Did you know? Nearly half of all Canadians will be diagnosed with cancer in their lifetime. This means that just about every family across the country will be affected by cancer some time in their life.
Out of all the cancers in Canada, breast cancer and prostate cancer are the most commonly diagnosed cancers. Out of all the provinces, New Brunswick has the highest rate of prostate cancer, while PEI and Nova Scotia having the second and third highest rate, respectively. This disturbing trend among the Maritime provinces is not just isolated to prostate cancer. In 2013, the Atlantic provinces showed both the highest cancer incidence and cancer mortality rates in Canada. Therefore, innovative changes are needed in regards to cancer care.
My motivation for studying cancer came after witnessing by beloved Opa dying of metastatic prostate cancer when he was only 67 years of age. At that moment, I felt compelled to do everything I could to make him proud and to help prevent other families from experiencing such a premature loss. I took every cancer related university course I could, spent countless hours job shadowing the top integrative cancer doctors of North America, and during my clinical internship I worked at outreach clinics providing healthcare to patients living with cancer and other terminal illnesses. Today, I am a member of the Oncology Association of Naturopathic Physicians (OncANP) and am continually taking new courses to provide my patients with the best health care options possible.
In order to see changes here in New Brunswick’s cancer care, we need a new model of healthcare. One in which people are no longer forced to choose sides in their treatment -- either by conventional physicians warning against natural therapies, or by natural doctors insisting conventional treatments are all wrong. We have heard the term ‘complementary medicine’, but what does it actually mean? “Complementary” is defined as “two or more different things combining in such a way as to enhance or emphasize each other's qualities.” The new model of complementary cancer care involves conventional doctors and naturopathic doctors working together and combining the best of both medicines to create a comprehensive cancer treatment plan that would give you the best possible care.
Europe, USA, and other Canadian provinces are already doing this – they are integrating naturopathic medicine into their conventional cancer treatments with great success. For example, in other provinces such as BC, there are multiple integrative cancer centers with oncologists, radiologists, surgeons, and naturopathic doctors all working together to develop a plan tailored specifically to the individual. At the Moncton Naturopathic Medical Clinic we intend to bring this level of cancer care to the Atlantic.
In previous Time & Transcript articles, I further discussed my cancer mission and vision (click here). In today’s article, I will describe our dual approach to integrative oncology care. Although this approach can be successfully applied to any cancer case, I will emphasize prostate cancer care in honor of ‘Movember’. Earlier this month, Dr. Gleixner and I presented at the Greater Moncton Prostate Cancer Support Group on ‘Integrating naturopathic therapies in prostate cancer care’. This article will summarize some of the topics we discussed at that meeting.
Dual approach to integrative oncology care:
Step 1) The first step is to improve your outcome. This is achieved by setting up a personalized treatment plan specific to your cancer type and the cancer treatments you are receiving.
Step 2) The second step is to prevent re-occurrences and to prevent secondary cancers. This is done by determining and correcting any underlying imbalances that initially led to the development of the cancer. Click here to read step 2.
Step 1: Improving your outcome
Proper diagnosis: Death of the PSA test?
In medicine, in order to get the best outcome, you need the correct diagnosis. In Canada, one of the main diagnostic tests used to detect prostate cancer is a blood test called the prostate specific antigen (PSA). This type of test is called a screening test. Screening tests are designed to allow for early diagnosis in order to reduce the number of deaths from a disease. There is an organization called the U.S. Preventative Task Force that assesses each of the screening methods used in medicine and creates a recommendation based on the strength of the evidence and the balance of benefits and risks of a preventive service. When the Task Force assessed prostate screening in 2012 they officially recommended that “no one be screened with a PSA test because it doesn't actually show a survival benefit.” After going through the research, they found that the reduction in prostate cancer deaths from PSA screening is at most very small. A large U.S. study showed no benefit from screening. A large European study that found the highest reported benefit suggests that no more than 1 in 1,000 men avoids death from prostate cancer because of screening. Other studies found no benefit at all.
The Task Force found that PSA screening also has important potential harms. The PSA screening test has an 80% false positive rate -- meaning 80% of the elevated PSA tests are suggestive of prostate cancer, but are not actually cancer. In fact, anything that affects the gland (infection, prostatitis, sex, cycling, benign prostate hyperplasia (BPH), etc) can elevate the PSA level. When the doctor receives this elevated PSA score, most patients get sent for an immediate biopsy. Therefore, 75-80% of the patients receiving the biopsy did not actually need the biopsy done. Not only does this experience cause worry and anxiety, but roughly one third of men receiving the biopsy experience unpleasant side effects, and there are also some concerns of the biopsy potentially spreading the cancer.
Since there are an increased number of biopsies conducted, there are an increased number of early prostate cancers found. Almost all of these men (90%) end up undergoing treatment with surgery, radiation, or hormone therapy. However, many of these men did not actually need treatment because their cancer would never have grown or cause any health problems during their lifetime, even without treatment. This type of cancer is called “indolent” cancer. Indolent cancer is often stereotyped as a form where “the patient will live 20 years and probably pass away from something else.” According to the 2010 data from the American Cancer Society, it takes 14 unnecessary prostate cancer treatments to save 3 men from dying of it. In other words, 82% of prostate cancer treatments are unnecessary.
