Integrative Medicine and
and
Multiple My
pyeloma
Loch Chandler, N.D., M.S.O.M., L.Ac.
Providence Portland
Portland Cancer Center
Integrative Medicine Clinic
August 5th, 2010
What is Integrative
Md
Me ii
dicine?
· Combines: the best of non-traditional
care with mainstream traditional therapies
· Uses: therapies with evidence for benefit,
reasonable cost
cost, and safety
· Focuses on: the whole person,
accessibility, more time and touch, and
greater patient involvement in decision
making
Team Medicine
The Consortium of Academic Health Centers
for Integrative
Integrative Medicine
Medicine (CAHCIM):
(CAHCIM):
"Integrative medicine makes use of all
appropriate therapeutic approaches, health
care professionals and disciplines to achieve
optimal health and healing."
Goals of Integrative
Medicine with Cancer
Mobilize the person's healing capacity
Improve tolerance of conventional
therapy by decreasing side effects
Improve survival, decrease risk of cancer
recurrence
Improve
li
qua ty f
o life issues
How Integrative Medicine
Can Help
Help
·Using food,
g, supp
p lements
p
, acupuncture
p
and massage to help address concerns
such as:
· PAIN
· Addressing possible
· Neuropathy
nutrient deficiencies
· Mucositis/stomatitis
· Hli
Helping non-cancer
· Cachexia
related symptoms
· Nausea/Vomiting
· Improving tolerance
tolerance of
of
· Diarrhea, Constipation
conventional therapies
· Fatigue
· Minimizing medications
· Depression/anxiety
used to treat side effects
Our Discussion Today
· Diet & Nutrition
· Lifestyle
· Supplements and Side Effects of
of Cancer
Cancer
Treatment
· Massage
· Chinese M di
e
i
c ne
d
an Acupuncture
Di t
e
d
an N t
u rition
How Nutrition and
Lifestyle May
May Affect Risk
Exercise, certain foods and food components:
· Help the body break down cancer-causing
substances, aid elimination
· Improved appropriate cell growth (aka cell
differentiation)
· Reduce blood supply to abnormal cells (anti-
angiogenesis)
· Hormonal regulation of cell growth
· Support the
the immune system
· Improve the healing and recovery
Mediterranean Diet
Two studies
studies (each for 4 years):
Lyon Heart: Randomized prospective controlled
study, 4-year followup (10)
Greek Epic: Observational, (n=22,043 people,
44 months) (11)
More: vegetables, carrots, tomatoes, fruit,
legumes, grains, fish, olive oil, canola oil,
less red meat (particularly preserved
meats), more white meat, dairy (cheese,
yogurt), butter, moderate alcohol OK, sage
(12)
Both: 60-70% reduction in all cancers,
cardiac events and diabetes...preventative
Powerhouse Fruits
-Berries:
-Especially raspberries and blueberries
-High
g antioxidant levels
-Reduce growth of colon and prostate
cancer cells
-Tomatoes:
-Contain lycopene protective against
prostate, lung, colon and breast cancer
-Cook tomatoes and eat with fat (i.e.
olive oil) for better absorption of
lycopene
Powerhouse Vegetables
Cruciferae Family (Genus Brassica) Vegetables:
Vegetables:
· Arugula, bok choy, broccoli, Brussels sprouts, cabbage,
cauliflower, collard greens, watercress, radishes, kale,
mustard greens
greens, rutabagas/turnips, daikon, Chinese
Chinese cabbage
cabbage
Associated with lower rates of breast, prostate, lung
(inverse relationship; 2, 3) and colon cancer (4)
Reduces tumor growth/incidence or delays onset in animal
models (5, 6, 7)
Indoles favorably shift
shift hormone breakdown pathways (8)
(8)
Induce enzyme detoxification of carcinogen
(9)
More frequent intake may reduce risk of
myeloma (Brown, Cancer Causes & Control, 2001;12(2):117-125)
Powerhouse Vegetables
Onion (Allium)
(Allium) Family Vegetables:
· Garlic, onions, scallions, leeks,
chives
· Improve our ability to break down
cancer-causing chemicals
· Decreases nitrosation, the
conversion of some substances in
foods into carcinogens Harrison, E, et al,
Analytical Biochemistry, 2010.
