Is There a Role for Homeopathy in Cancer Care? Questions and Challenges

Abstract

Patients with cancer commonly use complementary and integrative medicine, including homeopathy. Homeopathy has grown in popularity with the public but is viewed with skepticism by medical academia and is still excluded from conventionally prescribed treatments. In recent years, homeopathy has been used in cancer care in Europe and other countries worldwide. This use raised the question if there is any benefit in utilizing this type of care with cancer patients. The purpose of this manuscript is to explore the evidence related to the benefit of homeopathy in cancer care. Limited research has suggested that homeopathic remedies appear to cause cellular changes in some cancer cells. In animal models, several homeopathic remedies have had an inhibitory effect on certain tumor development. Some clinical studies of homeopathic remedies combined with conventional care have shown that homeopathic remedies improve quality of life, reduce symptom burden, and possibly improve survival in patients with cancer. The findings from several lab and clinical studies suggest that homeopathy might have some beneficial effect in cancer care; however, further large, comprehensive clinical studies are needed to determine these beneficial effects. Although additional studies are needed to confirm these findings, given the low cost, minimal risks, and the potential magnitude of homeopathy's effects, this use might be considered in certain situations as an additional tool to integrate into cancer care.

Full text

INTEGRATIVE CARE (C LAMMERSFELD, SECTION EDITOR)
Is There a Role for Homeopathy in Cancer Care? Questions
and Challenges
Moshe Frenkel
1,2,3
#Springer Science+Business Media New York 2015
Abstract Patients with cancer commonly use complementary
and integrative medicine, including homeopathy. Homeopa-
thy has grown in popularity with the public but is viewed with
skepticism by medical academia and is still excluded from
conventionally prescribed treatments. In recent years, home-
opathy has been used in cancer care in Europe and other coun-
tries worldwide. This use raised the question if there is any
benefit in utilizing this type of care with cancer patients. The
purpose of this manuscriptis to explore the evidence related to
the benefit of homeopathy in cancer care. Limited research has
suggested that homeopathic remedies appear to cause cellular
changes in some cancer cells. In animal models, several ho-
meopathic remedies have had an inhibitory effect on certain
tumor development. Some clinical studies of homeopathic
remedies combined with conventional care have shown that
homeopathic remedies improve quality of life, reduce symp-
tom burden, and possibly improve survival in patients with
cancer. The findings from several lab and clinical studies sug-
gest that homeopathy might have some beneficial effect in
cancer care; however, further large, comprehensive clinical
studies are needed to determine these beneficial effects. Al-
though additional studies are needed to confirm these find-
ings, given the low cost, minimal risks, and the potential
magnitude of homeopathy’seffects,thisusemightbeconsid-
ered in certain situations as an additional tool to integrate into
cancer care.
Keywords Homeopathy .Cancer care .Ultra-diluted
remedies .Complementary medicine .Integrative medicine .
Quality of life in cancer care
Introduction
Patients with cancer commonly use complementary and inte-
grative medicine (CIM) to improve their quality of life, to gain
a sense of control, and to participate actively in their care.
Patients often search for additional options to manage the
chronic side effects of treatments, for ways to reduce the risk
of recurrence or secondary cancers, and sometimes for addi-
tional treatments for comorbid conditions exacerbated by their
illness. In order to achieve these goals, some patients choose
to incorporate CIM therapies such as meditation, acupuncture,
homeopathy, yoga, and diet into their care [1–3].
Homeopathy has grown in popularity with the public but is
viewed with skepticism by medical academia and is still ex-
cluded from current conventional recommendations. Home-
opathy is practiced extensively in Europe, Asia, Middle East,
and South America to treat functional disorders and minor
ailments. Homeopathy is based on the theory that highly di-
luted natural substances affect illness and improve symptoms.
At times, the dilution level is far beyond the Avogadro number
which reflects that there are no original molecules in those
dilutions. In the USA, the homeopathic remedies that are pre-
pared in this unique process are supervised by the Federal
Drug Administration [4].
