Complementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers’ understanding of integrative medicine.
Data Sources
Randomized controlled trials involving integrative medicine or complementary and alternative medicine treatment for cancer patients.
Review Methods
Trials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management.
Conclusions
Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine.
Implications for Practice
In the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information to effectively counsel their patients.
BarnesPMBloomBNahinRL.Complementary and Alternative Medicine Use among Adults and Children: United States, 2007. Hyattsville, MD: National Center for Health Statistics; 2008. National health statistics report 12.
3.
National Center for Complementary and Integrative Health. Complementary, alternative, or integrative health: what’s in a name?https://nccih.nih.gov/health/integrative-health. Published 2015. Accessed August 11, 2015.
4.
MildenSPStokolsD.Physicians’ attitudes and practices regarding complementary and alternative medicine. Behav Med. 2004;30:73-82.
MillerMCPribitkinEADifabioTKeaneWM.Prevalence of complementary and alternative medicine use among a population of head and neck cancer patients: a survey-based study. Ear Nose Throat J. 2010;89:E23-E27.
7.
TrinidadeAShakeelMHurmanDHussainA.Traditional and complementary and alternative medicines make for unwilling bedfellows in the management of cancer: a case report with a tragic outcome. J Laryngol Otol. 2011;125:1193-1195.
8.
MolassiotisAOzdenGPlatinN. Complementary and alternative medicine use in patients with head and neck cancers in Europe. Eur J Cancer Care (Engl). 2006;15:19-24.
9.
WarrickPDIrishJCMorningstarMGilbertRBrownDGullaneP.Use of alternative medicine among patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 1999;125:573-579.
10.
GreenleeHBalneavesLGCarlsonLE. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;2014:346-358.
11.
ErnstECassilethBR.The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. 1998;83:777-782.
12.
HorneberMBueschelGDennertGLessDRitterEZwahlenM.How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012;11:187-203.
13.
AsherBFSeidmanMSnydermanC.Complementary and alternative medicine in otolaryngology. Laryngoscope. 2001;111:1383-1389.
14.
HendershotKADixonMKonoSAShinDMPentzRD.Patients’ perceptions of complementary and alternative medicine in head and neck cancer: a qualitative, pilot study with clinical implications. Complement Ther Clin Pract. 2014;20:213-218.
15.
GoelAJhuraniSAggarwalBB.Multi-targeted therapy by curcumin: how spicy is it?Mol Nutr Food Res. 2008;52:1010-1030.
16.
WilkenRVeenaMSWangMBSrivatsanES.Curcumin: a review of anti-cancer properties and therapeutic activity in head and neck squamous cell carcinoma. Mol Cancer. 2011;10:12.
17.
LoTempioMMVeenaMSSteeleHL. Curcumin suppresses growth of head and neck squamous cell carcinoma. Clin Cancer Res. 2005;11(19, pt 1):6994-7002.
18.
LawendaBDKellyKMLadasEJSagarSMVickersABlumbergJB.Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy?J Natl Cancer Inst. 2008;100:773-783.
19.
KhanNAfaqFMukhtarH.Cancer chemoprevention through dietary antioxidants: progress and promise. Antioxid Redox Signal. 2008;10:475-510.
20.
ZlotogorskiADayanADayanDChaushuGSaloTVeredM.Nutraceuticals as new treatment approaches for oral cancer II: green tea extracts and resveratol. Oral Oncol. 2013;49:502-506.
21.
DuffySARonisDLMcLeanS. Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma. J Clin Oncol. 2009;27:1969-1975.
22.
ArthurAEPetersonKERozekLS. Pretreatment dietary patterns, weight status, and head and neck squamous cell carcinoma prognosis. Am J Clin Nutr. 2013;97:360-368.
23.
SarkarFHLiY.Soy isoflavones and cancer prevention. Cancer Invest. 2003;21:744-757.
24.
AlhasanSAPietrasczkiwiczHAlonsoMDEnsleyJSarkarFH.Genistein-induced cell cycle arrest and apoptosis in a head and neck squamous cell carcinoma cell line. Nutr Cancer. 1999;34:12-19.
25.
