PROVIDING INTEGRATIVE CARE IV
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Presenters: Timothy Birdsall, N.D.
Moderator: Roberto Mayo
Commmentator: Susan Sencer, M.D.
Session: Su4; June 12, 1999I. Abstract
Timothy C. Birdsall, ND; Director of Naturopathic Medicine at the Cancer Treatment Centers of America - Midwestern Regional Medical Center, Zion, IL. Dr. Birdsall’s presentation was about Integrated Oncology Care. The main point stressed throughout Dr. Birdsall’s presentation was the importance of combining the practices of tradition and conventional cancer treatments with newly examined and alternative treatments. Cancer is widespread disease, has many facets and will affect at least 33% of the US population today. To optimize a patient’s chance of survival, the scope of their treatment and their care giving team must be widened and diversified.
II. The Cancer-Related Issue Addressed
This session addressed the importance of the ongoing work of the Cancer Treatment Centers of America (CTCA), the largest US organization to integrate conventional and complimentary cancer therapies. Too many clashes of conventional and alternative medicine occur. The CTCA’s goal is to combine and integrate the two often rival realms of cancer treatment to design individual treatments based in conventional as well alternative medicine to fully optimize the care given to cancer patients.
III. The Program
A. Philosophical Background
No cancer patient should have to face the rigors of their disease or their treatment without having the opportunity to take advantage of the benefits offered by integrated care. Conventional cancer care as commonly practiced in the U.S. has an unacceptably high rate of side effects relative to cure rate. Complementary medicine has a wide variety of treatments which have been shown to improve the effectiveness of treatment at the same time they reduce side effects. Patients benefit when all their care providers work together as an integrated team.
Care providers benefit from a team approach because we learn from each other and can complement our strengths and weaknesses. The future of oncology care lies in combining the newer, less toxic, more tumor-specific treatments with patient-specific, tumor-specific, and treatment-specific naturopathic therapies.
B. Details
Building a care-giving team:
- Patient and family
- Oncologists
- Naturopathic Physicians
- Nutritionists
- Psychoneuroimmunologists
- Occupational/Physical Therapist
- Spiritual counselors/clergy
- Acupuncture/homeopathy/ayurvedic
- Massage Therapists
- Meals on wheels
- Social workers
- Home health care/visiting nurses
- Hospice workers
- Support groups
Conventional Treatments
- Surgery
- Chemotherapy
- Radiation
- Immunotherapy
- Bone marrow/stem cell transplants
- Hormonal blocking agents
Cutting-Edge Technologies
- Fractionated dose chemotherapy
- Intra-arterial chemotherapy infusion
- Chemo-resistance testing
- Antiangiogenic factors
- Monoclonal antibody targeted chemo/radiation
- Photo-dynamic chemotherapy
- Intensity-Modulated Radiation Therapy
- High Dose Rate Brachytherapy
Principles of Naturopathic Medicine
- The Healing Power of Nature
- First Do No Harm
- Identify and Treat the Causes
- Doctor As Teacher
- Treat the Whole Person
- Prevention
Goals of Naturopathic Co-treatment
- Support normal metabolism during therapy
- Provide ongoing patient-centered healthcare
- Speed surgical recovery
- Reduce side effects of chemo/radiation
- Enhance tumor kill from chemo/radiation
- Immune support
- Hormonal modulation
- Detoxification
Naturopathic Modalities
- Dietary Modification
- Nutritional Support and Supplementation
- Botanical Medicines
- Natural anti-tumor agents
- Detoxification
- Homeopathy/Acupuncture
- Coordination of Complementary Care
Designing an Integrated Program
- Accurate diagnosis and staging
- Conventional treatment history
- Conventional treatment plan
- General Nutritional Status
- Functional Immune Status
- Detoxification Capacity Status
Designing an Integrated Program
- Spiritual Care Assessment
- Emotional/Psychological Assessment
- Exercise/Motion/Activities of Daily Living
- Pain Evaluation
Administrative Logistics of an Integrated Program
- Licensure and Professional Regulation
- Recruitment and Hiring Decisions
- Financial Structure
- Job Descriptions and Role Definition
- Communication and Process Issues
- Documentation
- Tools of the Trade
Clinical Logistics of an Integrated Program
- Scientific Validation
- Concurrent Management and Follow-up
- Research and Outcomes
- Organizational Compatibility
- Levels of Integration
- Education and Training
Naturopathic Treatment Goals for Surgical Patients
- Prevent complications
- Reduce post-op pain and swelling
- Reduce post-op constipation
- Speed healing
- Support immunity
- Reduce/prevent spread of cancer cells
Naturopathic Support for Surgery
- Pre-op/Post-op Nutritional Guidelines
- Bromelain - Reduces inflammation and thrombophlebitis
- Curcumin - Reduces post-op pain
- Catechin - Reduces adhesions and post-op edema
- Modified Citrus Pectin
- Fractions of longer carbohydrate chains derived from citrus pectin
- Bind to cancer cell surface galectin-3 proteins
