What is integrative medicine? Podcast explores nutrition and holistic cancer therapies

What is integrative medicine? Podcast explores nutrition and holistic cancer therapies

A nutritionist has launched a platform sharing expertise on food and the fight against cancer. Jason Bosley-Smith is founder and host of ONCancer Health. The online resource offers podcast interviews and content from clinicians and academics working in nutrition and cancer. Topics involve evidence-based studies with a focus on exploring cutting-edge, holistic therapies.

A proponent of integrative medicine, Bosley-Smith teaches at the Maryland University of Integrative Health. Patients are no longer satisfied with one-size-fits-all guidelines. Instead, they desire customizable herbal, exercise, and nutritional remedies, according to Bosley-Smith.

“There’s been somewhat of a paradigm shift toward functional and complementary medicine. In the healthcare system, some traditional dietary recommendations have become a bit antiquated,” he said to SmartBridge Health.

A licensed nutritionist, Bosley-Smith said his interest in nutrition, health, and specifically cancer, stemmed from personal experiences. His grandfather died from colorectal cancer. Later, a childhood friend entered hospice care because of skin cancer. The friend was a 36-year-old mother of two young children.

What's the difference between active surveillance and watchful waiting when treating prostate cancer?

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Prostate cancer often grows slowly and should not be treated unless it is likely to cause a patient harm during his lifetime.  Based on the traits of a patient's prostate cancer, his overall health and medical condition, a game plan which avoids surgery and radiation may be best.  

Active surveillance is where the patient and physician defer surgery or radiation right away, and instead track the cancer's status.  With active surveillance, you and your doctor will follow clues from routine PSA tests, DREs (Digital Rectal Exams), biopsies and imaging (i.e., MRI) to determine if the cancer is growing or getting more aggressive.  If that happens, then you and your doctor will work out the next steps.  

Active surveillance is best for men with small, low-risk tumors without symptoms.  It is also good for men who are at a higher risk from surgery or radiation.  Action is taken only if the cancer changes or grows.  Active surveillance may require you to have multiple biopsies to track cancer growth.  

Watchful waiting is a less aggressive form of monitoring prostate cancer without treating it.  It does not involve regular biopsies or other frequent testing.  Watchful waiting is best used for men with prostate cancer who do not want or cannot have treatment therapies, especially those men with other life-threatening medical conditions. 

The main benefit of watchful waiting is that it avoids many treatment and surveillance-related risks and side effects.  However, with this approach the cancer could grow and spread between follow-up visits and ultimately make it harder to treat.  Patients should talk with their doctors about which method is best.  

Why should I get a prostate cancer screening?

Why should I get a prostate cancer screening?

It's time for men to break the stigma. Dr. Kelvin Moses, Urologist at Vanderbilt University, shares why it's important to talk about prostate cancer screening with the men in your life. 

"That’s very important because men in general and certainly black men... are maybe afraid. Prostate function deals with sexual function and urinary function and maybe not everybody is comfortable talking about that..."

Watch the VIDEO to hear ways to help men start the conversation on prostate health

What should I eat if I have cancer?

What should I eat if I have cancer?

A common question patients have is what they can do from a dietary standpoint upon being diagnosed with cancer. While most cancer-treated is focused on doctor prescribed regimens (chemotherapy, hormonal therapy, radiation, surgery), there are many studies that have focused on nutrition. Are there "good" foods to eat from a cancer standpoint? 

Should I use marijuana as part of my cancer treatment?

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Marijuana as Medicine

Marijuana has been used in herbal remedies for centuries. There are two main biologically active components in marijuana: tetrahydrocannabinol (THC) and cannabidiol (CBD). A number of studies of marijuana found that the active components can be helpful in treating a number of cancer-related symptoms, including nausea and vomiting from chemotherapy, neuropathic pain (pain caused by damaged nerves), poor appetite, pain relief, anxiety and insomnia.

There are two chemically-pure drugs based on marijuana compounds that have been approved by the US Food and Drug Administration (FDA) for medical use.

  • Dronabinol (Marinol®) is a gelatin capsule containing delta-9-tetrahydrocannabinol (THC) that is approved by the FDA to treat nausea and vomiting caused by cancer chemotherapy as well as weight loss and poor appetite in patients with AIDS.
  • Nabilone (Cesamet®) is a synthetic cannabinoid that acts much like THC. It can be taken by mouth to treat nausea and vomiting caused by cancer chemotherapy when other drugs have not worked.

