Thursday, February 22, 2018

How to Evaluate Cancer Treatments

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Category: Cancer

While space limitations prevent consideration of specific cancers here, no matter what kind of cancer you have, the experts agree that a step-by-step approach is the way to go to evaluate what cancer treatment options will work best for you. Following are recommendations for how to evaluate cancer treatments.

Step 1: Decide for Yourself About Cancer Treatment Issues

“Thank you, but I’m going to deal with this my own way.” As soon as family practitioner Anne Simons, M.D., an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center, got diagnosed with breast cancer in 1991, friends and colleagues began calling with advice: You really should see this-or-that oncologist, or become a vegetarian, or take this-or-that vitamin regimen or herb formula, or go to this-or-that clinic in Mexico. “I knew they all wanted to help,” she explains, “but when you’re reeling from a cancer diagnosis, badgering is not helpful. I needed to decide for myself how I wanted to get treated.”

You’re in charge of your treatment. Some people delegate their care entirely to their family doctor or to an oncologist, and prefer not to learn much about their cancer. Others delegate their care but ask their doctors to keep them informed. Some form a partnership with their doctors and other practitioners, and are deeply involved in decision-making about their care. There is no right or wrong here. The important thing is to understand that you’re in charge of your treatment. Understand your options and then decide how you want to proceed. Down the road, you’re free to change your mind if you wish.

“Everyone deals with cancer their own way,” Dr. Lerner says. “If you get cancer and want to join a support group, or take herbs, or go for long walks on the beach, fine, do it. But when people you care about get cancer, they need to make the decisions. You can offer suggestions, but if they choose paths different from the one you would choose, it’s usually best to support their decisions.”

Step 2: Organize Your Social Support System to Cope With Cancer

Get help so you can focus on your own needs. When you’re diagnosed with cancer, you typically feel swept up in an emotional whirlwind. The same thing happens, to a lesser extent, to your family and friends. It’s a difficult time. It brings out the best in some people, and less-than-the-best in others.

You need to do everything you can to cope with your illness and take care of yourself. Maybe you want to talk to everyone you know, but perhaps you don’t. Maybe you want to provide support for other people, but perhaps you don’t. Maybe you want to delve into researching your disase, but perhaps you don’t. Maybe you want to shop, cook, and run errands as you always have, but perhaps you don’t.

Decide what you want to do, how you want to spend your time. Then ask a few people close to you to handle the other chores. “Being a doctor, I wanted to research my breast cancer,” Dr. Simons recalls. “But I did not want to provide support to friends and family members who where upset about my illness. Right after my diagnosis, I actually had friends call and sob on the phone, as if I were supposed to take care of them. I also had a friend call and describe her mother’s horrible death from breast cancer. I really didn’t need to hear that. So I went to the medical library, and had my husband handle the phone.”

Make a list of your chores, errands, and other necessary tasks. When friends say, “Call if you need anything,” make one specific request, for example, “How about bringing my family dinner Wednesday night.”

“The period right after diagnosis is emotionally the hardest,” says Mary Jane Massie, M.D., a psychiatrist at Memorial Sloan-Kettering Cancer Center in New York. “For those who have always been self-reliant, it can be difficult to ask for help or accept it. I tell people: It’s okay to be a little selfish, and ask for what you need.”

Step 3: Join a Cancer Support Group

You’ll feel better and may live longer. Beyond support from those you know, joining a support group can provide tremendous comfort—and might even extend your survival.

In the late 1970s, Stanford psychiatrist David Spiegel, M.D., theorized that support groups might help people cope with the stress of having a life-threatening illness. He divided 86 women with advanced, no-longer-treatable breast cancer into two groups. One received standard medical care, the other, standard care plus participation in a weekly 90-minute support group that Dr. Spiegel led. He theorized that the support group would improve participants’ coping abilities, and it did. But the group also did something he never expected: It extended their lives. After 10 years, 83 of the 86 women had died, but those in the support group survived twice as long—an average of 37 months compared with just 19 months for those who received only standard care.

Dr. Spiegel’s findings have been corroborated by Fawzy I. Fawzy, M.D., a professor of psychiatry at the UCLA School of Medicine. Dr. Fawzy recruited 68 people with malignant melanoma skin cancer and invited half to participate in a 90-minute education and support group once a week for six weeks. Compared with melanoma patients who received just standard medical care, those in the group showed less fatigue and depression, and better coping abilities. Six years after Dr. Fawzy completed this study, he learned of Dr. Spiegel’s research and tracked down his participants to see if those in his group had survived any longer. Despite the brevity of his group (just six weeks), they had: Among the patients who received only standard care, 10 had died. But among his group participants, there were only three deaths.

More evidence of the value of social support comes from a study at Laval University in Quebec. Three months after breast cancer survery, the researchers asked 235 women how many confidants they turned to for emotional support. Seven years later, the women with no confidants had a survival rate of 56 percent. The figure for those with two or more confidants was 76 percent.

To find a support group near you, ask your family doctor or oncologist for referrals to the cancer resource organizations in your community.

