The Spectrum of Integrative Cancer Therapies
Given how complex your choices are in integrative cancer therapies, it may help to have a framework for evaluating them.
Ten Criteria for Evaluating Integrative Cancer Therapies
Five criteria for evaluating therapies that consider risk, lineage, evidence, use with conventional therapies, and mechanism:
- Some are inherently health-promoting. Others involve both benefits and risks.
- Some are ancient. Others are more recent, or contemporary.
- Some offer no evidence. Others have anecdotal or case evidence. Still others are more formally researched.
- Some are alternative. Other are complementary to conventional medicine. Still other are truly integrative.
- Some operate by known biochemical or other mechanisms. Others are said to operate by controversial or unknown mechanisms, including healing energies or prayer.
Five more criteria of a very practical nature considering cost, availability, locality, applicability, and need for instruction:
- Some therapies are free or low-cost. Others are costly.
- Some are readily available. Others are very difficult to obtain.
- Some you can find online or close to home. Others require travel or residential stays.
- Some therapies address only certain types of cancer, while others are broadly applicable.
- Some therapies can be employed at home while others require guidance, training, or a prescription.
These ten criteria for evaluating integrative cancer therapies are by no means the only ones. You may have others that are equally important to you.
Your intuition about what might be helpful can offer important additional guidance.
Different voices inform your choices better than a single voice.
We don’t offer a single voice in the discussion of treatment options. We have selected advisors in part for their diverse views. At the same time, our goal is objective assessment wherever the facts make such evaluation possible.
BCCT’s presentation of therapies attempts to address these various dimensions where appropriate.
The Burden of Proof
BCCT advisor Donald Abrams, MD, makes a critical distinction between science-informed and science-based integrative cancer therapies.
- Science-based therapies have strong science behind them, such as the Cochrane Database of Systematic Reviews. Scientists have come to widespread (although not unanimous) agreement about benefits and risks.
- Science-informed therapies typically have some science behind them, but not enough to be described as science-based.
The lower the risk of harm, the lower the burden of proof.
Experimental therapies both in mainstream cancer medicine and in complementary medicine can be considered science-informed. Because the scientific process can be slow to accumulate enough evidence to be conclusive, and because cancer patients often don’t have decades for rigorous research results, science-informed therapies are often the only option beyond standard therapies.
Dr. Abrams makes another critical point with respect to science-informed therapies: The lower the risk of harm, the lower the burden of proof. The burden of proof is lower if a therapy meets these criteria:
- It is unlikely to do harm.
- The patient considers it affordable.
- The patient is drawn to it or believes it may have value.
BCCT supports patients and clinicians in investigating complementary therapies, especially when the potential for benefit is demonstrated and the risk of harm is low. A video at right details the approach of using therapies with potential benefit and little risk through three personal stories: Surviving Terminal Cancer.
We summarize the evidence behind therapies and approaches without ignoring or avoiding those therapies lacking rigorous evidence to date. For some therapies, a lack of evidence is not the same as evidence of no effect, and many situations can contribute to a lack of evidence:
- Some therapies without much profit potential have not attracted research funding. Large, carefully controlled medical studies are costly and often rely on funding by big pharmaceutical companies. If no one is formally investigating a therapy, no evidence of its effectiveness will be available.1
- Some therapies work best in combinations, but studies to date have focused on stand-alone uses.
- Some therapies work best with certain genetic profiles. Conventional medical research recognizes this with the development of precision medicine and targeted therapy in treatments. However, the interaction of genetics and therapies has not yet been formally studied for many complementary therapies. Published research does not contain all the accumulated knowledge gained from years and generations of experience in treating patients.
- Some therapies work best or work only with certain subpopulations of patients. For example, research with both conventional and integrative therapies has found that people with some particular tumor types or some states of nutritional or genetic enzyme deficiency can show substantial response to a therapy. However, if only a small portion of study subjects have these characteristics, the overall conclusion may be that a therapy is ineffective, even if it is highly effective for some patients.
We focus on those therapies with good indications of safety and effectiveness.
We focus on those therapies with good indications of safety and effectiveness. We will also list separately therapies that evidence to date shows to be either ineffective or more harmful than beneficial. As research continues to bring us closer to full understanding of therapies, BCCT will adjust and update our summaries of therapies. We cannot provide more understanding than what is available from our sources, and so we do not claim to offer “the truth.” Like you, our readers, we continue to seek more precise answers, in part by inviting comments and discussion from our readers.
We invite you to walk through a brief discussion of various therapies and the evidence or indications behind them:
- Eating well
- Moving more
- Managing stress
- Sleeping well
- Creating a healing environment
- Sharing love and support
- Exploring what matters now
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer