About Complementary/Integrative Medicine
The definitions provided below are from various authoritative sources and are provided here for general explanation purposes. Please refer to the Web pages for more details.
The term conventional medicine refers to medicine as practiced by holders of M.D. (medical doctor), D.O. (doctor of osteopathy) degrees and allied health professionals, some of whom may also practice complementary and alternative medicine. Other terms for conventional medicine are allopathic, western, orthodox and mainstream medicine and biomedicine.
Therapeutic approaches taken in place of traditional medicine and used to treat or ameliorate disease
Therapies practiced together with, or in addition to conventional (or allopathic) medicine
Combines traditional western (or allopathic) and complementary approaches, but does not replace conventional therapy. It may be used for:
- Managing symptoms
- Increasing wellness (quality of life, reported sense of well-being)
- Improving treatment efficacy
Basic Principles of Integrative Medicine
- A partnership between patient and practitioner in the healing process
- Appropriate use of conventional and complementary methods to facilitate the body's innate healing response
- Focuses on the whole person
- Consideration of all factors that influence health, wellness and disease, including mind-spirit and social physical dimensions of health
- A philosophy that neither rejects conventional medicine nor accepts alternative medicine uncritically, but is informed by evidence
- Recognition that good medicine should be based in good science, inquiry driven and open to new paradigms
- The broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
"CAM" Complementary/Alternative Medicine
An acronym describing the meaning complementary and alternative medicine
An acronym used when describing the combined use of complementary and integrative medicine approaches.
National Center for Complementary and Alternative Medicine (NCCAM): Major Domains of Complementary and Alternative Medicine (for Consumers and Practitioners)
Complementary and alternative healthcare and medical practices (CAM) are those healthcare and medical practices that are not currently an integral part of conventional medicine. The list of practices that are considered CAM changes continually as CAM practices and therapies that are proven safe and effective become accepted as "mainstream" healthcare practices. Today, CAM practices may be grouped within five major domains:
- Whole medical systems
- Mind-body medicine
- Biologically-based practices
- Manipulative and body-based practices
- Energy medicine
The individual systems and treatments comprising these categories are too numerous to list in this document. Thus, only limited examples are provided within each.
Whole Medical Systems
Whole medical systems involve complete systems of theory and practice that have evolved independent of and often prior to the conventional biomedical approach. Many are traditional systems of medicine that are practiced by individual cultures throughout the world.
Traditional oriental medicine emphasizes the proper balance or disturbances of qi (pronounced chi), or vital energy, in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods, including acupuncture, herbal medicine, oriental massage and qi gong (a form of energy therapy described more fully below). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a needle.
Ayurveda (Eye yer vay duh) is India's traditional system of medicine. Ayurvedic medicine (meaning "science of life") is a comprehensive system of medicine that places equal emphasis on body, mind and spirit, and strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight and controlled breathing.
Other traditional medical systems have been developed by Native American, Aboriginal, African, Middle-Eastern, Tibetan, Central and South American cultures.
Homeopathy and naturopathy are also examples of complete alternative medical systems. Homeopathy is an unconventional Western system that is based on the principle that "like cures like," i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic physicians believe that the more dilute the remedy, the greater its potency. Therefore, homeopaths use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness.
Naturopathy views disease as a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies involving electric currents, ultrasound and light therapy, therapeutic counseling and pharmacology.
Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a subset of mind-body interventions are considered CAM. Many that have a well-documented theoretical basis, for example, patient education and cognitive-behavioral approaches are now considered "mainstream." On the other hand, meditation, certain uses of hypnosis, dance, music and art therapy and prayer and mental healing are categorized as complementary and alternative.
This category of CAM includes natural and biologically-based practices, interventions and products, many of which overlap with conventional medicine's use of dietary supplements. Included are herbal, special dietary, orthomolecular and individual biological therapies.
Herbal therapies employ individual or mixtures of herbs for therapeutic value. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin and Weil, are believed to prevent and or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals, such as, magnesium, melatonin and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and bee pollen to treat autoimmune and inflammatory diseases.
