PLENARY
INTEGRATIVE ONCOLOGY: ONE PHYSICIAN’S EFFORT TO COMBINE THE BEST OF COMPLEMENTARY MEDICINE AND CONVENTIONAL CARE
Keith Block, M.D.
June 11, 1999
When patients go through their diagnosis or go in for new scans, it is a traumatic and stressful period. If we are not sensitive as caregivers, then it’s very difficult for the patient. As we begin to add integrative components to conventional medicine, they still have been isolated. They usually are not integrated together were you start to see the synergism that is involved.
I. The Program
Three components of the program are as follows:
1) The Core: Involves addressing who the patient is, how they live, how they take care of themselves, who their immediate others are, basically looking at the internal and external microenvironment of the patient. It addresses purpose and meaning in the life of the patient, a high level of functionality both physically and intellectually, finding their passion for living, engaging in an attitude of play, and finding something deep within them, like spirituality or prayer, that is therapeutic and healing.
2) The Foundation: Superimposed upon the core is a foundation of complementary intervention, such as nutrition, physical care, stress care interventions, and biological response modification, including natural compounds and integrative therapies.
3) The Therapeutic Approach: Superimposed upon the foundation, and not in reverse, the therapeutic approach included what is appropriate and necessary in terms of conventional therapy, experimental therapies, and alternative therapies.
The patient is therefore assessed very carefully and intensively. Considerations include: every aspect of their care including how they live at home, physical exams, histories, immune disregulation, and advanced laboratory analysis. From there psychosocial evaluations, fitness assessment, and nutritional assessment are applied in order to tailor a regimen appropriate for that individual.
Consequences of cancer include:
Biological consequences of stress related to cancer include:
A study from University of California Los Angles (UCLA), a malignant melanoma early stage study, showed that there was a trend for reducing recurrent rates by doing a psychosocial intervention of just 1 ½ hours once a week for six weeks. Survival was also significantly increased by 3-fold.
Dr. Block’s center has several ways to help patients: imagery, meditation, biofeedback, counseling individually and in support groups, and cognitive therapy. They also evaluate the patient by strength testing, aerobic functioning, and flexibility. The patients are then placed on a comprehensive fitness regimen that includes building strength, doing meridian exercises based on yoga techniques, and participating in Qigong. Additional therapies include bodywork such as shiatsu, acupuncture, and massage.
In the areas of treatment, recurrent rates and progression of cancer there is really not much dispute at all the benefits of lowering fat in the diet. There are 7 terrific studies done to support them and 3 not so wonderfully done studies with design flaws that actually show some controversy in this but most agree that there is a fat association in this regard.
Fat tract:
Optimal ratio 2: 1 (omega 6:omega3) or 1: 1, in the U.S. population its mostly 20:1 or 10:1
Omega 6 fatty acids tract: Omega 3 fatty acids tract:
Meat low fat diet
Oils vegetables
Egg yolks fruits
Poultry
Dairy products
These provide an environment for tumor These provide for tumor inhibiting,
promotion as well as metastatic, clot inhibiting, anti-inflammatory,
enhancing, progressive disease, anti-metastatic type of environment.
inflammatory mediator, apoptosis,
angiogenesis
An observation study in Hawaii looking at 675 patients with lung cancer in terms of survival and their vegetable consumption. The highest group of vegetable intake had nearly doubled the survival compared to the group eating the lowest amount of vegetables. For those who where obese, the effect of being obese negated the benefits of consuming vegetables in this study.
In a ten-year study looking at breast cancer in the USA, Vanderbilt Hospitals compared to Japanese’s peasant diet in women with breast cancer looking at the ten-year survival. In the postmenopausal women there is nearly a doubling of survival over the ten-year period. While the data for premenopausal women was not as dramatic. There were earlier studies that showed a benefit of this diet in younger women. The lower survival rates for younger Japanese women in this study are probably due to the westernization of their diets.
Dr. Block’s program consider 5 food groups:
They also consider 8 different vegetable groups. Soybeans are recommended in high doses if patients are willing to use them. Cereal grains and legumes, a wide variety of detoxification vegetables like cabbages, garlic, onions, cold water fish, and tomatoes (the riper and redder the better). In a Detroit study patients in a randomized trial were given 15mg of lycopene per day three weeks prior to the prostatectomy. This resulted in a decline in the level of prostate specific antigen (PSA), a smaller tumor size, more confinement of the disease to the prostate, signs of tumor regression, and a decrease in malignancy. Blueberries are also have very powerful phytochemical properties.
Tumor versus Terrain is a focus of his research in the different mechanisms to combat these cancers. Most of us are still functioning with the 1947 experiment that came up with the initiation, promotion, and progression schematic of cancer. That scheme is a relic today because cancer is not an irreversible process and its not a single one time process of mutation followed by growth, followed by progression. So Dr. Block’s group combined clonal evolution with immune dysregulation as a model in terms of the microenvironment of cancer. In this model, the initiation is mutagenesis and progression is mitogenesis. The entire process is driven by mutagens, mitogens, and an oxidative stress leading to immune dysregulation. This is an ongoing process, a random process that keeps repeating itself through the life of the cancer from the very early cell periods and even pre-malignancy working its way through progressively even to late stage disease. Dr. Block believes that by intervening aggressively the drives behind this system can be reduced. In their model there is decreased cell mediated immunity, disrupted TH1 and TH2 ratios, decreased natural killer cell activity, increased systemic inflammation, and dysregulation of adhesion molecules. If you interject with cytoreductive therapy, you may get eradication of the most aggressive cell line. However, cells often escape and the tumor grows again. Remission consolidation is one of the major focuses. In addition cytoreductive therapies, they add the regimens described earlier to prolong the stage where cancer may reoccur.
In a study in which chemotherapy patients were given micronutrients, the bone marrow functioning was increased by about 300%. The administration of vitamin A in breast cancer patients undergoing nearly doubled the response rates. In postmenopausal women, it nearly tripled the response rate.
Another study of bladder cancer, evaluated the use of RDA multivitamin verses a generic megavitamin. Patients receiving the megavitamin had half the recurrence rates as the control group. Adding a Chinese herb, called donchen, for large cell malignant lymphoma patients, increasing total remission rate by 25%..
Another study introduced fish oil was given to different end stage cancer patients. This large dose of fish oil with vitamin E improved helper T cell ratios and nearly tripled survival in this population.
In signal cell transduction, there are a variety of processes taking place in a cell. So Dr. Block’s group is looking where they can intervene at these different mechanisms, with regimens and formulas for patients trying to stop the progression of the disease.
Purity may be a problem with dietary supplements and herbs. Twenty two to twenty eight percent of the herbs coming into United States are laced with contaminants, antibiotics, and powerful prescription drugs. Concentration can also be problem because often the amount of the active ingredient is not known. There is also a problem with giving these supplements and herbs with chemotherapy. There may be adverse interactions between nutrients and herbs and the disease, i.e. some may be tumor promoting. Other supplements may interact with the chemotherapeutic agents or may enhance the side effects of chemotherapy. There may also be adverse interactions between nutrients themselves. If you use them in combination with chemotherapy and radiation it requires a lot of knowledge and tailoring.
Dr. Block stresses the importance of quality of life when doing regiments like this and really living your life with great passion.