What is Integrative Oncology?
There are many approaches to treating cancer. The Center for Advanced Medicine believes integrative oncology combines the best aspects of two seemingly contradictory branches of medicine:
• Conventional Medicine also referred to as allopathic, Western, or modern medicine;
• Alternative Medicine also referred to as natural or holistic medicine.
With regard to cancer, The Center for Advanced Medicine’s integrative approach provides a wider palette of therapies and treatments. It is a necessary step forward in the progression of how we treat a disease which does not respond well to purely conventional or alternative approaches alone.
There are a lot of great aspects of Western medicine, and we focus on the best of conventional medicine. We also embrace the best of a more natural approach. The Center for Advanced Medicine combines those for each patient, individually. That’s really what integrative means — the best of both worlds’ approach where we’re integrating both conventional and natural medicine.
What integrative oncology seeks to do is pick up where conventional oncology leaves off, and improve it greatly by incorporating evidence-based therapies from the natural and alternative realms. The value lies in offering a best-of-both-worlds approach to treating cancer.
The Center for Advanced Medicine does this by utilizing treatments which are within the standard of care, as well as many which are not necessarily within those standards but have shown some level of promise against cancer.
We do not — and must not — abandon evidence-based medicine, but we are willing to evaluate that evidence through a different lens.
The general principle behind integrative oncology is that we take the best aspects of modern medicine and the best aspects of natural medicine, and we combine these two philosophies in a strategic way so that the treatment protocol is personalized for each patient. We do not reject any treatment unless we feel that the potential harms outweigh the potential benefits.
Unfortunately, this reasonable approach is not common in cancer treatment today. Providers on both “sides” tend to embrace one philosophy while completely rejecting the other. This is neither evidence-based nor is it fair to patients who are, many times, desperate for a comprehensive treatment program which addresses their treatment goals.
Sobering facts about cancer
• Cancer is quickly becoming the number one killer of people in developed countries, overtaking heart disease.
• The lifetime risk for any person developing cancer has increased dramatically; today, the risk is nearly 1 out of 2.
• Despite billions of dollars spent to find a cure, the death rate from cancer has not significantly improved.
Something must be done to address this …
Problems with the Current Standard of Care
As it stands today, we know more about cancer than ever before in history. We have made tremendous strides in the field of radiology, in the development of new chemotherapy and immunotherapy drugs, and in the precision with which we perform surgical procedures. The standards of care today are evidenced-based with an overwhelming amount of good science and rigorous studies to back up their use.
However, this does not mean that the way that we treat cancer is not without its shortcomings. Particularly, in light of the disappointing statistics, we realize that for all of our research and knowledge, we still are not winning the war on cancer. In fact, we are losing badly.
As it turns out, there is still plenty we do not know, and we stand to learn a lot. While conventional oncology today does all it can within its purview, there is more that can be done. It is my sincere belief, based on my training and clinical practice, that we can do far better.
To start with, it is helpful to know what the process looks like for someone who is diagnosed with cancer.
If you are a woman, and you feel a lump in your breast, you will hopefully have either your OB-GYN, family doctor or internist examine the lump. Your doctor will likely order a mammogram and an ultrasound, and if it still looks suspicious, you will typically have a biopsy to confirm cancer.
If the biopsy is positive, your doctor will refer you to a medical oncologist and a surgical oncologist. You might also be referred to a radiation oncologist. The order of referral might vary some degree. Sometimes, the medical oncologist will coordinate both surgery and radiation consults.
Often, the process between diagnosis and treatment moves very quickly. Following their first trip to a medical oncologist, many patients are scheduled to begin treatment within a few days. This haste is large because the protocols for cancer treatment are well established within conventional oncology. For example, if you have a certain type of breast cancer, and it is at a specific stage, there is what is known as a first-line treatment. This will include treatments that are known to work best for this specific kind of cancer at this stage. If that series of treatments are unsuccessful, your oncologist will likely recommend second-line treatments, which entails a different combination also thought to have efficacy against your particular cancer.