Step 4: Get the Cancer Pathology Report in Writing

Exactly which type and stage of cancer do you have? When a doctor suspects cancer, the lump or some cells in the affected area are removed (biopsy), placed on slides, and examined under a microscope by a pathologist. If the cells are cancerous, the pathologist decides which kind of cancer—among the more than 200—you have, and writes that up in a report than includes your tumor’s specific type (most cancers come in several varieties), its aggressiveness (how fast it’s growing), its stage (early, meaning confined to one area; moderately metastaic, meaning some spread; or advanced, meaning distant metastases), and possibly other characteristics as well.

“All treatment decisions follow from the pathology report,” says Dr. Thomas Grogan, professor of pathology at the University of Arizona Cancer Center, “so you need to be very clear about it. Get your pathology report in writing, and make sure you understand what it says. Ask your doctor. If you still have questions, ask the pathologist.”

Because all treatment decisions flow from the pathology report, it’s crucial that it’s correct. The best way to be sure is to request a second opinion on your slides. This implies no mistrust of your pathologist, just a need to be sure the report is correct.

Most pathologists automatically send slides of tumor tissue to colleagues if they have any doubts about the tumor’s classification. Ask if your pathologist has done this, and if not, ask that it be done. Dr. Simons’ slides were sent from San Francisco to Memorial Sloan-Kettering Cancer Center in New York City, where pathologists confirmed the original report.

Dr. Grogan is an expert in lymphoma. Pathologists from coast to coast send him slides to check their findings. “If I were diagnosed with cancer,” he says, “I’d definitely ask to have my slides checked by a leading expert.”

When you get your pathology report, get it in writing. A verbal report caused Dr. Simons a great deal of unnecessary anguish. She began her treatment based on a pathology report communicated from the lab to her surgeon by phone. Unfortunately, somewhere along the line, someone made a mistake. Based on the error, she took the wrong chemotherapy until she saw the report in writing. “That foul-up was the emotional low-point of my cancer experience,” she says. “I should have insisted on seeing the written report before I began treatment.”

Step 5: Gather Information About Your Cancer

It’s easier than you might think. Once you’re certain which specific type of cancer you have, it’s time to research it. A great deal of information is only a few phone calls away:

• Contact your local office of the American Cancer Society. This private, nonprofit education and research organization can provide you with general information about your cancer and referrals to cancer resources and support groups in your area. In addition, the ACS’s “Reach to Recovery” program can put you in touch with survivors of your specific cancer, who can share their experiences of treatment and recovery. “Talking with people who’d had breast cancer was very important for me,” Dr. Simons says. “Frequently, the worst part is enduring the treatment. The breast cancer survivors I contacted told me how surgery, radiation, and chemotherapy felt, which helped me prepare for my treatments.”

• Call 1-800-4-CANCER. This connects you with the Cancer Information Service (CIS), a program of the National Cancer Institute (NCI) in Bethesda, Maryland, the federal agency that coordinates the nation’s fight against cancer. The CIS provides current information about all cancers—for free. Two types of information packets are available, one for patients that contains basic background information, and another for physicians that contains state-of-the-art treatment recommendations, updated monthly from the NCI’s Physicians Date Query (PDQ) system, the world’s largest database of cancer treatment information. But you don’t have to be a doctor to request the state-of-the-art treatment packet. It’s dense with technical terms, but your doctor can explain its recommendations to you.

The CIS is staffed by 250 specially trained cancer information experts who work at 19 offices around the country. When you call, you’re automatically connected to the office nearest you. Open Monday through Friday, 9 a.m. to 4:30 p.m. local time, the CIS receives more than 500,000 calls a year, so you may get a busy signal. Keep trying.

CIS operators can also provide referrals to hospital-based cancer programs around the country. Just mention your zip code, and the CIS database produces a list of programs in your vicinity. CIS operators don’t recommend individual physicians. But once you’re plugged into a cancer program in your area, it’s rarely a problem to find specialists. Callers who live in remote locales can request wide-area searches.

CIS operators also provide information about eligibility criteria for clinical trials (see below).

• If you’d like even more information, contact The Health Resource, a personalized medical research service in Conway, Arkansas. Founder Janice Guthrie, a former administrator at the University of Arkansas in Little Rock, was diagnosed with a rare form of ovarian cancer at age 41 in 1983. Her doctor recommended standard treatment, surgery plus radiation. But just to make sure he was right, Guthrie spent some time researching her disease at the University Medical Center’s library. She discovered Scandinavian studies showing, that for her specific type of ovarian cancer, radiation offered no survival advantage and but caused potentially troubling side effects. She showed the studies to her doctor, who cancelled her radiation. Ovarian cancer has a five-year survivial rate of 48 percent, and only 33 percent survive as long as Guthrie has—16 years. After she recovered from her surgery, Guthrie quit her job, and launched The Health Resource, to do medical research for others. The Health Resource publishes reports on all the most common cancers for about $100. Contact The Health Resource at 564 Locust Ave., Conway, AR 72032; (501) 329-5272.

• If you have a computer that is online, the Internet contains a wealth of information about cancer. “Using any search engine, just type in your specific type of cancer, and you’re likely to get hundreds of listings,” says Tom Ferguson, M.D., of Austin, Texas, who specializes in online medical information.

