National Cancer InstituteOffice of Cancer Complementary and Alternative Medicine

A N N U A L R E P O R T O N

Complementary and Alternative Medicine

F I S CA L Y E A R 2 0 0 9

U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES

National Institutes 

of Health

NCI CAM ANNUAL REPORT 2009 1

DIRECTOR’S MESSAGE

The research the National Cancer Institute (NCI) 

supports, both in our own laboratories and at 

institutions worldwide, is focused on the ultimate 

goal of helping cancer patients. That mission – 

achieved through rigorous science – extends to 

NCI’s program on complementary and alternative medicine, also known as CAM. 

It is with great pleasure and pride that we once 

again provide NCI’s research partners, physicians, the advocacy community, policymakers 

and cancer patients with this fifth annual review 

of NCI’s extensive accomplishments in advancing 

evidence-based CAM interventions and therapies. 

Fiscal year (FY) 2009, marked the 10th anniversary of the establishment of NCI’s Office of 

Cancer Complementary and Alternative 

Medicine (OCCAM). Since its creation, OCCAM 

has held the job of coordinating and fostering the 

Institute’s CAM research portfolio and partnerships with extramural researchers as well as 

within NCI’s intramural programs. 

Over the past ten years, NCI’s portfolio of CAM 

research grew from about $20 million to around 

$120 million. This growth has been due to the 

hard work of hundreds of cancer researchers 

around the world as well as many individuals 

throughout the NCI, including OCCAM’s 

efforts in developing new funding opportunities, 

enhancing CAM technical assistance to grant 

applicants, and creating collaborative partnerships. There also has been substantial growth 

in the number of clinical trials relevant to CAM 

therapies, including landmark studies which 

for the first time provided solid evidence that 

improvements in lifestyle and dietary interventions are feasible and can impact the recurrence 

of certain cancers. 

NCI’s commitment to CAM research and clinical 

practice has been steadily supported, coordinated, and expanded by OCCAM over the years. 

That mission is continuing with the identification 

of new research priorities for NCI’s CAM office. 

OCCAM’s new priorities will expand NCI’s 

ability to extend the search for effective therapies 

into areas outside the mainstream of conventional 

biomedical research.

I hope you find this report helpful and informative. I also hope that it will generate an enhanced 

dialogue – especially between patients and health 

care professionals – about the appropriate uses of 

CAM interventions in conjunction with conventional medicine. Cancer patients deserve credible, 

unbiased information about any intervention or 

treatment regimen that they are considering. It is 

our duty to conduct and support the science that 

makes wise and informed decisions possible.

Jeffrey D. White, M.D.

Director

Office of Cancer Complementary and Alternative Medicine

Division of Cancer Treatment and Diagnosis 

National Cancer Institute
The following acronyms are used throughout this report: 

NCI National Cancer Institute

CAM complementary and alternative medicine

OCCAM Office of Cancer Complementary and Alternative Medicine

FY fiscal year

NIH National Institutes of Health

DCB Division of Cancer Biology

DCCPS Division of Cancer Control and Population Sciences

DCP Division of Cancer Prevention

DCTD Division of Cancer Treatment and Diagnosis

CCR Center for Cancer Research

DCEG Division of Cancer Epidemiology and Genetics

ARRA American Recovery and Reinvestment Act

DOC Divisions, Offices and Centers

TCM Traditional Chinese Medicine

MOU Memorandum of Understanding

NPB Natural Products Branch

DTP Developmental Therapeutics Program

CSC cancer stem cells

RDSP Research Development and Support Program

PA program announcement

CCOP Community Clinical Oncology Program

CARRA Consumer Advocates in Research and Related Activities 

COP Communications and Outreach Program

PAP Practice Assessment Program 

BCS Best Case Series 

CIS Cancer Information Service

PDQ Physician Data Query

SQF Sheng Qi Formula

ND Naturopathic Doctor

FOA funding opportunity announcement

CDC Centers for Disease Control and Prevention

PMID PubMed Identifier
CONTENTS

Director’s Message 1

Introduction 5

Office of Cancer Complementary and Alternative Medicine (OCCAM) 6

NCI CAM Communications Programs 16

Training and Conferences 22

HIGHLIGHTS	FROM	NCI’S	CAM	TRAINING	PROJECTS 26

NCI Supports Mentoring Program in Psychoneuroimmunology Research 28

Mentoring Helps Researcher Pursue Study of Ginger for Preventing Colorectal Cancer 29

Naturopathic Doctor Studies Antioxidant Use in Breast Cancer Patients 30

NCI Research in Complementary and Alternative Medicine 32

NCI	CAM	RESEARCH	PORTFOLIO	ANALYSIS:	FY	2009	 35

HIGHLIGHTS	FROM	NCI’S	WIDE-RANGING	CAM	RESEARCH 38

Understanding the Causes and Mechanisms of Cancer 40

Pooling Resources to Examine Associations Between Vitamin D and Risk of Rarer Cancers 41

Large Populations and Rigorous Methods Needed for Vitamin D Research 42

Targeting Prostate Cancer Cells with Bioflavonoids 43

Traditional Chinese Mind-Body Practice Studied in Long-Term Cancer Survivors 44

Traditional Chinese Medicine Oil Studied Against Prostate Cancer 46

Accelerating Progress in Cancer Prevention 48

West African Plants Studied for Inflammation and Cancer Prevention 49

Exercise May Boost the Immune System and Improve Cancer Vaccine Effectiveness 50

Red Algae from the Sea Studied for Colon Cancer Prevention 51

Pomegranate Studied as Preventive Agent Against Prostate Cancer 52

Dietary Components May Help Colon Cancer by Targeting Inflammation 53

Cranberry Juice Shows Promise for the Prevention of Bladder Cancer 54

Ancient Medicine from India Studied to Prevent Prostate Cancer 55

Developing Effective and Efficient Treatments 56

Vitamin K Studied in Treatment and Prevention of Liver Cancer 57

Vitamin D Studied to Treat Advanced Prostate Cancer 58

Dietary Restrictions Treat Cancer as a Metabolic Disease 59

Exercise and Antidepressants May Counteract Stress-induced Tumor Growth 60

Enhancing Cancer Immunoprevention and Immunotherapy with Naturally Occurring Beta Glucans 61

Botanical Products Examined for Prevention of Endometrial Cancer From Tamoxifen Treatment 62

Improving the Quality of Life for Cancer Patients, Survivors, and their Families 63

Cranial Stimulation Tried for Managing Side Effects of Chemotherapy in Breast Cancer 64

Exercise Intervention Studied for Heart Failure in Cancer Survivors 65

SCIENTIFIC	PUBLICATIONS	 66

Appendix 68

NCI CAM ANNUAL REPORT 2009 3
FIGURE 1. MAJOR CATEGORIES OF CAM THERAPIES

ALTERNATIVE MEDICAL SYSTEMS 

DEFINITION: Alternative medical systems are built upon complete 

systems of theory and practice. Often, these systems have evolved 

apart from and earlier than the conventional medical approach used 

in the United States. 

EXAMPLES: Acupuncture, Ayurveda, Homeopathy, Naturopathy, 

Traditional Chinese Medicine, Tibetan Medicine 

ENERGY THERAPIES 

DEFINITION: Energy therapies involve the use of energy fields. 

There are two types: 

• Biofield therapies are intended to affect energy fields that 

purportedly surround and penetrate the human body. The existence 

of such fields has not yet been scientifically proven. 

EXAMPLES: Qi gong, Reiki, Therapeutic touch 

• Electromagnetic-based therapies involve the unconventional use 

of electromagnetic fields, such as pulsed fields, magnetic fields, or 

alternating current or direct current fields. 

EXAMPLES: Pulsed electromagnetic fields, Magnet therapy 

EXERCISE THERAPIES 

DEFINITION: Exercise therapies include health-enhancing systems 

of exercise and movement.

EXAMPLES: T’ai chi, Yoga asanas

MANIPULATIVE AND BODY-BASED METHODS 

DEFINITION: Manipulative and body-based methods in CAM are 

based on manipulation and/or movement of one or more parts of 

the body.

EXAMPLES: Chiropractic, Therapeutic massage, Osteopathy, 

Reflexology 

MIND-BODY INTERVENTIONS 

DEFINITION: Mind-body medicine uses a variety of techniques 

designed to enhance the mind’s capacity to affect bodily function 

and symptom. 

EXAMPLES: Meditation, Hypnosis, Art therapy, Biofeedback, 

Imagery, Relaxation therapy, Support groups, Music therapy, 

Cognitive-behavioral therapy, Aromatherapy 

NUTRITIONAL THERAPEUTICS 

DEFINITION: Nutritional therapeutics are an assortment of 

nutrients and non-nutrients, bioactive food components used as 

chemo-preventive agents, and specific foods or diets used as cancer 

prevention or treatment strategies.

EXAMPLES: Macrobiotic diet, Vegetarianism, Gerson therapy, 

Kelley/Gonzalez regimen, Vitamins, Soy phytoestrogens, 

Antioxidants, Selenium, Coenzyme Q10 

PHARMACOLOGICAL AND BIOLOGIC TREATMENTS 

DEFINITION: Pharmacological and biologic treatments include the 

off-label use of prescription drugs, hormones, complex natural 

products, vaccines, and other biological interventions not yet 

accepted in mainstream medicine. 

EXAMPLES: Antineoplastions, 714X, Low dose naltrexone, 

Immunoaugmentative therapy, Laetrile, Hydrazine sulfate, 

Melatonin 

COMPLEX NATURAL PRODUCTS

DEFINITION: Complex natural products are an assortment of 

plant samples (botanicals), extracts of crude natural substances, 

and un-fractionated extracts from marine organisms used for 

healing and treatment of disease. 

EXAMPLES: Herbs and herbal extracts, Mistletoe, Mixtures of 

tea polyphenols, Shark cartilage 

SPIRITUAL THERAPIES 

DEFINITION: Spiritual therapies are therapies that focus on deep, 

often religious beliefs and feelings, including a person’s sense of 

peace, purpose, connection to others, and beliefs about the meaning 

of life.

EXAMPLES: Intercessory prayer, Spiritual healing 
INTRODUCTION

Each year, Congress requests a report of the 

National Cancer Institute’s (NCI) annual expenditures in complementary and alternative medicine (CAM)* research. To give more meaning 

to the numbers provided to Congress, a more 

detailed account of the Institute’s investment in 

CAM has been produced for the last four years. 

The reports, (including last year’s NCI’s Annual 

Report on Complementary and Alternative 

Medicine: Fiscal Year 2008), are intended as a 

way for NCI to communicate its progress in this 

area of medical research, not only to Congress 

but also to other interested stakeholders including cancer researchers, CAM practitioners, health 

care providers, advocacy organizations, cancer 

patients, and the general public.

The NCI’s Office of Cancer Complementary and 

Alternative Medicine (OCCAM) is proud to 

present the latest such report, NCI’s Annual 

Report on Complementary and Alternative 

Medicine: Fiscal Year 2009. Similar to the 

previous reports, this publication provides an 

overview of the NCI-supported work in this 

field along with details on certain selected 

projects in the areas of cancer CAM relating 

to communication, training and conferences, 

and research.

This report highlights projects, grants, and 

cooperative agreements supported by each of 

the Institute’s extramural grant funding divisions 

– Division of Cancer Biology (DCB), Division of 

Cancer Control and Population Sciences (DCCPS), Division of Cancer Prevention (DCP), and 

the Division of Cancer Treatment and Diagnosis 

(DCTD), along with projects from NCI’s intramural laboratories – Center for Cancer Research 

(CCR) and the Division of Cancer Epidemiology 

and Genetics (DCEG). These projects represent 

a variety of CAM categories, cancer types, 

research types, and grant mechanisms. This 

report includes summaries of selected training 

grant awards, as well as a breakdown of NCI’s 

CAM research portfolio. In fiscal year (FY) 2009, 

NCI’s research expenditures for CAM were an 

estimated $114,441,501 for the funding of 429 

CAM research projects. In addition, during FY 

2009, NCI used $21,637,877 in funds from 

the American Recovery and Reinvestment Act 

(ARRA) to award 104 CAM research grants.

As this report on cancer CAM indicates, we at 

the NCI are committed to an integrated approach 

to marshalling all of the many resources and 

approaches necessary to make cancer a condition 

that is – at worst – a manageable, chronic illness 

similar to heart disease and diabetes. We believe 

that evidence-based CAM techniques, systems, 

and products can have an important role in 

helping us reach that worthwhile goal.

* CAM is often defined as any medical system, practice, or product that is not thought of as “western medicine” or standard medical 

care. Complementary medicine means it is used along with standard medicine, also called conventional medicine. Alternative medicine 

is used in place of standard treatments. CAM treatments may include dietary supplements, megadose vitamins, herbal preparations, 

acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation (See Figure 1, on page 4 for the major categories of 

CAM therapies).

 INTRODUCTION 5
6 NCI CAM ANNUAL REPORT 2009

Office of Cancer Complementary and Alternative Medicine
NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM) is a 

coordinating office responsible for: identifying gaps 

in the science and creating corresponding funding 

opportunities for cancer CAM research; partnering with NCI program staff and other governmental 

and nongovernmental organizations to increase the 

testing of CAM approaches for cancer prevention, 

diagnosis, treatment, symptom management, and 

rehabilitation; developing communication products 

for various audiences concerning the investigation 

and use of these approaches; and helping to build 

bridges between CAM practitioners and the cancer 

research community.

OFFICE OF CANCER COMPLEMENTARY AND ALTERNATIVE MEDICINE 7
OCCAM is part of the NCI Division of Cancer 

Treatment and Diagnosis (DCTD). The division’s 

mission is to improve the lives of the American 

public by discovering better ways to diagnose, 

assess, treat, and cure cancer through stimulating, 

coordinating, and funding a national program 

of cancer research. OCCAM’s programs and 

activities complement DCTD’s mission and are 

enhanced by the other major programs and 

branches within DCTD.

During FY 2009, OCCAM announced its new 

research priorities: 

• Identifying novel therapeutics in the pharmacopeia of traditional medical systems as defined 

by the World Health Organization 

• Using complementary approaches to improve 

the therapeutic ratio of standard and investigational anti-cancer therapies

• Research on lifestyle modifications (e.g., diet, 

exercise, mind-body approaches) for their 

impact on cancer outcomes (e.g., response 

to conventional cancer therapy, survival)

The new priorities were developed after OCCAM 

became part of the NCI Division of Cancer Treatment and Diagnosis (DCTD) in FY 2007. This 

move allowed OCCAM to develop a new focus 

on cancer treatment research in addition to its 

historical role of supporting the growth of CAM 

research in all of NCI’s divisions, offices, and 

centers (DOCs). The three research priorities 

identified by OCCAM represent areas of special 

opportunities in the CAM field that do not overlap 

with the DOCs’ existing research projects.

FOCUSING ON BOTANICALS RESEARCH 

BOTANICALS AND CANCER RESEARCH: 

CLINICAL TRIALS WORKSHOP

In July 2009, OCCAM convened a meeting attended 

by more than 100 researchers, policymakers, and 

experts for a two-day workshop designed to tackle 

the topic of botanicals and clinical cancer research. 

Based on the type of expertise, the attendees were 

assigned to one of the following six working groups:

• Targets, Pathways, and Networks of 

Pre-Clinical Models;

• Botanical Drug Issues;

• Clinical Trial Design and Implementation I;

• Clinical Trial Design and Implementation II;

• Role of Industry in Botanical Drug 

Development; and

• Obtaining Grant Funding for Botanical Drug 

Research. 

Each working group was tasked to answer a series 

of questions about the challenges as well as the 

opportunities related to the current state of 

botanicals and cancer research.

A number of ideas emerged about how to establish 

an effective and organized clinical trial research 

infrastructure in the United States. The image of 

a pathway was used by some at the workshop as 

a way to describe how a botanical could move 

through the entire development spectrum: from 

discovery and reliable harvesting, into preclinical 

research at the bench, through to animal testing and 

human clinical trials, and ultimately to approval by 

the U.S. Food and Drug Administration (FDA) as 

a cancer treatment in humans. The discussions from 

this meeting are being used by OCCAM to better 

assess how to grow research in this topic and to 

improve technical assistance to grant applicants.

For more information, visit http://www.cancer.gov/cam/

attachments/workshop_agenda_09.pdf.

8 NCI CAM ANNUAL REPORT 2009
NCI SIGNS RESEARCH AGREEMENT WITH 

CHINESE BOTANICAL INSTITUTE

After the United States government signed a research 

agreement with China to foster collaboration between 

researchers studying integrative and Traditional 

Chinese Medicine (TCM) in both countries, one 

of the first and most promising of these projects 

is a partnership between the Kunming Institute of 

Botany (KIB) of China Academy of Sciences and 

two groups at NCI.

OCCAM began to oversee the growing collaboration 

after a Memorandum of Understanding (MOU) was 

signed between KIB and NCI in October 2008. KIB 

is supplying unique natural compounds from Chinese plants, while NCI’s Natural Products Branch 

(NPB) of the Developmental Therapeutics Program 

(DTP) will screen them for anticancer activity in 

NCI’s system of 60 human cancer cell lines. If any 

of the botanical compounds show promise, more 

drug analysis and development will follow.

OCCAM SUPPORTS INTRAMURAL RESEARCH

During FY 2009, OCCAM financially supported 

two research projects within NCI’s Center for 

Cancer Research (CCR). One research project led 

by William Farrar, Ph.D., head of the CCR Cancer 

Stem Cell Section, identified two phytochemicals 

– parthenolide and gossypol – that target prostate 

cancer stem cells (CSC) and may be used to eradicate 

CSCs in such tumors. 

Thus far, parthenolide has been shown to affect: 

1. tumor incidence and latency in animal studies; 

2. signals associated with tumor proliferation and 

cancer cell invasion in micro-array studies; and 

3. prostate cancer initiation, progression, and 

metastasis through altering transcription factor binding, which was found in protein/DNA array studies. 

1999-2009

OCCAM COMPLETES ITS 

FIRST DECADE AT NCI

The beginning of FY 2009 marked 

the 10th anniversary of OCCAM’s 

creation at NCI. During its first 

decade, OCCAM contributed to and 

documented the approximately 

$100 million growth of NCI’s CAM 

research portfolio. There was also 

significant growth in the number 

of clinical trials of CAM interventions, including landmark studies 

which for the first time provided 

solid evidence that improvements 

in lifestyle and dietary interventions 

are feasible and can impact the 

recurrence of certain cancers. 

NCI’s commitment to CAM 

research and clinical practice has 

been steadily supported, coordinated, 

and expanded by OCCAM over the 

years and that mission continues.

OFFICE OF CANCER COMPLEMENTARY AND ALTERNATIVE MEDICINE 9
The following articles, that present the results of 

this research, were published in FY 2009 (PubMed 

Identifier (PMID) numbers are provided for the 

citations):

• Kawasaki BT, Farrar WL. Cancer stem cells, 

CD200 and immunoevasion. Trends Immunology, October 2008;29(10):464-8. Epub 2008 

Sep 3. PMID: 18775673.

• Kawasaki BT, Hurt EM, Kalathur M, Duhagon 

MA, Milner JA, Kim YS, Farrar WL. Effects 

of the sesquiterpene lactone parthenolide on 

prostate tumor-initiating cells: An integrated 

molecular profiling approach. Prostate, June 1, 

2009; 69(8):827-37. PMID: 19204913.

• Klarmann GJ, Hurt EM, Mathews LA, Zhang 

X, Duhagon MA, Mistree T, Thomas SB, Farrar 

WL. Invasive prostate cancer cells are tumor 

initiating cells that have a stem cell-like genomic 

signature. Clinical & Experimental Metastasis, 

2009; 26(5):433-46. Epub 2009 Feb 17. 

PMID: 19221883.

• Mathews LA, Crea F, Farrar WL. Epigenetic 

gene regulation in stem cells and correlation to 

cancer. Differentiation, July 2009;78(1):1-17. 

Epub 2009 May 14. Review. PMID: 19443100.

In addition, for a third year, OCCAM has supported a CCR study on the Traditional Chinese 

Medicine (TCM) therapy called Sheng Qi Formula 

(SQF). O.M. “Zack” Howard, Ph.D., staff scientist 

and her team in the CCR Laboratory of Molecular 

Immunoregulation, Cancer and Inflammation Program conducted several studies during FY 2009 in 

follow up to work that was featured in a previous 

NCI CAM research annual report (An article on 

the earlier research is on page 35 of the FY 2007 

CAM report which can be found at http://www.

cancer.gov/cam/attachments/CAMAnnualReport

FY2007.pdf). 

These previous studies largely focused on the immunologic mechanisms of action of SQF. However, the 

CCR researchers’ recent experiments have begun 

to explore the direct effects of the TCM therapy 

on cancer cells. The resulting data from this year’s 

work indicate that the in vitro and in vivo effects of 

SQF on the 4T1 breast cancer model are due to the 

induction of apoptosis through the mitochondrial 

pathway.

OCCAM PROGRAMS

RESEARCH DEVELOPMENT AND 

SUPPORT PROGRAM

NCI sponsored 387 cancer CAM research projects 

in FY 2009, each of which are managed within 

the various Divisions and Centers of the Institute. 

OCCAM’s Research Development and Support 

Program (RDSP) staff manages a portion of this 

portfolio and works with other program staff 

throughout NCI, assists investigators in identifying 

funding opportunities, and provides guidance in the 

pre- and post-review periods of grant application. 

The staff also coordinates programs and initiatives 

designed to stimulate research in cancer CAM as 

well as activities to develop the foundation of the 

science in cancer CAM research.

Isis Mikhail, M.D., M.P.H., Dr.P.H. was named 

as RDSP Program Director in November 2008. 

