Integrative Cancer Care: Combining Conventional & Complementary Treatments
Featuring: Donald Abrams, MD
In short
Integrative oncologist Donald Abrams, MD, walks cancer patients and caregivers through how to combine conventional treatments — chemotherapy, radiation, surgery, immunotherapy — with complementary approaches like diet, exercise, supplements, and stress reduction. The focus is on giving patients a concrete way to feel more in control of their care while being honest about where the evidence is strong and where it isn't. Specific guidance covers what to eat, which supplements may help or harm depending on your treatment, and how to have productive conversations with your medical team.
- •Before adding any supplement, share it with your medical team — some, like antioxidants during chemo or radiation, or mushroom capsules during immunotherapy, may interfere with your treatment.
- •A plant-based diet rich in cruciferous vegetables (broccoli, kale, Brussels sprouts), deeply pigmented fruits like berries, and seasonings like turmeric and garlic is broadly recommended regardless of cancer type.
- •Time-restricted eating — for example, finishing dinner by 6 pm and not eating again until morning — may be beneficial, but skipping breakfast is not advised.
- •Ask whether a complementary therapy is 'evidence-based' (proven in clinical trials) or only 'evidence-informed' (supported by some data but not gold-standard proof), so you can weigh the uncertainty before deciding.
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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.
Meeting Summary
, 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.
, 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. 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. , 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. He 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. 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.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?
•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?
•Take Vitamin D supplements if you have low levels
•Take B12 supplements if you are on proton pump inhibitors
•Take Coenzyme Q10 if you are on statins
•Take calcium, magnesium, and zinc supplements if you have prostate cancer and for the immune system
•Choose cannabis tinctures if you are taking cannabis, due to the absorption profile and reduced risk of side effects
•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?
•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. 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.
•Nutrition is important in healthcare, with dietary issues a leading cause of mortality in the US.
•People should be following an organic, plant-based diet rich in antioxidants and anti- inflammatory foods, and some supplements.
•There are potential interactions between pharmaceuticals and supplements.
•Patients should have control over their treatment through diet, exercise, and stress management.
•Decreasing inflammation and stress can help increase a person's sense of hope and empowerment in living with and beyond cancer.
•Healthcare professionals generally do not collect data on individual patients' integrative treatment outcomes. Nutrition and supplements for cancer patients, with a focus on whole foods and avoiding processed foods.
•There isn't enough data to recommend specific foods for lymphoma treatment.
•Observational studies suggest cannabis use may worsen immunotherapy outcomes.
•You should avoid sugar and processed foods for cancer prevention.
•Guidelines suggest healthy weight, physical activity, and avoiding sugary drinks for cancer survivors.
•If you are getting immunotherapy you should avoid alcohol and medicinal mushrooms.
•Exercise has many potential benefits of exercise, including reducing cellular toxicity.
•If you are getting immunotherapy, you should avoid taking mushroom capsules due to potential cancer-causing compounds.
•Paul Stamets' has done extensive research on mushrooms, including an old growth forest mushroom agarikon, which may have immune-enhancing features.
•If you are taking mushroom supplements, you should alternate different mushroom types for maximum immune benefit.
•You should be skeptical about fasting due to potential harm to normal cells.
•Time-restricted eating may be beneficial, particularly if you don’t skip breakfast.
•A high protein, low carb breakfast is recommended. Cannabis
•A 14-year prostate cancer survivor experienced afib (atrial fibrillation, an arrhythmia) after taking marijuana.
•Tinctures are recommended due to faster absorption and reduced risk of side effects.
•Ingesting THC (Delta-9-tetrahydrocannabinol, the principal psychoactive compound and 1 of the 113 cannabinoids identified within the class of cannabinoid medications, used to treat chemotherapy-induced nausea and vomiting and stimulate appetite) orally can lead to psychoactive effects, cardiovascular effects, and ego dystonic reactions (negative assessments that people make of their thoughts, emotions, impulses, or behaviors when they feel they are inconsistent with who they are or what they believe, including feelings of repugnance, distress, or unacceptability.) Evidence-based medicine, evidence-informed medicine, and integrative oncology.