Unfortunately, not much research has been published on
the use of homeopathy among cancer patients in the USA. A
This article is part of the Topical Collection on Integrative Care
*Moshe Frenkel
frenkelm@netvision.net.il
1
Department of Family Medicine, The University of Texas Medical
Branch at Galveston, Galveston, TX, USA
2
Integrative Medicine Unit, Institute of Oncology Meir Medical
Center, Kfar Saba, Israel
3
Hashoftim 1 B, Zichron Yaacov 30900, Israel
Curr Oncol Rep (2015) 17:43
DOI 10.1007/s11912-015-0467-8

2015 search of the term Bhomeopathy^in PubMed produced
over 5000 citations; approximately 250 of these citations
relate to homeopathy and cancer [5]. With this increased
interest in homeopathy among the general public in
many countries, as well as among cancer patients world-
wide, the need to explore the evidence about the benefit
of this method of care arose. In this paper, we will first
establish the popular use of homeopathy throughout the
world, and then we will address the frequent questions
and challenges that arise with this use, such as the clin-
ical effectiveness of homeopathy in cancer care, the safe-
ty of homeopathy, and the effect of combining homeo-
pathy with conventional cancer care as well as findings
from the laboratory such as in vitro studies and animal
studies.
Popular Use of Homeopathy
A recent survey, published in 2015 in the USA, revealed a
trend of increased use of homeopathy in the general popula-
tion. The study estimated that over five million adults and over
one million children use homeopathy. Homeopathy is used
more than well-known CIM therapies such as guided imagery,
acupuncture, energy healing therapy, naturopathy, hypnosis,
biofeedback, and Ayurvedic medicine [4].
In Europe, homeopathy is used during and after cancer
treatments. A survey of close to 1000 cancer patients in 14
European countries revealed that 36 % of cancer patients were
using some form of complementary medicine. In the surveyed
countries, cancer patients often used homeopathy with herbal
remedies as the main CIM therapy [6].
In the UK, a questionnaire-based study revealed that ho-
meopathy was one of the mainly used CIM therapies by can-
cer patients [7].
Approximately 34 % of patients treated in a French cancer
department reported using CIM; of these patients, the majority
(42 %) used homeopathy [8].
In Germany, cancer patients (both adults and children)
tend to use homeopathy in addition to conventional treat-
ments. Homeopathy, as a matter of fact, is the most fre-
quently used CIM treatment among German adults and
children with cancer [9,10].
In Italy, homeopathy is also commonly used and is one of
the three leading complementary therapies used by cancer
patients [11]. One survey at two oncology day hospitals in
Italy revealed that 17 % of patients on chemotherapy used
CIM. Homeopathy and herbal medicine were the most com-
monly used forms of CIM in those hospitals [12].
Another large European survey published in 2015 involved
236 centers that provide integrative oncology services in the
public health system. In this recent study, homeopathy was
one of the leading CIM therapies (40.4 %) [13••].
Effectiveness of Homeopathy in Clinical Care
Clinicians often question the effectiveness of homeopathic
remedies in cancer care. Are there any scientific studies that
support the claim that homeopathy has clinical effects? Con-
ventionally trained healthcare providers often are skeptical of
the idea that a medication that is diluted to the extent that there
is no original material still has clinical effects. But even when
phenomena appear to have no explanation, one needs to ap-
proach these questions scientifically as with any clinical
question.
A recent report from an Australian team assessed the
general effectiveness of homeopathy. This study was
based on three sources: Ban overview of published sys-
tematic reviews done by an independent contractor dat-
ing 1997–2012, an independent evaluation of informa-
tion provided by homeopathy interest groups in Austra-
lia, and consideration of clinical practice guidelines and
government reports on homeopathy published in other
countries^[14]. However, the study did not include
any in vitro studies, animal studies, or studies that were
not included in the systematic reviews published before
1997 or after 2012. The study did not cover cancer as a
possible health condition other than hot flashes that was a
result of breast cancer treatment. The study concluded that
no reliable evidence shows that homeopathy effectively
treats any illnesses [14].
However, in 2011, the Swiss government published a
report in English concerning the use of homeopathic
medicine [15]. This report comprehensively evaluated
homeopathy as a medical system integrated into
healthcare. This government initiative resulted from the
high demand for and widespread use of CIM therapies
in Switzerland, not only among consumers but also
among physicians.
The Swiss report carefully reviewed the evidence
from randomized double-blind and placebo controlled
clinical trials testing homeopathic medicines, they also
evaluated the Breal world effectiveness^as well as safe-
ty and cost-effectiveness [15]. The report also conducted
a comprehensive review of preclinical research such as
botanical studies, animal studies, and in vitro studies
with human cells. After assessing the evidence from
basic science research and high-quality clinical studies,
the Swiss concluded that homeopathic remedies seem to
induce cellular effects as well as changes in living or-
ganisms. The report also mentioned that 20 of the 22
systematic reviews of clinical research, testing homeo-
pathic medicines, detected a trend in favor of homeop-
athy. The authors concluded that homeopathic treatments
should be reimbursed by Switzerland’s national health
insurance program, and the Swiss government followed
this recommendation [15].