• Read Dr. Lerner’s book, Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer. It provides the best overview of all the options in cancer treatment, both mainstream and alternative.

If you don’t have the desire or energy to research your cancer, ask people in your support network to do it for you. Today, it’s so easy to find so much information on cancer treatment that with only minimal effort, you can become overwhelmed. If you’d rather not plough through it all yourself, friends or family can do it for you, and let you know what they’ve found.

Step 6: Cancer Survival Statistics are not Prophecy, and Doctors are not Prophets

Take survival statistics with a grain of salt. Survival statistics provide a “big picture” look at your cancer, the odds that someone with your disease will live for a certain period of time, usually five years. “But statistics are by no means destiny,” says Theodore Calderone, M.D., a Baton Rouge, Louisiana, pediatrician, who is a nine-year survivor of multiple myeloma, which has a five-year survival rate of just 26 percent. “Even the least treatable cancers have long-term survivors. Only 13 percent of people with my cancer survive as long as I have, but I’m still here. Someone has to be in that 13 percent.”

Overall survival statistics are also misleading because they are averages that include cancers diagnosed at every stage of development, from very early to far advanced. The stage of your cancer plays an enormous role in your survival odds. If malignant melanoma has metastasized by the time it’s diagnosed, five-year survival is only 12 percent. But if it’s caught early, the survival rate is 96 percent. The same is true of every other cancer, which is why the ACS and NCI promote cancer screening for early detection (see sidebar).

Finally, survival statistics are several years old by the time they’re published, and don’t reflect that latest treatments. Pancreatic cancer’s current five-year survival rate is 4 percent. But that figure is headed upward because a new drug, Gemzar, is extending survival.

“Statistics describe large groups of people,” Dr. Calderone explains. “They don’t say much about the course of any individual’s cancer. People always ask their doctors, ‘How long do I have?’ Believe me, your doctor doesn’t know. Only God knows. Glib survival predictions do more harm than good. They set up self-fulfilling prophecies. People start counting down the months or weeks they supposedly have to live, and often become terribly depressed about how little time they supposedly have left. That destroys their quality of life, and impairs their immune system’s ability to fight their cancer.”

Dr. Calderone advises: “Respect the survivial statistics as far as they go. But understand they they say nothing about how long you personally will survive. You live until you die, and every day is another day.”

No doctor can predict how long you’ll live. Once a cancer sufferer is pronounced “terminal,” the person and the family often look to a doctor to tell them how long the person has left. But doctors are not God. They have no idea how long anyone will survive. Recently, Canadian researchers asked oncologists to estimate the survival times for 233 people with cancer considered terminal, that is, all standard treatments had been given but the cancer could not be controlled. The oncologists prediced survival within one month in only 25 percent of cases. They underestimated survival in 23 percent, and overestimated it in 52 percent. In other words, the doctors’ predictions were wrong in three cases out of four. These days, many oncologists are careful not to make predictions. But some still do. They shouldn’t because they don’t know.

Step 7: Don’t Rush into Cancer Treatment Decisions

It’s fine to take a little time. The anxiety cancer engenders makes many people very impatient to begin treatment. They don’t want to waste a moment for fear that their cancer will spread. This feeling is understandable—but uninformed, Dr. Dougherty explains: “By the time cancer gets diagnosed, it’s usually been growing for several years. Except for a very small number of extremely aggressive cancers, waiting a few weeks or a month has no effect on survival. In fact, you should take some time—to research your options and get a few opinions on treatment. You don’t want to dawdle, but I encourage patients to take up to a few weeks to consult experts and plan their treatment.”

“I took several weeks to decide on my treatment,” Dr. Calderone explains. “It was a very important decision, and I wanted to be sure I made the right one. I didn’t want to feel rushed.”

Step 8: Consult an Oncologist

Cancer requires a specialist. According to NCI estimates, only about one-third of cancer patients ever consult oncologists. Some don’t want to offend their family physicians by consulting other doctors. Others believe there are no specialists near them. And some believe that to find an oncologist, they must travel long distances to such noted cancer centers as Memorial Sloan-Kettering in New York City, or M.D. Anderson in Houston.

No good family doctor gets offended when people diagnosed with cancer ask for referrals to oncologists, Dr. Simons says: “I’m a family doctor. I refer patients to specialists all the time. When I got cancer, my family doctor sent me to an oncologist right away.” If your doctor balks at referring you to an oncologist, Dr. Grogan says, “You’ve got the wrong doctor.”

As for access to cancer specialists, there are oncologists and hospital cancer programs from coast to coast. Sloan-Kettering and M.D. Anderson are just two of 40 institutions accredited by the NCI as providing state-of-the-art cancer care, among them: The Vermont Regional Cancer Center in Burlington, the Utah Cancer Center in Salt Lake City, the Birmingham Comprehensive Cancer Center at the University of Alabama, and the Sylvester Comprehensive Cancer Center in Miami, Florida.

