What’s the Bottom Line?

Complementary health approaches may play a role in cancer care, but using them inappropriately can be harmful. For your safety:

• Don’t use unproven products or practices to replace or delay medical treatment for cancer.
• If you have cancer, consult your health care provider before adding any complementary health products or practices to your treatment program.

What do we know about the usefulness of complementary approaches for cancer?

• No complementary health approach has been shown to prevent or cure cancer.
• Some complementary health approaches, such as acupuncture, mindfulness-based stress reduction, and yoga, may help manage cancer symptoms and side effects of treatment.

What do we know about the safety of complementary approaches for cancer?

• Psychological and physical practices such as hypnosis, massage therapy, and yoga are usually safe when used appropriately. However, special precautions may need to be taken to make some of these practices safe for people with cancer.
• Some complementary health approaches can interfere with medical treatment for cancer. For example, some herbs may make chemotherapy drugs less effective.
• Some of the fraudulent cancer “cures” marketed via the internet are dangerous in themselves, and others can be harmful if people use them instead of seeking effective medical treatment.

About Cancer

Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. Although cancer is the second leading cause of death in the United States, people with cancer are living longer because of improvements in early detection and treatment. About two out of every three people in the United States diagnosed with cancer will live at least 5 years after diagnosis.

About Complementary Health Approaches

Complementary health approaches are a group of diverse medical and health care systems, practices, and products whose origins come from outside of mainstream medicine. They include such products and practices as herbal supplements, other dietary supplements, meditation, spinal manipulation, and acupuncture.

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

• Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies)
• Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies)
• Physical (e.g., acupuncture, massage, spinal manipulation)
• Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating)

Nutritional approaches include what NCCIH previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

This publication looks at complementary health approaches that have been studied for cancer prevention, treatment of the disease, or symptom management, including what the science says about their effectiveness and any concerns that have been raised about their safety.

Incorporating Complementary Health Approaches Into Cancer Care

The Society for Integrative Oncology has issued evidence-based clinical practice guidelines for health care providers to consider when incorporating complementary health approaches in the care of people with cancer.

The guidelines state that, when used in addition to conventional therapies, some of these approaches help to control symptoms and enhance patients’ well-being. The guidelines warn, however, that unproven methods shouldn’t be used in place of conventional treatment because delayed treatment of cancer reduces the likelihood of a remission or cure.

Complementary Health Approaches for Cancer Symptoms and Treatment Side Effects

Some complementary health approaches may help people manage cancer symptoms or the side effects of treatment. However, some approaches may interfere with conventional cancer treatment or have other risks. People who have been diagnosed with cancer should consult their health care providers before using any complementary health approach.

Psychological and Physical Approaches

Acupuncture

• Several evaluations of the evidence have concluded that acupuncture can help manage treatment-related nausea and vomiting in people with cancer.
• A 2020 combined analysis of 14 studies (920 participants) found that acupuncture was associated with significant reductions in cancer pain, both in studies where acupuncture was compared with sham (simulated) acupuncture and in studies where acupuncture was compared with no treatment. In two studies, the use of acupuncture or acupressure in addition to pain medicine helped people with cancer reduce their dose of pain medicine.
• A 2018 review of 10 studies (1,327 participants) showed that acupuncture may be more helpful than sham acupuncture or usual care in relieving cancer-related fatigue.
• Research on the effects of acupuncture on cancer-related hot flashes is limited.
• Complications from acupuncture are rare, as long as the acupuncturist uses sterile needles and proper procedures. Chemotherapy and radiation therapy weaken the immune system, so it’s especially important for acupuncturists to follow strict clean-needle procedures to reduce the risk of infection when treating people with cancer.

Hypnosis

• Hypnosis may be helpful for pain caused by cancer itself or by procedures used in cancer care, for nausea and vomiting in people with breast cancer, and for anxiety and distress around surgical and medical procedures in both adults and children. It may also be helpful for hot flashes in women with breast cancer.
• Hypnosis is a safe technique when practiced by a trained, experienced, licensed health care provider.

