One of the most important strategies for treating women with estrogen-positive breast cancer is to block the action of estrogen. In estrogen positive (ER+) breast cancers, the natural estrogen in the body attaches to the estrogen receptors on cancer cells and stimulates them to divide, which makes breast tumors grow.
Once the initial treatment of breast cancer is completed, (surgery, chemotherapy, radiation), it is usually recommended that patients with ER+ tumors undergo long-term treatment with drugs like tamoxifen, which blocks estrogen activity, and aromatase inhibitors – Aromasin, Arimidex and Femara – which block the synthesis of estrogen in fat tissue in the body. These estrogen-blocking drugs work well for most women, but unfortunately, not all women respond to them, and it is not unusual for tumors to develop resistance to these drugs.
We are now learning more about why estrogen-blocking drugs may not work all the time, and one of the mechanisms comes from a surprising source: cholesterol! Like most molecules in the body, cholesterol gets metabolically transformed into other molecules by various enzymes in our body. One of the molecules that is derived from cholesterol, and which is present in fairly high levels in the body, is 27-hydroxycholesterol (27-HC). This interesting molecule can attach to and actually stimulate estrogen receptors in the body. Patients with ER+ breast cancer have higher amounts of 27-HC in the normal tissue in their breasts than women who have not been diagnosed with ER+ breast cancer. And the amount of 27-HC in breast tumors is even higher. This is because the enzyme that converts cholesterol to 27-HC is found in high levels in some breast cancer cells, especially in higher-grade tumors (higher grade tumors tend to grow rapidly and spread faster than lower grade tumors), and also in immune cells called macrophages, that sometimes infiltrate breast tumors.
Qigong is a traditional Chinese exercise modality. It aligns breathing, mental focus (or awareness) and movement for purposes of exercise, meditation and balancing of the “qi,” or life energy, in healing. It emphasizes and cultivates a calm and relaxing state of mind. At the Block Center, qigong exercises are often integrated into the physical activity component of our patients’ individualized treatment plans.
A study recently published in the Journal of Cancer Survivorship compared qigong with stretching classes in the framework of a randomized, controlled trial. The main goal of the study was to evaluate whether qigong helps with fatigue – a common problem for many cancer patients, both during and after treatment – in prostate cancer survivors. Many studies have been done on ways to address this fatigue; of special interest to our clinicians are non-drug interventions that may be helpful.
This study was designed especially well, which makes its conclusions even stronger than most of the previous studies that have looked at exercise for cancer patients. 40 men (average age 74) with prostate cancer were randomized to take either qigong classes or controlled stretching classes twice a week for 12 weeks. Both types of classes were an hour long, included sitting and standing exercises, and had DVDs to encourage participants to practice at home. One particular strength of the study was the fact that the control group was doing an exercise intervention at the same time as the qigong group. This ensures that it is not simply an increase in activity that would cause any beneficial effects from the qigong classes, but rather something unique about the qigong itself as an exercise system.
When is an antioxidant not an
antioxidant? This curious question was
explored in a scientific poster that Dr. Block presented at the 10th
International Conference of the Society for Integrative Oncology (SIO), held October
20-22 of this year. The answer to the question was suggested in the title of
the poster, “Antioxidants as pro-oxidants in cancer cells.” What, you might ask, is a pro-oxidant? As the name suggests, it’s the opposite of an
antioxidant! Antioxidants neutralize
free radicals, while pro-oxidants stimulate and produce free radicals, or, in
scientific jargon, reactive oxygen species (ROS).
Why are we interested in producing free
radicals in cancer cells? Isn’t this the
opposite of what we want to do? And why
would an antioxidant suddenly turn into a pro-oxidant when you put it into a
cancer cell? Actually, it’s well known
that many antioxidants can act as pro-oxidants – this fact even appears in
Wikipedia! However, the Wikipedia
discussion of antioxidants overlooks some new data that are coming to light
about pro-oxidants and antioxidants as they relate to cancer treatment.