Once you have a list of oncologists near you, Dr. Calderone suggests choosing among them by assessing both their competence and their empathy. For competence, he suggests looking for an oncologist who’s busy, one whose services are in demand. Ask how many cases like yours the oncologist has treated in the last few years, and how those people have fared. Use the ACS “Reach to Recovery” program to find people who have survived your cancer, and ask them who they consulted. When in doubt, look for an oncologist affiliated with a comprehensive cancer center, or an oncologist who trained at one.

“But by itself, clinical competence isn’t enough,” he insists. “It’s equally important to feel comfortable on a personal level.” Empathy is fairly easy to asses: Do you like the oncologist or not? Does the oncologist listen to you? Care about your concerns? And respond in a manner that inspires your confidence?

Step 9: Organize Your Doctors

Become the captain of your treatment team. Before you decide on a treatment program, you may need to consult quite a few doctors: your family physician, a pathologist, a surgeon, a radiation oncologist, and a medical oncologist. No other disease involves as many professional consultations with so many different kinds of doctors. The effort required can be enormous, especially in the immediate emotional aftermath of a cancer diagnosis. In addition, specialists typically discuss only their specific specialty, and you might come away feeling that none of them are looking at you as a whole person.

The best way to think about deciding on a treatment plan is that it’s a team effort, with you—or a key support person you designate—as captain of your team. Drs. Simons and Calderone offer these suggestions for coordinating your team effort:

Don’t abandon your family doctor. The oncologists you consult may know more about treating cancer, but they don’t know you and your family as well as your family doctor does. Your family doctor can provide valuable perspective on what the specialists recommend. If you’re confused about your options, your family doctor can call the specialists and help clarify their recommendations.

Jot down what every specialist recommends. Or tape record them. You need to know not only what kind of surgery, radiation, and/or chemotherapy they recommend, but also the order these treatments should be administered. Which should you have first? Can you do chemo and radiation at the same time? How long after surgery should you wait before starting other treatment? Let each specialist know what the others recommend, and try to develop a consensus opinion on how best to proceed.

Ask the specialists to talk with each other. If disagreements arise, urge your oncologists consult one another to work them out. They may not talk to each other if you don’t insist.

Step 10: Get Several Opinions About Your Cancer Diagnosis

You need to feel comfortable with the treatment program you choose. As if you don’t already have enough to deal with, cancer experts agree that before deciding on treatment, it’s best to consult several surgeons, radiation oncologists, and medical oncologists. “When I was diagnosed with multiple myeloma, I read about it voluminously,” Dr. Calderone recalls. “Through my research and with the help of the Myeloma Foundation, I identified three cancer centers that seemed to me to be the best: Fred Hutchinson in Seattle, Dana Farber in Boston, and M.D. Anderson in Houston. I contacted the myeloma experts there by phone. I faxed them my pathology report. And I talked with them at length about what they would recommend for me—and what the oncologists at the other cancer centers had said. It took a few weeks, but by the time I was finished, I felt comfortable with the consensus treatment plan they all helped me develop.”

But what if you don’t have the energy or assertiveness to call oncologists all over the country? You might ask a support person to do this for you. Or you might simply consult one of the nation’s approximately 100 Multidisciplinary Second Opinon Panels. You send your medical records to the panel’s coordinator, who forwards them to local cancer specialists, who volunteer their time on the panel. Then you and anyone you want to bring attend a meeting with all the experts. They discuss your case and develop a consensus set of treatment recommendations.

The first Multidisciplinary Second Opinion panel was organized in the late 1980s by Richard Bloch, the “R” in H&R Block, a 19-year survivor of lung cancer, and founder of the R.A. Bloch Cancer Foundation in Kansas City, Missouri. The idea was to save cancer patients time and trouble by providing one-stop second opinions. Bloch’s second-opinion panel was an instant hit. Today, every major metropolitan area has at least one. To find the panel nearest you, contact the R.A. Bloch Cancer Foundation at (800) 433-0464.

Step 11: Use Mainstream Cancer Treatments

Conventional oncology has a great deal to offer. “When it comes to curing cancer, mainstream oncology has a better track record than anything else,” Dr. Lerner says. “Every cancer patient should work with an oncologist.” He feels so strongly about this that no one is admitted to his Cancer Help Program unless they are under an oncologist’s care.

But this doesn’t mean that American oncology is the only conventional way to go. The nation’s leading physicians insist that Americans enjoy the best health care in the world. The implication is: Don’t question your doctor or seek alternatives because anything other than what M.D.s recommend is less than the best. But what’s “best” is a matter of opinion. The best care that American oncologists have to offer may not be viewed as best by their colleagues in other countries.

“The oncologists in the U.S., England, France, Germany, and Japan all have access to exactly the same scientific information,” Dr. Lerner explains. “Yet they all treat cancer differently.” French physicians are deeply concerned with the aesthetics of the body. They’re wary of disfiguring surgery, and pioneered less drastic surgical procedures, for example, lumpectomy for breast cancer. They also prefer gentle, complementary therapies like homeopathy. Germans M.D.s are very open to herbal medicine. Many German physicians send their cancer patients to hospitals that combine conventional care with herbal medicine.

