MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Today is WORLD CANCER DAY. A good reason, I feel, to remind everyone of the existence of CAM-CANCER, an initiative that I have been involved with from its start (in fact, I was one of its initiators). Essentially, we – that is an international team of CAM-experts – conduct systematic reviews of CAMs often advertised for cancer. We then offer them as a free web resource providing the public with evidence-based information about all sorts of CAMs for cancer.

CAM-Cancer follows a strict methodology to produce CAM-summaries of high quality. Writing, review and editorial processes all follow pre-defined methods and the CAM-Cancer editorial team and Executive Committee ensure that CAM-summaries comply with the guidelines and templates. We are independent from commercial funders and strive to be as objective as possible. Most of the experts are more enthusiastic about the value of CAM than I am, but we do our very best to avoid letting sentiments get in the way of rigorous scientific assessments.

So far, we have managed to publish a respectably large and diverse array of summaries. Here is the full list:

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Y

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Let me pick out just one of the summaries, Gerson therapy. This topic has led to fierce debates on my blog. The ‘key points’ of the CAM-CANCER summary are as follows:

  • Gerson therapy uses a special diet, supplements and coffee enemas with the aim of detoxifying and stimulating the body’s metabolism.
  • No substantial evidence exists in the scientific literature to support the claims that the Gerson therapy is an effective alternative therapy for cancer.
  • Some evidence exists to suggest that elements of the therapy (coffee enemas in particular) are potentially dangerous if used excessively.
  • The specific safety problems, advice to stop conventional cancer therapies and the lack of substantial evidence for efficacy outweigh any benefits associated with the Gerson therapy.

I think this is clear enough and it certainly corresponds well with what I previously wrote about Gerson on this blog. The style of presentation might be different, but the information and conclusions are almost identical.

Altogether, our CAM-CANCER summaries are well-informed, concise, and strictly evidence-based. On this WORLD CANCER DAY, I therefore warmly recommend them to everyone and sincerely hope you make good use of them, for instance, by telling other interested parties about this little-known but precious resource.

11 Responses to CAM-CANCER: a most valuable source of information

  • Thank you Professor Ernst. That’s a great resource for skeptics.

  • Thank-you for this informative list. I thought you might be interested in my own thoughts on some of these:

    Aloe vera
    We used to use aloe vera gel for women undergoing breast radiotherapy. I don’t suppose it had a great deal of effect on the severity and duration of radiation dermatitis, which is self-limiting and runs its course over 2 – 3 months, but our patients reported that they found it soothing. Generally speaking, irradiated skin is very sensitive, and almost anything (soap, rubbing, sunlight, bathing) will make the dermatitis worse.

    Cucurmin, pomegranite, green tea
    A colleague of mine, Professor Rob Thomas at Cambridge, investigated these three foods together with broccoli as a possible treatment for early prostate cancer. He had extracts of the four ingredients made into a pill, together with identical placebo pills. He looked at men with early, low-risk prostate cancer, which is generally managed by active surveillance (i.e. monitoring for signs of progression, in the knowledge that most of this population will never require treatment), following them over two years in a double-blind randomised prospective trial. He found that there was a lower rate of intervention (i.e. radiotherapy or prostatectomy) in the non-placebo group. Afterwards the company who made up the pills marketed them as Pomi-T.

    My personal take in green tea is that it is delicious, but it is almost impossible to find anything worth drinking outside Asia. Popular brands in the UK taste like cardboard, and what you can find in specialist shops is stale. Happily there are Chinese suppliers which will take orders online and ship to the UK. I suspect that the health-giving effects are overstated.

    Pomegranite juice
    As far as I know the interest in pomegranite juice was kicked off by a single study which showed that it lowered PSA in prostate cancer patients. PSA was taken as a surrogate for cancer response, but while this may be helpful to a clinican in monitoring treatment, what really matters is survival, disease-free survival and quality of life. It later transpired that the main sponsor of the study was the manufacturer of the juice.

    Selenium
    There was an important prostate cancer prevention trial published within the last few years known as SELECT. This was a prospective double-blind placebo-controlled trial with a four-way randomisation between selenium, vitamin E, both and neither. The findings were that selenium had no effect on cancer risk, but vitamin E increased it (which is in line with other cancer-prevention trials which have found increased rates of cancer with antioxidants).

