Entries in Difficult-to-treat Diseases (4)

Friday
Apr182014

IS A CURE STILL POSSIBLE ?

The Dolder Grand

Health Care &
Rejuvenation

 

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine 

 

 

 

 

There are gracious times in our lives, filled with dreams, beginnings, promise, and excitement.

Then one day we wake up and situations and circumstances around us change. All of a sudden the promise looks impossible, instead of being united there is division, instead of growth there is loss, instead of having enough there is drastic change, instead of vision and wonder there are trials, instead of health there is suffering.

If for some reason your life is turned upside down and you don't know how you are going to get through the next weeks, call upon us for rescue. We accept  the responsibility of doing everything humanly possible to find, to define, to open up a last resort solution for you.

It is our strength to find new resources, to identify the best researchers and physicians or consultants in their fields, to provide cutting edge knowledge and expertise to overcome health issues (terminal disease, cancer, cardiovascular disease, autoimmune disease, multiple sclerosis, connective tissue disease, incapacitating mental disorders, depression, exhaustion, alcohol or drug dependence) or to overcome crisis (grief, bereavement, separation, abandonment, solitude, loss of meaning) to identify a way out towards physical, mental, social and spiritual recovery.

 

 

 

 

 

 

 

 

 

The academic approach 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last resort solution finding and healing

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine

 

Re-evaluate the existing situation

In-depth consultation and re-examination

Body: We offer sophisticated high-tech diagnostics, imaging and lab tests to re-evaluate the existing situation

Mind: Gestalt desktop constellation to improve your mental resolve, for personal stocktaking and life course adjustment

Dolder Health Care & Rejuvenation
and
Double Check Swiss Academic Center for Checkups and Second Opinions 

Second opinion and options: The academic approach 

We bring the best experts from various fields and subspecialities, together with them we do research for you, evaluate novel scientific findings, bring the best, the newest, the most promising therapies to you

Dolder Health Care & Rejuvenation
and
Professors from the University Hospital Zurich and other leading Swiss Hospitals and
Double Check Swiss Academic Center for Checkups and Second Opinions 

Second opinion and options: The integrative approach 

Complementary medicines comprising nutritional medicine, herbal remedies, acupuncture, healing touch and energy medicine, neuroimagination. Many of the therapies now considered complementary  will become mainstream medicine in the future when more research results become available

Dolder Health Care & Rejuvenation

  

Friday
Sep272013

DEFEATING CANCER - Reinvent the Body, Resurrect the Soul Following Treatment for Cancer

The Dolder Grand

Health Care &
Rejuvenation Center

 

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine 

Timeea-Laura Burci
Lifestyle Coach & Jin Shin Jyutsu

 

 

 

 

 

 

 

Gains in cancer survivorship have been accomplished through increasingly complex primary treatments, often combining surgery, radiation therapy, and chemotherapy. There are possible long-term sequelae from each of these treatments, including the effects of radiation damage to normal tissues, infertility, second malignancies, and cardiovascular, pulmonary, and neurologic toxicity.

Patients with cancer face a variety of issues related to rehabilitation, many of which are specific to a given tumor, eg, rehabilitation issues among women treated for breast cancer may include lymphedema, body image issues, and sexual dysfunction. Important sequelae of treatment for early stage prostate cancer include urinary incontinence, rectal urgency, diarrhea (from radiation therapy), and sexual dysfunction. For men treated for advanced disease, androgen deprivation therapy can result in decreased libido, impotence, fatigue, loss of bone and lean body mass, and decreased muscle strength.

The adverse effects of cancer are complex and highly individual. In some cases, distress is related to the associated mood effects or functional impairments that follow cancer treatment. In other cases, it is the meaning that is attributed to cancer that drives suffering. Given the multidimensional nature of cancer, a diverse array of interventions may provide benefit.

Outcomes following treatment, and disease- or treatment-related impairment of mood and function will be improved by the adjunctive use of psychological, rehabilitative, and integrative therapies. Such nonpharmacologic strategies may provide pain relief, ameliorate side effects of drugs, better outcomes with regard to physical and psychosocial functioning. Data from randomized trials and meta-analyses support the utility of psychosocial interventions as a component of multimodality treatment. Potentially beneficial strategies include mind-body therapies such as imagery, hypnosis, meditation, healing touch acupressure and therapeutic exercise (physical therapy).