This can be thought of as “flow chart” medicine, or “cookbook” medicine. It is very much a one-size-fits-all approach to treating cancer. There is a general lack of personalization or tailoring of treatment to each patient. This may be an efficient way of treating cancer if your intent is to treat as many patients as possible, but it certainly generalizes the entire patient population and makes assumptions about commonalities between patients.
Your cancer is as unique as your fingerprint. No one else’s is exactly like yours. And that’s a big shift from what a lot of people are getting from their oncologist in terms of this is your diagnosis and this is your treatment, and they look around the room and everyone else with their diagnosis is getting the exact same treatment.
As a result of this individuality, each case comes with its own share of hurdles and challenges. By denying this individuality, conventional oncology probably affects many of its outcomes negatively. This is not to say that conventional oncology does not receive good outcomes, necessarily. However, we have learned that by tailoring treatment to the individual patient, you are able to target cancer in a way that most effectively treats it, minimize collateral damage, and give the best chance at a good outcome.
'Looking through a periscope'evaluating evidence through a different lens
What You Will and Will Not Hear From Your Oncologist
In the short period of time between diagnosis and the start of treatment, there are a few things that you likely will hear from your oncologist:
- Discuss prognosis and chances of success based on existing data.
- Surgery, if you are thought to be a good candidate.
- The best course of chemotherapy, what side effects to be prepared for, and how to best mitigate them.
- Often, your oncologist will go ahead and write prescriptions for drugs that help with the side effects of chemotherapy and/or immunotherapy, such as nausea, vomiting, diarrhea, and fatigue.
- If radiation is appropriate, that will be discussed as well. You will get referrals and a schedule for upcoming treatments within this standard of care.
What you will most certainly not hear about is anything related to nutrition, supplementation, exercise, stress reduction, or any other natural or alternative therapies. At the most, your oncologist might ask you about the supplements you are taking, if any, for fear of them interfering with the chemotherapy treatment or other prescription drugs.
As far as diet is concerned, no nutritional information is typically offered by conventional oncology. In fact, if you ask your oncologist about diet, most will tell you that it does not matter what you eat, at least as far as your treatment is concerned.
This is inexcusable for any physician who claims to practice evidence-based medicine! At most, you will get warnings about losing too much weight during treatment. Anything in addition to that, in terms of diet, is ignored.
Sometimes, an oncologist will refer patients to a nutritionist. Sadly, much of the advice issued by nutritionists is fairly poor, particularly when it comes to a diet that would potentially help fight against cancer.
The fact that we do not have randomized, double-blind, placebo-controlled studies on the efficacy of diet is frustrating, simply because there is some good evidence that diet and nutrition play a key role in cancer treatment.
However, it serves to underscore perhaps one of the biggest flaws in conventional oncology: many in the field possess an inability to accept anything that has not been taught to them as the standard of care.
Moreover, most will not even entertain the notion that other modalities might be beneficial in some regard — all while watching many of their patients die. We are still left not knowing what we do not know. It is a scary thought to reflect on what we do not know when it comes to optimal cancer treatment.
What we know for a fact — including chemotherapy, radiation, immunotherapy, and surgery, for example — we know very well. We know how they work, and in many cases, how well they are likely to work. But we are clearly missing something, as evidenced by the lack of significant progress in treatment outcomes.
In presentations, I often describe the typical approach to cancer treatment as looking through a periscope. We can see a lot when we look through a periscope — far more than if we only look underwater. But the fact remains that we certainly cannot see everything. The danger lies in assuming that what we see through the periscope is all that exists.
Therapies for a Foundationholistic approach — treating the whole person, the whole body
Similarities between Conventional and Integrative Oncology
In the interest of taking a best-of-both-worlds approach, integrative oncology incorporates many of the same diagnostic and treatment tools as does conventional oncology. Diagnostically, we really do not change anything. Patients still need to have appropriate biopsies. We embrace biopsies and conventional lab testing such as tumor markers (for example, CA 15-3, CA 19-9, CA 27.29, CA 125, CEA, AFP, etc.).
