Ask-the-Expert Online ConferenceOn Wednesday, October 20, 2004, our Ask-the-Expert Online Conference was called Complementary and Holistic Techniques. Dan Benor, M.D.,Larry Lachman, Psy.D., and moderator Jennifer Griggs, M.D., M.P.H. answered your questions about the various complementary and holistic treatments that may benefit those with breast cancer.
- Question from Julie: Are there any studies that show benefits of massage therapy in relation to breast cancer, especially in preventing/minimizing lymphedema?
- Answers - Dan Benor Massage, especially lymphedema massage, is extremely effective in treating post-surgical problems. It can alleviate swelling and pain. Massage also is a general tonic, in that it relaxes people. And with relaxation, people just deal with their stresses better, and their bodies heal better with just about every illness. Massage is also a form of touch therapy, and touch in itself is healing.
From my point of view, one of the things that people frequently end up with, especially if they're hospitalized and have a lot of needles, with an ingoing port, is that they're not aware their bodies have been harmed by medical touch. Not that it's done intentionally, but there is a lot of pain there. How I suggest people cope following the intensive treatment regimen is to get non-medical, non-invasive touch through a certified massage therapist or energy healer.
After I underwent prostate cancer surgery, I knew I had to desensitize my body from that physical trauma. My body had been conditioned to medical touch, and I knew I had to get some comforting, non-traumatic, non-painful touch. First, it was a Thai massage therapist, and then a general massage therapist. The first time they put their hands on me I almost clocked them one in the head! My body was so reactive. It took a good month or so to calm the body and counteract the trauma. So massage is important.
- Jennifer Griggs, M.D., M.P.H. I'd like to add that massage can be a way to carve out some time for yourself. For so many women, maintaining their roles during treatment can leave them with very little time for themselves. So an hour or 90 minutes on the massage table can be a therapeutic way to capture some time of your own with a healer. Some insurance companies will cover massage.
- Dan Benor Massage doesn't have to be done by a professional. Just comforting massage or touch from a family member can be enormously helpful, both to the person who is ill and to the person giving the touch, so they can feel they're being helpful and appreciated.
- Larry Lachman I agree. When someone is diagnosed with breast cancer, the whole family has the disease in a sense, but the patient is the only one to get treatment. Many times, those of us who are cancer survivors may feel like damaged goods, and that can affect intimacy and coupling. One of the ways to counteract the closing off of intimacy is exactly what Dr. Benor just talked about: having family members reconnect in a non-threatening way.
- Jennifer Griggs, M.D., M.P.H. Regarding lymphedema, there are practitioners, maybe one in a city, who are specially trained in managing lymphedema. Your own doctor may not know who that person is in your community, but the American Cancer Society or the National Lymphedema Network can usually identify the specialist in your area. Early treatment is absolutely critical, so don't minimize your symptoms.
- Question from Connie: Are there any types of massage that should not be pursued by breast cancer patients, either during chemo or afterwards?
- Answers - Jennifer Griggs, M.D., M.P.H. Anything that hurts.
The obvious is if you have a wound or suture area or painful area, or something from radiation where the skin hurts. You don't necessarily want someone to grind on it, as sometimes deep-tissue massage people might do. And it goes without saying that whatever you're going to do — family or a formal integrative medicine treatment — you want the left hand and right hand to know what's going on. In other words, you want your oncologists to know what types of alternative therapy you're getting, and vice versa.
Most of the oncologists I work with, as long as their patients tell them what they're doing, whether it's yoga or Reiki or creative visualization, they're usually fine with it. They just want to make sure that nothing is going to be contra-indicated with something else. For example, if you're on antidepressants or chemotherapy and you're experimenting with herbs, etc., they will want to know.
In the last 15 years or so, the divisiveness and the division between allopathic (conventional) and naturopathic (holistic) camps are giving way to more cooperation. More cancer therapy clinics will give massage, etc. in a traditional medical center. Even in dentistry, you may find relaxation therapies to help you get through dental work. As long as there's communication between the healing practitioners so they can work together with the patients as active participants in their own care, then massage is more and more accepted as being fine.
- Jennifer Griggs, M.D., M.P.H. Speaking as an oncologist, we'll take any help we can get! The drugs we give you may have side effects, so we give you more medicine. I agree there's been a sea change in how most oncologists regard alternative therapies. They're much more open-minded than they used to be.
