Unorthodox Cancer Medicine

Barrie R. Cassileth, PhD Helene Brown

Introduction popularityinrecentyears,as wellas the The use of unorthodox, alternative, or un toxicities often associated with them. It in cludes research-based suggestions for the proven treatments by cancer patients rep resents an important social, economic, and clinician who must deal with a patient using or considering an alternative treatment reg clinical problem. The public spends ap imen, and it attempts to place the contem proximately four billion dollars on un porary zeal for unorthodox practices in so proven cancer cures each year.' Contrary cial and historical perspective. to the stereotype, however, patients who seek. unproven methods include the edu cated, the middle to upper class, and thq@se who are not necessarily terminal or even From to beyond hope of cure or remission by con High Colonics ventional treatments.2 Also contrary to many people's impressions, today's prac The most commonly used alternative treat titioners of unproven remedies are often ment for cancer today is so-called meta licensed MDs or scientists engaged in re bolic therapy, a practitioner-specific com search. They typically work within a ho bination. of special diet, detoxification by meopathic or naturopathic framework in internal cleansing, spiritual or emotional treating patients with cancer and other ma restoration, and high-dose and jor illnesses. They also often claim to be .2Maintenanceoftheseregimens ahead of their time or misbranded by the requires a full-time commitment of activity “¿medicalestablishment.― andtimeby thepatientand typicallyalsoa closefamilymember. This article reviews the types of un proven cancer remedies that have achieved Metabolic therapy and other variant treatments are based on a philosophy of health and illness that views disease not as Dr. Cassileth is Director of Psychosocial Pro a localized or system-specific disorder, but grams at the University of Pennsylvania Cancer rather as an expression of systemic pathol CenterinPhiladelphia,Pennsylvania. ogy.Cancer,forexample,isthereforeper Ms. Brown is Director of Community Applica ceivedasoneofmany possibleexpressions tions, Division of Cancer Control, at the Ionsson ofunderlyingdysfunction.Itistheunder Comprehensive Cancer Center, at the Univer sity of California, Los Angeles, in Los Angeles. lying dysfunction, not the symptom—can California. cer—thatis treated. SupportedinpartbyNIH GrantCA 31147. This philosophy and its implicit self This is an edited version of an article that ap carecomponentsareabsolutelycentralto peared in Cancer Investigation 4:591—598, contemporary unorthodox cancer medi 1986.Reprintedwithpermission. cine. It is precisely this ideology, rather

