Integrating Cancer Care
Integrating Cancer Care
Integrative medicine is gaining ground to enhance cancer treatment as well as aid in cancer prevention. Cancer treatments such as chemotherapy, radiation therapy and surgery are combined with integrative oncology services to aggressively treat all types of cancer.
Cheryl Myers, RN, is chief of scientific affairs and education for Wisconsin-based EuroPharma, Inc., makers of the EuroMedica brand of dietary supplements and natural medicines. She has past certifications in oncology and gerontology, and has worked in inpatient cancer treatment and as a pain control specialist in hospice care. She volunteers to provide individual and family counseling on health and endof- life care.
Here she discusses natural medicine and cancer care with Natural Practitioner (NP).
NP: When and why do cancer patients seek alternative care?
Myers: First, I do not use the term “alternative care.” Natural medicine and other health practices are not an alternative.Alternative also sounds like the lesser of two options. Most patients do not pick one intervention at the exclusion of the other.The best chance for optimal cancer outcomes happen when a selection of validated modalities is overseen by a knowledgeable health professional and integrated into a comprehensive plan of care. For one patient, it may be a combination of diet, surgery, walking the dog, and supplements.For another, it may be massage, prescription drugs, IV vitamin C and prayer. I believe that as long as an intervention promotes healing, it should be respected as medicine. That is why I prefer the term “integrative” medicine.
As for when patients seek this care, some individuals are already utilizing natural medicine at the time of a cancer diagnosis, so it makes sense that they would continue to incorporate natural medicine practices into their care. However, the majority of patients seek integrative healthcare because they are not getting the results they desire with mainstream cancer care. Perhaps their symptoms are not controlled, or they have been told their cancer is incurable. Sadly, many people who turn to interventions outside the usual mainstream care are doing so out of pain or fear.
NP: How should practitioners discuss cancer with their patients to fully understand their needs?
Myers: First, cancer is not a singular diagnosis, and this multifaceted disease presents itself differently in every patient.Therefore, the best practitioners have long discussions with their patients to better understand the strengths and challenges.The art of the H&P (history and physical) is diminishing in mainstream medicine as financial pressures continue to shorten the time a practitioner can spend with a patient.
While it is important to be as factual as possible, one has to constantly monitor the patient’s response to these facts and their ability to listen. Anxiety creates huge barriers to attention. I always ask patients to bring a trusted person along to their appointment, to write down their questions in advance and to take notes during the discussion of diagnosis and treatment options. I also make sure patients leave with a phone number to call to ask additional questions, and at least one piece of printed material to which he or she can refer.
From a psychological standpoint, practitioners need to sit down with their patients, especially when discussing potentially devastating news. Working in a hospital in the past, I have seen practitioners deliver terrible news while standing above the patient,Who was either seated or reclining. Sitting down, making eye contact, all show that you are present with them at this terrible time, and lets them know you will fight cancer together—as a team. They are not alone.
NP: What are the common natural treatments?
Myers: There are many natural treatments used with cancer patients. Some of the most common I have seen are special diets, supplements/natural medicines, acupuncture, and intravenous therapy (IV) often with high dose vitamin C or glutathione.
Given the field in which I work, I have the most exposure to supplements/natural medicines. The most potently anti-cancer herb I have seen investigated to date is curcumin, an extract of the herb turmeric. Our company uses a special form of curcumin in our products called BCM-95 Curcumin.It is a blend of curcumin and turmeric essential oil, is up to 10 times better absorbed than plain curcumin, and has 15 studies published on its use so far. Other supplements that can be useful are boswellia, coenzyme Q10 (I prefer the ubiquinol form), animal-based, broad-spectrum enzymes, highly standardized milk thistle and TOA-free cat’s claw, to name a few. Certain mushrooms and products of fermentation processes can also be part of a cancer care/health protocol. There are almost too many to mention. My first question with any supplement for people with cancer is to see if it has published studies.
NP: How are CAM treatments integrated with traditional Western methods?
Myers: Sometimes CAM and mainstream treatments are very badly integrated, sometimes with deleterious effects, because patients are using a variety of interventions without sharing that with their primary cancer care provider. I understand why they don’t share, but this still sets up a very unfortunate situation.
