Integrative Solutions for Cancer Survivors

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According to the World Cancer Research Fund (WCRF) the number of global cancers has increased by a fifth in less than a decade to around 12 million new cases each year.[1] While cancer diagnoses worldwide are expected to increase by 45% in the next 20 years, more than 60% of cancer patients will survive more than five years after diagnosis. In a 2005 survey of mid-aged Australian women with all cancers combined, 15.7% were found to consult a naturopath or herbalist.[2] The usage of naturopathic and herbal therapies has continued to grow among people diagnosed with cancer with a 2015 survey suggesting that 1 out of every 4 seniors diagnosed with cancer utilise complementary and alternative dietary supplements.[3Furthermore, as thousands of Australians transition from cancer treatment into “survivor mode,” they are anxious for expert guidance regarding diet, lifestyle and dietary supplements. In fact, cancer survivors are some of the highest users of complementary and alternative medicine, as well as dietary supplements. Surveys regularly report that the majority of cancer survivors utilise dietary supplements and other complementary lifestyle approaches such as diet, relaxation and physical activity. When dietary supplement use is singled out, recent surveys suggest that as many as one out of ever three cancer survivors utilise dietary supplements with the main reasons cited as prevention of recurrence and to improve health.[4]

...cancer survivors are some of the highest users of complementary and alternative medicine, as well as dietary supplements.

The survivor population is so significant that leading organisations such as the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncologists (ASCO) and the American Cancer Society have established survivorship guidelines that must be adhered to in the US by all accredited cancer centres beginning in 2015. These guidelines are designed to help the special needs of cancer survivors. ASCO guidelines specifically address the key areas of mental health, fatigue and neuropathic pain. NCCN adds cognitive function and other forms of pain to this list of survivorship issues. Integrative care can help fill in the wellness gaps that presently exist with cancer survivors. Diet, lifestyle factors and targeted dietary supplements can significantly strengthen the impact of conventional medical support for this growing patient population.

Supplemented Nutrients

Presently 1 in 2 men and 1 in 3 women will develop cancer in their lifetime so it is probable that there are already patients in your clinical practice who have had a cancer diagnosis. These patients may not seek integrative care specifically to address their diagnosis; however, they invariably have a number of health issues related to both the cancer and its treatment. These issues significantly influence their overall health. Furthermore, these patients are often discharged from oncology care without having a healthcare provider that can provide for their ongoing needs after treatment.  In addition to their acute health needs, cancer survivors who visit integrative practitioners will likely have a range of cancer treatment-related issues and concerns regarding recurrence. The key for the integrative practitioner is to determine how to efficiently and effectively help these patients thrive well beyond their diagnosis. Addressing special dietary supplement needs is an important first step.

Presently 1 in 2 men and 1 in 3 women will develop cancer in their lifetime...

When it comes to dietary supplement recommendations, healthcare practitioners often begin by suggesting a multivitamin and mineral supplement. However, there are several unique issues related to cancer survivors that make finding a multivitamin challenging. For example, several studies have demonstrated that supplemented beta-carotene is inversely associated with overall survival and cancer-free survival in smokers[5] and in women with a history of breast cancer.[6]  In addition, both copper and boron have been shown to be potentially problematic for cancer survivors. Boron, while beneficial for healthy bone metabolism, has been shown to increase serum 0estradiol and testosterone levels, hormones which can fuel hormone-dependent cancers.[7] As for copper, angiogenesis is a copper-dependent process. Angiogenesis is required for tumour proliferation thus restricting excess copper is an important consideration.[8]

With these considerations in mind, a vitamin and mineral supplementation for people with a history of cancer should not include beta-carotene, copper or boron. Desirable supplemented vitamins and minerals for survivors include B vitamins such as pyridoxine,[9] vitamin D,[10] vitamin E - especially as tocotrienols,[11] methylated folate[12,13] and amino acid chelated minerals such as selenium.[14] A 2013 paper featured in the Journal of the American College of Nutrition demonstrated that survivors gain significant benefit by taking a multivitamin because it can also help reduce fatigue, facilitate recovery of detoxification enzymes, support cognitive function and improve overall survival.[15

Special Patients with Special Needs

Prescribing vitamins and minerals is not the only consideration in this population. Fatigue that can significantly disrupt quality of life is a big issue for cancer survivors. A 2007 paper featured in the journal, The Oncologist, reported that up to 90% of patients who receive radiation therapy and up to 80% of patients who receive chemotherapy experience fatigue.[16] Cancer-related fatigue can linger for months, even years after therapy is done. Herbal adaptogens, notably Panax ginseng[17] and Rhodiola rosea[18] have been shown to enhance energy levels and can be impactful for cancer survivors who are experiencing fatigue. Ameliorating patient fatigue will be of tremendous benefit to the patient and to their overall whole-person care. 