Dr. Mikhail received her medical degree from Cairo 

University Medical School. She then received her 

MPH and DrPH degrees in Epidemiology and 

International Health from the University of 

Alabama at Birmingham. Before coming to 

OCCAM, Dr. Mikhail was a program director, 

epidemiologist and acting branch chief at the 

Clinical and Translational Epidemiology Branch 

(CTEB) of the NCI Division of Cancer Control 

and Population Sciences (DCCPS). 

10 NCI CAM ANNUAL REPORT 2009
Under Dr. Mikhail’s leadership, OCCAM reissued 

the program announcement (PA) PA-09-167 

“Developmental Projects in Complementary 

Approaches to Cancer Care and Treatment” in 

April 2009. This PA solicits grant applications to 

encourage and support the development of basic 

and clinical complementary cancer research projects 

(prevention, therapeutic, and palliative) through the 

exploratory/developmental research grant (R21) 

award mechanism. 

For more information, visit

http://grants.nih.gov/grants/guide/pa-files/PA-09-167.html.

In addition, OCCAM initiated a new small grant 

R03 funding opportunity announcement. This announcement, PA-09-168 offered R03 grant awards 

for researchers interested in starting small pilot and 

feasibility studies of CAM therapies and practices. 

Through this mechanism, studies can be funded 

that generate data needed for conducting larger 

scientific studies of CAM. OCCAM seeks to 

encourage investigators to initiate research in areas 

not typically explored in larger studies funded by 

other grant mechanisms, such as R01 and R21 

awards. Outreach to international audiences 

was conducted for this PA.

For more information, visit 

http://grants.nih.gov/grants/guide/pa-files/PA-09-168.html.

Funding CAM Research with Stimulus Act Funds

OCCAM successfully proposed funding from the 

American Recovery and Reinvestment Act (ARRA) 

of 2009 for three new supplements to grants in its 

portfolio. The ARRA awardees were chosen, in 

part, because they were addressing highly significant areas of cancer research:

• Dr. Rakesh Srivastava “Chemoprevention of 

Pancreatic Cancer by EGCG” 

(3R01CA125262-02S1). University of Texas 

Health Center at Tyler.

• Dr. Fazlul Sarkar “A Novel and Targeted 

Approach to Inhibit Invasion and Angiogenesis” (R01CA131151-02S1). Wayne State 

University, Detroit, Michigan.

• Dr. Yung-Chi Cheng “Nucleoside Analogs as 

Anticancer Compounds” (3R01CA063477-

14S1). Yale University.

OCCAM also provided an administrative supplement to the Radiation Therapy Oncology Group, 

Community Clinical Oncology Program (CCOP) 

Research Base (CA037422) to support components 

of a phase II/III study comparing acupuncture-like 

transcutaneous electrical nerve stimulation 

(ALTENS) versus pilocarpine in treating early 

radiation-induced xerostomia (dry mouth).

COMMUNICATIONS AND OUTREACH 

PROGRAM

OCCAM’s Communications and Outreach Program 

(COP) develops and disseminates information 

about NCI program initiatives and funding 

opportunities, workshops and other events, 

and educational materials through OCCAM’s 

publications and Web site (http://www.cancer.gov/

cam).

This program also assesses the opinions, interests, 

and informational needs of cancer researchers, 

CAM practitioners, and cancer patients regarding 

CAM research through surveys, public comment 

sessions, and focus groups. Results from these 

explorations are used to guide outreach efforts to 

these communities.

Assessing Cancer Patients Information Needs

In FY 2009, COP made a commitment to expand 

its outreach and communication efforts to cancer 

patients and produce additional resources that fill 

the existing gaps in patients’ information needs. 

OFFICE OF CANCER COMPLEMENTARY AND ALTERNATIVE MEDICINE 11
In order to develop resources that best serve the 

needs of patients, OCCAM began a qualitative 

needs assessment to identify the CAM issues and 

topics most important to cancer patients. The 

needs assessment started by targeting health care 

professionals who work closely with patients, 

including patient educators, social workers, nurses, 

physicians, and CAM practitioners. The information collected in OCCAM’s assessment will shape 

a dialogue about cancer patients’ needs related to 

CAM. It will also help NCI determine high priority areas for new patient-focused publications and 

resources. 

Other major communication activities in FY 2009 

included:

• Redesign of Health Information and About Us 

sections of the OCCAM website, along with 

usability testing of entire website. 

• Creating a Wikipedia entry on OCCAM 

http://www.cancer.gov/cam/newsletter/2009-

fall/cam_information_occam_fall2009.html

COP also published the following publications in 

FY 2009:

• NCI’s Annual Report on Complementary and 

Alternative Medicine: Fiscal Year 2008 

http://www.cancer.gov/cam/attachments/

fy2008_CAM_annual_report.pdf

• NCI CAM News – Spring 2009 

http://www.cancer.gov/cam/newsletter/ 

2009-spring/home.html

• NCI CAM News – Fall 2009 

http://www.cancer.gov/cam/newsletter/2009-

fall/fall2009_OCCAM_newsletter_home.html

In addition to sending staff and publications to the 

numerous professional meetings listed below, COP 

improved OCCAM’s outreach efforts by unveiling 

a new exhibit on NCI CAM research in FY 2009. 

This exhibit better promotes the mission of 

OCCAM and gives NCI a larger, more integral 

presence at key cancer CAM meetings, events, and 

symposia.

• Frontiers in Integrative Oncology; American 

College for Advancement in Medicine; Las 

Vegas, NV; October 15-19, 2008 (OCCAM 

staff attending: Shea Buckman)

• 5th International Conference of the Society for 

Integrative Oncology; Atlanta, GA; November 

20-21, 2008 (OCCAM staff attending: Shea 

Buckman, Dr. Isis Mikhail, Dr. Dan Xi)

• Evidence-based Complementary and Alternative Cancer Therapies Conference; West Palm 

Beach, FL; January 8-10, 2009 (OCCAM staff 

attending: Shea Buckman)

• 8th Annual Oxford International Conference 

on the Science of Botanicals; Oxford, MS; 

April 2009 (OCCAM staff attending: Shea 

Buckman, Dr. Isis Mikhail)

• North American Research Conference on 

Complementary and Integrative Medicine; 

Minneapolis, MN; May 2009; (OCCAM staff 

attending: Shea Buckman, Commander 

Colleen Lee, Dr. Dan Xi)

• Oncology Nursing Society (OCCAM staff 

attending: Commander Colleen Lee)

• American Society of Clinical Oncology 

(OCCAM staff attending: Dr. Farah Zia) 

• American Association of Family Physicians 

(materials only)

COP Collaborations

Each fiscal year, groups around NCI request the 

expertise of the COP staff. In FY 2009, COP:

• Assisted the NCI Office of Partnerships and 

Dissemination Initiatives’ Multicultural Media 

Outreach Program with developing an article 

on CAM titled: “Interested in Complementary 

12 NCI CAM ANNUAL REPORT 2009
and Alternative Medicine for Cancer? Talk 

with Your Doctor” for NCI’s Lifelines, a 

biweekly column outreaching to Hispanic and 

African American community newspapers 

across the country. The CAM article was made 

available to the BlackPressUSA.com via the 

National Newspaper Publishers Association 

and Journey to Wellness, a radio media brand 

that provides health care and health literacy 

information through syndicated radio programming on public radio stations and on 

the CNN Radio network.

• Worked with the NCI Cancer Information 

Service’s (CIS) to edit the CAM script for the 

recorded message on CAM offered through 

the 1-800-4-CANCER telephone line. 

The CAM script is one of six automated 

treatment messages. 

• Provided content review of CAM articles 

written for the NCI Cancer Bulletin biweekly 

newsletter, which reaches approximately 

52,000 subscribers. In FY 2009, COP 

participated in the following article reviews: 

– Harnessing the Biological Activity of Natural 

Products

– Chemotherapy Provides Longer Survival 

than Enzyme Therapy for Pancreatic Cancer

– Dietary Supplements and Cancer Treatment: 

 A Risky Mixture

– Researchers Urge Caution and Greater 

Scrutiny of Colon-related CAM Treatments.

In FY 2009, cancer patient advocates were involved in the review of NCI’s CAM Annual 

Report. OCCAM solicited feedback from four 

Consumer Advocates in Research and Related 

Activities (CARRA) members who agreed to review a draft of the FY 2008 report. These members provided comments on whether the document 

was easy to read, contained relevant information 

to the cancer patient community, or omitted topics 

of patient interest. The feedback from these 

CARRA members improved the quality of the 

NCI’s Annual Report on Complementary and 

Alternative Medicine: Fiscal Year 2008.

PRACTICE ASSESSMENT PROGRAM

OCCAM’s Practice Assessment Program (PAP) 

reviews information on cancer patients treated 

with alternative therapies. PAP manages the NCI 

Best Case Series (BCS) Program, which provides 

an opportunity for CAM practitioners to submit 

retrospective case reports regarding cancer CAM 

treatments used in their settings. Practitioners are 

asked to submit patient records for evaluation by 

experts in clinical assessment and cancer treatment 

research. Results of the NCI BCS Program are 

used to inform decisions regarding NCI-initiated 

research and to share well-documented best cases 

with interested members of the scientific community in order to stimulate research.

In FY 2009, 29 cases of cancer patients treated 

with an alternative approach were submitted to the 

NCI Best Case Series Program and reviewed for 

eligibility. Two cases were found to fit the program 

criteria and reviews were completed on those cases 

(i.e., confirmation of pathological diagnosis of 

cancer, confirmation of radiological response to 

alternative treatment, and summary letter sent to 

submitters). 

PAP is involved in an on-going collaboration with 

NCI’s Community Oncology and Prevention Trials 

Research Group of the Division of Cancer Prevention, which is involved in all aspects of the design 

and implementation of NCI’s large cancer prevention and symptom management clinical trials. 

PAP participates in concept and protocol reviews 

of trials utilizing CAM approaches, providing 

medical oncology and CAM research expertise 

and guidance.

OFFICE OF CANCER COMPLEMENTARY AND ALTERNATIVE MEDICINE 13
14 NCI CAM ANNUAL REPORT 2009

During FY 2009, OCCAM staff published two 

articles about the NCI BCS Program and CAM 

practitioners:

• Zia F, White J. Letter to the Editor. Integrative 

Cancer Therapies, 2009; 8(2),113-114. 

• Lee C., Zia F., Olaku O., Michie J., White J. 

Survey of CAM practitioners regarding cancer 

management and research. Journal of the 

Society of Integrative Oncology, Winter 2009; 

7(1), 26-34.

On February 4, 2009, PAP hosted a talk given by 

Drs. Mary Tagliaferri and Emma Shtivelman, from 

Bionovo Inc. titled “Anti-tumor Effects of BZL 101 

for Patients with Advanced Breast Cancer.” 

OCCAM’S PARTICIPATION AT MAJOR 

PROFESSIONAL CONFERENCES

OCCAM staff members are active in both domestic 

and international professional conferences through 

presentations and interactions with cancer CAM 

researchers, practitioners, and patient advocacy 

groups attending the conferences. 

During FY 2009, this encompassed several 

important meetings (OCCAM staff attending):

• Cancer Patient Education Network Annual 

Meeting; October 20-22, 2008; Clearwater, FL; 

(Shea Buckman)

• Cancer Foundation of China: The Progress and 

Prospect of Traditional Chinese Medicine Cancer Therapy and Prevention; October 22-24, 

2008; Zhangjiajie, China; (Dr. Libin Jia gave a 

presentation titled “Overview of the National 

Cancer Institute’s Cancer CAM Research”)

• 2nd International Congress of TCM and 

Integrated TCM-Western Medicine Oncology; 

October 24-26, 2008; Beijing, China; (Dr. Libin 

Jia was a session chairperson and gave a presentation titled “National Cancer Institute’s Traditional Chinese Medicine Related Research”)

• New York International Traditional Chinese 

Medicine Summit; New York City, NY; 

November 1-2, 2008; (Dr. Libin Jia gave a 

presentation titled “Cancer Research and 

Traditional Chinese Medicine: A Perspective 

from the U.S. National Cancer Institute”)

• Institute of Medicine Summit on Integrative 

Medicine and the Health of the Public; Washington, D.C.; February 25-27, 2009; (Dr. Isis 

Mikhail, Lauren Rice, Vera Rosenthal)

• American Association for Cancer Research 

Annual Meeting; Denver, CO; April 18-22, 

2009; (Dr. Isis Mikhail and Dr. Libin Jia 

participated in Meet-the-Expert sessions)
• City of Hope CAM Research Seminar; 

Duarte, CA; May 15, 2009; (Dr. Jeffrey 

D. White gave a presentation titled “Complementary and Alternative Medicine and 

Cancer Research”)

• American Society of Clinical Oncology Annual 

Meeting; Orlando, FL; May 29-June 2, 2009; 

(Dr. Libin Jia participated in a Meet-the-Expert 

session)

• Cancer GuidesTM II Cutting Edge Integrative 

Cancer Care; Washington, D.C.; June 11-14, 

2009; (Dr. Isis Mikhail gave a presentation 

titled “Understanding OCCAM and Applying 

for Assistance” and Dr. Jeffrey D. White gave 

a presentation titled “Integrative Oncology: 

Thoughts Regarding Future Development”)

• International Workshop on Bioinformatics and 

Systems Biology in Traditional Chinese 

Medicine Research; Shanghai, China; 

August 3-6, 2009; (Dr. Dan Xi was co-chair)

• 8th Meeting of the Consortium for the 

Globalization of Chinese Medicine; Nottingham, England; August 25-28, 2009, 

(Dr. Jeffrey D. White was co-chair of session 

titled ”Clinical Trial I: Cancer and Liver 

Inflammation”)

• 9th Annual Meeting of the Comprehensive 

Cancer Center of Wake Forest University 

Community Clinical Oncology Program 

Research Base; Ashville, NC; September 24-

26, 2009; (Dr. Isis Mikhail gave a presentation 

titled “Complementary and Alternative 

Medicine at the NCI”)

• HINTS Data Users Conference Partners in 

Progress; Silver Spring, MD; September 24-25, 

2009; (Elizabeth Austin)

OCCAM STAFF LIST: FY 2009 

Jeffrey D. White, M.D. Director, OCCAM

Christina Armstrong Administrative Program Specialist

Akia Samuda Administrative Assistant

Isis Mikhail, M.D., Dr.P.H., M.P.H. Director, Research Support and Development Program 

Dan Xi, Ph.D. Program Officer, Research Support and Development Program

Oluwadamilola Olaku, M.D., M.P.H. Scientific Program Analyst

Libin Jia, M.D. Scientific Program Manager

Akiko Nakayama, M.S. Scientific Program Analyst

Juanita Cox, B.S. NCI Administrative Career Development Intern 

Farah Zeba Zia, M.D. Director, Practice Assessment Program

CDR (U.S. PHS) Colleen Lee, M.S., AOCN® Coordinator, Practice Assessment Program

Shea Buckman, M.A. Coordinator, Communications and Outreach Program

Lauren Rice, M.S. Communications Analyst

Vera Rosenthal, M.P.H. Health Communications Intern

Elizabeth Austin, M.S. Health Communications Intern

OFFICE OF CANCER COMPLEMENTARY AND ALTERNATIVE MEDICINE 15
NCI CAM Communications Programs
NCI directs communications programs committed to 

providing current and credible information resources 

about CAM to its stakeholders.

NCI CAM COMMUNICATIONS PROGRAMS 17
PROVIDING INFORMATION ONLINE

OCCAM’s Web site (http://www.cancer.gov/cam) 

serves as NCI’s information hub on CAM issues. 

It provides a wealth of information resources and 

timely updates about the Institute’s CAM research 

portfolio, grant opportunities, and other news. 

Included on the OCCAM site are links to other 

information sources such as the Physician Data 

Query (PDQ®), which is NCI’s comprehensive 

cancer database. PDQ produces summaries 

covering topics such as cancer treatment, 

prevention, screening, and CAM. 

MOST FREQUENTLY ACCESSED PDQ 

CAM SUMMARIES

NCI tracks the number of page views of each PDQ 

CAM summary on Cancer.gov within both the 

patient and health professional versions. The number of page views is determined by the number of 

views to the first page of each PDQ summary. 

In FY 2009, the patient version summary with 

the highest number of page views was Essaic/FlorEssence, which had 31,002 page views. The second 

highest number of page views was for the patient 

version of Laetrile/Amygdalin, at 18,116. Third 

in the rankings was the Coenzyme Q10 patient 

summary, which had 17,462. 

During FY 2009, the highest number of page views 

received for a health professional version of a PDQ 

CAM summary was 6,085 for Mistletoe Extracts. 

The second most page views for the health professional versions was for Coenzyme Q10 with 5,366. 

The third most page views was for the Aromatherapy 

professional summary, which received 4,869. 

Figure 2 shows the total number of page views during FY 2009 for all of the PDQ CAM summaries in 

both the patient and health professional versions.

PDQ CAM CLINICAL TRIALS

NCI sponsors clinical studies on CAM approaches 

for cancer. The OCCAM Web site hosts a database 

which organizes CAM clinical trials by cancer types 

and types of symptoms. Clicking on an entry in the 

table triggers a search of the NCI’s PDQ Cancer 

Clinical Trials Registry, which includes approximately 4,500 abstracts of protocols that are open 

and approved to accept patients. Many, but not all, 

of these trials are conducted with NCI support. The 

table also archives trials that are currently closed. 

The Registry is available on the NCI Web site at 

http://www.cancer.gov/clinicaltrials/search/.

In FY 2009, there were 80 NCI-supported CAM 

clinical trials (See appendix for the complete list).

For the current list of CAM clinical trials by cancer type 

and to access the CAM clinical trials table, go to http://

www.cancer.gov/cam/clinicaltrials_list.html.

FIGURE 2. PDQ CAM SUMMARIES FY09

PATIENT SUMMARY PAGE VIEWS 

714X	 Acupuncture	 Antineoplastons	 Aromatherapy	 Cancell/Entelev	 Cartilage Coenzyme	Q10	 Essiac/Flor-Essence	 Gerson	Therapy	 

Totals 4182 11662 9651 5745 17462 9347 31002 25581 16637 

HEALTH PROFESSIONAL SUMMARY PAGE VIEWS

714X	 Acupuncture	 Antineoplastons	 Aromatherapy	 Cancell/Entelev	 Cartilage		 Coenzyme	Q10	 Essiac/Flor-Essence	 Gerson	Therapy	 

Totals 1248 3191 1544 4869 827 1282 5366 3755 1879 

18 NCI CAM ANNUAL REPORT 2009
Gonzalez	Regimen	 Hydrazine	Sulfate	 Laetrile/Amygdalin	 Milk	Thistle	 Mistletoe	Extracts	 Newcastle	 PC-SPES	 Selected	Vegetables/	 Spirituality	in

Disease	Virus	 	 Sun’s	Soup	 Cancer	Care

2066 6300 18116 15571 16527 3674 5510 5957 7031

Newcastle	 	 Selected	Vegetables/		 Spirituality	in	

Gonzalez	Regimen	 Hydrazine	Sulfate	 Laetrile/Amygdalin	 Milk	Thistle	 Mistletoe	Extracts	 Disease	Virus	 PC-SPES	 Sun’s	Soup	 Cancer	Care	 	

NCI CAM COMMUNICATIONS PROGRAMS 19

1296 637 1848 2602 6085 1176 1918 1989 3507

PRODUCING PUBLICATIONS

Various offices within NCI provide educational 

materials on CAM in print format to health 

professionals, people affected by cancer, and the 

general public.

NCI’S ANNUAL REPORTS ON CAM

OCCAM published NCI’s Annual Report on 

Complementary and Alternative Medicine: Fiscal 

Year 2008, which documented NCI’s participation 

in and support of a wide range of CAM activities. 

The report highlights the contributions of communications programs, training and conferences, 

and cancer CAM research in addressing the NCI 

strategic areas.

The report can be viewed and downloaded from http://

www.cancer.gov/cam/attachments/fy2008_CAM_annual_

report.pdf.

NEWSLETTER ON NCI’S CAM ACTIVITIES

OCCAM’s twice-yearly newsletter NCI CAM News 

provides the latest information on NCI-sponsored 

research, funding opportunities, meetings and 

workshops, as well as educational information on 

cancer and CAM. NCI CAM News also includes 

features on cancer CAM projects representing the 

full range of NCI’s activities as well as OCCAM 

program updates. 

The following issues of NCI CAM News were 

made available online in FY 2009:

• Spring 2009 http://www.cancer.gov/cam/

newsletter/2009-spring/home.html

• Fall 2009 http://www.cancer.gov/cam/

newsletter/2009-fall/fall2009_OCCAM_

newsletter_home.html

Note: NCI Web sites do not offer personalized medical advice 

to individuals about their condition or treatment, and the 

resources on the sites should not be used as a substitute for 

professional medical care.
CAM IN NCI NEWSLETTERS AND

PUBLICATIONS

The NCI Cancer Bulletin is a biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer research 

community. During FY 2009, there were numerous 

cancer CAM studies featured in the NCI Cancer 

Bulletin:

• Harnessing the Biological Activity of Natural 

Products, September 22, 2009 

• Chemotherapy Provides Longer Survival than 

Enzyme Therapy for Pancreatic Cancer,

September 8, 2009 

• Weight Lifting Reduces Lymphedema 

Symptoms after Breast Cancer, September 8, 

2009 

• Review Finds No Firm Evidence that 

Green Tea Prevents Cancer, August 11, 2009 

• Dietary Supplements and Cancer Treatment: 

A Risky Mixture, August 11, 2009 

• Cutting Calories to Prevent Cancer,

July 14, 2009 

• Ginger Helps Reduce Nausea from 

Chemotherapy, May 19, 2009 

• A Conversation with Dr. Rashmi Sinha, 

April 7, 2009

• Study Suggests Low, Moderate Alcohol Use 

Increases Cancer Risk, March 10, 2009 

• Researchers Urge Caution, Greater Scrutiny 

of Colon-related CAM Treatments, March 10, 

2009 

• Compounds Found in Green Tea Block 

Bortezomib, February 24, 2009 

• A Conversation with Dr. Richard Troiano[

diet and physical activity], January 27, 2009

• Two Prevention Trials Show Antioxidants 

Do Not Cut Cancer Risk December 16, 2008

• Selenium and Vitamin E Fail to Reduce 

Prostate Cancer Risk, November 4, 2008

• Delving Deeper into Exercise and Breast 

Cancer Prevention, October 21, 2008

Likewise, in FY2009, cancer CAM was the topic of 

stories in other NCI publications:

• A Diet That Works: New Study Shows Early 

Response of Colon Cancer to Dietary Change, 

CCR Connections, Volume 3, No.1, 2009

• Dietary and Factors and Small Intestinal 

Cancer, Linkage, March 2009 

NCI FACT SHEETS ON CAM

The NCI “fact sheet” collection addresses a variety 

of cancer topics, including cancer CAM topics. The 

fact sheets are frequently updated and revised based 

on the latest cancer research. During FY 2009, NCI 

issued a new fact sheet on “Calcium and Cancer 

Prevention: Strengths and Limits of the Evidence.” 