Horn-RossPLHoggattKJLeeMM.Phytoestrogens and thyroid cancer risk: the San Francisco Bay Area thyroid cancer study. Cancer Epidemiol Biomarkers Prev. 2002;11:43-49.
26.
TsaoASLiuDMartinJ. Phase II randomized, placebo-controlled trial of green tea extract in patients with high-risk oral premalignant lesions. Cancer Prev Res. 2009;2:931-941.
27.
AstinJA.Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548-1553.
NewmanDJCraggGM.Natural Products as sources of new drugs over the 30 years from 1981 to 2010. J Nat Prod. 2012;75:311-335.
30.
ZerpSFStoterTRHoebersFJ. Targeting anti-apoptotic Bcl-2 by AT-101 to increase radiation efficacy: data from in vitro and clinical pharmacokinetic studies in head and neck cancer. Radiat Oncol. 2015;10:158.
31.
WolterKGWangSJHensonBS. (–)-Gossypol inhibits growth and promotes apoptosis of human head and neck squamous cell carcinoma in vivo. Neoplasia. 2006;8:163-172.
32.
KlingbeilMFXavierFCSardinhaLR. Cytotoxic effects of mistletoe (Viscum album L) in head and neck squamous cell carcinoma cell lines. Oncol Rep. 2013;30:2316-2322.
33.
ShakeelMTrinidadeAGeiderSAh-SeeKW.The case for mistletoe in the treatment of laryngeal cancer. J Laryngol Otol. 2014;128:302-306.
34.
AbuzeidWMDavisSTangAL. Sensitzation of head and neck cancer to cisplatin through the use of a novel curcumin analog. Arch Otolarygnol Head Neck Surg. 2011;137:499-507.
35.
KhafifALev-AriSVexlerA. Curcumin: a potential radio-enhancer in head and neck cancer. Laryngoscope. 2009;119:2019-2026.
36.
Steuer-VogtMKBonkowskyVAmbroschP. The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients. Eur J Cancer. 2001;37:23-31.
37.
Worden F; University of Michigan Comprehensive Cancer Center. Chemotherapy and Bcl-xL inhibitor (AT-101) for organ preservation in adults with advanced laryngeal cancer. https://clinicaltrials.gov/ct2/show/NCT01633541?term=NCT01633541&rank=1. Updated March10, 2016. Accessed February 16, 2016.
38.
FrenkelMCohenLPetersonNPalmerJLSwintKBrueraE.Integrative medicine consultation service in a comprehensive cancer center: findings and outcomes. Integr Cancer Ther. 2010;9:276-283.
39.
ChoHKJeongYMLeeHSLeeYJHwangSH.Effects of honey on oral mucositis in patients with head and neck cancer: a meta-analysis. Laryngoscope. 2015;125:2085-2092.
40.
KumarSJuresicEBartonMShafiqJ.Management of skin toxicity during radiation therapy: a review of the evidence. J Med Imaging Radiat Oncol. 2010;54:264-279.
41.
PfisterDGCassilethBRDengGE. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. 2010;28:2565-2570.
42.
AlimiDRubinoCPichard-LeandriEFermand-BruleSDubreuil-LemaireMLHillC.Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol. 2003;21:4120-4126.
43.
GillettJIentileCHiscockJPlankAMartinJM.Complementary and alternative medicine use in radiotherapy: what are patients using?J Altern Complement Med. 2012;18:1014-1020.
SimcockRFallowfieldLMonsonK. ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol. 2013;24:776-783.
BaiderLUzielyBDe-NourAK.Progressive muscle relaxation and guided imagery in cancer patients. Gen Hosp Psychiatry. 1994;16:340-347.
48.
FrenkelMBen AryeE.The growing need to teach about complementary and alternative medicine: questions and challenges. Acad Med. 2001;76:251-254.
49.
AminMGlynnFRowleyS. Complementary medicine use in patients with head and neck cancer in Ireland. Eur Arch Otorhinolaryngol. 2010;267:1291-1297.
50.
WeigerWASmithMBoonH. Advising patients who seek complementay and alternative therapies for cancer. Ann Intern Med. 2002;137:889-903.
