Integrative oncology: A primer

• What is integrative oncology?
• What is complementary and alternative medicine?
• The dangers of complementary and alternative medicine
• How can doctors be more receptive to complementary and alternative forms of medicine?
• Which forms of complementary and alternative medicine do doctors feel comfortable about?
• Diet issues
• Notion of ‘natural’ products
• Conclusions

What is integrative oncology?

The term integrative oncology has started appearing in the international cancer literature to describe the use of scientifically-proven complementary therapies alongside more conventional medical treatments.

Many Australian doctors may have a dislike to the word ‘integrative’, based on its (mis)use during the 1980s as part of the term ‘integrative medicine’. This was used to describe treatments that were generally not accepted by the profession, such as chelation therapy (a process involving the use of chemical agents which form complexes by binding metal ions, to remove heavy metals from the body) to treat disorders of the heart and major vessels.

However, outside Australia, the word has no such negative implications and has recently been used for a newly formed international organisation (the Society of Integrative Oncology) which holds successful annual conferences. It has established its own academic journal (the Journal of the Society of Integrative Oncology, currently published quarterly). This journal aims to make people more aware of the new advances and research in the treatment of cancer. The Society invites interested health professionals from all countries to join.

What is complementary and alternative medicine?

Many patients suffering from a range of chronic illnesses including cancer turn to ‘complementary’ and ‘alternative’ methods of treatment. The blanket term CAM – complementary and alternative medicine – is often used in the literature, but it must be recognized that C and A are not the same.

Complementary medicine refers to various forms of therapy that are viewed as acting alongside conventional methods to help either enhance or reach the desired outcome. These include therapies such as acupuncture, homeopathy, osteopathy, massage and reflexology.

On the other hand, alternative medicine refers to therapies that are available and can provide another option in the treatment of a medical problem.

The dangers of complementary and alternative medicine

While many such treatments may be harmless, and a few may be beneficial for the patient, they also carry dangers. Very few such treatments have been subjected to adequate scientific scrutiny for us to know whether they have any effects against cancer.

Dr Lowenthal’s experience in treating a prominent politician with cancer opened his eyes to the extent of CAM’s promotion in the Australian community. When a prominent Tasmanian politician made it known publicly that he had contracted lung cancer, he and his wife were bombarded with gratuitous advice and offers of ‘miracle cures’. Many proposals were made, ranging from potentially beneficial forms of complementary therapy (see below) to the completely crackpot.

Doctors treating cancer cannot ignore this phenomenon. These days cancer patients (or more usually their children) scour the internet for easy cures. Putting the word ‘cancer’ into Google brings up over 620,000,000 hits! A number of the top hits promote sales of questionable cures such as ‘liquid ionic cesium with rubidium’.

How can doctors be more receptive to complementary and alternative forms of medicine?

Your doctor may be able to:

• Talk with you, and to take into account your views about the illness you are suffering from, and various forms of treatment that may help;
• Give sensible dietary advice and steer you (and your partner) away from herbs and harmful extreme diets such as those involving a single ingredient;
• Direct you to helpful websites/literature that provide a balanced view of complementary and alternative treatments;
• Guide you to those centres (regrettably so far in Australia, too few) that provide a limited range of harmless and potentially helpful complementary and alternative treatments, within the setting of a hospital cancer service. In your treatment, it is also important to recognize that you may like to feel like you are actively involved in your own treatment.

Engagement with your doctor in CAM is one option that you may appreciate – another benefit in these cases is that your doctor can also be involved in ensuring that any harm that might come from such involvement is minimised. In addition, doctors can warn you about those forms of CAM known to be harmful.

Which forms of complementary and alternative medicine do doctors feel comfortable about?

There is reasonable evidence that acupuncture can help control cancer pain and some other symptoms (but not dyspnoea). If performed by qualified professionals, it carries minimal risk. Meditation has been shown in a number of studies to help patients cope with their disease and its treatment. However, it is important to be clear that mental attitudes and thoughts cannot influence the biological course of cancer.

Many people have found that involvement in self-help groups, such as are provided by some larger hospitals or state Cancer Councils, provides a good level of comfort and support. Massage, music therapy and relaxation techniques can also be helpful.

However, complementary treatments are not for everyone and patients should not be pressured into taking them up.

