Integrative cancer care treats the disease with surgery, chemotherapy and other conventional tools, while also supporting a patient’s strengths, stamina and quality of life with evidence-informed complementary approaches such as diet, targeted supplements, and mind-body approaches.
Source: BCCT
Treating Cancer with Integrative Medicine
Dr. Andrew Weil is the world’s leading proponent of integrative medicine, a philosophy that is considerably different from a blanket endorsement of alternative medicine.
To fully understand Dr. Weil’s advice – presented in his website, bestselling books and lectures, and reflected in the daily practice of thousands of physicians worldwide (thanks to the in-depth training acquired at the Andrew Weil Center For Integrative Medicine at the University Of Arizona in Tucson) – it is important to grasp what integrative medicine is, and is not.
The first step is mastering some basic terms. Using synthetic drugs and surgery to treat health conditions was known just a few decades ago as, simply, “medicine.” Today, this system is increasingly being termed “conventional medicine.” This is the kind of medicine most Americans still encounter in hospitals and clinics. Often both expensive and invasive, it is also very good at some things; for example, handling emergency conditions such as massive injury or a life-threatening stroke. Dr. Weil is unstinting in his appreciation for conventional medicine’s strengths. “If I were hit by a bus,” he says, “I’d want to be taken immediately to a high-tech emergency room.” Some conventional medicine is scientifically validated, some is not.
- Watch Dr. Weil discuss the advantages of integrative medicine.
Any therapy that is typically excluded by conventional medicine, and that patients use instead of conventional medicine, is known as “alternative medicine.” It is a catch-all term that includes hundreds of old and new practices ranging from acupuncture to homeopathy to iridology. Generally alternative therapies are closer to nature, cheaper, and less invasive than conventional therapies, although there are exceptions. Some alternative therapies are scientifically validated, some are not. An alternative medicine practice that is used in conjunction with a conventional one is known as a “complementary” medicine. Example: using ginger syrup to prevent nausea during chemotherapy. Together, complementary and alternative medicines are often referred to by the acronym CAM.
Enter integrative medicine. As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine “combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.”
In other words, integrative medicine “cherry picks” the very best, scientifically-validated therapies from both conventional and CAM systems. In his New York Times review of Dr. Weil’s latest book, Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being, Abraham Verghese, M.D. summed up this orientation well, stating that Dr. Weil, “doesn’t seem wedded to a particular dogma, Western or Eastern, only to the get-the-patient-better philosophy.”
So this is a basic definition of Integrative Medicine. What follows is the complete one, which serves to guide both Dr. Weil’s work and that of integrative medicine physicians and teachers around the world:
Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.
The principles of integrative medicine:
- A partnership between patient and practitioner in the healing process
- Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response
- Consideration of all factors that influence health, wellness, and disease, including mind, spirit, and community as well as body
- A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
- Recognition that good medicine should be based in good science, be inquiry-driven, and be open to new paradigms
- Use of natural, effective, less-invasive interventions whenever possible
- Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
- Training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development.
Dr. Andrew Weil and Donald I. Abrams, M.D., the former Director of Clinical Programs at the University of California, San Francisco Osher Center for Integrative Medicine, assembled a team of experts to assess what the emerging field of integrative oncology has to offer cancer patients.
Published by Oxford University Press, Integrative Oncology is aimed at health professionals but can be understood by cancer patients and their families as well as by health-conscious individuals concerned with cancer prevention. The book is the first in a planned series on integrative medicine’s role in various medical specialties including psychiatry, rheumatology, asthma, and immunology, pediatrics, women’s health, and others.
Dr. Abrams talks about his practice of integrative oncology and how integrative medicine can enhance cancer treatment.
What role does integrative medicine (IM) play in cancer treatment?