    Vitamin E during cancer treatment
    I don’t know anything about this, and I was interested to read your review. It makes sense that a topical antioxidant would reduce local effects of radiotherapy, since the action of radiotherapy is dependent on the creation of oxygen free-radicals. However, if it does reduce some of the long-term toxicity of cytotoxics this is potentially important as e.g. neurotoxicity is a serious problem.

    PC-SPES
    I have always wondered how the manufacturers could claim that their product was “contaminated” with synthetic pharmaceuticals. Considering that diethylstilbestrol (DES), warfarin and indomethacin were present in therapeutic quantities and seem to have been chosen for their effect on metastatic prostate cancer, their presence cannot have been anything other than deliberate. DES is used in the UK as treatment for metastatic prostate cancer and is effective though it does have significant toxicities (anti-androgenic effects, breast development, nausea and most importantly a marked increase in blood clotting leading to strokes, pulmonary embolism and myocardial infarction). It is always prescribed, therefore, with an antithrombotic agent; it used to be low-dose warfarin, but people differ so much in their sensitivity to warfarin that nowadays aspirin is used as it is considered to be safer. Indomethacin is a very powerful anti-inflammatory agent which would certainly reduce pain due to bone secondaries. However, it is also one of the most toxic NSAIDs, so its use is restricted to short-term use for severe problems (such as gout). The risk of bleeding is so high that it is absolutely contraindicated with warfarin. The rebound effect on the cancer after stopping treatment is just as you would expect with DES.

    PC-SPES, then, is nothing but a cocktail of powerful drugs used in a very unsafe way and dressed up as a herbal supplement. The fact that it exists at all shows a callous disregard by the manufacturers for the wellbeing of their customers. The replacement, SPES-2, does not as far as I know contain any synthetic drugs, and presumably its sales depend on the reputation of PC-SPES.

    • thanks; looks like you might be a good person to join our CAM-CANCER group. if you are interested and well enough to do some work, I’d be delighted to suggest you to the group.

  • I had only heard of the Gerson Therapy as a “treatment” for autism. It is good to see that coffee enemas work for cancer as well. Is there a veterinary version for horses?

  • Dr Money-Kyrle:
    Are you able to offer any references for Dr Rob Thomas’s important work which you cite?
    I assume it has been published.

    Many thanks.

    • Certainly Richard:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020278/

      Also on the Pomi-T Web site there is a summary of the trial which was presented at the ASCO (the American Society of Clinical Oncology) annual meeting – where you will find a large fraction of the world’s oncologists:
      https://www.pomi-t.co.uk/pomi-t-summary-presented-at-asco/

      Actually this paper is slightly different from what I remember of a presentation that Professor Thomas made to the BUG (British Uro-oncology Group) annual meeting, which was in September 2014 (I have checked the date as I was usually the official photographer at the meeting and it is the only year in which I have photographs of him). I have clearly misremembered the duration of follow-up, as I thought it was longer than six months (unless he was presenting more recent data at BUG). Also, in the paper the end-points are change in mean PSA and proportion of patients with stable or falling PSA, whereas I remember him talking about the number of patients who went on to have definitive treatment (radiotherapy or surgery).

      On reading the paper just now I have a few comments to make as I doubt that many of the people reading this are familiar with the natural history and management of prostate cancer.

      There were two completely different groups of patients studied. The first, designated the AS (active surveillance) group had a diagnosis of low-risk prostate cancer. We know that many of these don’t behave like cancer at all, and never progress to the point of endangering health. However, some of them prove to be intrinsically more aggressive, and at the moment the only way of distinguishing them is to see how they behave (though it seems likely that molecular markers will be found soon to answer that question). Active surveillance involves regular monitoring of PSA together with annual MRI scans and at least one follow-up biopsy. We would therefore expect a large proportion in the AS group not to show much change in PSA.

      The second, designated WW (watchful waiting) had already had definitive treatment for a previous prostate cancer (such as radiotherapy) and had then relapsed. They were deemed unsuitable for salvage therapy (i.e. a second attempt at curative treatment) and instead were being monitored with a view to starting palliative treatment (i.e. to control but not cure the cancer) at some point in the future. For a slow-growing tumour this is reasonable management, as the mainstay of treatment is to block testosterone, which does have side-effects, and this approach can delay the start of hormonal therapy by several years. For a fast-growing tumour you would want to start hormones much earlier, and the PSA doubling time is very useful here. For the purposes of the trial, you would expect most patients in this group to show a PSA rise.

