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Tag Archives: integrative oncology

A Practical Guide to Cancer and CAM: Melatonin

hayleyerdmanby Dr. Hayley Erdman B.Sc (Hons), ND

 

Finding credible information about how to incorporate complementary and alternative medicine (CAM) can be overwhelming for patients and caregivers, particularly after a cancer diagnosis. The perceived stakes are higher compared to the average healthcare consumer and the questions are many:

 

Will this supplement interfere with chemotherapy or radiation treatment?

Will this natural substance reduce or increase my chance of recurrence? Will it be beneficial or detrimental to my overall survival?

What does the research say about this CAM therapy and does it apply to me?

Do we know how this substance works in the body?

 

Helping individuals with a cancer history to navigate the complex and often conflicting opinions of CAM is vital. As a naturopathic doctor, my role is to educate patients regarding the benefits and risks of these therapies in the context of the best available evidence, allowing them to make more informed choices when combining natural supportive therapies and conventional medical treatment. Through this series of articles, I hope to provide a basic understanding of some of the most commonly suggested supplements used for cancer support, making the evidence more accessible and providing a starting point for those looking to start a conversation with their medical team about the addition of CAM therapies to their oncology care plan.

 

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Cancer Survivorship – a role for integrative medicine in the new ‘epidemic’

hayleyerdmanby Dr. Hayley Erdman B.Sc (Hons), ND

 

Now, more than ever, there is a growing group of people who are living longer after their cancer diagnosis. According to the Canadian Cancer Society, between 1992-1994 and 2006-2008, 5-year survival rates increased from 56% to 63% for all cancers combined. This may be due to advances in detection, early treatment, and the development of novel medical therapies. Whatever the reason, this inspires hope for those of us with loved ones dealing with the challenges that come with a cancer diagnosis. If you have lived through a cancer experience, this is an exciting time – you are truly part of a growing epidemic of cancer survivorship. The goal is to maintain this momentum and to help all survivors to live long and full lives.

 

The flipside of this swell in survivorship is that it requires an examination of the health challenges that remain after the dust settles from the acute treatment phase. The therapies used to achieve remission and, hopefully, a cure, are unfortunately not benign. The stress that comes along with a cancer diagnosis, and the upheaval to one’s life can take its toll on a patient’s mental and emotional wellbeing. By talking about the challenges that can arise as a result of cancer and its treatment, patients and families can be better prepared to face them and can even take steps to proactively reduce the risk of development or progression of many of these chronic health concerns, termed long-term and late effects.

 

Long term effects are conditions that develop during active chemotherapy, radiation or as a result of surgery and persist for a period of time after therapy is completed. Examples include pain, fatigue, neuropathies (numbness, tingling or pain associated with nerve injury), lymphedema, cognitive difficulties (brain fog), mental health concerns like anxiety or depression, early menopausal symptoms, erectile dysfunction or loss of libido, and significant weight gain or loss.

 

Late effects are concerns that develop months or years after the completion of active treatment, which can include cardiovascular complications (e.g. heart failure, valvular dysfunction), hypothyroidism, diabetes, metabolic syndrome and secondary cancers. Many of the long-term effects can manifest as late effects if they appear after active treatment is complete.

 

If the healthcare needs of the growing population of cancer survivors are to be met, our understanding of these lingering health concerns must continue to develop. How can we better identify individuals at risk for certain long-term and late effects? Are these conditions directly attributable to cancer and its treatment, or do they simply have risk factors in common with cancer initiation and progression? The formulation of more effective therapies and prevention strategies is dependent on additional research and a willingness to integrate existing best practices from a variety of healthcare disciplines.

 

Proactive, integrative cancer survivorship: Filling an unmet need

Upon completion of primary cancer therapy, follow-up care often comprises regular, albeit less frequent appointments with the treating oncologist for recurrence monitoring. Additional institutional resources, like social workers, dieticians and nurses continue to be available to the patient to assist in managing late and long-term effects as they arise. Is there room for growth in this existing framework of cancer survivorship care?

