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Total Cancer Care

When Molly Mitchell, a 30-year-old San Francisco advertising manager, was embarking on treatment for breast cancer, she felt like she had somehow just lost the reins on her life.

But Mitchell was lucky. Her primary oncologist recommended that she consult with a colleague, integrative oncologist Donald Abrams, M.D., at the University of California, San Francisco's Osher Center for Integrative Medicine, to help her weather chemotherapy and radiation, improve her well-being, and prevent recurrence. Abrams recommended a personalized program of diet, supplements, acupuncture, massage, and other therapies -- all administered by practitioners skilled in cancer care.

The result? A plan designed to support her body, mind, and spirit while she underwent conventional treatment. "Modern Western medicine is all about expelling evil without concentrating on supporting good," says Abrams. "I tell patients that I am supporting good."

Holistic cancer care has come a long way from the times when patients had to visit rogue alternative clinics on the sly, only to risk taking unproven remedies that could interfere with treatment. These days, a growing body of evidence shows the value of complementary approaches to cancer, from dietary changes and herbs to acupuncture and yoga.

And Abrams and other renowned integrative oncologists now staff the country's best university hospitals and cancer centers, from New York's Memorial Sloan-Kettering to Houston's M.D. Anderson. That's good news for the estimated 41 percent of breast-cancer patients who try complementary approaches. "So much about breast cancer makes you feel like less of a person," notes Mitchell. "These complementary therapies have helped me begin to feel whole again."

Granted, not everyone lives near an integrative-treatment center. But for women undergoing treatment for breast cancer, certain complementary therapies are worth exploring in partnership with their physicians. Here are some of the best-researched options.

Food and Drink
Besides being conscious of nutrition -- essential for those undergoing cancer treatment -- many integrative-cancer specialists have two goals when advising breast-cancer patients about what to eat: reducing inflammation in the body, which can fuel tumor growth, and limiting exposure to estrogen, which contributes to an estimated 70 percent of breast cancer cases.

With that in mind, Abrams advises patients to eat a plant-based diet high in fruits and vegetables -- particularly cruciferous veggies like broccoli and brussels sprouts, which contain indole-3-carbinol, a compound known to affect estrogen metabolism. Seasoning meals with generous amounts of garlic, ginger, onion, and turmeric, which boast anti-inflammatory and anti-cancer properties, may be helpful. As for beverages, cancer experts cite green tea as a favorite; drinking five or more cups a day may help reduce breast-cancer risk by 22 percent.

What you don't eat and drink can prove just as important. Abrams recommends eliminating foods that increase inflammation and tumor growth, such as refined carbohydrates, and avoiding red meat and dairy, which can contain hormones, as much as possible. (Oily fish like wild salmon, rich in anti-inflammatory and cancer-preventive omega-3s and vitamin D, are a great meat substitute.) Abram recommends avoiding char-grilling and other high-heat methods, as they boost meat's carcinogenic compounds.

As for soy, it's often touted for anticancer properties, but some research suggests that "these effects may occur only if you ate soy foods as a young girl," says Abrams. Because of soy's phytoestrogens, "women who have estrogen-receptor-positive breast cancer should avoid it," he cautions. If you do eat soy, choose whole forms like soybeans, tofu, and tempeh. And since alcohol consumption can increase estrogen and is a risk factor for breast cancer, Abrams recommends limiting intake to a glass a week.

Exercise and Weight Control
Cancer treatment can bring fatigue, nausea, and pain -- hardly catalysts for working out. But regular physical activity is crucial. "The benefits have been demonstrated," notes Abrams.

Women who walk at least three hours a week have an improved survival rate, and those who do aerobic exercise during radiation are less likely to develop low red-blood-cell counts. Other studies suggest that exercise reduces fatigue and improves cardiovascular health. Abrams recommends that most breast-cancer patients aim for 30 to 60 minutes of moderate-intensity exercise on most days of the week, including bone-building resistance exercise (since breast-cancer patients are prone to bone metastases).

Unless you are obese, try to keep your weight stable, cautions Abrams, who says drastic fluctuations in either direction can increase the risk of cancer.

Acupuncture
Used for millennia as a part of Traditional Chinese Medicine, acupuncture is now an evidence-based standard of integrative care for alleviating chemo-induced nausea and pain, and experts say it also helps with fatigue, anxiety, depression, inflammation, and swelling.