Massage Therapy

• Massage therapy, with or without aromatherapy (the use of essential oils), has been used to attempt to relieve pain, anxiety, and other symptoms in people with cancer. However, there is only limited evidence on whether it is beneficial.
  • A 2021 review of 13 studies (1,100 participants) of various manual therapies, including but not limited to massage therapy, provided evidence for benefits on pain, physical function, and global well-being but not fatigue, nausea, anxiety, or depression. These results should be interpreted cautiously because a variety of different manual therapies and measurement techniques were included and because some studies included small numbers of participants or were of low quality.
  • A 2016 evaluation of 19 studies (more than 1,200 participants) of massage for people with cancer found some evidence that massage might help with pain and anxiety, but the quality of the evidence was very low, and findings were not consistent.
• Massage therapists may need to modify their usual techniques when working with people with cancer; for example, they may have to use less pressure than usual in areas that are sensitive because of cancer or cancer treatments.

Mindfulness-Based Stress Reduction

• A 2020 review of 26 studies (3,476 participants) of people with various types of cancer showed that those who participated in mindfulness-based interventions had less anxiety, depression, fatigue, and stress, and a better quality of life than those who did not participate in mindfulness-based interventions.
• Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions. For example, if you can’t sit still comfortably for long periods of time, your meditation instructor can adapt the meditation practice so that you don’t need to do this.

Tai Chi and Qigong

• A 2020 review looked at 16 studies (1,268 participants) of tai chi in women with breast cancer. Some of the studies evaluated tai chi as an alternative to conventional supportive care interventions such as aerobic exercise and cognitive behavioral therapy, and others evaluated it as an addition to conventional care. Tai chi improved fatigue when used as an addition to conventional care (two studies) but not when used as an alternative to conventional care (two studies). Tai chi improved overall quality of life when used either as an addition to conventional care (four studies) or as an alternative to conventional care (two studies).
• A 2019 review of 12 recent studies (915 participants) of qigong or tai chi for patients with various types of cancer found favorable effects on symptoms of fatigue and sleep quality that were large enough to be meaningful to patients.
• Tai chi and qigong are generally considered to be safe practices.

Yoga

• A 2020 evaluation of 24 studies of yoga for women with breast cancer, involving a total of more than 1,600 participants, concluded that yoga provides small-to-moderate improvements in cancer-related fatigue and quality of life compared to interventions not involving physical activity. Therefore, it could be a supportive intervention for women with breast cancer, as an addition to standard treatment.
• A 2021 review of 26 studies of yoga-based interventions for depressive symptoms (1,486 participants) and 16 studies of yoga-based interventions for anxiety symptoms (977 participants) in people with various types of cancer found evidence that the interventions were helpful for both types of symptoms. The majority of the studies involved women with breast cancer.
• Yoga is generally considered a safe form of physical activity for healthy people when performed properly under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare. In studies of yoga in people with cancer, adverse events have mostly been minor. However, having an ongoing health problem such as cancer may increase the risks of doing yoga. If you have cancer, talk with your health care providers to find out whether any aspects of yoga might be unsafe for you.

Nutritional Approaches

Ginger

• Ginger is an herb that is sold as a dietary supplement. A 2019 evaluation of 18 studies with more than 1,600 participants concluded that the evidence on whether ginger is helpful for nausea associated with cancer chemotherapy is mixed. Some studies suggested that ginger helped to control nausea, but in other studies, ginger didn’t seem to have any effect.
• People diagnosed with cancer should consult their health care providers before taking ginger or any other dietary supplement.

Complementary Health Approaches for Cancer Treatment

No complementary approach has been shown to cure cancer or cause it to go into remission. Some products or practices that have been advocated for cancer treatment may interfere with conventional cancer treatments or have other risks. If you’ve been diagnosed with cancer, you should consult your health care providers before using any complementary health approach.

Herbal Supplements

• Studies on whether herbal supplements or substances derived from them might be of value in cancer treatment are in their early stages, and scientific evidence is limited. Herbal supplements may have side effects, and some may interact in harmful ways with drugs, including those used in cancer treatment.

Vitamin, Mineral, and Antioxidant Dietary Supplements

• The effects of taking vitamin and mineral dietary supplements, including antioxidant supplements, during cancer treatment are uncertain. Because these supplements might interfere with the effectiveness of chemotherapy or other cancer therapies, if you are being treated for cancer, you should discuss their use with your health care providers.

Black Salves

• Products called black salves have been marketed for self-treatment of a variety of skin conditions, including skin cancer. Black salves are neither safe nor effective. When used to treat a skin cancer, black salve products may not remove all of it, which may allow the cancer to spread and become more serious. Also, black salves can destroy both cancerous and healthy skin. They can cause scarring and tissue damage, which is sometimes severe and disfiguring. Most black salve research involves case studies; well-controlled clinical trials have not been conducted.