The British take a ‘stiff upper lip’ view of oncology. They spend only about half of what we do per capita on health care, and for cancer, they emphasize comfort over cure. The Japanese combine Western oncology with Asian medicine. American medicine is the most aggressive in the world. We have very high rates of cesarean section, back surgery, and other radical procedures. American oncologists are quick to recommend surgery and aggressive chemotherapy and radiation regimens that oncologists in other countries might not recommend.”

Lerner says he can’t say which of these different forms of conventional oncology is “best.” “But once people understand that the advanced countries practice oncology in different ways, they interpret medical recommendations differently. When an oncologist says, ‘You really ought to do X,’ they appreciate that they’re hearing that doctor’s best assessment, but that the doctor’s opinion is not necessarily the only way to view their situation.”

Step 12: Consider a Clinical Trial for Cancer Treatment

You’re not a guinea pig. After promising new cancer treatments have been thoroughly tested in animals, they must be tested on human cancer patients before they can be approved for general use. Of the more than 1 million Americans diagnosed with cancer each year, only 20,000 to 30,000 enroll in these tests of the latest treatments. Why so few? “Most people have no idea what clinical trials are,” says Jeffrey Abrams, M.D., a research scientist in the NCI’s Cancer Therapy Evaluation Program, “and many who do feel fearful of becoming ‘guinea pigs.'”

It’s possible to feel dehumanized in a clinical trial, but more often, you feel very well cared for because the researchers are so interested in how you’re doing. “Every aspect of clinical trials is governed by strict federal regulations,” says Leonard Zwelling, M.D., associate vice president for clinical research at M.D. Anderson Cancer Center in Houston, “Before enrolling, you sign an informed consent document that describes every aspect of the study in great detail. If you ever regret joining, you’re free to drop out at any time.”

Clinical trials take place in three phases. Phase I trials are small studies that determine the new treatment’s safe dose and side effects. About 1,000 people participate in Phase I trials each year. Those who are eligible have not responded to the best standard care, or can’t tolerate standard therapy, or have a cancer that responds poorly to standard treatment. “People in Phase I trials have basically run out of standard options,” Dr. Abrams says. “A Phase I trial gives them hope that their disease may be treatable.” But enrolling in a Phase I trial is a gamble. The price of renewed hope is a risk of possibly severe side effects.

Once scientists confirm that a new treatment’s side effects are no worse than those caused by standard therapies, they begin Phase II trials to determine which cancers respond best to the new treatment, as well as the most effective dose. Again, enrollees must have either a poor prognosis, or have suffered side effects that forced them off standard care, or a cancer that responds poorly to standard treatments. About 2,000 cancer patients enroll each year.

When researchers know which cancers respond best to a new treatment, it enters larger Phase III trials. Some 20,000 to 25,000 cancer patients participate in Phase III trials annually, about 85 percent of all people in clinical trials each year. In Phase III trials, you get the best possible mainstream treatment—either the current standard of care, or that plus the new treatment that might be even better. “The only catch with most Phase III trials,” Dr. Abrams explains, “is that quite often, patients cannot have had any previous cancer treatment, so you have to consider participating before you begin any other treatment.”

Clinical trials were once conducted only at the nation’s regional cancer centers. But to open them up to all Americans, the NCI now encourages participation by oncologists everywhere, and even family doctors. “No one is excluded simply because they live in a rural area,” Dr. Abrams says. To obtain descriptions and eligibility criteria for the approximately 1,500 clinical trials now in progress, ask your oncologist or call 1-800-4-CANCER.

“If I developed any metastatic cancer,” says Therese Bevers, M.D., medical director of the Cancer Prevention Center at M.D. Anderson Cancer Center in Houston, “I would seriously look into joining a Phase III trial. What would I have to lose? I’d either get the standard of care, or that plus something new that might be even better. I might develop some unusual side effect from the new treatment, but the same thing could happen with standard treatment. I wouldn’t feel like a ‘guinea pig’ at all. I’d see the experience as an opportunity to get the best possible care.”

Dr. Calderone enrolled in a Phase III trial: “When I was diagnosed, standard treatment for multiple myeloma involved initial chemotherapy, then a bone marrow transplant, followed by total body radiation. But total body radiation didn’t appeal to me, and during my research I found that the evidence in its favor was pretty thin. So I made some inquiries and discovered that M.D. Anderson was involved in a Phase III trial that involved chemotherapy and bone marrow transplantation, but no radiation. I enrolled and spent a month in Houston getting treated. About a year later, the trial results showed that total body radiation offered no survival advantage, and now it’s no longer done. I’m very glad I enrolled in that trial. It saved me unnecessary treatment and the risks and side effects of radiation.”

Step 13: Use the “health-Promoting Quartet” of Complementary Therapies

A healthy lifestyle helps. There are two kinds of complementary cancer therapies: Some are inherently health-promoting: nutritional enhancement and supplementation, exercise, psychological support, and stress management through deep relaxation. Others are more drug-like: herbal medicine, Chinese medicine, and the clinics in Mexico and the Bahamas.

Dr. Lerner wholeheartedly endorses the health-promoting approaches: “If you’re eating well, getting regular moderate exercise, enjoying psychological support, and working to manage your stress,” he explains, “you become a healthier cancer patient. You’re not healthy, of course, because you’re dealing with cancer, but compared with cancer patients who don’t work on these elements of life, you’re healthier. Healthier cancer patients often respond better to conventional care and have better treatment outcomes—better quality of life and longer, healthier, disease-free survival.”