Biological-based Practices may be further subdivided into:
The specific definition of an herb is any seed producing plant that does not have persistent woody tissue, but rather dies down at the end of a season. The general definition is a plant valued for its medicinal, savory or aromatic properties.*
Nutrition and Special Diets
Nutrition is defined generally as the act or process of nourishing; specifically it is the sum of the process by which an animal or plant takes in and utilizes food substances*. Diets commonly used by patients with cancer may be described as restrictive, supplemental or simply require changes in food habits.
Non-plant biologic (related to life*) organic (derived from living organisms*) pharmacologic (drugs or substances used as medications*) make up the remaining category of biological therapies that are usually swallowed, injected or applied to the skin.
*Webster's Medical Desk Dictionary. Merriam-Webster, Inc., Springfield, MA (1986).
Manipulative and Body-Based Practices
This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure (primarily the spine) and function, and how that relationship affects the preservation and restoration of health, using manipulative therapy as an integral treatment tool. Some osteopaths, who place particular emphasis on the musculoskelatal system, believing that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body, practice osteopathic manipulation. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
Energy therapies focus either on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields).
Biofield therapies are intended to affect the energy fields, whose existence is not yet experimentally proven, that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, to improve blood circulation and to enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that by channeling spiritual energy through the practitioner the spirit is healed, and it in turn heals the physical body. Therapeutic Touch is derived from the ancient technique of "laying-on of hands" and is based on the premise that it is the healing force of the therapist that affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances.
Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields or alternating current or direct current fields, to, for example, treat asthma or cancer, or manage pain and migraine headaches.
Bias involves human choices or any other factors beside the treatments being tested that affect a study's results. Clinical trials use many methods to avoid bias, because biased results may not be correct.
In a clinical trial, the group of people that receives standard treatment of care, and is compared to the treatment group in order to evaluate the new treatment. (See Treatment group.)
Informed consent is the process in which a person learns key facts about a clinical trial or research study and then agrees voluntarily to take part or decides against it. This process includes signing a form that describes the benefits and risks that may occur if the person decides to take part.
Institutional Review Board (IRB)
The IRB is a group of scientists, doctors, clergy and consumers at each health care facility at which a clinical trial takes place. Designed to protect patients who take part in studies, IRBs review and must approve the protocols for all clinical trials funded by the Federal Government. They check to see that the study is well-designed, does not involve undue risks, and includes safeguards for patients.
A researcher in a treatment study
A doctor who specializes in treating cancer
A tablet, capsule or injection that looks like the drug or other substance being tested but contains no drug
A protocol is an action plan for a clinical trial. The plan states what will be done in the study and why. It outlines how many people will take part in the study, what types of patients may take part, what tests they will receive and how often and the treatment plan.
Randomization is a scientific method used to prevent bias in research. People are assigned by chance to either the treatment or control group.
When the signs and symptoms of cancer go away, the disease is said to be "in remission." A remission can be temporary or permanent.
Problems that occur when treatment affects healthy cells. Common side effects of standard cancer treatments are fatigue, nausea, vomiting, decreased blood cell counts, hair loss and mouth sores. New treatments being tested may have these or other unknown side effects.
Single blind study
This is a research method used to prevent bias in treatment studies. In a single blind study, the patient is not told whether he/she is taking the standard treatment or the new treatment being tested. Only the doctors know.
Double blind study
In a double blind study, neither the patient nor the doctor knows who is taking the standard treatment or the new treatment being tested.
The stage refers to the extent of a cancer and whether the disease has spread from the original site to other parts of the body. Numbers with or without letters are used to define cancer stages (e.g., Stage IIb).
Standard treatment/Standard of Care
Treatment based on the consensus of experts; deemed appropriate and widely used. Also refer to as a best practice
The group that receives the new treatment being tested during a study (See Control group.)
Clinical trial/Clinical study
A type of research study that tests how well new medical approaches work in people. May explore new methods of screening, prevention, diagnosis, or treatment.
The goal of this research is to find better ways to treat cancer and help cancer patients. Clinical trials test many types of treatment such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments or new methods such as gene therapy.