- Interfere with ability of cancer cells to aggregate and to attach to healthy cells
Common Side Effects of Chemotherapy
- Nausea/vomiting
- Mucositis
- Diarrhea
- Fatigue
- Hair loss
- Anemia
- Leukopenia
- Thrombocytopenia
Potential Long-term Side Effects
- Development of tumor resistance
- Increased risk of secondary cancers
- Increased risk of leukemia/lymphoma
- Infertility
- Persistent fatigue
- Persistent marrow suppression
Naturopathic Treatment Goals During Chemotherapy
- Enhance tumor kill during treatment
- Reduce side effects during treatment
- Prevent long term complications
Naturopathic Support During Chemotherapy
- Vitamin A
- Vitamin C
- Vitamin E
- Glutathione
- L-glutamine
- Co-enzyme Q10
- Green tea
Homeopathic Remedies for Chemotherapy Side-effects
- Arsenicum
- Cadmium sulfuratum
- China officinalis
- Ipecac
- Nux vomica
- Phosphorus
Radiation Therapy
- Side effects
- burning
- desquamation
- discoloration
- fat necrosis
- nerve damage
- reduced blood counts
- fatigue
- Collateral damage to other tissues (heart, lungs, intestines etc)
- Secondary cancers
Homeopathic Remedies for Radiation Side-effects
- Remedies listed for chemotherapy
- Calcarea fluorica
- Fluoricum acidum
- Radium bromatum
- Sol
- X-ray
Immune Support
- Basic Good Nutrition
- adequate protein
- low sugar and simple carbohydrates
- Vitamin C
- Vitamin A
- Zinc
- Carotenoids
- Vitamin E
Immune Support
- Astragalus, Echinacea, berberine
- Thymus extracts
- Bromelain
- Mushroom polysaccharides
- 1,3 beta glucan
- Omega 3 fats
- L-arginine
- PNI & stress reduction
Natural Anti-tumor Agents
- Cause cell death / induce apoptosis
- Antiangiogenic
- Anti-metastatic
- Slow/arrest abnormal cell division
- Block hormonal stimulation
- Stimulate immune system (esp. NK cells)
D. Research
To Support Benefits of Radiation
- Genestein (Clin Cancer Res 1997;3:1775)
- PSK (Anticancer Res 1993;13:1815)
- Ashwaganda (Ind J Exp Biol 1996;34:927)
- Quercetin (Cancer Res 1997;3:1775)
- Vitamin A (J Natl Cancer Inst 1984;73:1167)
- Niacin 500-6000 mg daily
To Reduce Radiation Damage
- Squalene (Lipids 1993;28:555)
- Green tea (Life Sci 1992:50:147)
- Vitamin C (Am J Clin Nutr 1991;54:1281s)
- Vitamin E (Bull Cancer Radiother 1996;83:12-16)
- Glutamine (J Parent Ent Nutr 1990;14s:106s)
- Zinc aspartate (Int J Cancer 1992;52:604)
- Anti-oxidants (Jpn Heart J 1996;37:353)
- Curcumin - Induces apoptosis
Cancer Res 1999 Feb 1;59(3):597-601- Inhibits cancer at initiation, promotion & progression stages
J Am Coll Nutr 1992;11:192-8- Reduces lipid peroxidation
Mol Cell Biochem 1992;111:117-24- Pancreatic and Colorectal cancer
Int J Cancer 1997;70:225- Lung cancer
Jpn J Ca Res 1995;86:1027- Prostate and Breast cancer
Cancer Lett 1995;96:239
Melatonin
- May reduce cachexia via TNF
- Useful in Breast, Lung and Colon cancer
- Prolongs survival in NSC lung cancer
Oncology 1992;49:336- Reduces disease progression in melanoma patients
J Pineal Res 1996;21:239IV. Limitations
In addition to specific medical difficulties that have arisen through systematic and scientific medical trials, Dr. Birdsall could not stress enough the difficulties involved when two clashing fields of medicine try to work together. Dr. Birdsall cited that nearly 80% of cancer patient have tried some sort of alternative medicine in conjunction with their traditional or conventional medical treatment. However only a small fraction of those patients have told their traditional clinician about their alternative pursuits. Instead of working independently of each other, alternative and conventional cancer clinicians need to integrate their treatments along with myriad other care-givers to provide the very best treatment for a patient.
The Antioxidant Controversy
"For many years it was assumed that radiation therapy and many chemotherapeutic drugs killed malignant cells directly by wreaking widespread havoc in their DNA. We now know that the treatments often harm DNA to a relatively minor extent. Never the less the affected cells perceive that the inflicted damage can not be easily repaired and they actively kill themselves." Sci Am 1996;275(3):62-70
"Many cancer cells lacking p53 do not undergo apoptosis in response to DNA damaging drugs or radiation and drugs that stimulate apoptotic pathways would be useful in this regard" Cell 1994;79(4):573-582
"antioxidants significantly enhance tumor growth inhibition by cytotoxic chemotherapy in vitro and in vivo." Nature Med 1997;3(11):1233-1241
"Patients receiving antioxidants were able to tolerate chemotherapy and radiation treatment well. Surviving patients started antioxidant treatment in general earlier than those who succumbed." Anticancer Res 1992;12(3):599-606
V. Comments:
Dr. Susan Sencer, MD, of the Children’s Hospital and Clinics (Minneapolis) agreed and stressed and reiterated the importance of preventative medicine and a healthy lifestyle. Not only is important to for an adult to abide by healthy life practices, but Dr. Sencer stressed the importance of reaching out to children and catching them before their relative health deteriorates.
VI. Resources:
Tim Birdsall, ND
Midwestern Regional Medical Center
2520 Elisha Avenue
Zion, IL 60099
847-872-6067
tim.birdsall@mrmc-ctca.com