      These two groups (AS and WW) were analysed separately, but in fact the both showed similar differences between the FSG (food supplement group) and the PG (placebo group), suggesting that Pomi-T was beneficial in both cases.

      I was a little surprised to see a larger rise in PSA in the untreated AS group than I would have expected, particularly as the follow-up period was only six months – indeed, most patients on active surveillance in my experience hardly show any change in PSA over such a short period of time.

      It is important to remember that a rising PSA is not necessarily the same as a progressing cancer, and what really matters is whether an intervention can have an effect on overall survival, disease-free survival or quality of life. Having said that, if Pomi-T is able to reduce the number of patients on active surveillance who then go on to have either prostatectomy or prostate radiotherapy, then it is clearly sparing them the side-effects of treatment. For that matter, there is no good evidence that prostatectomy prolongs survival (there is some evidence for radiotherapy, however).

      Nevertheless the trial seems to have been well-designed and the results are certainly very interesting.

      Coming back to PSA, it was always my practice to plot every PSA measurement I could find for each patient on a semi-logarithmic graph (i.e. log(PSA) against time). This would generally give a straight line, and the PSA doubling time could be derived from the slope. This was very useful as changes in doubling time, representing changes in the behaviour of the tumour (usually due to the emergence of a faster-growing clone) were very obvious and were clear indicators of the need to change treatment. It was also clear that many standard interventions (for instance blocking testosterone with an LHRH analogue such as Zoladex) shifted the line downwards (usually by a factor of about 100) but didn’t change the slope, indicating that they had halted the disease in most of the tumour cells and left it unaffected in some of them. Sometimes the plot didn’t follow a straight line at all, which usually meant that any PSA rise was due to prostatitis rather than cancer. Sometimes it would fall and then rise to rejoin the original curve, indicating that treatment may have lowered the PSA for a while, but did not have any appreciable effect on the cancer long-term (this was often the case adding bicalutamide after progression through an LHRH analogue).

      I didn’t know any other prostate oncologist who used this graphical method, probably because it takes a lot of time to enter the data, and also because there was no suitable off-the-shelf software (I wrote my own). Although many pathology reporting systems now include the option to graph a series of results, I have yet to come across one that will use a logarithmic scale (which turns an exponential curve into a straight line) or derive a doubling time.

      Monitoring the PSA in this way is very useful for follow-up after treatment, since both radiotherapy and surgery either remove or destroy any functioning prostate tissue (the situation with the WW group in the trial)

      However, with an intact, untreated prostate, the cancer will only represent a small proportion of the prostate, and most of the PSA will come from the benign tissue. This means that a doubling in size of the cancer might only give a 10% rise in the PSA, for instance. In this situation (the AS group in the trial) the absolute rather than proportional rate of rise in PSA is more useful (rather confusingly this is referred to as the “PSA velocity” although not being a vector it isn’t a velocity in any mathematical sense of the word).

      Sorry, I think I have strayed a bit from your question, though I suppose I have given some idea of what is required in order to extract meaningful information from PSA measurements.

  • Thanks for the list. Makes for a great bookmark right up there beside your blog and SkepDoc’s website!

    A little surprised to read this about aromatherapy: “There is no strong evidence for long-term aromatherapy effects.” Since cannabis has become legal here is Canada, my neighbours swear by it. I THINK that’s aromatherapy, anyway.

  • This is a great resource and one I was not previously aware of. Is the target audience members of the general public or primarily those people with a science and / or medical background? For the latter it is great but I’m not sure most of what’s on there is written in a way that will help members of the public make informed decisions. For instance for reflexology it says in the key points:
    Reflexology employs manual pressure to specific areas of the body, usually the feet, which are thought to correspond to internal organs with a view of generating positive health effects.
    Evidence for improvements in pain, quality of life, anxiety and breathlessness are limited by methodological shortcomings of trials
    Reflexology has a good safety record.

    A member of the public might conclude that reflexology is worth a go because it’s safe and it may generate some “positive health effects”. I don’t think that most members of the public would understand that “limited by methodological shortcomings of trials” basically means it’s not been shown to be beneficial. It would also be good if the page made it clear that there really isn’t a link between parts of the feet and internal organs and therefore reflexology doesn’t have a plausible mechanism of action.

    This isn’t intended to be critical as I do think this is a great resource. However, I do question whether it is suitable for members of the general public in its current form.

  • The great service in this blog and the nice technology is visible in this blog. I am really very happy for the nice approach is visible in this blog and thank you very much for using the nice technology in this blog

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