nov 2014 webinar: complementary alternative medicine
DESCRIPTION
Many complementary therapies, used along with conventional medicine, can support cancer treatments, reduce some of the adverse effects of cancer treatment, ease tension and pain, and contribute to overall health. This is known as integrative medicine. Integrative medicine can be a part of your plan throughout the entire treatment and survivorship experience. In this webinar, we will talk about how integration can be helpful to you after a colorectal cancer diagnosis and your journey forward. Presented by Dr. Lisa Corbin: a board-certified internist, Associate Professor in the Department of Internal Medicine at the University of Colorado School of Medicine. In 2001, she helped the University of Colorado Hospital establish the Center for Integrative Medicine (TCFIM) and has served as the Medical Director ever since.TRANSCRIPT
Welcome to Fight Colorectal Cancer’s Webinar:FAD or FACT. How to determine if
complementary & alternative medicine is for you.
Make Sure You Know the Latest News About CRC Research and Treatment visit fightcrc.org
Our webinar will begin shortly.
Today’s Webinar:1. Today’s Speaker: Lisa W. Corbin, MD, FACP
2. Archived Webinars: FightColorectalCancer.org/Webinars
3. AFTER THE WEBINAR: expect an email with links to the material. Also a survey on how we did, receive a Blue Star pin when completed
4. Ask a question in the panel on the RIGHT SIDE of your screen
5. Follow along via Twitter – use the hashtag #CRCWebinar
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GuideInTheFight/
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DisclaimerThe information and services provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses, or treatment.
If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room.
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SpeakerLisa W. Corbin, MD, FACPDr. Corbin is a board-certified internist, Associate Professor in the Department of Internal Medicine at the University of Colorado School of Medicine. In 2001, she helped the University of Colorado Hospital establish the Center for Integrative Medicine (TCFIM) and has served as the Medical Director ever since. Dr. Corbin works closely with oncologists in the community and from the University of Colorado Comprehensive Cancer Center to help their patients manage side effects of treatment, reduce chance of recurrence, and improve quality of life using lifestyle approaches and complementary / alternative medicine therapies that align with the patient’s values and interests.
Fad or Fact?Complementary and Integrative
Medicine
Lisa W. Corbin, MD, FACPMedical Director, Integrative MedicineUniversity of Colorado HospitalAssociate Professor, Internal MedicineUniversity of Colorado School of Medicine
Definitions CAM Complementary / Alternative
Medicine Therapies not historically part of
conventional medicine Chiropractic, acupuncture, massage,
herbals…
Lifestyle medicine Use of stress reduction, exercise,
nutrition for health benefits
Integrative medicine CAM therapies and lifestyle
approaches coordinated with conventional medical treatments
Who’s Using CAM? Nearly 50% of general public uses CAM 70 – 85% of patients with cancer used at least one
CAM treatment 80% used spiritual practices 63% used herbs / supplements 60% used movement / physical therapies
Reasons for use: Feel hopeful (73%) Boost immune system (63%) Want control (38 - 44%) Prevent recurrence (43%) Aid conventional therapy / treat cancer (28 – 38%)
Case Vignettes• MS, a 54 year old woman with metastatic
colon cancer. Was able to keep it “in check” with chemotherapy, but was so sick every 3 weeks for 1.5 weeks that she had to quit work as a medical technician. She came to us stating it was a last resort, she was planning to take a “last hurrah” trip to Greece. After discussion, she agreed to try acupuncture before chemotherapy, and this worked so well for her that she was able to continue getting the life sustaining chemo and even went back to work for four years
Case Vignettes• MK, a 60 year old female runner, had colon
cancer treated with chemotherapy, radiation, and surgery. Was dismayed that after treatment she was still fatigued and could “only” run 3 miles (prior 10+). We discussed exercise and local programs for cancer survivors, she worked with a dietician to improve diet, she worked with a psychologist on mind/body strategies for fatigue management. Gradually she was able to increase her tolerance and was back to running half-marathons within 18 months.
Case Vignettes• SS, a 62 year old male with rectal cancer just
starting treatment with chemotherapy. Family insisted that he take herbs and change his diet; some told him the chemotherapy was toxic and “would kill him, not the cancer”. He was understandably anxious about treatment and by family recommendations. He had persistent pain at the site of a surgical procedure. We suggested working with the psychologist for anxiety reduction and how to respond to well-meaning family. He began massage therapy for anxiety and pain reduction. He discussed supplements and diet with a dietician. He used acupuncture during chemotherapy and came through his treatment better than he had expected.
