Integrative Cancer Care: Combining Conventional and Complementary Treatments

“Integrative Cancer Care” (Donald Abrams, MD) [#102] Brad Power June 19, 2024 “My goal when I see a patient is to give them back a sense of control. When you hear the diagnosis that you have cancer, your locus of control has been ripped from underneath you. You're now at the mercy of the surgeon, the radiation oncologist, the medical oncologist, and even the chemotherapy nurse.

By giving the patients things that they can do themselves: modifying their diet, increasing their physical activity, rational use of supplements, decreasing stress, that allows the patient to have an increased sense of control.” – Donald Abrams Meeting Summary Cancer patients are motivated to maximize the effect of their main conventional cancer treatment (e.g.

, chemotherapy, radiation, surgery, immunotherapy, targeted drugs) with complementary treatments (e.g., diet, supplements, exercise, yoga, meditation). Some of these complementary therapies are generally accepted as healthy practices -- they are not unique to cancer; they are the same if you want to have a healthy heart or a healthy brain, such as exercise and a healthy diet.

Some are situationally employed as complementary to a main therapy, such as hyperbaric oxygen to help with wound healing. To improve outcomes from their main conventional cancer treatment, patients and caregivers need to consider the “terrain”, not just the tumor, and tailor the treatment uniquely to the individual.

Traditional standard treatments can be delivered according to a standard protocol and miss critical factors that may impact the individual patient, such as the gut microbiome, immune system, inflammation, hormone modulation, stress, and mental and emotional state. Some complementary or integrative therapies have a strong evidence base (from randomized clinical trials), but many don't.

Much of complementary or integrative cancer care is “evidence- informed” and not necessarily “evidence-based”. This gray zone that is not firmly a standard practice requires judgment, which often falls on the personal preferences of the patient and caregiver. They are challenged to evaluate non-standard treatments, and especially how they may work in combination with other therapies.

Donald Abrams, M.D., is uniquely qualified to talk about integrating complementary and conventional therapies. He is an integrative oncologist at the UCSF Osher Center for Integrative Medicine and Professor Emeritus of Medicine at the University of California San Francisco. He believes that cancer patients benefit from having both a conventional treatment plan as well as a whole-person approach.

He was Chief of Hematology-Oncology at Zuckerberg San Francisco General from 2003-2017. He graduated from Brown University in 1972 and from the Stanford University School of Medicine in 1977.

ckerberg San Francisco General from 2003-2017. He graduated from Brown University in 1972 and from the Stanford University School of Medicine in 1977. After completing an Internal Medicine residency at the Kaiser Foundation Hospital in San Francisco, he became a fellow in Hematology-Oncology at UCSF in 1980. During his fellowship, Dr.

Abrams spent eight months working in the retrovirology laboratory of Harold Varmus, M.D., during the time that the first cases of AIDS were being diagnosed. He subsequently returned to the clinical arena where he was one of the original clinician/investigators to recognize many of the early AIDS-related conditions.

“Integrative Cancer Care” (Donald Abrams, MD) [#102] conducted numerous clinical trials investigating conventional as well as complementary therapies in patients with HIV including therapeutic touch, Traditional Chinese Medicine interventions, medicinal mushrooms, medical cannabis and distant healing.

He is considered to be a pioneer in the investigation of inhaled cannabis, having conducted studies funded by the NIH and the University of California Center for Medicinal Cannabis Research. His interest in botanical therapies led him to complete a two-year Fellowship in the Program in Integrative Medicine at the University of Arizona in December 2004.

He co-edited the Oxford University Press textbook, Integrative Oncology, with Andrew Weil, M.D.. Dr. Abrams was a long time member of the NCI PDQ Integrative, Alternative and Complementary Therapies Editorial Board and a past President of the Society of Integrative Oncology.

In 1998 UCSF established the Osher Center for Integrative Health, the first center to comprise fully developed integrative programs in clinical care, education, and research. It is one of the leading integrative health institutes in the world.

Their strengths include robust, multidisciplinary research and education programs in integrative medicine, as well as clinical services that provide an optimal healing environment for patients and a range of approaches for individuals and families seeking health and well-being. What are the challenges that patients and caregivers face in adopting integrative treatments?

●There usually isn't enough data to confidently recommend specific therapies or foods for a particular patient, e.g., for lymphoma treatment, or as a complement to chemotherapy. What strategies should you employ to decide whether to adopt possible integrative treatments?

