乳腺癌患者开始接受替代疗法（英文）

MSNBC.NEWS

　　Breast cancer patients turning to alternative care

　　Six months of chemotherapy for breast cancer weighed heavily on Karen Lehman. “I felt crummy,” says the normally cheerful 49-year-old. “There was the fatigue and the constant queasiness.” To help cope, she tried acupuncture and craniosacral massage and is considering other alternative therapies as she continues battling cancer.（十月20日—经历了六个月的乳腺癌化疗之后，Karen Lehman付出了沉重的代价。“我感到无法忍受，”一向乐观的现已49岁的Karen Lehman说“化疗期间经常会出现疲劳和恶心。”为了解决这个问题，她准备接受针灸、捏脊以及其他替代疗法的辅助治疗。）

　　HER HOLISTIC APPROACH is not unusual. In fact, Lehman is one of a growing majority of breast cancer patients who are turning to alternative therapies to help deal with the side effects of conventional treatment or compensate for the times when mainstream medicine falls short.

　　As many as 70 percent of cancer patients use alternative therapies, including dietary supplements, acupuncture, hypnotism, massage, guided imagery, magnets and biofeedback, according to a recent report in The Journal of Alternative and Complementary Medicine. The study, a telephone survey of more than 350 cancer patients in Washington state, found that breast cancer patients were the group most likely to try holistic approaches and that almost all respondents believed the treatments improved their well-being. Other studies have also shown that alternative medicine use is common among people with life-threatening illnesses.

　　“I expected there to be a high percentage of cancer patients using alternative therapies because I think these patients are looking for ways to help their health and to take control of their health care,” says study author Ruth Patterson, a scientist at the Fred Hutchinson Cancer Research Center in Seattle. “The unexpected piece of this is just how high the satisfaction level was. Patients felt these things helped them feel better — that’s nothing to sneeze at.”

　　Alternative practitioners, who emphasize mind/body wellness, can be a welcome change to patients frustrated with hurried doctors who don’t always have the answers — or who give conflicting advice on key issues like mammograms and breast self-exams.

　　INdivIDUALIZED APPROACH

　　“People feel that alternative medicine is more tuned into their bodies, rather than a one-size-fits-all approach that tends to be common in Western medicine,” says Dr. Debu Tripathy, director of the breast cancer research program at the University of Texas Southwestern Medical Center at Dallas and co-editor of the new book “Breast Cancer: Beyond Convention” (Atria Books, 2002).

　　But the new survey findings raise questions that are at the heart of the ongoing debate over alternative therapies. Do they actually fight disease? Or is the effect just psychological? Or a combination of both? When it comes to breast cancer, as with many diseases, there are few clear answers.

　　Supplements are one of the most popular alternative therapies for breast cancer, but experts say there is no convincing evidence to support their use. “Most of what is sold to treat or cure cancer are concoctions that people put together,” says Barrie Cassileth, chief of the integrative medicine service at Memorial Sloan-Kettering Cancer Center in New York. “They should be looked at with a jaundiced eye.”

　　Click on a tab above to learn what experts say about some of the alternative therapies for breast cancer. Always check with your doctor before trying alternative approaches.

　　Acupuncture - Can reduce chemotherapy-induced nausea and vomiting, and may also fight pain and fatigue.

　　Massage - Can relieve stress and fatigue.

　　Meditation - Can ease stress and improve overall well-being.

　　Yoga - Can ease stress and improve overall well-being.

　　Support groups - May ease stress and help patients cope. One study suggests support groups may even help breast cancer patients live longer.

　　St. John's wort - Can reduce the effectiveness of chemotherapy by as much as half.

　　Antioxidants - Vitamins including C and E may interfere with conventional cancer treatments such as chemotherapy. They may also cause bleeding complications during surgery.

　　Soy supplements - Supplements containing soy or other plant estrogens known as phytoestrogens may fuel the growth of tumors in women with estrogen-dependent cancers.

　　Chaparral - Has been linked to severe liver damage.

　　Essiac - May damage the heart and kidneys, particularly when combined with chemotherapy.

　　Printable version SUPPLEMENT DANGERS

　　What’s more, certain supplements may be dangerous. “Herbs can interfere with the amount of medicine that can get into the body and can also interfere with the coagulation of blood, which can be a problem with surgery,” Cassileth warns. For instance, St. John’s wort and various antioxidants, including vitamins C and E, may reduce the effectiveness of standard treatments like chemotherapy. And experts say that although soy in the diet may offer some protection against breast cancer, high-dose soy supplements or other products containing plant estrogens may, paradoxically, have the opposite effect — fueling the growth of tumors — in women with the disease.

　　Another concern is that a supplement may not contain what the label claims or may be contaminated with harmful substances, says Leanna Standish, a naturopathic doctor at Bastyr University in Kenmore, Wash. Supplements are not subject to the same strict safety and effectiveness standards as drugs. Because of this, Standish generally advises patients to avoid over-the-counter supplements.

　　In some cases, though, supplements prescribed by a qualified naturopath or herbalist may be used safely as an adjunct to standard care, she maintains. Standish receives many referrals from oncologists whose patients are interested in trying alternatives. Though not definitively proven to work, she often prescribes coenzyme Q10, vitamins E and B6, quercetin and garlic because laboratory studies have suggested they may be beneficial. Standish is tracking her patients to see if the supplements actually work. But she cautions patients against rushing to take these supplements on their own, since they may cause problems depending on the dose and other treatments used.

　　Tripathy also is studying herbs to see if they can help with the side effects of chemotherapy or as actual cancer fighters. One of his studies is testing whether herbs such as skullcap, which showed promise in the lab, can help shrink breast tumors in patients with advanced disease who cannot be cured by conventional medicine.

　　While the jury remains out on supplements for breast cancer, some alternative therapies are gaining acceptance as potentially beneficial modalities when used in conjunction with standard care. Such “complementary” approaches as massage therapy, meditation and yoga may boost patients’ mood and well-being, experts say. “Some of the mind/body techniques can certainly help the emotional state and that’s a valuable thing,” says Tripathy. “The question is, Can they help the cancer itself?”

　　Lehman has had mixed results with the alternative approaches she’s tried. Though acupuncture has been shown to fight chemotherapy-induced nausea, she doesn’t think her 10-week treatment helped all that much. “I had one week where it was wow — I was symptom-free — but it went downhill after that,” says Lehman, a flight attendant for Northwest Airlines who lives in Seattle. The craniosacral massage, a technique that focuses on the head and lower spine, “took the stress totally away but it didn’t do anything for my nausea.”

　　Still, as Lehman continues treatment, she is open to the idea of trying other alternative therapies under the guidance of her doctors. She just started experimenting with a homeopathic remedy containing the herb arnica to help her heal from a recent double mastectomy and may use it as an aid during upcoming radiation treatments.

　　“And if I had a cancer recurrence,” Lehman adds, “I would say, ‘What else is out there?’”

2002.10.21