Using an Integrative Approach Avoid harmful practices Don’t overlook lifestyle / self-
care Sleep Exercise Mind / body techniques Nutrition
Consider safe, plausible CAM therapies Herbs / supplements Acupuncture Massage
Harmful Therapies• Colonic hydrotherapy• Chelation therapy• Ionic foot baths• Restrictive diets• Some supplements• Financial toxicity!• Anything used IN PLACE OF a
curative conventional treatment
Ionic Foot Baths
Ionic Foot Baths
http://www.wikihow.com/Test-a-Detox-Foot-Bath
Detoxification Human body is evolved to get rid of
toxins Skin Lungs Colon Kidney Liver
Be natural – let the body do what it’s good at! Support the processes: Drink plenty of fluids Exercise Don’t put a lot of toxins in in the first
place!
Helpful Therapies
• LIFESTYLE– Sleep – Exercise– Mind / body techniques– Nutrition
• CAM APPROACHES– Supplements– Acupuncture– Massage
Why Lifestyle Approaches?
Gives you more control over your health and an active role in your care
Low / no cost Can help current cancer-related
concerns, also to help prevent future illness
Get Some Sleep! Restorative sleep improves pain,
fatigue, mood Sleep deprived “normals” develop
chronic pain Links: breast cancer, weight gain
Behavioral approaches: Don’t eat, drink, exercise just before bed Avoid late day caffeine, too much alcohol Get consistent exercise earlier in the day Pay attention to room environment Establish consistent sleep times Get out of bed if not tired Don’t nap
Exercise for Prevention
• Primary prevention– Most versus least active = 27%
reduction in colon cancer– Being generally active likely helps, too
Exercise for Prevention
Exercise During Treatment
• Prevents weight gain • Decreases fatigue• Improves stamina• Helps balance• Decreases anemia
during radiation • What to “take” for my
immune system? EXERCISE!
Exercise Can Help Symptoms
• Improves pain in general• Helps memory and concentration• Improves sleep, depression• Good for the rest of life, too:
– Helps high blood pressure, diabetes, cholesterol, improves bone mass
Unlike late night TV claims, this product CAN help you lose 20 pounds and improve your sex life!
Simple Exercise Prescription: FIT
F requency Exercise every day
I ntensity Break a sweat; increase difficulty of
exercise T ime
Start with 5 minutes daily, increase by 1 minute daily each week; goal 30 minutes
(Final goal - 30 min vigorous or 60 min moderate activity daily)
Why Mind-body? Help restore locus of control Mind-body therapies are generally
safe Perception of symptoms requires
processing by the mind; mind-body therapies can alter perception
Decrease pain, stress, anxiety Often covered by insurance
Mind-body Therapies Cognitive Behavioral Tx Relaxation techniques Breathing techniques Biofeedback / heart math Art, music, pet therapy Mindfulness / Meditation Imagery / visualization Yoga / tai chi Hypnosis
Mindfulness-Based Stress Reduction• Promotes relaxation through
nonjudgmental awareness of sensations, experiences, and reactions: being “present”, “in the moment”
• Randomized wait-list vs MBSR in 107 cancer patients– Improvement in mood and stress– Effect maintained 6 months after program
ended
Yoga
• Combines physical movement, breath control, and meditation
• Promoted for patients with cancer• Studied in breast cancer; recent
study in Germany just completed for colon cancer
Support Groups
• Andersen and colleagues RCT– psychologist-led group support
resulted in improvements in QoL, in aspects of immune function, and in life expectancy.
Cancer 2008; 113: 3450 – 8.
Diet / Nutrition
Estimated percentages of cancer due to selected factors:
• Diet* 35-60%• Tobacco 30%• Air & water pollution 1-5%• Alcohol 3%• Radiation 3%• Medications 2%* Primarily obesity
Specific Dietary Factors
• Fruits/ vegetables• Inconsistency in studies showing protection
• 50% reduction in one study, no association in another
• If valuable, probably most of risk reduction is in increasing over 100 g / day (easily get this in reasonably well balanced diet – apple is 200 g!)
• Red meat / animal fat / cholesterol• Increased risk 3x for highest intake vs
lowest intact• Fiber
• 4 large studies show decreased risk, 2 no association
Nutrition: Summary• Plant based diet, less
meat and dairy • 5 + fruits / vegetables• 7 + high fiber complex
carbohydrates • Low saturated/trans fat• Less n-6, more n-3 FA• Limited alcohol
Excellent resource: AICR
Real Nutrition Questions
Should I take
supplements?
Does “sugar feed the tumor”?
Do I have to eat
organic?Is soy good for
me?