The scientific literature has only recently elucidated a connection between chemotherapy and diffuse brain injury that results in neuropsychological issues. Several studies, published as recently as 2015, have confirmed that chemotherapy induces direct cognitive deficits in people treated for a variety of cancers.[19] Often referred to as chemobrain, this condition can affect patients during and after treatment. Cognitive impairments have been documented in women diagnosed with breast cancer even 20 years after the chemotherapy treatment was completed.[20] Some preliminary data indicates that physical activity may help lessen chemotherapy related cognitive issues. While research involving nutrient support specific to chemobrain is not yet available, there is theoretical plausibility for certain supplements which can reduce brain inflammation and oxidative stress while enhancing brain connectivity  - all key aspects of chemobrain. Some of these include the phospholipid citicoline,[21] Lion’s mane mushroom,[22] Bacopa monnieri[23] and the amino acid acetyl-L-carnitine.[24] These are just a few of many supplements that may address a significant impairment to the quality of life of cancer survivors.

From Surviving to Thriving

Cancer survivors often refer to themselves as thrivers. To help these patients thrive, their special health needs must be addressed. This includes making sure they have nutritional supplementation that makes sense, as well as tackling energy and brain health issues with targeted nutrients. However, dietary supplements are only a part of the picture. A whole foods, unprocessed Mediterranean diet with its focus on colourful fresh fruits and vegetables, healthy fats and lean meats and fish supports healthy longevity. Obtaining sufficient sleep and regular physical activity are critical to full recovery, optimal wellbeing and reduced risk of recurrence. 

As for sleep, studies clearly indicate that less than six hours of sleep per night will put the body into a state of insulin resistance,[25] encourage weight gain and reduce immunity – all of which cumulatively increase cancer risk. The value of exercise cannot be overstated. Evidence from over 27 observational studies has demonstrated that physical activity is associated with reduced all-cause, breast cancer-specific and colon cancer-specific mortality.[26] There is a developing association in the literature between exercise and reduced mortality from a variety of other cancers as well. Exercise reduces insulin resistance, inflammation and supports immunity – all of which optimise long term cancer survival and quality of life.

When integrative practitioners include a wellness approach that includes diet, lifestyle and targeted dietary supplements, they can help their cancer survivors become thrivers.

References

  1. Kelland K. Healthier living could cut 2.8 million cancer cases. Reuters 2011. Viewed 15 September 2015, http://www.reuters.com/article/2011/09/07/us-cancer-preventable-idUSTRE7...
     
  2. Adams J, Sibbritt D, Young AF. Naturopathy/herbalism consultations by mid-aged Australian women who have cancer. Eur J Cancer Care 2005;14(5):443-447. [Abstract]
     
  3. Nightingale G, Hajjar E, Guo K, et al. A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer. J Geriatr Oncol 2015 Aug 12. [Epub ahead of print] [Abstract]
     
  4. Bours MJ, Beijer S, Winkels RM, et al. Dietary changes and dietary supplement use, and underlying motives for these habits reported by colorectal cancer survivors of the Patient Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) registry. Br J Nutr 2015;114(2):286-296. [Abstract]
     
  5. Rowe PM. CARET and ATBC refine conclusions about ß-carotene. The Lancet;1996;348(9038):1369. [Abstract]
     
  6. Greenlee H, Hershman DL, Jacobsen JS. Use of antioxidant supplements during breast cancer treatment: a comprehensive review. Breast Cancer Res Treat 2009;115(3):437-452. [Abstract]
     
  7. Neilsen FH, Hunt CD, Mullen LM, et al. Effect of dietary boron on mineral, estrogen and testosterone metabolism in postmenopausal women. FASEB J 1987;1(5):394-397. [PDF]
     
  8. Redman BG, Esper P, Pan Q, et al. Phase II trial of tetrathiomolybdate in patients with advanced kidney cancer. Clin Cancer Res 2003;9(5):1666-1672. [Full text]
     
