The unfortunate failures of standard medicine in the treatment of cancer, and the obvious need to integrate Complementary Medicine to improve overall success
Standard medicine admits that there is no known cure for cancer, but that many cancers go into remission. Remission may be induced by an array of therapies, or it may be spontaneous. There is currently much concern surrounding long-term studies that show little difference in the world-wide rates of spontaneous remission and those attributed to standard cancer therapies. Some of the most prevalent cancers, such as prostate cancer, show an age-adjusted mortality rate unchanged since 1949 (Cancer J Clin 1989;39:3-10 and Postgrad Med 1992;92:67-89). Standard therapy for cancer care has finally evolved to focus on the metabolism of cancer and the homeostatic control of genetic protein expression, correction of mutation and regulation of programmed cell death, areas that science is proving have been the foci of Complementary and Integrative Medicine (CIM) for many decades, if not centuries. Newer cancer treatments in standard medicine involve using 'biologic' mechanisms, much like natural medicines, stimulating better immune responses. Altered immune cells and genetically modified viruses are being used to target very specific mechanisms, and some of these show much promise, but also are mostly years away still from full safety approval, and come with considerable risk of harm. Integrating CIM/TCM could help reduce or prevent adverse health effects when these newer biologics are chosen in the future. Hopefully, a more thorough and holistic approach will finally be encouraged in the future and produce better outcomes in treating cancer. The history of treatment so far has been universally disappointing, and grossly expensive.
The stated goals of cancer therapy in standard medicine include delaying death by a relatively short period of time for many (partial remission), or relieving symptoms (palliative). The psychology of cancer is now a concern in the medical community, as numerous studies indicate an unrealistic attitude on the part of most patients. Chemotherapy is the most prevalent treatment for cancer, and most chemotherapy is administered as a palliative, to temporarily reduce the worst symptoms of the cancerous growth, yet numerous studies cite surveys that show that a majority of patients receiving palliative chemotherapy believe that the treatment will cure their cancer. Unrealistic expectations drive cancer therapies today, and inhibit many patients from exploring an expanded protocol with Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM).
A March 3, 2011 article in the New York Times explores the psychology of cancer patients and false expectations. The article reveals that generally, fewer than 5 percent of patients benefit from trials of new cancer therapies, and that the stated goals of early trials are to determine dosage and toxicity, not to test for cure, which is not expected. Nevertheless, it is not difficult to find patients for these trials, and studies reveal that a majority of patients in these trials do believe that the new therapy will cure their cancer. Medical ethicists are concerned that a culture of false belief has benefited the business of cancer therapy, but not the patient. Such a false set of expectations deters many patients from expanding their search for a better overall treatment protocol, and for many years, financial competition has led most standard oncologists to strongly discourage Complementary Medicine. Only when surveys found that a large percentage of patients were now interested in these integrative therapies did standard oncology start to incorporate them. The types of Integrative and Complementary Medicine offered, though, are often not the most effective in standard oncology practices. More and more, oncology is becoming the realm of corporate business, not private practice, and this type of business model is based upon monetary expectations.
An article in the November 22, 2011 New York Science Times by Gina Kolata continued the reporting of an evolution of concern in the medical community about how we use the term cancer to inappropriately alarm patients to sell therapy that is often unnecessary and lacks a true objective decision making process. Leading experts in the field of cancer have urged the medical community to quit calling noninvasive tumors cancer or carcinoma, words that are loaded with frightening expectations of the worst type of malignancy and death, such as the so-called ductal carcinoma in situ (DCIS) in breast cancer screening, and the Gleason 3 + 3 lesion in prostate cancer screening. A 2009 expert panel at the National Institutes of Health recommended that the DCIS should be renamed without the use of the word carcinoma, since a carcinoma is invasive, and the term in situ means that the tissue lesion is not spreading outside of ductal tissue. The panel recommended that the term cancer, or carcinoma, be relegated to the very small percentage of these lesions that do develop into an invasive growth. In 2013, this expert working group of the U.S. National Cancer Institute, 4 years later, again published recommendations, this time in the Journal of the American Medical Association (JAMA), headed by the renowned Dr. Laura J. Esserman of the University of California San Francisco (UCSF), that again called on the medical community to redefine the term cancer and quit calling nonthreatening lesions in the breast, prostate, lung, esophagus, thyroid and other tissues cancer, or carcinoma. We are still waiting.
This practice of calling non-spreading lesions cancer generates an enormous number of cancer diagnoses yearly, yet has not reduced the number of aggressive malignant cancers with the harsh therapies utilized for these tissue lesions that are not posing a current threat to health. The pathologist that invented the Gleason score to identify potential cancerous lesions in prostate cancer, Dr. Donald Gleason, called for this type of tissue lesion to be called an adenosis, not a carcinoma or cancer. The standard medical community overrode his wishes. Most men would not consent to harsh anticancer therapies if the lesion was termed an adenosis. Now some of these noninvasive cell growths have been properly termed. In 1988, cervical dysplasia, or cervical intraepithelial neoplasia, was renamed from the prior classification of Stage 0 cervical cancer, or carcinoma. Since then, almost all women have opted for conservative therapies to prevent the potential of the dysplasia to develop into true invasive cancerous growth. This has resulted in much lower profits, but a much better outcome and quality of life for the patients. If cervical dysplasia was still called "cancer" most of the women with this tissue abnormality would have chosen a harsh and expensive therapy to stop the cancer. The term cancer comes with an incredible amount of simplified definition in the patient population, striking immediate alarm and fear, whereas only a few percent of even true cancers develop into a threatening and invasive disease. Medical doctors are not doing a good job of educating the patient population to the nuances of the term, instead using the fear of cancer to gain consent to perform harsh, and often unnecessary, and expensive, therapies. There is now much speculation that the practice of calling noninvasive lesions cancers was mainly a ploy to enhance cancer statistics, as these large numbers of benign cases of course had better outcome measures.
In 2014, a comprehensive long-term study of the benefits of mastectomy, and especially double radical mastectomy, in California, by the Stanford University School of Medicine and the Cancer Prevention Institute of California, found that there was no benefit to long-term survival with this now common surgical procedure. The lead author on this comprehensive study, published in the Journal of the American Medical Association (JAMA), Dr. Allison Kurian, explained that this large study utilized the comprehensive data on all patients diagnosed with breast cancer, followed for an average of 7 years, with the strongest analysis of research possible in consideration of factors that may affect survival. Dr. Kurian stated in an interview with The Independent: "We can now say that the average breast cancer patient who has bilateral mastectomy will have no better survival than the average patient who has lumpectomy plus radiation." Despite prior studies in Europe showing these same results, the percentage of women diagnosed with breast cancer, or even so-called cancer in situ, which is not an actual cancer but is treated as such, rose from just 2 percent in 1998 to 12.3 percent in 2011, with about 33 percent of women under age 40 opting for double mastectomy to prevent future cancer. The opting for a radical surgery that does not statistically show any benefit for cancer survival is not only driven by fear and misinformation, but more importantly, provides a false sense of security that often discourages the multitude of benign therapeutic choices that could be essential to an actual prevention of future cancers and increased survival time.
When tissue lesions and noninvasive cancers are detected, patients should be informed of the actual risks in detail, and when appropriate, safe and effective treatment with Complementary Medicine should be recommended and integrated into the treatment protocol. If the tissue lesion poses no immediate threat, the guidelines in standard medicine most often recommend that the growth or abnormality is monitored, not treated with harsh drugs, surgery or radiation. What is missing from this protocol is the integration of herbal and nutrient medicine, dietary protocols, acupuncture and physiotherapy, and a holistic mind-body approach to overall health improvement, as well as improvement in the specific cellular environment related to the abnormal tissue.