Herbs and Supplements Three types of medicines:
Prescription (Rx) Over-the-counter (OTC) Dietary Supplements
Unlike Rx and OTC, supplements: Are not required to prove safety, efficacy Are not required to enforce quality control Can vary in concentration of ingredients
Over 60% of cancer patients use supplements
General Advice: Supplements
• Natural safe• Use extra caution with prescriptions• Use trustworthy resources for information
– Health food store, internet notoriously suspect– Good: NMCD, ODS
• If you choose to take a supplement:– Look for a well-labeled brand– Avoid combination products, MLM sales– Watch for red flags:
– Direct mail, infomercial, ads disguised as news articles, back of the magazine ads, testimonials
– Claims a “cure”– “Secret ingredients”, “one manufacturer”
Manufacturers More Likely to Produce Quality Products
Nature’s Way Nature’s Made Nature’s Bounty Costco (Kirkland) Walmart (Equiline) Phytopharmica Puritan’s Pride
In General: Avoid Supplements During
Treatment• Antioxidants may decrease effect
of some chemo, radiation• Some supplements directly
inhibit some chemotherapy (St. John’s wort)
• Some supplements may increase risk of bleeding during surgery or interfere with anesthesia
Specific Supplements• Consider:
– Omega 3 fatty acids (fish oils): anti-inflammatory
– Glutamine– Probiotics (decrease diarrhea, may
break down carcinogens)– Ginger (for nausea)– Melatonin (consider if also sleep
deprived!)– Other chinese herbals may improve
response rate according to 2012 Cochrane review
AcupunctureChinese Medicine Background
Health = balance of yin and yang Qi = energy force created by interaction of yin and yang Meridians = channels that carry qi throughout
the body; each corresponds with a specific organ
Excess, deficiency, or stagnant flow of qi results in disease
Examples of TCM diagnoses: Yin deficiency and yang predominance with reduced
kidney qi Stomach qi rebelling
AcupunctureWestern Medicine Background
Osler, 19th century “best treatment for lumbago”
James Reston, China, 1971 Biological effects
Local nerve activation Endorphins, ACTH, endogenous opioids
(reversal of analgesia with naloxone) SPECT scanning: increased activity and
reversal of asymmetry in chronic pain patients in thalamic and prefrontal cortex during acupuncture over baseline
General Advice: Acupuncture
Acupuncture is generally safe Adverse events: minor or rare (pain,
bleeding, fatigue) Disposable needles, alcohol wipes avoid
infection Practitioners
Must have a license in CO (LAc); scope of practice for MD, DO, DC
TCM: National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org)
MD: American Academy of Medical Acupuncture (www.medicalacupuncture.org)
Costs Initial / follow up: $100 / $55 for LAc Covered by some insurances
Benefits: Acupuncture• Reduces nausea / vomiting due to
chemo• May help return of bowel function
post-op• Decreases neuropathy• Pain control• Helps depression• May stimulate immune system • Recommended for dry mouth
Massage Therapy Developed by
almost all cultures Many different
forms Emphasis on
improving circulation, releasing muscle tension, calming and relaxing patient
Massage Therapy: Facts Over 20% of patients with cancer use
massage therapy Many patients remain unaware of the
potential benefits of massage Some patients are mistakenly told to avoid
massage if they have cancer
General Advice: Massage Generally safe. Use caution with:
Congestive heart failure Infections Blood clots / bleeding disorders Osteoporosis or bone metastases Pregnancy Does NOT spread tumor
Requirements for licensure or registration vary by state
Look for involvement in AMTA (www.amtamassage.org)
Extra training for oncology available $60 - $120 / hour, occasionally covered
Massage Therapy: Benefits Relaxation, improved QOL Depression, anxiety, sleep Post-operative wound healing Lymphedema treatment Pain management
Finding a Good Provider
Training and licensure Experience with cancer Expected benefits Risks
Direct risks or side effects, interactions?
Costs / reimbursement Time frame / progress assessment Ability to work with conventional
providers
Summary• CAM treatments can be safely
integrated with conventional treatments– Don’t use harmful therapies – Use therapies shown to be beneficial
• Lifestyle approaches often overlooked• If it sounds too good to be true…
– Consider safe, plausible therapies • If they help you, they are beneficial!
• Find good practitioners, use good resources
“Be open minded, but not so open minded that your brains fall out”
Widely attributed
Internet Resources• CU Integrative Medicine: www.uch.edu/integrativemed• NCI (follow links for CAM):
www.cancer.gov/cancer_information/ or http://occam.nci.nih.gov
• ACS: www.cancer.org• ASCO patient information:
www.PeopleLivingWithCancer.org• Nutrition - AICR: www.aicr.org• Supplements: http://ods.od.nih.gov/• Consortium of Academic Health Centers for Integrative
Medicine: www.imconsortium.org• NCCAM: http://nccam.nih.gov/
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