Lerner is quick to point out that the four health-promoting complementary approaches don’t cure cancer, nor does embracing them guarantee a better outcome. But the research in favor of them is impressive. The value of support groups has already been discussed. Here’s a sampling of studies that show the benefits of the other health-promoting complementary therapies:

Gerson diet therapy appears to extend survival in people with malignant melanoma. Max Gerson, M.D., whom Albert Scweitzer called “one of the geniuses in medical history,” prescribed a nutritional approach to cancer treatment in the 1940s and 1950s, until opposition led by the American Medical Association forced him out of the country. The Gerson Institute in Bonita, California, continues to promote his approach, and the Gerson Clinic in Tijuana, Mexico, continues to administer it. The Gerson diet is very low in fat and salt, and lactovegetarian (low-fat dairy items allowed), with supplemental nutrients administered by drinking large quantities of fruit and vegetable juices. The Gerson program also involves hormonal thyroid stimulation and coffee enemas, which Gerson believed detoxify the liver. (As strange as coffee enemas may sound, there is some research support for Gerson’s claim.)

Over the years, several intriguing studies have hinted that Gerson therapy helps treat some people with a variety of cancers. The latest report comes from a team of researchers at the University of California, San Diego, Cancer Prevention and Control Program, who worked with clinicians in the Gerson organization. They studied 82 Gerson patients with malignant melanoma, and compared their survival with survival rates reported by conventional oncologists in the medical literature. For localized, early-stage melanoma, 100 percent of the Gerson patients survived five years, compared with 79 percent survival among those who used conventional oncology. For moderately metastacized melanoma, 75 percent of the Gerson group lived five years, compared with 40 percent of those treated conventionally. For widely metastacized melanoma, the figures were 39 percent for Gerson, 6 percent for conventional oncology.

Certain supplements aid cancer treatment. Cancer depletes many nutrients—including those that support the immune system, which fights cancer. Advocates believe that supplementation can boost the body’s ability to fight cancer. A good deal of research supports this view:

Megadose antioxidants help prevent bladder cancer recurrences. In a five-year study, urologist Donald Lamm, M.D., and colleagues at West Virginia University in Morgantown, gave 65 bladder cancer survivors either the RDA of vitamins A, C, D, E, the B vitamins and zinc, or the following high-dose regimen: vitamin A (40,000 IU), B6 (100 mg), vitamin C (2,000 mg) vitamin E (400 IU), and zinc (90 mg). After four years, the high-dose supplement takers developed only half as many recurrences.

Antioxidants extend life in lung cancer. In addition to conventional treatment, Finnish researchers gave 18 people with lung cancer a supplement containing antioxidant vitamin and minerals. Compared with lung cancer patients who did not take the supplement, those who did were better able to tolerate chemotherapy and radiation, and they survived longer.

Fish oil extends life in advanced cancers. Greek researchers gave 60 people with a variety of advanced, metastatic cancers either a placebo or fish oil (18 g a day), a good source of omega-3 fatty acids, anti-inflammatory, immune-boosting compounds that help treat many of the conditions discussed in this book. The immune systems of those in the placebo group went downhill, but among those taking fish oil, immune response rallied. The fish oil group also lived significantly longer.

Melatonin extends life in advanced lung cancer. Italian researchers studied 63 people with matastatic lung cancer who were considered untreatable because they no longer responded to standard chemotherapy. Half received supportive care (pain medication, fluids, etc.). Half were given supportive care plus melatonin (10 mg/day), based on animal studies showing that the hormone widely used as a sleep aid, also has some anti-cancer action. After one year, the survival rate in the melatonin group was significantly higher. A pilot study by the same researchers also showed that melatonin boosts the effectiveness of the hormonal drug, tamoxifen, in treating advanced breast cancer.

Supplements reduce the toxicity of chemotherapy. Cisplatin, used to treat ovarian cancer, can cause kidney damage, suppression of infection-fighting white blood cells, and a need for blood transfusion. Chinese researchers gave selenium (4,000 mcg a day) to 20 people taking cisplatin, starting four days before treatment and continuing for four days afterward. Compared with untreated controls, the selenium group experienced signficantly less white-blood-cell loss, less kidney damage, and less need for transfusions. Italian researchers conducted a similar study using supplemental glutamine, an amino acid (3 g a day), in people being treated for leukemia. Those taking glutamine experienced significantly less diarrhea, and were able to eat more normally.

Vitamin E oil heals mouth sores caused by chemotherapy. In addition to nausea and fatigue, chemotherapy can also cause other side effects, among them painful sores in the mouth. At the VA Medical Center in Washington, D.C., researchers studied 18 people with a variety of cancers who developed mouth sores from chemotherapy. Half applied an oil containing vitamin E daily. The other half applied a placebo. After five days, mouth sores disappeared in one person taking the placebo, but in six who took vitamin E.