Even if the diagnosis is one of invasive cancer, Complementary Medicine will improve the outcome. Complementary Medicine has long been proven to effectively improve quality of life and treat the symptoms of cancer, yet the standard medical community continues to refer to this treatment as a dangerous alternative rather than a safe integrative medicine. Complementary Medicine also has the capability to assist the patient in health improvements that could contribute to spontaneous remission. Complementary Medicine, in the form of professional acupuncture and herbal/nutient medicine, is also proven to alleviate the harsh side effects of standard cancer therapies, and to assist in a quick recovery from the deleterious effects of chemotherapy, radiation and surgery. To date, standard medicine has not produced cancer therapies that are very effective, and there is no standard cure for cancer. On the other hand, there is a fairly large percentage of cancers that do go into remission, and for many, this remission is long-term or permanent. There is much cause for optimism on the part of the cancer patient, and utilizing Complementary Medicine, and personalized care and treatment, to guide the patient to improved health and cancer remission is a smart choice. Most patients that emerged from a diagnosis of cancer in health are not "cancer survivors", but simply those who experienced cancer remission and significant repair and restoration of the genetic mutations and cellular environment that made this possible. The labeling of these smart and healthy individuals whose bodies achieved remission, from either precancerous, benign cancer, or even malignant cancer, "survivors" is not helpful, and instead creates a stigma, and a mindset. This term is not used with other diseases, and we must wonder why.
Making the best decisions in the total treatment protocol with cancer with Complementary and Integrative Medicine (CIM/TCM)
The first thing that the cancer patient must learn is how to utilize an array of integrative medical care to achieve optimum results. Each case has its own set of parameters, and there are many types of cancer, each with many potential physiological concerns. Cancer is now defined not as a single disease, but a set of various diseases with dysfunctions in an array of systems in the body. This definition implies that a holistic approach is important to the overall treatment strategy in cancer therapies. Modern medicine continues to improve the first line of therapies for malignant cancer, and the first decision is whether the biopsy and oncology report produces evidence that the cancerous cells are benign or malignant, and whether they are fast or slow growing. If the cancer is malignant, or potentially able to spread, and the type of cells are fast growing, realistically, the options available are to 1) destroy or remove as many of the malignant cancer cells as possible and then clean up the damage from treatment, 2) help the body to destroy the tumor cells, and 3) help the body to stop the mechanisms that are causing the cancerous cell mutations, and restore the physiological environment that protects against future cancer growth. To insure optimum results, the patient may choose to include all three of these strategies into the integrative treatment protocol. If the cancer is not fast growing and malignant, more conservative options should be discussed, and a realistic window of treatment opportunity defined, so that you can utilize less harmful treatment strategies and measure the results before committing to harsh treatments.
In 2010, a five year study conducted in Europe showed that breast cancer patients with a diagnosis of a precancerous lesion or small tumor in early stages, fared just as well with lumpectomy, removal of just the sentinel lymph node, and application of radiation once during surgery, than with the standard practice of removal of all the lymph nodes under the arm, and weeks of radiation therapy. In fact, research showed that the course of 6 weeks of radiation was the deciding factor in opting for a complete mastectomy for many patients, which required no radiation therapy, but often was accompanied by chemotherapy or hormonal ablation. The study designers at University College London were trying to ascertain whether improved quality of life could accompany effective cancer protocol, and the results showed that the outcomes were identical with much less treatment (see the link to the article in the New York Times below). Many experts still question whether most of these cases of breast cancer with precancerous lesions, called carcinoma in situ, should be treated with even the lumpectomy and one dose of radiation. In the United States, most women are receiving lumpectomy with extensive radiation and hormonal therapies, or a mastectomy with chemotherapy and hormonal ablation. The side effects of these extensive therapies are very harsh, especially when the chance that the precancerous lesions will develop into a metastatic cancer are slim. Recent studies show that the percentage of ductal carcinoma in situ (DCIS), or precancerous lesions, that become a true metastatic cancer are less than one percent. The fact that the more minimal surgery and radiation worked just as well as the extensive protocol suggests that perhaps cancer experts were suggesting too harsh of treatment for a disease with little chance of mortality. Fear of the term cancer appears to drive the increased choice of these harsh cancer therapies when there is very little risk of benign lesions turning into invasive cancers, and of course a strongly biased source of information and counseling. Al large follow-up study in California, by experts at Stanford University, confirmed that the outcomes for most cases of early stage breast cancer and especially precancerous DCIS were much better with lumpectomy, removal of a sentinel lymph node, and targeted radiation, rather than mastectomy and more extensive removal of lymphatics with more extensive radiation of chemotherapy. Often, complete reliance on hormonal therapies and biologics is not the best idea, either, as many cases or true cancer still progress to more serious stages and spreading, despite reassurances that this will not happen, often with an explanation that the estrogen receptor positive cancer changed or became unresponsive to the drugs used. Addition of more therapeutic protocol insures better outcomes, and more and more we see standard cancer clinics using Complementary and Integrative Medicine for this very reason. Not only diet and stress reduction, though, but proven adjunct therapies with herbal and nutrient medicine, acupuncture and even physiotherapy can be of great help when integrated into the care.
While many breast cancer patients opt for the more extensive surgeries and treatment instead of more minimal surgical and radiation or chemotherapy treatments that are proven to be just as effective, these choices are often made without the complete knowledge of risks and harm. For example, a large percentage of breast cancer patients that received extensive lymph node removal are unaware of the percentage of these surgeries that result in lymphedema of the upper arm over time. Similarly, a relatively large percentage of patients undergoing extensive lymph node resection at the groin in cervical, endometrial, and ovarian cancer patients experience lymphedema in the legs. A 2009 study of 694 such patients found that about 21% of ovarian cancer patients, 28% of endometrial cancer patients, and 30% of cervical cancer patients developed lymphedema over time after extensive lymph node removal, with a median time of onset between 4-7 months, but some occurring as late as 4 years after the procedure. Radiation therapy increased this risk, but other surgeries did not. (Gynecological Lymphedema Study Group, Sappora Medical University Hospital et al, BMC Cancer. 2009;9:47). Lymphedema is a permanent enlargement of the limb resulting from poor lymph flow and subsequent vascular damage, and is accompanied by pain, painful sensitivity, and decrease in mobility. There is no cure at present for lymphedema. Numerous studies show that the risk for lymphedema is much higher with more extensive lymph node removal and radiation than with removal of just the sentinel lymph node and minimal radiation. Just 4-13% of women will eventually experience lymphedema of the arm after sentinel lymph node dissection, while between 20-40% of women with more extensive axillary lymph node dissection eventually experienced lymphedema, with onset between 3 months and 3 years after the procedure. With integration of Complementary Medicine, the risk of lymphedema could be further reduced with early treatment, prevented, or successfully reduced after onset. Studies cited in Additional Information show that short course of acupuncture alone will reduce the risk of lymphedema dreamatically after lymphatic resection, and will treat this condition better than any standard therapy.
A 2013 study of the efficacy of acupuncture to treat lymphedema after breast cancer treatment at the esteemed Memorial Sloan-Kettering Cancer Center in New York City found that with just a short course of simple acupuncture alone that an average decrease in the arm circumference of about 1 cm in women with lymphedema, 6 months to 5 years after removal of lymph nodes to treat breast cancer, was achieved, and that 11 of 33 patients exhibited a reduction of greater than 30 percent of lymphedema after just 8 treatments (see study link below). No other therapy has shown efficacy to treat lymphedema. Combining these short course of acupuncture with studied herbal and nutrient formulas would increase this treatment efficacy, and would be very inexpensive.
Other studies have shown that acupuncture during or after chemotherapy and/or radiation could increase leukocyte counts, countering the expected leukopenia and risk of immune deficiency and anemia. A 2007 meta-review of such human clinical trials in China by the esteemed Dana-Farber Cancer Institute in Boston, Massachusetts, showed that this has been proven in 7 published studies in China, and needs to be further evaluated in standard medicine in the United States. The combination of minimal but effective treatment in breast cancer combined with a short course of acupuncture and herbal/nutrient medicine provides for optimal outcome with minimal adverse health effects. While sound clinical trials of herbs and nutrient medicines in adjunct patient care in the West are still few, and rarely published in standard medical journals, there is evidence supporting its use. For instance, in 2013, the British Medical Journal (BMJ), reported on a meta-review from experts at the Clalit Health Services Integrative Oncology Program, in Haifa, Israel, that selenium supplement (methylselenocysteine) is shown to reduce the incidence and severity of upper limb lymphedema following surgery and radiation for breast cancer (PMID: 24644186). While long-term use of these supplements, or overuse, has not been shown to be wise, specific protocols, directed by physicians trained in this discipline, such as Naturopathic Doctors and TCM physicians (Licensed Acupuncturists), is supported by sound evidence. With all of this evidence, though, a recommendation of removal of just the sentinel lymph node, and then a short course of acupuncture with the addition of an herbal and nutrient protocol including methylselenocysteine, is still rarely recommended.
