It is often said that traditional Chinese medicine (TCM) should not be used together with Western cancer treatments. Dr. David Tan, Clinical Oncologist at Asian Alliance Radiation & Oncology, evaluates the emerging role of TCM as a possible adjunct to cancer management and the potential benefits of these modalities acting as complements.
Cancer treatment can be extremely demanding on the body as a patient goes through multiple and, often, consecutive treatments involving surgery, chemotherapy, or radiation therapy.
Beyond the usual physical stresses, a cancer diagnosis from the start can affect the emotional and psychological health of a patient and his caregivers. Common feelings during this life-changing experience include anxiety, frustration, and depression. In addition, roles at home, school, and work can be affected.
Over the past decade, significant advances that have greatly improved cancer survival rates have been made in oncology research. “With more precise, targeted, and individualized treatments available in this day and age, we are seeing higher cure rates and longer life expectancy in our patients,” says Dr. Tan. “Yet one of the challenges that remains for Western medicine is that while these advanced treatments work better and for much longer, these can leave some physical scars on our patients.”
For example, certain patients may develop long-term side effects from chemotherapy or radiotherapy, such as numbness and chronic pain. For many of Dr. Tan’s patients with gynecological cancers, they have had surgery to remove their ovaries which has caused them to enter premature menopause and thus experience long-term hormonal symptoms.
On another concern, Dr. Tan observes, when terminal cancer patients are kept alive for longer due to better systemic treatments, many are on maximum pain medication but yet their discomfort persists.
“In situations like these, I have seen how the use of acupuncture, for example, has helped some patients cope better with pain or numbness. Other patients who turn to TCM for help with menopausal symptoms have also found improvement after taking herbs and natural supplements. Perhaps, with better education and increased knowledge, TCM could be integrated into Western cancer management,” Dr. Tan comments.
In 2019, the World Health Organization incorporated a chapter on TCM in its International Classification of Diseases (ICD) document1 for the first time in history, indirectly signaling an endorsement of this branch of medicine as a recognized treatment.
While many medical and science journals have raised questions over WHO's decision, primarily due to limited data supporting the effectiveness of the associated traditional remedies, the reality is that recent decades have seen TCM being accepted and used widely in cancer care,2 with beneficial effects for cancer patients.3
Evidence-based guidelines have also been recently published by Western bodies such as the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) to make recommendations on integrative approaches to managing symptoms, including chronic pain, in cancer patients.4
The principal strategies of Western cancer treatment include surgical resection, radiotherapy, and chemotherapy. While all of these modalities destroy cancer cells, they may also damage some healthy cells during treatment. The patient may feel weak, tired, or experience side effects as a result. The good news is that these normal cells can be repaired or replaced on their own. TCM’s prescription of herbal medicine and acupuncture can potentially aid this process of repair and strengthen the body to better withstand ongoing or future treatments.5
Dr. Tan adds, “Many TCM physicians now undergo observerships in Western cancer hospitals as part of their formal training. As a result of this exposure, they are now able to better understand Western clinical practices, including assessing the patient's medical background and medications, and interpreting their blood test and scan results.”
Reputable TCM practices then seek to complement Western treatments by applying appropriate modalities such as the use of herbs, acupuncture, and even massage therapy to support patients with their symptoms and the side effects of treatments.
TCM should not be used as a replacement for Western cancer treatment. Dr. Tan cautions, "If a patient wants to consider using TCM, it is imperative that he speaks to his oncologist first as many types of Chinese herbal medicines can interfere with Western cancer treatment. The oncologist will then decide whether TCM is safe to be combined with the patient’s cancer treatment.”
The ideal setting, Dr. Tan advises, is one where the oncologist directly explains the patient’s treatment plan to the attending TCM physician and both agree on the appropriate supportive measures to take. In this regard, Dr. Tan has worked closely with oncology-trained TCM physicians to ensure the best continuity of care.
Formally approaching cancer treatment with the possible aid of TCM can be said to be already underway. In Singapore, there is a regulatory body for TCM to ensure formal training and accord credentials to its practitioners,6 and major established medical centers like The University of Texas MD Anderson Cancer Center7 and Mayo Clinic Integrative Medicine and Health8 have already started incorporating TCM and alternative medicine into their services to complement Western oncology practice.
Dr. Tan offers, “I do not think that TCM is ready to be adopted as a mainstream oncological treatment in our society as yet, and it will take more time and research for Western medical practitioners to better understand and accept its utility with ongoing or active cancer treatment.
“However, in the post-radiotherapy, chemotherapy, or surgery setting, or in cases where patients undergo a treatment break to recover from the side effects of treatment, I am definitely open to integrating TCM treatments in our care plans for the benefit of our patients."
References
1 https://www.who.int/standards/classifications/frequently-asked-questions/traditional-medicine
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536969/
3 https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/integrative-medicine-center/clinical-services.html
4 Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol. 2022 Dec 1;40(34):3998-4024. doi: 10.1200/JCO.22.01357. Epub 2022 Sep 19. PMID: 36122322.
5 https://www.sma.org.sg/news/2019/April/a-tcm-perspective-on-cancer-management
6 https://www.healthprofessionals.gov.sg/tcmpb/en
7 https://streaming.mdanderson.org/transcript/traditional-chinese-medicine-and-cancer-treatment.html
8 https://medprofvideos.mayoclinic.org/videos/evidence-based-acupuncture-for-cancer-patients