Laetrile

• Laetrile is another name for the natural substance amygdalin, a chemical constituent found in the pits of many fruits. A 2019 review of research on laetrile found no clinical evidence it is effective as a cancer treatment. Laetrile can have toxic effects.

Intravenous Vitamin C

• Studies on the benefit of high-dose, intravenous vitamin C use for cancer have yielded varying results. Research in people is limited; most of the evidence is based on animal and laboratory research. The evidence is mixed for intravenous vitamin C’s impact on tumor growth or overall survival. Some studies have found an increase in quality of life and a decrease in cancer treatment–related toxicities, but the findings are not conclusive.
• Treatment with intravenous vitamin C generally seems to be well-tolerated and safe, but patients with certain conditions (e.g., iron overload, kidney disease) are at increased risk for serious toxicity.

Curcumin

• Curcumin, a substance found in turmeric, has been studied for its possible effects on cancer development and progression. Because a variety of different products and dosages were tested, and because the studies were brief and included only small numbers of people, there isn’t enough evidence to recommend products that contain curcumin for the treatment of people with cancer.
• Researchers are studying curcumin’s usefulness for alleviating side effects caused by cancer treatment, such as oral mucositis and radiation-induced dermatitis (a skin rash caused by radiation treatment), as well as quality of life.

Beware of Cancer Treatment Frauds

The U.S. Food and Drug Administration (FDA) has warned the public to beware of fraudulent cancer treatments promoted on websites or social media platforms.

Some fraudulent cancer treatments are harmful by themselves, and others can be indirectly harmful because people may delay seeking medical care while they try them, or because the fraudulent product interferes with the effectiveness of proven cancer treatments.

The people who sell fraudulent cancer treatments often market them with claims such as “treats all forms of cancer,” “cures cancer,” “selectively kills cancer cells,” or “more effective than chemotherapy.”

If you’re considering using any anticancer product that you’ve seen in an advertisement, talk with your health care provider first.

Complementary Health Approaches for Cancer Prevention

You can reduce your risk of cancer in several ways—including making healthy choices (such as avoiding tobacco and maintaining a healthy weight), getting recommended vaccines against hepatitis B and human papillomavirus (HPV), and getting appropriate cancer screening tests. Research has also been done to see whether various nutritional approaches might help to prevent cancer.

Vitamin and Mineral Supplements

The U.S. Preventive Services Task Force—an expert group that makes recommendations about the types of health care people should receive to prevent diseases—evaluated the evidence on vitamin and mineral supplements and cancer prevention in 2014. (A 2021 update to the report is underway and is anticipated to give the same advice.) The recommendations state that:

• You shouldn’t take vitamin E supplements to try to prevent cancer. Studies have shown that they don’t work.
• You shouldn’t take beta-carotene supplements to try to prevent cancer. Studies have shown that they don’t work, and they can harm some people, such as those who smoke tobacco.
• For all other vitamin and mineral supplements—including single vitamins or minerals, combinations such as calcium plus vitamin D, and multivitamins—there isn’t enough evidence to say whether they can help prevent cancer. The Task Force didn’t make a recommendation for or against the use of these supplements.

Green Tea

• Studies of green tea and cancer in people have had inconsistent results. Based on current evidence, it isn’t possible to say whether green tea helps to prevent cancer.
• Green tea is believed to be safe when consumed as a beverage in moderate amounts. Liver problems have been reported in a small number of people who took concentrated green tea extracts. Experts suggest that green tea extracts should be taken with food, people with liver problems should not take green tea extracts, and users should discontinue use and consult a health care provider if they develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice (yellowing of the skin or eyes).

Other Nutritional Approaches

Several other dietary supplements, including garlic,Ginkgo biloba, noni, and grape seed extract, have been investigated for possible cancer-preventive effects, but the evidence on these substances is too limited for any conclusions to be reached.

In two large observational studies in which researchers kept track of people over a period of years, people who took glucosamineand chondroitinwere less likely to develop colorectal cancer. Because these were observational studies, rather than trials in which people were randomly assigned to take a supplement or a placebo, the results can only provide clues for further research; they can’t prove a cause-and-effect relationship because other factors could be involved.

