Integrative Oncology

845 Pages·2014·4.32 MB·English

by  Donald I. Abrams

Integrative Oncology
Integrative Medicine Library
Published And Forthcoming Volumes
SERIES EDITOR
Andrew T. Weil, MD
Donald I. Abrams and Andrew T. Weil: Integrative Oncology
Timothy Culbert and Karen Olness: Integrative Pediatrics
Daniel A. Monti and Bernard D. Beitman: Integrative Psychiatry
Victoria Maizes and Tieraona Low Dog: Integrative Women’s Health
Gerard Mullin: Integrative Gastroenterology
Randy Horwitz and Daniel Muller: Integrative Rheumatology, Allergy,
and Immunology
Stephen DeVries and James Dalen: Integrative Cardiology
Robert Norman, Philip Shenefelt, and Reena Rupani: Integrative
Dermatology
Myles Spar and George Munoz: Integrative Men’s Health
Robert A. Bonakdar and Andrew W. Sukiennik: Integrative
Pain Management
Mary Jo Kreitzer and Mary Koithan, Integrative Nursing
Integrative Oncology
SECOND EDITION
EDITED BY
Donald I. Abrams, MD
Chief of Hematology-Oncology
San Francisco General Hospital
Integrative Oncology
UCSF Osher Center for Integrative Medicine
Professor of Clinical Medicine
University of California, San Francisco
San Francisco, California
Andrew T. Weil, MD
Director of The Arizona Center for Integrative Medicine
Lovell-Jones Professor of Integrative Rheumatology
Clinical Professor of Medicine
Professor of Public Health
University of Arizona
Tucson, Arizona
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Library of Congress Cataloging-in-Publication Data
Integrative oncology (Abrams)
Integrative oncology / edited by Donald I. Abrams, Andrew T. Weil. — Second edition.
p. ; cm. — (Integrative medicine library)
Includes bibliographical references and index.
ISBN 978–0–19–932972–4 (alk. paper)
I. Abrams, Donald I., editor of compilation. II. Weil, Andrew, editor of compilation.
III. Title. IV. Series: Weil integrative medicine library.
[DNLM: 1. Neoplasms—therapy. 2. Complementary Therapies.
3. Integrative Medicine. QZ 266]
RC254.5
616.99′406—dc23
2014000082
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professional advice. Treatment for the conditions described in this material is highly dependent on
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PREFACE TO THE SERIES
Integrative medicine (IM) is healing-oriented medicine that takes account
of the whole person (body, mind, spirit), as well as all aspects of lifestyle.
It emphasizes the therapeutic relationship and makes use of all appropri-
ate therapies, both conventional and complementary. IM is not synonymous
with alternative medicine or with CAM (complementary and alternative med-
icine). It neither rejects conventional medicine nor accepts alternative treat-
ments uncritically.
Integrative medicine is a rapidly growing movement in North America.
Consumer demand for it has increased steadily over the past decades. Now,
as the conventional health-care system collapses because of out-of-control
escalation of costs of high-tech medicine, medical institutions are finally tak-
ing IM seriously. The Consortium of Academic Health Centers for Integrative
Medicine has 57 members; among them are many leading medical schools,
whose deans and chancellors recognize the need to move medical education,
research, and practice in this direction. A major reason for the acceptance of
IM is awareness that it can lower health-care costs in two ways: (1) by shift-
ing the focus of health care from disease management to health promotion
through its attention to lifestyle and the innate healing potentials of the human
organism; and (2) by bringing lower-cost treatments into the mainstream that
can give outcomes as good as or better than those of pharmaceutical drugs and
other conventional therapies.
Practitioners are also increasingly drawn to IM because they recognize
its potential to restore core values of medicine that have eroded in the era
of profit-driven health care. Yet demand for clinicians trained to practice
IM greatly exceeds supply. The Arizona Center for Integrative Medicine that
I founded in 1994 has graduated more than 1000 physicians (and some nurse
practitioners) from comprehensive fellowships, mostly in distributed learning
formats. Many of them now direct IM programs at other institutions, some
are training others, and some have authored leading textbooks in the field.
The Center also trains medical students, pharmacists, and medical residents.
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One of its major goals is to develop a core curriculum in IM that will become
a required, accredited part of all residency training in all medical specialties.
In the meantime, there is an immediate need to organize and make acces-
sible to many more clinicians the basic principles of IM in practical application
to common health conditions. It is hoped that the present series of volumes
will help fulfill that need. Each volume will cover the relevance of IM to a
particular specialty, and each will draw on the editorial expertise of a specialist
who is fully trained in IM as well as the advice of senior experts who are open
to, but not directly involved with, the IM movement. Each volume will also
give detailed protocols for the management of conditions that respond well
to integrative treatment and will discuss areas of controversy and uncertainty
where further research is needed.
Some physicians may find this information of use in meeting the needs of
patients better. Some may use it to determine the best treatments for com-
mon conditions. Others may simply want to know more about CAM therapies
their patients are using, if only to be able to discuss them intelligently and
give advice about possible interactions between, say, conventional drugs and
dietary supplements or botanical remedies.
Promoters of IM have been criticized for advocating unscientific or even
antiscientific theories and practices. The commitment of all editors involved in
this project is to present the evidence base for integrative treatment strategies.
Readers should note, however, that IM teaches practitioners to use a sliding
scale of evidence in making therapeutic choices: the greater the potential of
a treatment to cause harm, the stricter the standard of evidence it should be
held to for efficacy. We may recommend therapies that do not yet have a solid
evidence base for efficacy if their potential for harm is low. Examples are sug-
gesting therapeutic massage for persons with advanced forms of cancer as a
means of improving quality of life or teaching hypertensive patients breathing
techniques to increase the tone of the parasympathetic nervous system. All
authors have been charged with the task of citing the best available evidence
for both safety and efficacy of therapies discussed.
Although randomized controlled trials of specific interventions are help-
ful, what is most needed are outcome studies comparing integrative versus
conventional management of common health problems, especially ones that
absorb many of our health-care dollars. Because integrative protocols are
complex—including, possibly, dietary change, dietary supplements, recom-
mendations for physical activity and stress reduction, mind–body therapies,
or use of a whole-system approach like Chinese medicine, in addition to
selective use of conventional therapies—and because they are customized to
address the problems of individual patients, studying them can be challenging.
Nonetheless, it is outcomes data that we must have to evaluate the effectiveness
Preface to the Series vii
and cost-effectiveness of IM relative to conventional medicine to advance the
field and change reimbursement priorities that now fully cover costly conven-
tional treatments but make it difficult for IM practitioners to get fair compen-
sation for their time and effort.
I am grateful to Oxford University Press for having the vision to suggest this
series of volumes, which I believe will be seen as a milestone in the develop-
ment of integrative medicine. I am more than pleased with the outstanding
work that the editors and coeditors have done in their selection of content and
authors. I have learned a great deal in the course of acting as series editor, not
the least from reading chapters as they came in. I hope you find these volumes
as stimulating and refreshing as I do.
Andrew T. Weil
Tucson, Arizona
June 2008
Updated February 2014

