THE EFFECT OF THE HOMOEOPATHIC SIMILIMUM ON SIDE EFFECTS OF CHEMOTHERAPY IN BREAST CANCER PATIENTS A Dissertation submitted to the Faculty of Health Sciences, University of Johannesburg, in partial fulfillment of the requirement for the degree of Master of Technology in the programme Homoeopathy By Vernisha Moodley (Student Number: 809806707) Supervisor: Date: Dr. N. Wolf Co-Supervisor: Date: Dr. C.A. Benn Promoter: Date: Dr. K. Peck Johannesburg, 2006
DECLARATION I declare that this dissertation is my own, unaided work. It is being submitted for the Degree of Master of Technology at the University of Johannesburg. It has not been submitted before for any degree or examination in any other Technikon or University. (Signature of Candidate) day of 2006 ii
ABSTRACT Breast cancer in South Africa has become one of the most prominent cancers affecting women. Worldwide, breast cancer results in more deaths amongst women than any other cancer (Vorobiof, 2001). Chemotherapy has become one of the most effective and commonly used adjuvant forms of treatment in breast cancer. However, despite its effectiveness, it has a variety of side effects ranging from nausea, fatigue, vomiting, alopecia to many others. Due to the significant levels of discomfort and disability associated with chemotherapy, patients often seek additional treatment to assist with these side effects. Many individuals combine complementary and alternative therapies with conventional treatment of their cancer (Breasthealth, 2005). Homoeopathy is often used to alleviate the side-effects resulting from the chemotherapy treatments (Diamond and Crowden, 1997). This research involved the individualized treatment of patients experiencing side effects from chemotherapy, employing homeopathic medicine. The study involved ten participants who had been diagnosed with breast cancer and who were scheduled for at least four chemotherapy treatments. The participants did not receive any homoeopathic remedies to assist with the side effects following the first chemotherapy treatment. The results from the first chemotherapy treatment were utilized to establish each individual s control results against which, future results would be compared. Participants received their homoeopathic similimum remedies to assist with their second, third and fourth chemotherapies. The appropriate homoeopathic remedy was determined using each patient s distinguishing, mental, emotional and physical symptoms following each chemotherapy treatment. Each participant completed the Researcher s Questionnaires (Appendix B) following their chemotherapy treatments and recorded the severity of their nausea, fatigue, vomiting and general symptoms experienced after each of the four chemotherapies. These were handed to the researcher at each follow-up consultation. These results, together with iii
the holistic progress as noted by the researcher at every consultation, were used to determine the efficacy of homoeopathy on the side effects of chemotherapy treatment. This study aimed to reduce the severity and duration of side effects resulting from chemotherapy treatment using individual homoeopathic remedies prescribed. The severity of side effects was graded and monitored for each patient following each chemotherapy session. Of the ten participants involved in this study, eight participants completed all their scheduled chemotherapy sessions. Two of the participants completed only three chemotherapies as their conditions had improved drastically and were not compelled to complete their remaining chemotherapies. Compliance with the homoeopathic treatments was thus effectively 100%. The results of this study indicated that all of the participants reported a statistically significant decrease in side effects after taking the similimum homoeopathic remedies and they also experienced a shorter duration of side effects. All patients in this study were better able to cope with the side effects of chemotherapy whilst taking the similimum Homoeopathic remedies. iv