National Institutes of Health Research on Complementary Health Approaches for Cancer

Some ongoing studies related to complementary approaches and cancer funded by the National Center for Complementary and Integrative Health (NCCIH) or NCI are looking at:

• Whether panaxynol, a substance from American ginseng, can suppress colitis and thereby lower the risk of colon cancer
• The potential value of a multimodal mind and body intervention for reducing fear of cancer recurrence
• Self-administered hypnosis to manage hot flashes (which may be caused by breast cancer treatment)
• The potential value of yoga as a treatment for peripheral neuropathy, a painful side effect of some types of cancer chemotherapy

More To Consider

• Gather information about the complementary health product or practice that interests you, and then discuss it with your health care providers. If you’ve been diagnosed with cancer, it’s especially important to talk with your health care providers before you start using any new complementary health approach. If you’re already using a complementary approach, tell your health care providers about it, even if your reason for using it has nothing to do with cancer. Here are examples of questions to ask:
  • What is known about the benefits and risks of this product or practice? Do the benefits outweigh the risks?
  • What are the potential side effects?
  • Will this approach interfere with my cancer treatment?
  • Can you refer me to a practitioner?
• Don’t use any health product or practice that has not been proven safe and effective to replace conventional cancer care or as a reason to postpone seeing your health care provider about any health problem.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

Fatigue is experienced by almost every patient undergoing cancer treatment. There are numerous contributing causes including anemia, nutritional deficiencies, endocrine dysfunction, cardiopulmonary dysfunction, mood disturbance, pain, sleep disturbance, deconditioning, treatment-related effects, and the underlying malignancy. The following therapeutic approaches are supported by recent studies:

• Aerobic exercise
• Meditation and Mindfulness-Based Stress Reduction (MBSR)
• Clinical hypnosis, Guided Imagery
• Cognitive Behavioral Therapy
• Energy therapieshealing touch, therapeutic touch
• Acupuncture
• Relaxation techniques
• Massage
• Yoga
• Qigong and tai chi
• L-carnitine up to 3 grams per day

Cancer pain can be described as nociceptive or neuropathic. Nociceptive pain results from damage to tissue, while neuropathic pain is caused primarily by nerve injury. Unfortunately, despite the availability of various pain therapies, cancer pain is estimated to be moderate to severe in 50% of patients. Potentially beneficial interventions include:

• Clinical hypnosisespecially preprocedural, and in particular for breast biopsy and during percutaneous tumor treatment; Guided Imagery
• Music therapy
• Acupuncture
• Massage
• Cognitive Behavioral Therapy (CBT)
• Relaxation techniques
• Meditation
• Energy therapieshealing touch, therapeutic touch, Reiki

Cancer is a difficult diagnosis to receive and the treatment can be prolonged. Many patients experience depression, anxiety, mental stress, and anguish at the time of diagnosis or during various stages of the treatment. Coping can be very difficult, and at times, medications are necessary.

Potentially beneficial approaches to consider specifically for people with cancer include:

• Counseling, therapy, and support groups
• Meditation and MBSR
• Music therapy
• Massage
• Yoga
• Energy therapies
• Relaxation techniquesprogressive muscle relaxation, Guided Imagery
• Clinical hypnosis
• Qigong and tai chi

Quality of sleep is a major indicator of well-being. Sleep disturbances and lack of quality sleep occur in 30% to 75% of patients with cancer. Consider the following in cancer patients, as these show promise in the research:

• CBT
• Meditation and MBSR
• Yoga
• Qigong and tai chi
• Clinical hypnosis, Guided Imagery
• Relaxation techniques
• Melatonin 1-20 mg nightly as needed; start low and gradually increase dose as tolerated

Peripheral neuropathy is a potentially debilitating side effect caused by a number of chemotherapeutic agents, especially the platinum-based drugs and taxanes. Therapies that have shown potential benefit for neuropathy include the following:

• Exercise
• Acupuncture
• L-glutamine: 10 gm three times a day for the first 7 days of chemotherapy or 10 gm 1-2 times a day for prevention and maintenance
• Vitamin E: 300 mg twice a day during and continued for 3 months after platinum- or taxane-based chemotherapy

Mucositis is a common side effect of chemotherapy, local radiation, and bone marrow transplant, and is often the dose-limiting side effect for treatment. Mucositis involves inflammation and ulceration of the mucosal lining in the oral cavity, which causes pain, discomfort, and difficulty eating and swallowing, increasing the risk for hospitalization.

