The Michigan Symposium for Integrative Oncology Amway Grand Plaza Hotel, Grand Rapids, Michigan September 23, 2005 Report by Holly Kiger, RN, MN INTEGRATIVE OLCOLOGY: COMPLEMENTARY THERAPIES IN CANCER CARE Keynote Speaker: Barrie R. Cassileth, MS, PhD Laurance S. Rockefeller Chair in Integrative Medicine Chief, Integrative Medicine Service Memorial Sloan-Kettering Cancer Center Dr.Cassileth first differentiated between alternative (promoted as instead of mainstream treatments--costly, and potentially harmful), complementary (used with mainstream treatments--non-invasive, inexpensive, safe, and evidence based) and integrative medicine (combines the best of complementary and mainstream care). She then highlighted some problematic alternative therapies, summarized complementary therapies, their application and study, discussed herbs and other botanicals, and presented the Memorial Sloan-Kettering Cancer Center (MSKCC) model. She noted that various studies have shown that 69-80% of cancer patients use CAM, including special diets, vitamins, herbs or acupuncture. She stated that many alternative therapies were problematic, including oxygen therapies (currently barred from marketing products with unsupported claims), no-dairy breast cancer prevention program (a study of one—no research base), antioxidants (has potential, but more research needed; a recently published meta-analysis indicated that both beta-carotene and high-dose vitamin E (>400 IU daily) can increase mortality in some patient populations), bioresonance therapy (prosecuted by FDA for unsubstantiated claims), IV vitamin C (is actually uptaken by cancer cells) and Laetrile and Vitamin B17 (studies by Mayo clinic and others have shown it to be ineffective). HOWEVER, she encouraged the use of complementary therapies to reduce side effects; enable self-care and control; enhance well-being and quality of life; strengthen the body to maximize treatment; and to reduce fear, distress, depression, and anxiety. The major clinical programs at MSKCC include touch therapies, mind-body approaches, music therapy, acupuncture, and fitness programs (exercise & nutrition). In addition they offer Yoga, Qi Gong, tai chi gong, and herb counseling programs for both patients & staff. Their pediatric programs include music therapy, hypnotherapy, multisensory therapy, massage (for kids and their parents), yoga, and Kids Kicking Cancer (Judo and dance). Integrative medicine research at MSKCC includes research on symptom control, anti-tumor botanicals, in collaboration with labs, services, and DMTs (disease management teams). She noted that follow-up questionnaires of 1,290 patients receiving massage therapy have been shown to reduce pain, fatigue, stress, nausea and depression by nearly 50%. Symptom reduction remained up to 48 hours later. They are now doing studies with 1-week follow-ups. She reported that they have also found music therapy to be very valuable in randomized research. (Cancer, Jan 2004) Next she discussed what is being learned about the mechanisms of acupuncture. She said that acupuncture acts as a neuromodulating input, involving the descending antinociceptvie system. This causes the release of endogenous opoids and may change pain perception via the limbic system and subcortical structures. The National Institute of Health supports and is very interested in acupuncture research. Acupuncture has been successful for symptom control in many areas including hot flashes (breast cancer patients) shortness of breath (lung and metastatic breast cancer patients), chronic fatigue, pancreatic cancer pain, shoulder pain (head and neck patients), Xerostomia, post-thoracotomy pain (lung patients). (JCO, May 2004), A pilot study at MSKCC showed that acupuncture “studs” were effective for post-thoracotomy pain reduction. The studs can stay in place and be checked in 1 week for removal or replacements. They have high hopes for positive results from this western adaptation of acupuncture. MSKCC is also conducting FDA approved Anti-Tumor Botanicals Research. Studies include the use of Huanglian in patients with advanced solid tumors; Sho-Saiko-To for hepatitis C patients and a pilot for liver cancer prevention; Sho-Saiko-To for treatment of liver cancer; Jin Fu Kang for lung cancer patients, and a Maitake lab research trial with breast cancer patients. Next she discussed some of the benefits and problems with herbs and other botanicals. She noted that many falsely assume that natural=safe and that long term use=effective. She stated that early research is showing that herbs and other botanicals may be OK for the general public, but are probably not good for cancer patients. Her concerns include contamination, toxicity, standardizations, and herb-drug interactions, including chemotherapy. Side effects and toxicities can include elevated INR (garlic, ginkgo, ginseng, vitamin E); low blood sugar (American Ginseng); cardiovascular instability (Ephedra-the first supplement to be taken off the US market); affects on blood levels of prescription medications (St. John’s Wart, Valerian); and elevated transaminase associated with kidney failure (Kava). Agents with anticoagulant effects include Vitamin E, garlic, Asian ginseng, St. John’s Wort, Dong Quai, and Valerian. Co-Q10 is a pro-coagulant; it inhibits warfarin. She noted that St. John’s Wort is an effective antidepressant that is comparable to Prozac and effectively reduces PMS. However, it can interact negatively with grapefruit juice and increase blood levels and toxicity of other drugs. NIH has recently provided funding to the MSKCC Research Center for Botanical Immunomodulators in collaboration with the Institute of Chinese Medicine at the Chinese University of Hong Kong. The five agents selected to be studied were Maitake, Juzentaihoto, Shi quan da bu tang, Echinacea, Astragalius and Turmeric. 30+ others will be screened, and the most effective agents will go to clinical trials. Primary Research Projects include: · Regulation by botanicals of immune response to cancer vaccines (preclinical) · Modulation by botanicals of antibody based cancer immunotherapy (preclinical) · Regulation of botanicals of pathogen-specific immune defense (animal model) · Development of biomarkers for study of botanical immunomodulators in humans (clinical) The MSKCC website includes over 200 monographs with extensive information about herbs, botanicals, vitamins, etc. www.mskcc.org/aboutherbs The Integrative Medicine Service Training Programs at MSKCC include Medical Massage for the Cancer Patient (open to licensed massage therapists with a minimum of 5 years experience); acupuncture for the cancer patient (open to certified acupuncturists); and weekend CME course for oncology professional and pharmacists. She highly recommended the 2nd International Conference on November 10-12, 2005 in San Diego, CA. 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