What cancer-related uses of fish oil have the best
scientific evidence behind them? Dr.
Block presented on this topic at the 10th International Society for Integrative
Oncology in Vancouver, British Columbia on Sunday, October 20.
Laboratory studies of fish oil show that it has many effects
on cancer, from modifying blood viscosity to modulating treatment
resistance. It has beneficial effects on
the important processes of apoptosis and angiogenesis. EPA and DHA, the major omega-3 fatty acids in
fish oil, diminish inflammation, a critical driver of many cancer processes.
Besides lab studies, several important recent observational
and clinical studies have shown the benefits of fish oil on different
cancers. Breast cancer patients whose
diets included the most EPA and DHA had 28% less risk of recurrence or
metastasis, and 41% lower risk of mortality than those with the least. A randomized study of fish oil taken during
chemotherapy for lung cancer found that patients had improved rates of tumor
shrinkage, less weight loss and better retention of muscle mass. Prostate cancer patients who were given fish
oil and a low fat diet before surgical removal of the prostate were found to
have tumors with lower rates of cancer cell proliferation than those who ate
typical Western diets. Fish oil also
helped to maintain weight and immune function in gastrointestinal cancer
patients who were receiving chemotherapy.
There are very few side effects from taking fish oil. Gastrointestinal side effects, such as belching
or stomach upset, can be minimized by taking enterically coated fish oil
capsules. We recommend fish oil that
contains added vitamin E to reduce oxidation, which fish oil is prone to. Finally, fish oil has blood thinning effects
and should be used cautiously with medications that thin the blood, and during
times when blood platelets are low due to chemotherapy. If your doctor tells you, for instance, that
you should not take aspirin due to low platelet counts, it is prudent to ask
her/him if you should also stop fish oil supplements.
Dr. Block also discussed the study on omega-3 blood levels of
prostate cancer patients by Brasky and colleagues that was discussed in this
blog a few weeks ago, concluding that the results of this study did not offer any
conclusive evidence of harm from taking fish oil. With the basis of randomized trials and
observational studies of solid design showing benefit from taking fish oil, we
continue to feel that this source of essential omega-3 fats is a healthful
supplement for cancer patients.
For more information on The Block Center for Integrative Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.
Resveratrol is a
phytochemical found in high levels in grape skins. Not only is resveratrol an
antioxidant, it has some cancer preventive properties as well. In addition,
there’s increasing interest in its potential use in cancer treatment. Since
it’s an antioxidant, and since many chemotherapies as well as radiation act by
producing free radicals that can damage cellular DNA, researchers and
clinicians have been cautious about combining resveratrol with conventional
treatment. Dr. Block and his research team have reviewed the clinical
literature on antioxidants and chemotherapy and feel this concern is misplaced.
Randomized clinical trials in which antioxidants were given with chemotherapy
did not show any reduction in anticancer effects compared to chemotherapy given
with no antioxidants. In addition, a new paper published in the Journal of
Surgical Research recently suggested that concern about combining resveratrol
with radiation therapy is similarly misplaced.
This
week, a study made the news suggesting there’s a substantial benefit to breast
cancer patients who take multivitamin-multi-mineral supplements. This study definitely warrants a closer look.
Dr.
Sylvia Wassertheil-Smoller of Albert Einstein College of Medicine, Yeshiva
University in New York, together with her colleagues, analyzed data from the
Women’s Health Initiative (WHI) clinical trials and observational study on the
use of supplements as it relates to mortality due to breast cancer. The WHI trials included 7,728 patients who
were diagnosed with breast cancer during the course of the studies, and were
followed for an average of 7 years after their diagnosis. At the start of the study, a thorough
assessment of diet, lifestyle and clinical condition was conducted. We think a particularly interesting feature
of the assessment was that information on what supplements were used was
obtained by having patients bring their bottles of vitamins and other
supplements to the clinic, so they could be accurately recorded by the
researchers (as opposed to the participants providing this information to the
researchers, which may not be as reliable).
