More is Not Necessarily Better When Treating CancerMarch 1, 2011
Cancer care in the U.S. has increasingly become the perfect example that confounds the American mind-set. After all, we have been culturally conditioned that if a little is good, a lot is better, and a whole lot is best of all. Our current American medical system is a great example that more medicine is not necessarily better medicine and often does not translate to a better outcome. And, lest we forget, more expensive care does not always translate into better care. It is becoming increasingly clear that working smarter is very important to navigate the medical system and to insure a better outcome.
Allow me to state my bias up front. In the last year, a dear friend, a close acquaintance, and my husband have all faced cancer. Facing cancer is scary. It completely overwhelms your life. Every day is a new challenge, another doctor with whom to deal, another blood test, another injection, another challenge in nutrition, and every single person who faces cancer is a true hero. You may be scared to death but you are a hero to go through facing cancer in the American medical system. There is no guide; finding your way is a maze. Taking steps to optimize your diet and nutrition, use supplements wisely, address your emotional and spiritual health along with researching and considering treatment options is dizzyingly complex. There are wonderful doctors out there and caring nurses but you are sadly mistaken to think anyone looks at you, your diagnosis, and your lifestyle as a whole. The medical system is much too fragmented for that to occur.
In December a routine PET scan (part of a follow up program) revealed positive findings and a diagnosis of stage III Lymphoma for my husband. We wondered out loud with his radiation oncologist (who was totally supportive of an integrative approach to a bout of stage I non-aggressive lymphoma 3 years previously) what else could have been done in the subsequent 3 years. We had addressed diet, inflammation, supplementation, hormonal balance, exercise, emotional and spiritual health issues. Was there something we had missed to be facing a serious stage III aggressive form of lymphoma? All the experts we consulted were unanimous that treating the original cancer more aggressively was not an effective way to prevent another bout of cancer. After reading and re-reading “The Emperor of All Maladies, a biography of cancer” by Dr. Siddhartha Mukherjee, I became educated that the cancer profession grudgingly came to agreement that more chemo does not necessarily produce a better outcome after years of patient trials and clinical experience. The side effects of additional aggressive chemo invariably outweigh the benefits. Much progress has been made to manage the side effects of chemotherapy. While multiple powerful chemotherapy agents are now the standard of care for many cancer diagnoses, the oncologist was clear “We’ll consider 6-8 rounds of chemotherapy, testing you after the initial 4. After 8 treatments, the side effects outweigh any potential benefit.”
Even the newer, more expensive drugs are not necessarily better to treat cancer. Gleevec, a new and expensive cancer drug, was acclaimed as a break through for certain leukemia diagnoses yet it is now appreciated that many patients become resistant to its effects. Avastin engendered controversy when federal regulators questioned its price and its success in certain cancer diagnoses. The use of Taxol and Herceptin while once acclaimed is now questioned in many because of the little life gained, their side effects, and their expense.
The same has become true of surgery to address cancer. The initial work of German surgeon Dr. Richard von Volkmann inspired the work of John Hopkins professor of surgery, Dr. Richard Halsted. Dr. Halsted and his protégés pioneered and established radical surgery when the patient faced breast cancer as the standard of care. It took many years and many disfigured patients before it was determined that radical, disfiguring surgery did not produce the best outcome for breast cancer. Pioneers like British Dr. Keynes, Dr. Criles, Jr. in the U.S. and Philadelphia surgeon Dr. Fisher along with the subtle shift of the doctor-patient relationship were instrumental for medicine to replace radical disfiguring mastectomies with removal of pectoral muscles and all area lymph glands with lumpectomies and other treatments. The February 8, 2011 issue of Journal of the American Medical Association again turned the conventional wisdom of breast cancer surgery inside out. For many patients facing breast cancer at an early stage (estimated to be up to 40,000 per year) the removal of area lymph modes with all of the accompanying side effects is now known to be unnecessary. And, thanks to the Internet (the ultimate lay home medical journal) nearly every woman facing this situation will put this game changer to her surgeon.
Gilbert Welch, MD, professor of medicine at Dartmouth University and author of “Should I be Tested for Cancer: Maybe Not and Here’s Why” stumped the morning TV talk show hosts with analysis of the medical literature. Mass screening of cancer often does not cause people to live longer or live better. Only those who have a genetic predisposition to cancer or whose environment/lifestyle puts them at risk of cancer are well served by routine cancer screening. The catch it in time mentality sold to all Americans thanks to public service announcements from drug companies and medical device companies has no science to back it up. Screening often identifies abnormalities that are not malignant. Screening can also set the stage for little attention to be paid to one’s lifestyle. That alone can be problematic as we now learn that we can turn off and turn on genes with lifestyle choices even innocuous things like laughter. Certainly, environmental factors can be powerful and sea of chemicals in which we now live and raise our children has been linked to an increased incidence of cancer.