The field of oncology (cancer treatment) is fairly new but has exploded in recent years and has become more and more specialized. A patient may need a surgical oncologist to remove a tumor, a radiation oncologist for radiation therapy, and a medical oncologist to provide chemotherapy, hormone therapy, and targeted cancer therapy (drugs that block cancer spread). Some oncologists now specialize in treating only certain types of cancer, such as colorectal or pancreatic. This increasing specialization benefits patients in that they get care from physicians who are experts in their specific disease but, in the process, the specialist may tend to see only the tumor and not the patient. Integrative oncology looks at the whole patient, body, mind, and spirit.
I tell my patients that I think of cancer as a weed. Modern western oncology is focused on destroying the weed while integrative oncology concentrates on the soil the weed grows in and on making the soil as inhospitable as possible to the growth and spread of the weed.
We also recognize that many cancer patients are people who have been highly functional and in control of their lives. A cancer diagnosis takes away that control and puts them at the mercy of doctors. In my practice, I try to return to the patient some sense of control by giving them things they can do to take their lives back into their own hands. At the same time, I am also trying to decrease ongoing inflammation in the body, which is at the root of many chronic diseases, and to enlist the body’s innate immunity to fight against the cancer as well as decreasing stress and increasing hope.
Are there dietary changes that can help patients fight cancer?
The one thing we know for sure about diet is that obesity increases the risk of a number of different types of cancer.
With hormonally driven cancers (such as breast cancer), obese patients have a worse prognosis than those with a healthy body mass index. So it is important for some patients to improve their nutritional status and decrease their weight. The most useful strategy is to eat a plant-based diet focusing on a wide variety of colored fruits and vegetables. Cruciferous vegetables such as broccoli, cauliflower, and cabbage contain a cancer-preventing compound so potent that is being investigated as a chemotherapy agent. Berries are rich in beneficial phytonutrients and antioxidants. Overall, a diet that emphasizes fruits and vegetables, whole grains, nuts, and cold water fish that provide omega-3 fatty acids (fish eaters have a reduced risk of cancer) is the best nutritional strategy.
At the same time, we recommend decreasing your intake of animal fats in general and red meat and dairy products in particular to control cancer-promoting inflammation in the body. I personally believe that refined sugar and carbohydrates are not beneficial for individuals living with cancer because of their effect on insulin production and insulin-like growth factors, which promote inflammation and are also associated with cancer cell division.
I appreciate the fact that organic fruits and vegetables are expensive, but they are the best choices for cancer patients, not just because they are grown without pesticides and other agricultural chemicals but because plants grown outdoors organically need to protect themselves from other plants, predators (insects, birds and animals) and the sun. Organically grown plants do this by producing more intense protective chemicals, known as phytonutrients, which are beneficial to us.
I also recommend seasoning food with ginger, garlic, onions, turmeric, drinking green tea, all of which have anti-inflammatory effects. If you drink alcohol, stick to red wine. Excessive alcohol consumption is a cancer risk. Men who drink alcohol should limit themselves to a maximum of two drinks daily and women to a maximum of one. For women at risk for breast cancer, one drink a week is safest.
What about IM strategies to counter the side effects of conventional cancer treatment?
I refer my patients to Traditional Chinese Medicine practitioners on the staff at the Osher Center. I believe that cancer patients treated concurrently with acupuncture tend to do better. In fact, the National Institutes of Health had a consensus conference on acupuncture in 1997 and found that it was useful in treating side effects of chemotherapy, including chemotherapy associated nausea and vomiting. I think it may also be useful for increasing energy, decreasing dry mouth, and relieving hormonally-induced hot flashes.
Traditional Chinese Medicine is all about expelling evil and supporting good. Modern western medicine is mainly about expelling evil. I think my role as an integrative oncologist is to support the good as well as expelling the evil.
You wrote about the uses of medical cannabis in cancer treatment and prevention. What role do you see it playing in the future?
