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Complementary therapies are adjuncts to mainstream care, used primarily for symptom control and to enhance physical and emotional strength during and after mainstream cancer treatment. These therapies are rational, noninvasive and evidence-based that have been subjected to study to determine their value, document the problems they aim to ameliorate and define the circumstances under which they are beneficial. By contrast, 'alternative' therapies are generally promoted as such-for use as actual antitumour treatments. Typically they lack biological plausibility and scientific evidence of safety and efficacy, and many are outright fraudulent. Combining the helpful complementary therapies with mainstream oncology care to address patients' physical, psychological and spiritual needs constitutes the practice of integrative oncology. By providing patients' nonpharmacological treatment modalities that reduce symptom burden and improve quality of life, physicians enable patients to have an active role in their care, which in turn improves the physician-patient relationship, the quality of cancer care and the well-being of patients and their families.

A well-informed oncologist can guide patients to use complementary treatments to maximize benefits and minimize the risk of harm. Patients need help to steer away from problematic alternatives that are worthless or dangerous. We want to help patients receive beneficial complementary modalities because they extend supportive care, and we certainly want to know more than most of us now do about herb-drug interactions.

The Gerson regimen, developed by Max Gerson in the 1930s, is promoted as an alternative cancer treatment. It involves consuming fresh, raw fruit and vegetable juices, eliminating salt from the diet, taking supplements such as potassium, vitamin B12, thyroid hormone, pancreatic enzymes, and detoxifying liver with coffee enemas to stimulate metabolism. Gerson therapy is based on the theory that cancer is caused by alteration of cell metabolism by toxic environmental substances and processed food, which changes its sodium and potassium content. It emphasizes increasing potassium intake and minimizing sodium consumption in an effort to correct the electrolyte imbalance, repair tissue, and detoxify the liver. The coffee enemas are believed to cause dilation of bile ducts and excretion of toxic breakdown products by the liver and through the colon wall. None of these theories has been substantiated by scientific research. Despite proponents' claims of recovery rates as high as 70% to 90%, case reviews by the National Cancer Institute (NCI) and the New York County Medical Society found no evidence of usefulness for the Gerson diet. An NCI-sponsored study of Gonzalez therapy, which is similar to the Gerson diet, showed that patients with inoperable pancreatic adenocarcinoma who underwent standard chemotherapy with gemcitabine (Gemzar) survived three times longer and had better quality of life than those who chose enzyme treatment, which included pancreatic enzymes, nutritional supplements, detoxification, and an organic diet.

Oxygen therapies are unproven alternatives promoted as a cure for cancer, acquired immune deficiency syndrome (AIDS), and other degenerative diseases. These "therapies" are offered at clinics in Mexico, the United States, and Europe. Proponents claim that many diseases, including cancer, are caused by oxygen deficiency and that oxygenation can restore health by destroying cancer cells, eliminating pathogens, stimulating metabolism, and by producing "oxidative detoxification." There is no scientific evidence to support any of these claims. Oxygen therapies include: (1) hydrogen peroxide therapy involving intravenous infusion, ingestion, colonic administration, or soaking in hydrogen peroxide solution; (2) ozone colonies and ozone autohemotherapy, in which blood is withdrawn and treated with ozone before reinfusion, and (3) "oxygenated" water, pills, and solutions. The use of oxygen therapies has resulted in serious adverse events and several deaths. Oxygen therapies should not be confused with those commonly used in respiratory care.

Graviola demonstrated anticancer effects in vitro, but has not been studied in humans. Despite the lack of human data, many websites promote graviola to cancer patients based on traditional use and on the in vitro studies. Caution is required as there is no evidence of safety or efficacy.