The researchers tracked mortality in this population of breast cancer
patients, and compared mortality of those who used versus those who did not use
multivitamin-multi-mineral supplements.
We are often asked if there are specific foods that can
boost cancer survival. For Breast Cancer
Awareness Month, we thought we’d address this question as it relates to breast
cancer.
Existing research doesn’t support the notion that specific
foods that can increase survival. However,
there is considerable evidence that dietary
patterns can make a significant difference for women fighting breast
cancer. Let’s take a look at some of these
dietary patterns.
Many cancer patients report suffering from significant
fatigue. Cancer-related fatigue is not simply feeling tired. It lasts longer
than ordinary fatigue, is more debilitating, and sleep does not relieve it. It
can affect all aspects of a patient’s life, and leave patients physically,
mentally and emotionally exhausted. There have been many studies of fatigue in
the past, and guidelines have been developed by the National Comprehensive
Cancer Network to help manage the fatigue. Though perhaps not as comprehensive
as we’d like to see, they do contain some useful strategies that patients can
adopt to help cope with their fatigue.
In 2012, researchers from the Mayo Clinic, led by Andrea
Cheville MD, decided to see how well patients with advanced cancers were being
advised about strategies for coping with cancer-related fatigue. They surveyed
160 patients with stage IV lung, breast, colon or prostate cancer about whether
they had received advice or treatments for their fatigue from their doctors.
The specific types of treatments were those mentioned in the National
Comprehensive Cancer Network guidelines: increasing exercise, seeking
psychosocial and behavioral help, and medications. Patients were asked about
how much information they had received, whether physicians had provided
specific instructions on treatment strategies, or given them a prescription to
address fatigue.
Very few patients had received comprehensive advice on
coping with fatigue. 15% of colon cancer patients and 17% of prostate cancer
patients had received advice on fatigue. 48% of breast cancer patients had been
told about psychosocial interventions, although only 10% of the entire group
received advice in this area. Over 37% received prescriptions for sleep
medications, though these are the least effective strategy for remedying
fatigue. The patients surveyed also demonstrated poor sleep habits: about a
third were napping during the day, which disrupts night-time sleep and worsens
fatigue. A little under 12% had received information about increasing exercise,
one of the most effective strategies for coping with cancer-related fatigue.
Unfortunately, it appears that the National Comprehensive Cancer Network
guidelines – which are based on the best available research in this area – are
not being communicated to patients.
To demonstrate the potential benefits of one of these
strategies, Cheville and colleagues did a randomized study in which stage IV
lung or colon cancer patients were randomly assigned to either usual care or to
a simple home-based exercise program of walking and strength training. 66
patients participated in the study. After 8 weeks, the exercise group had
better mobility, less fatigue and better sleep quality, showing how much even a
relatively simple exercise program can help advanced cancer patients!
For many years, we’ve recommended an individualized fitness
regimen to all of our patients. Our physical therapy staff works with patients
both during and after treatment. In addition, we offer patients a variety of
psychosocial strategies, including a comprehensive program for sleep problems
called Cognitive Behavioral Therapy for Insomnia. We also believe that the way
you eat can impact fatigue. Overemphasizing inflammatory foods and simple
sugars is certain to worsen fatigue for anyone, including cancer patients.
We look forward to the day when all cancer centers not only
recognize the potential value of these interventions, but then consistently
recommend these strategies to all of their patients struggling with
cancer-related fatigue.
For more information on The Block Center for Integrative
Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.