Integration of CAM and mainstream treatments is an area in which the natural practitioner can shine. There are many factors to consider when weaving together a plan of care that combines interventions from the natural and mainstream medical world. I am asked almost every day about potential nutrient drug interactions, concomitant use of natural medicine with chemo/radiotherapies, and prioritizing interventions when cost is an issue.
For example, there is science that demonstrates that curcumin increases the efficacy of both chemotherapy and radiation therapy with a few chemo exceptions based on theoretical concerns. We need practitioners who know which chemos might not benefit from adding curcumin to the plan of care,and which would be of great benefit. We need practitioners who are lifelong students, who continue to learn and evolve their care.
Health care providers with a passion for cancer care are much in demand to help guide the patient through the maze of natural and conventional options with intelligence and compassion. Integrated care can greatly improve recovery, survival and quality of life.
NP: What should patients and practitioners avoid during cancer care?
Myers: Patients should avoid working with a primary health care provider with whom they cannot be honest. The best outcomes occur when everyone on the team communicates and is pulling in the same direction.
Patients should avoid caregivers who discourage their questions or rush them through their visit. They should also be cautious of caregivers and/or practitioners who tell them what to do with no discussion or options. There is a big difference between the doc who says, “You will start chemo this Thursday” and the more reasonable, “Let’s discuss the pros and cons of chemotherapy.”
Patients should be cautious and ask for concrete reasons if they are told any intervention has to happen immediately without giving them time to consider the options and/or discuss with their family or other circle of caregivers.Patients should avoid any practitioner or product that is guaranteed to cure their cancer, that contains a secret ingredient, that makes claims that the U.S. health care system doesn’t want cancer cured and ran them out of the United States so now the patient must travel to XYZ and pay enormous amounts of money for this cancer cure, and/or who tells the patient they must not tell anyone in health care about their intervention. There are all too many predators out there preying on people who are desperate and afraid. I have heard heartbreaking stories of “guaranteed cancer cures” that cause patients and families enormous financial damage and grief.
Practitioners should avoid assumptions.It is easy to believe that because the last six cases of breast cancer responded well to a certain nutrient intervention, the seventh case will behave the same way.
NP: Please discuss recovery time and results. What are the challenges and opportunities?
Myers: I have seen many travesties of medical care. I have seen 90-plus-year-old men subjected to surgery for slow-growing prostate tumors, mastectomies for benign tumors, MRIs on hospice patients with less than two weeks to live, chemotherapy used indiscriminately in people whose health or age makes them poor candidates.
Sometimes practitioners feel ineffective if they do not offer treatment at any cost, and sometimes patients demand interventions that are completely impractical in their situation.This is a challenge—how to create realistic expectations.
The research is out there. Inserting validated natural therapies into our current mainstream paradigm remains both an enormous challenge and an opportunity.With continued pressure to integrate the best of CAM with mainstream interventions, we can promote more effective and sane cancer care.
NP: What studies/reports are you interested in regarding alternative cancer care?
Myers: I am fortunate to be in a position to know what research is recently published and what is in process for a variety of interventions.There is a study in development at Jewish General Hospital in Montreal, Quebec (Canada) to examine the effects of BCM-95 Curcumin in patients with lung cancer. Three arms are planned: BCM-95 Curcumin alone, Tarceva (a type of chemotherapy) alone, and BCM-95 Curcumin with Tarceva. That will be a very interesting study and I hope the results will give us further guidance on best integrative medicine practices.
Can Integrative Oncology Extend Life in Advanced Disease?
Integrative oncology might be helping to extend the lives of patients with advanced cancer, research indicates.
According to an article published in Medscape Medical News, although the outcomes data are far from conclusive, they are nevertheless interesting and promising. However, controlled studies are needed.
To date, the survival data compare favorably with national and regional statistics, said Leanna Standish, PhD, ND, Lac, from the School of Public Health at the University of Washington and the Bastyr University Integrative Oncology Research Center (BIORC), both in Seattle, WA.
However, the comparative use of publicly available survival datasets is limited, and a prospective matched controlled study is needed to determine the cause of the apparent survival benefit.
