Complementary and Alternative Medicine for Cancer Survivors

Transcription

1 Complementary and Alternative Medicine for Cancer Survivors Dan Labriola ND Northwest Natural Health A Specialty Care Clinic Moving Beyond Cancer to Wellness Fred Hutchinson Cancer Research Center Specialty Care Clinic 1

2 Objectives Review most common Survivorship strategies What patients are using What works What doesn t t work What s s risky Known mechanisms of action Review the evidence Specialty Care Clinic 2

3 Objectives Combine the best of conventional and natural medicine strategies Specialty Care Clinic 3

4 Most Common CAM Therapies in the US Acupuncture* Ayurveda* Biofeedback* Chelation therapy* Chiropractic or osteopathic manipulation* Deep breathing exercises Specialty Care Clinic 4

5 Most Common CAM Therapies in the US Diet-based therapies Atkins diet Macrobiotic diet Ornish diet Pritikin diet South Beach diet Vegetarian diet Zone diet Specialty Care Clinic 5

6 Most Common CAM Therapies in the US Energy healing therapy/reiki* Guided imagery Homeopathic treatment Hypnosis* Massage* Meditation Specialty Care Clinic 6

7 Most Common CAM Therapies in the US Movement therapies Alexander technique Feldenkreis Pilates Trager psychophysical integration Specialty Care Clinic 7

8 Most Common CAM Therapies in the US Natural products (nonvitamin and nonmineral, such as herbs and other products from plants, enzymes, etc.) Naturopathic Medicine* Progressive relaxation Qi gong Tai chi Specialty Care Clinic 8

9 Most Common CAM Therapies in the US Traditional healers* Botanica Curandero Espiritista Hierbero or Yerbera Native American healer/medicine man Shaman Sobador Yoga Specialty Care Clinic 9

10 CAM Use by US Adults and Children - NIH Specialty Care Clinic 10

11 CAM Use by Age Specialty Care Clinic 11

12 CAM Use by Children increases with a Specific Diagnosis Epilepsy 62% Cancer 59% Cerebral Palsy 56% Asthma 51% Sickle Cell Disease 47% Ped Neurology overall 44% General Pediatrics 36% Sources: University of Minnesota General and Specialty Medical Clinics U Michigan Medical Center U Alberta Canada Specialty Care Clinic 12

13 Adult CAM use by Race/Ethnicity 2007 Specialty Care Clinic 13

14 Acupuncture Specialty Care Clinic 14

15 Massage Specialty Care Clinic 15

16 Botanical Medicine Specialty Care Clinic 16

17 Botanical Medicine Specialty Care Clinic 17

18 Reiki practitioner with a patient. Reiki is an energy medicine practice that originated in Japan Specialty Care Clinic 18

19 A community group practices Tai Chi, a mind-body practice that originated in China as a martial art. Specialty Care Clinic 19

20 Participants in a yoga class Lunge Pose Lotus Pose Yoga Tree Pose Specialty Care Clinic 20

21 Where Patients Get their Information Specialty Care Clinic 21

22 What s s Really Important? Stay strong and healthy Avoid interactions with treatment Respect the Protected Zone Prevention Specialty Care Clinic 22

23 Survivorship Maintain quality of life before, during and after treatment in every way Overall Health Cancer specific issues Control adverse effects from treatment Manage Co-morbidities Specialty Care Clinic 23

24 Survivorship Strategies Maintain quality of life before, during and after treatment Cancer specific issues that can be helped Fatigue Emotional issues Relationships Sexuality Reproduction Appearance Pain Sleep quality Digestion, absorption, elimination Specialty Care Clinic 24

25 Survivorship Strategies Exercise improves Quality of life Cancer Related Fatigue Muscle Mass Mood Immunity Specialty Care Clinic 25

26 Survivorship Strategies Cancer, Spirituality and the Mind-Body Connection Self-forgiveness forgiveness improves QOL Visualization and Imagery improve QOL PsychoOncology strategies improve Quality of Life Outcomes!? Specialty Care Clinic 26