Side Effects

Like many other drugs, the prescription cannabinoids, dronabinol and nabilone, can cause side effects and complications. Some people have trouble with increased heart rate, decreased blood pressure, dizziness or lightheadedness. These drugs can cause drowsiness as well as mood changes or a feeling of being “high” that some people find uncomfortable. They can also worsen pre-existing mental illnesses. Patients have also reported problems with dry mouth and trouble with recent memory. People who have had emotional illnesses, paranoia, or hallucinations may find their symptoms are worse when taking cannabinoid drugs.

Marijuana Today

In addition to the two FDA-approved medications mentioned above, recreational use of marijuana is prevalent in cancer populations, particularly now that over half of the states have legalized its use. 

As of January 8, 2018, 30 states and Washington DC have legalized marijuana in one form or another (either only medical-use or both medical and recreational use). See the State Marijuana Laws in 2018 Map.

Meanwhile, a recent study found that where marijuana or its derivatives are legal, up to 25% of cancer patients engage in its use. However, as of date, the FDA has not approved the use of botanical marijuana to treat any medical condition. The FDA states more research and conclusive evidence are needed. 

Talk to your doctor about what you should expect when taking one of the FDA-approved drugs or if you are considering using recreational marijuana. It’s a good idea to have someone with you when you first start taking one of these drugs and after any dose changes.

References:

 

Post right hemi-colectomy. Refused chemo. Now discovered residual cancer in fatty tissue next to anastomosis. How do you treat this?

The patient underwent hemicolectomy without chemotherapy and had a locoregional, anastomotic recurrence.  

First, for proper staging, a PET CT should be performed. This is not an uncommon location for recurrence in patients who haven't undergone chemotherapy, though data is limited.

Repeat surgical resection, if the cancer is in fact localized to the are near anastomosis, should be the next step, along with evaluations by medical and radiation oncology who will coordinate care with the surgeon.

Chemotherapy, and possibly radiation therapy, should be strongly considered either before or after surgery.

What is the best treatment for adenocarcinoma of the lung?

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When considering treatment options for non-small cell lung cancer like adenocarcinoma, we evaluate the patient’s stage (I-IV) and if appropriate, molecular profile. Staging is dependent on the size, location, and number of lymph nodes involved in the lung cancer. Types of treatments include radiation therapy, surgery, and systemic therapy (which is further divided into chemotherapy, targeted therapy, and immunotherapy).

Stage IA lung cancers can be managed surgically if the patient is able to undergo an operation, and if the tumor is in a location that is surgically accessible. Radiation treatment alone may also be used.

For stage IB, II, and IIIA patients, surgery, radiation alone or with chemotherapy may also be used. These decisions depend on lymph nodes involved by the cancer, how healthy the patient is, and if the surgery had clean resection margins (meaning there was no cancer at the edges of the tumor).

Stage II and III patients with cancer that has spread to the lymph nodes also benefit from immunotherapy postoperatively.

Stage IIIB lung adenocarcinoma is treated with chemotherapy, radiation, and followed with an immunotherapy called durvalumab.

In patients with Stage IV, metastatic lung adenocarcinoma, we must first consider the performance status of the patient to ensure that our treatments will not cause undue harm. Surgery is rarely used in Stage IV lung cancer, and only if there are very few locations of metastasis in an otherwise healthy patient. Molecular testing including EGFR, ALK, ROS1, BRAF mutations and PD-L1 percentage are standard of care in this group of patients. In patients with cancers that harbor the aforementioned mutations, targeted, oral therapies are used. Chemotherapy and immunotherapy can be considered when the tumor develops resistance to these treatments. If PD-L1 status is greater than 50%, immunotherapy, namely pembrolizumab, is appropriate first line therapy. In the absence of mutations or high PD-L1 levels, chemotherapy, with or without immunotherapy, is front line treatment. Immunotherapy, other types of chemotherapy, and clinical trials represent options after chemotherapy.

Special considerations must also be taken for patients who have lung cancer that has metastasized to their brain. These cancers are treated with surgery and radiation, though some will have responses to chemotherapy or targeted therapy. We are not certain how effective immunotherapy is in patients with brain metastasis from lung cancer, but studies are ongoing.

I've heard that some alternative medicine treatments may actually cure cancer. Is this true?

