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Physicians Update

 
Summer 2007 Oncology

Integrative Medicine: The Best of Eastern and Western Treatments

The impact of cancer reaches beyond the physical disease. It shapes a patient’s thoughts and emotions. Increasingly, physicians are recognizing that treating cancer often means more than just aggressively attacking the malignancy. It means considering the whole person—mind, body and soul—and adding complementary approaches that increase health and well-being, reduce stress, boost tolerance of conventional treatments, improve quality of life and help people to live as fully as possible.

Historically, practitioners of conventional Western medicine considered their methods separate and incompatible with other styles or systems of medical care. This line has blurred as patients have sought broader clinical options, often combining conventional and alternative treatments that include herbal therapies, dietary supplements, mindbody techniques and many other non- Western therapeutic traditions—a style of medicine known as integrative medicine.

Some physicians may resist this hybrid approach but “there really is no conflict between conventional Western treatment and integrative medicine,” asserts oncologist John Glaspy, M.D., director of the Women’s Cancers Program at the UCLA Jonsson Comprehensive Cancer Center. Integrative medicine provides a win-win approach: “Combining conventional and alternative healing techniques is not a lion and a lamb relationship; it is two lions working in cooperation with each other for the benefit of the patient,” says Dr. Glaspy.

While clinical studies have not been conducted to demonstrate that complementary therapies directly influence the efficacy of conventional treatment and survival, practitioners report that in most cases these therapies do play a significant role in helping patients to cope with the frightening and life-altering experience of cancer.

“People often feel highly stressed and overwhelmed by the diagnosis of cancer,” says internist and integrativemedicine specialist Mary Hardy, M.D., medical director of the Simms/Mann– UCLA Center for Integrative Oncology (www.cancerresources.mednet.ucla.edu), formerly known as the Ted Mann Family Resource Center. “They are literally in the fight of their life, and we want to provide them with every tool available to help them stay as healthy and well as possible.”

Dr. Glaspy agrees. “These approaches improve the satisfaction of patients, lower their anxiety level and make them feel more in control,” he says. “It doesn’t really matter whether taking supplements makes the treatments more efficacious; if it doesn’t interfere with treatment and makes the patient’s life richer and helps them tolerate conventional treatment better, then the benefits are very positive.”

It is a trend that is welcomed by many physicians.  “The development of the Simms/Mann–UCLA Center for Integrative Oncology is extremely important and timely,” comments Helena Chang, M.D., Ph.D., director of the Revlon/ UCLA Breast Center. “It helps to define the new model in cancer care—from a disease-oriented treatment model to a patient-centered wellness model. I believe this is an improved model for patients and doctors to embrace.”

 The Simms/Mann Center is part of a broad program of integrative medicine, the UCLA Collaborative Centers for Integrative Medicine. Other core programs within the collaboration include the Center for East-West Medicine, the Center for Human Nutrition, the Cousins Center for Psychoneuroimmunology, the Mindful Awareness Research Center, the Center for Neurovisceral Sciences and Women’s Health, the Pediatric Pain Program at Mattel Children’s Hospital UCLA and the Stiles Program for Integrative Oncology at the Jonsson Comprehensive Cancer Center.

During active cancer treatment, the most urgent medical priorities include managing symptoms and minimizing side effects. In the integrative-medicine model, essential additional components include recovering and maintaining good physical health as soon as possible, for as long as possible, and maximizing quality of life through attention to psychological, social and spiritual well-being.

Most patients undergoing cancer therapy wouldn’t exchange conventional treatment for alternative approaches just to feel empowered and spiritually and psychologically fulfilled, says Anne Coscarelli, Ph.D., director of the Simms/Mann–UCLA Center for Integrative Oncology. Rather, they want these services and values integrated with their conventional medical care.

“Patients want to share this information with their providers and to make sure combining modalities is safe,” Dr. Coscarelli says. “People desire reliable information and value practitioners willing to consider multiple approaches.”

Yet, patients often do not tell their physicians about alternative therapies they are trying, and physicians don’t usually ask. While most supplements may be beneficial—or at least not harmful—some can be dangerous to a cancer patient and/or adverse to his or her treatment.

In light of that fact, physicians should open the door to discussion with patients about supplements they may be taking. If the physician lacks sufficient knowledge about alternative therapies, he or she can refer the patient to a practitioner who has a comprehensive understanding of conventional as well as complementary and alternative medicines.

“As physicians, we need to know what our patients take and use,” Dr. Glaspy says. “We need to be prepared for any problems these therapies might present.”

Patients often bring Dr. Hardy their supplements to determine whether they are compatible with their health needs and/or their conventional cancer treatment. “Patients with cancer have a real need to get accurate information about using dietary supplements and other complementary therapies,” says Dr. Hardy. “Our goal is to help patients make good choices that will not interfere with conventional treatments but do enhance their well-being.”

The Simms/Mann–UCLA Center for Integrative Oncology is a unique program of integrative medicine because it has expertise in many areas and combines all of these to facilitate the well-being of patients and family members. Karen Duvall, M.D., M.P.H., for example, works closely with patients to educate them about appropriate nutrition plans during the course of their treatment. “Nutrition is an important area in which individuals with cancer often have many concerns,” says Dr. Duvall, associate director of the Preventive Medicine Residency Program at the David Geffen School of Medicine at UCLA. “These concerns include issues about causes of cancer as well as its prevention and the role of nutrition in the sustenance of life.”

Dr. Duvall notes that patients may hear about nutrition or supplements through the media, but often it is difficult for them to know what is important or efficacious. “Recent research has identified certain foods and/or supplements that may be important in the prevention of cancers as well as the prevention of recurrence,” she says. “The role of such things as soy and what constitutes a healthy diet, for example, are areas under debate. It is our goal to discuss these issues with our patients so they can make informed choices.”

Deciding whether to incorporate alternative practices into the conventional treatment regimen often comes down to a question of who’s the boss: “Ultimately the patient is in charge of his or her treatment,” Dr. Glaspy says. “And patients are telling us—either in words or by their actions—that they value and benefit from integrative medicine.” 

Recommended reading

Hui KK, Hui EK, Johnston MF. The potential of a person-centered approach in caring for patients with cancer: a perspective from the UCLA Center for East-West Medicine. Integr Cancer Ther. 2006 March; 5(1); 56-62.

Jones LW, Demark-Wahnefried W. Diet, exercise and complementary therapies after primary treatment for cancer. Lancet Oncol. 2006 December; 7(12); 1017-26.

Robotin MC, Penman AG. Integrating complementary therapies into mainstream cancer care: which way forward?Med J Aust. 2006 October; 185(7); 377-9.





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