  9. Johansson M, Relton C, Ueland PM, et al. Serum B vitamin levels and risk of lung cancer. JAMA 2010;303(23):2377-2385. [Full text]
     
  10. Holick MF. Vitamin D and sunlight: strategies for cancer prevention and other health benefits. Clin J Am Soc Nephrol 2008;3(5):1548-1554. [Full text]
     
  11. Parajuli P, Tiwari RV, Sylvester PW. Anticancer effects of γ-yocotrienol are associated with a suppression in aerobic glycolysis. Biol Pharm Bull 2015;38(9):1352-1360. [Full text]
     
  12. Lee JE, Willett WC, Fuchs CS, et al. Folate intake and risk of colorectal cancer and adenomaL modification by time. Am J Clin Nutr 2011;93(4):817-825. [Full text]
     
  13. Cole BF, Baron JA, Sandler RS, et al. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA 2007;297(21):2351-2359. [Full text]
     
  14. Huang HY, Caballero B, Chang S, et al. Multivitamin/mineral supplements and prevention of chronic disease. Evid Rep Technol Assess (Full Rep). 2006;(139):1-117. [Full text]
     
  15. Alexander DD, Weed DL, Chang ET, et al. A systematic review of multivitamin-multimineral use and cardiovascular disease and cancer incidence and total mortality. J Am Coll Nutr. 2013;32(5):339-354. [Abstract]
     
  16. Mustian KM, Morrow GR, Carroll JK, et al. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 2007;12 Suppl 1:52-67. [Full text]
     
  17. Barton DL, et al. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. J Natl Cancer Inst. 2013;105(16):1230-1238. [Full text]
     
  18. Darbinyan V, Ketyan A, Panossian A, et al. Rhodiola rosea in stress induced fatigue – a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine 2000;7(5):365-371. [PDF]
     
  19. Joly F, Giffard B, Rigal O, et al. Impact of cancer and its treatment on cognitive function: advances in research from the Paris International Cognition and Cancer Task Force Symposium and update since 2012. J Pain Symptom Manage 2015 Sep 4. [Epub ahead of print] [Abstract]
     
  20. Koppelmans V, Breteler MM, Boogerd W, et al. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol 2012 ;30(10):1080-1086. [Full text]
     
  21. Bruce SE, Werner KB, Preston BF, et al. Improvements in concentration, working memory and sustained attention following consumption of a natural citicoline-caffeine beverage. Int J Food Sci Nutr 2014 Dec;65(8):1003-1007. [Abstract]
     
  22. Mori K, Inatomi S, Ouchi K, et al. Improving effects of the mushroom Yamabushitake (Hericium erinaceus) on mild cognitive impairment: a double-blind placebo-controlled clinical trial. Phytother Res 2009;23(3):367-372. [Abstract]
     
  23. Benson S, Downey LA, Stough C, et al. An acute, double-blind, placebo-controlled cross-over study of 320 mg and 640 mg doses of Bacopa monnieri (CDRI 08) on multitasking stress reactivity and mood. Phytother Res 2014;28(4):551-559. [Abstract]
     
  24. Salvioli G, Neri M. L-acetylcarnitine treatment of mental decline in the elderly. Drugs Exp Clin Res 1994;20(4):169-176. [Abstract]
     
  25. Rao MN, Neylan TC, Grunfeld C, et al. Subchronic sleep restriction causes tissue-specific insulin resistance. J Clin Endocrinol Metab 2015;100(4):1664-1671. [Abstract]
     
  26. Ballard-Barbash R, Friedenreich CM, Courneya KS, et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst 2012;104(11):815-840. [Full text]

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lise_alschuler's picture
lise_alschuler
Dr Lise Alschuler is a naturopathic physician with Board certification in naturopathic oncology. She practises naturopathic oncology at Naturopathic Specialists LLC in Scottsdale Arizona, specialising in prevention and naturopathic care for people who have been affected by cancer in their lives. Dr Alschuler has authored many articles in professional and popular press publications and co-authored The Definitive Guide to Cancer: An Integrative Approach to Prevention, Treatment and Healing. She also travels the world giving presentations about integratied healthcare, naturopathic medicine and naturopathic oncology. Dr Alschuler currently serves as the President of the American Association of Naturopathic Physicians (AANP).