· Associated with lower cancer risk (9)
· Associated with suppressed tumor
growth (10)
Whole Grains
Grains
· Includes: Whole
Whole wheat
wheat, corn, oats,
rye, hulled (not pearled) barley,
brown rice, millet, quinoa,
th
amaran
,
lt
spe , k
t
amu ...
· Wh l
o e grains are associated with
ith:
Lower risk of breast, prostate, and
colon cancer
Lower risk of heart disease
Lower risk of Type 2 Diabetes (11, 12,
13)
Whole Grains
Grains
How might whole grains
gg
work?
· Contain more minerals, vitamins &
antioxidants
· Have more fiber than refined grains (i.e.
white flour, white rice, most pasta,
bagels, breads...)
· Pt
Promotes lower insulilin levels,
h
w i
hi h
c
may reduce cancer risk
· Promote regular bowel movements and
healthy elimination
Celiac?
· A study looked at samples
yp
from
Myeloma patients.
35% of the monoclonal proteins had
anti-gliadin activity
gy
Lymphoma Res J, 2006; 30(12):1585-1586
· One research study screened for
celiac in lymphoma pati
tients
Found no correlation
Turkish J Gastro, 2009 Jun, 20(2):87-92 (n=119)
Other researchers felt that it could
predispose people to enteropathy-
tT
type T-cell l
h
ymp oma
Lancet, April 2009, 373(9673):1480-93.
Celiac?
· Verbeek, et al,
,, found `refractory
celiac disease,' which is
characterized by persisting mucosal
pathology
pgy in spite
p
of a strict gluten-
g
free diet (small percentage of celiac
positive people)
Also had aberrant T-lymphocytes
present in the small intestine
50-60% of these (rcd) patients develop
an
tt
enteropa h
thy
i
assoc t
a d
e T
ll
-ce
lymphoma
Cytometry Part B, Clinical Cytometry, 2009 Nov,
76(6) 367
:
-74.
Legumes
Di
Dri d
e beans ( i
p t
n o, kid
kidney,
hit
w
e,
lima, black, red), lentils, split peas,
black eye
-
peas
)
...
· Ii
Inexpensive and easy to cook
· More than 2 oz. (1/4 cup) per day
of legumes associated with
dd
reduced i
r sk f
o breast cancer
Legumes
How might
g
legumes
g
gg
work?
High in antioxidants, vitamins and
minerals
High in fiber (14)
`Healthy' weight loss, while maintaining
lean muscle mass
Promote lower
lower insulin levels
Have protease inhibitors
Lignans associated with lower breast,
prostate, and colon cancer risk (15, 16)
Healthy Fat
Fat Choices
· Omega-
Omega 3f
-3 ats
fats (EPA, DHA, and ALA [alpha
[alpha
linolenic acid]) found in fish, flax,
canola,tree nuts, particularly walnuts, and
some green vegetables
· Fish and olive oils tend to be anti-
inflammatory and lower risk (15)
· Olive oilil (E
(Extra Vi i
rg n is best)
t) appears
protective; countries where olive oil is the
predominant fat have lower rates of
of cancer
cancer
(16, 17)
Fish Oil
· Mt
Most st d
u i
dies suggest fi
fish is
tt
protec i
tive
against cancer, reduce tumor growth
(18)
· Omega 3 Fatty Acids (most studies use
fish oil) are associated with:
Less cancer cachexia (wasting) (19)
Improved cancer survival with
radiation therapy
therapy (20)
Fewer infections (21)
Fish Oil
· DHA (docoshexaenoic acid) exerts pro-
apoptotic effect in lung cancer cells (helps
programmed cell
cell death) (22)
· Reduced lung cancer cell g
ggrowth by
inhibiting integrin-linked kinase (23)
· Inverse risk of lung cancer with fish oil intake
(24)
· Cod Liver oil associated with lower risk of death
in patients with solid tumors (25)
Flax
· Flax meal (whole g
(ground flax seeds) is
preferred over flaxseed oil
· Contains lignans, associated with less
bd
breast, prostate, and
l
co on cancer
· Flaxseed are high in fiber and omega-3
fats
· How flax might work:
Encourages normal cell
cell
differentiation