The February 9, 2011 issue of the Journal of the American Medical Association (JAMA) reported on a U.S. followup to this European study of treatment with stage 2 invasive breast cancer with metastasis to a sentinel lymph node. This large multicenter trial involved 115 cancer treatment centers and enrolled 891 patients, from 1999 to 2004. All of the patients received lumpectomy and a short course of radiation, and the long-term survival rate for those opting for lumpectomy, removal of just one or two lymph nodes, and a short course of radiation was about 93 percent. The study clearly showed that half of the patients who received just a removal of one or two sentinel lymph nodes fared better in survivability and quality of health after 6 years, with the breast cancer patients receiving a removal of many lymph nodes having a higher mortality rate than those receiving less surgery. "The authors note that these results suggest that breast cancer patients, such as those in this study, do not benefit from the addition of axillary lymph node dissection in terms of local control, disease-free survival, or overall survival, and that axillary lymph node dissection may no longer be justified for certain patients (stage 2 breast cancer with metastasis to sentinel lymph nodes)." (JAMA 2011;305(6):569-575). The authors, Dr. Armando Guilano of the John Wayne Cancer Institute of Santa Monica, California, et al, stated that with implementation of these guidelines, that thousands of women each year would have improved outcomes, and reduction of the "unacceptable risk of complications such as seroma, infection, and lymphedema", and improved quality of life, with no decrease in the survivability and recurrence of their cancer. Why these guidelines are not fully implemented yet, or why it took so long to establish this more effective and less damaging therapy is in question. The question of why acupuncture and herbal/nutrient medicine is not integrated after lumpectomy, a single dose of radiation therapy, and the removal of just the sentinel lymph node, should also be questioned.
Each year, scientific research has produced more and more evidence of herbal and nutrient medicine capability to reduce the risk of recurrence of breast cancer, and address the underlying causes of the breast cancers that surgery, radiation and chemotherapy do not address. This adjunct therapy is without side effect or harm, and will potentially improve overall health as it helps in the breast cancer protocol.
Patient choices in breast and prostate cancers, and integrating Complementary Medicine to reduce the risk of recurrence and improve health during treatment
The first choice of the patient with fast growing malignant cancer comes with deciding whether it is viable or sensible to use surgery, radiation and/or chemotherapy to kill the malignant cells. Your oncologist should be able to give you the chances of treatment success. If this course is followed there will be much damage to clean up caused by the treatment, and even the best surgeon and radiologist will not be able to remove or destroy all cancer cells, or remove the cause of these cancer cells. Complementary and Integrative Medicine (CIM/TCM) offers more treatment options to accomplish these goals. If this course of surgery, radiation, and chemotherapy is not followed, an intense program of aiding the body's natural defenses against cancer must be initiated, and this program must be comprehensive. Either way, Complementary Medicine provides successful adjunct care to achieve your goals, and a knowledgeable Licensed Acupuncturist is able to provide a variety of treatments that are at the forefront of current evidence-based medical strategy. Another article on the website, entiltled Cancer Adjunct and Adjuvant Therapies, provides a wealth of information on proven adjunct care with CIM/TCM, with many more links to scientific studies. Clinical studies also consistently show that there are many patients of almost every cancer type who experience progression of the cancer or recurrence despite the use of surgery, chemotherapy and radiation therapy, and despite taking hormonal ablation, aromatase inhibitors, or other biologics, and here too is where Complementary Medicine is utilized to insure greater chance of success in reducing future risk of recurrence.
One of the primary concerns with radiation and chemotherapy is the subsequent anemia that results from toxic therapy. The ability of your marrow to produce new blood cells may be severely hampered by the damage caused by either chemotherapy or radiation therapy. Damage from these therapies is not limited to the site of the cancer. Standard treatment has included the use of EPO, or synthetic erythropoetin, a hormonal analog that stimulates marrow production of blood cells. A report in the Journal of the American Medical Association (JAMA), published in February of 2008, concluded that "Erythropoiesis-stimulating agent (ESA) administration to patients with cancer is associated with increased risks of venous thromboembolism and mortality. Our findings, in conjuction with basic science studies on erythropoietin and erythropoietin receptors in solid cancers, raise concern about the safety of (synthetic) ESA administration to patients with cancer." (JAMA. 2008;299(8):914-924). Complementary Medicine does offer safe and effective therapy to stimulate healthy bone marrow production of blood cell lines without the risks and side effects of synthetic hormonal therapy.
An article in the New York Times Business Day, Saturday, June 25, 2011, entitled F.D.A. Urges Less Use of Anemia Drugs, reveals that the FDA is urging medical doctors to curb the use of widely used drugs to treat anemia in cancer therapy. These drugs, erythropoetin-stimulating agents, referred to as EPO, or Epogen, Aranesp and Procrit, have been increasingly prescribed despite the 2008 conclusion cited above. The FDA concluded in 2011 that there are no risk-free dosages of EPO, and that the use of these drugs may have cost many patients their lives by inducing stroke and heart attack, and in cases may have sped the growth of cancerous tumors. Since these drugs are expensive and generate much profit in cancer therapy the prescription of these drugs in the U.S. system is much higher than in Europe, and government investigations have uncovered large consulting payments to the medical professionals that wrote guidelines for the drugs usage as well, raising eyebrows. With this stronger FDA guidance, we may finally see more utilization of, and integration with, Complementary Medicine, where research is increasingly identifying the efficacy of herbal medicines.
Another of the primary concerns in recent years is the development of multiple drug resistance with the use of chemotherapy. Drug resistance can be intrinsic (failure with the first use of the chemotherapy agent), or it can be acquired (success with the first chemotherapeutic course of drugs, but failure with the second). The failures of chemotherapy drugs may be attributable to the actions of the chemotherapy drug chosen, the tumor environment, or cell-specific issues related to the type of cancer. Researchers have been exploring herbal chemicals in order to find natural anti-tumor and anti-proliferative agents to utilize in case of multiple drug resistance in cancer, especially with regards to breast cancer and metastatic cancers. This research is finding promising herbal chemicals that have now passed early stage human clinical trials with success (see the link in additional information to one such study).
Since herbal medicine utilizes nontoxic treatment, as well as formulary that reduces even mild toxicities and supports the systems as well, the professional herbalist is able to deliver adjunct cancer therapy that not only protects against the toxicities of chemotherapy and radiation, but is also able to simultaneously deliver herbal therapies that may work even when the chemotherapy does not. Future research may even show that these herbal chemicals reduce acquired chemotherapy drug resistance, and provide a synergistic effect that allows for reduced dosage of chemotherapy drugs, and less chance of developing a drug resistance, giving Integrative Medicine more tools to insure a better outcome. In fact, a number of herbal extracts and formulas have demonstrated the ability to counter chemotherapy toxicities or reduced effective dosages (see studies cited below). For example, resveratrol, a chemical extracted from the Chinese herb Polygonum cuspidatum (Hu Zhang), effectively lowered the necessary dosage for chemotherapy in various studies. A combination of resveratrol and another chemical constituent of Chinese herbs, curcumin (E Zhu), was found by researchers at the Barbara Ann Karmanos Cancer Institute in Detroit to improve response rates to chemotherapy in the treatment of colon cancer. Dr. Adhip Majumdar, lead author of the study, stated that this research could lead to the lowered effective dosage of chemotherapy and less chance of colon cancer cells surviving chemotherapy or becoming drug-resistant. As time goes on, more and more scientific studies and clinical trials are demonstrating that potential to integrate herbal and nutrient medicine into the protocol to both enhance cancer drug therapies and alleviate the adverse effects. Links to these studies are provided below in Additional Information.