There is one mention in the 550 page + “The Emperor of All Maladies” of diet, nutrition, and lifestyle. It is a brilliantly written and well documented book. The lack of nutritional and lifestyle focus, research, education of physicians and their medical staff, and what happens in medical offices clearly bears this situation out. Every cancer expert we visited had a bowl of candy in their waiting room. Several offices were selling cancer to finance their foundations to help with patients’ needs. Nearly every oncologist acknowledged to us they knew nothing about diet and cancer. This situation is outrageously insulting to patients. Every parent knows unlimited candy/processed sugar is not good for growing children. Why would candy be acceptable in the office of every cancer treatment facility in the area?
I researched every site, journal, book I could find for my husband’s specific diagnosis.
None of these resources mentioned the nuggets we gleamed from phone consultations we scheduled with leading experts in integrative cancer care including:
• Spiritual health and your piece of mind are more important than any cancer treatment, conventional, alternative, or integrative, any diet, or any supplement you may use. The support of your respective faith community is amazing and does make a difference.
• Exercise is the one thing you can do to reduce your chance of cancer returning by up to 50%. There is no pill with that rate of efficacy.
• Diet does matter. Your immune system is 100% protein. It is important to get sufficient amounts (generally 1 g of protein for every 2 pounds of body weight) of high quality protein along with a nutrient dense diet focusing on fruits and vegetables. When your appetite fails and your GI tract is queasy, it is important to focus on foods that pack a nutritional punch. Good fats with their ability to modulate inflammation make a big difference, too. Take the bad fats out of your diet; if you eat a grain make it a whole grain; eat up to 11 servings of fruits and vegetables a day; eat some good fats each day; and get adequate protein. Sugar with its ability to stun the infection fighting white blood cells is not recommended for any cancer patient.
• There are some amazing foods/nutrients specific for certain cancers and certain chemo agents that our experts shared with us. I found none of these even with research skills honed from 26 years on air. Consider astragalus using cisplatin. Increase coenzyme Q10 when using doxorubicin/adriamycin. Sun Soup (mushrooms, Chinese herbs, certain vegetables) has an amazing ability to prolong the life of certain lung cancer patients. Cinnamon and Lemon Grass are worth considering for lymphoma. A blend of Ayurvedic/Indian herbs, Amrit Kalash, has good science about its benefits when used by those taking chemotherapy. Curry has amazing science for patients facing chemotherapy (contraindicated if cytoxan is used) and radiation. The use of plantain extract has been studied in a major cancer center and can be used topically to diminish the side effects of radiation. Intravenous vitamin C has been studied at NIH, University of KS, and other centers with positive results.
There is so much more that no one tells you but is in the scientific literature if you know the places to look or who to ask.
• Homeopathy may well be an unsung remedy of choice for many. The National Cancer Institute, MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, and others are looking seriously at the work of doctors using homeopathic remedies in foundations in India. The success rate can be impressive. At the least, there are ways to deal with the side effects of conventional cancer care (chemotherapy and radiation) using homeopathic remedies that are very successful. For example, there are various drug injections or blood transfusions used when chemotherapy invariably suppresses the bone marrows production of blood cells. These can adversely affect how long you live and can cause other side effects including all your bones aching. There is a homeopathic remedy, Ferrum phos, along with acupuncture that work quite well without these downsides and side effects. Who knew??
• There are therapies widely used in Europe and other countries that are never mentioned to most U.S, patients. The use of sound and light (photo and sonodynamic therapy) for certain cancer diagnoses is very real in other countries but not the U.S. Most European oncologists offer Coley’s fluid, once used routinely in the U.S., to harness the body’s power of fever and immune response to treat cancer. European cancer clinics use heat (hyperthermia) to treat cancer much more gently than chemotherapy and radiation and while it is being study at a major U.S. university, most oncologists never mention it to their patients. Worse yet, in the year 2011 patients continue to be pressured using tactics that are not professional when they choose to go a route outside surgery, chemotherapy, and radiation.
• Medicine has no explanation for patients who beat the odds, exceptional patients or spontaneous remissions. There is no medical certainty with regards to who survives, who does not, and for how long. Every patient is an individual with a personal genetic map in a unique environment affected by physical, emotional, and spiritual factors exclusive to them. Statistics are just numbers on a piece of paper. Hope conquers all is not a cliché. Faith sustains you can be as real as anything injected into you or given to you orally.
Patients have forever changed the practice of cancer medicine. It appears to be up to patients to educate themselves about the fact that lifestyle does matter. Lifestyle choices may actually affect how genes express themselves and whether cancer ever develops. Lifestyle choices undoubtedly affect how well those do when faced with cancer.
Deborah A. Ray, MT (ASCP)