American Cancer Society -California Division:

Complementary Care issues, December 5, 1997

One of the earliest speakers at this event was Helene Brown, who has spoken for ACS for 45 years. When she listed 4 great achievements in Public Health and included the use of DDT to destroy Yellow Fever and (the vicious) Boll Weevil, I knew we were on totally different wave lengths. No mention was made of the separation of water and sewage, which to my mind was one of the most important changes in the last century.

She also mentioned that ACS had funded "endless" studies on nausea and vomiting. The California division has 500 staff members and 130,000 volunteers. They collected $50 million in donations in 1996. They have a goal to reduce mortality by 50% by the year 2015.

Michael Lerner, PhD, Commonweal suggested that at least half of all cancer patients are interested in alternative or complementary treatments.

He outlined the areas of concern for this conference as: Choices in Healing (vs. cure)

Conventional Therapies

Complementary/alternative Therapies

Pain Control

Dying

Lerner said that biomedicine was about curing and alleviating pain whereas bio-psycho-social involved healing illness and alleviating suffering.

He pointed to the different cultures between radiologists, surgeons and oncologists and spoke of the separation between these providers in Europe and other parts of the world from us. Europe, for example, has different standards of conventional treatment, i.e. less chemo, less surgery and less radiation. Although he pointed out that the status of treatment here may be changing due to Managed Care.

Dr. Lerner mentioned that he personally has seen no cure for cancer in the complementary world. He said he has traveled for 15 years and looked at many modalities.

Many cancer patients combine conventional and complementary treatments in their search for the best possible care. How can we help patients choose the appropriate method for themselves.

A positive result of choice is stress reduction. Certainly many of us can attest to that. While on the cusp of a decision, the confusion and complications are painful but as soon as a decision is made, all of the anxiety can dissipate. We can focus our energy in the direction we have chosen. Lerner defined self-care as consisting of: spiritual aspects, physical, nutritional and psycho-social. When these are all attended to, there is enhanced quality of life. Lerner also talked about the placebo response mentioning the work of Herb Benson at Harvard who has redefined it as a more complex bodily response, which may consist of "remembered wellness".

He also suggested that research has demonstrated that cancer pain is actual less painful than most people anticipate and can be controlled. Many patients still do not get adequate pain control so that this remains an ongoing issue.

Lerner referred to the recent NIH statement that acupuncture can relieve pain. He also mentioned the TENS machines.

Dealing with the psychological approaches to pain, he pointed out that societyís view matters in our experience of pain. Many different cultures have expressed the idea of growth through suffering.

He touched briefly on the fact that dying was a normal part of life until the 19th Century. Now it is an isolated event in a hospital and perceived as a failure of the medical system.

Lerner said that it could be perceived as a time of spiritual growth. The mystery of death and how to face suffering are two areas of great interest worldwide. Is death the end of life, the beginning of a new life, or a mystery?

The next speaker was Julia Rowland, PhD who spoke about interpersonal relationships and the current studies. She discussed a recent study done in San Francisco of 378 women. The mean age was 56. The population consisted of women of Chinese, Latina, African and European backgrounds. Some of what was found included: 64% using at least one alternative; 50% used 2; duration of those treatments were 3-6 months; spiritual healing was used for more than 2 years. There were cultural differences in that African American women were more likely to use spiritual methods alone, while the Chinese Americans tended to use dietary and herbal interventions. The women of Hispanic ancestry tended toward dietary and spiritual methods and those of European background used psycho-social and dietary interventions. Most of these women were at later stages of disease and many were under 55 years old. If a family history was present, they were more likely to use other means than conventional. The more education, the more likely as well. This was particularly true for those using psycho-social means.

Another study done in Washington, D.C. found that 53% of those surveyed were interested in nutritional counseling; 44% wanted support groups; 43% wanted information as to how to self-control pain management. 34% were interested in individual counseling and 25% wanted counseling for family members.

58% of those surveyed wanted better doctor/patient communications. Many were concerned with intimacy issues, while younger women were interested in job counseling(23%).

It was suggested that women in rural or isolated communities or those that were very ill might benefit from telephone counseling or conference calls.

None of the above information is at all surprising. Scientists are happy to see it quantified. A statement made by this speaker "The patients participating in groups did no worse than controls".

Rowland had the following suggestions for ACS: 1) Increase provision of time-limited structured groups. 2) Develop health promoting stress reduction programs for healthy people, those at risk and survivor-oriented programs. 3) Expand peer-counseling activities. 4) Develop educational programs for health care professionals to explore the role of complementary/alternative therapies on patients and physician well-being. 5) Study/evaluate what researchers do?