176 CA-A CANCER JOURNAL FOR CLINICIANS than the particulars of the treatment regi far removed from conventional medicine's men per se, that patients acknowledge as a concerns with diet, lifestyle, environmen verity when they elect unproven methods. tal carcinogens, and the reciprocal relation Proponents of unproven therapies reject the ship between many emotional and physio concept that optimal treatment for cancer logic responses. At times, alternative varies with the specific diagnosis and the remedies also appear to be related to theo site, type, stage, and other particulars of ries that are presently under aggressive the disease. The underlying success of conventional investigation'. This is now the many proponents hinges on acceptance by case with the currently unproven immune patients of often unfounded messages con system therapies that claim to pursue an cerning the etiology of cancer. People re immunologic approach using the body's spond positively to oversimplified notions own biologics. of causality, especially concerning the Despite these important differences be complex and multifactorial causes of can tween unorthodox and conventional ap cer. proaches, it is perhaps both surprising and Every decade seems to bring its own reassuring to note that precedents exist for type of alternative cancer therapies. In the both the scope and the particular emphasis past, these were cancer-targeted quasi of contemporary unorthodox therapies. medicines in pill or liquid form.3 The early The 19th century, known as the golden age years of this century saw liquid cures such of quackery, produced an abundance of as Radol, Chamlee's Cancer Specific Puri self-care cults and the following statement fies-the-Blood Cure, and a host of others.4 from an anonymous physician, published Koch's.glyoxylide (distilled water) cure of in 1861: “¿Quackerykills a larger number the l940s was followed by the Hoxsey annually of the citizens of the United States treatment in extract and pill' form in the than all the diseases it pretends to cure.―5 1950s, by injectable Krebiozen during the At that time, as now, advocates worked 1960s, and by Laetrile in the 1970s. Each, for democratization of medical knowledge, in its own time, created a furor and degree of media exposure at least equal to that aroused recently by Laetrile. The public Typical contemporary unproven thera spends about four billion pies differ in three major ways from the previously popular' unorthodox cures of dollars on this century. First, contemporary cures unproven cancer cures may not be pills or potions, but are life each year; style-oriented remedies. They also have a do-it-yourself quality that speaks to demys tifying medicine and that is trendy in its with “¿everyman his own doctor,―and for approach to health promotion. Exercise, a “¿holistic,―self-care alternative to a dis dietary changes, megadoses of vitamins, ease-oriented, impersonal medical sys and self-management of stress direct pa tem.6 The 19th century movement arose in tients to' ‘¿natural―cures and self-care. For response to the development of modern these reasons, the currently popular treat clinical methods with the then-new empha ments can rarely be regulated by the Food sis on localized pathology. and Drug Administration (FDA). Today's medical counterculture mir Second, contemporary cures are not al rors the 19th century experience. The con ways secret formulae known only to their temporary version stems at least. in part manufacturers, but are activities of daily from an analogous reaction to today's tech living understood and accomplished by pa nologic, heroic medicine—against which tients themselves. the public attempts to protect itself through Finally, the cures carry an aura of re living wills, court battles to achieve the spectability, even a hint of conventional “¿rightto die,― and demands for “¿hu medicine's blessing, because they are not mane―alternatives. Medical specialization

VOL. 38, NO.3 MAY/JUNE 1988 177 offers sophisticated and clinically optimal unprecedented.9 To place recent unortho care,but it also createsdissatisfactiondox-medicine events in perspective, how among patientsand families. ever, it is important to note the similarities The following comment written in between them and each example in the ta 1932 isequallyvalidtoday:7The patient ble. As was true of Laetrile and now for feels“¿thatthereisno one who reallysees metabolic regimens, previous unproven him or is interested in him as a whole. The methods attracted many thousands of fol cultshave capitalizedon thisfailureof lowers, raised a great deal of money for modem medicine to view the patient as an practitioners, and were attacked by the entity,and toreplacetheoldfamilyphysi medical establishment, the United States cian with a coordinated specialism.' ‘¿8This Postal Service, and the Bureau of Chemis may be due to sometimes less than optimal try (later the FDA). Reports of the worth communication between physicians, pa lessness of most of these cures, and of tients, and families. Although a patient othersnot listedhere,were publishedat may have a clear understanding of the situ that time by the American Cancer Society ation, the family may be applying pressure and by the Journal of the American Medi to “¿tryeverything,― including unproven cal Association .@ routes. Patients, who are dependent psy The table also illustrates the shifting chologically and physically on their loved cyclesof popularunproven approaches, ones,may eventuallysuccumb and tryan from the “¿natural,―“¿holistic―alterna alternative method in order to please the tives of the 19th century,'° to the quasi family. medicines of the early and mid-2Oth cen Currentalternativecancerapproaches tury, to today's return to natural, holistic, diet-oriented regimens. These shifting preferences are also in keeping with the Contrary to the prevailing conventional-medicine em stereotype, patients who phases of the times. The unorthodox therapies listed in the seek unproven table represent only a sampling of the most remedies include the educated, popularregimensoftheirera.Olson'slist the middle of unproven cancer methods22 includes 59 to upper class, and those who entries for the years 1893 to 1971, and the American Cancer Society'sUnproven are not necessarily Methodslistwas evenmore extensive. terminal.