 

With genetic predisposition implicated only in an estimated 10% of cancer cases, the risk factors associated with cancer initiation and progression are overwhelmingly lifestyle related, such as smoking, fried food and red meat consumption, alcohol use, stress, infection, obesity and physical inactivity (Anand, 2008). If not identified and controlled, these factors can continue to impact a cancer survivor’s risk of recurrence and can play a role in the severity and development of many long-term and late effects discussed above. A patient’s relationship with their hospital-based care team in the cancer survivorship phase is too sporadic and the acute nature of general practitioner care in the community does not lend itself to the dissemination of health-promotion strategies to mitigate risk. Lifestyle changes require frequent, repetitive contact and support, with the goal of providing ongoing motivation and management of setbacks and obstacles to change. I propose that the model of naturopathic medicine, in which disease prevention is emphasized and longer appointments allow for an exploration of the mental, physical and emotional aspects of wellness, is uniquely placed to fill this gap in care. Naturopathic doctors empower patients in the adoption of foundational therapies like diet and lifestyle counselling, and incorporate health-behaviour changes with supportive evidence-based therapies like nutritional supplementation, herbal medicine and acupuncture, making them valuable additions to the group of health professionals that work to support cancer survivors.

 

Critics of integrative therapies in oncology cite a lack of quality research supporting their use and related patient safety concerns. Although the design and funding of high quality trials for naturopathic care is an area that requires growth, evidence supporting the beneficial role of naturopathic medicine as an adjunct to standard medical care in chronic disease management and risk reduction already exists in the literature, particularly in the areas of cardiovascular disease and anxiety (Seely 2013, Cooley 2009). The measures used in these studies were low in risk and could be safely applied to cancer survivors facing similar concerns. These studies could serve as a touchstone from which future trials are planned to determine the value of routinely adding integrative therapies into cancer survivorship care. With regard to patient safety, naturopathic doctors are trained to devote particular attention to the pharmacokinetics and the mechanism of action of all substances a patient is receiving to prevent interactions from occurring between drugs and supplements or herbs. By improving inter-professional communication, awareness of the growing body of evidence supporting naturopathic modalities in chronic disease management and the safety considerations made by naturopathic doctors, collaborative care and proactive management of the epidemic of cancer survivorship could become an increasing reality.

 


 

 

References:

Anand P, Kunnumakara AB, Sundaram C et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharm Res. 2008 Sep;25(9):2097-2116

Cooley K, Szczurko O, Perri D et al. Naturopathic care for anxiety: a randomized controlled trial. PLoS One. 2009 Aug 31;4(8):e6628

Seely D, Szczurko O, Cooley K et al. Naturopathic Medicine for the prevention of cardiovascular disease: a randomized clinical trial. CMAJ. 2013 Jun 11; 185(9):E409-E416

Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long term and late effects of cancer. Cancer 1 June 2008. 112(S11):2577-2592

Sussman J, Souter LH, Grunfeld E et al. Model of care for Cancer Survivorship. Cancer Care Ontario. 2012 Oct 26. https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=258053

 


 

 

Dr. Hayley Erdman B.Sc (Hons), ND is a naturopathic doctor at Durham Natural Health Centre in Pickering, Ontario. Dr. Erdman has a passion for integrative oncology and cancer survivorship care. She provides evidence-based natural therapies to improve side effect management and to help patients in re-establishing their physical and emotional health after conventional cancer treatment is completed. She welcomes inter-professional collaboration and aims to open dialogue between health professions, with the goal of improving patient outcomes. She is a registrant in good standing with the College of Naturopaths of Ontario, a member of the Ontario Association of Naturopathic Doctors and the Canadian Association of Naturopathic Doctors and regularly updates her skills and oncology-related knowledge as a member of the Oncology Association of Naturopathic Physicians.

 


 

Complementary Anti-Cancer Therapies: 10 Things you need to know

StevenSagarAfter reading the National Post article entitled: “Cancer patients are losing valuable time — and risking their lives — with alternative therapies, doctors say“, we wanted to weigh in with some practical guidelines about safe complementary cancer treatment.  Our Integrative Oncology Editor, Dr. Stephen Sagar has these comments:

 


 

Following a National Post article on patients foregoing medical treatment to treat cancer, I have provided some guidelines:

