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Complementary Medicine in the Care of the Cancer Patient

Cancer Support Community-Benjamin Center October 18, 2013. Complementary Medicine in the Care of the Cancer Patient. Los Angeles, California. Lucy Postolov, L.Ac. Master of Traditional Oriental Medicine Diplomate in Acupuncture (NCCAOM)

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Complementary Medicine in the Care of the Cancer Patient

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  1. Cancer Support Community-Benjamin Center October 18, 2013 Complementary Medicine in the Care of the Cancer Patient Los Angeles, California Lucy Postolov, L.Ac. Master of Traditional Oriental Medicine Diplomate in Acupuncture (NCCAOM) Allied Health Professional for Cedars-Sinai Medical CenterBoard Certification in Integrative Medicine

  2. From the History of Cancer

  3. Integrative Medicine is a part of Modern Medicine • Mainstream Medicine • Allopathic Medicine • CAM • Complimentary and Alternative Medicine

  4. NCCAM Groups CAM ModalitiesInto Five Major Domains • Alternative Medical Systems • Traditional Oriental Medicine and Homeopathy • Mind-Body Intervention • Meditation, Imagery, Relaxation • Biologically-Based Treatments • Herbals, High-Dose Vitamin Therapy, Enzyme Therapy • Manipulative and Body-Based Approaches • Massage, Yoga, Chiropractic, Micro Currency treatment • Energy Therapy • Qi Gong, Reiki,Therapeutic Touch

  5. Five Major Domains

  6. Epidemiological TrendsAdult usage of CAM ’Complementary and Alternative Medicine’ -Ernst,Edzard 2001

  7. Medical Visit Trends

  8. Out-of-pocket expenses ‘Complementary & Alternative Medicine’ -Ernst,Edzard 2001

  9. Why Patients Use Alternative MedicineResults of a National Study Recent studies in the United States and abroad support the prevalent use of alternative health care. For example, a 1994 survey of physicians from a wide array of medical specialties (in Washington State, New Mexico, and Israel) revealed that more than 60% recommended alternative therapies to their patients at least once in the preceding year, while 38% had done so in the previous month. 47% of these physicians also reported using alternative therapies themselves, while 23% incorporated them into their practices. Conclusion: Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. JAMA, 1998;279:1548-1553, John A. Astin, PhD, The Stanford Center for Research inDisease Prevention, Stanford University School of Medicine, Palo Alto , Calif.

  10. An Increasing Number of Cancer Patients are Turning to Complimentary and Alternative Medicine (CAM) CAM use among cancer patients is diverse and varies by region • National Center for CAM estimates • 7-54% of cancer patients use CAM • 48-88% of cancer patients used CAM while being treated in comprehensive cancer centers in the USA

  11. How Acupuncture Works The Eastern Philosophical Point of View

  12. How Acupuncture Works The Western Medical Point of View These are several consecutive transaxial slices from single-photon emission computed tomography scans of patient 2 with baseline scan (top row) showing initial thalamic (thick arrow) and basal ganglia (thin arrow) asymmetry with the right activity greater than the left. The postacupuncture scan (bottom row) shows normalization of the thalamic and basal ganglia asymmetry, with the both right and left having relatively equal activity. From Cerebral Blood Flow Effects of Pain and Acupuncture: A preliminary Single-Photon Emission Computed Tomography Imagining Study. Andrew B . Newberg MD, Patrick J. LaRiccia, MD Brunde Y. Lee, MD, John T. Farrar, MD, Lorna Lee, MA, Abass Alavi, MD

  13. NIH Consensus Development Panel on Acupuncture • Promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, strokerehabilitation, headache, menstrual cramps, tenniselbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful. JAMA. 1998;280:1518-1524

  14. Clinical Applications of Acupuncture for Patients with Cancers Chemotherapy Related Side Effects • Myelo-suppression: with leucopenia, thrombocytopenia, anemia • Nausea • Vomiting • Mucositis (mucus membrane ulceration) Radiotherapy Induced Symptoms • Xerostomia (Dry mouth condition caused by radiation) Symptom Management • Cancer Pain

  15. Journal of Clinical OncologyVolume 30, Number 36 December 20, 2012 • Acupuncture for Cancer-Related Fatigue in Patients with Breast Cancer: A Pragmatic Randomized Controlled Trial Alexander Molossiotis, Joy Bardy, Jennifer Finnegan-John, Peter Mackereth, David Ryder, Jacqueline Filshie, Emma Ream, Alison Richardson ASCO American Society of Clinical Oncology

  16. Journal of Clinical OncologyVolume 30, Number 36 December 20, 2012 Patients and Methods Total patients: 302 Usual Care: 75 Acupuncture + Usual Care: 227 Results General Fatigue improved by 36% at the end of the Second week intervention, compared with 19% in the acupressure group and 0.6% in the sham acupressure group. Conclusion Acupuncture is an effective intervention for managing general fatigue, anxiety, depression and improves the quality of life.

