Information is power—the power to make informed choices and to be an active participant in your own treatment experience.

Lise Alschuler, ND, FABNO, Professor of Clinical Medicine at the University of Arizona School of Medicine and Assistant Director of the the Integrative Medicine Fellowship at the Andrew Weil Center for Integrative Medicine

At a glance

For each complementary therapy, we search published medical studies to find evidence of these four medical benefits:

  • Treating cancer: Does the therapy improve survival, reduce metastasesthe development of secondary malignant growths (tumors) at a separate location from a primary site of cancer; metastasis is an indication of advanced cancer, shrink tumors or reduce tumor markers? Does it enhance other treatments?
  • Optimizing your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more: Does the therapy address factors known to support the growth or spread of cancer? 
  • Managing side effects and promoting wellness: Does the therapy prevent or reduce any of the common side effects of cancer treatments or symptoms of cancer?
  • Reducing risks of cancer or recurrence

We assess whether study results are clinically relevant, the size of effects, and whether studies involve humans or only cells or animals. We evaluate whether studies are designed well enough to draw meaningful conclusions. We determine whether findings across studies are consistent or conflicting. We summarize and interpret each set of findings for you but also allow you to see details and sources if that interests you.

After we assess the strength of evidence for each outcome, we rate therapies on a 0–5-point scale to answer seven questions that most people with cancer want to know:

  1. How well does this therapy treat cancer?
  2. How well does it improve my general health and resilience (body terrain)?
  3. How well does it manage side effects and symptoms?
  4. How well does it reduce my risk of cancer or recurrence?
  5. How do experts use this therapy?
  6. How safe is it?
  7. What does it cost, and where can I find it?

Researching medical effects

For each complementary therapy, we search published medical studies to find evidence of four medical benefits.

Treating cancer

Does the therapy

  1. Improve survival?
  2. Reduce metastases?
  3. Reduce or reverse tumor growth?
  4. Reduce cancer markers, such as PSA in prostate cancer?
  5. Enhance conventional treatments such as chemotherapy or surgery in achieving any of these effects?

Optimizing your body terrain

Does the therapy address these factors and others which are known to support the growth or spread of cancer when out of balance?

  • Bleeding and coagulation imbalance
  • Blood sugar and insulin resistance
  • Hormone imbalance
  • Immune function
  • Inflammation
  • Oxidation
  • Your microbiomethe collection of microbes living on and within your body

Managing side effects and promoting wellness

Does the therapy prevent or reduce any of the common side effects of cancer treatments or symptoms of cancer, such as these?

  • Anxiety
  • Blood-related symptoms
  • Body composition or cachexiaweakness and wasting of the body due to severe chronic illness
  • Breathlessness
  • Changes in appetite
  • Cognitive difficulties
  • Depression
  • Dehydration
  • Fatigue
  • Gastrointestinal symptoms
  • Hot flashes
  • Neuropathy and other neurological symptoms
  • Oral symptoms
  • Pain
  • Sexual difficulties
  • Sleep disruption
  • Stress

Reducing risks of cancer

Does the therapy reduce risks?

  • Cancer
  • Recurrence

Assessing the strength of the evidence 

After we gather all the evidence, we ask ourselves several further questions:

  • Are these results useful in the “real world” (clinically relevant)? How big are the effects? Are these effects found in humans (clinical studies) or is all the evidence from cell and animal studies (preclinical)?
  • How strong is the evidence? Are the studies large enough to assess effects? Are the studies designed well enough to draw meaningful conclusions? 
  • How consistent are the findings across studies? What might contribute to conflicting findings?

Study design and size

The strength of study evidence depends quite a lot on the study design and size. The design categories we use, from weakest to strongest:

  • Case studies and other uncontrolled studies: people are given a therapy and changes are observed; this is a weak design because researchers don’t know if any changes would have happened even without the therapy, such as less pain or less nausea over time
  • Observational studies: groups of people who use a therapy or practice a behavior are compared to others who do not use the therapy or practice the behavior; large studies finding trends and patterns can provide good evidence of a link but not that the therapy or practice caused any differences between groups
  • Randomized controlled trials (RCTs): people are assigned to groups, with some given a therapy and others not given the therapy, and the differences in groups is recorded; the strongest designs randomly assign large numbers of people to each group, and both the people in the study and the researchers are not aware whether they are receiving an active therapy or a similar but inactive therapy (a control or placebo)
  • Meta-analysis of RCTs or observational studies or an umbrella review: several studies are analyzed together as through they were one larger study; the combined analysis can be only as good as the studies being combined, and many meta-analyses rate the quality of the studies

