from Bottom Line Health
Get an Extra Edge Against Cancer
More than one-third of American adults reach for vitamins, herbs or other natural medicines when they have colds or other routine (and hopefully mild) health problems. Similar remedies can help when you have cancer.
To learn more about the best and safest ways to use natural therapies—also known as complementary and alternative medicine (CAM)—to fight cancer and its complications, Bottom Line Health spoke with Mark A. Stengler, NMD, a naturopathic physician who treats cancer patients.
HOW CAM CAN WORK
Research has shown that many so-called “alternative” treatments can enhance the effects of conventional cancer care such as surgery, radiation or chemotherapy…reduce treatment side effects…and possibly improve survival.
This type of integrative care doesn’t replace conventional cancer treatments. Rather, with the guidance of a doctor, complementary therapies are added to a patient’s treatment plan.
Important: To ensure that the therapies described below would be appropriate for you, consult the Society for Integrative Oncology (IntegrativeOnc.org) to find an integrative oncologist near you…or check with The American Association of Naturopathic Physicians (Naturopathic.org) to locate a naturopathic doctor who also treats cancer patients. Also: Be sure to ask the doctor you choose to be in touch with your oncologist. Here’s how CAM can help with problems that plague most cancer patients…
Get relief from “chemo brain.” It’s estimated that three-quarters of cancer patients will experience some degree of mental cloudiness. Known as “chemo brain,” it can include mood swings, memory loss and mental fatigue. It eventually improves, but some patients will feel like they’re in a mental fog years after their treatments have ended.
What helps: The omega-3 fatty acids in fish oil supplements—a typical daily dose is 1,000 mg total of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined—help regulate acetylcholine, a neurotransmitter that increases nerve growth factor and improves memory as well as energy levels.
The omega-3s also increase the effectiveness of 5-fluorouracil and other chemotherapy drugs, according to a study published in Clinical Nutrition Research. In research published in Cancer, lung cancer patients who took fish oil along with chemotherapy had a greater one-year survival rate than those who didn’t take the supplements.
Note: Fish oil may cause stomach upset in some patients, along with bleeding in those who are taking anticoagulant medications such as warfarin (Coumadin), apixaban (Eliquis) and rivaroxaban (Xarelto).
Boost energy levels. Ginseng is one of the more effective supplements for cancer patients. A number of studies have shown that it reduces treatment-related side effects, including weakness and fatigue. A double-blind study in Journal of the National Cancer Institute found that patients who took ginseng had less fatigue than those given placebos.
My advice: The American form of ginseng (Panax quinquefolius) is more effective than the Asian form. Typical dose: 1,300 mg to 2,000 mg daily. It rarely causes side effects, although it may lower blood sugar in those with diabetes.
Also helpful: Glutathione, a “super antioxidant” that can be combined with chemotherapy to reduce toxin-related fatigue and other side effects. It’s usually given in an IV solution. Side effects are unlikely, but it may interfere with some chemotherapy drugs. Be sure to consult an integrative oncologist to see whether you will/won’t benefit from glutathione.
Improve immune response. Turkey tail is one of the best–studied medicinal mushrooms. Available in capsule form, the supplement has chemical compounds (beta–glucans) that stimulate many aspects of the immune response, including antibody activity—important for inducing the death of cancer cells.
Impressive research: A study published in Cancer Immunology and Immunotherapy found that postsurgical remissions in colorectal cancer patients were twice as common in those who were given turkey tail. Typical dose: 3,000 mg daily. Side effects are unlikely.
A NUTRITIONAL BOOST
Conventional oncologists receive little training in nutrition, but it’s a critical issue for cancer patients. One study found that 91% of cancer patients had nutritional impairments, and 9% were seriously malnourished. Research shows that malnutrition contributes directly or indirectly to a significant number of cancer deaths due to poor appetite and the disease process of advanced cancer.
Loss of appetite is a major cause of malnutrition and muscle loss (cachexia). I advise patients who are losing weight to address these problems by getting more calories.
With every meal, include high-fat foods such as olive oil, coconut oil, avocado, nuts and seeds. A 10-year study, published in Archives of Internal Medicine, looked at more than 380,000 adults and found that a Mediterranean-style diet, which is high in olive oil and other healthy fats, reduced cancer deaths in men by 17% and 12% in women.
Also helpful: Protein shakes. They can provide the extra protein that’s critical for cancer patients. Up to 80% of those with advanced cancer experience muscle loss. Protein shakes can help reverse it. Best option: Ready-made whey protein or pea protein shakes—both are nutritious, have 5 g of sugar or less per serving and are readily available in health-food stores.
My advice: Get 1 g to 1.2 g of protein per kilogram (2.2 pounds) of body weight daily. This means that someone who weighs 150 pounds will need about 68 g to 82 g of protein daily. You can get that much from two or three servings of a typical whey protein beverage, which comes ready-mixed or in powdered form. Caution: If you have moderate or severe kidney disease, check with your doctor for advice on your protein intake.