"Covering it with insurance everywhere -- some states do -- would be a way for the health-care industry to reduce the costs of anti-nausea medications," notes David Rosenthal, M.D., director of the Zakim Center for Integrative Therapies at the Dana-Farber Cancer Institute in Boston.

Some research also suggests that this ancient needling technique may help with chemo-related cognitive problems in women with breast cancer. Beyond providing relief from symptoms within a conventional Western treatment model, TCM holds deeper lessons for some integrative practitioners.

From a TCM perspective, treatment "isn't about the location of a mass but about restoring balance" to the body, notes Abrams. "The more I do integrative oncology, the more I feel akin to this line of thinking. For me, the tumor is a seed and the person is the soil. My goal is to make the soil as infertile as possible for the growth and return of the seed."

Supplements and Herbs
Key supplements and botanical remedies may help counter the side effects of conventional cancer treatments, boost the immune system, and even help slow the cancer itself, but integrative cancer experts recommend using them only under an experienced practitioner's supervision. "Some over-the-
counter stuff can be very detrimental, so you have to be very careful," says Jody Noe, N.D., assistant professor at the University of Bridgeport College of Natural Medicine.

Essiac and Hoxsey teas, two formulas whose anticancer claims have been widely debunked, contain ingredients that may actually spur breast-cancer growth, she notes. Certain supplements may be safe for some types of breast cancer but not for others, and "a lot depends on where a woman is in
her course of therapy," says Noe, who collaborates with oncologists.

Many integrative practitioners prescribe therapeutic doses of melatonin, as it appears to reduce breast-cancer growth. (It's contraindicated for certain other types of cancers, however.) For those coping with the numbness and tingling of chemo-induced neuropathy, Abrams often recommends alpha-lipoic acid and vitamin B12. Coenzyme Q10 may protect the heart against damage from radiation to the chest.

As for antioxidant supplements, which the public often hears conflicting reports about, Noe explains that "they're a huge group; some help in specific chemos, but there are also certain ones you should not use with certain chemos or radiation."

Extracts of medicinal mushrooms such as turkey tail, reishi, maitake, and shiitake are often recommended for their immune-boosting and anti-cancer properties. The herb astragalus, long used in TCM, is another promising herb, and "turmeric is an excellent immune booster," says Noe, who recommends taking it in supplement form but cautions that it's contraindicated for certain types of chemo.

Relaxation and Support
Many complementary therapies help reduce stress -- and this is no small thing. "Stress is antithetical to healing," says Abrams. "It increases the hormones epinephrine and cortisol, both of which impede the immune system."

Whatever their mechanism, relaxation techniques have positive effects on women with breast cancer. The stretching and meditation of yoga, for example, have recently been shown to improve patients' quality of life; massage, meditation, and guided imagery may reduce stress in those with cancer.

It doesn't matter what patients do to relax, say experts, only that they do it regularly. "If somebody doesn't have interest in meditation, we have to find another way to reduce stress, whether through music, journaling, exercising, or other means," says Lorenzo Cohen, Ph.D., director of the Integrative Medicine Program at M.D. Anderson Cancer Center.

No matter where you are in the journey through breast cancer, support is key. Some research suggest that breast-cancer patients who join support groups feel better. Psychotherapy, particularly cognitive-behavioral therapy (which helps people change the way they think about and react to problems), has been shown to improve insomnia, depression, anxiety, and stress in women with breast cancer, and experts say it helps them regain a sense of empowerment.

With breast cancer, "you can lose your hair and your breast, experience early menopause, and you're dealing with a whole host of side effects -- hot flashes and sexual dysfunction, joint pains and fever. And you can be 25 and going through it," says Alyson Moadel, Ph.D., director of the Psychosocial Oncology program of the Albert Einstein Cancer Center in New York City. It's very important to know that you're not alone, says Moadel, and "to be able to put cancer in its place so it doesn't overwhelm your life."

And don't discount the power of belief: Combined with breathing and meditation, spirituality can reduce stress and give patients a way to deal with the emotional challenges of cancer. "I'm not talking about religion," says Noe, but about one of the least tangible -- but most important -- aspects of coping with breast-cancer treatment. "Hope is just as important as any pill or chemo or diet."

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