The document can be downloaded or printed 

from http://www.cancer.gov/cancertopics/factsheet/

prevention/calcium.

20 NCI CAM ANNUAL REPORT 2009
NCI CAM COMMUNICATIONS PROGRAMS 21

See Table 1 for the list of the current NCI 

CAM fact sheets and the number of page views 

each fact sheet received during FY 2009. The 

NCI fact sheets collection can be found at 

http://www.cancer.gov/cancertopics/factsheet.

RESPONDING TO CAM 

CANCER INQUIRIES

The Cancer Information Service (CIS) serves 

as NCI’s link to the public by interpreting and 

explaining research findings in a clear and 

understandable manner and providing personalized responses to specific questions about 

cancer. Highly trained cancer information 

specialists are available to answer questions 

via phone, live online chat, mail, and e-mail 

about cancer treatment and clinical trials, 

including CAM therapies. During FY 2009, 

CIS responded to 1,179 inquiries regarding 

CAM approaches for cancer.

Access the CIS by calling 1-800-4-CANCER 

(1-800-422-6237), or by using the LiveHelp 

instant-messaging service at https://cissecure.

nci.nih.gov/livehelp/welcome.asp.

TABLE 1: NCI CAM FACT SHEETS PAGE VIEWS 

STATISTICS FY 2009

Fact Sheet Title Total Views

Antioxidants and Cancer Prevention: Fact Sheet 71,513

Calcium and Cancer Prevention: 

Strengths and Limits of the Evidence 3,622

Garlic and Cancer Prevention: Questions and Answers 14,732

Physical Activity and Cancer: Fact Sheet 9,166

Questions and Answers About Beta Carotene 

Chemoprevention Trials 2,736

Red Wine and Cancer Prevention: Fact Sheet 18,769

Selenium and Vitamin E Cancer Prevention 

Trial (SELECT): Questions and Answers 1,885

Tea and Cancer Prevention: Fact Sheet 11,853

Vitamin D and Cancer Prevention: 

Strengths and Limits of the Evidence (New) 81

Complementary and Alternative Medicine in Cancer 

Treatment: Questions and Answers 24,353

158,710

THE NCI FACT SHEET “COMPLEMENTARY AND 

ALTERNATIVE MEDICINE IN CANCER TREATMENT: 

QUESTIONS AND ANSWERS” WAS VIEWED 

24,353 TIMES IN FY 2009. 

TO VIEW THIS PUBLICATION, 

PLEASE VISIT HTTP://WWW.CANCER.GOV/

CANCERTOPICS/FACTSHEET/THERAPY/CAM.
Training and Conferences

22 NCI CAM ANNUAL REPORT 2009
NCI provides a variety of training support programs 

on different aspects of CAM research including 

grant writing workshops and scientific conference 

sponsorships.

 TRAINING AND CONFERENCES 23
NCI LECTURES AND WORKSHOPS ON CAM

NCI provides educational opportunities for its staff, 

fellows, and the public on topics related to cancer. 

In FY 2009, the following seminars and lectures 

relevant to CAM research were held: 

• Epigenetics, Nutrition, and Disease 

Susceptibility – Randy Jirtle, Ph.D.

(Stars in Nutrition & Cancer Seminar Series, 

Division of Cancer Prevention) 

September 29, 2009 

• Natural Products as the Starting Point for 

New Discoveries – Zhu-Jun Yao, Jr. Ph.D.

(Center for Cancer Research)

August 3, 2009 

• Soy Protein and Isoflavones Research: 

Challenges in Designing and Evaluating 

Intervention Studies

(Office of Dietary Supplements cosponsored 

by NCI and other NIH Institutes and Centers)

July 28-29, 2009 

http://ods.od.nih.gov/News/Soy_ProteinIsoflavone_Research_Scientific_Workshop_

July_2009.aspx

• 7th Annual Cancer Survivorship Series: Living 

With, Through and Beyond Cancer, Part III: 

Survivors Too: Family, Friends and Loved Ones – 

Managing the Fatigue of Caregiving

June 23, 2009 

http://www.cancercare.org/get_help/tew_

details.php?tew=emotional_062309&ret=%2Fg

et_help%2Ftew_calendar.php

• Seventh International Conference on Diet and 

Activity Methods – Chair: Amy F. Subar, PhD, 

MPH, RD

(Sponsored in part by the National 

Cancer Institute)

June 5-7, 2009

http://www.icdam.org

• 7th Annual Cancer Survivorship Series: Living 

With, Through and Beyond Cancer, Part II: 

The Importance of Nutrition and Physical Activity

May 19, 2009

http://www.cancercare.org/get_help/tew_

details.php?tew=medical_051909&ret=%2Fg

et_help%2Ftew_calendar.php

• Selenium Redox Chemistry: Understanding Cancer 

Prevention and Therapy- Dr. Julian Spallholz

(Division of Cancer Prevention)

May 11, 2009 

• Oxidative Damage, Free Radicals, Antioxidants 

and Space Flight

April 27, 2009

http://calendar.nih.gov/app/MCalInfoView.

aspx?evtID=19360

• 7th Annual Cancer Survivorship Series: 

Living With, Through and Beyond Cancer, 

Part I: Managing the Stress of Survivorship

April 14, 2009

http://www.cancercare.org/get_help/tew_

details.php?tew=emotional_041409&ret=%2Fg

et_help%2Ftew_calendar.php

• Nanonutrition Frontiers: Lessons Learned from 

Imaging and Therapy- Martin Philbert, PhD

(Stars in Nutrition & Cancer Seminar Series, 

Division of Cancer Prevention)

March 19, 2009 

http://prevention.cancer.gov/newsandevents/

events/20090319

• Nutrition and Cancer Prevention Research 

Practicum

(Division of Cancer Prevention)

March 16-20, 2009 

http://prevention.cancer.gov/newsandevents/

events/20090316-20

24 NCI CAM ANNUAL REPORT 2009
TRAINING OPPORTUNITIES AT OCCAM

During FY 2009, OCCAM hosted two Health Communications 

Interns, Vera Rosenthal, M.P.H., and Elizabeth Austin, M.S., 

who helped organize and execute a scientific conference; wrote 

articles for the newsletter NCI CAM News, Annual Report on 

Complementary and Alternative Medicine, and promotional 

materials; and assisted with the management of OCCAM’s Web 

site. The interns also participated in professional meetings and 

NIH-sponsored training seminars.

CAM MONTHLY LECTURE SERIES AT NCI

The OCCAM Monthly Lecture Series informs the NCI 

community about recent and ongoing research projects in 

cancer CAM. These hour-long lectures feature a fifty-minute 

presentation on a cancer CAM topic and allow 10 minutes 

for questions. The lectures are open to the public and are 

archived as videocasts on the OCCAM Web site at 

http://www.cancer.gov/cam/news_lectures.html.

During FY 2009, the series included lectures on:

• Successful Combination of TCM and 

Chemotherapy: Immune and Oncological 

Effects of Sheng Qi Formula (SQF) on a 

Murine Model of Inflammatory Breast Cancer

• The Use of Curcumin and Flaxseed in 

Radiation Pneumonopathy

• Anti-tumor Effects of BZL 101 for Patients with 

Advanced Breast Cancer 

• Role of NFkB in Activity of Benzyl 

Isothiocyanate Against Pancreatic Cancer 

• Effects of Exercise on the Chronic Cardiac 

Dysfunction Associated with Doxorubicin 

• Dietary Fat-Gene Interaction in Prostate Cancer

• Chemoprevention of Lung Cancer by 

Naturally-occurring and Synthetic Compounds

• Breast Cancer Prevention and Treatment with Noni Juice

• Metabolomics Approach to Understanding Metabolic 

Disorders and Traditional 

Chinese Medicine

• Phenolic Antioxidants as Tumor Radio/

Chemosensitizers

• Evaluation of Resveratrol and Curcumin as Therapeutics 

Against High Risk Leukemia

SUPPORTING SCIENTIFIC CONFERENCES

In FY 2009, NCI supported the following 

conferences that included CAM content:

• American Psychosocial Oncology Society 

Annual Conference; Integrating Psychosocial Research and Practice into Quality 

Cancer Care: 

Setting the Standard 

February 5-8, 2009 

 Charlotte, NC 

GRANT NUMBER: 1R13CA138133-01

• American Society of Pharmacognosy 

Annual Meeting 

June 27-July 1, 2009 

 Honolulu, HI 

GRANT NUMBER: 1R13CA139768-01

• Translational Research in Acupuncture: 

Bridging Science, Practice, and Community 

March 18-21, 2010 

 Chapel Hill, NC 

GRANT NUMBER: 1R13AT005565-01

• American Society of Preventive Oncology 

Annual Conference 

March 20-23, 2010 

 Bethesda, MD 

GRANT NUMBER: 2R13CA094927-08

• Society for Behavioral Medicine 

April 7-10, 2010 

Seattle, WA 

GRANT NUMBER: 5R13CA091918-09

• PsychoNeuroImmunology Research 

 Society Annual Conference: Mentoring 

Program 

June 3-6, 2010 

Breckenridge, CO 

GRANT NUMBER: 1R13CA139766-01 

(See related story page 28)

TRAINING AND CONFERENCES 25
26 NCI CAM ANNUAL REPORT 2009

Highlights from NCI’s CAM Training Projects
HIGHLIGHTS FROM NCI’S CAM TRAINING PROJECTS 27

The highlights on the following pages are selected from 

the 33 CAM training projects 

that NCI supported during 

FY 2009 at laboratories and 

clinics throughout the United States and the world. 

NCI’s programs allow students and professionals at 

all stages of their careers to develop the skills necessary to conduct basic, clinical, and cancer control 

research into CAM therapies and interventions.

Abstracts for the CAM training projects featured 

in the report can be found by searching the NIH 

RePORTer research trials database at http://project

reporter.nih.gov/reporter.cfm.
28 NCI CAM ANNUAL REPORT 2009

NCI Supports Mentoring Program in Psychoneuroimmunology 

Research

DIVISION OF CANCER CONTROL AND POPULATION SCIENCES

Every year for the 

past decade, the 

PsychoNeuroImmunology Research 

Society (PNIRS) 

invites 25 of the 

most promising preand post-doctoral 

research scientists to 

participate in the society’s annual conference. Under 

an R13 training grant, funded primarily by NCI*, 

each PNIRS Trainee-Scholar receives $1,000 to cover 

airfare and hotel costs for the 3-day meeting.

The funds enable the younger scientists to participate 

in a PNIRS Educational Short Course, as well as a 

mentoring colloquium with senior faculty. These 

scientists also attend two workshops with junior 

faculty and NIH program staff, who provide advice 

on career building, grant writing, and funding opportunities in the growing research field of behavioral 

and neuroimmune interactions and their translational 

relevance for disease prevention and treatment.

“The program has been in place since 1999, and over 

the years, PNIRS has had more than 200 trainees 

at the annual conferences,” recalled Andrew Miller, 

M.D., professor of psychiatry and behavioral sciences 

at Emory University and director of psychiatric oncology at the Winship Cancer Institute. “The scholartrainee program is very competitive. In 2009, we had 

about 80 individuals applying for 25 slots.”

The Educational Short Course provides a didactic 

framework on an emerging topic in psychoneuroimmunology research. “Each speaker is encouraged 

to provide some basic foundation for their areas of 

investigation, and typically the first talk is an introduction to this whole research field,” Dr. Miller 

explained. During the 2009 conference he moderated 

a short course on his special interest of inflammation 

and its links to behavioral patterns in a variety of 

diseases including cancer. 

After the short course, the 25 trainees participate in 

a Senior Faculty-Trainee Colloquium. “We have the 

trainees break up into several small groups of five 

trainees each,” Dr. Miller said. “There are two senior 

faculty for each group. The trainees and faculty are 

carefully selected for each group, so the trainees will 

have faculty who are experts in the trainees’ fields of 

interest.”

Each trainee has three minutes in which they informally present their research projects to the faculty 

and peers. “After the trainees do their brief presentations everyone can ask questions,” Dr. Miller noted. 

“The faculty makes various suggestions about how 

the research projects could be improved, what things 

might be missing, what are the strengths. It gives the 

students the opportunity to really focus their ideas, 

make presentations, and meet their peers in the same 

field as well as senior faculty investigators.”

The PNIRS Trainee-Scholar program has demonstrated real benefits for the participants’ scientific careers. 

Dr. Miller noted a PubMed survey of former trainees 

from the 2004 PNIRS conference that found they had 

published more than 60 publications in peer-reviewed 

journals since participating in the program. 

“We also invite former trainee-scholars and other 

junior faculty members attending subsequent PNIRS 

meetings to a junior faculty workshop,” he added. 

“It really fosters the networking and helps the trainees get to know peers who’ve made that transition 

from post-doc or graduate school into a post-doc, 

junior faculty status.”

* GRANT NUMBER: 1R13CA139766-01
HIGHLIGHTS FROM NCI’S CAM TRAINING PROJECTS 29

Mentoring Helps Researcher Pursue Study of Ginger for 

Preventing Colorectal Cancer

CENTER FOR CANCER TRAINING

For at least 2,000 years, 

people have used ginger 

as a medicinal herb. In 

Western herbal medicine, 

ginger is used mainly 

as a remedy for digestive 

disorders. However, 

the prevalence of foods 

such as ginger, garlic, and 

chilies in the diets of people in southeast Asian 

countries is thought to contribute to the reduced 

occurrence of several types of cancer, including 

colon cancer, in that region. Furthermore, studies 

in animals have shown that ginger can prevent 

the development of colon cancer, leading some 

researchers to ask whether ginger can help prevent 

colorectal cancer in humans.

One researcher hoping to answer that question is 

Suzanna Zick, N.D., M.P.H., an assistant research 

professor in the department of family medicine at 

the University of Michigan, Ann Arbor. With support from a 5-year Mentored Career Development 

Award* from NCI, Dr. Zick has been doing a series 

of preliminary studies that she hopes will lead to 

a large clinical trial examining ginger’s ability to 

prevent colorectal cancer or prevent its recurrence 

in people at normal or high risk of developing the 

disease. 

Dr. Zick’s interest in the medicinal properties of 

ginger began with research she did on whether ginger 

could prevent nausea in adults who were receiving 

chemotherapy. As a member of a research group that 

studies cancer prevention, she became interested in 

ginger’s possible cancer-preventing properties. “I’m 

very keen about wellness and prevention,” she said, 

“and thought it would be wonderful to be able to use 

something that tasted good to help prevent cancer.”

The NCI career award “really kick-started and 

broadened my research career,” said Dr. Zick, a 

naturopathic physician. “It gave me the ability and 

time to develop new research skills, to understand 

the theories behind the research, and to develop 

grant-writing and manuscript-writing skills—all those 

things that we’re supposed to be able to do to develop 

into independent scientists,” she explained.

Because a diverse set of skills is needed to do rigorous 

studies of dietary supplements for cancer prevention, 

Dr. Zick has worked with five research mentors with 

different areas of expertise. With help from those 

mentors, she learned skills ranging from how to 

measure biological markers of disease in human tissue 

samples to how to carefully design cancer prevention studies. Her primary mentor, also in Michigan’s 

family medicine department, was Mack Ruffin, M.D., 

M.P.H., whose research interests include cancer chemoprevention. Chemoprevention is the use of drugs, 

vitamins, or other substances to reduce the risk of 

cancer or delay its development or recurrence. 

Dr. Zick also worked with a mentor who studies the 

effects of dietary factors on cancer risk and also does 

laboratory-based research to analyze biological markers of risk. She even spent time watching a senior 

clinician perform colonoscopies, so she could learn 

to identify precancerous growths or actual cancers 

in the colon. 

“Right now, there is no treatment that prevents colon 

cancer in either high-risk or normal individuals,” 

Dr. Zick noted. “We know some things work in 

epidemiological studies, but that doesn’t tell us for 

sure what will work in a clinical setting.” 

Dr. Zick is interested in a nutritional approach to 

cancer prevention, which might involve a combination of diet plus capsules or pills containing dietary 

supplements shown to prevent cancer. In the case of 

colon cancer, that might include a capsule containing powdered ginger, Dr. Zick said, or perhaps ginger 

ale, ginger tea, or ginger candy for individuals those 

who don’t like taking pills. Because it can be hard to 

convince people to take pills or make dietary changes 

to prevent a disease they don’t have and may never 

get, Dr. Zick said, “you have to make [this approach] 

as flexible, appealing, and low toxicity as possible. 

Giving people options is one way to increase the 

chance they will actually make these changes.”

*GRANT NUMBER: 5K07CA102592-05
30

Naturopathic Doctor Studies Antioxidant Use in Breast Cancer Patients

CENTER FOR CANCER TRAINING

Many cancer patients take over-the-counter antioxidant dietary supplements while undergoing radiation 

therapy or chemotherapy. The use of antioxidant supplements is controversial because doctors know little 

about the short-term or long-term effects. There is a 

concern that antioxidant supplements may counteract 

the effects of chemotherapy and radiation therapy, yet 

antioxidant supplements may also prevent side effects 

caused by cancer treatments. 

“We do not have good data to inform clinical guidelines either way,” explained Heather Greenlee, N.D., 

Ph.D., M.P.H, recipient of a five-year Mentored Patient-Oriented Research Career Development Award* 

from NCI. Dr. Greenlee, an assistant professor in the 

epidemiology department at Columbia University’s 

Mailman School of Public Health, is using the NCI 

grant to help gather data to help resolve the controversy over antioxidant supplement use, in particular 

during adjuvant therapy for breast cancer. Adjuvant 

therapy is any treatment given after the primary 

treatment to reduce the risk that cancer will recur.

As part of this research, Dr. Greenlee will do preliminary clinical studies on the safety and potential 

benefits of one particular antioxidant, coenzyme Q10 

(CoQ10), in women undergoing chemotherapy with 

doxorubicin, a drug used to treat many types of cancer. “Doxorubicin can cause significant cardiac toxicity—that is, damage to the heart muscle,” noted Dr. 

Greenlee. “For some women with breast cancer, this 

resolves after treatment is over, but for other women 

there is permanent damage.” 

CoQ10 has been shown in laboratory cell cultures 

and animal studies to prevent cardiac toxicity caused 

by doxorubicin, but a definitive study has never been 

done in breast cancer patients, Dr. Greenlee said. 

An estimated 45% to 80% of breast cancer patients 

take antioxidant supplements such as CoQ10, either 

for general health benefits or because they hope the 

supplements will help treat the cancer or keep it from 

recurring.

To address the question of the potential benefits of 

antioxidant supplements from a different angle, 

Dr. Greenlee will also use data from the Pathways 

Study, an ongoing observational epidemiology study 

being funded by NCI. The Pathways Study is gathering detailed information on diet, dietary supplement 

use, and physical activity from more than 4,000 

women diagnosed with breast cancer within the 

Kaiser Permanente Northern California health system. “We will be able to use the Pathways Study data 

to see whether or not the use of antioxidants during 

radiation therapy or during chemotherapy impacts 

the breast cancer recurrence rate or survival rate,” 

Dr. Greenlee explained. 

Dr. Greenlee is one of a handful of naturopathic 

doctors (N.D.) who are doing cancer research. Prior 

to going to a naturopathic medical school, “I’d been 

a research assistant at the Fred Hutchinson Cancer 

Research Center and I wanted to be able to identify 

things that women can do proactively to promote 

their health and prevent cancer,” she recalled. “I 

turned to naturopathic medicine to provide a model 

of health promotion and wellness, and that turned 

into me being interested in what cancer survivors can 

do beyond conventional treatment to improve their 

quality of life, to improve their recurrence rates, and 

overall improve their survival.” 

After her naturopathic training, Dr. Greenlee pursued 

a Master of Public Health degree in epidemiology 

at the University of Washington and a Ph.D. degree 

in epidemiology at Columbia University. Once she 

completes the additional training, course work, and 

mentoring provided by the NCI career development 

award, “my goal is to lead a major research program on the effects of CAM therapies and lifestyle 

modifications after cancer diagnosis for reducing 

side effects, reducing recurrence rates, and improving 

survival—to identify what works and what doesn’t 

work,” she commented. 