HOW TUMOR BOARDS HELP
Cancer care is rarely a straightforward process. From the time you are diagnosed until your treatments end, your care will depend on the opinions of a surprising number of specialists—and good communication among those experts can strongly affect how well you do.
Important recent finding: Among nearly 5,000 patients with colorectal and lung cancers, those whose doctors participated in weekly tumor boards lived longer, according to a study presented at a symposium of the American Society of Clinical Oncology.
To ensure that the medical center where you’re being treated relies on a tumor board’s guidance, you should seek out a cancer center designated by the National Cancer Institute or accredited by the Commission on Cancer.
Large cancer centers usually have separate tumor boards for different types of cancer. At smaller programs, a single board will review all or most cancer cases.
Tumor boards provide important oversight because what seems like a perfect treatment plan can fall short in real-world circumstances. For example, chemotherapy might be the recommended treatment for a specific cancer, but a tumor-board oncologist might argue that a particular patient isn’t healthy enough to withstand the treatment. A psychologist or social worker at a meeting might point out that the patient will need transportation to and from the chemotherapy clinic.
WHO GETS REVIEWED?
At MD Anderson Cancer Center and other large cancer centers, virtually all cases are discussed at a tumor board, although doctors give most of their attention to rare/complicated cases. There’s no separate charge to patients for the review.
My advice: If you’re not sure that your case has been discussed at your treatment center’s tumor board, ask your doctor whether it has been (or will be). Your doctor should not be offended by this question—especially if he/she will be presenting the case. If your case hasn’t been reviewed, ask why not. You have the right to request a tumor board review, but it might not be available at a smaller medical center.
Most tumor boards meet weekly or twice a month and are comprised of a dozen or more specialists, including surgeons, medical oncologists, radiation oncologists and pathologists. Depending on the cancer, other doctors—gynecologists, urologists, etc.—may participate. Meetings often include a nutritionist, nurses, mental health experts and a social worker.
THE BENEFITS
Your case might go before a tumor board prior to treatment…after a preliminary treatment plan has been initiated…or during treatment when there is an important change in clinical circumstances.
Important finding: When the records of more than 200 pancreatic cancer patients collected from various institutions without tumor boards were later evaluated by a panel at Johns Hopkins University School of Medicine that included medical and radiation oncologists, surgical oncologists, pathologists and other experts, treatment changes were recommended in nearly 25% of these cases.
Research also shows that patients tend to have better outcomes in terms of treatment responsiveness, recovery times and survival, among other factors, when their cases are discussed at a tumor board.
Also: Patients whose cases are reviewed are more likely to be guided to a clinical trial—one that their primary oncologist might not be aware of. Many cancer patients are eligible for these trials, which provide excellent care…yet only about 3% of patients ever participate. The more patients there are enrolled, the more quickly important clinical questions can be answered.
The National Cancer Institute website lists thousands of clinical trials that are looking for participants—to compare drug treatments, study new surgical techniques or radiation treatments, etc. Most tumor boards have a “checklist,” which includes the question of whether there is a trial for which the patient might be eligible.
THE PERSONAL TOUCH
The services provided by tumor boards go beyond the nuts and bolts of treatment. For example, many cancer patients lose weight during chemotherapy or radiation treatments. If poor nutrition is threatening your recovery—or even your ability to continue treatments, a nutritionist might recommend nutritional counseling, or even help you find a free meal service in your area.
Many cancer patients suffer from mental health issues—depression, bipolar disorder, etc. The best cancer plan won’t help if you’re unable (or unwilling) to continue treatments. A tumor board will attempt to address—or correct—all the issues that can affect how well or poorly you respond to treatments.
Patients don’t typically attend tumor boards. Many different cases are reviewed at any one meeting. The presence of a patient would affect the confidentiality of others’ personal health information.
Source: Richard A. Ehlers II, MD, associate professor, department of breast surgical oncology and associate vice president in the Division of Houston Area Locations at The University of Texas MD Anderson Cancer Center. He is also adjunct assistant professor in the department of surgery at The University of Texas Medical Branch at Galveston. Date: May 1, 2018 Publication: Bottom Line Health
The Right Team to Treat Your Cancer
If you or a loved one is being treated for cancer, you may not be aware of so-called “tumor boards.” But if you’re getting care at a major academic or cancer-specific medical center, these regular face-to-face gatherings of cancer specialists—oncologists, radiologists, surgeons, pathologists, psychologists and others—play a key role in assessing individual cases. This may involve reviewing the pathology report…tracking disease progression…and discussing the treatment options for different types of cancer.
What gets reviewed: If your case comes before a tumor board, the doctors likely will address a variety of issues. Is surgery an option or will radiation and/or chemotherapy be more appropriate? If surgery can be done, should it or chemotherapy be used first, followed by other treatments? Is this patient battling mental health issues…or getting the runaround from insurance to get coverage for certain drugs?