Rachel Naomi Remen, MD spoke about the spirit as a universal experience, the basis of value of human lives and the foundation of our sense of integrity. She said it was a universal, that is profoundly inclusive. She said only one way of looking at the spirit was religious, that there were many paths.

She spoke about the change in values(often actual reversals) perceived by many who are dying, as "soul-infused". She said this change can happen in family members or among friends also. Saying that not too many people who were dying valued their Mercedes, she spoke of seeing the familiar in new ways, making a shift in the ordinary aspects of life. Remen said that there was an instinctive reaching for meaning and an understanding and recovery of authentic values.

She told a story about a patient who dreamt about a small pink stone Buddha . In the dream, it had a black dagger stabbed through its heart. Then the statue grew larger and larger while the dagger remained the same size. Finally the Buddha was huge and the dagger a mere black speck against the pink. In interpreting this dream, she pointed out that the pink stone might be rose agate, a stone for healing.

Dr. Remen said that she often gives a program for doctors called "Detoxifying Death"(they get CME for it too). Doctors tend to withdraw when faced with terminal patients. She suggested that the ACS support legislation to legitimize this area. The program is done through Commonweal(she co-leads Commonweal with Michael Lerner). Doctors are taught to see Medicine as a relationship, looking for the meaning to their work. They are asked to keep a journal and answer three questions at the end of each day.

1) What surprised me? 2) What moved or touched me? 3) What inspired me today?

Next speaker was Keith Block, MD, Director of the Block Medical Center in Evanston, IL. He works with patients using integrative medicine. He defines integrative as a combination of conventional, experimental and alternative. He gave some specifics about the research on fats mentioning that canola, flax, walnut and pumpkin seed oil were as good as cold water fish oil all containing Omega 3 which is good for tumor inhibition, immune enhancement, anti-angiogenesis, anti-inflammatory and good for clot inhibition. However some studies show that prostate cancer cells lines can be promoted by one aspect of these items.

He stated that vegetarians had 21/2 times the cytotoxic capacity as meat eaters, mentioning that studies show collard greens and cabbage can slow tumor size in animals. In comparing patients with pancreatic cancer placed on a standard U.S. diet versus (his)therapeutic vegetarian diet, it was found that patients lived an average of 10 months longer.(a four-fold enhancement).

Block indicated that women on a vegetarian diet along with tamoxifen were found to have a better survival rate. (I did not get the study name but have written to him).

He mentioned several beneficial effects of vitamins which have been covered before, i.e. saponins(red beans and lentils) known to stop cell division; flavonoids-known to boost anti-oxidants and St. Johnís Wort which he said could bind to receptors like soy or curcumin(a cancer-fighting spice. He suggested that vitamin E succinate was the best type.

The Block Medical Center program uses four components: Nutrition, Bio-stress, Bio-fitness and Bio-modulation. In discussing liver detoxification, he stressed the use of selenium(methione), flavonoids, SOD(Super Oxy? Dismutase), cystein(NAC), NTE?, Glutathione methione, garlic, and sylmarin(milk thistle).

I was happy to hear him mention Vitamin A as a source for doubling remission in breast cancer patients both pre and post menopausal. He said that bone marrow suppression could be reduced during and prior to chemotherapy using selenium, A, E and C.

He suggested that bladder cancer could have less recurrence using A, B6, Zinc and E along with BCG(current non-chemo treatment). He mentioned the use of a Chinese herb Dan Shen as being able to affect remission in lymphoma.

He said that bone pain could be reduced using foot reflexology(self-administered). His center offers Chi Kung(Qi Gung) classes, bio-feedback and many hands-on massage techniques as well as physical exercise, breathing, hypnotherapy and support groups.

Harriet Beinfeld, a licensed acupuncturist spoke about the benefits of the treatment to enhance immune function. She mentioned astralagus as an herb that has been demonstrated to work both in vitro and in vivo. NIH has recently approved acupuncture for pain management among other areas including stroke.

The meeting then broke up into advisory groups and presented recommendations to the general body at the end. These will be transcribed and sent to ACS National. I remain hopeful that there will be a change. I believe ACS has recognized consumer demand for information. They may therefore, help open the door to more awareness, funding and availability of treatments. Access to information is critical for all patients. And, as ACS goes, so may insurance companies.

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