I have been an oncologist for almost 30 years so my career has spanned the yin and yang of society’s acceptance and rejection of cannabis for medical purposes. We know that cannabis is useful for treating nausea, appetite loss, pain, and insomnia that can be side-effects of chemotherapy or cancer itself. We now also appreciate that some components of cannabis may have significant anti-cancer effects. I wrote a chapter on cannabinoids and cancer in integrative oncology with Manuel Guzman, a Professor of Biochemistry and Molecular Biology in Spain who has done a lot of work in this area. Researchers are now looking at the impact of cannabinoids on cancer. I wouldn’t be surprised to see an impact on treatment.
Tell us about the importance of mind/body approaches in cancer treatment.
These approaches are vital. Patients have lost a sense of control and their bodies have been assaulted with chemotherapy and radiation. Learning mind body techniques – guided imagery, hypnosis, mindfulness, stress reduction, yoga, T’ai chi – helps decrease stress. Many people blame the stress in their lives for the development of cancer. I don’t think stress in and of itself is enough to cause cancer, but it does affect production of hormones such as epinephrine and cortisol that can depress the immune system. So, overall, stress may lead to an increased risk that cancer will spread and to shorter survival. It has been shown that women with ovarian cancer who lack a good support system have more distress and more aggressive malignancies, and this is just one example of a psychological association and a biological marker for more aggressive disease.
Let’s talk about prevention and lowering cancer risk. What are the basic tenets of integrative medicine (IM) in cancer prevention?
IM dietary recommendations for cancer prevention are much the same as they are for individuals being treated for cancer – consume a plant-based diet focusing on an array of fruits and vegetables of different colors. Cruciferous vegetables such as broccoli, cauliflower, and cabbage contain a cancer-preventing compound so potent that is being investigated as a chemotherapy agent. Eat berries for their beneficial phytonutrients and antioxidants. Emphasizing fruits and vegetables, whole grains, nuts, cold water fish that provide omega-3 fatty acids (fish eaters have a reduced risk of cancer) is the best nutritional strategy.
At the same time, you should reduce your intake of animal fats in general and red meat and dairy products in particular – this could help control any cancer-promoting inflammation in the body. Stay away from refined sugar and heavily refined carbohydrates because of their effect on insulin production and insulin-like growth factors, which promote inflammation and are also associated with cancer cell division.
And don’t forget physical activity. There’s a chapter in the book about how important exercise is for cancer risk reduction. We know that it helps protect against colon and breast cancer, and possibly endometrial, lung, and prostate cancer. Physical activity is also essential for maintaining a healthy body weight since obesity is a major risk factor for many cancers. All told, more than 180 epidemiological studies confirm a cancer-protective effect for physical activity.
Many recommendations for cancer prevention are lifestyle based. How can IM professionals get their patients to comply with these in the age of “just give me a pill?”
This is a problem that speaks to the need for changes in our medical system so that patients aren’t expecting that medication will solve all their problems. Right now, we do have a “find it, fix it” medical system mentality, largely because that’s what is taught in medical school and that is what gets reimbursed. As a result, physicians don’t spend enough time talking about prevention and teaching people to live healthy lives. Insurers don’t reimburse for well-being visits.
Another issue is the fact that we’re also an over-supplemented society. We see patients who come in with a bag full of supplements that they have read about on the internet or heard about – something their boss’ nephew took to cure his cancer. These patients are also looking for a quick fix, but instead of pharmaceuticals, they want quick-fix supplements.
Are there specific strategies for the prevention of specific cancers, or is the preventive lifestyle essentially the same for all types of cancer?
That’s a good question. If I can use an analogy: when we see a patient with established cancer – which I likened to a weed when we spoke about integrative oncology’s approach to cancer treatment – our goal is to make the soil that the weed grows in as inhospitable as possible for cancer. Our approach here is pretty much the same for all types of cancer. But there are some things that may help reduce the risk of specific cancers. For example, eating soy foods during adolescence works pretty well to reduce the risk of breast and prostate cancers in Asians who maintain a traditional Asian diet (when they move to the U.S., their diet changes and their risk becomes closer to a western one than an Asian one). Reducing your intake of red meat probably goes a long way to protect against a number of different cancers, but has been documented best for colorectal and pancreatic cancers. Unfortunately, we can’t do test tube studies to show how red meat affects cancer risk, and we can’t even study this in animals, because if an animal has a human tumor, its immune system has been altered to accept the tumor. And we can’t do a study to randomize red meat eaters and non-eaters, so we have to rely on population studies.