I'd like to respond to two points. First, what not to have with a massage: The body is connected to the person, and sometimes during a massage, emotions get dredged up because the body can store feelings and memories. If that happens during a massage, it's not necessarily a bad sign. Some people actually go for massage in order to uncover old memories or hurts that might be burdening them in some way. But it might be best not to go through that stress at a time when you're undergoing the physical stress of surgery or other breast cancer treatment.
The other point is that the side effects of chemotherapy can be markedly alleviated by energy healing. I learned this from a nurse in England. She is a very good healer, but her boss didn't want her doing 'healing' on the unit because he didn't feel comfortable with it. So she meditated and prayed for guidance on how to help her patients. She was inspired to give healing to the chemotherapy bottle, and her patients had much less nausea, vomiting, headaches, diarrhea, and other side effects. So healing is one way to lessen side effects of medication.
I second that. In fact, if people go to the National Institutes of Health (NIH) website, in the Complementary & Alternative Medicine section, it includes things in the psychiatric field that are traditional for us — biofeedback, deep breathing, guided imagery, hypnosis, and progressive relaxation. These are standard behavioral tools that we use, not only with cancer patients, but also patients with anxiety disorders, etc.
In addition to what Dr. Benor just said, deep breathing, biofeedback, hypnosis, and progressive relaxation have been shown to significantly decrease anticipatory nausea, where before the person even gets the chemo, just the cues of the building where they get the chemo or the alcohol smell of the swab can trigger that conditioned response. One of the ways to un-condition that pre-medicine nausea is to use one of those relaxation therapies.
- Dan Benor Dr. Lachman made a good point in that these techniques can be preventative, so a person can start learning them before going to treatment. One I find helpful is what I call WHEE. It's a potent and rapid self-healing technique. I use it a lot with children. It's very easy to learn and use, and very potent for dealing with pain, anxiety, and stress reactions.
- Question from Julie: Are there any scientific studies that show benefits from the use of essential oils, especially Frankincense, in relation to breast cancer?
- Answers - Jennifer Griggs, M.D., M.P.H. Patients have found that applying topical oils can be helpful. In the absence of evidence, since there isn't any medical evidence, it appears that the benefit is related to relaxation and honoring the body, which has been so traumatized, as we said before.
- Larry Lachman A general statement — smell and hearing are the older senses of humans and their brains, and you see that in hospice settings. A lot of times, when people get ill at ease, it can be related to smells. We talked about the anticipatory reaction to smells in chemo, so it doesn't surprise me that smells that a person finds pleasant and soothing could work in the opposite direction.
- Jennifer Griggs, M.D., M.P.H. That's a good point. I'd imagine that further down the road in someone's journey of healing, a smell they once enjoyed might take on a negative sense, since it's associated with their treatment.
- Dan Benor In Volume 2 of my book on Healing Research, I show that aromatherapy has significant positive effects in reducing pain, reducing anxieties and emotional distress, reducing depression, and enhancing immune cell activity. Sleep can be a problem when people are distressed, and aromatherapy has a calming and sedative effect. It can also have an analgesic, or pain-reducing, effect.
- Jennifer Griggs, M.D., M.P.H. I'd like to clarify what I said earlier. When I said "lack of evidence," I was referring to the therapeutic effect of application to the skin. Aromatherapy is a different aspect in the use of oils.
From the studies I've seen and surveys of people with cancer, the complementary therapies most requested by people with cancer are aromatherapy, acupuncture, Bach Flower Remedies, herbs, massage, meditation/visualization, and yoga. If you go to the NIH site, they break down what we're talking about into five general categories of: 1) alternative medical systems, like the Indian Ayurvedic; 2) the biologically based therapies like vitamins and nutrition; 3) the Complimentary and Alternative Medicine (CAM) modalities like energy therapies, 4) the manipulative body therapies like massage. And the fifth category, which I'm most familiar with, is the mind/body medicine techniques like deep breathing, visualization, etc.
It's interesting for those psychologists in the audience that in June 2003 in a journal called Professional Psychology, there was an article about CAM and challenges for psychologists. They did a survey of psychologists and out of 1000, only 202 answered, but the majority was aware of CAM therapies and had seen anecdotal evidence of the effectiveness of these therapies. But there was a split as to what the state licensing boards for psychologists had to say whether psychotherapists are allowed to refer out to CAM practitioners. Half said that since these other modalities were regulated under a different profession, it was OK to refer out because that profession had their own licensing and ethical guidelines. Half were concerned about being sanctioned by the state body. So there needs to be room for improvement regarding education and ethical guidelines. Overriding are (1) informed consent, and (2) doing no harm to your client.
