relaxation and other benefits just like any form of massage.
• Be low risk and can be a reasonable option if you're seeking relaxation and stress relief.
• Be helpful with the management of neuropathy symptoms that may affect the hands and feet.

Acupuncture (https://my.clevelandclinic.org/health/treatments/16883-complementary-therapy) Acupuncture is an ancient Chinese system of health care. This type of complementary medicine aims to prevent and cure specific diseases and conditions by sticking very fine, solid needles into points of the body. Acupuncture is believed to encourage the release of endorphins, natural painkillers that can also increase feelings of well-being. Acupressure, in which the same acupoints are stimulated by hand, may be effective in the same way, but to a lesser degree.

Cognitive Complementary Medicine:

Cognitive Therapies promote mind-body healing by using the power of positive thinking to facilitate recovery. Types of cognitive therapy include:

Guided Imagery Guided Imagery: (https://my.clevelandclinic.org/departments/wellness/integrative/treatments-services/guided-imagery#overview-tab) Visualization is a process where the patient is assisted in imagining positive images and desired outcomes to specific situations. The practitioner works with the patient initially to discover what it is they are trying to accomplish with the therapy. Then a mental image is created. For example, patients are asked to focus on feeling stronger or better, or to picture the destruction of tumor cells while in a state of relaxation. In one technique, patients visualize various aspects of treatment, from the least frightening to the most painful, remaining calm and relaxed at each step. This method has helped patients to control nausea before chemotherapy and promote relaxation and positive healing.

Hypnotherapy (https://my.clevelandclinic.org/health/treatments/9930-hypnotherapy) Hypnotherapy is a technique that uses the hypnotic state, which enables changes in perception and memory, a major increase in response to suggestion, and the potential for managing many physiological functions that are usually involuntary. Hypnotherapy uses guided relaxation, intense concentration and focused attention to achieve a heightened state of awareness that is sometimes called a trance. The person’s attention is so focused while in this state that anything going on around the person is temporarily blocked or ignored. In this naturally occurring state and with the help of a trained therapist, the person may focus his or her attention on specific thoughts or tasks.

Spiritual Care Spiritual care services help patients address existential life questions causing spiritual distress, which often arise when patients face life-threatening illnesses such as cancer. Spiritual counseling helps patients explore their religious and spiritual beliefs and use spiritual practices such as prayer, meditation, music, and the reading of scriptures. Spiritual caregivers include ministers, chaplains, priests, nuns, rabbis, and other trained religious professionals.

Cancer.net: https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/spiritual-support-when-you-have-cancer Discusses the benefits of spiritual counseling in cancer care.

National Cancer Institute: https://www.cancer.gov/about-cancer/coping/day-to-day/faith-and-spirituality/spirituality-pdq Discusses the benefits of spiritual counseling in cancer care.

National Comprehensive Cancer Network: https://www.nccn.org/patients/resources/life_with_cancer/spirituality.aspx Discusses the benefits of spiritual counseling in cancer care.

Meditation (https://my.clevelandclinic.org/health/articles/17906-meditation) Meditation is a method of relaxing and quieting the mind to reduce stress, reduce pain, and facilitate inner calm and peace. There are several forms of meditation, which are taught individually and in group settings. Common meditation forms used in healthcare are guided meditation and mindfulness. In guided meditation, the meditation teacher or guide provides verbal instructions to patients, which focuses the patient’s attention and cultivates awareness of their mind, body, and spirit. Mindfulness meditation is accomplished through both silent meditation and guided mediation. The mindfulness meditation approach focuses on helping patients relax and reduce stress, gain personal insight, and increase mindfulness in their everyday lives.

Insight Meditation Society: https://www.dharma.org/ Longstanding leader in advancing meditation practice and training, offers many free resources

Mindfulness Association: https://www.mindfulnessassociation.net/ Mindfulness training, teachers, and information resources

Esalen: https://www.esalen.org/ One of the longstanding and most respected resources for personal growth, including meditation. Many resources available.

Shambhala Mountain Center: https://www.shambhalamountain.org/ Longstanding leader in meditation practice with many resources.

Zen Mountain Monastery: https://zmm.org/ Longstanding leader in meditation practice with many resources.

Relaxation and Deep Breathing: (https://my.clevelandclinic.org/health/articles/6409-stress-management-and-emotional-health) Patients are taught these types of complementary medicine techniques to help to release muscle tension, relieve breathlessness, lessen anxiety, and encourage a greater sense of control. Breathing techniques also are used frequently during meditation.

Biofeedback: Biofeedback: (https://my.clevelandclinic.org/health/treatments/13354-biofeedback) Biofeedback is a treatment that teaches a person to change how the body functions. The treatment is meant to improve health and the body’s performance. Precise instruments measure activities in the body such as breathing, heart function, and muscle activity. Instruments quickly and accurately provide “feedback” information to the person. Often, changes in thinking, emotions, and behavior influence desired changes in the body. Such changes can continue on with time and practice, even if no instrument is used.

