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Integrative Oncology PDF

845 Pages·2014·4.32 MB·English
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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 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2014 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. 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 This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper 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. v vi PReFACe TO THe SeRIeS 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 ix

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