An increasing threat from the use of the first line of cancer treatment, destruction of the cancerous cells with chemotherapy and radiation, is the threat of secondary cancer, or cancer caused by the treatment. Yes, toxic chemistry and harmful radiation not only destroys cancer cells, but exposes the patient to the threat of cancerous mutations caused by these treatments. In general, radiation and chemotherapy was considered useful when the cancer was advanced, and was useful to delay the death of the cancer patient, but today, chemotherapy and radiation are used in many cancers that are less severe, creating a situation where the survival expectancy is longer. With a longer survival time, and the introduction of Integrative Medicine, which increases the patient vitality and also the survival time, the incidence of secondary cancer from chemotherapy and radiation is now very common. A July 17, 2012 New York Times Science Times article, entitled New Cancer Threat Lurks Long After Cure, revealed that secondary cancers now make up the sixth most common group of malignancies. One example, cited in this article, is myelodysplastic syndrome (MDS), or cancerous dysfunction of the bone marrow that produces improper levels of various types of blood cells (dysplasia). This is very similar to bone marrow leukemia. Secondary cancers, now very prevalent, point to the need to reduce toxicity of the chemotherapy and radiation, use these harsher therapies only when needed, and continued need for years after receiving chemotherapy and radiation to work to repair the damage and prevent catastrophic cell mutations resulting from the therapy. Complementary and Integrative Medicine are the way forward with these goals, and many scientists around the world are studying the potential of herbal and nutrient medicine, acupuncture, dietary and lifestyle changes, and better use of deep tissue massage therapy to prevent this secondary cancer.
A second line of cancer treatment, using the body's natural defenses to stop cancerous growth, cell mutation, and tissue dysfunction
The second treatment option in cancer therapy, after surgery and chemotherapy, concerns means of promoting the body's natural mechanisms to fight cancer and destroy cancerous cell growth. Since cellular mutation is occurring in each of us at all times, the body has devised a complex system of correcting this problem, utilizing primarily the immune and hormonal systems, but also the regulation of immune and hormonal mediators by enzymes and inflammatory mediators produced primarily in the liver. The main line of defense occurs with regulation of apoptosis, or normal programmed cell death, which clears old cells before they reach a point of dysfunction that prevents our immune system from controlling the cell mutations. The immune system constantly recognizes and attacks both cancerous cells and the cancerous mutations of the DNA within those cells, but may be overwhelmed both by the number of mutations in older cells, and by the degree of chronic inflammatory stress on the immune system. While newer biologic cancer therapies are now being utilized that enhance the patient's own immune blood cells to better attack cancer cell lines with specific antigens and mitogens, much can also be accomplished by integrating a more holistic, or less specific, immune enhancement with Chinese herbal medicine, nutrient medicine and acupuncture. Integration of these therapies could be the key to a better outcome for many patients. For instance, research at the Tel-Aviv Medical Center in Israel, at the Laboratory of Herbal Medicine and Cancer Research, in 2012, cited the fact that many herbal medicines are now proven to have anti-inflammatory and and anti-cancer activities related to the pathway of the immune cytokine NFkappaB, found active in most tumor cell lines, and the target of inhibition of many new biologic chemotherapeutic drugs (see study link below in Additional Information). While we may not expect as dramatic of an effect from these herbal medicines as a pharmaceutical biologic, the ability to enhance these immune effects safely and without side effects with specific herbal medicines make Complementary Medicine a sound choice in Integrative Oncology.
Other systems of the body are integrated to help the immune system, and the neuroendocrine balance is very important to the successful function of the cytological immune response. Hormones are simple cells that are created both systemically, and locally, and levels of the various hormones create the proper balance of hormone receptor stimulation. This complex feedback system creates a balance between maintaining cells and removing them, or anti-apoptosis and pro-apoptosis. The metabolic regulation of important chemicals and nutrients by the liver is also a key component to healthy immune function, as raw ingredients are a prime necessity for formation of the proper immune chemicals and hormones. Complementary Medicine, which addresses all of these concerns holistically, is thus shown to be a highly successful adjunct therapy in total cancer protocol. Cancerous tumors and metastatic spread of cancer cell lines occur when the body is overwhelmed by the level of cellular mutation. Maintaining optimal health and vitality is very important in the overall protocol, and this can be a big challenge when harsh therapies are destroying your vitality and you must maintain a level of activity to support your income and/or to care for your family.
Current scientific study has shown that a great number of cancers go into remission, even metastatic cancers. An October 27, 2009 article in the New York Times, cited in Additional Information with a link to the article, explains the findings published in a recent Journal of the American Medical Association (JAMA). The intelligent patient will utilize every means possible to enhance the body's ability to slow, stop or reverse the progress of cancerous growths, and Complementary Medicine provides this type of therapy, while standard medicine does not. This is the reason that many of the cutting edge cancer specialists in the world are now utilizing Complementary and Integrative Medicine (CIM) in their practice. Collaborating and integrating your care with a physician trained extensively in these therapies is a sensible choice. Allopathic physicians are not trained in herbal medicine, nutrient medicine, acupuncture, stress reduction techniques, and other standard therapies offered in Traditional Chinese Medicine. Choosing the right Licensed Acupuncturist (L.Ac.) and herbalist is important.
How do these therapies work? Besides maintaining and optimizing the natural homeostatic mechanisms against cancer in your body, recent research is opening up the role of herbal therapeutic approaches to stimulate the mechanisms of apoptosis, or single cell death, that your body utilizes to destroy new cancerous cells. For instance, 2012 research at the Medical University of South Carolina, Charleston, South Carolina, U.S.A. found that alcohol extracts of the Chinese herb Ganoderma lucidum (Ling zhi or Reishi mushroom) contained triterpenoids called Ganoderic Acids that were shown to have both anti-apoptotic and immune activating, or modulating, effects that could soon make this herbal medicinal an accepted chemoimmunotherapeutic agent in standard Integrative Medicine. A meta-review was conducted by the University of Sydney, Sydney, Australia, of the effects in human clinical studies of Ganoderma lucidum on long-term survival with cancer patients receiving standard care plus Integrative Medicine in 2012, and reported that while the size and number of such long-term studies was small, the accepted studies showed that integrating this Chinese herbal medicine with chemotherapy and/or radiation produced more positive results than these therapies alone, and that immune functions were improved with its use. Most of these studies reported improved Quality of Life with the addition of Ganoderma lucidum. No major toxicity or adverse effects were noted, and the study authors promoted this Chinese herbal medicine as an adjunct to standard therapy (see study link in Additional Information).
This is just one of thousands of researched herbal cancer adjunct therapies proven effective, but we see now that many of these herbal medicines marketed commercially are not what they claim to be (see the article on this website entitled Herbal and Nutrient Medicine: Quality Assurance). One can fully depend on professional herbal and nutrient products, prescribed by a professional herbalist, such as a Licensed Acupuncturist or Naturopathic Doctor, for assured and tested quality and dosage, but many of the products bought off the shelf and online are not what they say they are. In such an important area as cancer care, this is a very important subject that is highly overlooked. As research reveals novel pharmacological approaches to cancer therapies, these approaches are researched to find the same mechanisms triggered by natural chemicals in herbs and foods, and very specific adjunct therapies are increasingly devised to improve the individualized step-by-step care in adjunct herbal medicine. Complementary and Integrative Medicine utilizes this vast industry research to improve targeted prescription of herbs and improved knowledge of the preparation of herbal products to achieve these therapeutic goals. Often, the research reveals that herbal approaches are not only without side effect, but are as effective as the pharmacological approach. Each patient may choose to utilize Complementary and Integrative Care in whatever way they are most comfortable with, as an adjunct treatment, to relieve side effects of standard therapy, or to improve Quality of Life and function. The choice is up to the patient in a patient-centered field such as Complementary Medicine.