Current Unproven Cancer Therapies represent a rejection of both conventional medicine and the previous unorthodox em The covertnatureof most contemporary phasis on targeted medications, profes unorthodox cures and the widespread dis sional authority, and disease as localized semination of self-care remedies through pathology.Now, as then,the counter books and periodicals preclude precise es culture is firmly rooted in a politicized anti timates of their popularity. Updated data bureaucracy,antigovernment,antiregula from our 1984 study,2 however, now based torycontext,and ambivalenceor hostilityon a nationalsampleof 1.000cancerpa toward the medical profession is clearly tients, reveal the six most common un evident. proven treatments. These include, in de The table illustrates some of the major scending order of frequency of use, unorthodox approaches that have captured metabolic therapy, diet treatments, mega national attention since the l800s. There is vitamins,mentalimageryappliedforanti a tendencytoview theparticularunortho tumor effect, spiritual or faith healing, and dox fashionof themoment—theLaetrile “¿immune―therapy.The firstfourarere experience of the l970s, for example—as viewed here.

178 CA-A CANCER JOURNAL FOR CLINICIANS Era Popular Unorthodox In US Approach Reference(s)

1800-1850 Thompsonianism 6,11,12 Belief:Alldiseaseresultsfromone general cause (cold),and can be cured by one general remedy(heat).Opposed“¿mineral―drugsand the “¿tyranny―ofdoctors. Remedy:Emeticsand hot baths.

1850-1900 Homeopathy 6,10,13 Belief:Likecures like(“Lawof Similia―); diseaseresultsfromsuppresseditch (“psora―). Remedy:Morethan3,000dlfterentdrugs,eacha highlydistilledorganicor inorganicsubstance.

1890- Naturopathy 10,14 Belief:Diseaseresultsnot fromexternal bacteria,but fromviolationof the naturallaws of living;drugs are harmful;“¿natural―products and activitiescure. Remedy:Diets,massages,colonicirrigation.

1890- Early Osteopathy and Chiropractic 10,15 Belief:Mechanisticviewofthebody;disease caused by dislocationof bonesin spine. Rejected drugs and germtheory. Remedy:Spinalmanipulation.

1900s Tablet and Ointment Cancer Cures 4 Bye,Buchanan,Chamlee,Curry,Leach(Cancerol), Mixer,Griffith(Radio-sulpho),Warner,Wells(Radol).

1920s “¿Energy―Cancer Cures 10 Abrams(RadioWavecure),Brown(RadioTherapy), Kay(cosmicenergy“¿vnlium),Ghadlali (Spectro-ChromeLightTherapy);Cayce'spsychic diagnosesand treatments

