Step into the chemotherapy room at the Los Angeles-based clinic of oncologist Lorne Feldman, MD, and see just how much cancer therapy has changed in the past four or five years. Music plays, as an acupuncturist and a massage therapist circulate among the dozen patients who are chatting while they get their infusions. A dietitian answers questions about nutrition. Nurses trained as cancer counselors do research for patients and provide medical referrals. Dr. Feldman, a graduate of our Program in Integrative Medicine’s Associate Fellowship and a man who has been living with cancer himself for eight years, says, “My patients almost look forward to their treatments when they can get together with their friends. It’s a very good support group.”
It pleases me to see how many cancer centers around the country now routinely offer nutritional counseling, acupuncture, massage, mind-body techniques, and support groups to people getting chemotherapy and radiation. Hospital administrators are responding to patient demand, as the overwhelming majority of cancer patients are already using some form of complementary and alternative medicine (CAM). And oncologists are responding to increased evidence that these therapies improve the experience and possibly the prognosis for cancer patients. Even the generally conservative American Society of Clinical Oncology now offers information about CAM therapies on its patient website (www.cancer.net).
There’s still a way to go before true integrative oncology is the standard of cancer care. None of the so-called integrative cancer centers I know of are willing to recommend the use of natural products like astragalus and other Chinese herbs to reduce toxicity of chemotherapy and radiation, or Asian mushrooms for anti-cancer effects. Instead, they stick to “safe” modalities like massage and counseling (full list of complimentary treatments on cancer.gov)
Still, the new whole-person, patient-centered approach gives cancer patients more say in their treatment decisions and more options for self-care. There are now many ways you can actively participate in your healing, helping yourself to feel better and function better—before, during, and after chemotherapy and radiation. I think even those who need only surgical treatment for cancer can benefit from the advice below.
Before Treatment Begins
If you have a few weeks before treatments begin, use that time to put your game plan in place. Build your strength through good nutrition, regular exercise, and plenty of rest. Educate yourself about the form and stage of cancer you have, and make sure you understand clearly the goals of the treatment you’re about to undergo. Choose a state-of-the-art health-care team willing to partner with you in your care. Pull together your support crew—the people who will do research, take you to medical appointments, fill your refrigerator, drive your kids to soccer, provide progress reports to your friends, and keep you sane. Learn mind-body techniques such as self-hypnosis, guided imagery, or progressive muscle relaxation from a professional or a good-quality audiotape. Assess your personal strengths—such as a positive outlook and determination—and consider how to use them best.
During Chemotherapy or Radiation
I recommend few herbs, vitamins, or supplements during the course of chemotherapy or radiation, except for those in the botanicals section below and in the box at right. The reason for this is a lack of solid research on their risks and benefits. Some herbs and supplements have the potential to interfere with chemotherapy and radiation. For instance, there’s an ongoing controversy about whether taking antioxidant vitamins and minerals interferes with conventional therapy or enhances it. I prefer to err on the side of caution, and recommend against taking any supplements—even a multivitamin—that may have antioxidant activity during treatment.
The recommendations below are general, since specific prescriptions for diet, exercise, stress reduction, and psychological support may vary based on a patient’s form and stage of cancer, other health problems, and personal preferences.
The six essential supports during cancer treatment
1. Healthy diet.
Eat a whole-foods diet high in fruits and vegetables, including berries and dark leafy greens, which are rich in protective phytochemicals. (Don’t skimp on fruits and veggies out of fears that they contain antioxidants; the concern is about antioxidant supplements, not food sources of them.) Go easy on animal protein, and get no more than 30 percent of total calories from fat, mostly from healthy monounsaturated fat (found in olive oil, nuts, and avocados) and omega-3 fatty acids (in salmon, walnuts, and ground flaxseed). Flaxseed may also be protective for those with hormonally driven cancers of the prostate, breast, ovaries, or uterus. If you eat meat, try to find hormone-free, organic varieties. Until the controversy about whether or not soy stimulates cancer cells is settled, eat no more than one serving a day of whole soy foods like tofu or soy milk, and avoid soy supplements (including soy protein powder). Right now, the data is mixed on whether soy may interact with tamoxifen (used to treat breast cancer or prevent its recurrence), so those on the drug may want to avoid soy altogether. Drink your six to eight glasses of water and other healthy beverages like green tea every day to help flush the toxic byproducts of treatment from your body.