The emergence of biologic medicine to slow or reverse cancer, meaning the use of medicines created by biological processes, not just chemical synthesis
The third choice in standard therapy is whether to use the new chemical, or biological, strategies for inhibiting estrogen receptors, androgen receptors, etc., or harnessing immune cells or altered viruses to affect biologic modulation, called "biologics". A biologic is defined as a preparation, such as a drug, vaccine or antitoxin, that is synthesized from living organisms or their products and used as a diagnostic, preventive or therapeutic agent. These chemical biologics mimic the effects of herbal and nutrient chemicals, stimulating natural biologic processes to improve or alter the body's natural defenses.
These are typically Tamoxifen and Herceptin, used primarily in SER2 positive breast cancer, and Lupron et al, to inhibit hormone production that is linked to ovarian and prostate cancers, or the aromatase inhibitors Arimidex, Femara or Aromasin. The guidelines for use of the aromatase inhibitors for estrogen receptor positive breast cancers in premenopausal women suggest that ovarian function be stopped before use, either by removing the ovaries, or by using drugs that suppress ovarian function, such as Lupron, Zoladex or Trelstar. Large clinical trials, such as the Suppression of Ovarian Function Trial, or SOFT, had not issued findings yet, as of 2013, and many oncologists are still using these only for postmenopausal women, although ovarian function in postmenopausal women is minimal. Results of the large phase 3 clinical trials with SOFT, the Austrian Breast and Colorectal Cancer Study Group trial (ABSCG-12) and the TEXT trial comparing Tamoxifen to newer aromatase inhibiting drugs, did not demonstrate improvement in disease-free survival with ovarian suppression in the overall population, although they did see some mildly improved benefit for younger women with higher recurrence risk. Toxicity and adverse effects with these hormonal biologic therapies were much worse, though, for women receiving ovarian suppression, and recommendations emerged in 2015 to avoid hormonal therapies in postmenopausal women when possible, and to avoid ovarian suppression and to monitor premenopausal women for acquired resistance or changes to the types of potential cancer cells (Oncology 2015 Jul; 29(7):473-8). A large randomized study of the benefits of ovarian suppression before using aromatase inhibiting drugs to prevent cancer return in estrogen positive breast cancers was conducted by The Institute of Cancer Research in the United Kingdom, and 2144 patients, randomly assigned to either chemical ovarian suppression with drugs such as Lupron, or not, showed that using these harsh drugs showed no statistical benefit in the long-term, with the trial ending in 2000, and the study findings in a 2006 follow-up (see the study link below in Additional Information). To confuse the matter further, the U.S. National Cancer Institute also instituted another trial entitled SOFT, or Soft Tissue Sarcoma Trial, and patients are awaiting the expected results of the U.S. trial of the need for ovarian suppression, still, while many oncologists are ignoring the completed trial in the United Kingdom.
There is much hope in the positive statistics associated with pharmaceutical biologics, although these more natural pharmacological biologics are not without significant adverse effects. As more information on this topic is disseminated, studies show that a significant percentage of women are confused and alarmed about these biologic drugs, adding stress to the already stressful treatment strategy. Better discussion of risks versus benefits is needed. Tamoxifen, and other aromatase inhibitors, occupy estrogen receptor sites in breast tissue to decrease risk of a return of malignancy, although they do not block estrogen's effects elsewhere in the body and are purported to double or triple the risk of uterine and ovarian cancer. They have also been shown to increase risk of blood clots and decrease production of various blood cell lines. Many women also go off of these medications quickly due to adverse side effects, often similar to a strong menopausal syndrome, as well as significant joint stiffness and pain with aromatase inhibitors. If you do use this SERM (selective estrogen receptor modulation) treatment protocol, or protocols affecting androgen and progesterone receptors, adjunct therapy with Complementary Medicine is very useful to decrease risks and problems with side effects. A study at the University of Sydney School of Medicine, Australia, in 2013, as well as a 2010 study at Columbia University, New York, New York, U.S.A. found that acupuncture provided safe and effective therapy for the common complaint of joint stiffness and pain as a side effect of aromatase inhibitors (see study links below). SERM protocol could be individualized and made much safer, and perhaps more effective, with integration of proper Complementary Medicine.
A 2012 study of the use of Tamoxifen in breast cancer prevention, by Dr. Monica Morrow M.D. of the esteemed Memorial Sloan Kettering Cancer Center in New York, New York, U.S.A. found that the benefits of use have been overstated, and the risks and adverse effects understated. Dr. Morrow explained that current statistics show that for women diagnosed with so-called ductal carcinoma in situ (DCIS), which is a controversial term, since these lesions are not actually cancer, long-term studies show that risk of cancer death after any surgical approach, even lumpectomy with targeted radiation and removal of the sentinel lymph node, now the preferred treatment, is extremely low, ranging from 2.3 to 4.7 percent in studies after 15 years.
She emphasizes that this is not changed with the addition of Tamoxifen therapy. Radical mastectomy does reduce this 15 year risk to 1 percent from 2.3 percent, but for many women, this is not significant enough to opt for mastectomy. Dr. Morrow notes that when the initial reports of reduced risk with Tamoxifen use were published, that a 37 percent reduction in relative risk of future breast cancer was reported, but closer scrutiny showed only a 5.2 percent difference between the groups that received Tamoxifen and those that did not. After the publication of the long-term NSABP study, only 19 percent of breast cancer patients in Australia and New Zealand opted for Tamoxifen therapy. In the United States, a different advice, or interpretation of the facts, was given to patients, and up to 91 percent were urged to take Tamoxifen. Despite this, only about a half of these patients chose to take the drug due to the adverse effects and health risks relative to benefit, and a high percentage of users discontinued use during the course due to side effects. By 2005, the percentage of patients in the United States that were diagnosed with DCIS declined to 20.5 percent. In response, an analysis of a subset of patients with ER positive findings showed that the difference between groups using Tamoxifen and those not choosing to take it was 11 percent, not 5.2 percent. This was a controversial method of analysis, though, and still, with a relatively low incidence of increased cancer mortality after 15 years without taking the drug, the difference even of 11 percent should be put into a proper perspective. Dr. Morrow states that in the end the analysis of benefit to justify Tamoxifen use, or in postmenopausal women, Raloxifene, is small. She then argues that since many women are frightened enough by the thought of breast cancer now, though, that an increasing percentage of women are opting for a double radical mastectomy, which comes with negative risks and adverse effects, and so physicians might argue for Tamoxifen or Raloxifene, despite its small statistical benefits, with a diagnosis of DCIS ER positive, to discourage these double radical mastectomies (see the study link below in Additional Information). All of this is confusing to most patients, and oncologists are not presenting the data and advice in this way to most patients in the United States, though. The data and advice most often overwhelms the patient with a relatively benign diagnosis of DCIS ER positive, which is not actually cancer, but in a small percentage of patients may be called precancerous, and the patient often chooses a radical course of therapy when overwhelmed by worry and data.
While more women have been opting for a more radical approach to benign breast cancer in the last decade, this trend may finally be reversing. The large studies that showed that women who chose a simple lumpectomy and sentinel lymph node removal faired better than those that chose radical mastectomy has had an increasing effect. The readiness to perform breast reconstruction and have it paid for, though, became more of a factor as well. The choice in taking a SERM, though, should not be swayed by these issues, and the risks versus benefits of these long courses of drug therapy should stand on their own. When learning of the many harsh side effects of these SERM biologics, many women are now interested in SERM protocol that is not synthetic, but derived from plant sources, such as estriol, as well as the I3C extracts from cruciferous vegetables and herbs, or the active metabolite DIM, etc. Herbal and nutrient SERM protocol is of course not as strong as pharmacological protocol, but offers safe and effective therapy as an adjunct to this treatment, or in cases where the patient chooses to avoid the protocol, or shorten the course of this therapy. Such therapy is not an alternative touted to be just as effective, but is instead a viable adjunct therapy that may be appropriately added to the patient choices where applicable. To deny this proven SERM protocol to the many patients that choose to avoid, discontinue, or shorten their normal SERM treatment seems cruel and unnecessary. In addition, this more benign herbal and nutrient SERM protocol is now proven to enhance the long-term benefits of standard SERM protocol.