Antioxidant
Reduced supply of blood to tumor
(29)
Fats to Limit
· Omega-6 fatty acids found in: soy, corn,
cottonseed, sunfl
flower, safflower, peanut
High in Western diets, may be associated with
more cancer (26, 27)
· Recent study (questionnaire, 10 year followup,
of 617,000 people) showed slightly increased
cancer mortality from red
d
an processed meat
(28)
· Countries with lower rates of cancer tend to eat less
meat (29, 30)
· Possible association with red meat intake and post-
menopausal breast cancer ER/PR+ (31)
Basic Diet
Rd
Recommendati
tions
· Limit portion sizes of
of red
red meats
No apparent relation of red meat intake and
myeloma (30)
(30)
· Enjoy cold-water fish 2-3 times per week (salmon,
tuna in water, halibut, herring, mackeral, sardines)
sardines)
· Limit alcohol intake to 3-5 drinks per week
· >300 grams/week (>300 ml, >10 oz)
oz) seemed to
have a reduced risk for non-Hodgkin lymphoma (vs
<1 drink per mo)
p)
Kanda, J, et al, Canc Epidem Biomarkers Prev, 2010 Jan;
19(2):OF1-6.
Basic Diet
Rd
Recommendati
tions
· Avoid:
Refined flours
Refined s gars
u
and juices
Artificial sweeteners: especially
high fructose corn syrup (HFCS)!!!
Hydrogenated and
and partially
hydrogenated oils ("trans fats") and
oils heated to smoking
· Are associated with more cancer,
heart disease and diabetes
Basic Diet
Rd
Recommendati
tions
· Avoid (continued):
()
Processed, preserved or cured meats (e.g.
lunchmeats, bacon, ham)
· Associated with more
more cancer
cancer, heart disease
disease and
diabetes (31)
Lifestyle
Lifestyle:
PH
Proper Hydrati
tion
· Ft
Fa i
tigue can bt
be a symptom f
o
dehydration
· Ot
One st d
u y f
o hypo hd
-hyd t
ra i
tion f
d
oun
low water reduced muscle endurance
(35)
· One study (n=24), found higher
fatigue scores when dehydrated as
opposed to normal hydration
hydration states
· Found a decrease in visual memory
· Checked more symptoms and greater
severity when dehydrated (36)
Lifestyle:
The Benefit
fits f
o Exercise!
· A recent review: Graded exercise
therapy reduced symptoms and
improved functi
tion (37)
(37)
· Active people are less depressed
(38)
· Study found a person's beliefs
and social context were
were very
very
important with myeloma patient's
exercise regimen to
to help reduce
reduce
fatigue with treatment Coon, Onc Nurs
For, 2004;31(6):1127-35
Exercise and Myeloma
Myeloma
· Exercise during active & off-treatment
were positively associated with QOL
Jones, Supp Care in Cancer, 2004;12(11):780-88 (n=86).
· Exercise appears to help decrease
fatigue and mood disturbance and
improves sleep (n=24)
Coleman, Cancer Nursing, 2003;26(5)410-409.
· Incorporate aerobic and
strength/resistance training
training
b
... e
be flexible
and simply and use a support system
Coleman, Clin J Onc Nurs, 2003;7(5):529-34.
Lifestyle:
Ei
Exercise
d
an Fati
tigue
· The more exercise you do
during the week the more
energy you report
· The revi
'
ew s RCTs sh
d
owe
10-20 wks of activity
increased energy among
fatigued people with medical
conditions (40)
Lifestyle:
Bf
Bene it
fits f
o Exercise
· Reduced cancer incidence, may
,y reduce risk
of recurrence and improve survival
· Improves energy, mood, sleep, immune
fi
function, weight regul i
at on,
d
pro
i
uct vity
· Decreases blood pressure and risk of
developing Alzheimer's
During cancer treatment:
· Improves energy, mood, quality of life, sleep
· Reduces nausea (41, 42)
· Improves blood counts (43)
Lifestyle: Exercise
· Study: 707 nonsmoking, physically
capable Honolulu men 61-81 years old.
