A patient goes to his doctor and he says, "Doc, I have an earache." In 1000 B.C., the doctor replies, "Here, eat this root." In 1000 A.D.

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1 Brief History of Medicine: A patient goes to his doctor and he says, "Doc, I have an earache." In 1000 B.C., the doctor replies, "Here, eat this root." In 1000 A.D., the doctor replies, "That root is heathen. Say this prayer." In 1850 A.D., the doctor says, "That prayer's superstition. Drink this potion." In 1950 A.D., the doctor says, "That poison is snake oil. Swallow this pill." In 2000 A.D., the doctor says, "That pill is artificial. Here, eat this root."

2 Integrative Oncology Integrating Alternative, Complementary and Conventional Therapies for COMPREHENSIVE CANCER CARE

3 Complementary medicine = used together with conventional medicine Alternative medicine = used in place of conventional medicine Integrative medicine = combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

4 Integrative medicine combinesconventional medicine, which primarily investigates and treats physical symptoms, with complementary practices that include the inner healing processes of mind and spirit supports the body s healing abilities through nutrition, physical activity, relaxation, and social and spiritual connections CTCA

5 Exploratory Survey Among Cancer Patients at the UP-PGH Cancer Institute Use of CAM Including prayer/ psychosocial support, 99% of the patients use CAM, with an overlap use 2-3 CAM types Excluding prayer/ psychosocial support, 81% use CAM The patients demographic or clinical profile showed no correlation with CAM use 36% of the patients consulted a CAM provider

6 Why Patients Use CAM - Results of a National Study John A. Astin, PhD JAMA. 1998;279: Conclusion: Along with being more educated and reporting poorer health status, the majority of CAM users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.

7 Complementary Medicine Use Among Filipino Cancer Patients (UP-PGH Medical Oncology Study Group, 2005) Filipino Cancer Patients Perception of CAM vs CONV Cancer Treatment Weighted means p- CONV CAM value Prevents spread of cancer Cures cancer Relieves symptoms Assists body s natural forces to heal Easy to understand how they work Prevents recurrence of cancer Gives feeling of self-control over cancer Safe Improves quality of life Weakens body s natural reserves Have side effects Boosts immune system Reduces chance that the other therapy will work

8 Complementary Medicine Use Among Filipino Cancer Patients (UP-PGH Medical Oncology Study Group, 2005) Rank Mean Filipino Cancer Patients Reason for CAM Use 3.37 To stabilize present condition 4.00 To boost immune system 4.14 To aid conventional treatment 4.18 To treat cancer 4.31 To improve quality of life 4.64 To have a control over life 5.19 To treat side effects of conventional medicine 6.29 To compensate for failed conventional medicine

9 answers the patients question What else can I do? important role of SELF CARE in cancer care...

10 38% of the patients disclosed to their doctors that they were using a CAM remedy Among these doctors: 20% advised their continued use 25% advised possible adverse effects from CAM use Reason for Non-disclosure to Physicians The doctor did not ask 74 Patient is not sure if CAM will help at all The doctor may prohibit use or may disagree with patient The doctor may not understand patient s use % 20 The doctor may stop treating patient 4 9 8

11 As Oncologists, As Physicians to these Cancer Patients We must be enlighten more than our patients to be able to understand to be able to Prescribe or Not Integrative Medicine.

12 Cancer Treatment Centers of America offers the most sophisticated forms of surgery, radiation, and chemotherapy in combination with complementary therapies that include; nutrition, spiritual support, mind-body medicine, and naturopathic medicine

13 Mission Cancer Treatment Centers of America CTCA is the HOME of integrative and compassionate cancer care. We never stop searching for and providing powerful and innovative therapies to treat the whole person, improve quality of life and restore hope.