The chemicals in herbal and nutrient medicine, DIM and bioidentical estriol, have long been studied and found effective in a SERM protocol, but as this research expands, a host of other natural medicinals have also been found to be safe and effective. Combinations of these herbal and nutrient medicines seems most sensible to achieve the greatest effect. Chemicals in plants that exert hormonal modulation, such as lignans and bioflavones, as well as coumarins, are also proven to be effective SERM protocol in recent scientific studies and human clinical trials (cited below in Additional Information with linkes to the study summaries). A particular herbal chemical, Pterostilbene, an analog of Resveratrol, found in the Chinese herb Polygonum Cuspidatum, or Hu zhang, has demonstated potential as a synergistic treatment with tamoxifen that may decrease risk of breast cancer recurrence by inducing cancer cell apoptosis. You do need to consult with a knowledgeable Complementary care physician, such as a Licensed Acupuncturist with this specialty, to insure that you follow a safe protocol. Such therapy may be safely tried if the cancer is not aggressive, and harsher pharmaceutical SERM protocols used if there is not success, or it may be used to enhance the effects of standard SERM protocol. In this case, therapy to address the numerous side effects of pharmaceutical SERM biologics may also be utilized to insure a better outcome and quality of life.
While the scientific proof of herbal and nutrient chemicals that achieve such biologic goals as aromatase inhibition and modulation of estrogen receptors effectively grows each year, standard medicine still tenaciously clings to an outmoded discouragement of effective Complementary Medicine. Many patients will choose to not take potentially harsh medications, or when experiencing adverse effects, opt for a shorter course, and a reasonable option would be to honestly discuss the risks and benefits and allow the patient to utilize better Complementary Medicine in these cases. This is not happening, and over 90 percent of hospitals and clinics still discourage almost all effective herbal therapy, despite years of failure to show real clinical risks. Potential herb-drug interactions of just a few herbs are used to discourage almost all herbal medicine, effectively tying the hands of Complementary Medicine physicians who could deliver more effective research-based therapies. To see the expanding list of scientific studies and clinical trials of herbal and nutrient chemicals that effectively act as aromatase inhibitors and estrogen receptor modulators to decrease risk of recurrence of breast cancer after a lumpectomy, or even prevent breast cancer, go to the section at the end of this article entitled Information Resources / Additional Information to see summaries and links to the studies.
These biologic drugs are not only promoted to treat estrogen-receptor positive breast cancers and prevent recurrence, though. They are also now heavily promoted to prevent breast cancer, although the prescription of these drugs has fallen off considerably with evidence of health risks and adverse effects, such as blood clots and osteoporosis. Women without a diagnosis of cancer have shown great reluctance in taking these preventive drugs after researching the potential adverse effects, which could be worse than the cancer. To increase sales, new versions of these aromatase inhibitors are being created to ease fears of side effects. One new drug, exemestane, marketed as Aromasin, is promoted to treat early stages of breast cancer in post-menopausal women, or who already have been unsuccessfully treated with tamoxifen (Nolvadex). Like these other biologic aromatase inhibitors, many women experience hormonal side effects of hot flush, sweating, tiredness, nervousness, depression, hair loss, etc., when taking Aromasin. The initial course of treatment with Tamoxifen, also an aromatase inhibitor, involved 5 years of continuous use in the United States originally, but many European studies showed that the prolonged use had limited benefits but increased health risks, and that the high incidence of adverse side effects over time prompted a great percentage of women to quit taking the medication before the 5 year course was completed. Aromasin was created to try to keep breast cancer patients with estrogen-receptor positive tissues on an aromatase inhibitor for a full 5 years. The manufacturer, Pfizer pharmaceuticals, states, though, that the common side effects for Aromasin are similar to Tamoxifen, with over 20 percent of women in the short term trials experiencing hot flashes, and over 12 percent experiencing increased sweating, insomnia, fatigue and joint pain. Pfizer admits that the incidence of side effects, and adverse effects such as osteoporosis, are greater with Aromasin than Tamoxifen.
While limited initial trials of Aromasin indicated that estrogen-receptor positive breast cancers may be reduced with preventive use in women with markers of high risk (see my article on this website entitled Cancer Screening), subsequent studies showed that the risks of serious adverse health effects, such as osteoporosis, were dramatic. A study published in The Lancet Oncology online, February 6, 2012, and initially in June of 2011, found that a 2 year course of Aromasin resulted in an average bone loss of 6.1 percent of bone mineral density, compared to similar women who received a placebo, who averaged only 1.8 percent loss. This study of 4560 postmenopausal women with high-resolution peripheral quantitative CT scanning not only showed an accelerated bone density change, but indicated that that there was evidence of weakening of the bone matrix, or structure supporting mineral hardening, as well. These adverse effects, along with a high percentage of patients experiencing increased joint pain, indicate that the negative effects on overall endocrine homeostasis may be considerable. The FDA in 2012 is still evaluating approval of Aromasin for preventive use in this subset of women, who are postmenopausal and test postive for markers of high risk for estrogen-receptor positive cancers. Of course, experts in the field still encourage the use of such drugs as the only alternative to mastectomy, ignoring the mounting evidence of the efficacy of herbal and nutrient medicine, and overall improvements in hormonal health, in real prevention of breast cancers without side effects.
Of course, new biologics will be introduced with research to try to find a drug regimen that involves fewer adverse health consequences. One promising class of biologics, PARP inhibitors, or Poly-ADP ribose polymerase inhibitors, such as Iniparib, Oliparib, Ruciparib et al, has shown much promise and is in the stage of clinical trials in Japan in 2013. This class of biologics is specific for breast cancers related to the BRCA gene markers, which are associated with metastatic breast cancer. Researchers in Japan, at the National Cancer Research Institute, are also finding that a combination of herbal medicine and PARP inhibitors may be the solution to enhanced effects in biologic medicine with lower dosage, and thus fewer adverse effects. Research cited below in additional information found that the common Chinese herbal anti-cancer chemical Curcumin enhances the effects of PARP inhibitors. Such research demonstrates that the findings of numerous studies of herbal anti-cancer effects is being taken seriously and will soon be integrated into standard practice.
Another class of biologics that is promising is monoclonal antibodies, or specialized antibody proteins created by human immune cells or their identical clones. One such biologic agent approved by the U.S. FDA in 2015 to treat the most dangerous type of cancer, metastatic squamous non-small cell lung cancer (NSCLC), is nivolumab, called Opdivo. Opdivo, or nivolumab, is a fully human IgG type 4 monoclonal antibody that modulates the immune response by blocking activation of the programmed cell death 1 (PD-1) receptor on activated T cells. Many cancers survive and spread with metastasis by blocking this T cell mechanism that attacks cancer cells and kills them by using this PD-1 receptor ligand (activating ion of covalent molecule), evolved by the cancer cells. Such biologics help the immune homeostasis to clear cancer cells by overriding just one of the adaptive mechanisms that stop the body from killing cancer cells. Unfortunately, this is just one mechanism of action of many involving genetic protein expression, and however important, was found in clinical trials to only increase survival time of this metastatic cancer by a little more than 3 months on average, and did not reduce the size of tumors in 85 percent of patients. While such biologic medicine should be applauded, added to the harsh effects of platinum-based chemotherapy, the standard treatment, which has been mildly effective in prolonging survival time, and docetaxel, a chemotherapy that interferes with all cell mitosis, or cell division, and thus adds harsh side effects, such as hair loss, bone degeneration, anemia, immune deficiency, neuropathy, gastrointestinal dysfunction, fatigue, etc., it is obvious that these chemotherapies and biologics still provide for a relatively short survival, and very diminished quality of life. Integration of Complementary Medicine into this protocol would perhaps further extend survival, and more importantly, relieve these harsh side effects and improve function and Quality of Life. Unfortunately, faced with such a serious cancer, few patients will take advantage of such integrated adjunct care unless their oncologist tells them that this is safe and sensible.
