A systematic literature review on biologically based CAM-practices for cancer patients Christine Paludan-Müller, PhD, The Danish Cancer Society Anita Lunde, Scientific Assistant, cand.cur., The University of Southern Denmark Helle Johannessen, Professor, PhD, The University of Southern Denmark
Purpose To provide an overview of high-quality reviews on biologically based CAM-practices against cancer or cancer-related symptoms To investigate and evaluate reviews: types of practices types of cancer diseases Efficacy parameters focus of research Evidence for cancer, side-effects and quality of life
Definition of biologically based CAM-practices: Biologically-based CAM-practices: Herbal remedies, dietary supplements, vitamins and other natural products (NCCAM, NIH, USA)
Methods (1) Systematic literature search: Databases: PubMed, Social Science Citation index, AMED and the Cochrane library Time period: Language: Key words: Type of articles: 2000-2008 (peer reviewed journals) English, German or Scandinavian languages Complementary therapies, Alternative therapies and neoplasms review, meta-analysis systematic review
Methods (2) Exclusion criteria: Studies on the prevention of cancer In vitro/animal studies Pilot studies Case studies Guidelines, letters etc... Studies/reviews on the use of CAM Reviews covered human studies in relation to cancer treatment
Methods (3) Included reviews were sorted according to the NCCAM classification system Biologically based CAM-practices Quality rating of literature: The Scottish Intercollegiate Guidelines Network (SIGN) (www.sign.ac.uk) Internal validity: Quality score (++, +, -) Description of included studies: Classification (1,2,3,4) Recommendation and evidence: Level (A, B, C, D)
Classification and rating of reviews 103 reviews Included: 78 reviews Excluded: 25 reviews A:15 B:17 C:7 D:39 only A and B reviews further studied
Types of interventions reviewed Intervention 1 Number of reviews (A & B) Chinese herbal medicine 7 Plant estrogens (soy) 7 Antioxidants 5 Mistletoe 4 Aloe vera 3 Homeopathic medicine 3 Shark cartilage 2 Amygdaline (vitamin B17) 2 Others 2 8 1 Some reviews included more than one intervention 2 Garlic, Co-enzyme Q10, anthroposofic medicine, calendula, camomile, honey, amygdalin (vitamin B17)
Types of Cancer reviewed Cancer disease Number of reviews (A and B) Breast cancer 8 Prostate cancer 4 Lung cancer 3 Colorectal cancer 3 Head and neck cancer 1 Mixed types of cancer 19
Types of efficacy parameters reviewed Effect of practices on Cancer (Survival, mortality (specific and overall), tumor response, Prostate Specific Antigen (PSA), relapse No. of reviews 15 Side effects 11* Quality of life 10 Pain 4 Immune system 3 Late effects 2 *Side effects (no. reviews): Symptoms on menopause (5), radiation injuries (2), oral mucositis (2), nausea and vomiting induced by chemotherapy (2)
Summary of evidence (1) INTERVENTION EFFECT ON CANCER SIDE EFFECTS QUALITY OF LIFE Chinese herbal medicine? +? Plant hormones (soy) - Antioxidants - Mistletoe + + Aloe vera Homeopatic medicine Shark cartilage Amygdalin (vitamin B17) - Antroposofic medicine??? Garlic? Camomile Honey Coenzyme Q10? Calendula + Negative effect - warning + Possible positive effect? Further studies required No effect Not studied/not relevant
Summary of evidence (2) Chinese herbal medicine Further studies required Possible positive effects on side effects and quality of life - astragalus most studied Plant estrogens (Soy) Discourage use among breast cancer patients Further studies required for other types of plant hormones Further studies required on prostate cancer
Summary of evidence (3) Antioxidants Discourage use of high-dose antioxidants Lack of clinical data on intravenous vitamin C Mistletoe No evidence for efficacy against cancer Possible positive effects on side effects and quality of life
Conclusion 32 reviews provided reliable information Need for reviews that do not include studies on both treatment and prevention of cancer No evidence for efficacy against cancer Discourage use of high-dose antioxidants, vitamin B17 and soy (breast cancer) Possible positive effects of practices were related to reduction of side effects and improvement of quality of life - further studies required
Thank you for your attention!
Extra slide: Reference list - reviews classified as high quality (A) Block (2007) Borelli & Ernst (2002) Davies (2006) Ernst (2003) Ernst (2004) Kienle & Kiene (2007) Krebs (2004) McCulloch 2006 Milazzo (2006) Richardson (2005) Taixiang (2007) Weiger (2002) Worthington (2007) Xu (2007) Zhang (2007) Zhang (2007)
Extra slide: Reference list - Reviews classified as high quality (B) Mcquestion (2006) Moyad (2002) Nedrow (2006) Nelson (2003) Pittler 2007 Vickers (2002) von Löw (2007) Wilkinson 2003 Kienle (2003) Milazzo et al. (2007) Pilkington (2006) Roffe (2004) Rui (2007) Stauder (2002) Walji (2007) Milazzo et al. (2006) Bjelacovic (2008)
Extra slide: Characteristics of C and D Intervention Plant hormones (soy) 12 Dietary supplements different types Antioxidants 8 Chinese herbal medicine 3 Marietidsel 3 Homeopathic medicine 2 Vitamin C (i.v.) 2 Garlic 1 Ginseng 1 Ayervedic medicine 1 Number of reviews (C and D) 10