14 Integrative Care Model Naturopathic Medicine Surgical Oncology Medical Oncology Mind-Body Medicine Patient and Family Pastoral care Radiation Oncology Motion for Life Nutrition

15 Planned Team Interaction Team Cases Review 3x weekly Surgical, Medical, Radiation Oncologists Medical Specialists Naturopathic Physicians Nutritionists Mind-Body Medicine Therapists Physical Therapists Pain Specialists Nurse Case Managers Pastoral Care/Social Services

16 CAM Modalities Used by Filipino Cancer Patients % Prayer by self, prayer by others, vitamins, exercise % Herbal, vegetarian diet, cleansing/ detoxifying diet 50-64% Toning or pyramid power, iridology, vacuum cupping, reflexology, therapeutic massage, acupuncture Vegan/ macrobiotic diet, psychotherapy, tai chi, hypnosis, pranic healing, shark cartilage, acupressure, music therapy Chiropractic/ osteopathic, journaling, melatonin, immune therapy, bioelectromagnetic, chelation 38-48% 15-30% <10%

17 Clinical Nutrition: That "food is the best medicine" is a cornerstone of naturopathic practice. Naturopathic Doctors use diet, natural hygiene, fasting, and nutritional supplementation in their practice.

18 Why should we integrate NUTRITION? It has a tremendous effect on patients well being and quality of life It may affect their ability to tolerate treatment side effects They have the tendency to change their diet and have demonstrated a willingness to make significant changes

19 Why should we integrate NUTRITION? An important component of the holistic approach to cancer care. It may affect the tumor s response to treatment and thereby affect treatment outcome. It is important in cancer prevention. Obesity is a risk factor for cancer, regardless of the content of one s diet. Caution against baseless and potentially harmful alternative diets for cancer patients.

20 Oriental Medicine: An important understanding of the unity of the body and mind and adds to the Western understanding of physiology Acupuncture provides a method of treatment that can unify and harmonize the imbalances present in disease conditions, which in turn stimulates the immune system and the healing response

21 Qi gong- reduces fatigue Acupuncture- pain control increases immunity nausea/vomiting (11 RCT s) fatigue immunomodulation radiation induced xerostomia hiccups anxiety Ginger- reduces nausea/vomiting

22 Mind-Body-Spirit Interventions Uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques have become mainstream (e.g., patient support groups and cognitive-behavioral therapy). Other mind-body techniques - meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

23 MindBodySpirit Medicine is the HEART of Cancer Care Regardless of the kind or stage of illness, the human being who has cancer is CENTRAL It is a crucial part of the cancer patient s answer to What else can I do? Importance of acting on one s own behalf

24 Mind Body connection Cancer and the Mind Psychoneuroimmunology I found in the (cancer) patients a clear pattern of great crises, grave depressive afflictions, profound mourning, and all the sad emotions which have prolonged repercussions you can see in the patients prolonged and silent sorrow without the release of sobs and tears. E. Foque, MD 1931

25 Woody Allen s wisdom In the movie Manhattan, he has just been dumped by his girlfriend, Diane Keaton, who started a relationship with his best friend. Keaton: Why don t you get angry so that we can get it out in the open? Allen: I don t get angry, OK? I mean, I have a tendency to internalize. That s one of my problems. I I grow a tumor instead.

26 Testing Woody s Hypothesis CAN THE MIND PLAY A ROLE IN CANCER RISK? 5 of 9 prospective studies show significant link between non-expression of emotions and cancer risk Only 2 of 9 reveal association between depression and cancer

27 Social factors and life events identified in 3 studies: Social isolation Lack of parental affection in childhood Poor relationship potential Maternal death in childhood Strongest data is for non expression or repression of emotions

28 Basis: Psychoneuroimmunology, Psychobiology Stress, ANS and Cancer Perception influences Neurophysiology Emotions influence Neurophysiology

29 Mind Body Spirit approaches: Self Awareness- expressive writing, drawings, movement and dance Relaxation- music therapy, hypnosis, guided imagery Meditation- concentrative, awareness, expressive Group Support

30 Group Support the research is as good as that for many standard treatments other supports: individual counseling family and friends One of the most difficult of all things to endure for a crow, a raven, a wolf, or a human is to feel alone and separated from one s own kind. A sense of belonging is one of the most universal of all feelings. -Lawrence Kilham, 1989

31 Prayer and Spiritualityremote, intercessory prayer, distant healing A sense of spirituality can help you realize that you re not alone, and that you can turn to a larger force for help, support or comfort.