Dr. Standish presented the data at the 10th International Conference of the Society for Integrative Oncology. She emphasized, “I am just reporting the data we have;” they are not from a randomized trial.
Standish’s team gathered preliminary survival data to answer the most common patient questions: “How long am I going to live and what is my quality of life going to be?”
The BIORC opened in 2009, after receiving a $50,000 grant from a man whose wife had died from breast cancer who wanted to see if there was a better way to treat the disease. To date, 521 cancer patients have been enrolled in a prospective consecutive case series that involves all disease stages, including ductal carcinoma in situ, Dr. Standish reported.
The most common types of cancers seen at BIORC are breast cancer, lung, colon, pancreatic, brain, and Merkel cell carcinoma, which is a highly aggressive skin cancer. About 30 percent of the patients have stage IV disease.
Limited Comparison Data
One of the major challenges in doing a prospective consecutive case series is finding the right comparison data Dr. Standish said. “The Seattle Cancer Care Alliance, which is just next door, has outcomes online for all the major types of cancer, so we have been matching our outcomes with their data.”
But the problem with those data, even though they were collected in the same city, is that they date from 1998 to 2002.The SEER (Surveillance, Epidemiology, and End Results Program) data are also out of date, Dr. Standish pointed out. “In fact, every kind of cancer registry that you can find is out of date.”
Encouraging Stats
Since 2009, the BIORC has treated eight patients with stage IV colon cancer. Three years after the initiation of their care, 80 percent were still alive; only 15 percent of Seattle Cancer Care patients in this group were alive at three years.
Of the 12 consecutive patients with stage IV lung cancer treated at BIORC, 64 percent were still alive at three years. This compares favorably with the 15 percent reported by Seattle Cancer Care and the 3 percent reported by SEER.
To calculate median survival, you have to wait until 50 percent of your patients have died, Dr. Standish explained. “We haven’t lost 50 percent of our patients, so we can’t calculate it. Even though the Seattle data are old, the comparison is interesting.”
However, at this point, it is unclear whether “these are just special people or it’s something we are doing,” she added.
The BIORC has treated 12 patients with stage IV ovarian cancer. Median survival is two years, which is about the same as reported in the published data.”But I am encouraged that our four- and five-year survival will be better,” she noted. “In the literature, the highest survival at five years is 18 percent.”
Advice for Health
Lise Alschuler, ND, FABNO is the author of The Definitive Guide to Thriving After Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. A naturopathic doctor with advanced training in caring for cancer patients, Dr. Alschuler herself had breast cancer and used an integrative approach to treat it.
In an interview with Better Nutrition magazine, Dr. Alschuler narrowed down five favorite pieces of advice for reducing the risk of cancer:
1. Eat a colorful diet. When there’s a rainbow of naturally occurring colors on your plate for every meal, you’re eating foods with a broad array of cancer-fighting compounds.
2. Exercise outdoors. Exercising for at least 30 minutes every single day lowers the risk of developing almost all cancers and improves the survival rates of people who have already been diagnosed with cancer. Exercising outdoors is even more beneficial, with greater impacts on the immune system and on stress reduction.
3. Laugh and experience joy. Laughter, especially joyful laughter, increases the activity of natural killer cells, one of our most powerful weapons against cancer.
4. Supplement your diet with targeted nutrients. Diet is foundational to prevention, but there are nutrients that can be concentrated into dietary supplements to augment the anticancer effects of diet.
5. Live with integrity. Being true to ourselves and our deepest sense of purpose in community with those we love is the endall and be-all of cancer prevention.
Healthy Take Aways
• The best chance for optimal cancer outcomes happen when a selection of validated modalities is overseen by a knowledgeable health professional and integrated into a comprehensive plan of care.
• From a psychological standpoint, practitioners need to sit down with their patients, especially when discussing potentially devastating news.
• Supplements useful for integrative cancer care include curcumin and turmeric essential oil, boswellia, coenzyme Q10, animal- based, broad-spectrum enzymes, highly standardized milk thistle and TOA-free cat’s claw.
FOR MORE INFORMATION:
Bastyr, (425) 602-3000, www.bastyr.edu
EuroMedica, (866) 842-7256, www.euromedicausa.com
Medscape Medical News, www.medscape.com