Cancer rehabilitation helps a person with cancer obtain the best physical, social, psychological, and work-related functioning during and after cancer treatment. The goal of rehabilitation is to help a person regain control over their lives and remain independent and productive. Rehabilitation is valuable to anyone with cancer and those recovering from cancer treatment.

 

We offer a highly individual Cancer Rehabilitation Program at the Dolder Grand and Spa in Zurich, please seek out what you and/or your loved ones may need to regain joy, confidence, strength, health, and independence.

 

PD Dr. Rainer Arendt

Internal Medicine & Cardiology FMH
Exec. Coaching & Corporate Health


Timeea-Laura Burci

Lifestyle Coach & Jin Shin Jyutsu

 

 

Introduction to the program

 

 

Initial consultation

Dr. Rainer Arendt

Medical Wellness Practice

 

Salutogenesis and Rejuvenation 

 

In-depth consultation, physical examination, comprehensive lab check incl. biological age, assessment of deficits, written report with recommendations and prescriptions

Dr. Rainer Arendt

Medical Wellness Practice

 

Second Opinion: Oncology

 

 

Make sure you are on the right track, bring all former medical reports and images and have our specialists from Double Check Swiss Academic Center for Checkups and Second Opinions, the University Hospital Zurich or the Hirslanden Private Hospital Group double-check on former results and suggested treatments or treatments received

Partners from Leading Swiss Hospitals and Double Check Swiss Academic Center for Checkups and Second Opinions

 

Rejuvenation: IV and Oral Detox

 

 

Individualized detox and chelation therapy

Dr. Rainer Arendt

Medical Wellness Practice

 

Rejuvenation: Cell-Based Therapies

Individualized therapies depending on indications and available evidence or experts' consensus with cellular therapies

Dr. Rainer Arendt

Medical Wellness Practice
and
Partner Institutes

Reinventing the Body

Personal and nutritional training, hormonal or herbal treatments, “deep trance" rejuvenation and body repair with two therapists, experience how the mind and neuro-imagination techniques shape the body, increase strength and confidence. Learn how to erase the "body memory" coding for pain, fatigue, or depression

Dr. Rainer Arendt
Timeea-Laura Burci

Medical Wellness Practice

Resurrecting the Soul and Stress Relief

 

 

Gestalt desktop constellation for personal stocktaking and life course adjustment, autohypnosis, ego state coaching, EMDR, “deep trance" repair with two therapists (male and female). Your subconscious mind will relay signals of health, strength, beauty, youthfulness via the intricate networks of hormones and neurotransmitters

Dr. Rainer Arendt
Timeea-Laura Burci

Medical Wellness Practice

 

"La Grande Bellezza" Program

 

 

Healing Touch and Deep Trance body sculpturing for inner and outer beauty. Reinventing the body, resurrecting the soul, enrich your life and your female/male well-being by beauty, grace, and sexual magnetism 

Timeea-Laura Burci
Dr. Rainer Arendt

Medical Wellness Practice

The Spa

The importance of physical fitness for people living with and beyond cancer cannot be overemphasized. We will start you on your individual training program to strength, confidence and health regained

The Dolder Grand & Spa

 

 

Lucas Cranach d. Ä.. The fountain of youth. 1546. Oil on lime wood panel. National Museums in Berlin, Preussischer Kulturbesitz. 

Tuesday
Dec062011

Complementary and Alternative Oncology: Innovative Approaches to Optimize Standard Therapy for Cancer

The Dolder Grand

Health Care &
Rejuvenation

 

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine 

 

 

 

 

 

 

 

 

Cancer demands diagnostic and therapeutic measures with proven quality, safety and efficacy.

Complementary and alternative medicine in oncology has emerged out of disappointment with the results of traditional treatment options. Despite innovative approaches towards cancer destruction, including surgery, chemo-, radio- or hormone therapy, cancer mortality rates have not been significantly reduced in the past twenty years. Notable treatment success, however, has been achieved in rare cancers such as testicular cancer, leukaemia and lymphoma.

Global analyses dampened the optimism associated with chemotherapy for advanced carcinomas, especially when responses (temporary cancer shrinkage) are used as a measure of therapeutic success. Therefore, some researchers urge the medical community to think about new therapeutic strategies.