· 12 year follow up
· Mortality halved in those who
who walked >2
miles per day vs <1 mile per day,
results were
were `dose related'
related
· Cancer deaths were 57% less
NEJM, 1998;338:94-99
Lifestyle: Exercise
Recommendations:
· Start low, work up to 30-45 minutes daily, 5-7
days/week
· Break up activity into shorter sessions
· The world is your gym: stairs, sidewalks,
chopping wood, parks, pools, puddles, hula
hoops, jump rope...
Manual labor and vigorous recreational
recreational exercise
exercise are
are
the most beneficial. Thune, NEJM, 1997;336:1269-75
· Buy a pedometer and aim for 10,000 steps daily
· Any exercise is better than no exercise!
Supplements and Side Effects of
Cancer Treatment
What About
Sl
Suppl
t
emen s?
· Higher nutrient intake from
from whole
whole
foods is associated with better cancer
outcomes
· Nutritional deficiency is
is common
common
during cancer treatment
Animal studies suggest supplements
supplements
improve outcomes
Human d t
a a is very li it
m
d
e (44)
(44)
What About
Sl
Suppl
t
emen s?
· Nutritional deficiency is
is common
common during
cancer treatment
· Studies show nutritional supplements can
benefit and harm (28, 52, 53, 54, 57)
Vit
i
am n C may it
interfere
i
w th
ith Vl
Velcade
according to a cancer cell study (55)
However, frequent intake from food
and supplements was found to be
protective (not associated with
Velcade) (56)
Cachexia and
and Fish Oil
· Omega-3 fats:
fats: appear beneficial
for cancer cachexia (45)
2-6 gm EPA daily reversed weight
loss in patients with pancreatic
cancer (46, 47)
18 gm/day fish oil significantly
improved mean survival in both
well-nourished and malnourished
patients with
with generalized
malignancy (48)
Cachexia and
and Fish Oil
· Omega 3 Fatty Acids have
been found to help with:
Increased weight and
appetite
Improved quality of life
Reduced post-surgical
morbidity (49)
Cachexia and Fish Oil
· Reasonable dose: 1-2 Tbsp
Tbsp per day
· High-dose omega-3 fats have
significant anti
anti-depressant value
(50)
· Hl
Helps if
in l
flammatory bowel di
disease,
rheumatoid arthritis, asthma, heart
disease...
· Possible enhanced benefit when
omega-6 fats (vegetable oils) are
ii
mini i
m zed
Peripheral Neuropathy
and Glutamine
Glutamine
· Glutamine: 10 gm three times daily after
paclitaxel significantly reduced severity of
neuropathy (66)
· Also consider for chemotherapy-
associated peripheral neuropathy:
Alpha lilipoic acid: 800-1800 mg per day (67)
(67)
Evening primrose oil: 480 mg per day
B6: 50
50 mg
mg 2 times per day
B12: 1 mg per day (68)
Acupuncture and Massage
Peripheral Neuropathy
Neuropathy
· Vitamin B6 (Py
(yridoxine): 50 mg 2 times p
gper
day
ASCO 2009 Annual Meeting, Verschraegen, CF, et
al, J Clin Oncol,
,, 2009.
3 cohorts: Taxane (n=49), Vincristine or Vinblastine (n=7), and
Platinum (n=25)
Taxane c hort reported:
reported:
· Randomized to:
1/6 of 100% DRD multivitamin (placebo; n=22)
Same
Same + B6a
B6 t5
at 0m
50
gt
mg id
tid + B121m
B12 1
g/3-
mg/3 4w
4
ks
wks (n
(n=24)
· Assessed over 4 cycles of chemotherapy
· No other supplements allowed
Placebo group significantly
d
worsene ,
especially in cold sensation (p=0.0097)
Cachexia and
and Glutamine
· Glutamine: A non-essential amino
acid which becomes essential under
states of stress
· 2 heaped Tbsp per day (about 15 gms)
appears to help cachexia
Attenuates loss of muscle in animal
models (51)
· Taken: mixed in juice or smoothie,
with fiber drinks, or soup (fairly
tasteless)
Mucositis and
and Glutamine
· Glutamine:
30 gm per day (about 3 Tbsp per
day) reduced `leaky gut' during
radiation (53)
16 gm per day in patients receiving
receiving
mouth radiation had significantly
less mucositis (54)
· 4 gm in 240 ml water, swish & spit 4x per day.
