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Naturopathic Oncology: a chapter in Integrative Cancer Care.

You or a person you care about is diagnosed with cancer. A whirlwind of emotions and thoughts about life and death may begin to enter your heart and soul at some level. Has the cancer been caught early enough? Is the cancer treatable? How effective are the treatments for my case? What can I do to help minimize the risks? For some patients, the situation involve a recurrence, in which a past cancer has come back. For others, conventional treatments may not be working as well as they should be. And, finally, there are those cancers for which no noteworthy treatment or perhaps only marginal treatments are available in the first place.

There is also another group of people with a cancer diagnosis--who are either in active treatment or who have finished--who have been hurt by the treatments that are designed to help (it's the unfortunate double-edged sword of conventional cancer treatment--helpful in treating the cancer site yet potentially harmful to the rest of the body). For example, over time, some chemotherapy medicines may cause nerve problems, and radiation treatments can harm the tissues and organs. Some patients need to halt treatments because of low white blood cell counts, and others may need blood transfusions. Still other patients literally may be consumed by feelings of fatigue, either during treatment or from months to years post-treatment. In fact, fatigue is one of the most common and debilitating symptoms experienced by patients with cancer.

The emerging field of Naturopathic Oncology may hold answers and support for people found in the above situations of the cancer care paradigm. For those unfamiliar with naturopathic medicine and trained naturopathic physicians, let me first shed some light. In the Canadian province of British Columbia, for example, naturopathic physicians have had their own act in the government since the 1920s; it is not a new profession. Naturopathic physicians are licensed and insured as primary care providers and have a similar legal responsibility as medical doctors. To become a Naturopathic Doctor (ND), one needs to complete the standard pre-medical school courses (about four years) and then complete four to five years of naturopathic medical education. Once in naturopathic medical school, students are exposed to a broad field of natural medicine and healing philosophies. For example, botanical/ herbal medicine, homeopathic medicine, Traditional Chinese Medicine (TCM), acupuncture, Ayurvedic medicine, nutritional medicine, physical medicine (akin to courses taken by a physiotherapist or chiropractor), diet and lifestyle counseling, along with psychological counseling are some of the areas that make up naturopathic medicine. At graduation, N Ds have completed more than 4800 hours of naturopathic medical education.

Moreover, NDs also have the advantage of being trained in conventional medical care and diagnostics, offering patients a "best of both worlds" approach. Consequently, in my practice, I help patients read medical reports, laboratory tests, and imaging studies (CT Scan/X-rays, etc.). When needed, I perform physical exams, order blood tests, medically monitor patients, intravenously support (i.e., hydrate), and make referrals to their oncology team. In Naturopathic Oncology, understanding standard oncology medicine is vital. In fact, I am finding more and more patients coming to my office who have been recently diagnosed with cancer and who are simply looking for help in understanding what their cancer diagnosis means. (As you can imagine, most patients are overwhelmed.)

Naturopathic Oncology is simply the use of naturopathic medicine and its principles in specifically assisting and/or treating patients with cancer. Enhanced survival and quality of life are the main focus. An emerging organization known as the Oncology Association of Naturopathic Physicians (OncANP) is helping to standardize this important specialty. Another more commonly used term, which also signifies the blending of both worlds (i.e., Eastern & Western medicine) and a more holistic approach to cancer, is Integrative Cancer Care (ICC). A practitioner of Naturopathic Oncology is not the same as a Medical Oncologist or Radiation Oncologist, who are specifically trained in conventional cancer care and treatments. Rather, an ND practicing Naturopathic Oncology is devoting time, energy, and practice focus into determining how more natural methods of health and healing safely fit into a cancer patient's treatment program. For example, in my practice, over 90% of the patients treated have cancer. Of those, the majority are also receiving some form of standard cancer care. Moreover, because an ND is also trained in conventional medical care, we can offer suggestions on standard oncology treatment(s) and also provide direction and supervision on more experimental or unconventional options, if desired.

Why is Naturopathic Oncology so important, especially during this time of medicine? First of all, it is becoming more and more common for patients diagnosed with cancer to seek and incorporate complementary and alternative medicine (CAM). For example, more than 80% of all women with breast cancer report using CAM. Moreover, there are groups of patients with cancer who use CAM without the knowledge of their treating medical oncologist and staff. This is potentially dangerous for both the patient and doctor, as the choice of a qualified practitioner comes into question. There are potential areas of concern (i.e., contraindications) that exist between herbal-vitamin products, medications, and standard cancer care of which a patient may not be aware. An ND with an interest in oncology is a perfect bridge for such situations.