•What is the difference between evidence-based medicine and evidence-informed recommendations?
•The American Institute for Cancer Research World Cancer Research Fund's continuous update project, which includes a panel of experts with more than 24 people in integrative medicine, is an authoritative, trustworthy source of information.
•The effectiveness of supplements in integrative oncology is questionable, given a lack of evidence-based research.
•The Society for Integrative Oncology has a panel of 600 members from around the world, but they have not conducted a comprehensive review of supplements for cancer treatment.
•Evidence-based and evidence-informed practices should not be mixed. Supplements for cancer treatment, with recommendations for vitamin D, Omega-3, and calcium
•Vitamin D supplements are recommended for cancer patients with low levels.
•B12 supplements are recommended for people on proton pump inhibitors, especially older adults, due to statins depleting Coenzyme Q10.
•Calcium, magnesium, and zinc supplements are recommended for prostate cancer patients.
•Quercetin, resveratrol, and other unproven supplements should be avoided.
Full transcript
Brad Power This is the Cancer Patient Lab. Today we are honored to have Dr. Donald Abrams with us. He is a leader in integrative oncology. We've had several conversations about integrative oncology, or complementary therapies, or alternative therapies, from Bapcha Murthy, who said that so much of this is a scam , to Nasha Winters, who said that this is all good stuff you should be considering .
There is a gray zone in between these two extremes, of how you evaluate treatments where it's not clear that it's evidence-based and solid, or something that's probably pretty shaky, and you should be skeptical of. I expect that Dr. Abrams will speak to that gray zone and the decision-making process people need to go through. This is not medical advice. This is information for you to take to your medical team. We are a patient-led community.
If you're inspired to donate, please check out our website and click the donate button. Donald Abrams 2:02 I was chief of Oncology at Zuckerberg San Francisco General for 15 years. I stepped down eight years ago. I've been an oncologist now for 41 years, and at the beginning of my training to be an oncologist, suddenly AIDS came out of the blue. We didn't know what it was or what to do about it, and it impacted my community.
I was very much involved in the early days of HIV/AIDS. I became a champion at that time of alternative therapies, even though there was no conventional therapy to be alternative to. ” I wrote all the chapters in all the AIDS textbooks on complementary and alternative therapies in HIV.
Then in 1992, someone challenged me to study cannabis as a treatment for “AIDS wasting syndrome” (a rare condition that causes people with advanced HIV disease to lose more than 10% of their body weight, especially muscle). I said, “Okay. I can do that.
” I fought the government for five years and ultimately won and got marijuana and money to do research, which gave me a strong appreciation of the power of plants as medicine, which then took me to the Telluride mushroom festival in Telluride, Colorado. ” But in Telluride, I met Andrew Weil, the guru of integrative medicine.
He described a two year online distance learning fellowship you could do with his program in Integrative Medicine at the University of Arizona. I said, “Aha. ” So I did, and it changed my life. When I finished, I said, “I'm done with HIV/AIDS. I've done that for 25 years. It's very different from when I started.
” I couldn't really do that at San Francisco General, where I often say, for most of my patients there, cancer is the least of their problems. They're homeless. They're addicted. They're psychotic, or they're undocumented. So I can't really talk to them about eating organic or doing yoga.
I went over to our Osher Center for Integrative Medicine, now, the Osher Center for Integrative Health at the University of California, San Francisco, and I asked if I could just do a half-day clinic just to see if I liked it, in 2005. I did, and I liked it, and I did two half days, and then I became the director for a few years.
I stepped down from that, but I continued to work at the Osher Center, and I retired from UCSF in 2020, in the middle of the pandemic. My retirement party was online instead of on top of the new hospital building. But at UCSF, they allow you to retire and disappear for a month, and then you could be recalled for emeritus status.
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