With my clients, I will definitely encourage them to learn as much as possible about whatever therapy they're considering — allopathic (conventional) or naturopathic (holistic) — to help patients be active in their own care. And you should get second and third opinions with both types of practitioners.
- Jennifer Griggs, M.D., M.P.H. I would like to know if you've noticed a change in the allopathic medical community that respects the non-western aspects of medicine. I have patients who say, "It's in my head, so it's not real."
- Dan Benor I like your observation. I'm a member of the American Holistic Medical Association, where doctors who are now opening to these ideas are coming together to support each other, to share our knowledge and learn more about how to help the whole person in body, emotions, mind, relationships with other people, environment, and spirit.
I second that. In fact, in ten minutes today on the Web site of nih.gov and the American Cancer Society site, cancer.org, you read the following: They quote David Rosenthal, M.D., professor of Medicine at Harvard, and he's saying it's important for physicians to listen and not judge their patients so patients feel comfortable sharing ideas about CAM (Complementary and Alternative Medicine). And this is the American Cancer Society Web site! 20 years ago you wouldn't have seen this. So this is a mainstream doctor at Harvard talking about the very thing that Dr. Griggs just brought up. And also today, on the NIH website, it said more than 90% of Americans believe in God. 77% of patients in one survey wanted their doctors to take their spiritual concerns into consideration.
This reminds me of a workshop I attended at UCI medical school, where they their med students were taught — in addition to taking history and blood tests and CAT scans — to take spiritual histories. FICA was the acronym, standing for Faith Importance, Community, and Active. Basically, the physician in training was being taught to first assess whether the person had an active faith, or how they were brought up, how important it currently was to that person, whether they were connected with C, a community of like-minded spiritual people, and A, how they wanted these concerns to affect their treatment. So for the most part, it's truly been a revolution in that allopathic Western medicine is more open. It's not so much with orthopedics and heart or brain surgeons, but more with oncologists and immunologists.
- Dan Benor Dr. Lachman has been very quiet and modest here in not mentioning his book, Parallel Journeys, which gives an excellent introduction to the ways these therapies can be helpful, from his own experience.
I'm taking my psychologist hat off and putting my cancer survivor hat on. When I was diagnosed with Stage 2B cancer of the prostate, I went in with two preconceived ideas. One was that the traditional allopathic Western physician was going to be dictatorial and patronizing and authoritarian, and the holistic complementary healers would be supportive and caring and collaborative. What happened was the opposite, which floored me. My urologist, internist, and surgeon listened, considered me as an equal member of the treatment team, showed me what to expect, and provided adequate post-op pain management. My first phone call to a CAM practitioner was with a 23-year-old Caucasian female, not married, who professed to practicing polarity therapy and therapeutic touch. The first thing out of her mouth was, "Why did you have to bring the cancer on yourself?" The second was, "What anger or resentment did you not express that you had to manufacture a tumor?"
Now here I am, already depressed, weak from surgery, trying to get a fighting spirit up and get my immune system going, and here's someone blaming me like blaming a rape victim, for bringing on my cancer. After I clarified that's what she'd said, I used a few expletives and hung up on her. So this brings up a central point: we are connected, mind, body, and spirit. Disease is the physical part of cancer, but illness is the subjective or psycho-social part. We may or may not be able to influence the disease, but we can definitely impact our thoughts, feelings, and behaviors about the disease. That's different from blaming someone for bringing on his or her illness. That's why when traditional medicine folks yell, "Quack! Snake Oil" at these fringe alternative therapists, it's taking the mind/body connection and distorting the science to blame people for something they don't really have control over.
Bernie Siegel had to backtrack from his original statements, because a lot of what he was saying was on the edge of blaming people. From my perspective, five things contribute to getting cancer. (1) Genetics. How can you blame people for their parents? Come on! (2) Environment. 30 years ago, we didn't know that using baby oil on the beach and roasting ourselves like lobsters would come back to hurt us. And when I was working as a student in a library, who knew that was asbestos falling on me? Pesticides in food, etc. Who knew? (3) Diet. When President Clinton was growing up, they didn't know about diet as we do now. (4) Behavior. Dr. Griggs can correct me if I'm wrong, but as far as I know, the only thing proven to have cause and effect hands down is cigarette smoking and not using sun block protection in skin cancer. Finally, (5) Random chance. Every time you show me someone who smoked who did get lung cancer, I can show you someone who got small cell lung cancer who never touched a cigarette, and the 90-year-old guy smoking like a chimney who never got cancer. So you've got all these random chances.
