Cancer Survivorship: A Role for Integrative Medicine

Posted By SHL Librarian

Presented by: Sue Kim, MD, MS
Integrative Medicine Specialist
September 18, 2014

More than 80 million Americans use complementary and alternative medicine (CAM) every year. CAM refers to a number of health care therapies, practices, and products that do not typically fall within the paradigm of conventional Western medicine—such as acupuncture, mindfulness meditation, massage, and botanicals. “Complementary” medicine refers to the use of these therapies in conjunction with conventional medicine, while “alternative” medicine denotes the use of these therapies instead of Western medicine.

In contrast, integrative medicine is a relatively newer discipline that blends Western medicine with certain CAM practices to optimize health and healing, as well as to treat disease, particularly for cancer patients and survivors. CAM therapies offer additional options for supportive care beyond standard pharmaceuticals in controlling symptoms such as pain, nausea and vomiting, loss of appetite, and improving overall quality of life. In addition, some studies have shown that certain botanicals and foods may even help to decrease risks of cancer as well diminish the risk of recurrence.

“Much of integrative medicine is about taking appropriate preventive measures, such as limiting exposure to chemicals and toxins, and eating a healthy diet,” said Sue Kim, MD, MS. who recently delivered a presentation sponsored by Stanford’s Cancer Supportive Care Program and the Stanford Hospital Health Library.

Focus on Diet
“Food is a cornerstone of integrative medicine. We are seeing evidence that eating a healthy diet may in fact help to lower cancer risk,” said Dr. Kim, who believes that a healthful diet can help to boost immunity, aid digestion, and modulate blood pressure. “Try to eat clean by being aware of where your food comes from and what’s been added to it. “

The standard American diet, with its high levels of sugar, fat, refined grains, and meat should be replaced with a Mediterranean whole-foods style of diet, which emphasize fresh vegetables and fruit, olive oil, and fish. Avoid additives like growth hormones, preservatives, trans-fats, and other undesirable substances such azodicarbonamide, substance used in making yoga mats that is found in more than 500 food items. Other substances to avoid include chemicals like bisphenol A (BPA), a chemical used in food canning, packaging, and plastic bottles.

Dr. Kim advised avoiding environmental exposures, such as tobacco, unnecessary radiation, parabens, and phthalates—hormone modulators and endocrine disrupters that are found in many hair and body products. Certain professions may also increase cancer risk due to exposure to toxins, including working as a gas station attendant, hairdresser, agricultural worker, painter, shoemaker, or airline crew.

Benefits may come from the addition of herbs and supplements to the diet, such as botanicals, vitamins, minerals, and probiotics. A few can interact with conventional medications, and it may be best to avoid St. John’s wort, copper, grapefruit juice, echinacea, and ginseng. Others may actually promote angiogenesis (the growth of new blood vessels) or encourage tumor growth in other ways, so consult first with a knowledgeable health-care provider.

One of the most-studied botanicals is curcumin, found in turmeric, which has been shown to have anti-cancer benefits in laboratory settings. Studies of supplements in humans are being undertaken, but in the meantime, Dr. Kim encourages the generous use of turmeric in cooking. She notes that it is important to combine turmeric with ginger or black pepper to optimize absorption.

Cruciferous vegetables, such as broccoli, Brussels sprouts, cabbage, kale, and turnips provide indole-3 carbinol, which has shown promising effects on breast, colon, prostate, and other cancers. “Until we know more, it’s best to include a variety of cruciferous vegetables in your diet rather than ingesting supplemental forms,” she advised.

Green tea contains ECGC—a powerful antioxidant that appears to work in synergy with other foods like soy. She recommended steeping high-quality green tea leaves for four to five minutes in very hot water to optimize the amount of ECGC.

Recent studies have addressed some of the controversy around the use of soy, which appears in recent studies to reduce the risk of breast cancer. The most benefit comes from eating two to three servings of whole, organic soy foods such as edamame, soy milk, tofu, and tempeh, rather than using it in supplemental form.

Other foods of interest include pineapple, which contains bromelain, an extract that aids digestion, and mushrooms, which are being studied for their immunomodulatory and anti-cancer properties.

Supplements
Despite low levels of fish oil (omega-3) in American diets, studies have not shown conclusive evidence of its benefits to cancer patients and survivors, although it does not appear to be harmful. Skip the odorless supplements because of quality concerns, she said, “and, as is usually the case, food trumps pills.” Limit the risk of mercury toxicity by choosing smaller fish, such as sardines, arctic char, wild salmon (Alaskan), or black cod.

Probiotics, such as yogurt and tempeh, contain bacteria or yeast that can help to optimize intestinal function and maintain the integrity of the lining of the intestines. Probiotics may help to promote healthier gut microflora that may support and modulate the immune system in beneficial ways.