The enormous monetary cost of these new pharmaceutical therapies is becoming an issue as well, creating a burden of stress for cancer patients and their families that is rarely discussed when considering treatment options. Extensive genetic mapping has now revealed that for the wide variety of cancers studied, an average of 10 biological genetic dysfunctions is occurring, with many other biological dysfunctions secondary to these altered expressions actually driving the cancer metabolism as well. Targeting just one of these dysfunctions with a biologic drug may not be enough, yet using 10 such drugs would be overwhelming in terms of adverse effects and cost. The sensible approach would be to better define the specific cancer case and combine the most important biologic drug with an array of inexpensive biologic herbal and nutrient medicines to achieve a more holistic treatment outcome, yet this approach is strongly discouraged in standard medicine. The reasons why such an approach is still discouraged make little sense when analyzed, though, considering the enormous and growing scientific study that has refuted the potential dangers of integrating Complementary Medicine into the cancer care.
Biologic drugs that inhibit normal hormone production, the risk versus benefit equation
The use of Lupron in prostate and ovarian cancer therapy also presents severe side effects and risks, limited benefit, and the need for a more comprehensive therapeutic approach to achieve maximum results. Lupron, and other drugs in this class, work by inhibiting hormone production throughout the body, and effect the entire endocrine system. The theory behind this treatment is that androgen ablation will decrease the stimulation of androgen receptors that are responsible for the uncontrolled growth of cancerous tumors. The truth revealed in recent research is that DHT (dihydrotestosterone), an active metabolite of androgens, or testosterone, converted in local tissues, is what stimulates androgen receptors the most, not systemic androgens / testosterone. Control of connversion of one type of hormone into another in local tissues is much more important than total circulating hormone levels, and a variety of factors acting holistically controls this homeostatic process. Recent research on hormonal receptors also reveals that a gradual imbalance of hormonal cell receptors in local tissues tilts the balance of maintaining older cells with replacing these cells. This process is called apoptosis, or programmed cell death, and is utilized by your body to remove older cells and replace them with new healthier cells to avoid the cell mutations that result in cancerous growth.
When the body faces hormonal imbalance, such as in menopause, andropause, or even with premenstrual syndromes, this hormonal imbalance may stimulate an increase of the receptors that prevent normal cell death, or apoptosis. This is because the deficiency in certain local hormones prompts increased creation of the receptors for these hormones on the outside of the cell. In testosterone driven cancers, such as prostate, it is now known that the deficiency of testosterone drives this process of excess creation of external cell receptors. When an imbalance of testosterone receptor types is created, and a relative excess of receptors on the outside of the cell in relation to testosterone receptors on the inside of the cell occurs, normal programmed cell death, or apoptosis, is inhibited, and the older cells mutate excessively into cancer cells. Maintaining physiologically normal levels of testosterone is important. While active testosterone metabolites, such as DHT, as well as estradiol, do stimulate cancer growth, restoration and maintenance of physiological normal levels of hormones has been proven to reverse this process. The scientific understanding of last year is being overturned by the increased scientific understanding of the present year. Complementary Medicine is not tied to the need to promote expensive drugs based on old evidence, but is able to utilize current research to deliver a host of natural products that are not tied to the patent system.
We now know from extensive research how misdirected the standard therapy in prostate cancer was, and still is in many cases. A meta-analysis by the Harvard Medical School in 2009, published in the Frontiers of Hormone Research, 2009;37:197-203, found that a number of "clinical trials and population studies consistently failed to support the historical idea that Testosterone therapy posed an increased risk of prostate cancer or exacerbation of symptoms due to benign prostate hyperplasia." This was because exogenous testosterone does not raise intraprostatic concentrations of testosterone or DHT (dehydrotestosterone), the active metabolite of testosterone. The study found that, in contrast, "there is mounting evidence that low serum testosterone is associated with greater prostatic cancer risk, and more worrisome features of prostate cancer." To see a summary of this study, click here: http:www.//ncbi.nlm.nih.gov/pubmed/19011298. The damage to overall health from hormone ablation therapy coupled with the physiological lack of positive effect in reversing or slowing prostate cancer has harmed many patients with a usually slowly progressing form of cancer, which may be in fact be slowed or reversed by restoration of normal anticancer homeostatic mechanisms, including restoration of a physiologically normal level of testosterone production.
In 2015, finally a large cohort study of patients who received androgen ablation therapy, or Lupron, was conducted and found that this androgen deprivation therapy increased the risk and incidence of Alzheimer's disease, nearly 2 times the risk within a few years, and over 2 times the risk of developing the neurodegenerative disease in the long term. The retrospective study, examining health records of 9.2 million patients treated through the Stanford Health Care in Palo Alto, California, and the Mount Sinai Hospital system in New York City, found that of 18,000 patients treated for prostate cancer, 2,397 had been treated with Lupron, or other androgen deprivation. Of this 16,800 patients diagnosed with prostate cancer 16,888 did not have metastatic cancer, or cancer that was spreading, yet many of these patients were apparently treated with androgen deprivation therapy. To see a summary of this study from Stanford University, click here: http://med.stanford.edu/news/all-news/2015/12/common-prostate-cancer-treatment-appears-to-double-alzheimers-risk.html. Hormonal balance is intricately tied to accumulation of amyloid plaques in Alzheimer's disease, and affects the healthy function of the immune system, and repair and growth of neural tissues. While androgen deprivation is needed for specific subsets of prostate cancer patients, the ignoring of risk versus benefit, and the promotion of a one-size-fits-all approach is obviously misguided. When this hormone ablation therapy must be used, Complementary and Integrative Medicine (CIM/TCM) can be utilized to help decrease these adverse health effects, such as the prevention of Alzheimer's disease.
While androgen ablation with pharmaceuticals is still the primary protocol in more aggressive prostate cancers, a relatively large percentage of these patients develops a clear resistance to androgen ablation. To treat these patients, new drugs have been devised that act to individually enhance immune cells in the patient's blood by inserting genetic components to enhance the normal immune responses to these prostate cancer cells. While this therapy was shown to increase survival time by up to a year and a half, the cost for this treatment per patient has been controversial, considering the fact that escalating health care costs are the prime reason for the enormous federal and state deficits, and even military expense growth. These escalating health care costs are an issue with affordability of health care insurance as well, creating a scenario where more and more families can no longer afford the insurance, even when it is partially paid by the employer. The average cost of this new immune enhancement therapy could be as high as $500,000 per patient over the course of a year to two years, or more. Many researchers are looking to the promise of herbal and nutrient medicine to integrate into this immune enhancement to reduce the overall dosage and need of the therapy, thus greatly reducing the cost.
In 2014, a large study of the outcomes with androgen ablating drugs for the treatment of prostate cancer, by the Rutgers Cancer Institute of New Jersey, headed by Dr. Grace L. Lu-Yao, and published in the July 14, 2014 JAMA International Medicine, following tens of thousands of men with early prostate cancer for as long as 15 years, found that for the majority of men with prostate cancer, that this standard, and in fact sometimes only, therapeutic approach was "not a good option".
An article in the July 15, 2014 New York Times, entitled Study Questions Testosterone-Suppressing Therapy for Early Prostate Cancer, quotes another expert, Dr. James M. McKiernan, chairman of urology at Presbyterian Hospital Columbia University Medical Center, as stating that this study is "eye-opening and even alarming". A number of studies now confirm the obvious, that the use of testosterone ablation with biologic drugs such as Lupron does not deliver the promised inhibition of the growth of prostate cancer, and that the side effects are very harsh, often worse than the slowly advancing effects of the prostate cancer itself. Today, more than one-fourth of all patients diagnosed with prostate cancer receive this "chemical castration" of suppressed testosterone, often for the rest of their life, and this large study definitively shows that these drugs were not associated with greater long-term survival. Experts at the Dana-Farber Cancer Institute in Boston, Massachusetts, U.S.A. stated that with this study, and another large study last year in Europe, that there is now "no compelling evidence" to justify androgen ablation for men with early stages of prostate cancer. Such study calls into question the entire strategy and science of the treatment of hormone receptor positive cancers in the last two decades.