*GRANT NUMBER: 1K23CA141052-01

 NCI CAM ANNUAL REPORT 2009
 HIGHLIGHTS FROM NCI’S CAM TRAINING PROJECTS 31
NCI Research in Complementary and Alternative Medicine
NCI RESEARCH IN COMPLEMENTARY AND ALTERNATIVE MEDICINE 33

How much money does NCI 

spend on CAM research each 

year? This is one of the questions most frequently posed to 

OCCAM. Researchers, cancer 

patient advocates, proponents of CAM, and Congress 

are interested in the answer, and OCCAM is responsible for gathering the data needed to report the total 

CAM expenditures budget figure each year. 
34 NCI CAM ANNUAL REPORT 2009
NCI CAM RESEARCH PORTFOLIO ANALYSIS: FY 2009

It is a common misconception that OCCAM 

manages all of the CAM projects for NCI. The vast 

majority of CAM projects are managed by other 

programs and laboratories throughout the Institute. 

After the close of the fiscal year, NCI’s Division of 

Extramural Activities (DEA) provides OCCAM 

with a list of funded grants and cooperative agreements coded as containing some component of 

CAM research. Similarly, NCI’s two intramural 

components, the Center for Cancer Research (CCR) 

and the Division of Cancer Epidemiology and 

Genetics (DCEG), provide lists of their potentially 

relevant projects. Also, a list of contracts identified 

as potentially containing CAM research is provided. 

OCCAM staff review each project to confirm they 

are accurately classified as CAM research. Then 

aspects of each project are identified allowing their 

placement into a sub-categories based on the type 

of research and CAM intervention type. 

NCI’s total CAM expenditure figure includes money 

awarded for intramural projects (projects conducted 

within NIH facilities and labs), extramural grants 

(projects conducted outside of NIH), cooperative 

agreements, contracts, and supplements. It is important to note the reported figure for total NCI CAM 

expenditures for a fiscal year only includes projects 

for which NCI is the primary funder.

TOTAL ESTIMATED CANCER CAM 

RESEARCH EXPENDITURE

In FY 2009, NCI invested $114,441,501 for 

429 intramural and extramural research projects 

relevant to CAM. For the purpose of the FY 2009 

analysis, the following types of funding are included: 

intramural projects and extramural grants, cooperative agreements, contracts, and supplements. 

(See Figure 3.) 

In addition, during FY 2009, NCI used $21,637,877 

in funds from the American Recovery and Reinvestment Act (ARRA) to award 104 CAM research 

grants.

The above numbers do not include CAM training 

grants (T and F awards), or K (research career) and 

R25 (cancer education) grants. These numbers are 

listed separately in Figure 4. 

GRANT AWARDS BY FUNDING 

OPPORTUNITY ANNOUNCEMENT

In FY 2009, there were 73 funding opportunity 

announcements (FOA) that yielded cancer CAM 

grants. The program announcement (PA) “Research 

Project Grants (Parent R01)” (PA-07-070) was 

the most productive mechanism for attracting new 

CAM grants to NCI. A total of 65 of the 210 CAM 

grants awarded through FOAs in FY 2009 came to 

NCI through this announcement. (See Figure 5.) FIGURE 3. NCI CAM EXPENDITURES: FY 2004-2009

Millions

$130

$125

$120

$115

$110

$105

$128,671,113

$123,076,167 $121,832,765 $121,076,919 $121,264,507

$114,441,501

2004 2005 2006 2007 2008 2009

* Footnote: Includes grants, cooperative agreements, intramural projects, and contracts. 

 Grants and cooperative agreements are only included when NCI is the primary funding agency. 

 Excludes training grants (Ts, Fs, Ks, and R25s). Total projects include all active projects in FY 2009.

NCI RESEARCH IN COMPLEMENTARY AND ALTERNATIVE MEDICINE 35
FIGURE 4. NCI CAM TRAINING PROJECTS 2009

Training Grant Mechanisms Number of Grants Total Funding

F (31, 32) 5 $ 142,346

K (01, 05, 07, 22, 23, 24) 24 $ 2,208,263

R25 3 $ 681,286

T32 1 $ 286,091

TOTAL 33 $3,317,986

Note: does not include ARRA awards 

FIGURE 5. NUMBER OF GRANT AWARDS BY FUNDING OPPORTUNITY ANNOUNCEMENT

Funding Opportunity Number

*CA05-013 2

*CA05-014 1

*CA07-025 6

*CA08-004 1

*CA08-018 1

*ES02-009 1

*HL08-013 1

*OD03-008 1

PA02-169 1

PA04-046 1

PA04-053 3

PA04-068 1

PA04-099 2

PA04-108 1

PA05-027 1

PA05-040 1

PA05-059 1

PA05-125 2

PA05-141 1

PA06-042 2

PA06-283 2

PA06-303 1

PA06-314 2

PA06-315 6

PA06-351 4

PA06-400 7

PA06-412 3

PA06-413 3

PA06-414 2

PA06-440 1

PA06-510 9

PA07-007 3

PA07-070 65

PA07-100 2

PA07-174 1

PA07-175 2

PA07-176 1

PA07-177 1

PA07-257 2

PA07-258 1

PA07-280 1

PA07-320 1

PA07-356 1

PA07-362 5

PA08-032 1

PA08-050 1

PA08-051 1

PA08-074 1

PA08-121 1

PA08-149 1

PA08-209 1

PAR03-153 1

PAR04-011 1

PAR05-156 5

PAR06-073 2

PAR06-294 4

PAR06-313 21

PAR06-451 1

PAR06-458 1

PAR06-505 1

PAR08-020 1

PAR08-055 15

PAR08-135 2

PAS02-009 1

Total 

Solicited 237

Total 

Unsolicited 150 

Total 

Grants 

Awarded 387

* Request for Applications (RFA).

FIGURE 6. NCI CAM RESEARCH PROJECTS BY 

RESEARCH TYPE*

Prevention

$68,393,265

59.8%	

Treatment

$23,055,689

20.1%	

Symptom/SideEffect	Management	

$14,749,112

12.9%	

Epidemiology	

$8,223,435

7.2%

Conferences

$20,000

0.02%

* Includes grants, cooperative agreements, intramural projects, and 

 contracts. Grants and cooperative agreements are only included when 

 NCI is the primary funding agency. Excludes training grants (Ts, Fs, 

 Ks, and R25s). Total projects include all active projects in FY 2009.

FIGURE 7. NCI CAM RESEARCH PROJECTS BY CAM CATEGORY*

73.1% 11.4% 5.5%

Nutritional Pharmacological and Mind-Body 

Therapeutics Biologic Treatments Interventions

 $83,646,697 $13,048,857 $6,270,236

.4% .7% 5.2%

Manipulative & Body- Alternative Exercise Therapies

Based Methods Medical Systems $5,993,532 

$478,068 $821,476

.4% 2.3% .9%

Spiritual Therapies Miscellaneous Energy Therapies

$491,493 $2,615,049 $1,076,093

36 NCI CAM ANNUAL REPORT 2009
BREAKDOWN BY RESEARCH TYPE

The accompanying pie-chart (Figure 6) shows 

the distribution of the projects by prevention, 

treatment, symptom/side effect management, 

epidemiology, and conferences. In FY 2009, 59.8% 

of cancer CAM-related research project funds went 

to various cancer prevention efforts, while treatment, symptom/side effect management, epidemiology, and conferences received 20.1%, 12.9%, 

7.2%, and 0.02%, respectively.

BREAKDOWN BY MAJOR CAM 

THERAPY CATEGORY

In FY 2009, NCI performed or supported research 

addressing a variety of CAM therapies (Figure 7). 

These CAM therapies fall into nine groups: 

alternative medicine systems, exercise therapies, 

manipulative and body-based methods, mind-body 

interventions, nutritional therapeutics, pharmacological and biologic treatments, energy therapies, 

spiritual therapies, and miscellaneous (See page 4 

for definitions of CAM categories.)

The largest percentage (73.1%) of CAM research 

funding went to projects that investigated nutritional therapeutics, which can be further broken 

out into subcategories of research on: foods (e.g., 

broccoli and berries); minerals (e.g., calcium and 

selenium); vitamins (e.g., vitamins C and D); 

bioactive food components (e.g., isoflavones and 

carotenoids); dietary regimens (e.g., caloric restriction and high fruits and vegetables); fats (e.g., 

linoleic acid and omega-3); and amino acids and 

proteins (e.g., N-acetyl cysteine and glycine).

Figure 8 shows the distribution of projects by the 

subcategories of nutritional therapeutics.

FIGURE 8. NCI CAM NUTRITIONAL THERAPEUTICS PROJECTS 

BY CATEGORY*

Bioactive	Food		

Component

$31,009,307

37.1%	

Vitamins

$20,279,868

24.2%

Minerals	

$17,756,506	

21.1%	

Dietary	Regimens	

$4,771,114

5.7%

Fats

$5,013,649

6.0%

Food

$4,136,406

4.9%

Amino	Acids	and		

Proteins

$680,847	

0.8%

* Includes grants, cooperative agreements, intramural projects, and contracts. 

 Grants and cooperative agreements are only included when NCI is the primary 

 funding agency. Excludes training grants (Ts, Fs, Ks, and R25s). Total projects 

 include all active projects in FY 2009.

FIGURE 9. NCI CAM RESEARCH PROJECTS BY CANCER TYPE*

Cancer Type Amount

Bladder $1,199,673

Brain $78,271

Breast $16,507,760

Cervical $1,139,517

Childhood Cancer $255,131

Colorectal $13,328,973

Esophageal $1,215,134

Gastric $1,513,176

Head and Neck $2,734,530

Hematologic $1,746,274

Kidney $219,375

Liver $994,798

Lung $10,970,632

Multiple Types $34,929,506

Ovarian $325,644

Pancreatic $2,482,683

Prostate $21,294,607

Skin: Melanoma and Non-Melanoma $3,460,961

Small Intestines $44,856

TOTAL:	 $114,441,501

* Includes grants, cooperative agreements, intramural projects, and contracts. 

Grants and cooperative agreements are only included when NCI is the primary 

funding agency. Excludes training grants (Ts, Fs, Ks, and R25s). Total projects 

include all active projects in FY 2008.

NCI RESEARCH IN COMPLEMENTARY AND ALTERNATIVE MEDICINE 37
Highlights from NCI’s Wide-Ranging CAM Research
HIGHLIGHTS FROM NCI’S WIDE-RANGING CAM RESEARCH 39

The following research highlights are selected from the 

429 CAM research projects 

that NCI supported during FY 2009 at laboratories within the Institute and throughout the United 

States and the world. These research projects are 

organized under several categories reflecting NCI’s 

comprehensive research focus on understanding 

the underlying mechanisms of cancer causation, 

prevention, treatment, and symptom management 

and palliation of the disease.

Abstracts for the CAM research projects featured 

in the report can be found by searching the NIH 

RePORTer database at http://projectreporter.nih.

gov/reporter.cfm.
Understanding the Causes and 

Mechanisms of Cancer

Cancer is a complex set of diseases that scientists are 

striving to understand from multiple perspectives. 

Research that improves our understanding of its causes and 

the mechanisms that underlie its development – from 

assessing cancer risk to explaining the process 

of metastasis – is essential to our ability to develop 

and apply interventions to preempt cancer 

initiation and progression.
Pooling Resources to Examine Associations Between 

Vitamin D and Risk of Rarer Cancers

DIVISION OF CANCER EPIDEMIOLOGY AND GENETICS

Questions about whether 

vitamin D can increase 

or reduce the risks of 

certain cancer types remain vigorously debated 

in the scientific community. For researchers 

studying the effect of 

vitamin D on rarer types 

of cancer –such as pancreatic and ovarian cancer – 

the difficulty of teasing out the effects of the vitamin 

in epidemiologic studies are compounded by the relative scarcity of patients to study.

In 2007, Demetrius Albanes, M.D., senior investigator in the Nutritional Epidemiology Branch of 

NCI’s Division of Cancer Epidemiology and Genetics, joined with a group of scientists from the United 

States and abroad to launch the NCI Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. 

The project* was designed to gather data on enough 

patients with less common cancers to allow the 

researchers to more accurately estimate the associations between serum vitamin D concentrations and 

the development of six malignancies: pancreatic, 

ovarian, upper gastrointestinal (including esophagus 

and stomach), endometrial, renal, and non-Hodgkin 

lymphoma.

The project has studied over 5,000 patients diagnosed with one of these rarer cancers and over 5,000 

matched control participants without cancer, taken 

from 10 participating cohort studies. In order to 

remove the variability sometimes found when blood 

samples are analyzed in different laboratories and at 

different times, samples from cancer cases and control participants from all 10 cohorts were analyzed 

in the same dedicated laboratory with the same 

equipment over a 3-month period. 

In addition, “we matched the cases and controls for 

the calendar date of when their blood was collected 

and therefore for the season and approximate sun 

exposure at the time of collection,” explained Dr. 

Albanes. “We also adjusted for season of collection 

in our statistical models.” This is important, because 

blood levels of vitamin D are influenced by sun 

exposure and can vary drastically between seasons 

and by level of outdoor activity, making the date of 

blood collection an important factor to control for in 

such studies.

According to published results** and contrary to the 

researchers’ expectations, “we did not see lower cancer risk in persons with high vitamin D blood concentrations compared to normal concentrations for any 

of these cancers, nor did we see higher cancer risk for 

participants with low levels,” reported Dr. Albanes.

The researchers did observe an increased risk of 

pancreatic cancer in patients with the highest blood 

levels of vitamin D, a finding seen previously by some 

studies. “This result is a bit troubling, since people 

tend to believe that taking more vitamin D can only 

be beneficial,” noted Dr. Albanes. “So this needs to 

be clarified, and it’s one thing that we’re going to 

follow up on in future studies.” 

The Vitamin D Pooling Project has also examined 

blood samples from their cohorts’ patients at the 

genetic level. In another published report***, the 

researchers described findings from a genome-wide 

association study to discover common variations in 

several genes that are associated with circulating vitamin D levels. One of the genes identified, codes for a 

binding protein that transports vitamin D within the 

body and three other genes code for proteins that are 

involved in vitamin D synthesis and metabolism.

The next step for the investigators will be to look at 

whether these genetic variations mediate the relationship between circulating vitamin D and cancer risk. 

“Knowing people’s genetic predisposition to higher or 

lower vitamin D levels should help us refine the relationship between people’s actual vitamin D exposures 

and cancer risk,” Dr. Albanes explained. “Some of 

the inconsistencies we’ve seen across vitamin D studies to date may be due to such genetic variations.”

** Helzlsouer KJ for the VDPP Steering Committee. Overview of the Cohort 

Consortium Vitamin D Pooling Project of Rarer Cancers. American Journal of 

Epidemiology, 2010;172(1):4–9.

***Ahn J, Yu K, Stolzenberg-Solomon R, Simon KC, McCullough ML, 

Gallicchio L, Jacobs EJ, Ascherio A, Helzlsouer K, Jacobs KB, Li Q, Weinstein 

SJ, Purdue M, Virtamo J, Horst R, Wheeler W, Chanock S, Hunter DJ, Hayes 

RB, Kraft P, Albanes D. Genome-wide association study of circulating vitamin 

D levels. Human Molecular Genetics, 2010;19(13):2739-45.

* PROJECT NUMBER: Z01 CP010195-04

UNDERSTANDING THE CAUSES AND MECHANISMS OF CANCER 41
Large Populations and Rigorous Methods Needed for 

Vitamin D Research

DIVISION OF CANCER EPIDEMIOLOGY AND GENETICS

Vitamin D has been 

thought to potentially affect a person’s 

cancer risk, and in 

laboratory studies, 

researchers have 

shown that it can 

decrease cancer cell 

growth, promote 

cancer cell death, and affect other cellular processes. 

However, studies examining the relationship between 

blood levels of vitamin D in humans and the risk of 

many types of cancer have proved largely inconclusive. “At this stage, we don’t really have a clear idea 

if vitamin D is protective against cancer, and if so 

against which cancers, or at what stage in a cancer’s 

development,” explained D. Michal Freedman, J.D., 

M.P.H., Ph.D., an epidemiologist in NCI’s Division of 

Cancer Epidemiology and Genetics.

Dr. Freedman and her colleagues from NCI and the 

Centers for Disease Control and Prevention (CDC) 

recently analyzed blood samples taken from over 

16,000 participants in the Third National Health 

and Nutrition Examination Survey* (NHANES III) 

between 1988 and 1994. At the time of the 

researchers’ analysis, the survey participants had 

been followed through 2000.

During that period, 536 NHANES III participants 

died of cancer. Although the researchers did not find 

any association between blood levels of vitamin D 

and total cancer mortality, they did find a reduced 

risk of death from colorectal cancer in participants 

with higher levels of circulating vitamin D. NCI and 

CDC investigators have continued to follow the 

NHANES III participants and are using additional 

data collected on cancer mortality. “With larger 

numbers, and more cancer deaths, we have opportunities to look at risks by sex, within racial and 

ethnic groups, and for less common cancer sites,” 

she explained.

Another aspect of Dr. Freedman’s work is focusing on 

how the methods of measuring vitamin D levels may 

affect the results of epidemiologic studies. In recent 

research**, she and her colleagues examined whether 

a delay between blood collection and processing 

could alter the end results for vitamin D measurement. Fortunately, they found that this was not the 

case and that variations in the collection process did 

not affect the measurements. 

Currently, they are examining the degree of correlation between levels of vitamin D in blood samples 

taken during one season with those found in samples 

collected during other seasons (i.e., winter versus 

summer)***. “There’s an assumption that a single 

measurement is a good surrogate for usual or longterm circulating levels of vitamin D, and a single 

measurement is what’s been used in most studies,” 

explained Dr. Freedman. “We want to examine this 

assumption, because our study could shed light on 

the strength of the evidence provided by the singlesample studies.” 

**Freedman DM, Looker AC, Chang SC, Graubard BI. Prospective study of 

serum vitamin D and cancer mortality in the United States. Journal of the 

National Cancer Institute, November 7, 2007;99(21):1594-602.

***Yu CL, Falk RT, Kimlin MG, Rajaraman P, Sigurdson AJ, Horst RL, 

Cosentino LM, Linet MS, Freedman DM. The impact of delayed blood 

centrifuging, choice of collection tube, and type of assay on 25-hydroxyvitamin 

D concentrations. Cancer Causes and Control, April 2010;21(4):643-8.

* PROJECT NUMBER: Z01 CP010132-15

42 NCI CAM ANNUAL REPORT 2009
Targeting Prostate Cancer Cells with Bioflavonoids

DIVISION OF CANCER BIOLOGY

Current treatments 

for prostate cancer 

– including surgery, 

radiation therapy, and 

hormone therapy – can 

be effective, and in 

some cases cure men of 

their cancer. However, 

all of these treatments 

can cause major side effects. Researchers are looking 

for additional targeted therapies for prostate cancer 

that will halt the growth of cancer cells while leaving 

normal cells largely unaffected.

The type II [3H]estradiol binding site plays an important role in regulating cell proliferation in prostate 

and other cancers. In normal cells, a molecule called 

methyl p-hydroxyphenyllactate (MeHPLA) is thought 

to occupy most of the type II [3H]estradiol binding 

sites, blocking cell-signaling pathways that encourage 

the cells to divide. Malignant cells, including breast 

and prostate cancer cells contain higher than normal levels of a type of molecule called esterase that 

destroys MeHPLA, thereby freeing the type II [3H]

estradiol binding sites and triggering DNA synthesis 

and cancer cell proliferation. Thus, drugs that act like 

MeHPLA, but are not destroyed by this esterase, are 

potentially very effective anticancer agents.

Barry Markaverich, Ph.D., associate professor in the 

Department of Molecular and Cellular Biology at 

Baylor College of Medicine in Houston, Texas has 

been studying the type II [3H]estradiol binding sites 

for over 30 years. Dr. Markaverich and his colleagues 

discovered that MeHPLA is a metabolite of bioflavonoids – compounds commonly found in plants 

and thought to have potential medicinal properties, 

including anti-cancer effects. Bioflavonoids can be 

obtained in the diet by the consumption of fruits and 

vegetables.

His laboratory has extended this understanding to 

a search for natural and synthetic compounds to 

replace the destroyed MeHPLA in cancer cells, 

and thus block uncontrolled cell division. Luteolin – 

a bioflavonoid found in some vegetables, herbs, 

and other plant products consumed in the diet – 

is structurally similar to MeHPLA and can successfully bind to the type II [3H]estradiol binding sites.

In a recent set of experiments*, Dr. Markaverich and 

his colleagues used prostate cancer cell lines to better 

understand the effects on gene regulation of luteolin 

and two structurally similar synthetic compounds 

they designed: BMHPC and ZN-2. The researchers 

found that luteolin treatment significantly altered 32 

important cell regulatory pathways involved in the 

cell cycle and RNA transcription, which may affect 

cancer cell growth. 

With NCI funding**, Dr. Markaverich is currently 

examining how luteolin, BMHPC, and ZN-2 affect 

the epidermal growth factor signaling pathway – a 

cell-signaling pathway often disregulated in cancer 

cells. The researchers will focus particularly on an oncogene called c-fos and are planning to test the three 

compounds in mouse models of prostate cancer.

Since type II [3H]estradiol binding sites are found in 

all cells, Dr. Markaverich proposes that their compounds could be effective against hormone-dependent 

prostate cancers (that require the presence of hormones to grow) as well as hormone-independent versions. These types of compounds previously showed 

anti-tumor activity in all of the cell lines in the 

Human Tumor Cell Line Screen belonging to NCI’s 

Developmental Therapeutics Program.

NCI Program Director Neeraja Sathyamoorthy 

Ph.D., commented, “Dr. Markaverich’s group is delineating the mechanism by which dietary agents with 

structures resembling estrogen, inhibit the proliferation of prostate cancer cells. Their group has demonstrated that luteolin regulates gene expression by 

epigenetic mechanisms. Elucidating the mechanism 

of action of these agents could lead to the development of type II site binding compounds that inhibit 

the growth of prostate cancer cells. This could help 

identify potential strategic sites for targeted therapy.” 