DEDICATION This study is dedicated to every female who has been afflicted with breast cancer and who has experienced the devastating side effects of chemotherapy, and to those who have persevered through any type of cancer. v
ACKNOWLEDGEMENTS The researcher would like to convey her sincere gratitude to the following individuals for their contribution and support. DR. NATASHA WOLF, for your understanding, patience, support and guidance throughout this endeavor. For your unfailing optimism and strength. And most of all, for setting a precedent of homoeopathic practice for many good doctors to follow. DR. CAROL-ANN BENN, for your amazing personality, your boundless vision, your bountiful love and dedication to your patients. Most of all for your drive to ensure a better healthcare practice for each female who has been or will be diagnosed with breast cancer. DR. NOZWORTHY, AND SISTER MARY FARRELL, for your expertise, guidance, advice and support. For your perseverance in assisting me throughout this research and for the example you have set of your remarkable patient care. DR. MOODLEY AND DR. DEMETRIOU, for your patience and assistance with referral of patients participating in this research. MRS S. K. MOODLEY, for being a pillar of support, for your unconditional assistance, and most of all for the sacrifices you had to make to ensure that I fulfill my goals. A child could not ask for more. MR. B MOODLEY, for being an example of love, for your motivation, guidance, and most of all for being there and for being you. MRS L. STRYDOM, for your assistance, guidance, overbearing motivation, for your contagious and uplifting laughter, for being my support and my strength. vi
TABLE OF CONTENTS PAGE Declaration Abstract Dedication Acknowledgements Table of Contents Page List of Appendices List of Figures ii iii v vi vii xiii xiv CHAPTER ONE INTRODUCTION 1 1.1 Problem Statement 1 1.2 Aim of the Study 1 1.3 Hypothesis 2 1.4 Null Hypothesis 2 1.5 Importance of the Problem 3 CHAPTER TWO LITERATURE REVIEW 5 2.1 Breast Cancer 5 2.1.1 Introduction 5 2.1.2 The Breast 6 2.1.2.1 Anatomical Location of the Female Breast 7 2.1.2.2 Shape and Size of the Breast 8 2.1.2.3 External Appearance of the Breast 8 2.1.2.4 Internal Anatomy of the Breast 8 2.1.2.5 Arterial Supply of the Breast 9 vii
2.1.2.6 Venous Drainage of the Breast 9 2.1.2.7 Lymphatic Drainage of the Breast 9 2.1.2.8 Innervation of the Breast 10 2.1.3 Aetiolology and Risk Factors of Breast Cancer 10 2.1.3.1 Age 11 2.1.3.2 Family History 11 2.1.3.3 Reproductive History 12 2.1.3.4 Hormonal Changes 12 2.1.3.5 Alcohol and Smoking 13 2.1.3.6 Environmental Factors 13 2.1.3.7 Chemical Factors 14 2.1.4 Pathology of Breast Cancer 14 2.1.5 Classification of Breast Cancer 15 2.1.5.1 In-Situ Carcinomas 16 2.1.5.1.A Ductal Carcinoma In-Situ (DCIS) 16 2.1.5.1.B Lobular Carcinoma In-Situ 17 2.1.5.2 Invasive/ Infiltrating Carcinomas 18 2.1.5.2.A Invasive Ductal Carcinomas 18 2.1.5.2.B Invasive Lobular Carcinomas 19 2.1.5.3 Inflammatory Breast Carcinoma 20 2.1.5.4 Pagets Disease of the Nipple 21 2.1.6 Methods of Diagnosing Breast Cancer 21 2.1.6.1 Mammography 21 2.1.6.2 Physical Examination 22 2.1.6.3 Tumour Biopsy 22 2.1.6.4 Other Methods of Diagnosis 23 viii