1940s Koch's Glyoxylide 5,16,17

1950s Hoxsey's Cancer Treatment 5,16,18

1960s lvy@sKrebiozen 5,16,19

1970s Laetrile 20,21

1980s Metabolic Therapies 2 Diet,HiØiColonics, Vitamins,and Minerals

VOL. 38. NO.3 MAY/JUNE 1988 179 Metabolic Therapy with metabolic cures are less restrictive. Metabolic therapy, which was received by 45 percentofpatientsinthestudywho used Diet Treatments unorthodox regimens with or without con Diet treatments consist of particular, prac ventional care,2 is based on the theory that titioner-specific foods. Dietary cures were toxins and waste materials in the body in tried by 32 percent of study patients who terfere with metabolism and healing, and usedunprovenmethods.2A varietyofdiet that cells lack the nutrients essential to therapiesexist,fromthegrapecure,toraw health. Cancer and other chronic illnesses foods, to wheatgrass extract. Probably the are viewed as the result of degeneration of most commonly adopted dietary remedy the liver, pancreas, and immune and “¿oxytouted in the US today is macrobiotic ther genation―systems. Treatment is directed apy. at cellular “¿detoxificationand restora The , offered by its tion. “¿2325Although metabolic regimens proponentsas botha cancerpreventative vary by practitioner, they typically include and a cancercure,isbasedon Easternyin special diets; detoxification by colonic yangphilosophicalprinciplesandon afully cleansing; and vitamins, minerals, and en formulatedalternativeconceptof human zymes. physiology and disease.29,31@A “¿motherred Metabolic therapies are available from blood cell―in the intestine is viewed as the clinics and individual practitioners in the soleprogenitorofallbodycellsandorgans. United States, Europe, and Canada, with a Food intake must be carefully balanced to special concentration of clinics near the US counteract disease. The notion of balance border in Mexico. The major medical tox iscentraltotreatment;yinfoodsarepre icity associated with metabolic regimens scribedforyang cancers,and viceversa. The macrobioticdietwas expandedseveral years ago after a patient died of malnutri There isa highly tion, so that it now includes whole grains, significant inverse relationship some specially cooked vegetables, and between the miso (a productof soybeanfermentation quality of patients' experience believedtohaveanticancerproperties).3° with conventional Nutritional deficiency, a potential re sult of dietary cures,3135 is particularly medicine and their use of hazardous for patients with cancer. Dietary unproven methods. regimens have a special attraction for the general public today. given conventional medicine'semphasison dietaryrestrictions results from colonic irrigation, which is topreventheartdiseaseandcancerand the typically given in the form of coffee (which view of the relationship between some proponents say will detoxify the liver) ene foods and the possible increased incidence mas or high colonics with coffee, of some cancers.Patientsthereforeoften grass,orothersubstances. make the mistaken but seemingly logical Deaths from electrolyteimbalance, leapoffaithfromtheconventionalposition bowel necrosisand perforation.toxiccoli thatdietmay preventcancer,totheuncon tis.amebiasis,hypokalemia.and sepsis ventional position that diet can cure cancer. caused by colonic irrigation have been re Many unprovencancertherapiescome ported.26-2―Difficulties associated with the equippedwiththeirown diagnostictech dietaryand vitamincomponentsof meta niques.Macrobioticpractitionersuse in bolic therapy are discussed below under dology forthispurpose.This procedure regimensinvolvingdietorvitaminsexclu involveslookingat the iris,each pie sively. These components seem to be less shaped segment of which isbelievedto problematicinthecontextofmetabolicther representa differentorganor body area. apy,probablybecausethedietsassociated For example. a discoloration in the 8-

180 CA-A CANCER JOURNAL FOR CLINICIANS o'clock segment of the right iris would sup so because they were uninformed miracle posedly be diagnostic of liver cancer. An seekers grasping at straws. Such patients evaluation of iridology, reported in the sci were seen as “¿innocentvictims― of entific literature, documented its useless quackery47@48and in need of factual infor ness.@ It may be assumed that reports of at mation from the American Cancer Society least some macrobiotic cures are attribut or the FDA, information likely to dissuade able to healthy patients who had been mis them from use of unorthodox practices.22 diagnosed with cancer by iridology. They were assumed to be underprivileged, poor, and not well-educated.49 The limited number of studies of cancer Megavitamins patients, as well as more general studies of Megavitamins, used by 20 percent of the the use of marginal medicine, show that patients,2 involves consumption of large people who use alternative therapies are at quantities of high-dose vitamins, believed least as well educated and informed as pa to enhance the body's capacity to destroy tients who do not.2849_MOur study indi cancer cells.37@38Excessive intake cated that cancer patients who used un can be toxic, if not useless.39-42 Here orthodox treatments exclusively or in again, however, it requires a sophisticated conjunction with conventional therapy and discerning public to differentiate be tended to be better educated than patients tween unfounded claims for vitamin cures who used chemotherapy, radiation ther and scientific reports with headlines like apy, or surgery only @2Education, however, “¿Researchon Vitamin-Cancer Relation is not always synonymous with being well ship Getting Big Boost.―43 informed. A college education does not inure patients to the claims of miracle