Prevents chemotherapy induced
stomatitis (55)
· About 8 gm per day.
Diarrhea
aea and Gluta
utamine
· Glutamine: up to 10 gm 3 times per
day
Fewer stools, shorter p
,period of
diarrhea, less use of anti-diarrheal
medications (56, 57)
· Also helps radiation-induced diarrhea
· At very high doses may lead to
constipation
· Also helps viral diarrhea (58)
Diarrhea and Probiotics
Probiotics
·
Probiotics (e
(e.g. lactobacilli, intestinal
"gut bugs"):
Multiple effects: improve
improve mucosal barrier and
immune response, decrease inflammation
Improve synthesis and absorption of
of nutrients
Reduces radiation-induced diarrhea (59)
Reduces antibiotic-associated diarrhea
by average of 60%
Various supplements; Nancy's plain yogurt (60)
Vitamin D
· Recent Revie
iew article stated
appropriate serum levels could reduce
breast and colon cancer
cancer cases by
by
58,000 and 49,000 cases per year in
U.S. and Canada
· Often deficient in the NW
· Focus on adequate sun exp
qposure and
adequate dietary intake with
supplementation if necessary
· Supplementation: 2,000 i.u. per day
· Goal: 50-80 ng/mL in serum (61, 62)
Vitamin D
· Inverse relationship bet een
w
Vitamin D
and cancer risk (colon, breast,
prostate, lung, leukemia) (63)
(63)
Colon CA & D, Meta-analysis, Wei, MY, et al, Cancer
Epidemiol Biomarkers Prev, 2008;17(11):2958-2969.
· Acts by:
Inhibition of tumor angiogenesis
Increased cell death (apoptosis)
(apoptosis)
Cell cycle stabilization
Anti-angiog
ggenesis (decrease
(
blood supp
p l
p y)
y)
Enhanced expression of tumor
suppressors (64, 65)
Vitamin D
· Epidemiological
pg
data indicate low Vitamin D
may play a role in the genesis of malignant
lymphoma
· C l
a it
c ri l
o has strong antiproliferative effects in
prostate, breast, colorectal, head/neck, lung
cancer, lymphoma, leukemia and myeloma
· Effects are associated with G0/G1 arrest (cell
division), induction of apoptosis, differentiation
and modulation
modulation of
of growth
growth mediate
-
signaling
signaling in
in
tumor cells
· Calcitriol (Vit D3)
() app
p ears
p
to potentiate
p
the
antitumor effects of cytotoxic agents
Anticancer Res, 2006, 26(4A):2551-6
Vitamin D
· Vitamin D deficiency has been
associated with myeloma
J Env Path, Tox & Oncology, 2009, 28(2):133-141.
· Study looked at Vitamin D levels in 148
newld
ly i
diagnosed MM
MM pati
ti
t
en s
Level of Vitamin D deficiency worsened with
stagin
g g (Sta
(
ge I: 16%, Stag
,ge II: 20%, Stag
,ge
III: 37%)
Also levels of CRP, creatinine levels than
controls
Am J Hem, July 2009, 84(7):397-400
Radiation and Skin
Irritation
· Calendula cream after
XRT reduced
reduced skin pain
and redness (69)
Green Tea (Camellia
sinensis)
· Protective effects from
from oxidative
oxidative
stress (anti-oxidant polyphenols)
· Same plant for: Green, Black, &
White teas
· Al
Also conti
tains 1/3
1/3
f
ca fi
ffeine as
coffee
· Numerous health benefits from
cancer-protective to blood sugar
balancing
Green Tea
(C
( amellia sinensis)
· Found to inhibit growth of many
gy
cancers: lung, colon, breast,
prostate, melanoma, leukemia (72)
· Decreases blood vessel growth
growth
Inhibits/reduces VEGF (70, 71)
· Cell studies have shown
shown EGCG
EGCG induces
apoptosis in myeloma cells (34), in vitro
(cell cultures) and in vivo (mice)
Blood, 2006 Oct, 108(8):2804-2810.