* Shoulars K, Rodriguez MA, Thompson T, Markaverich BM. Regulation of cell 

cycle and RNA transcription genes identified by microarray analysis of PC-3 human prostate cancer cells treated with luteolin. Journal of Steroid Biochemistry 

and Molecular Biology, January 2010;118(1-2):41-50.

**GRANT NUMBER: 5R01CA128932-02

 UNDERSTANDING THE CAUSES AND MECHANISMS OF CANCER 43
Traditional Chinese Mind-Body Practice Studied in 

Long-Term Cancer Survivors

DIVISION OF CANCER CONTROL AND POPULATION SCIENCES

Researchers are studying 

the traditional Chinese 

mind-body practice of 

qigong (pronounced 

CHEE-gong) among 

long-term cancer 

survi vors in China to 

assess the potential 

benefits on their quality 

of life (QOL) and other health outcomes. These 

efforts seek to establish a strong, evidence-based 

foundation for the introduction and promotion of 

qigong to U.S. cancer survivors.

Weimo Zhu, Ph.D., a professor in the Department of 

Kinesiology and Community Health at the University 

of Illinois at Urbana-Champaign, has practiced and 

taught qigong for many years. His interest in the use 

of qigong in cancer treatment was triggered when 

he was a graduate student in China in 1982 and 

was introduced to a woman with stage III stomach 

cancer. After surgery and chemotherapy, her doctors 

“thought she had only a few months to live,” Dr. 

Zhu recalled. As a last resort, she learned and began practicing Guo Lin Qi-Gong (GLQG), a special 

qigong regimen developed by a long-term uterine 

cancer survivor in the 1950s. He said, “She said after 

just three qigong practice sessions, she felt like she 

had more energy.”

Years later in 2005, “I organized a research conference supported by the National Institutes of Health 

on walking for health,” Dr. Zhu continued. “I found 

[the patient in China] not only alive, but she was 

very healthy and very active. So we brought her to 

the conference, and she did some demonstrations of 

qigong. Qigong got a very positive response among 

the participants.”

Dr. Zhu returned to China to learn more about 

GLQG, which features unique walking (touching 

heels and toes) and breathing (inhale, inhale and 

exhale) patterns. Qigong has three general principles: 

1) regulate the posture 2) regulate the breathing with 

a purposive pattern; and 3) regulate the mind with 

meditation. During the 1970s and 1980s, GLQG 

became widely popular in China among cancer patients 

and was credited as an agent in cancer remission in 

many cases by the Chinese government, Dr. Zhu said. 

With funding from NCI*, Dr. Zhu conducted a small 

study among 40 long-term (10 or more years) cancer 

survivors who had practiced GLQG since shortly 

after their cancer diagnoses, and he compared them 

with a control group of 40 long-term survivors who 

had not practiced qigong.

One of preliminary results they found was that “oxygen intake from GLQG practice is really not that high 

in absolute terms,” Dr. Zhu said. “These are really 

just moderate kinds of physical activity,” he added. 

“Their energy expenditure is moderate intensity, 

around 3 METs (metabolic equivalent). But the interesting part is, using the unique breathing patterns of 

qigong, their relative oxygen intake is really high for 

that level of activity (slow walking at a pace of about 

20 meters per minute).” This “slow walking, but 

moderate-intensity” feature should be very appropriate for cancer patients, considering they may be weak 

and quick to fatigue during or after conventional 

treatment. Preliminary data also indicate the GLQG 

cancer survivors had better health status, lower pain 

scores, lower recurrence rates, and were less depressed than the control group cancer survivors, 

Dr. Zhu reported. The GLQG intervention in China 

is different from using exercise to help offset side 

effects of cancer and its treatments, as exercise is 

often used in western societies, Dr. Zhu added. 

“In China, GLQG is used as a treatment of last resort 

after conventional medicine and Traditional Chinese 

Medicine have been tried unsuccessfully.”

NCI Program Director Catherine Alfano, Ph.D., 

commented, “Dr. Zhu’s study is part of an important 

and novel line of research that seeks to identify which 

kinds of physical activities are most effective for improving health outcomes in cancer survivors suffering 

from specific long-term effects of cancer treatment 

that limit their functional ability.”

*GRANT NUMBER: 5R03CA126407-02

44 NCI CAM ANNUAL REPORT 2009

Traditional Chinese Medicine Oil Studied Against Prostate Cancer

DIVISION OF CANCER TREATMENT AND DIAGNOSIS

Since prostate cancer 

is the third leading cause of cancer 

death in U.S. males, 

an army of researchers is looking for 

answers. One of 

these researchers, 

Yongkui Jing, Ph.D., 

a biologist at the Mt. Sinai School of Medicine, 

is doing basic research, focusing on one of the 

pathways long known to be important to tumor 

growth in prostate, lung, and other cancers. This 

pathway is known by the name of one of it major 

components, the mammalian target of the drug 

rapamycin or mTOR. 

Dr. Jing explained that mTOR seems to act as a 

switch for the growth and proliferation of tumor 

cells. The drug rapamycin – also known as sirolimus – was originally discovered from bacteria found 

in the soil on Easter Island. It seems to have a lot of 

potential uses in cancer and other conditions and is 

a staple used to suppress the body’s immune system 

during organ transplants, he added. But rapamycin, 

like androgen treatments for prostate cancer, can 

have a lot of side effects, especially in the older 

patients, who make up the majority of prostate 

cancer cases, Dr. Jing noted.

Dr. Jing was originally trained in medicine in Beijing, 

China, and is very familiar with traditional Chinese 

medicine (TCM). His current NCI-funded work* 

is focused on a natural product mixture known as 

the essential oil of Wen Ezhu, which is derived from 

a tumeric-root tuber plant found throughout Asia 

called Curcuma wenyujin. He and others have found 

that Ezhu oil targets the mTOR pathway.

“It has been used to combat viruses for a long time,” 

explained Dr. Jing, “and for three or four decades 

researchers in China and the United States have been 

finding anti-cancer effects.” Though there may be as 

many as 30 active components in the Ezhu oil used 

in TCM, his lab is concentrating on the substance 

curcumol to see whether it is the primary active 

inhibitor of mTOR. They are testing human prostate 

cancer cells and mice with prostate cancer for the impact of the Ezhu oil in its natural form, as compared 

to curcumol. They are also looking at a separate drug 

designed along the lines of rapamycin, to see whether 

it adds to the impact on cancer cells when used in 

combination with the oil or curcumol.

“We really need to figure out if the combination has 

synergistic or enhanced effects,” Dr. Jing said. “Once 

we are confident we know which signaling pathways 

are involved, we might be able to use other drugs, less 

toxic than rapamycin, in combination with Ezhu oil.”

NCI Program Director Yali Fu, Ph.D., commented, 

“This work is a good example of tapping into traditional knowledge on natural medicines in use alone 

or in combination with modern cancer biology. 

Active components in Ezhu oil, such as curcumol, 

used alone or in combination with other mTORsignaling pathway inhibitors, could potentially 

reduce toxicity and increase effectiveness of 

prostate cancer therapy.” 

*GRANT NUMBER: 1R21CA-144064-01A2

46 NCI CAM ANNUAL REPORT 2009

Accelerating Progress in 

Cancer Prevention

Prevention is our first line of defense against cancer. 

Efforts to prevent cancer focus on understanding 

and modifying behaviors that increase risk, 

mitigating the influence of genetic and environmental 

risk factors, and interrupting cancer-causing 

processes through early medical intervention.
West African Plants Studied for Inflammation and 

Cancer Prevention

DIVISION OF CANCER PREVENTION

Research findings about 

the harmful effects of 

chronic inflammation 

on human health – 

plus the extensive experience with studying 

the effects of aspirin 

and other nonsteroidal 

anti-inflammatory 

drugs – have led researchers to suspect a link between 

chronic inflammation and cancer. In particular, cyclooxygenase (COX) enzymes were found to be turned 

on by the body in response to long-term inflammation and in the early signs of cancer activity. One 

class of drugs to reduce pain and inflammation, called 

COX-2 inhibitors, have shown preliminary signs of 

success in reducing the development of adenomas 

that are known to lead to colorectal cancer.

However, problems arose when the most celebrated 

of these drugs rofecoxib (Vioxx) was pulled off the 

market in 2004, because it posed an increased risk 

of heart attack, stroke, and gastrointestinal bleeding. 

A similar drug celecoxib (Celebrex) is still in use but 

also carries the same risks. This led Michael Wargovich, Ph.D., F.A.C.N., to wonder “if there might be 

natural products that would hit these same targets 

but hopefully without the significant side effects.”

Dr. Wargovich, a professor of Cell and Molecular 

Pharmacology at the Medical University of South 

Carolina, said his interest in ethnobotany is longstanding and started during a visit to Conakry, capital 

of the Republic of Guinea in West Africa. An official in the Republic of Guinea’s Ministry of Health 

provided Dr. Wargovich with a catalog of traditional 

African medicines. He subsequently developed a 

short-list of plants that practicing native healers use 

for pain and inflammation. Dr. Wargovich eventually 

returned to his laboratory with five promising West 

African plant extracts from the neem and baobab 

trees, African basil, the kinkrissi bush, and the bark 

of the Senegal mahogany tree.

With NCI funding*, Dr. Wargovich is studying these 

natural products in rigorous detail. “There are a 

number of important steps we need to go through, 

but eventually, we hope to find the active inhibitors 

of the pathways leading to inflammation, polyps, and 

colon cancer,” he explained. This entails exposing 

cancer cells to the isolates and extracts, which 

Dr. Wargovich and his colleagues develop from the 

African plants. The researchers also test these plants 

for specific kinds of anticancer activity, especially 

COX inhibition, on colon cancer cell lines. Once the 

active ingredients are isolated and characterized, they 

hope to learn more about the mechanisms that appear to be working against cancer and test them 

in animal models. 

If successful, the work may eventually progress to 

human studies, Dr. Wargovich said. “The current 

COX-drugs are expensive,” he commented. 

“It would be helpful to develop an alternative 

that was derived from traditional medicine which 

could be more cheaply available as a preventive in 

Africa and the developing world.” 

NCI Division of Cancer Prevention Program Director Vernon Steele, Ph.D., M.P.H., commented, “This 

is a interesting and potentially very important study 

on West African medicinal plants to prevent cancer. 

These plant extracts should present a much lower 

toxicity profile (necessary for cancer prevention-type 

drugs) based on generations of use in the African 

people. There are currently few studies of traditional 

herbal medicines worldwide to prevent cancer.”

*GRANT NUMBER: 7R21CA107138-03

ACCELERATING PROGRESS IN CANCER PREVENTION 49
Exercise May Boost the Immune System and Improve 

Cancer Vaccine Effectiveness

CENTER FOR CANCER RESEARCH

A great deal of 

epidemiological 

evidence shows that 

regular physical activity lowers the risk 

of developing certain 

types of cancer, 

especially cancers of 

the colon and breast. 

Scientists have proposed that exercise may protect 

against cancer by boosting the body’s immunity, 

in particular the immune system’s ability to detect 

cancerous cells and prevent tumor formation. But the 

immune system is complex; the effects of exercise on 

this intricate system are not well understood.

John W. Greiner, Ph.D., a staff scientist at NCI’s 

Center for Cancer Research (CCR), is studying this 

question in collaboration with Connie J. Rogers, 

Ph.D., M.P.H., an assistant professor at Penn State 

University. “There’s been this knowledge that regular, 

moderate exercise can enhance the ‘innate’ immune 

response, the part of the immune system that immediately reacts to infection,” explained Dr. Greiner. 

“But we looked at whether voluntary exercise can 

influence the ‘adaptive’ arm of the immune system” 

which recognizes and remembers infectious agents 

such as viruses, enabling the body to quickly eliminate disease-causing organisms when infections recur. 

This “memory” aspect of the immune system is also 

responsible for the body’s response to vaccines.

Dr. Greiner’s research group within CCR’s Laboratory of Tumor Immunology and Biology is developing vaccines against prostate and colon cancer. They 

are interested in ways to increase the effectiveness of 

anticancer vaccines, and Dr. Rogers was interested 

in the role voluntary exercise plays in cancer risk. 

The researchers did a study* of young, healthy mice 

that had a propensity for exercising on running 

wheels. These mice served as an animal model for 

the effects of moderate, voluntary exercise in humans. 

Half of the mice in the study had access to running 

wheels, while the other half did not. After eight 

weeks, all of the mice were vaccinated with a vaccine 

that was known to trigger a strong response by the 

immune system. Dr. Greiner and his colleagues then 

examined multiple aspects of the immune response in 

the mice to see if they could build on the response to 

the vaccine with voluntary exercise.

They found that “in those mice that were running 

for eight weeks, you get a higher immune response to 

the vaccine,” said Dr. Greiner. The most important 

finding, he added, “is that we were increasing the 

immune cells that have memory.”

If a similar immune response to exercise occurs in 

humans, “there are two ways that this could impact 

prevention of cancer,” Dr. Greiner explained. 

“The first is that just by exercising, you could boost 

your immune system without a vaccine. The second 

is that if you have a cancer vaccine, you might be 

able to increase the effectiveness of that vaccine 

through exercise,” he added.

To investigate these possibilities, Dr. Greiner and 

Dr. Rogers are collaborating on follow-up studies 

in both mice and humans. In a strain of mice that 

is prone to tumors, they are examining whether 

voluntary exercise can increase the effectiveness of 

a cancer vaccine that Dr. Greiner’s group has developed. He is also establishing collaboration with 

colleagues in NCI’s Cancer Prevention Branch, who 

are studying whether a 10,000-step daily exercise 

regimen can help prevent cancer recurrence in women 

who have had surgery for breast cancer. In an effort 

to translate his findings to humans, he hopes to ask 

some women in the study to provide blood and tissue 

samples that he can analyze to see if the women’s 

immune response has been heightened due to the 

exercise.

*PROJECT NUMBER: ZIA BC 010967

50 NCI CAM ANNUAL REPORT 2009
Red Algae from the Sea Studied for Colon Cancer Prevention

DIVISION OF CANCER PREVENTION

Calcium is a mineral, 

the ionic form (Ca2+) of 

which moves in and out 

of cells and conveys important signals. It is an 

essential component of 

the diet, but calcium’s 

direct relationship 

with cancer is unclear. 

Evidence that calcium can prevent cancer is strongest in colorectal cancer compared to other cancers, 

although some studies have failed to show an impact. 

In contrast, there is some evidence that high calcium 

levels might even increase the risk of prostate cancer.

James Varani, Ph.D., professor of Pathology at the 

University of Michigan, sees these unclear effects of 

calcium on cancer as an opportunity. Because calcium 

is instrumental in a wide range of the body’s functions, figuring out how it works in different kinds of 

cancer cells could possibly lead to a number of useful 

insights, he believes. The calcium-sensing receptor 

(CaSR) in cells is a major avenue for calcium’s ability 

to regulate cell growth. Some studies have shown 

little or no expression of CaSR in colon cancer, 

Dr. Varani noted. “If we could find a way to more 

effectively deliver calcium by upregulating CaSR, 

we might be able to stop a lot of the early cellular 

changes that we know lead to colon cancer.”

NCI is funding* Dr. Varani’s lab to look at a new 

and promising way to deliver calcium to these CaSRdeficient cells. Red algae, known as Lithothamnion 

calcareum, extracts calcium from the sea and becomes progressively calcified as it grows. “The fronds 

accumulate minerals very effectively and eventually 

become so heavy they are just an organic matrix of 

minerals,” he explained. “Red algae can be harvested 

from shallow waters. It has been a ‘treasure chest’ 

for us, because more than 70 other trace minerals, 

in addition to calcium, have been identified.” 

First, “we are trying to confirm that the red algae 

extract is effective against colon cancer,” Dr. Varani 

said. He and his colleagues are conducting animal 

studies using a xenograft model, where colon cancer cells are directly grown in mice. The researchers 

are feeding the mice a high-fat diet for 15 months. 

Some of the rodents will get either a “plain vanilla” 

inorganic calcium supplement, while other mice will 

receive the red algae extract, he explained. 

“If the extract is more effective at inhibiting colon 

cancer and polyps,” said Dr. Varani, “it opens up an 

interesting question: is the high calcium content in 

the extract getting to the right prevention targets? 

If so, there must be something else among the many 

additional trace elements in the algae that is transporting calcium into the cells, compared to the 

calcium the control mice are getting.” Another 

possibility the researchers need to consider is the 

direct or synergistic impact of those additional 

minerals, especially magnesium. The experiments 

will also provide information about the CaSR 

receptor’s role, if any, in red algae’s impact on 

cancer cells.

*GRANT NUMBER: 5R21CA140760-02

ACCELERATING PROGRESS IN CANCER PREVENTION 51
Pomegranate Studied as Preventive Agent Against Prostate Cancer

DIVISION OF CANCER PREVENTION

In recent years, the 

pomegranate has 

been on the cancer 

biologists’ research 

menu because of 

the Middle Eastern 

fruit’s promise as an 

antioxidant capable 

of targeting multiple 

pathways in the cancer development process. Hasan 

Mukhtar, Ph.D., director and vice chair of research in 

Dermatology at the Medical Sciences Center, University of Wisconsin has done some of the earliest studies 

to isolate the active ingredients in the pomegranate 

that have been shown to affect a variety of cancer 

cells in the laboratory. 

Earlier work with pomegranate in Dr. Mukhtar’s lab 

identified six distinct anthocyanins that have some 

activity when exposed to cancer cell lines. Flavonoids 

like these give the pomegranate its color and are beginning to gain a reputation as a dietary supplement 

that may have beneficial effects against various 

diseases. “We tested all six of the compounds, but 

one of them – delphinidin – had distinctly more 

impact on these cancer cell lines than the others,” 

he reported. Working as a biological response modifier, delphinidin showed the ability to reduce inflammation, protected healthy cells’ DNA, kept blood 

vessels from growing that might otherwise support 

tumors, and limited the number of free radicals that 

are continuously being generated by the body, 

Dr. Mukhtar noted.

His current work funded by NCI* is focusing on 

prostate cancer. The active ingredients in pomegranate appear to affect several steps in some of the early 

stages of the disease. “We’re literally slowing this progression of the cancer by interfering at these earlier 

carcinogenic stages,” Dr. Mukhtar said. Prostate 

cancer “grows very slowly, likely for decades, before 

symptoms appear, typically in men older than 50, 

and a diagnosis is finally established,” he continued. 

Because of this long latency period, even a modest delay in disease progression for prostate cancer 

could have a positive impact at the population level, 

reducing the number of people who develop clinical 

disease, he noted.

Dr. Mukhtar and his colleagues are looking at 

delphinidin’s effect on one transcription factor in 

particular: NFkB. By controlling this cellular “master 

switch”, other genes are turned on and off and can 

thus affect many of the molecular pathways involved 

in the survival of cells, he explained. “We are using a 

very controlled extract to look at delphinidin’s impact 

on NFkB in human prostate cancer cells and also 

prostate cancer animal models in the lab.”

NCI Program Director Marjorie Perloff, Ph.D., 

commented, “There is a major need for effective 

and nontoxic agents capable of preventing prostate 

cancer. Compounds derived from natural substances, 

such as the pomegranate, hold much promise for 

potential development as chemopreventive agents. 

Dr. Mukhtar’s work in tissue culture and in animals 

to define what compounds in the fruit might be most 

actively involved as cancer preventive agents provides critical information that allows us to determine 

whether or not these compounds are suitable for 

further development as chemopreventive agents and 

specifically whether or not clinical trials should be 

undertaken.”

*GRANT NUMBER: 5R01CA120451-04

52 NCI CAM ANNUAL REPORT 2009
Dietary Components May Help Colon Cancer by 

Targeting Inflammation

DIVISION OF CANCER PREVENTION

Inflammation sits at the 

intersection of modern 

cancer research and traditional medicine. Many 

of the phytochemicals 

found in plants used 

in Asian medicines 

have demonstrated 

anti-inflammatory, 

anti-carcinogenic effects in modern laboratories, 

which suggests why flavonols and certain other 

common plant compounds recur in the catalogs and 

pharmacopeias of traditional medicine across cultures 

and down through time. 

Angela Murphy, Ph.D., research assistant professor in 

the Division of Applied Physiology at the University 

of South Carolina is trying to look more closely at 

how inflammation may increase the risk of colorectal 

cancer (CRC), and how foods or naturally occurring 

supplements with bioactive components linked to 

beneficial health effects might reduce that risk.

Dietary flavonols occur in various fruits and vegetables, but one of them quercetin – commonly found in 

apples, blueberries, grapes, and some vegetables – has 

only recently begin to draw the attention of researchers, said Dr. Murphy. “Quercetin is an exciting target 

to study because of its role in inflammation. We have 

shown some significant anti-inflammatory activity in 

a mouse model of CRC.”

NCI funding* is helping Dr. Murphy and colleagues 

look deeper into the molecular details of inflammation and CRC. “We and many others have also 

found significant anti-inflammatory activity with 

curcumin,” another herbal extract from the plant 

used to make curry in Indian dishes, she added. 

The researchers will explore whether these two 

different compounds might have an additive or 

even synergistic impact on the inflammatory tumor 

microenvironment found in CRC.

The molecular and chemical process of inflammation 

at tumor sites is complex, but a central actor is 

the macrophage, explained Dr. Murphy. Tumorassociated macrophages are mature cells that develop 

from monocytes, a precursor cell type circulating 

in the blood. A signal known as monocyte chemoattractant protein recruits these cells to a site in the 

body where inflammation has or could begin to 

develop, a process that can cause precancerous polyps 

to form in the colon, she said. Once there, macrophages fuel inflammation, enhancing the survival, 

growth and motility of cancer cells.

“We know that macrophage-induced inflammation 

plays an important role in the initiation and progression of CRC,” Dr. Murphy noted, “and it may also 

be responsible for the fatigue, lack of appetite and 

body wasting that so compromises the quality of life 

in these patients. This is a cancer where nutrition and 

diet play an important role in causing many cases.” 