  17. Other Symptoms as a Result of Chemotherapy Toxicity Other Symptoms CNS Toxicity • Insomnia • Fatigue • Mood Disorder • Feeling a Loss of Control Loss of Appetite Weakened Immune System Alopecia

  18. Other Clinical Issues • Cancer Treatment Induced Early Menopause • Chemotherapy-Induced Diarrhea or Constipation • Post-Operative Pain • Neuropathy • Skin Reaction • Liver Toxicity • End of Life Care

  19. Acupuncture helps tolook and feel beautiful after cancer related treatments • Facial Rejuvenation • Weight loss OR gain • Return of sexual desire • Gain the energy back • Balance of hormones • Micro Currency TX

  20. Risk of Harm Associated with Non-Conventional Approaches to Cancer Management • Symptom control of nausea and vomiting should be initiated after underlying causes have been identified • Claims to “cure” cancer with natural and non-toxic treatment • Herb-drug interactions • Side effects associated with unsafe and unregulated non-conventional interventions

  21. Requirements for Acupuncturists Working with Oncology patients • Acupuncture License • National (optional) • State (required) • General Medical Training Background • Hospital System Experience • Good Communication Skills • Experience Treating Oncology Patients

  22. Chinese Herbal Medicine to Support Patients Going Through Chemo and Radiation Bu Zhong Yi Qi Tang RenShen Ginseng Rx. Bai Zhu Atractylodis Alba Rz Huang QiAstragali Rx Dang GuiAngelicaeSinensis Rx Dao ZaoJujubae Fr. Chen Pi CitriReticulatae Pc. ChaiHuBupleuri Rx. ZhiGan Cao Glycyrrhizae Rx. Preparata Sheng Jiang ZingiberisRecensRz Sheng Ma CimicifugaeRz.. Chemo-Support Huang Qi Radix AstragaliRen Shen Radix Ginseng Ling Zhi Ganoderma Xi Yang Shen Radix Panacisquinquefolii Mu Dan Pi Cortex Moutan Zhi Mu Radix Anemarrhenae Fu Ling Poria Chen Pi Pericarpium Citri reticulatae Mai Men Dong Radix Ophiopogonis Dang Gui Radix Angelicae sinensis Ban Xia Rhizoma Pinelliae Preparatum Lu Gen Rhizoma Phragmitis Nu Zhen Zi FructusLigustrilucidiShaRenFructusAmomi Huang Jing Rhizoma Polygonati Gan Cao Radix Glycyrrhizae uralensis Radio Support Huang Qi Radix Astragali Dang Gui Radix Angelicae sinsis Hong Hua Flos Carthami tinctorii Dan Shen Radix Salviae miltiorrhizae Shou Wu Radix Polygoni multiflori preparata Gou Qi Zi Fructus Lycii chinensis Wu Wei Zi Fructus Schisandrae Nu Zhen Zi FructusLigustrilucidi Zhi Mu Radix Anemarrhenae Mu Dan Pi Cortex Moutan Gan Cao Radix Glycyrrhizae uralensis Sheng Di Huang Radix Rehmanniae Chen Pi Pericarpium Citri reticulatae Yu Zhu Rhizoma Polygonati odorati

  23. Analysis of Individual Herbsin Chemo SupportPharmacology of Chemo Support Ingredients Huang Qi- Radix Astragali Membranacei • Enhancement of Immune Function The decoction given to mice increases the phagocytic activity of the reticuloendothelial system. • Antibacterial Effect In vitro was effective against Shigella Shigae, Bacillum anthracis, Streptococcus hemolyticus, and Staphyloccus aureus. • Effect on endurance Decoction of Huang Qi given to mice significantly increase the endurance in swimming tests.

  24. Dang Shen- Radix Codonopsis pilosulae Promotion of phagocytosis Daily administration of decoction enhanced reticuloendothelial phagocytosis Hematologic effect Oral and intravenous use of Dang Shen in normal rabbits caused an increase in red blood cell count and hemoglobin. Immunologic effect Dang Shen inhibited the febrile reaction to toxins such as turpentine in mice and rats. Anti-ulcerative effect Pre-treatment with the decoction of the herb reduced the incidence of ulcers in rats due to stress of pylorus ligation. Analysis of Individual Herbs in Chemo Support

  25. Current Research on Alternative Therapies Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p 126. Huston, TX. 2008 Humana Press.

  26. Bibliography • Maciocia, Giovanni, The Three Treasures Newsletters Autumn, 1999 • Perry M, Anderson C, Dorr V, Wilkes J, The Chemotherapy Sourcebook, Williams & Wilkins, Baltimore, Maryland, 1999. • Skeel R, Handbook of Cancer Chemotherapy, Williams & Wilkins, Baltimore, Maryland, 1999 • Zhu YP, Chinese Materia Medica, Harwood Academic Publishers, Amsterdam, 1998. • Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, Eastland Press, Seattle, 1993. • Chang H.M. and But P.P. Hay, Pharmacology and Applications of Chinese Materia Medica, World Scientific, Hong Kong, Vol. I, 1986., World Scientific, Hong Kong, Vol. I, 1986. • Dorsher PT, “The Neuroanatomic Basis of the Acupuncture Principal Meridians”, Mayo Foundation for Medical Education and Research 2009 • Harris RE et al.“Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ-opiod receptors (MORs)”, Elsevier Inc. 2009 • Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p126. Huston, TX. 2008 Humana Press.

  27. In The Battle of the Disease There are Three Warriors…

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