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INTEGRATED MEDICINE FOR THE CANCER PATIENT

RICHARD E. FREEMAN MD MPH LOCK HAVEN UNIVERSITY 2013. INTEGRATED MEDICINE FOR THE CANCER PATIENT. TO MAKE MAN WHOLE. CASE OF DR. FREEMAN AND MRS. ANDERSON. COMPLEMENTARY MEDICINE VS. ALTERNATIVE MEDICINE.

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INTEGRATED MEDICINE FOR THE CANCER PATIENT

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  1. RICHARD E. FREEMAN MD MPH LOCK HAVEN UNIVERSITY 2013 INTEGRATED MEDICINEFOR THE CANCER PATIENT

  2. TO MAKE MAN WHOLE

  3. CASE OF DR. FREEMAN • AND • MRS. ANDERSON

  4. COMPLEMENTARY MEDICINE VS.ALTERNATIVE MEDICINE • COMPLEMENTARY MEDICINE - therapies, treatments, products that are employed to complement or be used with conventional medicine • ALTERNATIVE MEDICINE – therapies, treatments, products are employed to take the place of conventional medicine

  5. INTEGRATIVE MEDICINE • INTEGRATIVE MEDICINE- comprehensive, evidence-based approach to care that addresses ALL participants at ALL levels of their being and experience

  6. INTEGRATIVE ONCOLOGY CARE • A COMPREHENSIVE EVIDENCE BASED APPROACH TO CANCER CARE THAT ADDRESSES ALL PARTICIPANTS AT ALL LEVELS OF THEIR BEING AND EXPERIENCE WITH DEFINABLE AND DESIRABLE OUTCOMES IN PREVENTIVE, SUPPORTIVE AND ANTINEOPLACTIC SPHERES • BASED ON or INCLUDING: • WESTERN MEDICAL PRACTICES • CONVENTIONAL MEDICINE • COMPLEMENTARY MEDICINE • ALTERNATIVE MEDICINE

  7. SPHERE OF ACTION-THE LADDER • PREVENTION • PRIMARY, SECONDARY, TERTIARY • SUPPORTIVE • SYMPTOMS, SIDE EFFECTS • ANTINEOPLASTIC • DIRECT ACTION

  8. WHY INTEGRATIVE ONCOLOGY?? • POSITIVES: • Significant decrease in death rates • ~70% patients with 5 yr survival • Technical and therapeutic advances • -diagnostic and treatment • Screening program successes • Population education • Oncological expertise advancements • Public Health/Environmental Improvements

  9. WHY INTEGRATIVE ONCOLOGY?? • NEGATIVES: • HIGH COSTS-THIRD PARTY PAYER DEPENDANCY • ~$200 BILLION/ YEAR • ~ $70 BILLION/ YEAR – DIRECT MEDICAL • ~$30 BILLION/YEAR – INDIRECT MORBIDITY COSTS • ~$100 BILLION/YEAR- INDIRECT MORTALITY COSTS • LIFETIME CANCER RISK STILL HIGH • MEN – 50%; WOMEN – 30% • CUREENTLY – 10 MILLION + CANCER SURVIVORS • SPECIAL NEEDS- MEDICAL, PSYCHOSOCIAL, LIFESTLE • LOSS OF THERAPEUTIC RELATIONSHIPS • ONCOLOGIST – NOT TRAINED IN NON-CONVENTIONAL APPROACHES • MISTRUST OF THE MEDICAL ESTABLISHMENT

  10. RESULTS: • BILLIONS SPENT OUT OF POCKET ON CAM TREATMENTS • UNDER UTILIZATION OF BENEFICIAL CHEAPER PROVEN CAM MODALITIES-PREVENTION AND SUPPORT • DANGEROUS INTERACTIONS BETWEEN CAM-CONVENTIONAL TREATMENTS • DELAYS IN SEEKING CONVENTIONAL TREATMENTS • PROVIDER BURNOUT

  11. CANCER SURVIVORS • PRAYER AND SPIRITUAL PRACTICES 60% • RELAXATION TECHNIQUES 45% • FAITH AND SPIRITUAL HEALING 40% • NUTRITIONAL SUPPLEMENTS 40%