43 Page 2 of 6 Curr Oncol Rep (2015) 17:43

Clinical Experience
Because of the scarcity of knowledge about the efficacy of
many CIM therapies used in cancer care, the National Cancer
Institute (NCI) has developed a program that encourages CIM
practitioners to present their data to evaluate if specific CIM
therapies can trigger further innovative research. Over the past
20 years, the Best Case Series Program has invited CIM prac-
titioners to submit clinical data on patients that had significant
tumor reduction in response to an alternative modality for
cancer treatment. Each case is reviewed against the same rig-
orous standards of evidence ofnovel conventional cancer ther-
apies. The NCI Best Case Series Program offers practitioners
who treat patients with cancer, expert assistance in identifying
and compiling persuasive case studies, as well as the oppor-
tunity to have their data evaluated at the National Institute of
Health [16,17].
In 1999, researchers from the Prasanta Banerji Homeopath-
ic Research Foundation (PBHRF) in Kolkata, India, submitted
data to this NCI program. These researchers developed a
method of using homeopathic medicines through prescribing
specific remedies for specific malignancies. They followed
17,324 patients with malignant tumors who were treated at
PBHRF between 1990 and 2005. In 19 % of the patients,
the malignant tumors completely regressed after homeopathic
treatment, and 21 % of the patients were the same or improved
after homeopathic treatment [18].
Drs. Prasanta and Pratip Banerji, the founders and leaders
of this clinic, presented to NCI the data from patients with
cancer treated with the Banerji protocol that had experienced
documented improvement. The patients treated in this clinic
received only homeopathic remedies and did not receive any
additional conventional treatment such as surgery, radiation,
or chemotherapy. After rigorous evaluation of the findings,
NCI concluded that there was sufficient evidence of possible
efficacy to warrant further research [19].
Another study by PBHRF researchers and researchers at
The University of Texas MD Anderson Cancer Center de-
scribed 15 patients diagnosed with documented intracranial
tumors who were treated exclusively with the homeopathic
remedies Ruta graveolens 6c and Calcarea phosphorica 3X,
without additional chemotherapy or radiation. Of these 15
patients, 6 of the 7 who had glioma showed complete regres-
sion of the tumors [20].
Safety of Homeopathy
A large prospective multicenter cohort study evaluated the
long-term health of patients 8 years after the use of homeo-
pathic treatments. In this study, researchers evaluated 103 ho-
meopathic primary care practices in Germany and Switzerland
involving 3709 patients. Patients had chronic ailments
including allergies, headaches, chronic skin problems such
as atopic dermatitis, and multiple recurrent infections in chil-
dren. The authors found that patients who seek homeopathic
treatment are likely to improve with treatment. This effect was
maintained for as long as 8 years. Because the study was not
intended to prove cause and effect, the authors were unable to
conclude if this effect was related to the homeopathic reme-
dies themselves or to the unique patient-doctor communica-
tion involved in this process [21].
In 2009, a review of clinical trials in homeopathy and can-
cer was performed by The Cochrane Collaboration. This re-
view evaluated the safety and effectiveness of homeopathic
medicines that were used to prevent or treat adverse effects of
cancer treatments. The reviewers found eight controlled trials
with a total of 664 participants. The researchers concluded that
there were no serious adverse effects related to the homeo-
pathic remedies that were used. The review also found some
preliminary data that suggest beneficial effect of homeopathy
in dermatitis during radiotherapy and chemotherapy-induced
stomatitis. There was no convincing evidence for the efficacy
of homeopathic remedies for other adverse effects of cancer
treatments [22].
Homeopathy Combined With Conventional Cancer
Care
To evaluate the added value of homeopathy to conventional
care, a prospective observational study in Switzerland and
Germany evaluated two cohorts of patients with cancer, one
cohort was treated with homeopathic complementary therapy
in addition to conventional care (surgery, chemotherapy, radi-
ation, hormone therapy, and others) and one cohort was treat-
ed with only conventional care. In this study of 639 patients,
researchers observed that quality of life and fatigue symptoms
improved in cancer patients who received the homeopathic
complementary treatment [23••].