Mental Imagery Mental imagery requires the patient to vis Give patients ualize or imagine the destruction of malig a role in their own care. nant cells.@45 Sixteen percent of patients This central used this technique, not for its potential component of unorthodox emotional benefit, but as a means of treat ing cancer.2 Destruction of cancerous cells regimens is is viewed as the result of a psychological largely absent in conventional influence on the immune system, which in medicine. turn counteracts the malignant process. Ac cording to an American Cancer Society re view, imagery's negative aspects include workers that a prayer cloth can heal or that no scientific proof of efficacy, no evidence there is such a thing as a “¿sure-cure―regi that personality contributes to the develop men. ment or cure of cancer, no evidence that The British royal family uses and sup stress or imagery affects cancer, possible ports alternative medicine, and the Prince guilt as a result of the false notion that a of Wales made a well-publicized trip to stressful lifestyle caused the cancer, inabil Bristol in 1983 to open the Cancer Help ity to self-cure, and possible abandonment Centre, which specializes in “¿complemen of conventional care tary―methods.55 Alternative medicine, in fact, is said to be one of the few growth Who Seeks Unorthodox Therapy, industries in contemporary Britain •¿)b.@ Who Dispenses It, and Why In an interesting historical note, Benja min Franklin wrote in 1731 to his sister: “¿I Prior to research investigation, it was gen know cancer of the breast is often thought erally believed that patients who sought to be incurable, yet we have here in town a marginal or unproven medical remedies did kind of shell made of some wood, cut at a

VOL. 38, NO.3 MAY/JUNE 1988 181 proper time, by some men of great skill Unorthodox cancer regimens also typi which has done wonders in this dise@.―47 cally involve travel to often distant clinics; The evidence seems overwhelming that the purchase of equipment, food process socioeconomic status is either independent ing devices, and special foods; and a major of the use of such therapies or that higher commitment of time and energy to the pur status and better educated individuals are suit of such regimens in the patient's home. overrepresented among the patients of These are activities that require the finan unorthodox practitioners.58 cial and human resources typical of middle Just as patients fail to conform to an and upper socioeconomic status. assumed stereotype, so do many unortho But the foregoing is not the whole an dox practitioners. Although some practi swer, nor does it explain the tacit or active tioners may indeed be appropriately classi participation by physicians who, one fied as untrained, unscrupulous quacks and would expect, have been trained to deliver charlatans,22@596'others may not. A survey rational, scientific therapies and to be able of 100 young physicians in Britain, for to distinguish between them and unproven example, revealed that 86 percent held fa treatments. vorable views toward alternative medicine A central point, usually unmentioned and that 43 percent had referred patients for in the literature, is that there are no un such treatment.57 Our study showed that of proven remedies for curable diseases. In l66 unorthodox practitioners, 51 percent the 19th century, quack remedies for tuber were MDs, 5 percent were DOs, and 18 culosis abounded, but they vanished when percent were verifiably board-certified in medical science discovered effective treat various specialties—not including oncol ment for the disease.9 Some cancers are ogy.2 curable, but the cure rates for the common The involvement of educated patients cancers (such as lung and colon cancers) with unproven remedies can be explained have remained stable for decades. Patients see a discrepancy between conventional-medicine statements that Patients need cancer is a curable disease and current can to believe, especially cer statistics that claim a cure rate ap when physical proaching 50 percent, and the experience of public figures, friends, and neighbors, deterioration approaches, who often die of cancer. The discrepancy that they will not be and cure-rate data have two important con abandoned. sequences—they shake patients' confi dence in the validity and veracity of con ventional cancer statistics, and they in part by the fact that several features of encourage patients to seek alternative op these contemporary cures require time, fi tions, which, they surmise, probably can nancial resources, and an educated, ques not offer cure rates that are any worse than tioning approach to illness. One must read 50 percent. Unconventional treatments the unorthodox literature to learn about al also have the benefit of seemingly being ternative remedies, to select among them, natural and nontoxic. Conventional cancer and to follow their self-care components. therapies, conversely, by their very nature, Patients typically are quite knowledgeable are harsh and difficult to manage. Patients about conventional options as well, having are familiar with the common toxicities and obtained second and third opinions and morbidity associated with surgery, chemo read relevant orthodox-medicine publica therapy, and radiation therapy—and so are tions. Comparison of conventional versus physicians. unorthodox options requires a level of in Patients and physicians who turn to volvement and intellect that the passive, unorthodox methods do so in part out of poorly educated patient is less likely to discouragement and despair concerning the display. realities of orthodox cancer treatment. The