  12. SOLUTION-HEALING IN ADDITION TO CURING ALL PARTICIPANTS ALL LEVELS OF BEING • PATIENTS • FAMILIES • PROVIDERS • COMMUNITIES • SOCIETY • MIND • THOUGHTS, FEELINGS, EMOTIONS, INTELLECT • BODY • BIOLOGIC, CHEMICAL, ENERGETIC BEING • SOUL • PERSONAL EXPERIENCE OF SELF • SPIRIT • ONE’S UNIFYING /UNIVERSAL APPROACH TO LIFE

  13. THE PRECAUTIONARY PRINCIPLE • A LACK OF SCIENTIFIC CERTAINTY SHALL NOT BE USED AS A REASON FOR NOT ACTING IN A WAY THAT PREVENTS HARM TO HUMAN HEALTH OR THE ENVIRONMENT. • USE WHEN DATA IS LIMITED OR NON-EXISTANT • ONLY WITH INFORMED CONSENT • PERCEIVED BENEFITS OUTWEIGHT RISKS • PREVENTIVE/SUPPORTIVE INTERVENTIONS • JUDGEMENT CALL-

  14. CAM/IM – “RED FLAGS” • “CURES”-OFFERED • CAN NOT PROVIDE EVIDENCE- BASED DATA • FDA NOT APPROVED • USES “TESTIMONIALS” FOR PROMOTION • PHYSICIANS, INFLUENTIAL INDIVIDUALS • DEROGATORY/ DEGRADING COMMENTS ABOUT CONVENTIONAL THERAPIES • REFUSES TO WORK AS A TEAM • RISKS OF THERAPY NOT ADDRESSED • REFUSE INSURANCE – CASH ONLY • MOST IMPORTANT – “GUT FEELING”

  15. SPHERE OF ACTION - LADDER • PREVENTION • PRIMARY, SECONDARY, TERTIARY • SUPPORTIVE • SYMPTOMS, SIDE EFFECTS • ANTINEOPLASTIC • DIRECT ACTION

  16. TYPES OF INTERVENTIONS ADJUNCTIVE/ALTERNATIVE SYSTEM CHINESE ACUPUNCTURE MIND/BODY SPIRITUAL MEDITATION/YOGA NUTRITIONAL SPECIAL VEGETABLE HIGH FIBER PHARMOCOLOGICAL/BIOLOGICAL BOTANICALS HERBS VACCINES HORMONES

  17. ALTERNATIVE • & • ADJUNCTIVE • SYSTEMS

  18. ACUPUNCTURE • SUPPORTIVE: • WELL ESTABLISHED AS A MEANS TO CONTROL CHEMOTHERAPY RELATED NAUSEA AND VOMITING. • PROBLEMS: NOT ENOUGH PRACTITIONERS

  19. AYURVEDIC Medicine • India: • Balance of Body, Mind Spirit

  20. CHINESE MEDICINE • CHINA & EASTERN ASIA: • BALANCE OF TWO FORCES:

  21. HOMEOPATHY • VERY SMALL DOSES OF A SUBSTANCE • TRIGGERS BODY TO HEAL ITSELF

  22. NATUROPATHIC MEDICINE • SEVERAL “NATURAL” MODALITIES • ENHANCING “SELF HEALING”

  23. MIND – BODY • MODALITIES

  24. RELAXATION TECHNIQUES • PROGRESSIVE RELAXATION • YOGA • TAI CHI/ • REICHI/THERAPUETIC TOUCH • MEDITATION • HYPNOSIS • IMAGERY • BIOFEEDBACK • STRESS MANAGEMENT/Creative outlets

  25. SUPPORT GROUPS • Shown to: • Reduce anxiety/depression/ loniness/suicide • Provide resource for education Improve nutritional/physical wellbeing • Reduce the dependency on providers/caregivers for support • Reduce caregiver burden

  26. SPIRITUALITY • MOST POWERFUL COPING TOOL • yet MOST UNDERUTILIZED- • PATIENT/PROVIDER AMBIVALENCE • SHOWN TO: • Improve overall QUALITY OF LIFE through creation of a positive mental attitude, hope, and sense of well being/inner peace.

