Integrative Oncology:

Complementary Therapies for

Mesothelioma

Mesothelioma Applied Research Foundation

New York, NY

September 28, 2012

Kathleen Wesa, MD Integrative Medicine Service

Memorial Sloan-Kettering Cancer Center New York, USA

Alternative vs Complementary

Alternative Therapies

• Promoted for use instead of mainstream

treatment for cancer & other serious illnesses

• Usually biologically invasive

• Costly; potentially harmful

Complementary Therapies

• Used WITH mainstream care for serious illnesses

• Non-invasive

• Inexpensive; safe; evidence-based

Seven Signs of Voodoo Medicine &

Science

1. Proponent pitches claim directly to media.

2. Claims a powerful establishment is suppressing his work.

3. The effect is at the very limit of detection.

4. Evidence is anecdotal.

5. He works in isolation.

6. Says a belief is credible because it has endured for decades or centuries.

7. Proposes new laws of nature to explain how it works.

From “Seven Signs of Voodoo Science” by Robert Park, physicist, 2003.

Integrative Oncology

Combines the best of

complementary and

mainstream care

Complementary Therapies

control many symptoms experienced by

patients and by people generally

• Pain

• Hot flashes

• Sexual dysfunction

• Urinary problems

• Fatigue

• Xerostomia (dry mouth)

• Anxiety, depression, stress

• Osteoarthritis

• Neuropathy

Essential per data on

activity and cancer outcome

2- Fitness/Physical Activity

When will we treat physical

activity as a legitimate medical

therapy… even though it does not

come in a pill?

Church T, Blair SN. Br J Sports Med 2008 Oct 16.

8

Summary of Exercise-Induced Changes

INCREASED

• Muscle mass,

strength & power

• CV fitness

• Max walk distance

• Immune system

capacity

• Physical functional

ability

• Flexibility

• QOL

• Hemoglobin

DECREASED

• Nausea

• Body fat

• Fatigue

• Symptom Experience

• Duration of

hospitalization

• HR

• SBP

• Psychological &

emotional stress

• Depression & anxiety

ACS/ASCM Physical Activity

Recommendations

for Cancer Survivors

• 30+ minutes of moderate to vigorous physical

activity, above usual activities, on 5+ days/ wk

• 45 to 60 minutes physical activity is preferable

• If sedentary, begin with 10 minutes fitness and add

10-15% each wk, total 30 min continuous/5 days

per wk

ACSM New Guidelines Presented at ASCO June 6, 2010

3-Nutrition Recommendations

WCRF/AICR Recommendations

1-Be as lean as possible w/o

being underweight

2-Limit consumption of energy-dense foods

• Avoid sugary drinks

3- Plant Foods

• 5+ servings of non-starchy veg and fruits every day

4-Animal Foods

• Limit intake of red meat

and avoid processed meat

5-Alcoholic Drinks

• ≤ 2 drinks/day for men and

≤ 1/day for women

6-Preservation,Processing,

Preparation

• Limit salt, avoid moldy cereals

7-Dietary Supplements

• Meet nutritional needs through

diet alone

• Dietary Supplements not

recommended for cancer

prevention

Dietary Supplements?

13

Or Substitution?

4- Botanicals and Nutritional

Supplements

• 28+ BILLION dollars are spent each year in

the USA on vitamins and nutritional

supplements

• Antioxidants are highly marketed and are of

uncertain benefit, can interact directly with

cancer treatments

• Wheat grass, Gogi, Noni, AÇAI,

Pomegranate, Mangostin, EGCG/green tea,

resveratrol, Vitamin A, C and E, selenium

Herbs and Other Botanicals

Benefits and Problems

• Faulty Assumptions Natural = safe; Long-term use = effective

• Botanicals are unrefined pharmaceuticals

• OK for general public, probably not for many cancer patients

• Concerns: contamination, toxicity, standardization, bioavailability, proper doses, and adverse herb-drug interactions

• Vitamin D may provide benefits aside from osteoporosis prevention and bone health, studies are in progress

Web site about herbs, botanicals,

vitamins, etc.

www.mskcc.org/aboutherbs

Astragalus

• Used in TCM for lung ailments

• Modern scientific studies show potent

immunostimulating effects and cytostatic activities

• Chinese herbal medicine containing Astragalus

can increase effectiveness and reduce side

effects of chemotherapy (McCulloch M. J Clin Oncol. 2006., Taixiang W. Cochrane Database

Syst Rev. 2005)

• May affect the function of immunosuppressant

drugs (Chu DT. J Clin Lab Immunol. 1988)

Application in Cancer Patients

• Pain

• Xerostomia (dry mouth)

• Neuropathy

• Nausea

• Fatigue

• Hot flashes

• Stress/Depression

• Bowel Irregularity

• Lymphedema

Acupuncture Needles

26

6-Types of Mind-Body practices

• Meditation- includes mantra, mindfulness

and relaxation techniques

• Yoga

• Tai Chi and Qi-Gong

• Hypnosis

• Guided Imagery

• Breath Awareness

• Music Therapy

Massage Therapy

012345678

Pain (n=625) Fatigue (n=819) Stress (n=786) Nausea (n=222) Depression (n=378)

Mean

sym

pto

m s

co

re (

0 -

10)

Symptom scores before and immediately after massage therapy

N=1,290

Pre-treatment Post-treatment

Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a

major cancer center. J Pain Symptom Manage 2004; 28:244-249

Complementary Medicine at the NIH

• Website for Office of Cancer

Complementary and Alternative

Medicine www.cancer.gov/cam

• National Center for Complementary

and Alternative Medicine

http://nccam.nih.gov

Summary

Eat food

Not too much

Mostly plants

Be physically active every day

Discuss all botanical/supplement use

Acupuncture can benefit many symptoms

Don’t forget the Mind-body interventions

Thank you for your attention!