Comprehensive Cancer Care: An Integrative Care Clinic Perspective- Effectively Targeting Cancer beyond the Treatment Phase
Integrative cancer care brings together the best ideas and evidence from both conventional and complementary and alternative medicine or so-called CAM. It is a more innovative and holistic approach to cancer which could prove critical to maximizing both quality and quantity of life. In applying the approach as an integrative practice, we like to break it down into phases of treatment because each phase represents a shift in how we might apply or utilize certain modalities or strategies.
Phases one and two- Initial Diagnosis and Treatments for Cancer
As an integrative care practice, the earlier we see our patients the better; getting them stronger and healthier, sleeping better, and coping better with a multidisciplinary approach when needed. A great example of the influence of sleep on drug effectiveness was recently reported in Cancer Research showing that the popular drug Tamoxifen, utilized mainly in the post- treatment phase for breast cancer, worked much better when women slept soundly 7-8 hours in a very dark room and when the drug was taken at night instead of in the morning. Fascinating, and makes sense given that we are circadian creatures and need to be in proper rhythm to be in balance. This is why seeing patients as soon as possible after a diagnosis of cancer can be very helpful to shifting the body into anti-cancer mode so to speak, while addressing the foundational pillars of the approach: diet/nutrition, stress management, physical activity, and sleep patterns.
During the conventional treatment phase for cancer (i.e. surgery, chemotherapy, radiation) we are interested in maximizing outcomes through the utilization of modalities which take into consideration the biology of cancer in order to synergistically target the multiple aspects of cancer behavior and thereby effectively complement the medical treatments. Modalities may include nutrition, targeted herbals and nutritional supplements, body work such as massage, energy work such as Reiki, acupuncture, and physical activity, along with assessment of and treatment for sleep problems and problematic coping patterns. These modalities must be expertly applied to be used in a synergistic manner during the treatment phase to work well with whatever intervention is being utilized, again whether that is surgery, chemotherapy or radiation therapies. At our practice, we utilize a team to guide these interventions and strategies.
Personalized chemotherapy is something we often discuss with patients. This approach, particularly in the setting of a cancer recurrence or more rare forms of cancer, offers a more effective approach to utilizing good cancer drugs, but personally applied to your cancer through what is called cytometric profiling, which measures apoptosis or programmed cellular death.
This involves taking a sample of tumor, blood or bone marrow (depending on the type of cancer) and utilizing cytometric profiling – looking for which drugs and or natural compounds seem to work best to induce apoptosis. This more personalized chemotherapy approach combined with the appropriate and targeted use of herbals and nutrition, as well as well- guided complementary modalities can more effectively treat cancer than standard of care options alone.
Phase 3- Post-Conventional Treatment- Recovery and Remission Phase
In this phase, the patient is declared to be in remission and is then followed by oncology with exams, bloodwork, scans, etc. Often however, the many risk factors for cancer that existed prior to the cancer, such as diet or weight issues or any sort of imbalance in the body have not been well-addressed in order to decrease the risk of recurrence in the patient. In addition, there can be lingering effects from treatments such as surgery, chemotherapy or radiation; whether they be pain, fatigue, cognitive issues, sleep issues, or neuropathy that are better addressed with an integrative approach.
Counseling and support for nutrition, stress management, sleep and healing of any lingering side effects from the primary treatment phase are the focus of the integrative approach in the recovery phase. However, the true integrative approach will also focus on biologic targets and environmental influences by assessing the biologic terrain of a person – their unique internal environment which can influence the possibility of cancer recurrence. As an integrative practice, we often keep a very strong focus on these influences, particularly in the first 2-3 years after treatment, with the goal of reducing risk of recurrence and the development of other health problems moving forward.
The areas we must address and some of the targeted herbals and nutritionals indicated- in order to effectively treat cancer include the following:
- General Wellbeing- nutrition, sleep, stress level, physical activity
- Promotion of Gene Stability and Modify Gene Expression- such as P53, P27 – use Vitamin E Succinate, Folate, Quercetin, Resveratrol , Curcumin , OPC’s and Indole-3- Carbinols from cruciferous vegetables, NAC
- Control Inflammation- start on anti-inflammatory diet, Turmeric , Boswelia, Bromelain, Quercetin, Melatonin, green tea, ginger, garlic
- Provide Immune Support- Use plant-based, healthy fats, lean protein diet, Green foods, Adaptogens for immune and adrenal support, Fish oil, Vitamin D, Quercetin, Selenium, DIM or Indole-3-Carbinols, lycopene, whey, mushrooms
- Induce Cytostasis- slow down the proliferation of cancer- use Green Tea, Boswellia, Bromelain
- Keep copper levels low- use Zinc, NAC, Molybdenum, Alpha Lipoic Acid. Ideally use TM in the post-treatment setting if possible- a compounded drug which chelates copper
- Induce Apoptosis- target BCL-2, Fish oil, Green Tea, Curcumin, Chinese skullcap, Mistletoe, Vitamin A, Forskolin, Ginger, Resveratrol, Quercetin
- Modulate Hormones- DIM or I-3-C’s – Chrysin, Isothiocyanates, passion flower nettles, mushrooms, blood sugar control. Treat insulin resistance
- Inhibit Invasion and Metastasis- Use Fish oils, Modified Citrus Pectin, Resveratrol, fermented soy
- Support Anti-Angiogenesis- the ability of cancer to grow new blood vessels- examples of nutritionals and herbals which inhibit include Quercetin, Panax Ginseng, Selenium, DIM, Vitamin D, Resveratrol
- Enhance Detoxification- NAC, milk thistle, green food based diet, bitters
In the recovery or remission phase we must continue to consider all of these areas involved with cancer behavior and continue to modify them in order to reduce cancer risk. For example, a woman on Tamoxifen in this phase of treatment would do well to further reduce her cancer and disease risk by addressing all of these areas through her diet, sleep patterns, correct and targeted use of supplements specific to her situation, as well as her stress and activity level. Help with achieving a health body weight is also critical. In the recovery and rebalancing phase patients are sometimes prescribed drugs such as Tamoxifen with the goal of reducing cancer recurrence, but effectiveness as we have already noted can be affected by health behaviors which integrative care can help with.
We encourage mindfulness of these influences by following the patient closely in the first 2-3 years post-treatment and improving their health as well as appropriate use of any testing to better assess the biologic terrain of a person, which can influence cancer recurrence and overall health. Labs and visits to assess and counsel the patient, are often helpful in knowing what needs to be addressed to achieve the best anti-cancer terrain possible. Examples of labs include inflammatory markers, blood sugar and insulin levels, Copper and Vitamin D levels. It is also important to understand the uniqueness of any particular type of cancer, a rather large catch-all term for what is really many different disease types each occurring within a unique individual human being with a unique internal terrain which can be worked with and modified when necessary to improve outcomes .
Colleen Tetzlaff, DNP, FNP-C, AOCNP is the owner of Integrative Therapies for Prevention, Cancer and Chronic Disease operating at the Integrative Health Center of Maine in Portland, Maine. She has been practicing as a nurse practitioner since 1997 and in private practice since 2010. She specializes in integrative cancer care, prevention-oriented primary care and chronic disease management using a functional medicine and integrative approach to care. Learn more about her practice at www.integrativetherapiesmaine.com or by calling 207-699-3838.
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