by 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.
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.