Mr. Smith comes to the clinic for his first round of radiation for prostate cancer. During check-in, he mentions that he just started taking selenium because his daughter read that it has anticancer effects and may help shrink his tumor. He asks if this works and if it’s safe.
Melissa Mills, BSN, RN, CCM, MHA
Melissa Mills, BSN, RN, CCM, MHA
HOW SHOULD THE NURSE RESPOND?
In the past, complementary therapies, or nonstandard therapies, were described as alternative or even irrational. Today, more and more complementary therapies are being integrated into care plans for patients with prostate cancer. Acupuncture, prayer, and meditation are examples of therapies that patients use to ease adverse events related to cancer or traditional cancer treatment.
In a recent study of men with prostate cancer, the findings showed that 65% of patients used herbal remedies and nutritional supplements during their conventional treatment.1 Other common complementary therapies included exercise programs, dietary changes, calcium supplements, and prayer. The results also revealed that just half of the patients discussed the use of these treatments with their physicians, and that patients usually initiated the conversations.1
Many individuals continue to use complementary therapies after completing active cancer treatment. In a study published in the Journal of Cancer Survivorship in 2016, approximately 79% of cancer survivors claimed to have used vitamins, minerals, or other complementary and alternative medicine modalities in the previous year.2
Some complementary therapies have undergone evaluation and been found to be safe and effective. Others are ineffective or even harmful.3 It’s important that oncology nurses are familiar with the most common complementary therapies so that they can help patients make safe decisions and communicate with a physician regarding potential interactions or issues.
A nutritious diet is an essential aspect of overall health. However, some nutritional supplements can cause harmful interactions with a patient’s therapy regimen.
Common nutritional therapies include antioxidants, such as beta-carotene, lycopene, and vitamins A, C, and E. Antioxidants may protect cells from damage caused by free radicals, which may lead to cancer.4 Patients with prostate cancer have commonly used antioxidants for both prevention and treatment.5
A 2009 study evaluated the use of vitamin E and selenium for prevention of prostate cancer in men over age 50. The results showed that neither supplement reduced the risk of prostate cancer development and that both were potentially harmful.5
Other common nutritional therapies include coenzyme Q10, dietary supplements, glutamine, and melatonin.4 Coenzyme Q10, an antioxidant made by the body and found in meat, fish, and whole grains, has been shown to stimulate the immune system and protect the heart during chemotherapy treatments that cause damage.
Glutamine, an amino acid, has been shown to reduce damage to the gastrointestinal tract that can happen during chemotherapy and radiation treatments. Supplemental use of glutamine during prostate cancer treatment may minimize treatment delays and dose reductions and improve quality of life. The hormone melatonin assists with sleep–wake cycles and may limit sleep disturbances during treatment.4 More research is under way regarding the use of melatonin supplements during cancer treatment.
A practice in traditional Chinese medicine, acupuncture is used to manage cancer-related symptoms, treat adverse events that might arise due to chemotherapy and radiation, boost blood cell counts, and enhance lymphocyte and natural killer cell activity.4 One study showed that acupuncture can help control cancer-related pain, decrease the frequency of vomiting, and reduce hot flashes and lethargy in prostate cancer patients.6 Overall, acupuncture is a useful supportive treatment when done in combination with allopathic medicine for prostate cancer treatment.6
Mind-body techniques such as cognitive-behavioral therapy (CBT) and hypnosis can combat the effects of cancer-related stress, anxiety, and depression. A type of psychotherapy, CBT helps patients change their behaviors by altering how they feel about certain aspects of care. CBT has been shown to be effective in treating anticipatory nausea and vomiting in patients undergoing cancer treatments. It has also proved effective in the treatment of depression and cancer-related posttraumatic stress.4 Hypnosis is also commonly used to treat anxiety and distress.4
BOTANICALS AND HERBAL PRODUCTS
The use of botanicals such as herbs ranges from controversial to commonplace. One popular kind used by patients with cancer is St John’s wort (Hypericum perforatum), for example. As a treatment for depression, its major active ingredients are thought to be melatonin, hypericin, hyperforin, and adhyperforin.7 This herb can decrease the effectiveness of other drugs, however, so it is important to notify the physician about a patient’s concomitant use of St. John’s wort.7
PUTTING IT INTO PRACTICE
Nurses who encounter an unfamiliar complementary therapy should do some investigative work before discussing it in detail with patients. Reliable resources include the National Center for Complementary and Alternative Medicine and the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine. At each visit, patients should be asked about any new medications or treatments, supplements, or therapeutic activities. Education regarding these therapies will help patients make the best decisions about all aspects of their cancer care.
- Lee RT, Herrerich JA, Kwon N, Bylow K, et al. The relationship between anxiety about prostate cancer among patients with biochemical cancer recurrence and the use of complementary and alternative medicines, diet, and exercise. Fam Med Community Health. 2017;5(2):139-148. doi: 10.15212/FMCH.2017.0129.
- John GM, Hershman DL, Falci L, Shi Z, Tsai W, Greenlee H. Complementary and alternative medicine use among US cancer survivors. J Cancer Surviv. 2016;10(5):850-864. doi: 10.1007/s11764-016-0530-y.
- Complementary and alternative medicine. National Cancer Institute website. cancer.gov/about-cancer/treatment/cam. Updated April 10, 2015. Accessed November 11, 2018.
- Topics in integrative, alternative, and complementary therapies (PDQ)–health professional version. National Cancer Institute website. cancer.gov/about-cancer/treatment/cam/hp/cam-topics-pdq#section/_16. Updated June 27, 2018. Accessed November 1, 2018.
- Klempner S, Bubley G. Complementary and alternative medicines in prostate cancer: from bench to bedside? Oncologist. 2012;17(6):830-7. doi: 10.1634/theoncologist.2012-0094.
- Andrew J. The role of acupuncture in the management of prostate cancer [published online June 17, 2015]. Med Acupunct. doi: 10.1089/acu.2015.1095.
- Cannabis and cannabinoids (PDQ) –health professional version. National Cancer Institute website. cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq. Updated August 16, 2018. Accessed November 1, 2018.