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It can be difficult sometimes to conduct evidence-based medicine clinical trials on these methods of treatment because there may not be clear-cut measurements that can tell us how effective they are in an isolated manner.  For example, someone may be doing some form of complementary medicine while also getting other standard treatment.  How do you determine which did what?  More and more scientifically based research is being done now and some therapies have been proven to be beneficial for cancer patients. 

There are lots of websites that claim something works.  They may be self reporting by a company and not credible conducted studies that are evidence-based and conducted in the rigid manner in which clinical trials are to be carried out.  These claims sound wonderful and even imply that it's a "cure for cancer" where there may be nothing that scientifically supports those claims.  Be cautious of advertisements that claim that for a fee they will mail you the cure for your cancer. 

If what they were selling really was a cure then an NCI-designated cancer center would be offering it and telling you about it.  The U.S. government founded the National Center for Complementary and Alternative Medicine as part of the National Institutes of Health with the intended goal of providing information about what is safe and effective regarding these types of therapies.  Ask your doctors or SmartBridge Health for input regarding information you have read about or heard so you can weed out accurate information from claims that may not be correct.  There are some types of therapies that would interfere with the treatments your doctor has given you.  For example, certain vitamins in high doses may impair the effect of some chemotherapy drugs.  There are other types of therapies that your doctor may encourage you to do, such as acupuncture or yoga.  

How might immunotherapy help the immune system fight cancer?

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There are different types of immunotherapies.  They can all help the immune system in different ways.  Let's take a closer look.  

Tricky cancer cells can escape from detector cells and deactivate fighter cells.  In turn, these cancer cells can continue to survive and grow into a tumor.  Your immune system may need help finding and attacking the tricky cancer cells again.  That's where immunotherapy comes in.

Immunotherapy can help your immune system fight cancer.  However, immunotherapy might also cause your immune system to harm healthy cells.  The way immunotherapy works is different from how other types of cancer treatment work.  For example, chemotherapy acts on fast-growing cells.  This may destroy cancer cells, but may also destroy healthy fast-growing cells, like hair cells.  

Some immunotherapies stop tricky cancer cells from escaping detector cells.  Then, detector cells can become alerted.  Other immunotherapies can help fighter cells stay activated.  The activated fighter cells can then attack cancer cells.  There is research being done to see how new immunotherapies may help your immune system fight cancer.  

What should I expect with chemotherapy?

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Drugs used for chemotherapy come in many different forms.  Some chemotherapy drugs are taken by mouth as pills while others are given into a vein (intravenously) in a doctor's office or clinic.  Patients may receive one chemotherapy drug or a combination of chemotherapy drugs.  

It may take several hours to have chemotherapy at a clinic or hospital.  Depending on the type of chemotherapy, the patient may take medications before the chemotherapy.  These are called premedications and can help stop or reduce certain side effects, such as nausea.  

Chemotherapy treatments are given in cycles.  Different chemotherapy drugs have different cycles.  For example, some chemotherapy drugs are given once a week, while others are given every three weeks.  Patients may not always get the same drug(s) on treatment days.  Patients take breaks between cycles and this may help reduce side effects.  

Possible side effects

Every patient may experience different side effects of chemotherapy drugs and the severity of side effects will vary from person to person.

While possible side effects vary with different chemotherapy drugs, the most common side effects include:

  • Anemia (low red blood cell count)
  • Extreme tiredness
  • Hair loss
  • Increased chance of bruising, bleeding, and infection
  • Nausea and vomiting
  • Neutropenia (low white blood cell count)

Most side effects are temporary and begin to lessen after treatment ends. You may need to take other medications to prevent or ease these side effects.  If side effects are severe, your doctor may temporarily stop or lower the dose of the chemotherapy.  Or your doctor may recommend a different chemotherapy medication.  

What's in my pathology report?

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Because every person's cancer is different, it's important to understand your unique diagnosis and tumor biology to help guide your personalized treatment.  To provide specific information about your cancer, your physicians will perform several tests on your tumor tissue.  

Your pathology report is one of the resources that contains information about your tumor, which will help guide your healthcare team in planning the appropriate treatment for you.  Ask your doctor if there are additional tests you should consider to ensure you have the most complete picture of your unique cancer.  

Here is some information about your tumor that is contained in your pathology report:

Stage:  Staging is the assessment of how far the cancer has progressed.  In most cases, the lower the stage, the better the prognosis.  (Stage 0 to Stage IV)

Tumor Size:  The size of the cancer is one of the factors that determines the stage of the breast cancer.  