27 Survivorship Strategies Social support = 21.8% improvement in quality of life New exercises reduce lymphedema Hyperbaric oxygen improves healing without affecting safety (Pilot study) Weight training improves quality of life IVF does not increase risk Specialty Care Clinic 27

28 Survivorship Strategies Back and Neck Pain Manipulative Therapies Omega 3 oils Glucosamine Chondroitin Specialty Care Clinic 28

29 Survivorship Strategies Head and Chest Cold Safety and Efficacy Depend on Timing and Dose Echinacea Omega 3 oils Herbal combinations Flax oil*** Vitamin C Vitamin D Specialty Care Clinic 29

30 Survivorship Strategies Anxiety and Stress Safety and Efficacy Depend on Timing and Dose B complex Flax oil Omega 3 EPA and DHA Combination herbals Kava Kava Valerian Caffeine Ephedra Ginseng Specialty Care Clinic 30

31 Survivorship Strategies Musculoskeletal Manipulative therapies Omega 3 oils Glucosamine Chondroitin Calcium Magnesium Specialty Care Clinic 31

32 Manipulative Therapies Potential Benefits Relieve neck and back pain Help with ROM Potential Risks Stretch connective tissue Trauma Specialty Care Clinic 32

33 Survivorship Strategies Insomnia Safety and Efficacy Depend on Kava Kava Valerian Calcium Hypnosis Ginseng!? Timing and Dose Specialty Care Clinic 33

34 Omega 3 Benefits and Risks Intervention or replacement? Potential Benefits Reduce TG Reduce heart attack risk Reduce clot formation Slow RA progression Help mood (depression and anxiety Reduce cancer risk Helped learning impaired children Help atopic dermatitis Help with autism Potential Risks Increased bleed times Reduced glycemic control with diabetics Hypervitaminosis A and D Rancidify easily Specialty Care Clinic 34

35 The Omega 3 - Flaxseed Oil Debate Very low conversion rate Some Carcinogenic results Specialty Care Clinic 35

36 EFA Conversion ALA (Flax Oil) Delta 6 desaturase EPA Delta 5 desaturase DHA Specialty Care Clinic 36

37 Echinacea Many species White blood cell stimulator Microbial considerations Unknown effects on immature immune systems therefore not recommended below age 14 (or pregnancy or lactation) Hepatic metabolism Counteracts immune suppression treatment Specialty Care Clinic 37

38 Potential Echinacea Side Effects Allergic including anaphylaxis, asthma Thrombocytopenia Purpurea Leucopenia Disrupted WBC differential Abdominal pain Dysuria Arthralgia Myalgia Dizziness Dry mouth Specialty Care Clinic 38

39 Herbal combinations General Considerations Many species, actions, interactions Microbial considerations Pediatric dosage may not be proportional to weight Unknown effects on metabolism, immature immune systems, development. Evaluate each ingredient Hepatic metabolism Specialty Care Clinic 39

40 Homeopathics Very low dosages, highly diluted Immune mediated theory of action Minimal evidence Extensive anecdotal history Experienced, responsible, licensed provider Specialty Care Clinic 40

41 Natural Product Quality Control DSHEA GRAS CGMPs No microbial rules Label accuracy Specialty Care Clinic 41

42 Diet Therapies Many objectives with cancer survivors Weight loss Protein sparing works best Durable results only with behavior modification Therapeutic Cancer, heart disease, neurological etc. Frequently combined with herbs, physical therapy and hydrotherapy Replacement or Intervention? Specialty Care Clinic 42

43 Diet Therapies Avoid extremes when reducing fats, carbohydrates or protein Beware ketoacidosis Avoid extensive fasting Impaired glucose metabolism Impaired peds development in many systems including neurological, bone Specialty Care Clinic 43

44 Survivorship Strategies Why Combining Conventional and Natural Treatment Works Best Conventional treatment has come a long way Give it a chance to work Specialty Care Clinic 44

45 New Breast Cancer Cases Nationwide 18% Increase 215, , , , , , , , , , , New Cancer Cases Specialty Care Clinic 45

46 Breast Cancer Mortality Nationwide 6% Decrease Cancer Deaths Specialty Care Clinic 46

47 Survivorship Strategies Avoid Possible interactions with cancer treatment Chemotherapy Radiation Surgery Targeted Therapies Specialty Care Clinic 47