Source unknown

While mainstream oncology has introduced promising therapeutic innovations, e.g. targeted antibody/antisense therapies, specific inhibitors of cancer cell growth factors, efficient but tolerable new chemotherapeutic agents, advanced concepts for radiotherapies, novel non-toxic but promising complementary approaches have been tested in scientific and clinical trials.

Presently, there is no compelling evidence that any alternative therapy is associated with prolongation of life. However, the search for effective alternative therapies continues to be intense. It is important to note that claims of efficacy should be supported with acceptable evidence by those who make these claims, rather than rejected through research carried out by those who doubt them.

Also, outlandish and irresponsible claims continue to be published in the medical literature, therefore, it is understandable that oncologists are concerned about the high level of acceptance of alternative therapies by cancer patients.

On the other hand, outright rejection of these treatments might be counter-productive for the following reason: Every now and then impressively successful case reports emerge from credible sources. An open mind toward plausible complementary options might therefore be a good general policy.

 Users of complementary and alternative oncology are generally not dissatisfied with conventional medicine but find alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. Factors reported to be associated with use of complementary and alternative therapies in cancer patients include:

  • Increased psychosocial stress (eg, anxiety, depression)
  • Being given a less hopeful prognosis
  • Having the feeling of "nothing to lose"
  • Attending support groups
  • Age (younger versus older) and gender (women more than men)

The role of complementary therapies in palliative and supportive cancer is a different matter and seems more promising. Several of these therapies have potential for improving quality of life. Proponents of these therapies have repeatedly argued that it would be inhumane not to provide such treatments if patients want them. Oncologists should certainly not hinder patients from seeking such help. On the other hand, one should still insist that the usefulness of these therapies be demonstrated beyond reasonable doubt.

The often emotional conflicts between opponents and proponents of complementary and alternative oncology are, to a large degree, a regrettable artifact caused by the lack of reliable evidence in this area. If more convincing data existed, there would be far less room for disagreement. It follows that more research efforts (and research funds) should be directed towards creating reliable evidence. In the United States, the National Institutes of Health (NIH) Center for Complementary and Alternative Medicine and the National Cancer Institute are supporting well designed studies of alternative medicine. Information is available through the NCI website (cancer.gov/cancerinfo/treatment/cam), and the Cochrane Collaborative (http://www.compmed.umm.edu/cochrane.asp).


ALTERNATIVE CANCER TREATMENTS (ACTs) are defined as complementary and alternative medicine (CAM) therapies that are promoted for reducing tumor burden or prolonging the life of cancer patients. The following ACTs are currently popular and will be discussed:

Dietary treatments

Herbal medicinal products

Non-herbal supplements

Dietary treatments — A systematic review of the evidence found that so far none of the many dietary regimens has been convincingly shown to cure cancer or significantly prolong the life of cancer patients. However, selected vegetables and herb mix (SV) a blended product containing ingredients with purported immune-stimulatory and anticancer properties: soybeans, mushrooms, mung beans, red dates, scallion, garlic, lentils, leek, hawthorn fruit, onion, ginseng, angelica, dandelion, senegal root, licorice, ginger, olives, sesame seeds, and parsley has been investigated in two small studies conducted in patients with cancer. In a matched-control study involving patients with stage III/IV non-small cell lung cancer, median survival duration among the 11 patients who ingested SV daily was three-fold longer than that of 13 patients who did not receive the supplement (15 versus 4 months). A similar suggestion of prolonged survival was noted in a second study of 18 patients with stage III/IV NSCLC who had either rejected or failed to respond to conventional therapies. The median survival was 33.5 months for the 12 patients who used SV for two months or longer, and at five years, 50 percent of the patients remained alive. When these data were presented to the Cancer Advisory Panel for Complementary and Alternative Medicine, SV was judged worthy of further definitive research. Further information can be found at the NCI website (cancer.gov/cancerinfo/pdq/cam/vegetables-sun-soup).

 

Herbal medicinal products — Numerous herbal medicinal products (HMPs) are promoted as ACTs. The examples listed below represent only a brief selection.

Individualized therapy — Chinese herbal medicines are widely used in many areas of Asia to reduce the toxicity associated with conventional anticancer therapy; however, the efficacy of herbal therapy to minimize chemotherapy-related toxicity is unclear:

This approach was assessed in a double-blind, placebo-controlled trial, in which 120 patients receiving adjuvant chemotherapy for breast or colon cancer were evaluated by a qualified Chinese herbalist. Treatment was prescribed and the active herbs or a matched control were dispensed in a blinded fashion. There was no difference between the two groups in hematologic toxicity, which was the primary end point. Among 16 non-hematologic parameters assessed, the only statistically significant difference was a reduction in the severity of nausea with active treatment.