A more recent randomized controlled trial evaluated classic
homeopathy as a supplement to conventional cancer care. All
patients received standard anti-neoplastic therapy and were
randomized to receive classic homeopathic adjunctive therapy
in addition to standard therapy. This study of 285 patients
revealed that patients who received the homeopathic treatment
had significantly better global health status and subjective
well-being than those who received only conventional cancer
care [24••].
A triple-blinded study with a meticulous research method-
ology (Jadad score 5) investigated the effectiveness of single
and combination homeopathic remedies used to treat hot
flushes in women with a history of breast cancer. In this study,
patients were randomized into three groups: a placebo combi-
nation and a verum single remedy, a verum combination med-
icine and a verum single remedy, and two placebo
Curr Oncol Rep (2015) 17:43 Page 3 of 6 43

combinations. The selected remedies were individualized for
each patient and included Sepia,Calcarea carbonica,Sulfur,
Llachesis, and Kali carbonicum. The combination remedy
was Hyland’s Menopause tablets, which contain amyl nitrate,
Sanguinaria canadensis,andLachesis. Even though the re-
sults were not positive for improving hot flushes, one cannot
ignore a significant improvement in general health score that
was observed in both homeopathy groups as compared with
the placebo group. Researchers concluded that breast cancer
survivors did have some positive benefit from the use of ho-
meopathic remedies [25].
Homeopathy and Survival
Other than encouraging case reports, there is little research on
long-term survival of patients who used homeopathic care
during cancer treatment. There are a few clues coming from
clinical practice and limited research. As mentioned above,
Dr. Banerji reported that in 40 % of his patients, the malignant
tumors were either completely regressed, improved, or static
after homeopathic treatment [18]. Unfortunately, this claim
was not substantiated with rigorous scientific research.
At the Medical University of Vienna in Austria, researchers
collected survival data on 538 patients with fatal disease and
poor prognosis who used homeopathy in addition to conven-
tional cancer care. The study included patients with glioblas-
toma, lung cancer, cholangiocellular carcinoma, pancreatic
adenocarcinoma, metastatic sarcoma, and metastatic renal cell
carcinoma [26••]. Median overall survival was compared with
experts’predictions of survival outcomes by specific cancer
type. The researchers found that these patients survived longer
than the expected prognosis, across all observed cancer types.
Although the results were promising, the authors were cau-
tious about the findings owing to the small sample size and
limited data about specific treatment characteristics. The au-
thors emphasized the need for further study of homeopathic
care in cancer patients.
Preclinical Findings: In Vitro and Animal Studies
The clinical response to homeopathic remedies could suggest
that the homeopathic treatment could relate to placebo effect
or effects related to a unique patient doctor communication.
So researchers have also investigated the effect of homeopath-
ic remedies on cancer cell survival in the laboratory where
those indirect factors cannot influence this response.
In 2004 at MD Anderson Cancer Center, Pathak et al.
showed that Ruta graveolens, a homeopathic remedy com-
monly used by Dr. Banerji for brain cancer, Bselectively in-
duces cell death in brain cancer cells (Glioblastoma
multiforme) while promoting proliferation in normal periph-
eral blood lymphocytes^[20].
Because of this study, many patients with brain cancer that
attended the integrative medicine clinic of MD Anderson
raised questions about this homeopathic remedy or had
marked interest in integrating this treatment into their conven-
tional care [27]. Most of the information on this treatment is
available to patients on the internet, health food stores, and
through support groups.
Out of this interest, a study conducted in the lab at MD
Anderson revealed that four ultradiluted remedies
(Carcinosin,Phytolacca,Conium,andThuja) exerted prefer-
ential cytotoxic effects against breast cancer cells, causing cell
cycle delay and apoptosis without affecting the normal mam-
mary epithelial cells. These effects were accompanied by al-
tered expression of the cell cycle regulatory proteins, includ-
ing downregulation of phosphorylated rb and upregulation of
the CDK inhibitor p27, which were likely responsible for the
cell cycle delay/arrest as well as induction of the apoptotic
cascade that manifested in the activation of caspase 7 and
cleavage of PArP in the treated cells.
Another observation that caused increased interest in-
volved a comparison of the cytotoxic effect of the homeopath-
ic remedies to Paclitaxel, a commonly used chemotherapeutic
drug for breast cancer. In this study, the cytotoxic effect of two
of the remedies, Carcinosin and Phytolacca, appeared to have
similar cytotoxic effect to the activity of Paclitaxel on the
breast cancer cells. On the other hand, the homeopathic rem-
edies did not affect the normal mammary epithelial cells while
the Paclitaxel had similar cytotoxic effect as it had on the
breast cancer cells [28].