51.
EisenbergDM.Advising patients who seek alternative medical therapies. Ann Intern Med. 1997;127:61-69.
52.
Ben-AryeESchiffEZollmanC. Integrating complementary medicine in supportive cancer care models across four continents. Med Oncol. 2013;30:511.
53.
Institute of Medicine Committee on the Use of Complementary and Alternative Medicine by the American Public. Complementary and Alternative Medicine in the United States. Washington, DC: National Academies Press; 2005.
54.
WhiteJD.The National Cancer Institute’s perspective and agenda for promoting awareness and research on alternative therapies for cancer. J Altern Complement Med. 2002;8:545-550.
55.
SankaranarayananRMathewBVargheseC. Chemoprevention of oral leukoplakia with vitamin A and beta carotene: an assessment. Oral Oncol. 1997;33:231-236.
56.
HongWKEndicottJItriLM. 13-Cis-retinoic acid in the treatment of oral leukoplakia. N Engl J Med. 1986;315:1501-1505.
57.
HongWKLippmanSMItriLM. Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med. 1990;323:795-801.
58.
MayneSTCartmelBBaumM. Randomized trial of supplemental beta-carotene to prevent second head and neck cancer. Cancer Res. 2001;61:1457-1463.
59.
DashCChungFLRohanJA. A six-month crossover chemoprevention clinical trial of tea in smokers and non-smokers: methodological issues in a feasibility study. BMC Complement Altern Med. 2012;12:96.
60.
HalderARaychowdhuryRGhoshADeM.Black tea (Camellia sinensis) as a chemopreventive agent in oral precancerous lesions. J Environ Pathol Toxicol Oncol. 2005;24:141-144.
61.
LiNSunZHanCChenJ.The chemopreventive effects of tea on human oral precancerous mucosa lesions. Proc Soc Exp Biol Med. 1999;220:218-224.
62.
MallerySTongMShumwayB. Topical application of a mucoadhesive freeze-dried black raspberry gel induces clinical and histologic regression and reduces loss of heterozygosity events in premalignant oral intraepithelial lesions: results from a multicentered, placebo-controlled clinical trial. Clin Cancer Res. 2014;20:1910-1924.
PistersKMNewmanRAColdmanB. Phase I trial of oral green tea extract in adult patients with solid tumors. J Clin Oncol. 2001;19:1830-1838.
66.
BartonDLSooriGSBauerBA. Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA. Support Cancer Care. 2010;18:179-187.
67.
ChenZJGuoYPWuZC.Observation on the therapeutic effect of acupuncture at pain points on cancer pain. Zhongguo Zhen Jiu (Chinese Acupunct Moxibustion). 2008;28:251-253.
68.
JayachandranSBalajiN.Evaluating the effectiveness of topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis. Indian J Palliat Care. 2012;18:190-195.
69.
SahebjameeMMansourianAMohammadM. Comparative efficacy of aloe vera and benzydamine mouthwashes on radiation-induced oral mucositis: a triple-blind, randomised, controlled clinical trial. Oral Health Prev Dent. 2015;13:309-315.
70.
TsujimotoTYamamotoYWasaM. L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial. Oncol Rep. 2015;33:33-39.
71.
PalattyPLAzmidahARaoS. Topical application of a sandal wood oil and turmeric based cream prevents radiodermatitis in head and neck cancer patients undergoing external beam radiotherapy: a pilot study. Br J Radiol. 2014;87(1038):20130490.
72.
LuWWaynePMDavisRB. Acupuncture for dysphagia after chemoradiation in head and neck cancer: rationale and design of a randomized, sham-controlled trial. Contemp Clin Trials. 2012;33:700-711.
73.
MengZKay GarciaMHuC. Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer. 2012;48:1692-1699.
74.
YouWCHsiehCCHuangJT.Effect of extracts from indigowood root (Isatis indigotica Fort) on immune responses in radiation-induced mucositis. J Altern Complement Med. 2009;15:771-778.
75.
SuCKMehtaVRavikumarL. Phase II double-blind randomized study comparing oral aloe vera versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. Int J Radiat Oncol Biol Phys. 2004;60:171-177.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