A systematic review was conducted of four trials in which 270 patients with advanced or late stage gastric cancer were randomly assigned to the traditional Chinese medicinal herb Huachansu plus chemotherapy compared with the same chemotherapy alone. The authors concluded that there was relatively weak evidence that Huachansu improved leukopenia when used together with chemotherapy, but it did not improve any other side effect or the short-term efficacy of chemotherapy.

Of note, several Cochrane and other reviews were unable to find convincing evidence from randomized trials supporting the benefit of Chinese herbal medicine as a treatment for esophageal or lung cancer; none of the trials that claimed to be randomized were actually randomized.

 

Green tea — Green tea is derived from the plant Camellia sinensis, and contains a number of biologically active polyphenols. Herbal products are widely used as CAMs in cancer patients. Green tea is the most widely used herbal product, used by 24 to 30 percent of all cancer patients. The polyphenols in green tea have a variety of biologic activities that might influence tumor behavior. There are only limited data on possible clinical efficacy: A single case control study from China suggested that consumption of large amounts of green tea may have a protective effect against the development of prostate cancer. However, other case-control and cohort studies have not found a link between green tea intake and prostate cancer risk among Japanese men or Japanese-Americans living in Hawaii. A phase I study in lung cancer patients and a phase II study in prostate cancer patients showed no antitumor activity. Consumption of large amounts of green tea may correlate with improved survival in patients with ovarian cancer.

Essiac — Essiac is an herbal mixture originally formulated by a Canadian Ojibwa healer that has become popular in North America. The formula consists of burdock root (Arctium lappa), turkey rhubarb (Rheum palmatum), sheep or sheepshead sorrel (Rumex acetosella), and the inner bark of slippery elm (Ulmus fulva). Later, watercress, blessed thistle, red clover, and kelp were added. In vitro studies of the individual components of this mixture have demonstrated some evidence of biological activity, including antioxidant, antiestrogenic, immunostimulant, and antitumor actions. However, an attempted systematic review did not find a single published clinical trial testing this mixture in cancer patients. The author concluded that there is no definitive evidence of its utility but that Essiac is unlikely to cause serious adverse effects.

Mistletoe — Mistletoe extracts (Iscador, Helixor) contain various lectins and viscotoxins (including viscum fraxini-2). Evidence from in vitro experiments and animal models suggests that these components have some anticancer activity. Although dozens of matched pair cohort studies have largely supported a benefit for mistletoe extract in patients treated for cancer, randomized trials with various mistletoe preparations have given conflicting results. Three independent systematic reviews of the clinical evidence concluded that there are insufficient data to support the use of mistletoe extracts. A more recent meta-analysis suggested a modest survival benefit for cancer patients who received the mistletoe preparation Iscador. However, benefit was observed only in nonrandomized studies (hazard ratio [HR] for death 0.33, 95% CI 0.17 to 0.65) and not in randomized trials (HR for death 1.24, 95% CI 0.79 to 1.92), and there was a high probability of publication bias skewing the results. Numerous adverse effects are on record; the most serious is anaphylactic shock. Based upon the available evidence, it cannot be concluded that there is benefit from mistletoe extract.

 

PC-SPES — PC-SPES is an herbal dietary supplement consisting of seven Chinese and one American herbal extract. The name of the product emphasizes its intention: PC stands for 'prostate cancer' and spes is Latin for 'hope'. The eight herbs were selected for their immune stimulating, cytotoxic, and cytostatic properties. PC-SPES has potent estrogenic activity. In men with advanced prostate cancer, decreases in serum prostate specific antigen, improvement in bone scans, and objective shrinkage of soft tissue measurable disease have been reported with PC-SPES. However, adulteration and toxicity (an acquired bleeding diathesis) forced a recall of this compound by the United States Food and Drug Administration in February 2002. As a result, it is no longer commercially available.