Much research has also been directed at the physiological reasons why hormone ablation drug therapies do not work. In studies of prostate cancer that was found resistant to the androgen ablation, a number of mutations were found at the testosterone/androgen receptors. With normal androgen receptors, DHT (dehydrotestosterone), or the active form of testosterone, was the active agonist at the receptors. With a single mutation at the receptors (keep in mind that cell mutations are the hallmark of cancer) corticosteroids now triggered the receptor, and with a double mutation at the receptors, corticosteroids now were found to have a high affinity for the testosterone/androgen receptors. Keep in mind that prostate cancer is driven by excess stimulation of these receptors on the outside of the cells in relation to the receptors on the inside of the cells, which drive an anti-apoptotic (anti-normal programmed cell death cycle) mechanism which is responsible for the cancerous growth. Now, corticosteroids are a class of hormones produced in the adrenal gland, and include cortisol, cortisone, corticosterone, and aldosterone, which are derived from healthy cholesterol, and are constantly secreted in the body to maintain metabolic rates, first line inflammatory regulation, immune response, and electrolyte balance. But standard medicine has now made synthetic corticosteroids a very common part of pharmaceutical treatment for a wide range of diseases. The population now consumes synthetic corticosteroids as asthma inhalers, topical anti-inflammatories, eye drops, pills and injections. There are literally dozens of synthetic corticosteroids now prescribed to treat allergies, sinusitis, asthma, hepatitis, inflammatory bowel disease, eye disease, autoimmune disorders, skin diseases, etc. Injections of synthetic corticosteroids are frequently used to treat joint pain. Added to this, cortisol imbalance, and excess diurnal cortisol, is a frequent sign of chronic stress syndromes, post-menopausal hormone imbalances, andropausal syndromes, diabetes, metabolic syndrome, obesity, and other common diseases and syndromes. With all of these common circumstances as potential stimulators of androgen/testosterone receptors, androgen ablation drug therapy does not seem to be adequate in a treatment protocol where the patient desires a more thorough and comprehensive effect. This is why restoration of the cellular environment and normal homeostatic functions at the androgen/testosterone receptors is important in cancer therapy.
These same mutations in prostate cancer cells are found in hormone receptors in breast cancer, ovarian cancer and uterine cancer, and once again, corticosteroids are a prime trigger of the hormone receptor imbalances that lead to cancer. Both endogenous corticosteroids, such as cortisol, and exogenous corticosteroids used in allopathic medicine, may stimulate these hormone receptor mutations, and maintaining normal hormonal balance and avoiding corticosteroid drugs when possible is an important consideration. Since the diagnosis of these cancers alone triggers a high degree of stress in most patients, affecting cortisol balance, coupled with the underlying hormonal imbalances that already may be present with menopause, menstrual hormonal imbalances, or andropause, this presents the distinct possibility of cancer also driven by something other than localized estrogens and androgens. Both prostate cancer and breast cancer demand a restoration of cellular environments and normal homeostatic mechanisms to insure the optimal outcome.
Hormonally related growth factors are the subject of much study in cancer morphology at present, and drugs have been created to target cancer cells specifically driven by these growth factors. In breast cancer, the human epidermal growth factor receptor 2 (HER2/neu) has been detected in approximately 15-20% of tumors studied, and a drug called Herceptin (trastuzumab) is prescribed in these cases. This drug only inhibits cancer cell growth created by this specific growth factor, and works by promoting a protein enzyme that inhibits cell division related to HER2. It has been found that breast cancer with HER2 over-expression, which is driven by an imbalance of estrogen receptors, is particularly aggressive. The problem with this drug therapy, as an April 19, 2010 New York Times Research article explains, is that the side effects and risks are very serious, the cost is very high, and the testing has been shown to be unreliable in many cases. The article is cited in the section of this article entitled Additional Information. In this New York Times article, an M.D. cancer specialist, herself diagnosed with HER2 breast cancer declined the drug due to unclear test results, even though the testing showed that the cancer cells were HER2 positive. About one sixth of patients with HER2 positive tests had negative test results with retesting, casting much doubt upon the efficacy of this approach. By 2015, many questions still remained for real efficacy with these biologics for HER2 breast cancer. A combination of chemotherapy (taxane and anthracycline) and Herceptin, is most often used, for an extended period of time.
Taxane is derived from herbal medicine, a diterpene chemical found in the herb Pacific Yew, or Taxus wallichiana, but is also synthesized, and anthracycline is an antibiotic used in cancer treatment that has considerable adverse effects with cardiotoxicity, neutropenia and GI symptoms. In 2015, Dr. Stephen Chia M.D. of the University of British Columbia, in Canada, and a noted cancer expert, stated that the prognosis for HER2 breast cancer with no lymph node involvement is excellent, and that the use of extended chemotherapy with 12 months of Herceptin should be reduced to 4 cycles of taxane without anthracycline with Herceptin to reduce adverse effects. The role of extended Herceptin was questioned as well, and a large trial entitled ExteNet showed that patients with HER2 and positive lymph node involvement showed a 91.6 percent of 2-year disease free survival with placebo compared to 93.9 percent for those taking extended Herceptin. While this is used to justify extended treatment with Herceptin, patients need to make an informed choice based on the amount of benefit, which is slight, compared to the adverse effects. Questions remained concerning newer biologics, such as T-DM1 (ado-trastuzumab emtansine) and Pertuzumab, which have not shown significant benefits when added to the drug regimen. Dr. Sunil Verma M.D., of the University of Toronto and the Sunnybrook Odette Cancer Centre, in Canada, stated in an ASCO conference: "The standard practice should be that they (extended adjunct T-DM1 and Pertuzumab) not be used beyond progression because we have absolutely no evidence (of significant benefit)." More attention is finally being paid to reducing adverse effects of cancer therapy rather than adding more harsh extended therapy with little benefit shown. Of course, integrating safe and effective adjunct therapies of CIM/TCM seems sensible as well, especially as scientific evidence of effectiveness increases.
Currently, research is finding much potential with specific herbs in the inhibition of epidermal growth factors (EGF), which would present possibilities of utilizing a more benign approach to treatment of HER2 breast cancer when doubt proscribes the use of harsh drugs. For instance, a 2012 study at Sun-Yat Sen University, Guangzhou, China (cited below) found that a chemical in the Chinese herb Houttuyniae cordatae, or Yu xing cao, can inhibit HER2/neu signaling pathway and tumor growth related to HER2/neu. Yu xing cao has previously demonstrated the capacity to prevent breast cancer, and is safe and effective herb in Chinese Herbal Medicine long used to treat infection and cancer. A prior 2005 study at the Shanghai Institute of Materia Medica, Chinese Academy of Sciences, in Shanghai, China, found that the Chinese herb Shiraia bambusicola, or Dan Zhu Huang, an herb created from the sap of a bamboo species cultured with a fungus, contains a chemical 11,11'-dideoxy-verticillin that was proven to inhibit EGR receptor in HER2 breast cancer cells to exert potent anti-tumor activity (PMID: 15846117). These and other scientific studies are available in Additional Information with links to the studies. In addition, since HER2 overexpression is caused by estrogen dominance and an imbalance of estrogen receptor types, use of hormonal balancing therapies to restore the normal ratio of estrogens to progesterone, as well as to boost the benign type of estrogen called estriol, with bioidentical hormonal topical creams, could also significantly counter the HER2/neu mechanism. In fact, the above mentioned Chinese herbal formula researched in Beijing, and confirmed in research at UCSF (MF101 - see this formula in the article on this website entitled Cancer Adjunct and Adjuvant Care), is also shown to exert significant effects in balancing the estrogen receptor types to normalize expression. A combination to these safe and gentle therapeutic tools could potentially help a lot in adjunct cancer care. No matter what approach is decided in each individual case, Complementary Medicine and adjunct therapies present much potential.