Complementary & Integrative Cancer Care Clinician Scientist s View from a Naturopathic Doctor

Transcription

1 Complementary & Integrative Cancer Care Clinician Scientist s View from a Naturopathic Doctor Dugald Seely, ND, MSc, FABNO Founder & Executive Director; OICC Director; Research & Clinical Epidemiology; CCNM Laura Weeks Affiliate Investigator; OHRI Vice President; OncANP

2 Superseded cardiovascular disease as Canada s most deadly disease 39% of women and 44% of men will develop cancer in their lifetime 24% of women and 28% of men will die from cancer Largely preventable Aging population is driving these rates up Millenials have higher rates of CRC 2016 Canadian Cancer Society

3 Over half the population are using natural health products 11% of oncology patients report use of natural therapies prior to diagnosis. 58% report use of natural therapies after diagnosis. 52% of natural medicine consumers with cancer take dietary supplements. 41% of oncologists regularly ask their patients about supplement use. Two thirds of oncologists said they avoid this topic due to lack of training. Journal of Clinical Oncology, 2015 ASCO Annual Meeting (May 29 June 2, 2015) Vol 33, No 15_suppl (May 20 Supplement), 2015: Link to CDC report:

4 2000 survey on Complementary & Alternative Medicine (CAM) use. 83.3% used at least one CAM therapy concurrent with cancer treatment. 40% had not discussed CAM usage with their physicians. 24.7% used seven or more CAM therapies. Richardson et al. J Clin Oncol Survey of 3400 respondents, 87% used CAM during cancer care in comprehensive cancer care centre. Judson et al. Int Can Ther 2017

5 MISINFORMATION?

6 Patients refusing curative conventional treatment Belief that it is harmful Belief that there are natural cures Patients incurring significant costs (financial and time) on ineffective or untested NHPs Patients taking agents that interact with conventional treatments or are unsafe Risk of avoiding potentially curative or greatly supportive care Stress and anxiety information overload Loss of trust in therapeutic relationship with physicians Not reporting use and creating an information gap

7 41% discuss use of supplements with patients 26% of discussions initiated by the oncologist. 2 of 3 oncologists report they did not have enough knowledge to answer questions regarding herbs and supplements. 59% had not received any education about the topic. Lee et al. J Clin Oncol. 2014

8 Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment. Witt et al. JNCI Monographs. Nov 2017

9 As Defined by the Oncology Association of Naturopathic Physicians: Naturopathic oncology is: the application of the art and science of Naturopathic medicine to the field of cancer care and treatment. NDs trained in integrative oncology play an important role in the care of people with cancer to: Advise on safe, effective use of natural and supportive therapies combined with conventional treatment. Work collaboratively with other providers at all stages: At time of diagnosis (to prepare for what lies ahead). During active treatment (to manage side effects and address comanagement of disease process through natural approaches). Post-treatment (to help recovery and to support prevention of recurrence).

10 Guide safe use of natural and supportive therapies Support optimal health and wellbeing during cancer treatment Reduce or prevent cancer treatment-related side effects Patient education and advocacy Patient safety: Avoid drug/nutrient interactions to prevent under- or over-exposure to chemotherapy, radiotherapy or targeted agents Assess for supplement quality Advise on safe dosage Communicate with medical providers regarding use of natural therapies Potentially augment effects of conventional oncology care

11 Diagnosis: Simone is a 44 y.o. Caucasian woman diagnosed with Stage IIb invasive ductal carcinoma. Her left sided tumor was 5.5 cm, grade 2, ER+, PR+, HER2/neu-, and 0LN. Oncotype Dx risk of recurrence score = 42. TNM Breast Cancer Staging: T3pN0M0. T3 = Tumor size > 5cm, N0 = no cancer in lymph nodes found, M0 = no metastasis. Conventional Treatment: Simone completed left sided mastectomy followed by chemotherapy with dose dense Adriamycin (doxorubicin) & Cytoxan (cyclophosphamide) followed by Taxotere (docetaxel). She then began six weeks of radiation and afterward, Tamoxifen. Note: Simone s oncologist open to her seeing an ND and interested in knowing recommendations Problem List from ND history taken after completion of chemo/radio therapies (1) insomnia waking at 3 am (2) mild anxiety & depression 3/10 (3) fatigue 6/10 (4) keen on natural medicine to prevent side effects of cancer treatment (5) fear of recurrence and seeking plan to help avoid this. 11