Their work with curcumin and quercetin is designed 

to use diet to possibly prevent some of these cancers.

Dr. Murphy said there is already evidence that both 

curcumin and quercetin work independently against 

inflammation, however, looking at their impact in dietary combination is a new research approach. “They 

might be targeting different pathways and stages of 

the inflammatory process,” she said. The researchers 

will test to see if using the compounds together provides a synergistic effect greater than the sum of the 

parts. In addition, since the impact of these phytochemicals is dependent on how much of each compound the body actually absorbs, Dr. Murphy and 

colleagues will also be looking to see if the combination of curcumin and quercetin allows more of either 

or each ingredient to convert into actively circulating 

material in genetically-engineered mice. 

“This is a great opportunity for us to look more 

closely at inflammation and cancer at the cellular 

level,” she said, “and possibly add some scientific 

evidence” to the already significant anecdotal and 

traditional heritage of two traditional plant-based 

medicines.

*GRANT NUMBER: 1R21CA135377-01A1

ACCELERATING PROGRESS IN CANCER PREVENTION 53
Cranberry Juice Shows Promise for the Prevention of 

Bladder Cancer

DIVISION OF CANCER PREVENTION

Bladder cancer 

researchers are 

interested in certain 

chemicals in foods or 

dietary supplements 

that naturally concentrate in the urine 

and pass through 

the bladder that may 

help protect against bladder tumor formation. 

Dietary polyphenols are of high interest in recent 

years because of their promising efficacy with 

little or no toxicity in several pre-clinical cancer 

models. One naturally occurring source of these 

compounds is cranberries. 

“Cranberry fruits are rich in dietary polyphenols 

and it is well known that cranberry juice is helpful in 

treating and preventing urinary tract infections (UTIs) 

caused by E. coli,” noted Jeevan K. Prasain, Ph.D., 

assistant professor of Pharmacology & Toxicology, 

University of Alabama at Birmingham. He and his 

colleagues have conducted previous studies* demonstrating that a commercially available cranberry 

juice concentrate can prevent urinary bladder cancers 

in chemically-induced bladder carcinogenesis in rats 

when compared to the control group of animals that 

did not receive the juice. 

“Although our data suggest that the preventive efficacy of cranberries is due to the inhibition of tumor 

cell proliferation, at least one report has demonstrated that cranberries can impair angiogenesis (blood 

vessel growth in tumors) and, therefore prevent 

tumor growth, suggesting another possible mechanism,” he explained.

With funding from NCI **, Dr. Prasain is now seeking to determine the bioavailability (i.e., absorption 

and retention in an unmetabolized form) of various 

phytochemicals present in cranberry juice, identify 

metabolites of these compounds, measure their concentrations in urine in the bladder of rats, and assess 

their ability to block bladder carcinogenesis. 

A major focus is on quercetin and its glycosides, 

which are the major phytochemicals of cranberry 

juice concentrate. Their metabolism and bioavailability are complex, he noted. Although final results from 

the study are not expected until 2011, Dr. Prasain 

presented some preliminary data at the American 

Society of Mass Spectrometry annual conference in 

May 2010. 

He and his colleagues are using liquid chromatography tandem mass spectrometry for profiling the 

constituents of cranberry. They reported that metabolites of quercetin and methyl quercetin were detected 

in the urine samples collected overnight after 

oral administration of cranberry powder to rats. 

“The presence of quercetin glycoside in the urine 

indicates that the intact glycoside may be absorbed,” 

Dr. Prasain commented. “This report identifying 

cranberry metabolites in plasma and urine may 

explain their beneficial effects against bladder 

cancer.”

If the final results from the study show further promise, Dr. Prasain will apply for an additional grant “to 

expand our investigation into the mechanics of activity at the molecular level.” Cranberries are “popular 

as a functional food and the juice is safe to drink,” 

he added. Cranberries are also unique in the sense 

that they contain a mixture of many types of different 

natural compounds. “Because of the blending of so 

many different compounds, cranberries may be more 

effective than a single purified compound because 

of synergistic and additive effects,” Dr. Prasain said. 

However, he added, the fruit “has not been very well 

investigated. For now, the major question is whether 

it is truly a preventive agent.”

* Prasain JK, Jones K, Moore R, Barnes S, Leahy M, Roderick R, Juliana MM, 

Grubbs CJ. Effect of cranberry juice concentrate on chemically-induced urinary 

bladder cancers. Oncology Reports, June 2008;19:1565-70.

**GRANT NUMBER: 1R21CA137519-01

54 NCI CAM ANNUAL REPORT 2009
Ancient Medicine from India Studied to Prevent Prostate Cancer

DIVISION OF CANCER PREVENTION

Prostate cancer is a leading cause of cancerrelated deaths among 

men in the United 

States. Because the 

disease is usually diagnosed in the sixth or 

seventh decades of 

life, this allows a large 

window for intervention to prevent disease progression. Clinical development of safe agents that can 

prevent prostate cancer could have a significant impact on morbidity and mortality for a large segment 

of the population.

NCI is funding a small study* on Commiphora mukul extract (CME) for prevention of prostate cancer. 

The Commiphora mukul plant has been used in 

Ayurvedic medicine practice in India for thousands of 

years for different ailments, noted Dong Xiao, Ph.D., 

research assistant professor at the University of Pittsburgh, Pennsylvania. He and his colleagues are using 

a standardized formulation of CME called Gugulipid 

GL (GL) (standardized to 3.75% z-guggulsterone, 

z-Gug). This and two other formulations of CME are 

already in human use as cholesterol-lowering agents 

in India. 

“For the first time, we have investigated the antitumor activity of GL in human prostate cancer cells 

and in genetically-engineered (TRAMP) mice which 

is considered a close animal model for the human 

disease,” Dr. Xiao said. In the lab, GL treatment was 

found to decrease the viability of human prostate 

cancer cells LNCaP (androgen-dependent) and its 

androgen-independent cells by causing apoptosis 

(cell death) induction at pharmacologically achievable 

concentrations, he reported. “Interestingly, a normal 

human prostate epithelial cell line is significantly 

more resistant to growth inhibition and apoptosis 

induction by GL, since apoptosis is a highly desirable 

feature of potential cancer preventive agents,” he 

added.

“Most importantly,” Dr. Xiao continued, “our preliminary studies showed that oral administration of 

GL in TRAMP mice three times per week beginning 

at five weeks of age for 20 weeks, significantly inhibits prostate cancer incidence and progression without 

causing weight loss or any other side effects.”

He added, “Our next step will be to confirm these 

findings, using more mice. We also want to identify 

biomarkers of these responses to GL. These biomarkers will be very useful if GL moves on to human 

clinical trials.”

GL is a promising compound and has significant 

potential in preventive applications, since it has 

selective anticancer activity for prostate cancer, 

Dr. Xiao commented. “If a standardized GL can 

be developed into a prostate cancer preventive agent, 

the public health benefit could be tremendous.”

*GRANT NUMBER: 1R21CA143104-01A1

ACCELERATING PROGRESS IN CANCER PREVENTION 55
Developing Effective and 

Efficient Treatments

The development of more efficient and effective cancer 

treatments – that target cancer cells while leaving 

surrounding healthy tissue unharmed – is at the heart 

of NCI’s research agenda. We strive to develop well-tolerated, 

individualized therapies that are tailored to specific 

features of a patient’s cancer.
Vitamin K Studied in Treatment and Prevention of Liver Cancer

DIVISION OF CANCER BIOLOGY

Hepatocellular carcinoma (HCC), the most 

common type of primary liver tumor, is often 

found at an advanced 

stage and available 

treatments rarely offer 

a cure once the cancer 

has spread. There 

remains an urgent need for agents that can more 

effectively treat HCC or prevent liver cancer 

development.

Brian Carr, M.D., Ph.D., professor of medical oncology at Thomas Jefferson University’s Kimmel Cancer 

Center, has been exploring the use of vitamin K1 

(simply called vitamin K in the United States) and 

synthetic derivatives of the compound for the treatment of HCC for over 15 years. 

He first became drawn to the potential use of vitamin 

K in the treatment of HCC after reading the results 

of studies testing biomarkers to detect liver cancer. 

Alpha-fetoprotein, commonly used as a biomarker 

for HCC, is only expressed by 50% of those tumors. 

In contrast, an immature form of prothrombin (a 

protein involved in blood coagulation), called DCP, 

is secreted by about 80% of HCCs. 

“A known function of vitamin K in mammals is helping convert the immature protein DCP to mature prothrombin and this mechanism is broken in patients 

with HCC,” explained Dr. Carr. 

His laboratory began treating HCC cells with large 

doses of vitamin K. They observed that these doses 

restored normal prothrombin production in the 

cancerous cells and “the natural vitamin K, which 

corrected this defect, also stopped the cancer cells 

from growing,” Dr. Carr said. He also conducted a 

phase I/II study* of vitamin K and found no toxicity 

at doses up to 1,000 mg/day. 

With funding from NCI** , Dr. Carr’s laboratory 

collaborated with synthetic chemists to develop and 

test several derivatives of vitamin K, the most potent 

of which was called compound 5 (Cpd5). Cpd5 not 

only stopped cancer cells from growing—a cytostatic 

effect—it killed them, a cytotoxic effect. This cellkilling effect was caused by over-stimulation of a cellsignaling molecule called extracellular receptor kinase 

(ERK), which shut down the cell-growth machinery.

Unfortunately, research in animal models showed 

that the effective dose and the toxic dose of Cpd5 

were too close to each other, rendering Cpd5 unsuitable for human clinical trials. However, the recent 

development of mainstream cytostatic cancer drugs 

“made me realize that the paradigm we’ve had for 

the last 40 years of cancer treatment, of killing cancer 

cells, may be inadequate,” Dr. Carr said. “Instead of 

looking for more and more potent compounds, which 

kill normal cells as well as cancer cells, maybe we 

need to focus on blocking selected signaling pathways 

in HCC cells.” 

The Carr laboratory recently turned back to studying 

natural vitamin K, this time with the cytostatic drug 

sorafenib (Nexavar®). In preliminary in vitro and 

in vivo work, the addition of vitamin K significantly 

enhanced the effects of sorafenib and reduced the 

dose required to affect cell growth in both HCC*** 

and pancreatic cancer****.

*Carr BI. Suppression of DCP/PIVKA-2 and alpha-fetoprotein levels in 

human hepatocellular carcinoma (HCC) by high doses of vitamin K1 (VK1). 

Hepatology 1996;348A.

***Wei G, Wang M, Hyslop T, Wang Z, Carr BI. Vitamin K enhancement 

of sorafenib-mediated HCC cell growth inhibition in vitro and in vivo. 

International Journal of Cancer, June 7, 2010;[Epub ahead of print]

 Wei G, Wang M, Carr BI. Sorafenib combined vitamin K induces apoptosis 

in human pancreatic cancer cell lines through RAF/MEK/ERK and c-Jun NH2-

terminal kinase pathways. Journal of Cell Physiology,July 2010;224(1):112-9.

** GRANT NUMBER: 5R01CA082723-09

 DEVELOPING EFFECTIVE AND EFFICIENT TREATMENTS 57
Vitamin D Studied to Treat Advanced Prostate Cancer

DIVISION OF CANCER PREVENTION

Some unanswered 

questions remain 

about the link between Vitamin D and 

cancer risk, which 

continues to be a priority research topic 

(see related articles 

on pages 41 and 42). 

People primarily generate vitamin D3 when their skin 

is exposed to ultraviolet B radiation from the sun, 

explained Candace S. Johnson, Ph.D., deputy director 

and the Wallace Family Chair in Translational Research at the Roswell Park Cancer Institute in Buffalo, New York. Dietary vitamin D – found in eggs, fish 

and fortified dairy and cereal products – is usually 

inadequate so that people who live further from the 

equator and those who spend less time outdoors have 

higher rates of vitamin D deficiency, she added.

Dr. Johnson, and her colleague Roswell Park CEO 

Donald “Skip” Trump, M.D., have been pioneering 

ways to explore the vitamin D link to cancer risk, 

particularly in prostate cancer. In an earlier phase II 

trial*, more than 30 percent of men had their prostate-specific antigen (PSA) levels reduced by at least 

half, after taking a synthetic physiologically-active 

analog of vitamin D (1,25 dihydroxycholecalciferol) 

known as calcitriol. The vitamin D compound 

was given along with dexamethosone (one of the 

synthetic hormones known as glucocorticoids), 

which appeared to improve the impact of the drug, 

probably by increasing the amount of vitamin D 

receptor (VDR) that is expressed on most of the 

body’s cells, including cancer cells.

In her current NCI-funded research**, Dr. Johnson 

and her colleagues are looking at men with 

castration-resistant prostate cancer whose disease 

has usually spread (metastasized) and is growing 

without restraint. “Many of them have persistent 

bone pain and are feeling pretty lousy,” she noted. 

Most of these patients were originally treated with 

radiation or surgery, and now hormone therapy is no 

longer effective.

“Many of the men in our earlier trial felt better and 

had less bone pain after treatment with combination of calcitriol and dexamethosone,” explained 

Dr. Johnson. “We need to know more about what is 

happening at the molecular level, so that we can determine how much calcitriol we can give them safely, 

and the best way to administer it.” It turns out that 

blood levels of vitamin D do not simply rise when 

you give higher doses of calcitriol in some people. 

“I think that the dosing schedule may be a crucial 

part of the vitamin D puzzle,” she said. Early 

results suggest the best strategy might be to give 

very large doses for one or a few days, followed by 

4 or more days off.

So far, it seems, the more calcitriol, the greater the 

impact on the cancer and its symptoms, Dr. Johnson 

added. However, within minutes of calcitriol 

entering the bloodstream, the cyp24 gene is activated 

and starts a process that breaks down calcitriol. 

Dr. Johnson and her colleagues are now looking to 

add a third drug, ketoconazole, to the combination, 

with the idea that ketoconazole will turn off induction of cyp24 and thereby increase the amount of 

calcitriol actually getting to the prostate tumors.

“We’re looking at the whole sequence of events from 

every angle that we can,” Dr. Johnson said. If their 

current phase II trial provides good information 

about dosing and effectiveness of calcitrol in combination with the two drugs, it may eventually lead to 

another treatment option in prostate and other solid 

tumors, she added.

* Trump DL, Potter DM, Muindi J, Brufsky A, Johnson CS. Phase II trial 

of high-dose, intermittent calcitriol (1,25 dihydroxyvitamin D3) and dexamethasone in androgen-independent prostate cancer. Cancer, May 15, 

2006;106(10):2136-42.

**GRANT NUMBER: 5R01CA85142-10

58 NCI CAM ANNUAL REPORT 2009
Dietary Restrictions Treat Cancer as a Metabolic Disease

DIVISION OF CANCER TREATMENT AND DIAGNOSIS

In an era of targeted 

cancer treatment strategies, researchers try to 

exploit the inherent 

differences between 

normal and cancer 

cells. For example, patients often experience 

significant side effects 

when cell-killing (cytotoxic) chemotherapy is used 

because the drugs circulating through the bloodstream affect not only cancer cells but healthy cells 

as well. Targeted treatments such as Gleevec are 

designed to interfere primarily with molecules and 

cells that are actively involved in the cancer process 

but leave healthy cells alone.

Douglas Robert Spitz, Ph.D., director of the Free 

Radical Radiation Biology Program at the University 

of Iowa, thinks he may also be able to direct certain 

chemotherapies towards cancer cells by changes in 

the diet. If successful, the new strategy would allow 

them to deliver larger doses of these drugs more 

safely.

The body normally converts (metabolizes) food into 

energy by breaking down the glucose from carbohydrates (glycolysis). However, there is a second way 

that the body delivers chemical energy – in the form 

of adenosine triphosphate (ATP) – to its cells. Mitochondria are found in nearly every cell type in the 

body and because these “cellular power plants” use 

oxygen to create ATP, the process is known as mitochondrial respiration, Dr. Spitz explained. Researchers have known that cancer cells get their energy 

by increasing glycolysis, “since their mitochondrial 

respiration is somewhat compromised,” he added. 

“So we asked: what if you threaten their glucose 

energy supply? Will they be able to compensate with 

mitochondrial respiration?”

In work supported by NCI*, Dr. Spitz and his colleagues are treating human cancer cells with 2-deoxyglucose (2DG), an agent that inhibits both glucose 

metabolism and also the cells’ ability to cope with 

damaging oxidizing compounds known as hydroperoxides. They are finding that these glucose-starved 

cells are more likely to be found and killed by both 

radiation and chemotherapy. Compared to cells that 

were not treated with 2DG, both radiation and the 

chemotherapy drug cisplatin were more effective 

against human head and neck cancer cells treated 

with 2DG. The same was true of pancreatic cancer 

cells targeted with gemcitabine. The researchers will 

continue to refine this strategy and try to determine 

how best to increase the oxidative stress put on the 

cancer cells.

Before they can test the idea in a human trial, they 

also need to learn more from testing in mouse models, Dr. Spitz said. To reduce glycolysis in animals – 

and ultimately humans – you have to develop a diet 

that will safely force the body to switch its metabolism over to mitochondrial respiration. A ketogenic 

diet does this by essentially starving the body of 

carbohydrates, he explained. The dietary formulation they are testing in mice has a 10:1 ratio of fat to 

protein. Early results with mice on a ketogenic diet 

show that both radiation and cisplatin are significantly more effective at delaying tumor growth and 

extending survival when combined with 2DG, which 

can safely be given to humans as well.

“Radiotherapy and certain kinds of drugs like cisplatin kill cancer cells by increasing oxidative stress,” 

Dr. Spitz added. “When we manipulate these cancer 

cells closer to the edge of survival, smaller amounts of 

drugs and radiation appear to have a greater impact.”

NCI Program Director Suzanne Forry-Schaudies, 

Ph.D., commented, “Inhibiting and/or modifying 

cancer metabolism is an important and timely area 

of research. What makes Dr. Spitz’s work unique is 

the exploration of diet modification in combination 

with 2-DG, chemotherapy, or radiation treatment. 

The rational combination of therapeutic agents is 

currently an area of emphasis in NCI’s Division 

Treatment and Diagnosis.”

*GRANT NUMBER 1R21CA139182-01

 DEVELOPING EFFECTIVE AND EFFICIENT TREATMENTS 59
Exercise and Antidepressants May Counteract Stress-induced 

Tumor Growth

DIVISION OF CANCER CONTROL AND POPULATION SCIENCES

Higher levels of 

physical activity following the diagnosis 

of cancer have been 

associated with 

reduced rates of 

cancer recurrence. 

Physical activity 

has also been 

demonstrated to have antidepressant effects, 

benefiting individuals who are chronically stressed, 

including ovarian cancer patients. 

“Because chronic stress contributes to aggressive tumor 

growth and results in a poor outcome for cancer 

patients, we predict that changes in behavior that 

reduce chronic stress may also slow tumor growth,” 

said Rosemarie Schmandt, Ph.D., associate professor, 

Department of Gynecologic Oncology, University of 

Texas, M.D. Anderson Cancer Center. “We expect 

that the same molecular pathways activated by physical activity and antidepressants that reduce stress will 

also inhibit stress- mediated tumor growth.”

With NCI funding*, “we’re trying to understand 

the molecular biology that underlies the beneficial 

effect of physical activity for cancer patients,” Dr. 

Schmandt explained. “That’s what we’re looking at 

now using a mouse model of ovarian cancer.” Dr. 

Schmandt has conducted a series of studies in mice, 

with the first series comparing the impact of exercise 

on ovarian tumor growth in stressed and unstressed 

mice and the second study looking at the effects of 

the antidepressant fluoxetine on tumors in stressed 

and unstressed mice. In her experiments, tumors in 

chronically stressed animals grew to approximately 

twice the size as those in unstressed animals. Both 

exercise and the drug held ovarian tumor growth in 

check in the stressed animals to roughly the same 

size as the smaller tumors in unstressed mice, she 

reported.

At a molecular level, she predicts that these effects 

are modulated by the circuits inside the cells that 

are affected by brain derived neurotrophic factor 

(BDNF). This protein is produced in response to 

either antidepressant drugs or exercise and is required 

for antidepressant behavioral effects. Dr. Schmandt 

says, “We know that in cultured ovarian cancer cells, 

exposure to a ‘mature’ version of the BDNF protein 

activates an enzyme called AMPK, which negatively 

regulates cell growth. It’s kind of a tumor suppressor 

pathway.”

 “The really interesting thing is that our findings support the concept of ‘sound mind, sound body’,” Dr. 

Schmandt noted. 

If her findings about the beneficial effects of physical 

activity and antidepressants in mice and cancer cell 

lines are eventually confirmed in human studies, it 

could be helpful for ovarian cancer patients. “Ideally, you’d like people to feel healthy enough after 

their cancer treatment to go out and begin or resume 

exercising,” Dr. Schmandt said. “However, if a patient doesn’t feel up to exercising everyday, like when 

they’re undergoing chemotherapy, having a drug they 

can use to carry them through until they feel able to 

exercise again would be a real advantage.”

For follow-up, “we’re expanding our study to look at 

obesity which may be contributing to tumor growth 

in the same way that chronic stress does,” she added. 

“Some of these studies are already underway in our 

lab. AMPK is known to be activated by exercise as 

well and by dietary restriction. We’re now looking at 

obesity as a kind of chronic stressor.”

* GRANT NUMBER 1R21CA137399-01A1

60 NCI CAM ANNUAL REPORT 2009
Enhancing Cancer Immunoprevention and Immunotherapy 

with Naturally Occurring Beta Glucans

DIVISION OF CANCER PREVENTION

Beta glucans (β-glucans) 

are polysaccharides – 

long chains of sugar 

molecules – found on 

the surface of microorganisms such as bacteria and yeast, as well 

as in some plants and 

edible fungi such as 

mushrooms. Natural foods containing β-glucans, 

including Shitake mushrooms, have been used for 

centuries for treating both infectious diseases and 

cancer in traditional Asian medicine, but with 

mixed success.