Imagine another dilemma where a patient and support members are facing a cancer diagnosis that is not responding well to standard oncology care. In my experience, there tends to be an overwhelming amount of information recommended by concerned family and friends or through Internet sources, magazines, health shows, etc. on how a health product, diet program, or an out-of-the country clinic may help (or even "cure") patients with cancer. A hurricane of information, confusion, and stress can result from this process. However, for those that know a little about hurricanes, the center (also known as the eye of the storm) can be quite calm and clear. A goal of Naturopathic Oncology and ICC is to help create a place of clarity and stability so that all the above information can be objectively filtered, analyzed, and safely applied to each case under the care of the ND. It's a team-oriented process between the patient and the doctor. A patient, along with his or her support people, can gain a sense of control and attempt to also nourish mental and emotional well-being during these periods.

There are also situations where patients are seeking means of enhancing their treatment responses that may not be explained by their standard oncology team. For example, in women with breast cancer, research suggests that physical activity or simply walking three to five hours per week at a moderate pace helps to strongly decrease the relative risks of dying by almost 50%, especially in those with more hormone-sensitive forms (i.e., estrogen-positive) (JAMA 2005). Moreover, the results hold true if the cancer was diagnosed early and even more so in advanced cases (i.e., stage III). I have yet to read a patient's oncology medical report that suggests the potential importance of physical activity in increasing survival. Regarding colon cancer, a recent paper (JAMA 2007) revealed that patients with stage III disease who ate less of the typical North American diet (meat, fat, refined grains, and dessert.) and more fruits and vegetables, poultry, and fish lived longer (decreased recurrence risk) and performed better with surgery and chemotherapy. The above two examples shed light on how very simple interventions may strongly impact cancer. For those wanting to use varying degrees of integration (i.e., select natural health products, vaccines, intravenous therapies, etc.), interesting research also exists in those areas as well.

Overall, everyone is trying their best to help patients with cancer and ultimately find a cure whenever possible. When you are in the trenches with patients who are fighting cancer, any advantage, no matter how small, can be considered a ray of sunshine. 1 have personally seen many patients throughout the years who had been told they had weeks to a few months to live and yet are alive years later. While controversies exist on using combination approaches during standard cancer care, when a patient is monitored under appropriate supervision and feels empowered about decisions, he or she responds better and reports fewer side effects. I commonly hear patients report back to me that their medical oncologists have told them to "keep doing whatever you're doing." In the US, more and more hospitals are incorporating NDs working together as part of the oncology team. In Canada, ICC facilities such as Inspire Health in Vancouver are doing the same and leading the way. Naturopathic Oncology has risen to meet the calling for quality, regulated, and responsible physician-level practitioners to help lead the swell of interest and information regarding unconventional approaches to treat a person with cancer. Naturopathic Oncology, if the patient chooses, can be incorporated safely at any stage of a cancer treatment program (i.e., before, during, or after) and can also be utilized for those wanting to rebuild their health and support recovery. Having a naturopathic doctor who is primarily focused in oncology can be an integral part of a patient's cancer care team.

Dr. Walter Lemmo is a practicing naturopathic physician who has a specialized practice in Integrative Cancer Care. He is associated with Inspire Health, Vancouver's non-profit integrated Cancer Care facility. For more information, please visit www.lemmo.com or call 604-788-8858.

References

Boon HS, et al. Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005. BMC Womens Health. 2007;7:4.

Hofman M, et al. Cancer-related fatigue: The scale of the problem. Oncologist. 2007; 12 (Suppl 1): 4-10.

Holmes MD, et al. Physical activity and survival after breast cancer diagnosis. JAMA. 2005; 293(20):2479-86

Meyerhardt JA, et al. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA. 2007;298(7); 754-64.

Rubin D. Naturopathic oncology: an emerging discipline. Hematology & Oncology News & Issues. August 2005:19-22.

Weizer K. The eye of the hurricane: Surviving cancer. NO News & Review. 2006;2(2): 17.
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Author:Lemmo, Walter
Publication:Townsend Letter
Geographic Code:1USA
Date:Aug 1, 2008
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