Appropriate imaging, such as PET scans, CT scans, MRIs, and X-rays, is important as well. Getting a proper diagnosis of cancer is a critical first step in treating cancer, and having all of the pertinent information using as many tools as possible is critical to know what we are dealing with. It makes no sense going into battle without specific information as to who our foe is.
Once a proper diagnosis of cancer is made, including its stage, we begin to discuss treatment options. In my integrative oncology practice, we still use chemotherapy, although we use it in a way which I believe is more targeted and safer. We also embrace tools such as radiation and surgery, when indicated.
It is important for people — particularly those who are more natural-minded — to remember that these are tested and proven methods for dealing with cancer. It makes little sense to abandon these therapies simply because they are not ideal or perfect, especially when dealing with a complex and aggressive disease such as cancer.
Surgery, in particular, is often a critical first step in treating cancer. Many patients come into our office having avoided surgery, even after a diagnosis of cancer, sometimes years prior. Many of these cases had remarkably good prognoses at the time of diagnosis and still would be it not for patients delaying surgery indefinitely.
Many people simply do not want to have surgery, for a variety of reasons including a fear of anesthesia, concerns over an infection, and the belief that surgery spreads cancer.
Simply put, if a patient is a good candidate for surgery and the pros of a surgical procedure outweigh the cons, surgery is a critical first step in the treatment of cancer. An unwillingness to have surgery will likely make their journey much more difficult.
I am a firm believer in reviewing the conventional standard of care with any patient I see for consultation in my office. We discuss what the conventional approach would be based on the specifics of the diagnosis. I tell patients that we should consider these treatments as part of the plan.
Some patients choose to take the purely conventional route, and if that is their choice, I always make the proper referrals. For some cancers which respond remarkably well to conventional treatment alone, I feel that this is a reasonable choice.
For patients who choose to follow the integrative route, how we progress from that point differs dramatically from what a conventional protocol offers.
A Different Approach to Fighting Cancer
Integrative oncology sees the battle with cancer as having two fronts that must be addressed simultaneously. The first front is against a tumor (or, depending on the stage of disease, tumors). To this end, we have tools such as surgery to remove the tumor and tools like chemotherapy and radiation which can shrink the tumor and/or kill cancer cells.
Conventional oncology is well adept at fighting cancer in this regard. Another front to the battle against cancer, however, is against the systemic burden of cancer.
Cancerous tumors release what are called circulating tumor cells, or CTCs. A component of CTCs, known as cancer stem cells (or CSCs), can be thought of as synonymous for our purposes here. These cells are cancerous cells that can be found throughout the bloodstream, and are released by a tumor well before that tumor is able to be detected.
Because of the nature of cancer cells, these cells are essentially immortal; they will not die unless we kill them, and they are floating around the body waiting on the right opportunity to form a tumor elsewhere. This spread from the primary site is known as metastasis.
Interestingly, conventional oncology largely ignores this systemic burden of cancer, especially in early-stage cancers where the tumor is largely confined to one area. One of the biggest concerns with cancer is that even after successful treatment seemingly eliminates all traces of the disease, it can return years later.
Because conventional oncology ignores these circulating tumor cells, we see that people can have surgery, full-dose chemotherapy, and/or radiation, and be told they are “cancer-free,” “cured,” or “in remission,” but get cancer again months or years later.
In integrative oncology, we measure these levels of CTCs routinely, because they are critical for accurate diagnosis, appropriate treatment, and thorough monitoring. Many of the additional therapies we employ are aimed at killing these types of cells, as well as altering the “terrain” which provided an environment for cancer to grow and flourish.