The phases of clinical trials (from the National Cancer Institute (NCI) Office of Cancer Complementary Alternative Medicine update posted 04/2010):
Phase I trials
These first studies in people evaluate how a new drug should be given (by mouth, injected into the blood or injected into the muscle), how often and what dose is safe. A phase I trial usually enrolls only a small number of patients, sometimes as few as a dozen.
Phase II trials
A phase II trial continues to test the safety of the drug, and begins to evaluate how well the new drug works, efficacy. Phase II studies usually focus on a particular type of cancer.
Phase III trials
These studies test a new drug, a new combination of drugs or a new surgical procedure in comparison to the current standard for treatment. A participant will usually be assigned to the standard treatment group or the new treatment group at random (called randomization). Phase III trials often enroll large numbers of people and may be conducted at many doctors' offices, clinics and cancer centers nationwide.
Best case series
Investigators describe patients who they believe have had the best results with a particular treatment.
Since 1991, the National Cancer Institute (NCI) has had a process for evaluation of data from alternative medicine practitioners of groups of patients with cancer treated with alternative medical approaches. This process, called the Best Case Series Program, provides an independent review of the medical records and primary source materials (medical imaging [e.g., radiographic, or ultrasound films] and pathology [cytology and surgical pathology]) and an overall assessment of the evidence for a therapeutic effect. (National Cancer Institute (NCI) Office of Cancer Complementary Alternative Medicine update posted 10/2009)
Any Best Case Series described on this Web site will be designated as to whether or not they have been reviewed by the National Cancer Institute.
Responses to treatment
Standards for evaluation of the responses to treatment of measurable tumors have been defined by the National Cancer Institute
National Cancer Institute Response Criteria
Code and Label
- CR: Complete Response
- PR: Partial Response
- SD: Stable Disease
- PD: Progressive Disease
- Complete disappearance of all evident tumor
- A greater than or equal 50% decrease in the cross sectional area (product of the largest diameter and its perpendicular diameter) of measurable tumor without progression in other tumor sites or the appearance of new lesions
- Change in measurable disease too small to meet the requirements for partial response or progression without the appearance of new lesions
- Increase in greater than or equal 25% of any pretreatment area of measurable malignant disease, development of any new area of malignant disease, physiologic evidence of progression or significant clinical deterioration reasonably presumed to be related to malignant disease
Grossman SA and Burch PA. Quantitation of Tumor Response to Anti-Neoplastic Therapy. Seminars in Oncology, Vol 15, No 5 (October), 1988: pp 441-454.
Evaluations of responses to treatments described on this Web site that use criteria such as objective stabilization, objective response, mixed response or positive response will be defined within the Annotated Bibliographic description for the specific study.
Types of studies concerning risk or prevention of disease
Although the terms below are defined in the context of the risk of developing disease, the concepts are adaptable for describing the risk of death or other outcomes following the development of disease as in the clinical trials studies previously defined.
A group of people with a common characteristic (e.g. age, city of residence, exposure to a particular agent, etc.) is followed to determine the characteristics of those who develop disease. Cohorts may be compared with control groups that have not been exposed to a particular agent. These controls may be internal (from within the cohort) or external (outside of the cohort) that have not been exposed to a particular agent. In some cases, persons may function as their own (internal) controls by being exposed and then not exposed to a particular agent. Historical controls are a comparison group of persons who have been exposed to an agent prior to the current cohort (e.g., reported in a published medical article).
A group of people with a common characteristic is identified through a review of records. Characteristics, exposures and occurrence of disease that have already occurred subsequently, but still in the past are then determined. A more current term for this type of cohort would be "Historical Cohort".
Retrospective Cohort with Historical Controls
A group of people with a common characteristic is identified through a review of records. Their response to treatment is then compared with a group of patient with similar characteristics whose treatment and response have been previously reported in the medical literature.
A group or sample of persons with a particular disease (cases) is identified and then compared with another group or sample that does not have the disease (controls). This comparison focuses upon characteristics and exposures have occurred in the past within each group that may be associated with their current designation as a case or control.
Description of the diagnosis, treatment and response of an individual patient.