Just how effective are the preventive measures? Isn’t the risk of cancer mostly genetically determined?
Some cancers are genetically determined but, in the developed world, we know that 30 percent of avoidable cancer is related to tobacco use and therefore is preventable and that another 40 percent is related to nutrition and is also preventable. I don’t think genetically determined cancers are the majority. Instead, most cancer is related to environment, to smoking, nutrition, physical activity and from changes to healthy cells that might be brought on by infections, such as the hepatitis viruses, human papillomavirus, and Epstein-Barr virus.
Source: www.drweil.com
National Center for Complementary and Integrative Health
Clinical Digest for Health Professionals
It’s important for patients to know the science of health. As you know, there is a lot of inaccurate or misleading information circulating about health — from anecdotes disguised as evidence to excessive claims made by supplement manufacturers to TV doctors touting the latest “miracle cure.” Reliable health information is key to making good health decisions, but it can be difficult to tell the difference between facts and myths, particularly in the area of complementary and integrative health approaches.
The National Center for Complementary and Integrative Health’s (NCCIH’s) “Know the Science” initiative is a resource to help consumers better understand complex scientific topics related to health research. It can help them be discerning about what they hear and read so they can make well-informed decisions, especially about complementary and integrative health, where many approaches are readily available in the marketplace and are often selected for self-care. The Know the Science initiative covers topics such as how to make sense of a scientific journal article, medication-supplement interactions, facts about health news stories, the placebo effect, health-related risks, and the myths about “natural” products.
This issue of the digest highlights some of these topics to help your patients know the science of health and may help improve conversations about treatment options and health care decision making.
What the Science Says:
Know the Science of Complementary Health Approaches
Information for Your Patients
- Know the Science
- How to Make Sense of a Scientific Journal Article
- How Medications and Supplements Can Interact
- The Facts About Health News Stories
- How To Find Information About Complementary Health Approaches on PubMed®
- Natural Doesn’t Necessarily Mean Safer, or Better
NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.
The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.
Precision health takes into account differences in people’s genes, environments and lifestyles and formulates wellbeing support, health promotion and disease treatment strategies based on the individual’s unique backgrounds and conditions. We aim to marry both high-tech and high-touch approaches to tailor healthcare recommendations to the unique biology and life circumstances of each individual. Precision Health represents a fundamental shift to more proactive and personalised care that empowers people to lead healthy lives. It is a transformation from a ‘sick-care’ based model of medicine to personalized healthcare.
Functional Medicine is a unique personalized biological systems-based model that enables practitioners to work with clients to address the underlying causes of symptoms and health issues in order to promote optimal wellbeing. It is the medicine of ‘why’, focusing on the roots of disease rather than purely symptom management. For example, we dig into causes and triggers of IBS (a stomach upset on holiday, heavy antibiotic exposure etc) or what is really underlying fatigue in an individual.
The Functional Medicine model starts with a thorough exploration of each client’s genetic, biochemical and lifestyle factors and utilises this information intelligently to direct personalised treatment plans. Functional Medicine combines science, evidence and clinical insight and brings the art of medicine and the whole-person approach back into the therapeutic relationship between practitioner and client.
Lifestyle medicine is a branch of evidence-based medicine in which comprehensive lifestyle changes (including nutrition, physical activity, stress management, social support and environmental exposures) are used to prevent, treat and reverse the progression of chronic diseases by addressing their underlying causes.
Aika says
This is very informative and well-written. Integrative therapy can be used to treat any number of psychological problems and disorders, including depression, anxiety, and personality disorders.
Enrique Pasion says
Have been looking at the option of other means for therapy and this article is very much useful in helping me make an informed decision.