48 Survivorship Avoid cancer Primary Prevention Secondary Prevention Specialty Care Clinic 48

49 Primary Prevention Reduce Risk Reduce alcohol consumption Exercise Weight gain since age 18 and 30 Specialty Care Clinic 49

50 Primary Prevention Reduce Risk Control blood sugar Insulin resistance, diabetes and cancer association Address metabolic syndrome Specialty Care Clinic 50

51 Primary Prevention Reduce Risk Reduce workplace exposures to agents associated with increased cancer incidence Organic solvents Sterilizing agents (ethylene oxide) Some pesticides Circadian Dysrhythmia Tobacco smoke Specialty Care Clinic 51

52 Primary Prevention Diet and Nutrition Vitamin B12 Folate Vitamin D Fiber Fruits and vegetables Fish Some antioxidants Specialty Care Clinic 52

53 More Nutritional Treatments Vitamin E Selenium Calcium, vitamin D, phosphorus Zinc Beta carotene Antioxidants in general Consider IV delivery Specialty Care Clinic 53

54 More Nutritional Treatments Safety and Efficacy Depend on Timing and Dose Alanine Glycine Glutamic acid Corn Oil Diet Macrobiotic Zone Claunch Specialty Care Clinic 54

55 Botanical, Plant Based Treatments Safety and Efficacy Depend on Timing and Dose Serenoa Repens (Saw Palmetto) Lycopene Pygeum Africanum Pumpkin Seed Resveratrol Flaxseed oil (ALA) Soy Urtica Dioca (Stinging Nettles) Specialty Care Clinic 55

56 Primary Prevention Mediterranean Diet and Olive Oil Reduce Cancer Risk Reduced risk for cancer, heart disease Early studies Suppress overexpression of Her2NEU in test tubes Support the activity of Herceptin Specialty Care Clinic 56

57 After Diagnosis and Treatment More Secondary Prevention Hormones Diet and nutrition? Botanicals? Lifestyle Specialty Care Clinic 57

58 Survivorship What s s New Integrated, multidisciplinary care Improved tools that maximize the Benefit:Risk ratio Specialty Care Clinic 58

59 Frequent Questions Combining Complementary and Alternative Medicine with Conventional Therapy Specialty Care Clinic 59

60 Phytoestrogens Including Soy Isoflavones? Safe Replacement for Hormone Therapy? Answer: Probably the same risk as HRT Ask for Patient Briefing Paper Specialty Care Clinic 60

61 Menopause and Hot Flashes Estrogen replacement?? Effexor etc. Phytoestrogens?? Diet Sleep Exercise Weight Control Avoiding alcohol and sugar Nutrition and non-estrogen herbs Specialty Care Clinic 61

62 More IC Therapies for Treatment Urine retention Side Effects Botanical BPH remedies Interstitial cystitis Botanical antimicrobials, AB Diarrhea and bowel continence Colloidal minerals, diet, digestive enzymes Urgency, Dysuria Botanical antimicrobials, AB, diet Specialty Care Clinic 62

63 Conclusions Human CAM trials with Cancer are maturing Independent variables more frequently but not always well understood Large variation in results Mechanisms need more definition Agent purity issues Interaction mechanisms are well understood. Respect the Protected Zone Antioxidants v ROS (Recent Meyer et al Laval U) Platelet aggregation inhibition Many other interactions Control of side effects Not intuitive Trials in the pipeline Specialty Care Clinic 63

64 Cancer survivorship Care Plan A real plan: What to do when treatment is done Outcome objectives for Secondary prevention Quality of Life Activities of Daily Living Care options Prevention diet, lifestyle, screening, treatments Efficient delivery of nutrients and other treatments Specialty Care Clinic 64

65 Questions? Comments? We speak at support groups Dan Labriola ND Patrick Bufi ND Kathleen Pratt ND Northwest Natural Health, A Specialty Care Clinic 9 convenient locations nwnaturalhealth.com Specialty Care Clinic 65