2.1.7 Staging of Breast Cancer 23 2.1.8 Allopathic Treatment of Breast Cancer 23 2.1.8.1 Surgery 24 2.1.8.2 Radiation Therapy 24 2.1.8.3 Bone Marrow Transplantation 25 2.1.8.4 Hormonal Therapy 25 2.1.8.5 Monoclonal Antibody Therapy 25 2.1.8.6 Chemotherapy 26 2.1.8.6.A Cyclophosphamide 26 2.1.8.6.B Doxorubicon (Adriamycin) 27 2.1.8.6.C Fluorouracil 27 2.1.9 The Clinical Presentation of Side Effects of Chemotherapy 27 2.2 Homoeopathy 28 2.2.1 Definition of Homoeopathy 28 2.2.2 The Origins of Homoeopathy 28 2.2.3 The Development of Homoeopathy 29 2.2.4 Principles of Homoeopathy 30 2.2.4.1 Law of Similars 30 2.2.4.2 Potentisation 30 2.2.4.3 The Vital Force 31 2.2.5 The Homoeopathic Consultation 32 2.2.6 Finding the Indicated Remedy 32 ix
2.2.7 Repertorisation 33 CHAPTER THREE METHODOLOGY 35 3.1 Study Population 35 3.1.1 Inclusion Criteria 35 3.1.2 Exclusion Criteria 35 3.2 Study Sample 36 3.3 Methodology 36 3.3.1 Stage One 36 3.3.2 Stage Two 37 3.3.3 Stages Three and Four 37 3.3.4 Stage Five 37 3.4 Remedy Administration 38 3.5 The Homoeopathic Remedy 38 3.6 Data Collection and Analysis 38 CHAPTER FOUR RESULTS 39 4.1 Introduction to Results 39 4.2 Results Obtained 40 4.3 Results of All Participants 41 4.3.1 Nausea 41 4.3.2 Vomiting 42 4.3.3 Fatigue 43 4.3.4 Overall Side Effects 44 x
4.4 Results of Participant One 45 4.4.1 Nausea 45 4.4.2 Vomiting 46 4.4.3 Fatigue 47 4.4.4 Overall Side Effects 47 4.5 Results of Participant Two 49 4.5.1 Nausea 49 4.5.2 Vomiting 49 4.5.3 Fatigue 50 4.5.4 Overall Side Effects 50 4.6 Results of Participant Three 52 4.6.1 Nausea 52 4.6.2 Vomiting 52 4.6.3 Fatigue 53 4.6.4 Overall Side Effects 54 4.7 Results of Participant Four 55 4.7.1 Nausea 55 4.7.2 Vomiting 55 4.7.3 Fatigue 56 4.7.4 Overall Side Effects 57 4.8 Results of Participant Five 58 4.8.1 Nausea 58 4.8.2 Vomiting 59 4.8.3 Fatigue 59 4.8.4 Overall Side Effects 60 xi
4.9 Results of Participant Six 62 4.9.1 Nausea 62 4.9.2 Vomiting 63 4.9.3 Fatigue 64 4.9.4 Overall Side Effects 65 4.10 Results of Participant Seven 66 4.10.1 Nausea 66 4.10.2 Vomiting 67 4.10.3 Fatigue 68 4.10.4 Overall Side Effects 69 4.11 Results of Participant Eight 70 4.11.1 Nausea 70 4.11.2 Vomiting 71 4.11.3 Fatigue 72 4.11.4 Overall Side Effects 73 4.12 Results Participant Nine 74 4.12.1 Nausea 74 4.12.2 Vomiting 75 4.12.3 Fatigue 76 4.12.4 Overall Side Effects 76 4.13 Results of Participant Ten 78 4.13.1 Nausea 78 4.13.2 Vomiting 79 4.13.3 Fatigue 79 4.13.4 Overall Side Effects 80 xii
CHAPTER FIVE DISCUSSION 81 5.1 Introduction 81 5.2 Discussion of Results 82 5.3 Results Obtained 86 5.3.1 Nausea of All Participants 86 5.3.2 Vomiting of All Participants 86 5.3.3 Fatigue of All Participants 87 5.3.4 Overall Side Effects of All Participants 87 5.3.5 Participant One 88 5.3.6 Participant Two 89 5.3.7 Participant Three 89 5.3.8 Participant Four 90 5.3.9 Participant Five 91 5.3.10 Participant Six 92 5.3.11 Participant Seven 92 5.3.12 Participant Eight 93 5.3.13 Participant Nine 94 5.3.14 Participant Ten 94 CHAPTER SIX CONCLUSIONS AND RECOMMENDATIONS 96 6.1 Conclusion 96 6.2 Recommendation 96 CHAPTER SEVEN - REFERENCES 98 APPENDICES 105 Appendix A Participant Consent and Information Form 105 Appendix B Follow Up Questionnaire 107 xiii
