Every day I am asked about various natural and less invasive forms of cancer treatment. The clients I coach, and others, want to know how effective these solo or combination therapies are—typically to augment standard of care treatment, and not necessarily to replace that treatment with ‘alternative’ therapies.
To be clear, I am not talking about interventions that are known to be effective ‘supportive cancer care’ approaches, such as acupuncture, massage therapy, mindfulness-based stress reduction, and psychotherapy.
Those are often quite useful to help mitigate the often-deleterious side effects of conventional therapies such as chemotherapy, radiation therapy, and surgery—essentially used for symptom control for things like pain, nausea, fatigue, and depression. The published literature is quite clear in this regard.
In addition to single agent dietary supplements such as green tea, fish oil, vitamin D, and many other natural agents for oral consumption, the interventions I am asked most about include:
High-dose intravenous vitamin C
It is not the purpose of this article to weigh in on any of the above therapies. My goal is to offer an appropriate and meaningful lens through which you might consider navigating what can be a confusing process.
The 4-Step Decision-Making Framework for Cancer Treatment
The header reads ‘…decision-making framework for cancer treatment’ because this process generally holds true to any cancer treatment.
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Generally recognized as safe
Is the prospective intervention you are investigating considered safe for the specific underlying malignancy you are hosting? Does it take into consideration any and all physical limitations and comorbidities you may be managing?
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Published data showing efficacy
Is there peer-reviewed, published data on the prospective intervention that supports its intended use? There do not have to be large, randomized, placebo-controlled studies. In fact, most natural agents and less-invasive therapies are not supported by a plethora of large studies because these are quite laborious and expensive to execute. Another reason those large studies may not exist is because of the limited commercial potential for many of these agents and approaches.
Anyone can access published studies using PubMed—the National Library of Medicine’s database of the medical literature. The small list of aforementioned interventions I am most frequently asked about are linked to PubMed for quick reference. Pay attention to the type of studies listed; they will include:
- Preclinical: These ‘bench’ studies use various cancer cell lines, in-vitro (test tubes or petri dishes) to determine sensitivity to specific agents—natural or synthetic—and the mechanism of action through which they work as a therapy.
- Animal studies: Using mostly rodents such as mice, this next level of investigation uses an in-vivo to represent a model that is close to a human.
- Human studies: The so-called gold standard of biomedical science refers to double-blind, randomized controlled trials (RCTs) using humans.
However, in the context of natural agents and less invasive approaches to achieving potential positive clinical effects, unless there is substantive commercial potential with intellectual property to be developed and protected, we will not see many large, blinded RCTs.
Research funding would need to come from the investigating entity itself, or government, or philanthropy. The financial burden for any FDA approval process (for any prospective anticancer agents, medical devices, or other types of interventions) would be borne by the company and/or investors who are developing such agents/devices/interventions.
Case reports and case series.
Case reports and groupings of reports, each called ‘a case series’, are retrospective. They look back at a single patient’s journey and endeavor to draw correlations between various actions, interventions, and outcomes.
Case reports have heretofore been viewed as lower-tier evidence, and anecdotal. However, in an emerging world of truly personalized cancer care and an n of 1 approach to care, it is my view that case reports, and each series of which they form a part, will gain the gravitas they deserve.
For those challenged by advanced cancer—intractable disease for which several lines of treatment have been largely ineffective—searching the medical literature (PubMed) for case reports specific to the cancer type you (or a loved one) may be hosting can be quite useful. The medical literature referring to exceptional cancer responders dates back to the 1890s and contains over 1500 published case reports. The true number of exceptional responders will likely be more—not everything would have been recorded, and many would have been dismissed as outliers or treated as mere anecdotes.
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Accessible and you can afford it
Essentially, this assumes you have access to quality practitioners to provide certain services, and the cost of the recommended treatments are affordable and within reach of what you are willing to spend out-of-pocket, or come from other resources you can draw on—perhaps friends, family, crowdfunding—and will not create a personal financial hardship.
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Does not pose known contraindications
Meaning you have confirmed or will confirm that the prospective agents, devices, or other intervention(s) have been shown not to interfere with concurrent anticancer drug therapy or any other prescriptions, supplements, or over-the-counter agents you are currently taking. It also assumes you have checked that the proposed intervention does not pose a problem for your personal health and comorbidities (outside the cancer diagnosis) such as heart disease, type 2 diabetes, COPD.
Now You are Ready for MOR
After you have carefully gone through the 4 steps of the framework, and everything checks out, you can consider moving forward with your n of 1-type experiment. You are now ready for MOR.
Measure
Like any condition or disease, cancer needs to be accurately diagnosed. Any treatment approach—conventional, integrative, or lifestyle-driven—must be accurately measured to see what impact it may be having, positive or otherwise.
Specifically, for cancer, imaging is often used to monitor the size and proliferation of tumors. But there are myriad biomarkers—biological molecules—produced by the body or tumor that are specific to each tumor.
These various tests can include genomic assays to look at DNA sequences, and tests to measure RNA or protein levels. Biomarkers can be used to assess an individual’s cancer risk, determine risk of recurrence, predict the likelihood that a specific therapy will be effective, or monitor disease progression to determine if a therapy is working.
For the particular malignancy you may be hosting, ask your oncologist how the impact of treatment or overall management of the disease will be monitored and measured.
Create a simple spreadsheet to capture the data for each time specific tests such as bloodwork and imaging take place. Keep in mind that it takes three consecutive tests going in one direction or the other to show a trend.
Optimize
As you review your spreadsheet for what is being measured and tracked, you can begin to make correlations between activities and the objective response to the disease.
You can then decide, along with your practitioner(s) or consultant(s), if the therapy at its current dosing or treatment schedule is having the desired impact, or if a different approach should be considered.
Though it is often multiple therapeutic targets aimed at multiple pathways that can have the largest impact on cancer, it will always be easiest to make correlations when introducing one additional therapy at a time.
Repeat
If positive, compelling correlations are made between certain therapeutic actions and a clinical response, then, naturally, one would be inclined to continue the present course. If the correlations are not positive, and if you are motivated to continue carefully experimenting with new or additional ‘natural’ treatments, then I encourage you to do so by repeating the same basic MOR framework.
Conclusion
I know firsthand how confusing and intimidating it can be to sort through and decide on integrative care and natural product options. The core challenges include:
- limited research on efficacy;
- services and products are not typically covered by insurance or Medicare;
- it is out-of-pocket, and pricing can vary widely;
- different providers offer and therefore ‘recommend’ different services… theirs.
My hope is that the framework offered in this article will assist you in the decision-making process when considering the plethora of options you may be proactively exploring, while fielding those constantly foisted upon you, promoted at each bend and curve (each with all sorts of claims).
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Photo credit: bigstockphoto.com/Javi_Ruiz