Diet issues

Issues relating to diet are of common concern. Many patients who have been told that they have been diagnosed with cancer feel obliged to modify the food they eat. Often this is to a vegetarian diet, or to one where certain components which are thought to be harmful are excluded, such as mushrooms or sugar or milk products. It is true that life-long vegetarians have a lower rate of cancer than the rest of us, however there is not the slightest evidence that changes to your diet, (radical, vegetarian or otherwise), will significantly improve the chance of cure once the disease is established.

Weight loss is a common symptom found in patients with advanced cancer. Unfortunately, this is a poor predictive sign. Whether it is beneficial to actively and strenuously try and oppose this weight loss is controversial.

For someone not used to it, taking up vegetarianism in middle or old age is not easy. To obtain sufficient calories from an eating plan that cuts out meat requires taking in a greater bulk of food than from a traditional Australian diet.

For patients with active cancer, the disease itself or its treatment may increase the likelihood of them experiencing nausea and vomiting. This results in a decreased appetite and usually exaggerates the already present tendency to weight loss.

Weight loss will be much greater if the patient adopts one or other fad diets that have become popular lately such as the ‘grape cure’. Such diets are often taken up on the basis that they will ‘cleanse the system’, based on the concept that cancer is a ‘dirty’ disease. However, there is no evidence that such a course of action is at all beneficial – indeed, because weight loss is undesirable in patients with established cancer, such a process can only be harmful.

Dr Lowenthal’s advice to patients (and their partners, who are usually desperate to provide special foods to do their bit to help) is that patients should continue to eat food they enjoy and not radically change their food intake. Like everyone else, their diet should include fresh fruit and vegetables daily, but not to the extent that they become obsessed with this need, or go over to drinking huge quantities of juice to the exclusion of other foodstuffs (another popular recent fad). I point out to patients that published advice to take large quantities of additional vitamins and minerals in pill form, found in many of the popular ‘cure cancer’ tomes, often derives from large cities of the northern hemisphere. This is where obtaining fresh foodstuffs is not as easy as in Australia.

On the whole Australians are lucky in the food they have available. There is considerable evidence that we are all better off obtaining our vitamins, minerals and unknown important trace substances from whole foods rather than from purified extracts. Only when a normal diet is not possible should food supplements be necessary.

Learn more about nutrition in cancer patients.

Notion of ‘natural’ products

One harmful concept that really needs to be explored and corrected is the idea that because something is ‘natural’ is must be good. However, how many readers would allow their toddler children to wander through their front garden and eat any flowers or leaves found there? After all, garden plants are ‘natural’. So too are oleander, purple foxglove and tobacco. Even the leaves of potato and rhubarb plants are poisonous.

Many so-called natural herbs have been withdrawn from the market after years of use because they have been found to be dangerous. For example, comfrey (a herb in organic gardening) was once popular as a cancer cure, but is now known to be itself carcinogenic (i.e. cancer causing). Just because a substance is promoted as a ‘natural cancer cure’ doesn’t mean it’s harmless or a cure.

You should seek the advice of your local health professional before taking up the use of herbs and weird diets, on the premise that they may be able to do harm. Whilst some forms of CAM, such as vitamins, do not pose much harm to patients taking them, your health professional is available to provide accurate scientifically-based advice.

Unfortunately, the wicked and calculating are out there attempting to play confidence tricks on vulnerable cancer patients. Some forms of CAM that are advertised have no beneficial effects at all. Another responsibility of doctors is to be on the lookout for such scams. Where outrageous claims are made that cannot be supported by evidence, your doctor can report the perpetrators to the local (state) office of consumer affairs or the Australian Competition and Consumer Commission (ACCC). These organisations can have offending advertising withdrawn; the ACCC can impose substantial penalties. In this regard we should take as our example the actions of the Jelly Bean Lady.

Conclusions

In summary, use of complementary and alternative treatments for cancer is widespread in Australia. Your doctor and other health professionals are becoming more aware of this, and you should feel comfortable seeking their advice on certain treatments that you may be interested in. They are able to provide objective advice and warnings where these can be based on scientific evidence, but equally not condemn all forms of CAM. Doctors should support our patients’ use of appropriately tested and safe forms of CAM and incorporate this in our treatment recommendations where patients seek it – so-called ‘integrative oncology’.

 

Article kindly contributed by:

Dr Ray M Lowenthal
MBBS MD FRCR FRACP FACHPM, Director of Medical Oncology, Royal Hobart Hospital, Clinical Professor, University of Tasmania.

 

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