Margins:  This describes the area at the edge of the specimen being examined by the pathologist.  Positive margins mean that cancer cells are found at the edge of the material removed; negative/not involved/clear margins mean that no cancer cells are found at the outer edge; close margins are neither positive nor negative.  

 

My primary oncologist prescribed Zofran tabs sublingual (4 mg every 6 hours as needed) but I continue to have symptoms. I have no appetite and losing weight as a result. Are there any other options?

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I’m a patient currently being treated with R-CHOP therapy for lymphoma. I have persistent nausea that is incredibly burdensome.

I am very sorry to hear of your current nausea. This is a known side effect of some chemotherapy regimens. Fortunately, we have a lot of experience in managing nausea and numerous options are available to you.

In order to appropriately provide recommendations it is important to briefly review the different kinds of nausea and vomiting to determine the best approach for you. In your specific situation the major types of nausea are most likely acute or delayed chemotherapy-induced nausea/vomiting (CINV) and/or anticipatory nausea/vomiting (ANV). Acute CINV is when nausea occurs within the first 24 hours from receiving chemotherapy. Delayed CINV is when nausea occurs after 24 hours from receiving chemotherapy. Lastly, ANV is a conditioned response where someone has nausea prior to receiving chemotherapy.

Most oncologists consider patients who receive R-CHOP to be moderate to high risk for developing acute or delayed CINV. Thus, I would think this is what you might be experiencing. The standard way to approach this is using Zofran, which you are currently using. I would recommend scheduling your Zofran every 6 hours. You can try taking Zofran 30-60 minutes before you eat a meal, which should decrease your nausea prior to eating. If this does not work then it would be reasonable to use Compazine 10 mg four times a day. You can combine the Compazine at the same time you take Zofran.

If this does not work then I would recommend you contact your local oncologist for further therapeutic options, which may include Ativan, Dexamethasone, Olanzapine, and/or Marinol.

Prior to receiving your next dose of R-CHOP please let your oncologist know about your nausea, as we would like to prevent this from happening again in the future. We are able to prevent this by providing a combination of Emend + Dexamethasone + Olanzapine before, during, and immediately after receiving R-CHOP. Additionally, after completing the course of Emend + Dexamethasone + Olanzapine you can schedule Zofran every 4 hours with or without Compazine over 3-5 days.

Finally, it is important to review all of your medications with your oncologist. We want to ensure you are not taking medications that will create drug-to-drug interactions that could alter your heart rhythm. Your oncologist may ask for you to get an ECG (heart tracing) before taking certain anti-nausea medications to make sure your heart’s rhythm is normal. This information is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician prior to making decisions about your treatment.

As an African American male, what are my risks of developing prostate cancer?

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This year, the American Cancer Society estimates that nearly 1.5 million Americans will be diagnosed with some form of cancer. Scientific evidence shows that about one-third of those deaths could have been prevented by making lifestyle changes. Smoking, being overweight, lack of exercise, and eating a poor diet — all modifiable risk factors — have been linked to cancer.

Prostate cancer tends to affect older individuals. The median age at diagnosis is 68. Although most of these men die with prostate cancer, not from it, the median age of men who do succumb to the disease is 80. Because many diseases become more prevalent with increasing age, none of this may be particularly surprising.

What may be surprising is that race and ethnicity significantly influence who gets prostate cancer and who dies from it. African American men have, by far, the highest incidence of the disease: they are roughly 1.6 times more likely to develop prostate cancer than whites and 2.6 times more likely than Asian Americans. The gap in mortality rates is even more dramatic — African Americans are more than twice as likely to die of prostate cancer as whites and about five times more likely to die of it than Asian Americans.

Due to this data, many health care professionals agree to be more cautious when screening African American men for prostate cancer. However, over the last several years, controversy has developed as to who to screen and how. This is an ongoing discussion in the cancer communities, and guidelines will likely be shifting over the next several years. For now, we recommend patients engage in a discussion on the pros and cons of screening with their primary care physician. This may involve a blood test or other exam methodologies to examine prostate itself.

Sources: http://www.hopkinsmedicine.org/healthlibrary/conditions/prostate_health/prostate_c ancer_in_african-american_men_85,P01245 https://www.harvardprostateknowledge.org/prostate-cancer-risk-in-african-americans http://blog.dana-farber.org/insight/2015/09/what-african-american-men-need-toknow-about-prostate-cancer/