Relaxation therapies minimize nausea and vomiting associated with chemotherapy. Chemotherapy often causes nausea and vomiting. Many studies show that relaxation therapies help prevent it:

• At Vanderbilt University, researchers gave biofeedback relaxation training to some of a group of 81 people receiving chemotherapy. Compared with those who did not learn biofeedback, those who did reported significantly less nausea.

• Researchers at the VA Medical Center in New Orleans gave deep relaxation training to 30 people receiving chemotherapy, but not to 30 others. Those practicing deep relaxation experienced significantly less nausea and vomiting during chemotherapy, and also less anticipatory nausea as they approached their oncologists’ offices.

• At the Women’s and Infant’s Hospital in Providence, Rhode Island, researchers invited volunteers from a local spa to administer foot massages to people about to have chemotherapy. In addition, patients were encouraged to bring their dogs or cats with them, or if they did not have a pet, to play with a dog-on-staff. After one year, 90 percent of the patients said the massage-and-pets program reduced the stress of chemotherapy. In addition, before the program began, many of the medical oncologists affiliated with Women’s and Infant’s Hospital expressed skepticism about the wisdom of the massage-and-pets program. But in the evaluation, every one of them said it reduced the stress and discomfort of chemotherapy.

• Researchers at Montefiore Hospital in Pittsburgh, wondered if a program of calming music and visualizations might increase the benefits of standard antinausea drugs used during chemotherapy. In a study involving 15 adults suffering from a variety of cancers, the music/imagery program significantly reduced feelings of nausea, and the number and duration of vomiting epidoses.

Relaxation therapies ease cancer pain. Advanced cancers often cause pain that mainstream oncologists may undertreat because they are reluctant to prescribe high-dose narcotics. Complementary therapies can help control cancer pain:

• Stanford researchers gave standard care to some of a group of 54 women with advanced breast cancer, while the rest were enrolled in a weekly support group. Half of those in the support group were also trained in self-hypnosis. After a year, the standard-care group reported the most pain. The women in just the support group reported significantly less. And the support-group women who also learned self-hypnosis reported the least.

• At the University of South Carolina in Columbia, researchers gave 28 hospitalized cancer patients either a 10-minute visit, or a 10-minute massage. Pain levels were assessed using standard psychological tests. After just one 10-minute massage, pain levels decreased significantly. Other studies have shown that the longer the massage, the more pain relief people with cancer report—up to 60 percent less pain with a 30-minute massage. Massage increases blood levels of endorphins, the body’s own pain-relievers.

Relaxation therapies speed recovery from cancer surgery. Researchers at the Cleveland Clinic studied 130 people scheduled to have surgery for colorectal cancer. Compared with those who received no music, those who listened to calming music before and after surgery experienced significantly less anxiety, less pain, and faster return of bowel function. They also used 50 percent less medication, and left the hospital sooner.

Exercise helps treat cancer-treatment side effects. In addition to nausea, chemotherapy, radiation, and bone marrow transplantation are notorious causes of severe fatigue, diarrhea, pain, and loss of muscle strength. German researchers adapted a stationary cycle to allow people receiving high-dose chemotherapy and bone marrow transplants to exercise in bed. A control group of 37 people did not use the device, but 33 others did—for a half-hour a day throughout their hospitalization. The exercise group experienced significantly less fatigue, diarrhea, pain, and loss of strength, and they were able to leave the hospital sooner.

When she was diagnosed, Dr. Simons was already living a reasonably healthy lifestyle, but she became more of a vegetarian, joined a support group, and after she recovered from chemotherapy, took up yoga. “It’s impossible to know whether the lifestyle changes helped me survive, but I enjoy them, and they’re good for me, so why not?”

Dr. Calderone took “lots of vitamins,” joined a support group, spent a week at Dr. Lerner’s Cancer Help Program, which emphasizes the health-promoting quartet, and found additional psychological support online. “After my bone marrow transplant, when I was too sick to go out to my support group, finding support online really helped.” His oncologists supported these efforts: “Their attitude was that if, in addition to their treatment plan, I wanted to take vitamins, or become a vegetarian, or get massages, that was fine. There’s a growing consensus among oncologists that anything that helps people become healthier or feel more content also helps them deal with cancer.”

Step 14: Consider the Drug-like Complementary Therapies for Cancer Treatment

Support grows for complementing mainstream oncology with Chinese medicine. Dr. Lerner says, “Many many cancer patients have told me that acupuncture and Chinese herbal medicine have helped them cope with their pain and the side effects of radiation and chemotherapy.” The research agrees:

Acupuncture and acupressure prevent nausea and vomiting caused by chemotherapy. Several studies show that acupuncture reduces chemotherapy-related nausea and vomiting. For example, at UCLA researchers gave 30 women undergoing chemotherapy for breast cancer either real acupuncture at points used to relieve nausea, or acupuncture at placebo points. The real-acupuncture group reported only half as many episodes of nausea and vomiting.

Researchers at the Queen’s University in Belfast, Northern Ireland, came up with the same findings using acupressure in a study of 100 people who vomited as a result of chemotherapy. The patients were fitted with Sea Bands, elastic bands with buttons that press on Pericardium 6, a point used to treat nausea. More than 75 percent enjoyed significant relief from nausea. Pericardium 6 is located on the inside upper arm two thumb widths above the wrist crease.