Expressive Complementary Medicine:

Expressive Therapies are treatments in which patients are encouraged to express their thoughts. Expressive therapies are thought to alleviate anxiety by allowing the patient to release fear and frustration in a positive, creative fashion. These therapies include:

Psychotherapy and Counseling (https://www.cancer.net/coping-with-cancer/finding-social-support-and-information/counseling) Counseling helps people manage and respond to their mixed emotions about life’s challenges. Counselors cannot always solve problems, but they provide a safe place for people with cancer to talk about their concerns. Because counselors are separate from a person’s life, they provide a helpful, outside viewpoint.

It is normal to feel distressed while living with cancer. But it is important to seek help when the distress is long lasting. Seeking help is also important when your feelings affect your ability to cope with your daily life. You may find counseling helpful even if your level of distress is not severe. Living with cancer is a huge challenge for everyone. Even a few counseling sessions will likely help you.

Counseling may help you:

• Learn ways to cope with a cancer diagnosis and feel less overwhelmed and more in control.
• Explore what your cancer experience means to you.
• Manage distress associated with cancer including, but not limited to, anxiety and depression.

Support Groups Support groups provide patients, families, and friends an opportunity to share concerns, fears, and hope with others experiencing similar life challenges. Support groups also provide an opportunity to learn positive strategies to cope with challenges related to cancer. Groups may be led by oncology social workers, nurses or psychologists who are specialists in providing education and support in an atmosphere of encouragement.

Journal Writing: Writing in a journal is an effective way to understand and cope with emotions that living with cancer triggers. Often people facing a serious illness find it difficult to express their feelings to others. Journal-writing can help a person to express difficult feelings in a safe and private way. Regular journal-writing also helps people to clarify their thoughts and make good choices.

BreastCancer.org: https://www.breastcancer.org/treatment/comp_med/types/journaling Offers guidance to breast cancer patients and survivors on using journaling

Cancer.net: https://www.cancer.net/blog/2014-06/power-writing Advice on benefits of journaling for cancer patients and survivors.

Art Therapy: (https://my.clevelandclinic.org/departments/arts-medicine/therapy-performance-education/art-music-therapy) Art Therapy is engaging in the creation of art, with the help of an art therapist, to assist with both emotional and physical healing and growth. Art therapists are professionals who possess a master’s degree in the field of Art Therapy. Anyone can benefit from Art Therapy, it does not depend upon talent or technical ability. The art therapist will discuss your interests and goals for the session, and then suggest art tasks. This may include painting, simple sculpting, drawing, collage or craft work.

Physical Complementary Medicine:

Physical Therapies: (https://my.clevelandclinic.org/health/treatments/16883-complementary-therapy) When possible for the patient, physical therapies have been shown to release endorphins (mood elevating hormones) and promote better general health, relief of tension and positive attitudes. Even something as simple as walking and certain forms of dance have been helpful to patients.

Yoga (https://my.clevelandclinic.org/health/treatments/16883-complementary-therapy) Yoga is a gentle form of exercise consisting of movement and postures matched to ones breathing. It has been practiced for thousands of years in India to calm the mind and keep the body moving. It was meant to create harmony with the mind, body and spirit. In the last 20-30 years, yoga has become popular around the world and in the West. It is valued more for its physical than spiritual benefits, such as increased strength, flexibility and vitality. As with many types of complementary therapies, one of the main reasons people with cancer practice yoga is because it makes them feel good. Yoga is a way to help patients/caregivers relax and cope with stress, anxiety and depression. It can also improve fatigue, sleep, and focus. Increased energy and overall improved quality of life are other ways yoga can help. Patients should consult with their healthcare professional prior to practicing yoga.

Yoga for Cancer https://y4c.com/

T'ai Chi T'ai Chi: (https://my.clevelandclinic.org/health/treatments/16883-complementary-therapy) T’ai Chi is a non-combative martial art that uses breathing techniques and sequences of slow, graceful movements to improve the flow of qi, or "life energy," calm the mind, and to promote self-healing. It is often described as "meditation in motion." It is practiced more as a form of preventive health care than as a response to an ailment.

Other Medical Systems in Complementary Medicine:

Alternative or other medical systems describe health approaches based on complete systems of theory and practice. These systems are separate from conventional Western medicine. Examples include traditional Chinese medicine, Ayurveda, homeopathy, and naturopathy. Consideration of any alternative medical systems should involve the same research and discussion with your cancer care team that you would dedicate to consideration of any other CAM therapy.

General Precautions Regarding Complementary Medicine:

• Don’t use complementary or alternative medicine to postpone seeing a conventional health care provider about a medical problem
• Spend time researching any therapies you are considering and make sure your information comes from a reliable source.
• Talk to your cancer care team before starting any non-conventional form of treatment to make sure there are no harmful interactions with your established care plan.
• Tell your complementary medicine practitioner about any prescribed medication you are taking and any other complementary treatments you are receiving.
• Do not start on a vigorous exercise program without first consulting your doctor.
• See your doctor if symptoms persist or worsen.

Other Resources

National Cancer Institute Office of Cancer Complementary and Alternative Medicine (OCCAM): https://cam.cancer.gov/health_information/for_patients.htm

National Center for Complementary and Integrative Heath (NCCIH): https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name https://www.nccih.nih.gov/health/are-you-considering-a-complementary-health-approach