· Caffeinated appears MORE beneficial
Recommendation:
· Aim for 3-12 cups (20 - 72 ounces)/day
Green Tea
(C
( amellia sinensis)
· Consumption is most likely
py
contraindicated during cancer therapy
with Velcade
· Study done in vitro and in vivo
· EGCG prevented cell death by blocking
proteasome inhibition functions of
Vl
Velcade
· Interestingly, Green tea polyphenols are
conside
dered
ed to
to have proteaso
oteasome
inhibiting qualities Drug Resistance Updates,
2006;9(6):263-273.
· Could not induce tumor
tumor cell death
Blood, 2009 Jun, 113(23):5927-37.
Glycemic Index (GI)
(GI)
· The Glycemic Index scale ranks carbohydrate-rich
foods by how much they affect blood glucose levels
compared to glucose or white bread
· The speed at which food increases blood sugars is
the Glycemic Response (GR)
· High GI ratings (>70) raise blood sugars quickly =
BAD!
· Low GI ratings (<55) raise blood sugars slowly
· Low ratings are better for many reasons!
Glycemic Index
· Low Glycemic Index Foods:
Skim milk, plain yogurt, apple, sweet potato, oatmeal,
ht
hummus, nuts, h
c
i
err es, b
l
rocco ili, l t
e t
ttuce, yams, green peas,
lentils, pinto beans
· Medium GI Foods:
Banana, raisins, popcorn, brown/wild rice,
rye bread
· High GI Foods:
(HFCS), Watermelon, white bread, dried dates, cheerios,
baked white potato, parsnips, corn
corn flakes
flakes, bagels, french
french
fries, ice cream, potato chips, beets, scones,
gatorade
RESOURCE: lowglycemicdiet.com
Glycemic Control
· Glycemic
y
control:
Hyperglycemia and insulin resistance are
common in
in critically
critically ill patients, as
as a result of
stress-induced insulin resistance and
increased glucose production
production
Study looking at attaining normoglycemia in
surgical ICU patients (n=1548)
(n=1548) found
reduction in inflammation, quicker recovery,
less secondary infections
infections and anemia, and
decreased likelihood of polyneuropathy
by 44% (28 vs 52%) (45, 46)
Dexamethasone
· Increases serum glucose concentration
· The use of glucocorticoids can worsen pre-
existing blood sugar issues (i.e. diabetes, chronic
illness) and precipitate new steroid-induced
diabetes (SDM)
Found to also decrease serum thyroid hormone levels.
· Affect pancreatic beta cell function (insulin)
· Alters carbohydrate metabolism and lipid (fat)
metabolism...increasing lipid levels
· Dt
Dose amount and durati
tion may be most
important as a cause of SDM. Raul, Arch Med Res,
1998;29(3):259-62.
Chromium
·Appears to help balance blood sugars, increase
insulin sensitivity and improve carbohydrate and
lipid metabolism in DEX rat studies (49)
· Corticosteroids may increase urinary loss of
Chromium (50)
· Ch
i
rom um appears to increase il
insu ilin bi
bi d
n i
ding to
cells, insulin receptor number and activates insulin
receptor kinase leading
pg to increased insulin
sensitivity (51)
· Recommendation:
200 400
-
mcg 2 times per day ( ith
w
two l
t
arges
l
mea s f
o
the day) or
1-3 tsp of Brewer's yeast (has selenium too!)
Curcumin (Turmeric)
· Found to inhibit cancer cell invasion and
tumor metastasis in cell culture
· Also found to decrease cell proliferation,
tumor invasion, and angio
,g genesis
g
· May possess tumor suppressor actions
· May lead to increase in
in glutathione (73)
· Inhibited pro-survival pathways,
td
promoted apoptosis ( i
pr mary CLL
CLL
l
ce lll
lines) Asish, K, et al, Clin Can Res, Feb 15, 2009
Curcumin
· May act
act by inhibiting cyclooxygenase 2
-
(COX-2) isoenzyme and inhibit
prostaglandin E2. Lev-Ai
Ari, J Soc I t
n eg Onc,
2006;4(1):21-6.