- Dan Benor Adding and contrasting to what Dr. Lachman said, my mental picture is of all of those five factors where you put them in one side of a balance, and on the other side in your life you put the energy you have to deal with those factors. You have a picture of how people are challenged in their lives and how they deal with stress. Being a psychiatrist and working with people with psycho-neuro-immunology, PNI for short, I find there are people who can markedly influence their experience of their illness, and some who can apparently shift the course of their illness by shifting what's in the pan on one side or the other. And that's mostly on the side of stress and how they relate to it, because as Dr. Lachman pointed out, there's not much you can do with the other side.
- Question from Revcate: Is everything labeled "aromatherapy" as effective as another?
- Answers - Dan Benor Aromatherapy is an enormous field where they are just beginning to do research. In Volume 2 of my book on Healing Research, I summarize very briefly those symptoms which have been found to respond to particular oils. We're really in the early days of exploring those. Aromatherapy is administered in several different ways. The most common is through an inhaler system where they evaporate the oil with a little burner under a cup that's holding water with a few drops of oil. The second is where it's used topically, in massage oil. It serves to smooth the massage at the same time that the aroma is administered through the oil.
- Question from Britts: What are Bach flower remedies?
- Answers - Dan Benor In England, Edward Bach developed a series of some 36 different oils from plant material and found that these were extremely helpful with a spectrum of psychological and physical symptoms. The field of flower essence therapy has literally blossomed around the world, and there are now Alaskan, Californian, and many Hawaiian remedies that have extended the original 36. Many of them are not just for the physical and emotional, but go into spiritual as well. People refer to flower essences as spiritual homeopathy. On my website, www.wholistichealingresearch.com, I have an enormous spectrum of resources including a summary of the flower essences and sites where people can find out more about them.
- Larry Lachman In that same article I mentioned from the June 2003 Professional Psychology Journal, they cite an article by a researcher named Senior in 1995. Dr. Senior had performed an overall analysis of 25 years of clinical study on homeopathy, and of 107 controlled trials, 81 of those showed homeopathy to be effective. 8 out of 10 displayed positive results in relieving a lot of psychologically oriented stress disorders. In 1997 and 1994, in the British medical journal, The Lancet, articles by Dr. Linde and Dr. Reilly showed that homeopathy was effective beyond placebo control. So even in journals like this, they've shown efficacy for the homeopathy that Dr. Benor was talking about.
- Question from Stacey: Why is it when someone sees dramatic results using an alternative therapy, practitioners of Western medicine choose not to study it further?
It comes down to paradigms. Paradigms are literally world views. And if you have all your eggs in one paradigm basket, and another person comes up with another paradigm basket, then that can be very threatening. Most people have put their economic livelihood and their ego/self esteem into that one world view. When something outside their familiar paradigm is shown to be somewhat effective or even more effective, that can literally overwhelm the practitioner's paradigm and cause anxiety and self doubt.
Most people try to keep anxiety and self doubt at arm's length. The way some practitioners do that is by dismissing and belittling and ignoring and discounting dramatic improvements from another paradigm. Also, cancer patients' friends and family can do the same. We know you can't "catch" cancer, but cancer still has a lot of stigma and impact. I see patients in therapy groups, and what added insult to injury was their friends disappearing because they couldn't handle the mortality issues. Instead of trying to deal with their own anxiety, they kept it at arm's distance by keeping their friend, who now has cancer, at arm's distance. And that adds to the depression and feeling like damaged goods.
That's why support and therapy groups are essential. You hook up with people who are walking the walk, not just talking the talk, and you connect with people who care about you and aren't scared or threatened. Support groups improve quality of life, which means less anger, pain, rage, and better sleep, better pain control, and reduced post-operative complications compared to those who are isolated or don't have support.
Although they've had difficulty replicating Dr. Spiegel's work at Stanford with metastatic breast cancer patients, and Dr. Fawzy's malignant melanoma group at UCLA, they found that people who went to support groups had better quality of life, and the support group folks lived longer than those who weren't in groups. These studies haven't shown so much quantity of life as quality. So that's why people in general sometimes are dismissive, or don't want to give credit when they see other forms of treatment.