Chinese herbs extend survivial in throat cancer. At the Chinese Academy of Medical Sciences in Beijing, researchers treated 188 throat cancer patients with either standard radiation therapy, or radiation plus a Chinese herb formula. After five years, survival in the radiation-only group was 37 percent. But among those receiving both radiation and Chinese herbs, the figure was 53 percent, a significant difference. San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine, says the herbs most widely used in cancer treatment are considered strengthening (“tonifying”) in Chinese medicine, which usually corresponds to immune-enhancing in Western terms. Chinese herbs used to treat cancer include: astragalus, ginseng, Chinese angelica (dang gui), and rehmannia.

Shiitake mushroom extract enhances effectiveness of chemotherapy in stomach cancer. Long considered a health-promoting delicacy in Asian cuisines, shiitake mushrooms contain a compound, lentinan, that stimulates the immue system against infections and cancer. Lentinan injections are increasingly used to complement chemotherapy in Japan—and with good reason. In one study, 275 people with advanced stomach cancer were given chemotherapy with or without lentinan injections beforehand. The lentinan group showed greater immune system activity, and survived significantly longer. Maitake mushrooms have similar benefits, thanks to the immune-stimulating beta-glucan they contain.

Many Western herbs have antitumor effects. Among the most widely used American herbal cancer therapies is the Hoxsey program, which Harry Hoxsey, an ex-coal miner with no medical training, began promoting in the 1930s as his family’s secret herbal cancer cure. Tried several times for practicing medicine without a license, but never convicted because no patient ever testified being harmed by his herbs, Hoxsey was hounded out of the country in 1963 after his Dallas clinic was raided by the Food and Drug Administration. He died in 1974, but his clinic, the Biomedical Center, continues to operate in Tijuana, Mexico.

The Hoxsey formula contains 10 herbs: burdock (Arctium lappa), red clover (Trifolium pratens), licorice root (Glycyrrhiza glabra), poke root (Phytolacca americana), bloodroot (Sanguinaria canadensis), barberry root (Berberis, several species), buckthorn (Rhamnus purshiana), prickly ash (Zanthoxylum americanum), and stillingia root (Stillingia syvlatica). NCI studies have shown that nine of these 10 herbs exhibit antitumor activity in laboratory tests, and there are anecdotal reports of the Hoxsey formula producing dramatic cancer remissions. The Hoxsey formula remains extremely controversial and largely unresearched, but another herb, mistletoe, appears to hold some promise as a cancer treatment:

Mistletoe may be beneficial. Liquid extracts of mistletoe (Vicscum album), have been used in Europe for years to treat many cancers, among them tumors of the breast, colon, rectum, stomach, and kidney. University of Texas researchers recently analyzed 34 clinical trials of mistletoe extract in human cancer patients. Five showed that the herbal medicine significantly extended survival.

If you’re interested in any alternative cancer clinics—notably Gerson, Hoxsey, Burzynski antineoplaston therapy in Houston, and Burton immune-augmentation therapy in the Bahamas—they all have considerable testimonial support, but none has been shown to be reliably beneficial in rigorous clinical trials. Before enrolling, Dr. Lerner suggests examining their cost and the practitioner’s credentials and compassion, and then talking with people with your specific cancer who feel they were helped by the therapy.

Step 15: Demand Adequate Cancer Pain Control

You don’t have to suffer. Cancer patients often fear that they will have to endure terrible pain and suffering. Absolutely not. The vast majority of cancer pain can be well controlled with medication. Tragically, some oncologists undermedicate cancer patients in the mistaken belief that they will become addicted. Pain specialists say the risk of addiction is tiny. They view undermedication of cancer pain as unconscionable, and criticize oncologists for being slow to increase dosages, and slower still to embrace nondrug approaches with clearly demonstrated pain-relieving benefits: acupuncture, hypnosis, visualization, and TENS machines, small devices that deliver mild electrical current into the skin. “Clinics that specialize in chronic pain management use all these approaches routinely,” Dr. Lerner says, “yet many cancer patients still suffer because of inadequate pain control. It’s a terrible shame.”

Step 16: Understand the difference Between “Curing” and “Healing” Cancer

Even if cure is impossible, you can still heal. “Curing,” Dr. Lerner explains, “is what physicians hope to do. They strive to eliminate the disease and allow recovery. Healing is what patients bring to the experience. Healing is a deeply personal process of becoming whole again.” Mainstream oncology often gives short shrift to healing, leaving cancer patients feeling emotionally shortchanged, even if they recover.

Healing involves coming to terms with your life and working to live it to the fullest, even if cancer cuts it short. The tools of healing involve the complementary therapies: good nutrition, moderate exercise, social support, stress management, and a sense of connection to the natural world around you. They all improve quality of life.

“Even when cure is impossible,” Dr. Lerner explains, “healing need not stop. People can continue to grow even in the face of life-threatening illness. All the great religions teach that life involves suffering. Suffering can lead to bitterness and defeatism or to growth and wisdom. When you have a serious illness, you make that choice for yourself.”

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