Dr. Kim recommended avoiding mega-doses of vitamins and minerals, though recommended daily allowances of the B-vitamins, as well as vitamins A, C, D, and E can complement a diet that may lack adequate amounts. Large quantities of supplemental vitamins can be harmful because they may counter the beneficial effects of cancer therapies and may generate pro-oxidants that can be harmful to health.  Recent studies have suggested that multi-vitamins may be beneficial to cancer survivors; Dr. Kim recommended using food-based vitamin without added colors or chemicals.

Addressing Symptoms
Dr. Kim addressed some common side effects of cancer treatment and gave pragmatic suggestions on which complementary therapies might be most helpful. “Many symptoms can be alleviated—at least to some extent—with regular exercise, active hydration, and reduced intake of sugar, salt, and alcohol.”

  • Nausea and vomiting: Limit your intake of spicy food and dairy; consider peppermint, umeboshi (Japanese sour plums), and vitamin B-6 supplements; consider hypnosis or guided imagery—techniques that use the unconscious mind to guide thoughts in positive ways
  • Fatigue: Include plenty of omega-3, iron, magnesium, and coenzyme Q10 (found in soybean and olive oils, meats, and fish)
  • Depression: Be physically active during the day; if you are not taking other medication, consider St. John’s wort, omega-3s, or gamma-aminobutyric acid (GABA); explore relaxing activities like art or music therapy, or try psychotherapy approaches, such as cognitive behavior therapy—a type of behavioral intervention training
  • Sleeplessness: Make nighttime teas using chamomile, lavender, or lemon-balm; Dr. Kim recommended taking calcium and magnesium together after dinner; or try GABA, valerian root, or melatonin supplements

Whole Healing Traditions
Complementary medicine incorporates aspects of complex healing systems that share the belief that the body has the power to heal itself. Ayurveda practices from India, Shamanism, naturopathy, and Traditional Chinese Medicine (TCM) see lifestyle, beliefs, and surroundings as integral parts of health. Such systems are not derived from single practices or remedies—like massage—but comprise a core of practices that center around a particular healing philosophy, such as the power of nature or the flow of energy.

“To optimize health in integrative medicine, it’s important to remember that these systems are entire paradigms, and the concepts aren’t always parallel,” Dr. Kim said. A practitioner of TCM, for example, incorporates practices based on qi, blood, yin and yang, and the “five elements.” While acupuncture has been shown to be beneficial in addressing side effects of cancer treatments, like diarrhea, anxiety, or fatigue, TCM employs numerous herbs that may interact with traditional Western chemotherapies, and some herbal preparations contain ingredients that are not always identified or harvested to U.S. health standards.

Overall Health
“When making choices around health and disease using integrative medicine, it’s important to keep the focus on therapies that are most capable of improving quality of life without incurring undue risks. If there is minimal risk of toxicity, we should not let the lack of evidence of definitive benefit deter us from trying something new. It may still be useful to integrate it in a thoughtful manner.”

Dr. Kim also emphasized the importance of regular exercise, which can alleviate numerous cancer symptoms and improve both physical and mental health. In addition to physical health, it’s important to address emotional well-being—to control stress and manage depression through modalities like mindfulness-based mediation, yoga, massage, music or art therapy, or breath awareness. Minimize exposure to toxins as much as possible: Avoid second- and third-hand smoke and avoid parabens and phthalates in body care products.

“As far as supplements go, some, like omega-3, calcium, and vitamin D may be recommended at reasonable doses, but generally food is always better than pills,” she said.

About the Speaker
Sue Kim, MD, MS, practices integrative medicine at Google Wellness Centers in Mountain View and medical acupuncture/integrative medicine in her private practice. She received her medical degree from the University of Missouri-Columbia, completed residency training in internal medicine at Brown University in Rhode Island, and has completed fellowships in hematology (Stanford) and Integrative Medicine (AZCIM). She holds a Master’s degree in epidemiology from Stanford and completed a program in medical acupuncture through UCLA/Helms Medical Institute. She is currently a fellow in the Health 4 All Fellowship through Stanford’s Prevention Research Center.

Dr. Kim is board certified by the American Board of Internal Medicine, the American Board of Integrative and Holistic Medicine, and the American Board of Medical Acupuncture.

About the series:
The Ernest Rosenbaum Cancer Survivorship Lecture Series is named after the noted oncologist who established the Cancer Supportive Care Program at Stanford and the Comprehensive Cancer Care Program at UCSF’s Mount Zion Hospital. He wrote more than 25 books on cancer, most of them about living through treatments and about life after cancer. This program was one of a series sponsored by the Stanford Cancer Supportive Care Program.

For More Information:

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Cancer Supportive Care

Stanford Cancer Institute

Stanford Prevention Research Center

Stanford Integrative Medicine Interest Group