Complementary/Alternative Approaches in Advanced Cancer
Marc S. Micozzi, MD, PhD, Editor of Fundamentals of Complementary & Alternative Medicine, 5th ed. (2015), Elsevier Health Sciences, 759 pp; Editor of Complementary and Integrative Medicine in Cancer and Prevention: Foundations and Evidence-Based Interventions (2007), New York: Springer, 478 pp. www.drmicozzi.com
Q: Many, even millions, of Americans are living with advanced cancer. You are the author of the definitive text “Fundamentals of Complementary and Alternative Medicine,” now in its 5th edition. What forms of complementary and alternative medicine might be most useful for patients with advanced cancer?
A: In cancer treatment trials, both treatment and control groups receive treatment. Likewise, standard oncological treatments are not directly compared to various complementary/alternative (CAM) therapies. Rather CAM treatments are added, or not, to the standard oncological protocol. Thus, in research conducted, they are truly “complementary” as adjuncts to cancer treatment. Some trials on commonly occurring cancers have allowed observations of improvements in both survival times and quality of life in patients with advanced cancer. The most direct analogies to mainstream cancer treatments for research trials are dietary supplements (vitamin and mineral micronutrients, and botanicals) since they can be administered the same way as drug treatments.
Vitamin D shows strong clinical evidence of anti-cancer activity. In a recent study by Garland et al, people in the highest quantile of serum vitamin D had 17% less risk of developing advanced lung cancer compared with the lowest quantile. Men with blood serum vitamin D levels less than 30 ng/ml had 2.6 times greater likelihood of having an advanced form prostate cancer at time of diagnosis. People with lower vitamin D were four times more likely to develop aggressive melanoma. Women with malignant melanoma took in only 311 IU Vitamin D per day, about half the RDA of 600 IU/day. (Garland recommends 4000 IU daily; very few foods contain Vitamin D). In several clinical trials, women with advanced breast cancer administered Vitamin D dietary supplements showed significant improvements in quality of life and prolongation of survival time.
For Vitamin C, a key observation is that intravenous infusions are necessary to achieve the higher, steady state blood levels observed to benefit cancer patients. Clinical data suggest that high-dose Vitamin C infusions improve survival in advanced cancer patients. A study on IV vitamin C for cancer, conducted in 2012, focused on the inflammatory component of cancer. When cancer tumors are growing, there’s typically an inflammatory response in the local area. Elevated inflammation can worsen prognosis and shorten survival times in many forms of cancer. The researchers treated 45 patients with lymphoma or prostate, breast, bladder, pancreatic, lung, thyroid, or skin cancers with high-dose, IV vitamin C. In three-quarters of the patients, vitamin C treatment resulted in decreased levels of tumor markers which suggests that, over the long term, treatment with IV vitamin C would improve prognosis and survival rates in cancer patients. The study also tells us that it is probably impossible to achieve blood levels of vitamin C high enough to treat cancer by taking oral supplements.
Some cancer treatment studies had been conducted with Vitamin A (and analogue carotenoids and retinoids), which were limited by toxicity. Preliminary clinical studies suggest that micronutrients in combination are more effective than single ingredients.
A few botanical remedies, appropriate to consider this holiday season, include Boswellia, commonly known as Frankincense. It appears to distinguish cancer from normal cells, which could be helpful in targeting treatments, and avoiding toxicity of chemotherapy in advanced cancer. One study showed that frankincense could reduce the effective dose needed for cancer chemotherapy drugs. Its has been clinically demonstrated to reduce chronic inflammation, a sign of increased aggressiveness in advanced cancers. In a recent clinical trial, frankincense significantly reduced brain swelling in patients with advanced glioblastoma.
Mistletoe, or Iscador ®, is administered only by direct injection into or near the tumor site in advanced cancer patients. It is currently practiced in Germany and Switzerland, where over 80,000 patients have been treated over the past century. The evergreen tree, Pacific yew, from which the drug Taxol was derived, is used clinically for its activity against advanced breast and ovarian cancers.
Various mind-body therapies, such as biofeedback, hypnosis, mindfulness, meditation and yoga, have improved survival (through effects on cancer progression, primarily mediated by immune system), and quality of life (primarily through reduction of anxiety, depression, pain and stress, and side effects of chemotherapy), in advanced breast, prostate, and other cancers in multiple trials.
Clinical practice has yet to establish standard cancer treatment protocols routinely incorporating natural remedies, but available evidence suggests the value in CAM for advanced cancer. As Dr. George Lundberg says: what works is not ‘alternative,’ or ‘complementary;’ what works is just good medicine.
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