Another interesting report by Amri et al. from George-
town University revealed reduced tumor volume in mice
that were inoculated with human prostate cancer cells and
were treated with the homeopathic remedy of Sabal
serullata.Inthisstudy,theexamination of the ultrastruc-
tural cytomorphology revealed cellular disintegration
which cannot be explained with the well-defined apopto-
sis or necrosis cell death. The analysis indicated a novel
caspase-independent cell death, which might explain the
significant tumor size reduction in the treated animals.
The authors concluded that their data suggest that these
ultra low concentrations triggered a pathway not yet char-
acterized as cell death and not related to classical apopto-
sisornecrosis[29].
MacLaughlin and his group from the same university
found that prostate tumor xenograft size was significantly re-
duced in Sabal serrulata-treated mice compared to untreated
controls. The response in the human prostate cancer was spe-
cifically induced by S. serrulata; other homeopathic remedies
had no effect. The researchers concluded that S. serrulata
should be further investigated as a specific homeopathic rem-
edy for prostate cancer [30].
43 Page 4 of 6 Curr Oncol Rep (2015) 17:43

A few additional studies from India indicate that homeo-
pathic remedies at ultra low doses may be able to decrease
tumor progression.
Kumar et al. [31] evaluated the inhibitory effects of homeo-
pathic preparations Ruta 200C and Phosphorus 1M (1000C)
against N′-nitrosodiethylamine (NDEA)-induced hepatocellu-
lar carcinoma in rats as well as 3-methylcholanthrene-induced
sarcomas in mice. Administration of the homeopathic reme-
dies slowed the tumor growth and significantly reduced the
elevated marker enzyme levels as revealed by morphological,
biochemical, and histopathological evaluations, as well as in-
creased the life span of mice harboring the tumors [31].
Arora et al. evaluated the effect of homeopathic remedies
on human kidney, colon, and breast cancer cells [32]. Re-
searchers found that the Bhomeopathic medicines had highly
significant effects in those cancer lines, producing cytotoxicity
and a decrease in cell proliferation. In the homeopathic treated
cultures apoptosis was evident. There was cell shrinkage,
chromatin condensation, and DNA fragmentation. The au-
thors concluded that the study provides preliminary laboratory
evidence indicating the ability of homeopathic medicines to
function as anticancer agents^[32].
Sunila and Kuttan evaluated the effect of the homeopathic
remedy Thuja occidentalis extract on the inhibition of lung
metastasis induced by melanoma cells in C57BL/6 mice [33].
A marked reduction in tumor-nodule formation was shown.
The level of collagen hydroxyproline (21.13 μg/mg protein)
was higher in the lungs of control animals with lung metasta-
ses than in the lungs of normal animals (0.98 μg/mg protein);
however, the level was significantly reduced in animals treat-
ed with the homeopathic remedy. The lifespan of the Thuja--
treated animals also was reported to be significantly increased
[33].
Conclusion
Despite advances in cancer care, patients continue to experi-
ence distress and disability during cancer treatment and after-
ward. As a result, patients use complementary modalities such
as homeopathy to address these needs. Data from several
sources suggest that cancer patients throughout the world in-
creasingly use homeopathy. With the current trend in oncolo-
gy to look at personalized medicine, nanotechnology, and uti-
lization of substances that affect the immune system, there is a
need to keep an open mind to new possibilities of care that in
the past were considered implausible.
Limited research has suggested that homeopathic remedies
appear to cause cellular changes in some cancerous cells. In
animal models, specific homeopathic remedies have had an
inhibitory effect on tumor development. Studies of homeo-
pathic remedies combined with conventional cancer care
show that these remedies improve quality of life, reduce
symptom burden, and possibly improve survival in patients
with fatal disease. In vitro studies, animal studies, and clinical
interventions that combine homeopathy with conventional
cancer care suggest that homeopathy might improve the
well-being of patients and might affect the progression of
cancer and patient survival. These findings warrant compre-
hensive clinical studies to determine the effects of homeopa-
thy on cancer and patient survival. Although additional studies
are needed to confirm these findings, given the low cost and
minimal risks and the potential magnitude of homeopathy’s
effects, in certain situations, one might consider the use of
homeopathic remedies as an additional tool to integrate into
cancer care.
Compliance with Ethics Guidelines
Conflict of Interest The author declares that he has no competing
interests.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
of the authors.
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