●Review them with your medical team and other trustworthy sources ●Try to determine the evidence supporting the integrative treatment and confidence in it; understand whether the treatment is “evidence-based” or “evidence-informed”; be cautious about unproven approaches ●Check for potential interactions between the integrative treatments and your standard treatments, e.

in it; understand whether the treatment is “evidence-based” or “evidence-informed”; be cautious about unproven approaches ●Check for potential interactions between the integrative treatments and your standard treatments, e.

g, share your supplements in your medical record with your medical team ●Follow generally accepted healthy practices for diet, exercise, and stress management; choose therapies which maintain a healthy weight and decrease stress and inflammation ●Share your results from using integrative approaches What are generally-accepted healthy behaviors that everyone should follow?

“Integrative Cancer Care” (Donald Abrams, MD) [#102] ●Follow an organic, plant-based diet, rich in antioxidants and anti-inflammatory, real and whole foods, and some supplements; for example, eat fruits, vegetables, whole grains, nuts, and legumes; among the fruits and vegetables, favor cruciferous vegetables that grow in the shape of a cross: broccoli, cauliflower, Brussels sprouts, cabbage, kale, collard greens, bok choy, and arugula; season with ginger, garlic, onions, and turmeric; your fruit should be heavily pigmented, like berries ●Maintain a healthy weight ●Be physically active ●Reduce your stress level, e.

g, through yoga, meditation, exercise ●Restrict the time you eat, e.g.

, 6:00 pm to 7:00 am, but don’t skip breakfast – the most important meal of the day ●For breakfast, consider low sugar, complex carbohydrates, such as muesli with blueberries and walnuts, or mochi, which is pounded brown rice: puff it up in the oven, smear almond butter on it, and put a sweet potato on top What are personalized choices that depend on your situation?

“Integrative Cancer Care” (Donald Abrams, MD) [#102] ●Cook shiitake, maitake, Turkey Tail, and enoki mushrooms for immune system enhancement; if you are taking mushrooms, alternate different mushroom types for maximum immune benefit ●Take a probiotic supplement if you have been treated with chemo What are foods and supplements that you should avoid?

●Sugar, sugary drinks, including (fruit) juicing ●Processed foods, fast food ●Alcohol ●Eggs – second only to processed foods for increasing mortality; associated with prostate cancer ●Quercetin, resveratrol, and other unproven supplements ●Cannabis, alcohol, probiotics, and medicinal mushroom pills, if you are getting an immunotherapy ●Antioxidants, if you are getting chemotherapy or radiation ●Be skeptical about fasting, due to potential harm to normal cells ●Raw mushrooms ●Dairy ●Intravenous Vitamin C What can you do to learn more about integrative practices?

, and medicinal mushroom pills, if you are getting an immunotherapy ●Antioxidants, if you are getting chemotherapy or radiation ●Be skeptical about fasting, due to potential harm to normal cells ●Raw mushrooms ●Dairy ●Intravenous Vitamin C What can you do to learn more about integrative practices?

●Read the World Cancer Research Fund/American Institute for Cancer Research guidelines and visit the American Institute for Cancer Research website for evidence- based cancer prevention guidelines ●See our discussion with Nigel Brockton , PhD, Vice President of Research at the American Institute for Cancer Research, on “Scientific Research on Lifestyle Choices to Reduce Your Cancer Risk” ●You can join one of Dr.

Abrams’ group medical visits, where he sees up to 10 people for three sessions: (1) nutrition and cancer, (2) supplements, including cannabis and increasingly, psilocybin, and (3) physical activity, traditional Chinese medicine, stress reduction, etc.

The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

“Integrative Cancer Care” (Donald Abrams, MD) [#102] Meeting Notes KEYWORDS supplements, patients, cancer, eat, integrative medicine, immunotherapy, mushroom, talk, guidelines, evidence, cannabis, question, good, integrative oncology, lymphoma, abrams, number, people, recommendations, risk SPEAKERS Donald Abrams (67%), Allen Morris (9%), Brad Power (8%), Jeff Marchi (4%), Robb Owen (4%), Roger Royse (3%), Brian McCloskey (3%), Jeff Krolick (2%) SUMMARY Cancer patients can get many potential benefits from complementary therapies, such as personalized nutrition.

Evaluating and personalizing complementary therapies requires evidence to inform your decision-making. Conducting randomized double-blind placebo-controlled trials in nutrition and other complementary therapies is very challenging, so there is little “gold standard” evidence.

Therefore, patients and caregivers must make decisions which are “evidence- informed” rather than being able to follow a standard guideline that is “evidence-based”. OUTLINE Integrative oncology and the treatment decision-making process, with a focus on nutrition, supplements, and physical activity.

●Early in his career Donald Abrams, MD, was at San Francisco General, dealing with the HIV/AIDS epidemic, and then pivoted to become an integrative oncology pioneer at UCSF. ●Patients need evidence-informed integrative practices, incorporating complementary therapies with conventional cancer care.