182 CA-ACANCERJOURNALFORCLINICIANS medical profession often has not clearly conference of the American Medical As described what to expect of treatment, and sociation included a symposium on “¿Hol the media have promised more than we can istic Medicine and Health Care.' ‘¿65The yet deliver. The public has responded by holistic or naturopathic movement offers suspending belief and often by seeking al apparently rational, natural alternatives to ternative therapeutic options. There is a conventional drugs and surgery, along with credibility gap. the appealing emphasis on self-care, not There are additional factors that con only of the disease, but of the total person. tribute to the popularity of today's un It offers an alternative to the medical model proven cancer methods. Social and psycho of practice and belief, an alternative that logical pressures exerted on the patient has clearly reached people by “¿offering with disseminated disease, and the false something they want.― Although holistic hope for cure of far advanced disease of medicine is not typically a rational, safe fered by unorthodox healers,62 both play an alternative,5561-65 its populist roots and important role. Many patients, however, “¿freedomof choice― theme provide the use unorthodox methods in lieu of conven public with an opportunity to display its tional treatment, and others initiate un unhappiness with traditional medicine;@67 proven treatments with early-stage or local its preference for 19th century-style de izeddisease.2 mocratized health care now wrapped in the Fear, previousnegativeexperiences banner of patients' rights; and its dislike of with conventional medicine,59-60 lack of in bureaucratic, technologic, specialized care formation, and the patient's search for a of disease. more supportive therapeutic alliance45 are cited as reasons for the use of unproven cancer methods. Media overplay of uncon Suggestions for the Clinician ventional remedies has also been cited,63 as has the precept that “¿youreach people by The AmericanSocietyforClinicalOncol offering something they want.' ‘¿@This fun ogy has produceda layperson'sguideto damental law of communications provides “¿ineffectivecancer therapy.' ‘¿68Although a major clue to the attraction of patients and itslanguageissomewhat more complex physicians to unorthodox medicine. than is appropriate for all patients, it is an Alternative medicine, with its contem excellent review for most. Such a review porary focus on holistic and self-care, is could be made available to patients along what people think they want. It provides withtheothermaterialsusuallyavailable them not only with the particulars of treat in oncology clinics and offices, such as ment, but also with an entire belief system brochures about chemotherapy. that is consistent with a more general pre More important than written materials, vailing ideology. Today's unproven meth however, is the need to maintain open com ods represent a social movement, bound by munication with the patient in order to ac beliefs in the fundamental importance of complish two goals. First, patients must and responsibility for one's own perceive our interest in their general well health, by the understanding that conven being, not just our concern with their can tional medicine cannot cure most cancers, cer. Second, patients must be clearly in by opposition to technologic therapy and formed about treatment expectations, professional bureaucracy, by the above about what is potentially helpful and what mentioned credibility gap, and by repudia is not, and they must feel free to raise issues tion of basic scientific beliefs. about alternative methods with the convic This social movement is called holistic tion that they will be neither ridiculed nor medicine, or naturopathy, and it is under abandoned. At least 20 percent, and possi going a major renaissance today in the US bly up to 50 percent, of patients will seri and abroad. In 1978, the American Holistic ously consider or try alternatives. We can Medical Association held its first annual not deal with this inclination unless we meeting, and in that same year the annual know about it.

