What constitutes comprehensive cancer care? One
interpretation, by the National Cancer Institute (NCI), defines it as a commitment to
exploring the basic science and clinical care of patients with cancer. Cancer
centers designated by the NCI as "comprehensive" are expected to offer
state-of-the-art, multidisciplinary clinical services and to conduct biomedical
research to advance the understanding and treatment of cancer.
More generally, comprehensive care reflects a broadened sense of
responsibility for addressing all aspects of the cancer patient’s needs. There
is a growing trend in oncology to "treat the patient, not the
disease," and to incorporate patient services into comprehensive care. In
addition to traditional medical services, many cancer centers now recognize the
importance of dedicated nursing, symptom and pain management, psychosocial
counseling, patient advocacy, patient information centers, and other nonmedical
patient services. Complementary and alternative therapies may be added to this
conventional rosteradditions that put the "comprehensive" in
Comprehensive Cancer Care, a new book by Dr. James S. Gordon and Sharon Curtin.
Gordon is founder and director of the Center for Mind-Body
Medicine, a nonprofit, educational organization in Washington, DC, that focuses
on "models of healing that will transform all parties in the healing
process." He is also clinical professor of psychiatry and family medicine
at Georgetown University School of Medicine, and was recently appointed chairman
of the White House Commission on Complementary and Alternative Medicine Policy.
Although not an oncologist, Gordon has hosted three annual Comprehensive Cancer
Care conferencesmeetings that have served as forums for alternative and
complementary therapies in cancer to an audience of traditional and
Comprehensive Cancer Care is principally a distillation of the
1998 and 1999 conferences, interspersed with summaries and text from Gordon and
Curtin, along with clinical vignettes based on patients at the Center for
Mind-Body Medicine. (Content from both the conference’s formal presentations
and panel discussions can also be found at the Center’s website [www.cmbm.org]). The book seeks to be a "reliable guide" for those
interested in complementary and alternative therapies for cancer, with the
target audience clearly intended to be patients, families, and friends.
Gordon’s background in psychiatry and Curtin’s strength as a
patient advocate are evident in their sympathetic, insightful descriptions of
patients confronting cancer. Introductory chapters on the psychological
reactions to cancer and the understandable desires of diagnosed patients are
clearly written; they are sensitive to a variety of emotional and physical needs
of cancer patients, very supportive, and to the point. Cancer patients and their
families will find that this book resonates with their own experiences. Gordon
also captures many of the conflicting thoughts of patients and families: the
need to trust in professionals, yet take control of one’s treatment; the hope
for successful therapy tempered by an understanding that many treatments are
imperfect; the need for both acceptance and defiance.
Next, the authors present an overview of their mind-body
medicine program, emphasizing techniques for relaxation, stress management,
coping strategies, basic nutritional support, and social support from formal
support groups, social networks, clergy, and family. Principles of such
comprehensive care are well explained, and most of the recommendations are
straightforward and made without excessive claims. Emphasis is consistently
placed on improving quality of life for cancer patients, because clearly, such
activities play important roles in the care of many patients.
The latter half of the book covers less widely accepted medical
perspectives and treatments, such as traditional Chinese medicine,
phytochemicals, melatonin, therapeutic diets (involving soy, garlic, or shark
cartilage), "immunomodulation," and other therapies, such as Dr.
Burzynski’s antineoplastons. Gordon and Curtin are eager to distinguish these
alternative medicine approaches from "old wives’ tales."
The text in the chapters on alternative treatments closely
follows the presentations of various practitioners at the Comprehensive Cancer
Care conferences. Most chapters share a similar structure, consisting of a
purported rationale for the therapy, anecdotal or limited clinical evidence for
benefit, and the declaration of resolve to further study the intervention.
Alternative methods are described in reasonable detail, providing readers with
an understanding of the origins and current status of many of the more familiar
The authors make little attempt to hide their enthusiasm for
these alternative treatments, which they view as the "changing paradigm of
cancer care." It is clear that many patients are using alternative and
complementary therapies to address concerns about cancer symptoms, treatment
side effects, and quality of life. The possible benefits of alternative
therapies in addressing quality-of-life issues are explored at length, and a
variety of anecdotal evidence is described, suggesting that by taking part in
these various health-related practices, patients feel better about their cancer
experience. By acknowledging the role of alternative and complementary health
practices and by addressing the anxieties and psychological needs of patients,
Gordon and Curtin have made an important statement about the way these
treatments are used and how they may be helpful to patients.
Nonetheless, it becomes problematic when that enthusiasm leads
to claims about the therapeutic benefits of complementary health care in
treating cancer. In many instances, it is not so clear that enthusiasm is
justified by adequate clinical experience. While Gordon and Curtin emphasize the
need for properly conducted prospective clinical trials, there are precious few
instances of such data. I believe the book would have been stronger as a
valuable reference document if the authors had used more circumspection and made
a more critical appraisal of many of the reports presented at the Comprehensive
Cancer Care conferences.
As it now stands, the bookwith its exuberant toneis a
forum for upbeat presentations. The tone leads to occasional overstatements,
subtle contradictory points, and endorsements of treatments for which, the
authors acknowledge, there are no adequate data. For instance, the authors
"...using [traditional Chinese] herbs appropriately in
combination with chemotherapy and radiation significantly enhances the
effectiveness of these therapies."
"...virtually all those who offer comprehensive care now
recommend the inclusion of green tea as part of an anti-cancer strategy and as a
"...only case studies have been published. Randomized
clinical trials have not been completed. The evidence is strong enough that some
clinicians and many patients are using CoQ10 (co-enzyme Q10) as an adjunctive
therapy. We recommend it as well."
Cancer is a frightening disease, and it is understandable that
patients will pursue every possible option to help conquer it. Alternative and
complementary medicine is widely prevalent, and is becoming a standard part of
the conversation between doctors and patients. That in itself is a landmark
event, affording physicians a chance to more fully participate in the lives of
It is, indeed, important for clinicians to be aware of the
health-related activities in which our patients are engaged. But it is also
important to acknowledge the limitations of our knowledge,
and to distinguish recommendations built on compelling clinical trials from
those based on good ideas and good intentions.
When the data are insubstantial or nonexistent, prudence
dictates caution when making recommendations to patients. Patients will benefit
from openness, confidence, and optimismnot false hope.
Our era is not the first to be fascinated by alternative,
nonstandard medical treatments. Such therapies have existed alongside
"traditional" medicine for millennia. At the last fin de siecle, a
proliferation of "cures" across America prompted Mark Twain to write:
"They claim the ability to cure malignant cancer, and other affections
which have never been cured in the history of the race. There would seem to be
an element of danger here. It has the look of claiming too much, I think."
Organized medicine and the National Institutes of Health are
making a commitment to study alternative medicine and integrative care in a more
comprehensive, systematic, and thorough fashion. While awaiting the results of
these studies, we need to be careful not to claim too much.