The following article has been provided by Barrie R. Cassileth, MS, PhD. Dr. Cassileth is Laurance S. Rockefeller Chair in Integrative Medicine and Chief, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York; she is also a member of the Scientific Advisory Board of The “New” Prostate Cancer InfoLink.
What Is Integrative Oncology?
As those of us who experience the aftermath of prostate cancer regardless of where we sit — patient, partner or professional caregiver — well know, cancer and its treatments produce side effects that seriously decrease function and quality of life. Mainstream medical care often has no effective means of managing these problems, but complementary therapies may help. These include acupuncture, mind-body therapies, exercise/physical activity, and herbs and other botanicals.
Complementary therapies are commonly used as adjuncts to mainstream treatment to control symptoms, enhance quality of life, and contribute to physical and emotional well-being. These are non-invasive, non-pharmacologic therapies that control both physical and emotional symptoms. They do not cure cancer. They do, however, effectively provide relief from the symptoms that patients and survivors commonly experience.
The term “integrative oncology” refers to the combination of mainstream treatments and complementary therapies. There is growing recognition in cancer programs and centers nationally and internationally that the symptoms associated with cancer and its successful treatments, not just the tumor alone, must be addressed. That is the role and the goal of integrative oncology. Some important examples used in various cancers, not just in prostate cancer, are given below.
Acupuncture can reduce hot flashes, shortness of breath, chronic fatigue, pain, neuropathy and osteoarthritis. Make sure your acupuncturist is certified or licensed, and is trained or experienced in working with cancer patients, as acupoints may differ for the same problem in people with, versus without, a cancer diagnosis. Acupuncturists are required to use sterile, single-use needles. Acupuncture needles are not hollow like hospital needles, and therefore are very thin and virtually painless. No negative side effects, inexpensive, and worth a try. If it doesn’t help after three or four visits, give it up.
Mind-body therapies, including relaxation therapies, meditation, self-hypnosis (essentially a deeper form of meditation), music therapy, yoga and the like can relieve stress, pain, sleeplessness and anxiety. The department at Memorial Sloan-Kettering Cancer Center has several “Training for Treatment™” classes (or CDs for people from elsewhere), including one that teaches preoperative self-hypnosis. Learning the technique is easy, and applying it before surgery can produce faster return of physiologic systems, less time in the postoperative recovery room and shorter hospital stays.
Physical activity reduces fatigue and depression, and has a remarkable association with improved survival. Regular exercise after diagnosis can be associated with a 50-60 percent increase in length of survival. It also improves surgical outcomes, reduces physical and emotional symptoms, and helps manage the side effects of radiation and chemotherapy.
Australian exercise physiologist Rob Newton has shown that, in men with prostate cancer, exercise can limit or even reverse some of ADT’s adverse effects by increasing muscle mass, functional performance, and cardiorespiratory fitness without elevating testosterone levels. He stresses the importance of exercise to maintain physical function, reduce fat gain, and counteract muscle and bone loss. This is especially important because hormone therapies for prostate (and breast) cancer increase the risk of cardiovascular disease, obesity and type 2 diabetes, osteoporosis and bone loss. Decades of research and hundreds of randomized trials demonstrate that appropriate physical activity can prevent and help to manage these secondary diseases.
Herbs and Botanicals
Herbs and other botanicals are popular, but may interfere with prescription medication, including chemotherapy. For this reason, Memorial Sloan-Kettering Cancer Center guidelines forbid herbal supplements when receiving treatment for cancer. These are not culinary herbs, the kind one sprinkles on food. They are dietary supplements, biologically active agents that should be viewed as unrefined pharmaceuticals. Herbs and other dietary supplements vary in their effectiveness and are best examined individually. For objective, constantly updated, free information, log on to the About Herbs, Botanicals & Other Products page on the Memorial Sloan-Kettering Cancer Center web site. ( Scientific American voted it among the top five medical sites in 2003, the year it was launched.) The site contains two entry portals: one for oncology professionals and one for patients and the public; you can enter both portals.