Larger studies provide more confidence that a “fluke” error hasn’t been found. Larger studies are also able to find subtler effects than small studies. Study sizes we use:

SmallFewer than 100 participants
Mid-sized100 to 999 participants for observational studies or 100-499 participants for RCTs
Large1000 to 5000 participants for observational studies or 500 to 1000 participants for RCTs
Very largeMore than 5000 participants for observational studies or more than 1000 participants for RCTs

We mark meta-analyses as large if they include 10,000 to 100,000 subjects, and very large if they include more than that across all the studies in the combined analysis.

Because meta-analyses and umbrella reviews combine the results of several other studies—and typically report combined numbers of participants anywhere from several hundred to more than a million—they give greater confidence of an accurate assessment of effects. Of course, combining the results of several poorly designed studies still doesn’t provide good evidence. But typically it’s better evidence than each of the smaller studies alone.

We summarize all the strongest and most relevant studies we find, but we also interpret each set of findings for you so that you can read in a sentence or two what all the evidence may mean for you. We tell you how big the reported effects are and how strong the evidence is.

InsufficientPreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (an effect vs no evidence of an effect or evidence of worse outcomes) with the same treatment and the same general study population (same cancer type, for example)
WeakOne or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends
PreliminarySignificant effects in one or more small or poorly designed controlled clinical studies OR conflicting results in adequate studies but a preponderance of evidence in one direction
ModestSignificant effects in at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis
GoodSignificant effects in one large or several mid-sized and well-designed clinical studies (RCTs with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
StrongConsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results

Clinical evidence for each effect is presented in the How can this therapy (or practice) help me? part of each review. Further evidence, including notable preclinical evidencetesting a drug, a procedure or another medical treatment in isolated cells or in animals; preclinical evidence is considered only an initial indication of possible effects in people and modes of action, is presented in the Are you a health professional? section of each review.

Rating therapies on the evidence

For treating cancer, optimizing your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more, managing side effects and promoting wellness, and reducing cancer risk, we use this general rating scheme.

On a 0–5-point scale:

0Ineffective in clinical studies (no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. or insufficient evidence)
OR not studied for this effect
1Preclinical evidencetesting a drug, a procedure or another medical treatment in isolated cells or in animals; preclinical evidence is considered only an initial indication of possible effects in people only or weak clinical evidence (case studiesa descriptive and exploratory analysis of a person, group, or event regarding changes observed over time; because changes due to treatment are not compared to similar changes over time without treatment, a case study is considered a weak study design, uncontrolled trialsa study in which a therapy is used, but without a comparison group to judge outcomes against; an uncontrolled trial is considered a weak study design, or weak trendsan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently)) of positive effects for one or more medical benefit
2Preliminary clinical evidence (one or more studies totaling less than about 100 participants) of positive effects and/or slight/very small treatment effects and/or mixed results and/or weak study designs (serious confounds, for instance) for one or more medical benefit
3Modest evidence for one or more medical benefit: several small or at least one mid-sized clinical trial(s) or meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study (totaling more than 100 to a few hundred participants)
OR one or more smaller RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with adequate study design and modest to substantial treatment effects; both randomized and observational studies qualify
4Good or strong clinical evidence of small to modest positive treatment effects for one or more medical benefit with at least several hundred people in well-designed studies with good control comparisons
5Good or strong clinical evidence of moderate to substantial positive treatment effects for one or more medical benefit with at least several hundred people in well-designed studies with good control comparisons

Because any therapy can show medical benefits across a wide range of cancers and symptoms, our ratings reflect the highest effect shown by that therapy for each of the medical benefits. Check individual summaries for each effect to see how a therapy performs and what the evidence for that performance is.

Example 1: Turkey tail mushroom shows a wide range of benefits for treating cancer. It has modest evidence or preliminary evidence of benefit for some types of cancer, but no evidence of benefit for others. Because turkey tail has modest evidence of benefit for at least one type of cancer, we rate it 3 for treating cancer, but this does not mean it rates 3 for every type of cancer.