  27. Healing Attributes- Spiritual Belief System • ATTRIBUTES: • Decrease anxiety, depression, anger and discomfort • Decrease sense of isolation and suicide risk • Decrease alcohol and drug usage • Lowers blood pressure/decreases co morbidities • Aids in adjustment to cancer and treatment • Increases ability to enjoy life during treatment • Freedom from regret/satisfaction with life • May extend life!!! • Spiritual Distress- harder to cope

  28. SPIRITUAL ASSESSMENT • EXPLORES SPIRITUAL BELIEFS/PRACTICES • HELP PREDICT COPING MECHANISMS • OPENS DIALOG PATIENT-PROVIDER

  29. SPIRITUAL ASSESSMENT • INCLUDE QUESTIONS REGARDING: • DENOMINATION • BELIEF OR PHILOSOPHY OF LIFE & DEATH • SPIRITUAL PRACTICES/RITES/RITUALS • USE OF RELIGION AS SOURCE OF STRENGTH • INTERNAL RELIGIOUS SUPPORT STRUCTURE • CONFLICTS BETWEEN BELIEFS AND TREATMENTS • PRAYER AS PART OF TREATMENT • LOSS OF FAITH/TRUST/ABANDONMENT • INTERACTIONS BETWEEN PROVIDERS AND SPIRITUAL LEADERS-CONFIDENTIALITY • END OF LIFE PLANNING

  30. NUTRITIONAL SUPPLEMENTATION MODALITIES

  31. FIBER AND CANCER • HIGH FIBER DIET – PREVENTIVE 1 • DECREASE IN TRANSIT TIME • LESS TIME FOR BACTERIAL ACTION-METABOLITES • LESS TIME FOR MUCOSA CELL TOXIN EXPOSURE • USUALLY HIGH IN ANTI-OXIDANTS • LESS NITROSAMINE INGESTION • AFRICANS AND SEVENTH-DAY ADVENTISTS- Burkitt / SDA Studies • Vegetarian/Vegans • NURSES HEALTH STUDY-HARVARD

  32. ANTIOXIDANT THEORY • MECHANISM OF ACTION: Controversial • Free radicals produced by normal metabolism • Radicals – genetic mutations • Antioxidants – scavanger of radicals • Transit time theory • FOODS: Green teas, mushrooms, green/orange vegetables, Omega 3 FA, walnuts, flax lignans • Lycopene-containing foods • VITAMINS: A,C,E • Minerals: selenium • DEBATE: USE WITH CHEMOTHERAPY • PROPONENTS- LESSENS SIDE EFFECTS • DETRACTORS- TUMOR PROTECTED DURING CHEMO

  33. DIETSGONZALEZ/GERSON REGIMENS • SPHERE: SUPPORTIVE/ ANTINEOPLASTIC • INGREDIENTS: • PANCREATIC ENZYMES-(FREEZE-DRIED PORCINE)-MAJOR COMPONENT • ELIMINATE ABNORMAL CELLS, TOXIC WASTE PRODUCTS & ABNORMAL PROTEINS • COFFEE ENEMAS- • 2x / DAY – DETOXIFICATION- LIVER- IMPROVE FUNCTION/EMPTY GB • NUTRITIONAL SUPPLEMENTS- • VITS, MINERALS, TRACE ELEMENTS, AMINO ACIDS & ORGAN EXTRACTS(COW THYMUS) • SPECIAL DIET- 10 BASIC AND 90 VARIATIONS • BASED ON UNBALANCED METABOLIC PROFILES • MECHANISM: see above • EFFICACY: CONFLICTING • TRIALS: one ongoing • FDA STATUS: PPE – new and under investigation; rest dietary supplement