The unfortunate part of overtreatment is that the men receiving these unnecessary prostate cancer treatments may now suffer from lifelong damage, such as:
- Erectile dysfunction (impotence) from surgery, radiation therapy, or hormone therapy in 75% of cases;
- Urinary incontinence (leakage of urine) from radiation therapy or surgery in 54% of cases;
- Problems with bowel control from radiation therapy lasting 5 years post-radiation; and
- High rates of depression from these complications.
As you can see there is a snowball effect: the inaccuracy of the PSA test leads to an increase number of unnecessary biopsies; the increased number of biopsies results in the overdiagnosis of prostate cancer; the overdiagnosis leads to overtreatment; and the overtreatment leaves many of these indolent cancer patients with lifelong complications.
Therefore, new testing procedures are needed to ensure proper diagnosis and to prevent these unnecessary downstream procedures.
Proper diagnosis: PCA3 - the new gene-based urine test specific for prostate cancer
In late 2011, there was a new test that was approved by the FDA. The PCA3 test is a gene-based test that is performed on a urine sample. PCA3 stands for prostate cancer gene 3, a gene that is involved in development of prostate cancer.
Unlike PSA, the PCA3 result is not falsely elevated when a man suffers from a disease that increases the size of the prostate such as benign prostatic hyperplasia (BPH) or prostatitis. PCA3 is specific to prostate cancer cells. Therefore, it gives very useful information that can be used in combination with the PSA, in deciding if a biopsy is really needed.
The men that would most benefit from this new PCA3 testing are:
- men who have an abnormal PSA level, with or without a negative biopsy result.
- men who have already had a negative biopsy result.
- men who have a high cancer risk, or a family history of prostate cancer, even if you have a low PSA level.
- men who have already had treatment (e.g. surgery or radiation) for prostate cancer but want to monitor their health.
The Moncton Naturopathic Medical Clinic has access to this PCA3 testing for our patients. As of 2016, we also have access to ONCOblot testing.
- ONCOblot Test - blood test used to confirm cancer presence. Provides a non-invasive next step to existing tests such as a High PSA, Abnormal Mammogram, Suspicious PET Scan and biopsies. The test is being used to identify cancer of unknown primary (CUP), for recurrence monitoring, post cancer treatments and for targeted high risk populations. Ask our Naturopathic Doctors for more details.
Improving outcome: Ensuring safety, increasing effectiveness, reducing side effects, and improving healing.
After proper diagnosis is made, naturopathic doctors can then work with patients and their medical doctors to improve the outcome of the prostate cancer. Before we recommend any treatments or supplements, we first need to educate patients on which ones may be contraindicated. It has been found that around 70% of cancer patients use natural therapies. Often, when friends and family hear of their loved one’s diagnosis, they will lovingly bombard them with supplements touted as miracle cures on the internet. Therefore, one of our first goals is to help guide patients through the confusing marketplace of supplements and natural therapies by ensuring that such treatments are effective, safe, and not interfering with their conventional treatments or further promoting their cancer. For example, taking chondroitin or glucosamine supplements (commonly used for arthritis) may inadvertently increase the spread of prostate cancer. Naturopathic doctors are trained to choose the most effective therapies specific to your case and to guide you on which to avoid.
Naturopathic doctors are trained to work along side conventional treatments such as chemotherapy, radiation, or surgery. Integrating naturopathic medicine with conventional medical care can help to:
- increase the effectiveness of the therapy;
- speed healing time;
- prevent any risk of treatment induced tumor spread (e.g. biopsy, surgery);
- reduce complications or side-effects (e.g. nausea, fatigue, weight loss, bowel disturbances, nerve damage, reduced quality of life, “chemo brain”, depression, difficulty sleeping, etc); and
- keep your body healthy enough so that it can handle the full dose and optimal treatment schedule necessary to kill the cancer.
Naturopathic doctors have access to a wide-array of treatment options to effectively manage or improve each of these challenges including nutrition, herbal remedies, targeted nutraceuticals, acupuncture, and many others.
One therapy that we recently added to our cancer toolkit is high dose intravenous (IV) vitamin C. In October, I travelled to Portland, Oregon to learn the most recent advances of this integrative therapy by attending a course called “Clinical Applications and Advanced Topics of IV Nutrient Therapy.” IV vitamin C allows you to achieve levels of vitamin C high enough to selectively induce cell death in cancer cells, without harming normal healthy cells. Beyond this potential cancer killing action, IV vitamin C has been shown to stabilize cancer cases by arresting the growth and spread of tumors. IV vitamin C can also vastly improve quality of life by increasing appetite, raising platelet counts, increasing energy, boosting the immune system, and reducing pain. In a recent 2012 interview, Dr. Daniel Rubin, a leader in the naturopathic oncology field, said “I am not sure that any medical treatment in the integrative medicine world provides as many mechanistic anti-cancer activities than intravenous vitamin C packs in.”
Both naturopathic medicine and conventional medicine have their strengths. The debate is no longer whether it’s one or the other, but rather moving forward with the integration of both in cancer treatments. This integration not only improves your outcome, but also reduces the chance of recurrence.
Stay tuned for my next article when I will discuss step two of our dual approach: how to prevent the re-occurrence of cancer by targeting five key pathways in the body.
Click to see Dr. Anhorn's full bio and list of trainings.
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