In other words, anti-
anti inflammatory
· When given with ECGC decreased
effect;
h
w en given sequenti
tial
increased response
· Recommended dose: 500 mg three
times per day
Curcumin
· A lot of studies...not a lot of human studies
Most studies are cell studies (in vitro), mouse/rat
studies
· Contraindications:
avoid in patients with bile duct obstruction or
cholelithiasis (gallstones)
avoid in patients with gastric or duodenal ulcers, or
with hyperacidity disorders
· Caution:
can inhibit platelet aggregation
may inhibit cy
yytochrome p450
p
detoxification enzymes
(rat studies)...'inhibit' means could make more
cytotoxic by slowing degradation
Massage
Massage and
and Fatigue
· 1290 patients with cancer; out- & in-patient
· Statistically significant (>50%) reductions in:
Fatigue
Pain
Nausea
Anxiety, insomnia
Depression
· Outpatients had slightly more benefit than
inpatients, benefits persisted at least 48 hrs
· No side effects, greatly
greatly appreciated by
by
recipients (76)
Massage and
and Depression
· Meta-analysis of RCTs of massage
and depression
· 17 studies used with 786 people
· Other interventions or combined
treatments were excluded
· All trials showed a signifi
ificant
positive effect of massage therapy
on depressed people in
in the
the
treatment groups compared to the
control group
Wen-Hsuan Hou, et al, J Clin Psychiatry,
2010
Chinese Medicine &
Acupuncture
Acupuncture
· Involves placing thin surgical stainless
steel needles into the skin to promote
health
· Has been practiced for 3,000-5,000
years
· President Nixon's trip to China in the
early 1970s helped it grow in the U S
. .
· Used worldwide
· Tremendous growth in research in the
last 15-20 years
How Does Acupuncture
Wk
Wor ?
k?
· Conventional medicine:
Increased secretion of the endogenous
opioids (beta-endorphins, enkephalin and
dynorphin, endomorphin)
major
...
role
role
(antagonized by opioid receptor antagonist
naloxone)
Affects polymodal receptors (PMRs)
Affects release of bradykinin, histamine,
prostld
taglan i
dins,
t
sero
i
on n, dopamine
Affects the release of neuropeptides such as:
substance P, calcitonin generated peptide,
somatostatin, and vasoactive intestinal
peptide
Acupuncture
p
and Cancer
· Acupuncture can help with
with :
pain (neck and back, etc.)
nausea and vomiting
vomiting
loss of appetite
fatigue
g
peripheral neuropathy (numbness and
tingling in the fingers and toes)
poor sleep or insomnia
anxiety and depression
h
s ortness f
o b
th
rea
(77)
Acupuncture and
and Nausea
Cochrane Review
Review 11 pooled trials,
also used anti-emetics
· Acupuncture reduces acute vomiting
· Electroacupuncture reduces acute
vomiting
· Acupressure reduces severity of
acute nausea (78)
Pericardium-6 (PC-6
(
)
Acupuncture and
and Fatigue
· Study of 31 patients at Memorial Sloan Kettering
Cancer Center in New York
· Participants had completed chemo an average of
2 years previously
· Two Groups:
2 treatments per week for 4 weeks
1 treatment
treatment per week for 6 weeks
· Average improvement was 31%
(79)
Insomnia
·Systematic review of RCTs of acup
ypuncture
vs. placebo, Western Rx or controls
· 20 RCTs identified
· Concluded acupuncture more effective than:
Benzodiazepines: mean effective rates of
91% and 75% respectively
more than sham acupuncture or sleep
hygiene counseling
· Methodological shortcomings, better
studies needed
Yeung, WF, et al. Sleep Medicine, 2009 Aug, 10(7):694-704.