Tips for Mucositis

Mucositis is painful inflammation and ulceration of the lining of the digestive tract. To help with it, consider the following:

• Consume soft, moist, mild foods like fruit purees, soups, cooked cereals, pasta, and starchy vegetables.
• Try cold foods and drink through a straw.
• Maintain good oral hygiene and rinse the mouth
• Swish and swallow aloe vera juice a few times a day, and try drinking slippery elm or marshmallow root tea, for symptom relief. Topical application of 20 mL of pure honey 15 minutes before, 15 minutes after, and 6 hours after radiation therapy.
• Sucking on ice chips 5 minutes before, during, and after 5-FU infusion.

Other supplement to consider:

• L-glutamine can be used to prevent or treat oral mucositis
  • Oral: 5-10 gm 2-3 times a day
  • Swish and swallow: 16-24 gm of L-glutamine used four times a day or more
• Vitamin E has shown mixed results
  • Swish a vitamin E oil containing 400 mg/mL around the oral cavity twice a day
  • Zinc can be taken 25-50 mg three times a day during radiation to prevent or treat oral mucositis
  • Traumeel, a homeopathic remedy used as a mouthwash for chemotherapy patients, can be considered
  • Proteolytic enzymes containing papain, trypsin, and chymotrypsin taken three times a day from 3 days before until 5 days after radiation

Xerostomia is dry mouth caused by salivary gland damage due to head and neck radiation therapy. Decreased salivation can lead to dental caries, tooth decay, periodontal disease, inflammation, and ulceration, causing difficulty eating, swallowing, and speaking. Patients experience taste sensation changes, increased thirst, and tongue pain. Acute radiation-induced xerostomia is associated with an inflammatory reaction. Delayed radiation-induced xerostomia can occur up to one year after treatment from fibrosis of the salivary gland and is typically permanent.

Tips for Xerostomia

1. Add sauces and oils to increase the moisture content of food. Consume blended and pureed foods, soups, and stews to ease swallowing. Thick, creamy, nutrient-rich liquids are recommended.
2. Keep the mouth moist by sucking on ice chips, ice pops, or hard candy. Drink liquids with meals.
3. Add citric acid-containing foods to the diet to stimulate saliva production, including oranges and lemons. (Not recommended if one has mucositis as well.)
4. Avoid foods rough in texture or eaten at extreme temperatures as this could worsen injury. Avoid very dry foods.
5. To minimize the risk of oral infection, cleanse the palate by swishing with a saline solution (1 qt water with 3/4 tsp salt and 1 tsp to 1 tbsp baking soda) before and after eating. Practice good oral hygiene.
6. Acupuncture may stimulate salivary production.

Lymphedema is swelling that occurs in a limb. With breast cancer, it may occur postoperatively if lymph nodes are removed during surgery. It can occur months to years after treatment and is a chronic condition which can be managed but not cured. Numerous modalities can prevent lymphedema from occurring or reduce its progression.

• Massage and manual lymphatic drainage for treatment.
• Upper body exercise may help to prevent it
• Selenium selenite: 1,000 mcg daily loading dose for first week, 300 mcg for the next 2 weeks, and then a maintenance dose of 100 mcg for 3 months

Inflammation of the mucous membranes in the mouth is often associated with disruption of the gut mucosa, leading to gastrointestinal toxicity, such as leaky gut or diarrhea. The degree of mucositis is directly correlated with the severity of intestinal permeability. Lactose intolerance also increases during chemotherapy. Probiotics may prevent or reduce chemotherapy and radiation induced diarrhea and rarely cause severe adverse effects.

Tips for Diarrhea

1. Sip clear liquids throughout the day to prevent dehydration.
2. Eat small, frequent meals and snacks throughout the day.
3. Avoid greasy, fried, or spicy foods, caffeine, and chewing gum. Avoid commercial fruit juices.
4. Reduce fiber intake temporarily.
5. Consume bland foods as part of the BRAT diet.
6. Increase intake of potassium-containing foods.
7. Consider L-glutamine 5-10 gm orally 2-3 times daily.
8. Probiotics 1-3 times daily, containing Lactobacillus. VSL#3, a proprietary blend of eight bacterial strains, is also effective.

Approximately 80% of patients treated with radiation therapy experience some form of skin irritation, ranging from hyperpigmentation to ulceration. These conditions may lead to pain, discomfort, itching, burning, or even permanent scarring. Calendula cream might be helpful. Aloe vera gel and hyaluronic acid are not recommended due to lack of effect.