Adding to what Dr Lachman says, all of which I agree with, the support groups also give hope. They add positive ways of relating to illness that people explore and can help each other find and develop and enhance. They also serve to share information, because there is so much out there that it's impossible for one person to find all of it. So in a group of people with similar problems, many people can scan for information that's helpful to all.
I've been interested in the opposite question, namely how does change come about in people's attitude? And I have to say that the general public is way ahead of the medical profession. In 1993 and 1998, there were very important papers published by Dr. David Eisenberg at Harvard: surveys showing that almost as many dollars were spent by the public for complementary and alternative therapies as were spent for conventional medical treatment. These therapies were not covered by insurance, so it was clear people were paying that much money out-of-pocket. These surveys had the effect of opening doors in medical schools to exploring these therapies, which people were obviously finding worthwhile in a big way.
At the same time, doctors are cautious, and properly so, because snake oil and other treatments have been touted but found to be no more than sugar pills and sometimes poisonous pills. Doctors are also concerned that people might use these therapies as alternatives, and that's where the term "alternative therapy" has been threatening to doctors who think someone will find an alternative to their treatment, since they know little about it from their training. This is being corrected.
There is now an American Board of Holistic Medicine (ABHM), which is training and certifying doctors in these areas and giving them legitimacy. I was pleased and honored to be invited as a founding member of the ABHM to introduce evidence confirming that spiritual awareness and healing are effective modalities within this spectrum. Support groups often provide information that people can take back to their doctors. So they are not only asking the doctor about the therapy, they are educating the doctor as well. I've spent some 20 or more years collecting this sort of evidence in my books on Healing Research.
On the NIH (National Institutes of Health) Web site, May 2004, they surveyed over 31,000 people in the US. They found that 36% of all adults, not just cancer patients, were using some form of CAM (Complementary and Alternative Medicine). When they factored in vitamins and prayer, it rose to 62%. NIH in May states that women, more than men, tend to use CAM. People with higher education levels tend to use CAM. People who have been hospitalized in the last 12 months tend to use CAM. Former smokers use CAM more than current smokers.
CAM is used most frequently, at least in the US, for back problems, neck problems, headache, joint ache, chronic pain, colds, anxiety, depression, gastrointestinal disorders, and sleeping problems. 55% of those in the survey combined conventional and complementary to get the best of both. Citing a 1997 study, the American public spent between 36 and 47 billion dollars in 1997 on complementary and alternative medicine.
Jennifer Griggs, M.D., M.P.H.
I'd like to add an oncologist's perspective. In addition to physician discomfort over therapies, particularly therapies that people put in their bodies, with which they are not familiar, it is important to recognize the following. Even when randomized controlled trials costing millions of dollars demonstrate the benefit of a new therapy, treating physicians can be slow in taking up the use of a new treatment or diagnostic tool. In addition, even when drugs have been studied for years and been shown to be effective, long-term negative effects can show up even years after FDA approval. So as a group, physicians tend to be cautious — for better or for worse.
Obviously, caution is not always comfortable when we are dealing with cancer, but many of us believe that "doing no harm" is the most important thing we do for our patients.
Finally, many drugs that are used in "mainstream" medicine come from natural compounds, such as the bark of the Pacific yew tree (paclitaxel). So we oncologists do recognize the potential of the natural world to heal, but we also see the potential downsides of such products as well. We are no where near as cautious with treatments that aren't taken by mouth, such as massage and aromatherapy, but we may not be as familiar with these options.
- Question from Ann: I am a stage IV patient with mets in bones and mediastinal area. I am doing research on Quantum Energetics as a complementary therapy. Have you heard of this?
- Answers - Dan Benor All of the bioenergy approaches in the spectrum of spiritual healing can be helpful with pain, depression, and anxiety, and, as I mentioned before, decreasing side effects of medication. They can help with sleep, and with opening into spiritual awareness, which is something we are all challenged with as we face the possibility of approaching the end of our lives.
- Question from Fran: What would be good to take for depression?