  34. MILK THISTLE • SPHERE: ANTINEOPLASTIC • SOURCE: MILK THISTLE- • SILYMARINS-SILYBIN, ISOSILBIN, SILYCHRISTIN, SILYDIANIN • MECHANISM:ANTIOXIDANT • CELLULAR MEMBRANE STABILIZER • STIMULATES DETOXIFICATION PATHWAYS-LIVER • STIMLATES REGENERATION OF LIVER CELLS • INHIBITS GROWTH OF SPECIFIC CELL LINE • CYTOTOXIC TO CERTAIN CANCER LINES, • INCREASES EFFICACY OF SOME CHEMOTHERAPT AGENTS • TRIALS: obgoing • FDA STATUS: DIETARY SUPPLEMENT

  35. PHARMACOLOGICAL AND BIOLOGICAL MODALITIES

  36. COENZYME Q 10 • SPHERE: PREVENTIVE 1,2,3/SUPPORTIVE(ADJUNCTIVE) • SOURCE: Made naturally in the Human Body(Decrs c Age) • HEART, LIVER, KIDNEY, PANCREAS • MECHANISM:ANTIOXIDANT • CELLULAR –AEROBIC-METABOLISM • IMMUNE STIMULANT • LOW LEVELS SEEN IN CANCER PATIENTS • CARDIO-PROTECTIVE (CHEMOTHERAPY-ANTHRACYCLINES) • EFFICACY: POTENTIAL • TRIALS; NONE • FDA STATUS: DIETARY SUPPLEMENT

  37. CARTILAGE (SHARK & BOVINE) • SPHERE: ANTINEOPLASTIC • INGREDIENTS:CARTILAGE-SHARK/COW • MECHANISM: • DIRECTLY KILLS CELLS • STIMULATES IMMUNE SYSTEM • Collagens /glycoaminoglycans • Anti-inflammatory/ immune stimulators – may tumor cell toxic • BLOCKS ANGIOGENESIS • Angiogenesis inhibitors - chondrocytes • No blood vessels in cartilage • EFFICACY: • TRIALS: ONGOING – animal and human – oral, topical, enema, SQ • FDA STATUS:DIETARY SUPPLEMENT ONLY

  38. AMYGDALIN/LAETRILEMANDELONITRILE • SPHERE: ANTINEOPLASTIC • SOURCE: • FRUIT PITS – APRICOTS, PEACHES • LIMA BEANS, CLOVER, SORGHUM • MECHANISM: Cancer cell inhibitors • CYANIDE(cyanogenic glycoside)- CYANIDE POISONING (orally) • PRUNASIN & BENZALDEHYDE • EFFICACY: Animal – very little; human- NONE • HISTORY: Russia – 1840’s; US – 1920’s; • Usage stopped 1970- FDA – Not safe nor effective • 1970’s –challenged & legalized in 20 states • 1980- US Supreme Court overturned lower courts- Laetril – illegal in US • TRIALS: NONE • FDA STATUS: NOT APPROVED IN US • Common in other countries - Mexico

  39. ANTINEOPLASTINS-Bruzinski • SPHERE: ANTINEOPLASTIC • SOURCE: • ORIGINAL-HUMAN URINE- • SYNTHETIC- mixture of amino acids, peptides and derivatives • MECHANISM: • Antineoplastins are part of normal “surveillance” system of body necessary to switch abnormal cells to normal state of differentiation • Nonimmunological process • Peptides act as information carriers- • Antineoplastics are deficient in the cancer patient • EFFICACY: Specific to the Antineoplastin (many subtypes) and tumor type • IV, IM, PR, TOPICAL,INTRAPLEURAL, BLADDER INSTILLATION, PO, • TRIALS: • NO RANDOMIZED TO DATE • NONRANDOMIZED TRIAL AT DEVELOPERS INSTITUTE • FDA STATUS: NOT APPROVED

  40. BOTANTICALS & CANCER

  41. FOODS AND CANCER • GREEN /BLACK TEAS • SOY • OMEGA 3- FATTY ACIDS • LYCOPENE

  42. Great clinicial and patient resources • http://www.cancer.gov/cancertopics/cam • http://cam.cancer.gov

  43. QUESTIONS?

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