Cancer as a Metabolic Disease
Another fundamental difference between integrative and conventional oncology is that integrative oncology treats cancer as a metabolic disease. Generally speaking, when we refer to metabolism, we are referring to how the body uses food to create energy.
However, for our purposes, we need to think of metabolism on the cellular level; namely, the mechanisms by which cells obtain fuel and grow. At its core, treating cancer as a metabolic disease means that we attack the way cancer cells manufacture energy.
All cells — healthy cells and cancer cells — have a metabolic process by which they create energy. That energy currency is known as adenosine triphosphate or ATP. Healthy cells produce upwards of 36 units of ATP as the result of their metabolic processes. Because cancer cells are so reliant on glucose, they have more glucose and insulin receptors on their surface.
We can use these characteristics of cancer cells to our advantage, in a variety of ways. Another way we can use cancer’s metabolic processes against it is by going after one of its primary metabolic byproducts, lactic acid. Cancer cells create an abundance of lactic acid as a result of their metabolism.
This lactic acid can be thought of as a waste product. In order for a cancer cell to survive, that acid must be thrust out of the cell. Subsequently, we see that the areas surrounding cancer cells are far more acidic than the areas surrounding healthy cells. This is largely where you hear about the importance of pH in cancer development. We can use this in our favor.
By targeting cancer’s ability to remove lactic acid from the cells, and by targeting the acidic environment that surrounds cancer tumors and promotes their growth, we open ourselves up to more potentially effective treatment options.
Evaluate All Potential Therapiescomprehensive programs to addresses treatment goals
While the methods used today to diagnose and treat cancer have a tremendous body of research which supports their use, there are many other methods used in integrative cancer treatment which have shown promise but have not been studied on the scale necessary to become mainstream.
To ignore these types of studies is shortsighted in my opinion, especially given the fact that the outcomes from standard treatments have not significantly improved since President Nixon “declared war” on cancer nearly 50 years ago.
In evaluating potential treatments for my patients, I approach each one carefully, with open-minded skepticism. The paradigm of integrative oncology requires this open-minded skepticism. If a treatment has shown promise clinically and/or in a study, and if we believe that it could potentially provide benefit with a low likelihood of causing harm, why would we not at least consider its use?
This approach should be contrasted with closed-minded skepticism, which is typically how conventional oncology views any cancer treatment outside of the standard of care, as well as open-minded acceptance, which is often how alternative medicine proponents view any natural treatment that has claims of effectiveness.
In integrative oncology, we seek to critically evaluate all potential therapies. This entails being open to their potential benefit, while also requiring that there be a solid scientific basis for how and why they work.
In my practice, I offer a wide range of therapies which I think are all necessary.
• When we look at treating cancer cells themselves, the physical part of it, we, of course, are looking at fractionated chemotherapy, and we use insulin potentiation therapy, or IPT, with that. We feel like it targets those medications better to the cancer cells.
• We talk about IV vitamin C which we know kills cancer cells, and it works really well in tandem with chemotherapy. We found the outcomes are better when patients receive both.
• And of course, we talk about supplementation and nutrition. Those are all very valuable therapies that really form the foundation of our physical approach to treating cancer.
• On the other side, we have the mental and the emotional and the spiritual part. Mind, body, medicine is sort of a term for that, but we know there’s a great link between the mind and the body. And so patient stressors, their fears, their beliefs play a significant role in not only developing cancer but also healing from cancer.
I found hypnotherapy to be extremely valuable, which we offer in our office, as well as health coaching. So I have health coaches that meet with my patients as well and work on those underlying issues maybe that are there. Sometimes there can be blocks that are keeping patients from getting well, from having their immune system work as well as it could. So this is obviously a long-term approach to getting at some of these issues, but I found it to be essential.
So this really is a holistic approach. The word holistic gets thrown around a lot, but I view holistically as meaning we’re treating the whole person, the whole body — a physical perspective, a mental perspective, an emotional perspective, and surely a spiritual perspective. We have to address all those things if we’re going to give you the best chance of a good outcome.