Many cancer patients in search of relief from unpleasant symptoms and side effects from conventional cancer therapies wonder about incorporating complementary or integrative therapies into their treatment.

These terms refer to therapies used along with conventional medicine, including:

Natural products

• Non-prescription or over-the-counter herbs

• Supplements

• Vitamins

• Minerals

• Probiotics

Mind-body techniques

• Yoga

• Meditation

• Massage

• Hypnosis

• Acupuncture

These and other tools are often promoted as helpful in managing a wide range of symptoms, including pain, depression, fatigue, sleep disturbances, nausea, vomiting, negative body image and sexual dysfunction.

But how can we know which are reliable, and what works best for which symptoms?

"Too often, the data around dietary supplements and mind-body techniques come from poorly designed trials, and do not comprehensively evaluate risks versus benefits," says Debra Barton, R.N., Ph.D., the Mary Lou Willard French Professor of Nursing at the University of Michigan. "How these supplements work — or don't — isn't clear, and we don't have good data about proper dosing or potential toxicities."

Barton is equally wary about mind-body techniques. "These approaches, too, lack a body of rigorous trials that can inform us about their active ingredients, necessary doses and mechanisms."

'Complex interventions for complex symptoms'

Barton's research is at the forefront of separating fact from fiction to identify the strategies that offer real help and hope to cancer patients.

"Our minds, bodies, spirits and environments can all play a role in our health," explains Barton. "That's why I'm interested in natural products and mind-body techniques. I'm testing whether using whole plants with different biologic activity, and interventions like yoga that combine movement and meditation, might have a stronger impact: complex interventions for complex symptoms."

Some of Barton's recent collaborations focus on the role hypnotic relaxation techniques can play in reducing the severity of symptoms, like hot flashes, negative body image and fatigue, in female cancer survivors. Hypnotic relaxation uses imagery and breathing to achieve a state of relaxation where the subconscious is receptive to positive suggestions of self-acceptance, wholeness, energy and wellness.

Barton collaborates with Baylor University psychologist Gary Elkins, Ph.D., who initially developed and evaluated a hypnosis intervention to reduce hot flashes. In partnership with Elkins, Barton has continued to build on that research and extend it to other symptoms.

"Research in hypnosis demonstrates up to a 70% reduction in hot flashes," she says. "We wanted to know if we could achieve equally encouraging results with another side effect — negative body image." Particularly in women, body image is often distorted by cancer treatment.

Barton and her colleagues designed and tested whether a hypnotic relaxation intervention could improve how breast and gynecologic cancer survivors perceived their bodies. Patients were taught hypnotic relaxation through a combination of face-to-face therapy sessions, home-based practice and regular phone check-ins. The results suggested the intervention had promise, so Barton's team is now recruiting women for a larger study comparing hypnosis to simple relaxation to evaluate the efficacy.

"We are anxious to complete this study to better understand the contribution of hypnosis and relaxation to improving body image," says Barton.

"Not only are we interested in the effectiveness of hypnosis as an intervention, we also want to find ways to improve access to this therapy if it is found to be helpful for various symptoms. Hypnosis is most commonly delivered by psychologists, but our research demonstrates that it can be taught to other health care professionals, like nurses and social workers."

Nurses are often the first point of contact for patients with concerns about symptoms and side effects, and they need proven tools and resources they can share. "Our preliminary research indicates that, when properly trained, nurses could definitely play a role in making techniques like hypnosis more widely available to patients," Barton says.

Studying supplements

Barton's other area of interest is the potential of supplements to address issues, including cancer-related fatigue and vaginal pain. In placebo-controlled trials, few dietary supplements have shown proven benefits, she says, noting that American ginseng and DHEA (a natural or chemically-synthesized hormone) may be two exceptions.

Barton was principal author of a paper on ginseng and fatigue which showed that patients taking a ginseng supplement of 2000 mg daily for an eight weeks reduced their level of fatigue with no apparent toxicities. Another recently completed study in women yielded encouraging results about the effectiveness of DHEA in offsetting vaginal pain and dryness due to extremely low estrogen levels, improving overall sexual health.

When it comes to integrating mind-body techniques and OTC supplements into their cancer care, Barton hopes to help patients become more savvy consumers.

"It's tempting to think of these as low-risk options and adopt a 'what have I got to lose?' attitude," she admits. "But the fact is, we're still determining which approaches are safe and show true benefit. Most have yet to prove their worth. Hypnotic relaxation, American ginseng and DHEA are three promising exceptions, and we hope the list will continue to expand."

In the meantime, when it comes to managing symptoms, Barton advises patients to partner with their care teams. "Patients shouldn't suffer in silence. For many symptoms, there are evidence-based strategies that can be used. People living with a chronic illness have the right to enjoy their lives, and that means making sure side effects of the disease or treatment don't limit their activities or their ability to have fun."