12 Review treatment records, blood work: Vitamin D blood tests recommended. Height 154cm, weight 68kg; BMI = 28.7 Lifestyle/behavioural recommendations: Washing with gentle soap and water daily to attend radiation with clean dry skin. (1) Review sleep hygiene, recommend 8 hours sleep; note effect of steroid pre-meds on sleep. (2) Cardiovascular exercise and regular physical activity recommendations provided. (3,4,5) Nutritional counselling: 7-10 fruits and vegetables daily; promote whole foods plant-based diet; create goals for weight reduction via reduced carbohydrate intake & increased physical activity. (4) Evidence based natural health products: Melatonin 20 mg (6,7), Co Q mg (8), Ganoderma 1000mg. (9) 1. Bolderston. Supportive Care in Cancer McCurry et. al. JAMA Intern Med de Glas et al. Cancer Irwin et al. J Clin Oncol Borch et al. BMC Cancer Seely D et al. Int Can Ther Hansen et al. Breast Cancer Res Treat Srinisan et al. Breast Cancer Research and Treatment Zhoa et al. Evid Based Complement Alternat Med

13 Vitamin D level: 45 nmolar (deficient), recommend 4,000 IU vitamin D3 daily taken with meal with repeat blood work to check blood calcium level in 1 month and repeat vitamin D blood level at 3 months. Insomnia resolved. reports behavior change made to get 8 hours of sleep vs. 5-6; states sleep improved with melatonin; wakes feeling more rested. Intended weight loss via exercise & healthy diet. reports 3x/ weekly aerobic exercise and dietary recommendations with overall weight loss of 8 pounds, 3months after follow-up. Danielle is referred to nutritionist to continue progress on dietary goals tailored to her lifestyle and family. Energy level improved. Fatigue reported to be greatly improved 1-2/10 (10 most fatigue). Anxiety reduced. Simone reports feeling relieved having a prevention plan in place and with taking control of her health with exercise and nutrition. Understands it s impossible to be certain about recurrence risk but is greatly relieved with plan in place 13

14 Diagnosis: 52 yr. old man diagnosed with colorectal cancer (likely stage IIb) Tumour in transverse colon 6.0 cm, penetrated muscular layer, think his lymph nodes were positive. No metastases from imaging that he knows of. Conventional Treatment: Completed surgery following which he refused chemotherapy choosing to pursue alternative therapies Oncologist tells him that his chance of recurrence are higher without chemo and that any use of alternative medicine will be a headache and massive waste of money Circumstances - sees ND for additional things to help: wants to use natural medicine to prevent side effects of cancer treatment avid proponent of Chris Beat Cancer and all the videos on the Truth about cancer Both confident and anxious under surface witnessed mother die of chemo during his 20s

15 Currently doing/taking: Gerson diet Mega juicing (carrots, beets, kale 24 oz daily) Rick Simpson s oil (cannabis extract) Intense frequent saunas Essiac tea, curcumin, selenium, garlic, chagas mushroom, CoQ10, green tea extract, astragalus combo, echinacea, ginseng, pau d arco Varied doses at different times

16 Anger, fear of dying Fear of pain, loss of autonomy Uncertainty Fatigue, pain, insomnia and anxiety

17 Addressing root issues with compassion Providing true informed consent Levels of evidence Consideration of risk/benefit ratio How to measure for benefit and harm Costs and duration of care Realistic expectations Communications with health care team

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