Moderate exercise has been shown to reduce fatigue, anxiety, and depression in cancer patients, and may boost immune function. Start with as little as two or three minutes of walking at a time, if necessary, gradually building to at least 30 minutes five days a week. Gentle, more meditative types of exercise such as tai chi or qigong may increase your sense of well-being.
Ask your doctor for an exercise prescription that fits your specific situation. Cautions may vary; for example, someone with low blood counts may be told to avoid swimming due to concerns about bacterial infections.
3. Stress reduction.
Cancer treatment can be stressful, and chronic stress seems to weaken the immune system. Make sure to get enough sleep. Pick a mind-body technique that appeals to you and use it regularly to relieve anxiety, reduce pain and nausea, and help strengthen your immune system. Radiation oncologist Matt Mumber, MD, a graduate of the Associate Fellowship Program with a practice in Rome, Georgia, has found the Relaxing Breath described in my books and recordings to be very powerful for his patients.
4. Emotional and spiritual support.
The American Society of Clinical Oncology now states that high-quality cancer care “requires” psychosocial support for the patient. There are few studies yet, but I believe that such intangibles as patients’ active involvement in their care, their ability to cope with the changes in their lives caused by a cancer diagnosis and resulting treatment, and their sense of hope all affect quality of life and ability to heal. Surround yourself with positive people.
This is a time when many people turn toward the spiritual realm for strength and comfort. At our Program in Integrative Medicine (PIM) clinic, we do a spiritual assessment for our patients and try to match them with people or groups that meet their interests—anything from doing soul retrieval work with a shaman to consulting a Presbyterian minister.
Medicinal mushrooms and their extracts can boost the immune system and may also have anti-tumor effects, and they are used in Japan and China to increase the effectiveness of conventional cancer treatment. To get a range of mushrooms, try a combination product such as MycoSoft Gold or Stamets 7 from Fungi Perfecti (www.fungi.com or 800-780-9126), or Host Defense from New Chapter (available at health food stores). Dr. Mumber has found that a green tea/maitake mushroom blend is especially helpful for patients with cancer-related fatigue. At the PIM clinic, we have also recommended two Chinese herbal formulas, Chemo-Support and Radio-Support, to reduce the toxicity of conventional treatments. The Crane Herb Company (www.craneherb.com) sells both of these formulas to health practitioners.
If there are botanicals or supplements that you would like to take during treatment, be sure to talk to your physicians. They may not be willing to recommend products to you (on account of liability issues), but may accept your taking them on your own initiative.
6. Energy medicine.
PIM executive director Victoria Maizes, MD, always recommends acupuncture—during or after the course of treatment—to cancer patients at our clinic because she’s found that it reduces pain and nausea, raises low energy levels, and increases the ability of patients to tolerate chemotherapy. In addition, I suggest that you consider energy therapies such as Therapeutic Touch, Reiki, and Jin Shin Jyutsu.
Once Treatment Is Over
After chemotherapy and radiation are finished, the real work of restoring your health and preventing recurrence can begin. Start taking a good-quality multivitamin and multimineral supplement again. You can add a daily tonic such as Panax ginseng or eleuthero (Siberian) ginseng. Women recovering from breast cancer may want to take Coenzyme Q10 after chemotherapy is done (180 mg a day in softgel form with meals), as preliminary research suggests this supplement may increase longevity and prolong remission in breast-cancer patients. Also, preliminary research suggests high doses of melatonin (20 mg a day at bedtime) may extend survival and improve quality of life in people with advanced solid tumors who haven’t been helped by conventional treatment.
Consider traditional Chinese medicine to restore balance to your body. Maintain or gradually increase your exercise program. Your diet is a key preventive strategy to stop your cancer from coming back, so focus on fruits, vegetables, whole grains, and foods specifically associated with prevention of the type of cancer you had. Now may be a good time to find a counselor or a support group to help you deal with issues that have come up as a result of your cancer diagnosis.