  1. Seeking options is an intelligent choice, but selection of a management program requires a critical cognitive evaluation of credibility and evidence. Use thoroughly researched web sites such as at the Mayo Clinic, MD Anderson Cancer Center, and Sloan Kettering Cancer Center. They provide evidence based information on anti-cancer treatments, complementary therapies that alleviate some adverse effects, and other supportive care options.
  2. You should determine your personal goals that include cure, appropriate palliation, and quality of life. Beware spending time and money on futile choices.
  3. The structure of your management plan should be determined after a thorough discussion with an MD oncologist. You may be helped by referral for educational and psychological counseling. Most comprehensive cancer centres provide these opportunities. Mood disorders and acute stress can cloud the ability to make rational decisions. Make sure that you take some time to gather your thoughts and emotions. Seek a personal mentor and advocate, and appoint your own “Board” of advisers.
  4. An alternative practitioner who calls him/herself an oncologist is being deceptive. A physician oncologist has often had 12 years of training, including hospital medicine and research. He/she is certified and regulated by bodies with extremely high ethical and behavioural standards. Most oncologists have hospital privileges and university appointments, which means that they are rigorously and continually evaluated. Unfortunately, even government regulation does not protect you from receiving bogus treatments from unscrupulous alternative practitioners.
  5. If it sounds too good to be true, promises cure, no side effects, is widely advertised through the Internet and television infomercials, is branded with pseudoscience, plus not backed by quality clinical evidence, it is likely to be a bogus treatment.
  6. Practically no herbs or supplements cure cancer. IV therapies, routine enemas, and juicing are neither natural nor show any evidence that they help cure cancer. Occasionally, hydration and vitamin supplements may be indicated and can be administered at your cancer centre.
  7. There is no conspiracy by the pharmaceutical industry. Physicians, unlike alternative practitioners, cannot be affiliated with pharmaceutical products. If physicians are part of a pharmaceutical research program, they must declare that fact. There is a multi-billion dollar natural health product industry which is poorly regulated and often does not have to prove efficacy through clinical trials. Many alternative practitioners profit from selling these products. Paying for a product can induce a cognitive dissonance that it must work. Be wary and critical of cognitive distortions that effect the most intelligent of people.
  8. Some complementary therapies alleviate side effects of cancer and its treatment. These include psychological therapies, including yoga and meditation, sleep hygiene, exercise, nutrition with whole foods, and some select evidence based physical therapies, such as massage and acupuncture. Most of these are available in your cancer centre or through local patient support groups such as Wellspring.
  9. Discuss your values and fears with your oncologist. Make another appointment for further counseling. Make sure that you have a compassionate relationship. The oncology team includes expert nurses, dietitians, psychology counselors, and many others who are there to serve your needs. If you are still unsatisfied, seek another opinion from an MD oncologist. Your relationship with your physician may be dependent on mutual personalities, so make sure that you are comfortable and have an honest relationship.
  10. Receiving anti-cancer treatment can be a frightening and stressful experience. The oncology team is here to help you physically, psychologically, and spiritually. If you follow these guidelines, it should not be necessary to seek alternative medicine for the treatment of your cancer.

 


 

Cancer Related Fatigue: How Integrative Therapies Can Help

fatigueby Kira Taniguchi, MA, Coordinator, Department Publications and Lorenzo Cohen, Ph.D., Professor and Director, Integrative Medicine Program, The University of Texas MD Anderson Cancer Center

Did you know fatigue is the most common side effect of cancer treatment? Research suggests that most people receiving cancer treatment experience some type of fatigue.[i] In fact, between 60 and 90 percent of patients at The University of Texas MD Anderson Cancer Center have fatigue.

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Cancer Narratives: Complementary Cancer Treatments – How a Holistic Approach Has Changed My Life

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Using scientific research as a springboard for discussion, CKN is distilling this research into practical narratives that will improve the quality of life for patients and offer deeper understanding and connection for physicians.  Please join this Doctor-Patient conversation about Complementary Cancer Therapy.

 


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Recipes for Health: The Science of Epigenetic Nutritional Oncology

NutritionalOncologyby Stephen. M. Sagar MD, Professor of Oncology, McMaster University, Juravinski Cancer Centre, CKN Integrative Oncology Editor

 

The term epigenetics refers to modifications made on genetic material that change ways in which genes are switched on and off, but don’t alter the underlying genes. This means that our fate is not entirely predetermined from the genes received from our parents, but can be modified by the environment.

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