From a psychologist's standpoint, you always want to rule out physical causes, which means sometimes medicines we take for treatment can have a depressive effect. For example, some high blood pressure medications. Hypothyroidism can cause depressive symptoms, and people diagnosed with cancer forget the other illnesses associated with aging that may affect them. So if someone has depressive symptoms, you want to do blood tests to rule out metabolic causes on a purely organic level. From the psychosocial point, people with depressive symptoms may exhibit a normal reaction to an abnormal situation. Particularly, you don't want to over-pathologize. I mean, if you're diagnosed with cancer and your prognosis is so-so and you've lost your hair and you can't eat, that would make anyone depressed. It may or may not rise to the level of a clinical depression in the DSM book (the book used for psychiatric evaluation).
For clinical depression, I tell my patients the four D's - Distress and Dysfunctionality, i.e. the depressive symptoms are interfering with home/social life. It can also be potentially Deviant. In other words, it leads to behavior that the person says is abnormal. And it can potentially be Dangerous to the person or others. Three of four out of those 4 D's are usually there in severe clinical depression.
Between 25% and 45% of cancer patients will develop a full depressive diagnosis. So when people bring up depression, it may just be a normal reaction to a threat of loss of life. It may or may not rise to the level of a clinical state. Both medicines, in the form of drug and talk therapies, have been shown to be helpful, especially cognitive behavioral therapies. I'll let Dr. Benor address other things that may be helpful.
I agree with Dr. Lachman pointing out that depression is perfectly normal when there's a serious issue in your life. What are practical measures you can use to address the issues that are depressing? Going into treatment, the psychotherapeutic spectrum is very broad. WHEE, which I mentioned earlier, is in an article on my website under Self Healing. This is an acupressure technique combined with an affirmation, which can relieve symptoms of anxiety, depression, and pain, and help with insomnia.
Medicinally, St John's Wort is the gentlest antidepressant and the cheapest as well. In Europe, it is the most commonly prescribed anti-depressant and has no side effects. Because it's so gentle, it may take four to six weeks before it works. So for a serious depression, one might want to consider anti-depressant medications that work more quickly, but may have side effects such as loss of sexual activity, sleep disturbance, and nausea, which with chemo may be a problem. Some of the aromatherapy oils can be helpful with depression.
Among the flower essences in the Bach varieties, there are five different kinds of depressions that are recognized: depression with despondency, depression with anger, etc. So these are very specific, but may take a while to work. Homeopathy is incredibly helpful, because it's prescribed on a very individual basis. You don't give the same remedy to two people who have the same symptoms; you look at the whole person and find the remedy that's right for the whole person. And support groups are incredibly helpful in dealing with depression.
- Larry Lachman Two quick points. If someone is imminently suicidal, not eating, sleeping all the time, or having hallucinations or delusions, you need hospitalization, antidepressants, and follow-up therapy. The patients I've seen who are suicidal wanted to kill the pain, not themselves, but cognitively get so focused that the only way to kill the pain is to kill themselves. But when they see that the pain itself can be killed, they choose that way.
- Dan Benor Spiritual healing, as in therapeutic touch, Reiki, or prayer, has been shown in research to be effective for depression. Of course, pain is a major factor in depression, so dealing with the pain can be a help with the depression as well.
With pain, pills without skills won't do it, especially for chronic pain. You need the action techniques in addition to pain medicine. The American Cancer Society recommends asking these question before starting a CAM treatment (or any treatment): What claims does the practitioner make? What are the credentials of the person making the claim? How is the method promoted? What are the costs? Red flags to be wary of: Does the treatment claim to cure all cancers in all people? Do the promoters of the treatment tell you not to use any traditional treatment? If the treatment is only offered in secret by one individual, that's also a red flag.
What I've learned from my cancer journey is making peace with people with whom you've had falling outs, helping other cancer patients in need, setting good boundaries, reclaiming a spiritual path, and deciding to slow down and be less Type A. These will also help people deal with cancer.
- Question from Susie: Are there any cautions that should be considered with St. John's Wort or any of the other complementary medications?
Jennifer Griggs, M.D., M.P.H.
We need to be very respectful of the body and the way it handles drugs. In addition, interactions with complementary therapies have been shown. For example, St. John's Wort, to use the example Dr. Benor gave, has been shown to decrease the effectiveness of irinotecan, a new chemotherapy agent.
In addition, ginko biloba is a blood thinner and may be ill-advised in some patients going to surgery or with a bleeding tendency. Don't hesitate to talk with your treating oncologist and surgeon about what you are taking, both prescription and non-prescription drugs, so that you can receive the best treatment from all of your providers.