Our previous article on Cancer Rehab detailed
our "prehabilitation" program for patients who have been recently
diagnosed with cancer but have not yet started treatment. We explained why it’s important that patients
make every effort to strengthen themselves nutritionally, physically,
biologically and psychologically prior to starting treatment, and the
importance of individually tailoring each program to a patient’s unique
needs. Without this type of program, the
ability to tolerate and respond to treatment can easily be compromised (a
generic program, while helpful for general well-being, misses the power and
potential that an individually tailored regimen can provide). For instance, if we discover a
pro-inflammatory condition when we test a patient’s biochemical environment, we
can intervene with nutritional strategies that can prevent the inflammation
from interfering with the benefits of chemotherapy. And, knowing the specific chemotherapy a
patient is scheduled to receive enables us to make recommendations for
nutraceuticals that can help reduce a variety of toxicities such as nausea,
neuropathy or marrow suppression. In addition,
other nutraceutical formulations can be used to boost treatment effectiveness.
There is another patient population for which
a Cancer Rehabilitation program can be extremely relevant: cancer survivors. Those who have gone through treatment and
been deemed in remission.
The number of cancer survivors today exceeds
13.7 million people in the U.S. alone and, according to the National Cancer
Institute, will increase to almost 18 million by 2022. Once
they’ve completed their treatment, these patients are typically released from
care, returning only for scans or other tests to see if their cancer has
returned. This disconnect from care —
leaving the ongoing monitoring and routine presence of their clinicians — often
prompts or exacerbates fears of recurrence, and in almost all cases, these
patients face ongoing medical, psychological and even social challenges. Among the most common problems reported post
treatment: profound fatigue, muscle
pain, decline in cognitive function, and anxiety. Additionally, the existence of microscopic
cells following surgery and/or treatment are an unfortunate, common reality for
the vast majority of patients. So, while these patients may have been told they
are “cancer free,” they are not truly free of cancer.
“Without counseling and support, most of these
people resume the dietary and lifestyle patterns that may have made them more
vulnerable to cancer and cancer progression in the first place, and far too
often, experience cancer recurrence as a result,” explains Dr. Block. Cancer Rehab can play an important role in
helping these patients regain their health, restore vitality, and improve their
odds of avoiding the recurrence of cancer.
Cancer Rehab at the Block Center offers
cancer survivors an individually tailored, active plan to regain control of their
health and restore vitality. In
addition, it provides an ongoing support system that improves survivorship by
helping patients address the understandable fear of the cancer returning,
allowing patients to move forward with their lives.
Cancer Rehab for Patients with Advanced
Disease
An individualized Cancer Rehab program can
even make a profound difference for patients with advanced, or late-stage,
cancer. While these patients may have
been told “there’s nothing left to do” by their conventional medicine
physician, as regular readers of our blog already know, Dr. Block will never
give up on a patient. As he writes
in Life Over Cancer, “With my patients I have always been an
uncompromising realist, yet I have never given up on anyone.” He believes — and his thirty-plus years of
experience confirm — that many of these patients can still reclaim health and
a meaningful quality of life, reducing pain while improving the activities of
daily living and their potential to overcome cancer.
For more information on The Block Center for Integrative Cancer Treatment, call (847) 230-9107 or visit BlockMD.com.
The
recent publicity surrounding an article on cancer “prehabilitation” has likely
created greater awareness of what was touted as a “new” approach to patient
care. “New,” we wondered?!? Not here at the Block Center. We’ve been implementing “cancer rehab”
programs with our patients for over 2 decades!
Conventional
medicine typically takes a patient straight from diagnosis to treatment. Meaning, a patient hasn’t even had enough
time to digest the life-altering news that they’re facing cancer, and next thing
they know, they’re being scheduled for treatment. This blog isn’t the appropriate forum to
delve into “why” this is now the norm; however, in the vast majority of cases,
it’s safe to say this rush to treatment is medically unnecessary. In fact, we would suggest, it can, at times,
be medically disastrous. And yet, it
happens every day. We believe there’s a
much better way to transition patients into treatment. One that improves patients’ tolerance to
treatment and the odds of their beating cancer. And it’s what we do every day at the Block Center.