Anxiety/Depression
yp
· RCT, acupuncture + massage
massage + usual
usual
care (n=93) vs. usual care (n=45)
· Treatment group received acupuncture
and massage on Day 1 and Day 2 post-op
· Assessed: pain, nausea, vomiting and
mood
· Acupuncture and massage decreased
pain and depressive mood in post-op
cancer patients (
p(vs. usual care)
Mehling, W.E., et al, J Pain and Symptom Management,
2007, 33(3):258-266.
Hot Flashes and Breast
Cancer
· 72 women with
with breast cancer
cancer, RCT
· 3+ hot flashes per day
· Randomized: true vs. sham acup
· Treatments: 2X/wk for 4 weeks
· Hot flash frequency: baseline, 6 weeks, 6
months
· Mean number hot flashes acup group:
8.76.2/d, 10.07.6 in sham group
gp
· Reduction in both, not statistically significant
(sham point 3 cm away)
Deng, G, et al. J Clin Oncol, 2007 Dec, 25(35):5546-
5547.
Safety and Side
Side Effects
Effects
· Safe when conducted by
by a trained
professional
· Study of 574 British acupuncturists
acupuncturists and
involved 34,407 treatments
· Concluded: Acupuncture
p
is safe!
· Risks: infection, bleeding, pneumothorax,
nerve damage and allergic reactions (rare!)
(84, 85)
· Of 97,733 patient acupuncture visits in
Germany, only 6 potentially serious
adverse events were reported (86)
When to Consider
Integrative Medicine
Medicine
· Anyone with cancer before, duringo
during r
or after
treatment
· Reasonable indications:
nausea and vomiting
fatigue
pain, peripheral neuropathy
insomnia, anxiety, depression
· To help speed recovery from treatments
· To
To minimize use of
of medications
medications and their
associated side effects
Providence Integrative
Md
Me ii
dicine Cli
Cli i
n cs
Staff:
Laurie Skokan, PhD, Director
Miles Hassell, MD,
,, Medical Director
Mary Malinski, RN, LMT
Clinical Staff:
Loch Chandler, ND, MSOM, LAc
Ken Weizer, ND
Cindy Reuter, ND, MSOM, LAc, RD
Tony Borcich , LMT
Teresa Hill, LMT
Providence Integrative
Md
Me ii
dicine Cli
Cli i
n cs
Westside
Eastside
9135 S.W. Barnes Rd.,
4805 N.E. Glisan St., 1st
Suite 161
Floor North Tower
Suite 161
Portland, OR 97225
Portland, OR 97213
Phone: 503 216 0246
Phone: 503-215-3219
Phone: 503-216-0246
· Located in the East
· Located on the first
Pavillion (Medical
floor of the ca
cance
cer
Pavillion (Medical
Office Building) next
tower near the
to St. Vincents
elevators and the
Hospital
fountain
Books
· The Mediterranean Diet Cookbook,
Nancy Harmon-Jenkins.
Calorie Counting for a
Hl
Hea th
lthy BMI
BMI
·Walking 1 mile p
gper day = 100 calories = 10 lbs
loss/year.
· Pace while on phone...4 cal/min (10 min per
d)
day) = 4 lb
lbs loss per year.
· 8 ounces of water vs. juice daily, saves 90
calories per day
and
...
9 lbs
lbs per year.
Remember...increase exercise
exercise and vegetables and
reduce portion size
Reduce refined carbohydrates (pasta, bread) and
partially hydrogenated oils
Drink Water!!
Serving Sizes
Sizes
· All of the following are 1 serving
gg size:
1 medium piece of fruit
˝ cup
cup chopped fruit
1 cup of raw leafy vegetables
˝ cup
cup chopped vegetables
· Remember:
Fresh (raw or
or cooked)
cooked) and frozen are better
than dried or canned
Juices may be
be less
less beneficial: more in
calories, less total nutritional value/content,
increased weight gain
Celiac
· Gluten-
Gluten free foods:
Corn, potatoes, rice, tapioca, amaranth,
arrowroot, millet, quinoa, sweetpotato, yams,
taro, teff, etc.
· Tests (need to be eating wheat/gluten):
Anti-gliadin antibody
Salivary immunoglobulin A (sIgA)
Tissue transglutaminase
· More information:
li
www.csace
/
acs.org l
g t
u
ih
en-grains.php