32 Should we integrate the Biologically Based Therapies? Vitamins (A,C,E) Minerals (selenium) Hormones (melatonin) Enzymes Phytonutrients: garlic, green tea, grape seed extract, flavonoids, isoflavones, resveratrol, chorella, spirulina, mushroom extracts Essential fatty acids Probiotics, amino acids Accessory nutrients (co Q10, whey prot, bee propolis, shark liver oil)

33 It is important to distinguish between: Complementary therapies that are used alongside conventional medicine for symptom management & QoL versus Alternative therapies that are used instead of oncologic therapy for the purposes of cancer cure SUPPORT/ COMPLEMENTARY/ INTEGRATIVE NOT THERAPEUTIC/ ALTERNATIVE FOR CURE

34 ALTERNATIVE CANCER CURES DISPROVEN Vickens, A (Memorial Sloan Kettering Cancer Center). CA Cancer J Clin 2004; 54: Livingston-Wheeler Di Bella Multitherapy Antineoplastons Mega Vit C Hydralazine sulfate Laetrile Psychotherapy

35 Supplement Contraindications and Drug Interactions: Folic acid vs Methotrexate- activity depends on reduced folates to damage DNA Soy genistein vs Paclitaxel- may interfere with drug efficacy High dose Vit E vs Doxorubicin- may increase drug uptake and toxicity

36 Manipulative and Body-Based Methods based on manipulation and/or movement of one or more parts of the body; include chiropractic or osteopathic manipulation, and massage. May the work of your hands be a sign of gratitude and reverence to the human condition Mahatma Ghandi

37 Research on Massage Quality of Life- improved mood and sense of well being Anxiety and Pain- relaxation, reduced pain Post Surgery and Massage- less anxiety, depression, less pain medication, improved bowel function, sleep, shorter hospital stay Side effects of Chemotherapy- decreased nausea and vomiting, diarrhea, less fear, greater sense of control

38 Research on Massage Coping with cancer Depression- improved mood, decreased depression Fatigue Lymphedema

39 Massage therapy is not contraindicated in cancer patients, massaging a tumor is but there is great deal more to a person than their tumor. -Bernie Siegel, MD Cautions and Contraindications: Blood clots (DVT) Thrombocytopenia Avoid fragile or broken skin Don t do deep traumatic massage Not on the site of the tumor Not near radioactive implants

40 Energy Therapies Involve the use of energy fields, the normal self healing capacity of the body Biofield therapies Examples include qi gong, Reiki, and Therapeutic Touch Bioelectromagnetic-based therapies

41 Research: RCT s for Healing Touch and Therapeutic Massage Non randomized controlled study for Reiki Effects on: Quality of Life Pain Vitality Physical Functioning Fatigue Anxiety/Stress/Relaxation

42 Integration into Clinical Practice WHY? Improved patient well being during treatment Increased acceptance of treatment Increased patient satisfaction

43 Exercise A. Measurable Benefits: Improve mood and QOL Enhance Immunity Reduce symptoms Increase Longevity Decrease Risk B. Immeasurable Blessings: Moving beyond self limiting thoughts Getting back to your life

44 Talking with patients about Integrative Medicine: Concentrate Getting Better vs. Feeling Better Acknowledge the emotion Explore, validate, empathize Never argue with the patient

45 ITEM MINUTES PRICE Nutrition initial consult 85 $175 follow up consult 55 $125 Guided Imagery 50 $60 Yoga 50 $75 Qi Gong 50 $100 Massage Deluxe 80 $100 Full 50 $75 Hot Stone 80 $120 Lymphatic 80 $120

46 Complementary medicine is here to stay. It is no longer an option to ignore it or treat it as something outside the normal processes of medicine and science. - Wayne B. Jonas, MD Journal of American Medical Association Formerly of the National Institutes of Health

47 Medical spa comprehensive medical and wellness care in an environment which integrates spa services, as well as conventional and complementary therapies and treatments