β-glucans are recognized as foreign by the human 

immune system, which targets them in a complex 

pathway involving the complement system, sending 

leukocytes (white blood cells) to destroy their microbial carriers. Until recently, researchers did not understand the complexity of the immune system reactions 

involved, explained Jun Yan, M.D., Ph.D., associate 

professor of medicine in the Tumor Immunobiology 

Program at the University of Louisville, Kentucky. 

As research by Dr. Yan and others has now shown, 

the ability of β-glucans to increase the activity of leukocytes against cancer cells requires the presence of 

anti-tumor antibodies that activate the complement 

system. While the human immune system often does 

not recognize cancer cells in the bodies as invaders 

– and therefore does not produce antibodies to fight 

them – this discovery has important implications 

for the use of β-glucans as a non-toxic adjuvant for 

cancer-fighting monoclonal antibody treatments.

Monoclonal antibodies (mAbs) such as cetuximab, 

bevacizumab, and trastuzumab have improved the 

survival for many types of cancer. However, even the 

most effective mAb usually fails to eradicate all of the 

tumor cells in a patient. Although mAbs take advantage of part of the immune system, they often do not 

trigger a robust immune response in cancer patients.

By administering β-glucans along with mAbs, Dr. Yan 

hopes to increase the cancer cell killing effect over 

what would be achieved with a mAb alone by activating the complement system and triggering an innate 

immune response by leukocytes. Work performed 

by his laboratory using animal models of cancer has 

shown potential efficacy of this approach in several 

cancer types.*,

 **

With NCI funding***, Dr. Yan’s current research 

is investigating additional cellular and molecular 

mechanisms by which yeast-derived β-glucans exert 

their effect on the immune system. Better knowledge of these mechanisms of action will allow more 

effective incorporation into immunoprevention and 

immunotherapy regimens for cancer.

So far, his preliminary data has identified two cellular 

receptors that play critical roles in the early stages of 

an immune reaction to β-glucans. “In addition, we’ve 

found that β-glucans can also stimulate adaptive immune responses,” said Dr. Yan. The adaptive immune 

response, which ‘remembers’ previously encountered 

pathogens and other threats to the body, is what 

researchers are trying to harness to create anti-tumor 

vaccines. “And with any vaccine, you need an adjuvant treatment to augment efficacy,” he explained.

Dr. Yan and his colleagues are currently planning a 

clinical trial testing an oral formulation of particulate 

yeast β-glucans in combination with a dendriticcell-based tumor vaccine for non-small-cell lung 

adenocarcinoma.

* Driscoll M, Hansen R, Ding C, Cramer DE, Yan J. Therapeutic potential of 

various beta-glucan sources in conjunction with anti-tumor monoclonal antibody in cancer therapy. Cancer Biology and Therapy, February 2009;8(3):

218-25.

** Salvador C, Li B, Hansen R, Cramer DE, Kong M, Yan J. Yeast-derived betaglucan augments the therapeutic efficacy mediated by anti-vascular endothelial 

growth factor monoclonal antibody in human carcinoma xenograft models. 

Clinical Cancer Research, February 15, 2008;14(4):1239-47.

*** GRANT NUMBER: 1R01CA150947-01

 DEVELOPING EFFECTIVE AND EFFICIENT TREATMENTS 61
Botanical Products Examined for Prevention of Endometrial 

Cancer From Tamoxifen Treatment

DIVISION OF CANCER PREVENTION

Tamoxifen, a drug 

that blocks the effects of the hormone 

estrogen in breast 

tissue, is widely used 

in the treatment 

of breast cancer 

in women whose 

tumors express the 

cellular receptors for estrogen. Five years of tamoxifen treatment substantially reduces the risk of breastcancer recurrence, but the drug has several unwanted 

side effects, including an increased risk of endometrial cancer.

Birgit Dietz, Ph.D., research assistant professor in the 

Department of Medicinal Chemistry and Pharmacognosy at the University of Illinois, Chicago (UIC), 

is searching for natural products that could help 

prevent endometrial cancer in women taking tamoxifen. Her current work funded by NCI* focuses on 

two plants – black cohosh (Cimicifuga racemosa) and 

red clover (Trifolium pratense) – which are available 

as dietary supplements in the United States. Many 

women, including breast cancer survivors, use overthe-counter preparations of these herbs for the relief 

of menopausal symptoms such as hot flashes. 

Dr. Dietz and her colleagues first started looking at 

interactions between black cohosh, red clover, and 

tamoxifen for safety reasons, since studies had not 

been done to determine if the herbs interfered with 

the beneficial effects of tamoxifen in breast tissue. 

They confirmed that compounds in black cohosh 

have no estrogen-like activity, making it unlikely 

that these botanical supplements interfere with the 

estrogen-blocking effects of tamoxifen. 

“Our preliminary data have shown that both black 

cohosh and red clover contain antioxidative, antiproliferative, anti-inflammatory, and detoxificationenzyme-inducing compounds, which may inhibit 

carcinogenesis or retard the promotion and progression of precancerous cells,” explained Dr. Dietz.

Their studies have since expanded from safety to 

chemoprevention of endometrial cancer. In collaboration with the NIH Center for Botanical Dietary 

Supplements Research, Dr. Dietz’s laboratory has 

isolated specific compounds from the two herbs with 

antiproliferative and detoxification-enzyme-inducing 

properties, and the researchers are currently measuring which genes and proteins in cell proliferation 

pathways are affected by these compounds.

In a study presented** at the 2009 Frontiers in 

Cancer Prevention Research meeting, held by the 

American Association for Cancer Research, Dr. Dietz 

and her colleagues showed that black cohosh reduced 

tamoxifen-induced endometrial cell proliferation in 

a dose-dependent manner in human cell lines. Future 

work will use an animal model of tamoxifen-induced 

endometrial cancer to quantify the effect of the two 

botanical compounds.

“Interestingly, another research group recently 

revealed that black cohosh demonstrated synergistic 

antiproliferative effects in conjunction with tamoxifen in breast cancer cells, and another research group 

showed that genistein, a compound in red clover, had 

a similar effect,” Dr. Dietz reported. “We are also 

planning to examine the interactions of black cohosh, 

red clover, and tamoxifen in breast cancer cells and 

tissue as part of our future work.” 

NCI Program Director Maria Agelli, M.D., MS, 

FACPM, commented, “With a well designed study, 

moving progressively from cell line to animal 

model experiments, Dr. Dietz’s research will provide 

experimental evidence critical to assess the ability, 

and possible role, of black cohosh and red clover in 

the prevention of endometrial cancer secondary to 

treatment with tamoxifen.”

** Dietz BM, Hagos GK, Yao P, Lantvit DD, Chen SN, Goedecke T, Farnsworth NR, Pauli GF, Bolton JL. Abstract B67: Influence of black cohosh and 

its isolated triterpenes on tamoxifen-induced endometrial cell proliferation. 

Cancer Prevention Research, January 7, 2010 3:B67; doi:10.1158/1940-6207.

PREV-09-B67.

* GRANT NUMBER: 1R21CA135237-01A2

62 NCI CAM ANNUAL REPORT 2009
Improving the Quality of Life for Cancer 

Patients, Survivors, and their Families

Advances in our ability to detect, treat, and support cancer 

patients have turned this disease into one that is chronic, 

or readily managed, for many and curable for increasing 

numbers. While the ultimate goal of eliminating cancer 

altogether continues to be our long-term commitment, the 

capacity to dramatically reduce the suffering caused 

by cancer is within our immediate grasp.
Cranial Stimulation Tried for Managing Side Effects of 

Chemotherapy in Breast Cancer

DIVISION OF CANCER PREVENTION

Women being 

treated with chemotherapy for 

breast cancer often 

experience multiple 

side effects including fatigue, mild to 

moderate levels of 

anxiety and depressive 

symptoms, sleep disturbances, and pain. These side 

effects often occur together. “Conventional medications are not terribly effective for these symptoms,” 

noted Debra Lyon, R.N., Ph.D. “Furthermore, many 

women with breast cancer don’t want to take any 

extra medication, unless they absolutely have to.”

With funding from NCI*, Dr. Lyon, an associate 

professor and chair of the Department of Family and 

Community Health Nursing in the School of Nursing 

at Virginia Commonwealth University is exploring a 

new, drug-free approach to relieving these symptoms. 

The approach – known as cranial microcurrent electrical stimulation (CES) – delivers a low-level electrical 

current to the head using a portable electronic device 

known as an Alpha-Stim, which is roughly the size of 

a BlackBerry device. “It was designed to be something 

that busy people can use in their homes,” explained 

Dr. Lyon. In her study, women can carry the device in a 

pocket while they are walking around the house, doing 

chores, relaxing with a book, or watching TV.

Scientists do not yet understand the exact mechanism 

of how electrical stimulation can affect the brain, Dr. 

Lyon said, “but there is evidence that CES may initiate 

a physiological change by inducing changes in brain 

activity consistent with a relaxed state (as noted by 

EEG patterns), or by stimulating neurotransmitter or 

endorphin release. These physiological changes are 

associated with lower levels of pain and depressive and 

anxiety symptoms, and may also have positive effects 

on related symptoms of fatigue and sleep disturbances.”

Starting in April 2009, Dr. Lyon and her colleagues 

are recruiting a total of 166 women, who are receiving chemotherapy for early-stage breast cancer, to 

participate in the five-year study. Half of the women 

will be treated with CES for one hour a day. The 

other half will be given a “sham” device that appears 

identical to the Alpha-Stim unit but does not deliver any current through the electrodes. Neither the 

patients nor the researchers will know which device 

a patient has. The electrical current used in CES is so 

mild that patients cannot feel it, Dr. Lyon said. 

In a previous pilot study, also funded by NCI, Dr. 

Lyon found that women were not able to tell whether 

they had the actual or the sham electronic device. 

“Any standardized, portable, symptom-management 

therapy that we can use in breast cancer, and potentially in other cancers, to give patients a way to 

self-manage their common symptoms has potential 

importance for enhancing their quality of life, and 

also perhaps leading to their feeling like they can 

complete their treatment while continuing to manage 

multiple other daily concerns,” said Dr. Lyon. 

The cost of an Alpha-Stim device, which is available 

by prescription in the United States and runs on a 

9-volt battery, ranges from $300 to $600. “While the 

up-front cost may be a little higher than a one-month 

supply of medication,” noted Dr. Lyon, “over time it 

should be pretty cost-effective.”

As part of the current study Dr. Lyon will also 

investigate whether CES affects the levels of several 

proteins in the body that play a role in inflammation, and whether there is a link between the levels of 

these proteins and the symptoms being studied. Dr. 

Lyon has found that women with breast cancer have 

high levels of these proteins, and previous findings 

by others suggest a possible link between depression 

and elevated levels of inflammatory proteins. “What 

we’re thinking in this study, and in the field called 

psychoneuroimmunology, is that if individuals are 

feeling stress relief, that not only can it lead to symptom improvement, but it can also lead to stopping the 

biological chain reaction that promotes or enhances 

the level of stress,” Dr. Lyon said.

*GRANT NUMBER: 5R01CA127446-02

64 NCI CAM ANNUAL REPORT 2009
Exercise Intervention Studied for Heart Failure in 

Cancer Survivors

DIVISION OF CANCER CONTROL AND POPULATION SCIENCES

One of the more serious 

and distressing late side 

effects of cancer treatment is chemotherapyinduced heart failure. 

Exercise training has 

been found to be beneficial for non-cancer 

patients with heart 

failure, as well as for cancer survivors without heart 

failure. Researchers are now testing exercise in cancer 

survivors with chemotherapy-induced heart failure.

Karen Basen-Engquist, M.P.H., Ph.D., professor of 

behavioral science at the University of Texas M. D. 

Anderson Cancer Center, is co-principal investigator (co-PI) for the study called Take Heart. “I began 

planning this study a few years ago with one of the 

cardiologists at M.D. Anderson,” she recalled. The 

current pilot study, funded by NCI*, is a first-time 

collaboration between M.D. Anderson’s Behavioral 

Science and Cardiology Departments. Dr. BasenEngquist works closely with co-PI and cardiologist 

Elie Mouhayar, M.D., FACC.

Take Heart is a structured exercise intervention for 

patients with heart failure related to their chemotherapy. Patients in the intervention group exercise under 

supervision three times a week for 16 weeks, and during the last eight weeks, they also start home-based 

exercise. “The goal is to get the patients exercising 

up to 30 minutes at each session,” said Dr. BasenEngquist. “We start from wherever they are. Some 

come in at first and can only do a couple of minutes, 

rest, and then do a few more minutes, and that’s it. 

We work on building them up from there.” 

The pilot study will enroll 80 patients. After baseline 

testing, the patients will be randomly assigned to receive either the 16-week Take Heart lifestyle intervention or usual care, Dr. Basen-Engquist added. “We’ll 

take patients on the study once they’re stabilized on 

medication for heart failure,” she said. “One thing 

we’d like to learn from this study is whether it is 

possible to lower their drug dose if their heart failure 

symptoms are kept more under control with exercise. 

That’s not something we know yet.”

If results from the pilot study are promising, “we 

hope to move on to a larger clinical trial of Take 

Heart,” Dr. Basen-Engquist noted. “There have been 

cardiac rehabilitation programs for many years. 

Those of us who are doing exercise research in the 

cancer field are really looking at the creation of 

cancer rehabilitation programs. There are multiple 

benefits from exercise for people with cancer including quality of life. This points toward incorporating 

more exercise programs into cancer treatment and 

after-care.”

*GRANT NUMBER: 5R21CA135016-02

IMPROVING THE QUALITY OF LIFE FOR CANCER PATIENTS, SURVIVORS, AND THEIR FAMILIES 65
SCIENTIFIC PUBLICATIONS

This is a selected list of some of the most 

important peer-reviewed scientific articles about 

the findings and analyses of NCI-supported 

CAM research studies published during FY 

2009. The articles are classified and grouped 

according to research type: cancer prevention, 

cancer treatment, and cancer side effect/symptom 

management. 

Article citations marked with an asterisk (*) are 

studies which were featured in the NCI’s Annual 

Report on Complementary and Alternative 

Medicine: Fiscal Year 2008 which can be read 

and downloaded at http://www.cancer.gov/cam/

attachments/fy2008_CAM_annual_report.pdf.

Abstracts of all the articles are available online 

through the National Library of Medicine’s 

“PubMed” database at http://www.pubmed.com. 

A PubMed Identifier (PMID) number is provided 

for most of the citations.

Prevention

*

Carman S, Kamangar F, Freedman ND, Wright 

ME, Dawsey SM, Dixon LB, Subar A, Schatzkin A, 

Abnet CC. Vitamin E intake and risk of esophageal 

and gastric cancers in the NIH-AARP Diet and 

Health Study. International Journal of Cancer, July 1, 

2009;125(1):165-70. PMID: 19326432.

Deep G, Raina K, Singh RP, Oberlies NH, Kroll DJ, 

Agarwal R. Isosilibinin inhibits advanced human 

prostate cancer growth in athymic nude mice: 

comparison with silymarin and silibinin. International 

Journal of Cancer, December 15, 2008;123(12):2750-8.

*

Dickinson SE, Melton TF, Olson ER, Zhang J, 

Saboda K, Bowden GT. Inhibition of activator 

protein-1 by sulforaphane involves interaction 

with cysteine in the cFos DNA-binding domain: 

implications for chemoprevention of UVBinduced skin cancer. Cancer Research, September 

2009;69(17):7103-10. Epub 2009 Aug. 11. PMID: 

19671797.

*

Islami F, Malekshah AF, Kimiagar M, Pourshams 

A, Wakefield J, Goglani G, Rakhshani N, 

Nasrollahzadeh D, Salahi R, Semnani S, SaadatianElahi M, Abnet CC, Kamangar F, Dawsey SM, 

Brennan P, Boffetta P, Malekzadeh R. Patterns of food 

and nutrient consumption in northern Iran, a highrisk area for esophageal cancer. Nutrition and Cancer, 

2009;61(4):475-83. PMID: 19838919.

*

Lee JI, Nian H, Cooper AJ, Sinha R, Dai J, Bisson 

WH, Dashwood RH, Pinto JT. Alpha-keto acid 

metabolites of naturally occurring organoselenium 

compounds as inhibitors of histone deacetylase in 

human prostate cancer cells. Cancer Prevention 

Research, July 2009;2(7):683-93. PMID: 19584079.

66 NCI CAM ANNUAL REPORT 2009
Leitzmann MF, Koebnick C, Moore SC, Danforth 

KN, Brinton LA, Hollenbeck AR, Schatzkin A, Lacey 

JV. Prospective study of physical activity and the 

risk of ovarian cancer. Cancer Causes and Control, 

July 2009;20(5):765-73. Epub 2008 Dec. 31. PMID: 

19116765.

*

Mentor-Marcel RA, Bobe G, Barrett KG, Young 

MR, Albert PS, Bennink MR, Lanza E, Colburn 

NH. Inflammation-associated serum and colon 

markers as indicators of dietary attenuation of colon 

carcinogenesis in ob/ob mice. Cancer Prevention 

Research, January 2009;2(1):60-9. PMID: 19139019.

*

Nian H, Bisson WH, Dashwood WM, Pinto 

JT, Dashwood RH. Alpha-keto acid metabolites 

of organoselenium compounds inhibit histone 

deacetylase activity in human colon cancer cells.

Carcinogenesis, August 2009;30(8):1416-23. Epub 

2009 Jun 15. PMID: 19528666.

Peters TM, Schatzkin A, Gierach GL, Moore SC, 

Lacey JV, Wareham NJ, Ekelund U, Hollenbeck AR, 

Leitzmann MF. Physical activity and postmenopausal 

breast cancer risk in the NIH-AARP Diet and 

Health study. Cancer Epidemiology, Biomarkers 

and Prevention, January 2009;18(1):289-96. PMID: 

19124511.

*

Qiao YL, Dawsey SM, Kamangar F, Fan JH, Abnet 

CC, Sun XD, Johnson LL, Gail MH, Dong ZW, Yu B, 

Mark SD, Taylor PR. Total and cancer mortality after 

supplementation with vitamins and minerals: followup of the Linxian General Population Nutrition 

Intervention Trial. Journal of the National Cancer 

Institute, April 2009;101(7):507-18. Epub 2009 Mar 

24. PMID: 19318634.

*

Yaxiong Tang Y, Simoneau AR, Xie J, Shahandeh B, 

Zi X. Effects of the Kava Chalcone Flavokawain A 

Differ in Bladder Cancer Cells with Wild-type versus 

Mutant p53. Cancer Prevention Research, November 

2008;1(6):439-51. PMID: 19138991.

Treatment 

Cohen AN, Veena MS, Srivatsan ES, Wang MB. 

Suppression of interleukin 6 and 8 production in head 

and neck cancer cells with curcumin via inhibition 

of Ikappa beta kinase. Archives Of OtolaryngologyHead & Neck Surgery, February 2009;135(2):190-7.

Shabtay A, Sharabani H, Barvish Z, Kafka M, 

Amichay D, Levy J, Sharoni Y, Uskokovic MR, 

Studzinski GP, Danilenko M. Synergistic antileukemic 

activity of carnosic acid-rich rosemary extract and 

the 19-nor Gemini vitamin D analogue in a mouse 

model of systemic acute myeloid leukemia. Oncology, 

2008;75(3-4):203-14. Epub Oct. 14,2008.

Side Effect/Symptom Management

Freeman L, Cohen L, Stewart M, White R, Link 

J, Palmer JL, Welton D, McBride L, Hild CM. 

The experience of imagery as a post-treatment 

intervention in patients with breast cancer: program, 

process, and patient recommendations. Oncology 

Nursing Forum, November 2008;35(6):E116-21. 

Mosher CE, Sloane R, Morey MC, Snyder DC, Cohen 

HJ, Miller PE, Demark-Wahnefried W. Associations 

between lifestyle factors and quality of life among 

older long-term breast, prostate, and colorectal cancer 

survivors. Cancer, September, 1 2009; 115(17):4001-9.

*Schnur JB, David D, Kangas M, Green S, Bovbjerg 

DH, Montgomery GH. A Randomized trial of 

a cognitive-behavioral therapy and hypnosis 

intervention on positive and negative affect during 

breast cancer radiotherapy. Journal of Clinical 

Psychology, April 2009; 65(4): 443–455.

Quality of Life

Mosher CE, Fuemmeler BF, Sloane R, Kraus WE, 

Lobach DF, Snyder DC, Demark-Wahnefried W. 

Change in self-efficacy partially mediates the effects of 

the FRESH START intervention on cancer survivors’ 

dietary outcomes. Psychooncology, October, 2008; 

17(10):1014-23.

SCIENTIFIC PUBLICATIONS 67
APPENDIX

An NCI-sponsored clinical trial meets one or more of the following criteria: the protocol (1) has been reviewed and 

approved by NCI’s CTEP Protocol Review Committee or by an approved NCI-designated Cancer Center Protocol 

Review and Monitoring System and/or (2) receives support through an NCI grant, contract, or cooperative agreement.

PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Pediatric Trials

Phase III Randomized Study of Glutamic 

Acid in Reducing Vincristine-Related 

Peripheral Neurotoxicity in Young Patients 

Undergoing Vincristine-Containing 

Treatment for Wilms’ Tumor, Rhabdomyosarcoma, Acute Lymphoblastic 

Leukemia, or Non-Hodgkin’s Lymphoma

HLMCC-0402 Active Supportive care; Treatment 3 to 20 NCI Phase III

Phase I Study of Beta-Glucan and 

Monoclonal Antibody 3F8 in Patients with 

Metastatic Neuroblastoma

MSKCC-05073 Closed Treatment; Biomarker/

Laboratory analysis

Any age NCI Phase I

Pilot Study of Educational and Promotional Materials Development for Use in 

Promoting Physical Activity in Community-Based After-School Programs By 

Multiethnic, Urban Adolescents

MSUHNS-0003669 Active Prevention; Educational/

Counseling/Training

11 to 14 NCI No phase 

specified

Randomized Study of Electroacupuncture 

for Treatment of Delayed ChemotherapyInduced Nausea and Vomiting in Patients 

with Newly Diagnosed Pediatric Sarcoma, 

Neuroblastoma, Nasopharyngeal Carcinoma, Germ Cell Tumors, or Hodgkin 

Lymphoma

NCCAM-02-AT-0172 Active Supportive care 5 to 35 NCCAM; NCI No phase 

specified

Adult Trials

Bladder

Phase II Randomized Study of 

Neoadjuvant Polyphenon® E (Defined 

Green Tea Catechin Extract) in 

Patients with Nonmetastatic 

Bladder Cancer 

WCCC-UWI06-8-01 Active Treatment; Biomarker/

Laboratory analysis

18 and over NCI Phase II

Brain

Phase II Randomized Study of Adjuvant 

Boswellia serrata and Standard Treatment Versus Standard Treatment Alone 

in Patients with Newly Diagnosed or 

Recurrent High-Grade Gliomas

CASE-CCF-7348 Active Treatment 18 and over NCI Phase II

 Adult Trials

68 NCI CAM ANNUAL REPORT 2009
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Breast

Phase III Randomized Study of Cranial 

Microcurrent Electrical Stimulation in 

Reducing Chemotherapy-Related 

Symptoms in Women with Stage I-IIIA 

Breast Cancer Receiving Adjuvant 

Chemotherapy

MCV-MCC-11995 Active Supportive care; Biomarker/

Laboratory analysis

Adult NCI Phase III

Phase II Randomized Study of Soy 

Protein in Postmenopausal Women with 

Breast Disease Taking Tamoxifen and 

Experiencing Hot Flashes 

CALGB-79805 Closed Supportive care Postmenopausal (20 

and over)

NCI Phase II

Phase II Randomized Study of Three 

Different Programs of Paced Breathing 

in Women with Hot Flashes

MAYO-MC06C8 Active Supportive care 18 and over NCI Phase II

Phase II Pilot Study of Magnesium 

Oxide in Treating Menopausal Hot 

Flashes in Women with Cancer

MCV-MCC-12062 Active Supportive care 18 and over NCI Phase II

Phase II Randomized Study of Omega-3 

Fatty Acids in Women with Newly 

Diagnosed Ductal Carcinoma In Situ 

and/or Atypical Ductal Hyperplasia 

OHSU-3872 Active Treatment; Biomarker/

Laboratory analysis

Over 21 NCI Phase II

Phase II Randomized Study of Broccoli 

Sprout Extract in Women with Newly 

Diagnosed Ductal Carcinoma In Situ 

and/or Atypical Ductal Hyperplasia

OHSU-4702 Active Treatment; Biomarker/

Laboratory analysis

Over 21 NCI Phase II

Phase I Study of White Button 

Mushroom Extract in Preventing 

the Recurrence of Breast Cancer in 

Postmenopausal Women Who Are 

Breast Cancer Survivors

CHNMC-07213 Active Treatment; Biomarker/

Laboratory analysis

21 and over NCI Phase I

Study of Support Groups for AfricanAmerican Breast Cancer SurvivorsCHNMC-07170 Active Educational/Counseling/

Training; Supportive care

18 and over NCI No phase 

specified

APPENDIX 69
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Breast

Randomized Pilot Study of Hypnosis in 

Controlling Hot Flashes in Women Who 

Are Breast Cancer Survivors

S-WHITE-8165 Active Supportive care Over 18 NCI No phase 

specified

Pilot Study of Pre-Operative Hypnosis to 

Reduce Post-Operative Pain and Anesthesia-Related Side-Effects in Women 

Undergoing Surgery for Breast Cancer

CHNMC-08029 Active Supportive care 18 and over NCI No phase 

specified

Randomized Pilot Study of the Mindful 

Movement Program in Older Female 

Breast Cancer Survivors

CHNMC-08061 Closed Supportive care 50 and over NCI No phase 

specified

Randomized Study of Hatha Yoga in 

Improving Physical Activity, Inflammation, 

Fatigue, and Distress in Female Breast 

Cancer Survivors

OSU-2007C0004 Active Supportive care; Biomarker/

Laboratory analysis

21 and over NCI No phase 

specified

Randomized Study of Education with 

or without Exercise and Counseling in 

Preventing Lymphedema in Women with 

Stage I-III Breast Cancer Who Are Undergoing Axillary Lymph Node Dissection

CALGB-70305 Active Supportive care; Treatment 18 and over NCI No phase 

specified

Cervix

Phase II Randomized Study of Green Tea 

Extract (Polyphenon E) for the Prevention of Cervical Cancer in Patients with 

Human Papillomavirus (HPV) and LowGrade Cervical Intraepithelial Neoplasia 

(CIN 1)

UARIZ-UAZ03-1-02 Closed Prevention 18 and over NCI Phase II

Phase II Study of Folic Acid Supplementation in Women Infected with HPV-16 and 

Diagnosed with Grade 1 or Less Cervical 

Intraepithelial Neoplasia

UAB-F060511015 Active Prevention; Biomarker/

Laboratory analysis

19 and over NCI Phase II

Phase I Randomized Study of LeucineEnhanced Essential Amino Acid Supplement and/or Testosterone for Cancer-Related Cachexia in Patients with Advanced 

or Recurrent Cervical Carcinoma

UTMB-06073 Active Supportive care; Biomarker/

Laboratory analysis

18 to 59 NCI Phase I

Randomized Study of MindfulnessBased Stress Reduction Versus General 

Health Education in Improving Immune 

Response to Human Papilloma Virus in 

Patients with Cervical Dysplasia

FCCC-06851 Active Behavioral study; Educational/

Counseling/Training; 

Biomarker/Laboratory 

analysis

18 and over NCI No phase 

specified

Colon/Rectum

Phase III Study of the Effect of Vitamin 

E and/or Selenium on Adenomatous 

Colorectal Polyps in Men Enrolled on 

SELECT Trial SWOG-S0000

SWOG-S0000D Active Natural history/Epidemiology; 

Prevention

50 and over NCI Phase III

Phase III Randomized Study of Selenium 

in Patients with Adenomatous Colorectal 

Polyps

UARIZ-00-0430-01 Active Prevention 40 to 80 NCI Phase III

70 NCI CAM ANNUAL REPORT 2009
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Colon/Rectum

Phase II Randomized Study of Acupuncture in Reducing Postoperative Ileus in 

Patients Who Have Undergone Segmental 

or Subtotal Colectomy for Colorectal 

Cancer

MSKCC-06145 Active Supportive care Over 18 NCI Phase II

Phase I Study of Resveratrol in Patients 

with Resectable Colorectal Cancer 

CCUM-TASK2B Completed Treatment; Biomarker/

Laboratory analysis

Over 18 NCI Phase I

Early Phase I Randomized Study of High 

?-Tocopherol Vitamin E Mixture Supplementation in Patients Undergoing Surgery 

for Colorectal Cancer

CINJ-120901 Active Treatment; Biomarker/

Laboratory analysis

18 and over NCI Phase I

Head/Neck

Phase II Randomized Study of Fruit and 

Vegetable Extracts in Patients with Stage 

I-IVB Head and Neck Cancer

CCCWFU-0112 Closed Treatment 18 and over NCI Phase II

Phase II Randomized Chemoprevention 

Study of Bowman-Birk Inhibitor Concentrate in Patients with Oral Leukoplakia

UCIRVINE-UCI-98-34 Active Treatment; Prevention; 

Biomarker/Laboratory 

analysis

18 and over NCI Phase II

Randomized Pilot Study of Electroacupuncture for Chronic Radiation-Induced 

Xerostomia in Patients with Head and 

Neck Cancer

MAYO-MCS285 Active Supportive care 21 to 89 NCI No phase 

specified

Hematologic

Phase III Randomized Study of American 

Ginseng Extract to Prevent Respiratory Infection and Reduce Antibiotic Use 

in Patients with Chronic Lymphocytic 

Leukemia

CCCWFU-98308 Closed Supportive care 18 and over NCI Phase III

Lung

Phase III Randomized Chemoprevention 

Study of Selenium in Participants with 

Previously Resected Stage I Non-Small 

Cell Lung Cancer

ECOG-5597 Closed Prevention 18 and over NCI Phase III

Phase II Randomized Study of Green 

Tea or Polyphenon E in Preventing Lung 

Cancer in Former Smokers with Chronic 

Obstructive Pulmonary Disease

UARIZ-HSC-0353 Closed Prevention; Biomarker/

Laboratory analysis

40 to 80 NCI Phase II

Phase I Randomized Pilot Study of Dietary 

Flaxseed Supplementation in Patients 

with Locally Advanced or Metastatic 

Non-Small Cell Lung Cancer Undergoing 

Definitive Chemoradiotherapy

UPCC-03309 Active Treatment; Biomarker/

Laboratory analysis

18 and over NCI Phase I

Phase I Study of Beta-Glucan MM-10-

001in Patients with Locally Advanced or 

Metastatic Non-Small Cell Lung Cancer

CHNMC-07243 Active Treatment; Biomarker/Laboratory analysis

18 and over NCI; 

Pharmaceutical/

Industry

Phase I

 APPENDIX 71
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Multiple

Pilot Randomized Study of CognitiveBehavioral Therapy Versus Standard Care 

in Patients with Advanced Gastrointestinal 

Cancer or Lung Cancer

MGH-2007-P-000368 Active Educational/Counseling/

Training; Supportive care

Over 18 NCI No phase 

specified

Pilot Study of Restorative Yoga for Symptom Management and Stress Reduction in 

Women with Ovarian or Breast Cancer

CCCWFU-02403 Closed Supportive care 18 and over NCI No phase 

specified

Non-Cancer/Healthy Volunteers

Phase III Randomized Study of a Psychoeducation, Paced Respiration, and 

Relaxation Intervention for Caregivers 

of Patients Undergoing Bone Marrow 

Transplantation

UCHSC-080303 Active Educational/Counseling/

Training; Supportive care; 

Biomarker/Laboratory analysis

18 and over NCI Phase III

Phase III Randomized Study of the Effects 

of Dietary Soy on Estrogens in Breast 

Fluid, Serum, and Urine Samples from 

Healthy Women

UHM-CHS-4116 Closed Prevention; Biomarker/

Laboratory analysis

30 to 45 NCI Phase III

Phase II Randomized Study of Defined 

Green Tea Catechin Extract in Former or 

Current Heavy Smokers with Abnormal 

Sputum Score

BCCA-H03-61083 Closed Prevention; Biomarker/

Laboratory analysis

45 to 74 NCI Phase II

Phase II Randomized Study of Polyphenon 

E, A Defined Green Tea Catechin Extract, 

in Current or Former Smokers with 

Bronchial Dysplasia

BCCA-H07-02401 Active Prevention; Biomarker/

Laboratory analysis

45 to 74 NCI Phase II

Phase II Randomized Study of Inositol 

for the Prevention of Lung Cancer in 

Current or Former Smokers with 

Bronchial Dysplasia 

MAYO-MAY06-8-01 Active Prevention; Biomarker/

Laboratory analysis

45 to 79 NCI Phase II

Phase I Randomized Study of NutritionalGrade, Absorption-Enhanced Diindolylmethane (BR-DIM) in Healthy Volunteers

KUMC-HSC-9139-3 Completed Biomarker/Laboratory 

analysis; Prevention

18 to 70 NCI Phase I

Phase I Pilot Chemoprevention Study of 

IH636 Grape Seed Proanthocyanidin Extract in Healthy Postmenopausal Women 

at High Risk of Developing Breast Cancer

CHNMC-IRB-03178 Active Prevention 40 to 75 NCI Phase I

Phase I Randomized Study of a New 

Formulation of Bowman-Birk Inhibitor 

Concentrate in Healthy Male Participants 

UPCC-805938 Closed Prevention; Biomarker/

Laboratory analysis

18 to 65 NCI Phase I

Randomized Study of a Patient-Directed 

Lifestyle Change and Health Promotion 

Program Versus Usual Care in 

Low-Income, Uninsured Participants 

in Los Angeles County, California

UCLA-G-060801501A Active Behavioral study; Educational/

Counseling/Training; Health 

services research

18 and over NCI No phase 

specified

72 NCI CAM ANNUAL REPORT 2009
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Non-Cancer/Healthy Volunteers

Pilot Study of Standardized Freeze-Dried 

Table Grape Powder on Plasma Estrogen 

Levels in Postmenopausal Women 

Participating in the Mayo Mammography 

Health Study

MAYO-MC0536 Active Biomarker/Laboratory 

analysis; Prevention

18 and over NCI No phase 

specified

Pilot Study of Art Therapy Intervention 

for Caregivers of Pediatric Patients 

Undergoing Bone Marrow Transplantation 

for Cancer

CHNMC-08028 Active Supportive care 18 and over NCI No phase 

specified

Randomized Study of Fish Oil Supplements and Green Tea Extract in Preventing Prostate Cancer in Patients Who Are 

at Risk for Developing Prostate Cancer

OHSU-CI-CPC04131-LX

Active Prevention 18 and over NCI No phase 

specified

Randomized Study of Lycopene in 

Preventing Prostate Cancer in Healthy 

Participants

UIC-2004-0217 Active Prevention; Biomarker/Laboratory analysis

18 and over NCI No phase 

specified

Non-Specified

Phase III Randomized Study of (Valerian) 

for Improving Sleep in Patients with 

Cancer Receiving Adjuvant Therapy

NCCTG-N01C5 Completed Supportive care 18 and over NCI Phase III

Phase III Randomized Study of Levocarnitine (L-carnitine) for the Management of 

Fatigue in Cancer Patients

ECOG-E4Z02 Completed Supportive care 18 and over NCI Phase III

Phase III Randomized Study of AlphaLipoic Acid in Preventing PlatinumInduced Peripheral Neuropathy in 

Cancer Patients Receiving a Cisplatin- or 

Oxaliplatin-Containing Chemotherapy 

Regimen 

MDA-CCC-0327 Closed Supportive care Not specified NCI Phase III

Phase III Randomized Study of Vitamin 

E in Preventing Chemotherapy-Induced 

Peripheral Neuropathy in Patients Undergoing Curative Neurotoxic Chemotherapy 

for Cancer

NCCTG-N05C3 Closed Supportive care 18 and over NCI Phase III

Phase III Randomized Study of American 

Ginseng (Panax quinquefolius) in Patients 

with Cancer-Related Fatigue

NCCTG-N07C2 Active Supportive care 18 and over NCI Phase III

Phase II/III Randomized Study of Ginger 

for Chemotherapy-Related Nausea in 

Patients with Cancer

URCC-U1902 Closed Supportive care 18 and over NCI Phase II; 

Phase III

Phase II Randomized Study of a Multimedia Program About Massage Therapy for 

Cancer Patients and Their Care Partners

COLLINGE-06-200 Closed Educational/Counseling/

Training; Supportive care

21 and over NCI Phase II

Phase II Randomized Pilot Study of 

Massage Therapy in Patients with 

Cancer Pain 

MSKCC-03046A Closed Supportive care 18 and over NCI Phase II

 APPENDIX 73
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Non-Specified

Phase II Randomized Study of Hatha 

Yoga for Persistent Sleep Disturbance 

in Cancer Survivors

URCC-U3905 Closed Supportive care 21 and over

NCI

Phase II

Pilot Study of Psilocybin in Patients 

with Clinically Significant Depression 

or Anxiety Secondary to Cancer 

JHOC-J0647 Active Supportive care; Biomarker/

Laboratory analysis

21 to 70

NCI

Phase II

Phase I Study of High-Selenium Brassica 

Juncea in Combination with Irinotecan 

Hydrochloride and Capecitabine in Patients with Advanced Malignancies

CHNMC-05122 Active Treatment 18 and over

NCI

Phase I

Pilot, Randomized Study of Mindfulness 

Relaxation Versus Relaxing Music Versus 

Standard Symptom Management Education in Patients with Newly Diagnosed 

Solid Tumors Undergoing Chemotherapy

MDA-CCC-0106 Active Educational/Counseling/Training; Supportive care

18 and over

NCI

No phase 

specified

Randomized Study of Stress Management 

Therapy in Patients Undergoing 

Chemotherapy for Cancer

MCC-0501 Active Educational/Counseling/Training; Supportive care

18 and over

NCI

No phase 

specified

Randomized Study of an L-ArginineBased Nutritional Supplement (ArginMax®) in Female Cancer Survivors

CCCWFU-05-04-01 Active Supportive care Adult

NCI

No phase 

specified

Randomized Study of the Effect of 

Animal-Assisted Therapy and Recreational Therapy on Distress in Cancer Patients 

Undergoing Treatment for Pain

NCI-05-CC-0093 Closed Supportive care; Biomarker/

Laboratory analysis

18 and over

NCI

No phase 

specified

Randomized Study of Magnetic 

Acupressure in Reducing Pain in Cancer 

Patients Undergoing Bone Marrow 

Aspiration and Biopsy

JHOC-J07103 Active Supportive care; Diagnostic 18 and over

NCI

No phase 

specified

Ovary

Randomized Study of Restorative Yoga 

in Patients Undergoing Chemotherapy 

for Ovarian Cancer

CCCWFU-98408 Completed Supportive care 18 and over

NCI

No phase 

specified

Prostate

Phase III Randomized Study of Selenium 

for Prostate Cancer Prevention

UARIZ-99-0045-01 Active Prevention; Biomarker/

Laboratory analysis

Under 80

NCI

Phase III

Phase III Randomized Study of Soy 

Protein/Isoflavones and Venlafaxine on 

Vasomotor Symptoms in Patients with 

Prostate Cancer Undergoing Hormonal 

Manipulation

CCCWFU-97405 Active Supportive care 21 and over

NCI

Phase III

Phase III Randomized Study of Pomegranate Extract in Patients with Rising 

Prostate-Specific Antigen Levels After 

Surgery or Radiotherapy for Localized 

Prostate Cancer

ROLL-GUP-0205-1 Active Treatment 18 and over

NCI; 

Pharmaceutical/

Industry

Phase III

74 NCI CAM ANNUAL REPORT 2009
PDQ Clinical Trials Primary ID Current Status Type of Trial Age Range Sponsor of Trial Phase(s)

Adult Trials

Prostate

Phase II/III Randomized Study of 

Adjuvant Soy Protein Isolate in Preventing 

Recurrence in Patients Who Have 

Undergone Radical Prostatectomy for 

Stage II Prostate Cancer

UIC-2006-0706 Active Treatment; Biomarker/

Laboratory analysis

40 to 75

NCI

Phase II; 

Phase III

Phase II Randomized Study of Selenium 

in Patients with Adenocarcinoma of the 

Prostate

UARIZ-97-0395 Active Treatment; Biomarker/

Laboratory analysis

Under 85

NCI

Phase II

Phase II Randomized Study of Neoadjuvant Dietary Supplementation with Soy in 

Patients Undergoing Radical Prostatectomy for Localized Prostate Cancer

CCCWFU-98203 Closed Treatment; Biomarker/

Laboratory analysis

Over 18

NCI

Phase II

Phase II Study of Neoadjuvant Oral 

Microencapsulated Diindolylmethane in 

Patients with Stage I or II Adenocarcinoma of the Prostate Undergoing Radical 

Prostatectomy

WSU-2007-128 Active Treatment; Biomarker/

Laboratory analysis

18 and over

NCI

Phase II

Early Phase I Randomized Study of 

Vitamin E Supplementation in Patients 

Who Are at Risk for Prostate Cancer or 

Have Prostate Cancer

CINJ-120802 Active Biomarker/Laboratory 

analysis; Prevention

18 and over

NCI

Phase I

Phase I/II Study of the Effects of 

Tomato-Soy Juice on Biomarkers of 

Prostate and Cardiovascular Health in 

Patients with Prostate Cancer 

Undergoing Prostatectomy

OSU-2007C0026 Active Treatment; Biomarker/

Laboratory analysis

Any age

NCI

Phase I; 

Phase II

Phase I Study of Defined Green Tea 

Catechin Extract in Patients with 

Prostate Cancer Scheduled to Undergo 

Prostatectomy

UARIZ-UAZ05-6-01 Active Treatment; Biomarker/

Laboratory analysis

18 and over

NCI

Phase I

Phase I Study of White Button Mushroom 

Extract at Six Different Dose Levels in 

Patients with Biochemically Recurrent, 

Hormone-Naive Prostate Cancer After 

Local Therapy

CHNMC-08012 Active Treatment; Biomarker/

Laboratory analysis

Not specified

NCI

Phase I

 APPENDIX 75
OCCAM ORGANIZATIONAL CHART

NATIONAL CANCER INSTITUTE

DIVISION OF CANCER TREATMENT 

AND DIAGNOSIS

OFFICE OF CANCER COMPLEMENTARY AND 

ALTERNATIVE MEDICINE

RESEARCH DEVELOPMENT AND SUPPORT 

PROGRAM

	 Director

	 Program	Officer

OFFICE OF THE DIRECTOR 

Director

Administrative	Program	Specialist

Office	Assistant

Health	Science	Administrator

Scientific	Program	Analysts

Interns	and	Fellows

COMMUNICATIONS AND OUTREACH PROGRAM

Program	Coordinator

Program	Analyst

Health	Communications	Intern

PRACTICE ASSESSMENT PROGRAM

Director

Program	Coordinator

76 NCI CAM ANNUAL REPORT 2009

NIH Publication No. 11-7646

Printed February 2011