VOL 38, NO.3 MAY/JUNE 1988 183 A visit to a health food store will guidelines, for example, will diffuse the provide an eye-opening experience.69 attraction of alternative dietary therapies Hundreds of publications and products and simultaneously involve patients in their compete with conventional oncologic med own care. Supportive psychotherapy (sin icine. Patients are exposed to these mate gly or in groups) may be a helpful adjunct, rials during their own visits or through sug as are relevant printed materials. gestions by well-meaning friends and The initial interactions with patients are relatives. The seductive appeal and the crucial;22 they establish the style and qual sheer number of alternative publications ity of the doctor-patient relationship. Pa and products are overwhelming and can be tients who have good, satisfying relation fully appreciated only if experienced first ships with their physicians are far less hand. likely to seek alternative remedies. Support, reassurance, and clear expla nations are more readily available in the unorthodox clinic than in most oncologists' Conclusions offices. This time-consuming effort, how ever, is very much needed. There is a Contemporary unorthodox therapies ap highly significant inverse relationship be pear to be unprecedented in their scope and tween the quality of patients' experience specifics. They are not. We are experienc with conventional medicine and their use ing a revival of 19th century natural, holis of unproven methods.2 Other members of tic, every-man-his-own-doctor medicine. the health care team can participate in the Today this takes the form of metabolic can effort to show concern and interest, but the cer therapy, the most commonly sought physician must not abdicate this responsi alternativeofthemid-1980s. bility to others. Patients want to see evi Now, asthen,a substantialsegmentof dence of their physician's concern, and patientsand thehealthypopulationhave they want the opportunity to talk with their rejectedwhattheyperceivetobea disease physician.Ifthisisnotforthcoming,they oriented, technologic, authoritarian health will seek it in the caring, holistic offices of care system. Up to 50 percent of cancer the unorthodox practitioner. patients today consider or use unorthodox Ifpatientsraisethe issue,or ifyou treatments.Healthprofessionalsmust un sensethattheywould liketo,discussthe derstand the fear experienced by patients prosand cons of theparticularunproven and families:fearofdeathand physicalor method thathas capturedtheirattention.mental incapacity. Patients need to believe, To dismiss an alternative treatment ab especially when physical deterioration ap ruptly, calling it “¿ridiculous―or “¿quack proaches, that they will not be abandoned. ery― with no further discussion, is to dis They needtoknow thatthehealthteam is credit the patient's intelligence and credible, acting from a proven knowledge questioning ideas, and to leave the person base, and doing all that can be done. Pa with no ammunition with which to consider tients and families must be helped to under and,itishoped,rejectunprovenremedies. stand that, although cancer is not univer If active (rather than palliative) treat sally curable, it is always treatable. This ment modalities have been exhausted and takes time, and time and support must be the patient broaches an unproven tech given to explain all that the patient and nique, recommend participation in a clini family want to know—to explain the next cal trial involving investigative therapy. steps of care; to discuss expectations; to This may be an attractive option for the establish credence and belief in what the patienteager to pursue some additional healthcareteamhastooffer;andtodisplay form of treatment. (not just feel) understanding. interest, and Give patientsa roleintheirown care. concern. This centralcomponent of unorthodox Typically, unproven alternatives are regimensislargelyabsentinconventional embedded inan ideologythatpatientsfind oncologic practice. Reasonable dietary compelling and logical. This ideology in

184 CA-A CANCER JOURNAL FOR CLINICIANS cludes an emphasis on self-care, a systemic ventional care as they are drawn to un rather than a localized view of pathology proven alternatives, conventional medicine and of health, and belief in the fundamental can and should respond by incorporating importance of nutrition and whole-body fit the reasonable components of unorthodox ness. therapy that patients find lacking within the @ To the extent that patients reject con traditional health-care framework.

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