Example 2: Acupuncture shows a wide range of benefits for side effects and symptoms. It has good evidence of benefit for fatigue and other symptoms, but no evidence of an effect on gastrointestinal symptoms and other symptoms. Many other symptoms fall in between these endpoints. Because acupuncture has good evidence of benefit for at least one symptom, we rate it 5 for managing side effects and promoting wellness, but this does not mean it rates 5 for every symptom or side effect.

How experts use therapies

When rating therapies, we look to integrative oncology experts for what they say and how they use each therapy. We summarize this separately in the How do experts use [therapy]? section of each review. 

Medical research is very expensive to do properly. If no one has a financial incentive to conduct large studies, a therapy may not be well researched. How experts use a therapy can be a valuable source of information beyond what research shows. However, several of the expert sources we cite are several years old. 

If published research that is more recent than the programs or protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care we reference is available, we encourage you to consider both published research and expert use.

Clinical practice guidelines

Medical groups and societies convene groups of experts to evaluate all the evidence related to a set of therapies and make professional recommendations about their use. We report conclusions and recommendations from practice guidelines from integrative oncology groups including the Society for Integrative Oncology and many others.

Integrative oncology experts 

We look at published programs from experts, many of whom are among our advisors, and summarize if and how they use each therapy.

Use in traditional medicine

We report whether a therapy is used in traditional Chinese medicine, Ayurvedic medicine, or other traditional medical systems.

Rating expert use

We use this 0–5-point scale:

0No use in our program sources and/or recommendation against use in oncology clinical practice guidelines
1Very limited use (only one of our program sources) and not mentioned in oncology clinical practice guidelines
2Limited use by our program sources (fewer than four) and/or used only outside the US and not mentioned in cancer clinical practice guidelines and/or conflicts in use—conflicting recommendations across practice guidelines
OR widely used by our program sources and mentioned in practice guidelines without recommendation for use due to insufficient evidence
3Used in several (at least 4) of our program sources and recommended weakly or not mentioned in integrative cancer clinical practice guidelines
OR used by several of our program sources and in traditional medicine but not mentioned or no consensus reached in oncology clinical practice guidelines
OR mentioned with at least a weak recommendation in clinical practice guidelines
4Widely used by integrative practitioners and recommended weakly in integrative cancer clinical practice guidelines
OR used widely by integrative oncology experts but not yet evaluated in clinical practice guidelines
OR recommended more than weakly in clinical practice guidelines
5Widely used by integrative practitioners and recommended (more than weakly) in integrative cancer clinical practice guidelines

Safety, affordability, and access

We evaluate and rate therapies on their safety, affordability and access.

Rating safety 

0Dangerous for most or all people
1Extreme caution is needed with use by most people, and supervision by a medical professional is essential
2Extreme caution is needed with use by people with specific conditions, or those undergoing treatments which may cause significant, even life-threatening interactions; supervision by a medical professional is essential
3Moderate caution is needed or may interact with other treatments, and supervision by a medical professional is highly recommended
4Generally safe, although some serious side effects are possible; caution and supervision are needed for people with specific conditions
5Generally safe, with only minor side effects

Rating affordability and access 

Ratings reflect the more restrictive aspect, whether access or affordability. A therapy that is widely available but expensive (between $5000 US and $10,000 US) would be rated 2 due to expense, even though its is readily available.

0Unavailable in most places (such as controlled substances) and/or extremely expensive (more than $50,000 US)
1Unavailable in many places (perhaps only in a few countries) and/or very expensive (between $10,000 US and $50,000 US)
2Available with some difficulty (needing travel, for example) and/or expensive (between $5000 US and $10,000 US)
3Available with restrictions (such as a prescription) and/or moderately expensive (between $2000 and $5,000 US/year)
4Widely available without restriction and somewhat expensive (between $500 US and $2000 US/year)
5Widely available without restriction and generally inexpensive (less than $500 US/year)

Authors

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Reviewers

Maria Williams

Research and Communications Consultant
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Maria Williams is a research and communications consultant who brings over 15 years’ experience in research, consumer education, and science communication to CancerChoices. She has worked primarily in public health and environmental health.

Maria Williams Research and Communications Consultant

Andrew Jackson, ND

Research Associate
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Andrew Jackson, ND, serves as a CancerChoices research associate. As a naturopathic physician practicing in Kirkland, Washington, he teaches critical evaluation of the medical literture at Bastyr University in Kenmore, Washington. His great appreciation of scientific inquiry and the scientific process has led him to view research with a critical eye.

Andrew Jackson, ND Research Associate

Last update: June 26, 2022

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.