PREFACE TO THE FIRST EDITION
Integrative oncology can be defined as the rational, evidence-based com-
bination of conventional therapy with complementary interventions into
an individualized therapeutic regimen that addresses the whole person
living with and beyond cancer—body, mind, and spirit. The number of can-
cer patients and survivors incorporating complementary modalities into their
treatment programs is difficult to estimate precisely but seems to be large and
on the increase. Many choose not to disclose their use of complementary ther-
apies to conventional oncologists for fear of being ridiculed, abandoned, or
asked to stop. Others recognize that their oncology team has neither the time
nor the information to answer their often complex questions, so they remain
silent. Although there is little we can do to encourage patients living with or
beyond cancer to discuss their integration of complementary therapies, we
hope that this book will greatly assist all who care for them to become more
familiar with and comfortable discussing the most widely utilized modalities.
This volume is targeted at health-care providers who seek an up-to-date,
comprehensive, user-friendly source of information that will be relevant to the
care of their cancer patients. We hope that it will quickly become the defini-
tive resource in this emerging field. An outstanding group of renowned con-
tributors has produced chapters discussing the latest information on the most
widely used modalities employed in integrative oncology. We have attempted
to provide a text that is as global and inclusive as possible. The presence of a
chapter in the book does not necessarily indicate that we endorse a particu-
lar modality. Three chapters focus on the common cancers—breast, prostate,
and colon—presenting rational integrative treatment plans that demonstrate
how many of the individual modalities can be woven into a comprehensive
therapeutic approach. We also include discussions on research challenges,
communication issues, a patient perspective, and thoughts about the future of
integrative oncology.
We know that this comprehensive book will serve as a valuable resource for
all who provide care for patients living with cancer and cancer survivors. We
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