Appendix C Case History Form 110 Appendix D Case History of Participant One 115 Appendix E Case History of Participant Two 125 Appendix F Case History of Participant Three 132 Appendix G Case History of Participant Four 138 Appendix H Case History of Participant Five 145 Appendix I Case History of Participant Six 151 Appendix J Case History of Participant Seven 157 Appendix K Case History of Participant Eight 163 Appendix L Case History of Participant Nine 170 Appendix M Case History of Participant Ten 178 LIST OF FIGURES Figure 2.1: Anatomy of the breast 7 Figure 2.2: Blood supply to and from the breast 9 Figure 2.3: Lymphatic system serving the breast 10 Figure 2.4: Normal breast with Ductal Carcinoma in-situ with an enlarged 16 cross section of the duct Figure 2.5: Lobular Carcinoma in-situ and microscopic cross-section 17 enlargement of a breast lobule. Figure 2.6: Invasive Ductal Carcinoma and microscopic cross-section 19 enlargement of a breast cancer duct. Figure 2.7: Invasive Ductal Carcinoma 19 Figure 2.8: Inflammatory breast cancer 20 Figure 2.9: Mammographic image indicating a breast mass 21 Figure 2.10: Female breast indicating signs of nipple retraction 22 Figure 2.11: Specimen of cancerous tissue removed during a surgical operation 24 Figure 4.1: Nausea ratings for all participants 41 Figure 4.2: Vomiting ratings for all participants 42 Figure 4.3: Fatigue ratings for all participants 43 xiv
Figure 4.4: Overall side effects ratings for all participants 44 Figure 4.5: Nausea ratings for participant one 45 Figure 4.6: Vomiting ratings for participant one 46 Figure 4.7: Fatigue ratings for participant one 47 Figure 4.8: Overall side effects ratings for participant one 48 Figure 4.9: Nausea ratings for participant two 49 Figure 4.10: Fatigue ratings for participant two 50 Figure 4.11: Overall side effects ratings for participant two 51 Figure 4.12: Nausea ratings for participant three 52 Figure 4.13: Fatigue ratings for participant three 53 Figure 4.14: Overall side effects ratings for participant three 54 Figure 4.15: Nausea ratings for participant four 55 Figure 4.16: Fatigue ratings for participant four 56 Figure 4.17: Overall side effects ratings for participant four 57 Figure 4.18: Nausea ratings for participant five 58 Figure 4.19: Vomiting ratings for participant five 59 Figure 4.20: Fatigue ratings for participant five 60 Figure 4.21: Overall side effects ratings for participant five 61 Figure 4.22: Nausea ratings for participant six 62 Figure 4.23: Vomiting ratings for participant six 63 Figure 4.24: Fatigue ratings for participant six 64 Figure 4.25: Overall side effects ratings for participant six 65 Figure 4.26: Nausea ratings for participant seven 66 Figure 4.27: Vomiting ratings for participant seven 67 Figure 4.28: Fatigue ratings for participant seven 68 xv
Figure 4.29: Overall side effects ratings for participant seven 69 Figure 4.30: Nausea ratings for participant eight 70 Figure 4.31: Vomiting ratings for participant eight 71 Figure 4.32: Fatigue ratings for participant eight 72 Figure 4.33: Overall side effects ratings for participant eight 73 Figure 4.34: Nausea ratings for participant nine 74 Figure 4.35: Vomiting ratings for participant nine 75 Figure 4.36: Fatigue ratings for participant nine 76 Figure 4.37: Overall side effects ratings for participant nine 77 Figure 4.38: Nausea ratings for participant ten 78 Figure 4.39: Vomiting ratings for participant ten 79 Figure 4.40: Overall side effects ratings for participant ten 80 xvi