Sho-saiko-to — Sho-saiko-to is a traditional Chinese herbal mixture that contains extracts of seven medicinal herbs. It is widely administered in Japan to patients with chronic hepatitis and cirrhosis. Sho-saiko-to inhibits stellate cell activation and reduces hepatic fibrosis in vitro and in vivo.  It also inhibits chemical hepatocarcinogenesis in animals, acts as a biological response modifier, and suppresses the proliferation of hepatoma cells by inducing apoptosis. A prospective study of 260 cirrhotic patients found that a daily oral dose of sho-saiko-to (7.5 g) in addition to conventional therapy reduced the cumulative incidence of hepatocellular carcinoma over five years of follow-up compared with controls (p = 0.071). The difference was significant in patients who were hepatitis B surface antigen (HBsAg) negative (p = 0.024). Survival was also improved with sho-saiko-to therapy (p = 0.053), and again, the difference was significant in those who were HBsAg negative. Based on these results, the use of sho-saiko-to seems promising, but more clinical trials are required to be sure.

St. John's wort — St. John's wort has primarily been used to treat depression. An extract of St. John's wort, hypericin, has been noted to have a cytotoxic effect on tumor cells after photoactivation. In vitro studies and in vivo investigations in mice have demonstrated that intralesional hypericin has the potential for use in a number of tumors, including bladder, squamous cell, pancreatic, and prostate cancer. The only human study has involved intralesional injection of hypericin into basal cell and squamous cell carcinomas of the skin. Injection with the extract three to five times per week was followed by irradiation with visible light. The authors claim that hypericin displayed selective tumor targeting; penetration in the surrounding tissues did not induce necrosis or cell loss, and generation of a new epithelium at the surface of the malignancy was noticed. Clinical remissions were observed after six to eight weeks. These preliminary results require replication in a randomized trial.

Astragalus — The Chinese herb astragalus membranaceous is postulated to boost host immune function. A meta-analysis of randomized 34 trials found that the addition of astragalus to chemotherapy was associated with a reduced risk of death, an improved response rate, and a better performance status. However, significant methodologic limitations in these trials prevented definitive conclusions about the efficacy of this herb.

 

Nonherbal supplements — Among the nonherbal supplements that have been evaluated are melatonin, shark and bovine cartilage, hydrazine, and thymus extracts.

Melatonin — Melatonin, a normal secretion of the pineal gland, has captured public attention because of its effects on mood, sleep, and jet lag. It has also been suggested that melatonin stimulates the immune system  and has antioxidant, anticancer, and antiaging properties. Although melatonin has been evaluated in a number of settings in patients with cancer, it does not yet have an established role. Melatonin has been evaluated in combination with aloe vera, which may have immunomodulating properties. In one report, 50 patients with advanced solid malignancies for whom no effective standard anticancer therapy existed, were treated either with melatonin (920 mg per day) or with melatonin and aloe vera tincture (1 mL twice daily). No response was seen in the former group while two partial responses were observed in the group treated with aloe vera. This result awaits confirmation through a more rigorous trial.

Hydrazine — Hydrazine is a chemical with a variety of actions. It is an inhibitor of the enzyme phosphoenolpyruvate carboxykinase, a key enzyme in mammalian gluconeogenesis, a metabolic pathway that is thought to play a role in cancer cachexia. Four controlled trials have been reported. The first study, which randomly assigned 64 patients with lung cancer to receive chemotherapy with or without hydrazine (60 mg three times daily) failed to show a significant difference in survival between the two groups. Three subsequent trials, two in lung cancer, and one in colorectal cancer, also failed to demonstrate a positive impact of hydrazine on survival.

Coenzyme Q10 — Coenzyme Q10 (also known as Vitamin Q10, ubiquinone, or ubidecarenone) has been widely promoted for patients undergoing treatment for cancer, based upon the suggestion that it might improve tolerance for chemotherapy. However, in a preliminary report of a double-blind placebo-controlled trial in patients with newly diagnosed breast cancer, there was no benefit from the use of coenzyme Q in self-reported cancer treatment-related fatigue.

Thymus extracts — Several in-vitro studies have demonstrated that thymus extracts restore lymphocyte function, improve immunological variables, activate natural killer cells, and increase cytotoxic activity as well as mitogen-induced interferon levels in human lymphocytes. In addition, animal experiments have suggested that thymus extracts inhibit tumor growth. A systematic review located 13 randomized, controlled trials of thymus extracts for various human cancers. Five of these studies suggested that thymus extract therapy may have some benefit. However, the low average methodological quality of the trials and overt contradictions in terms of outcomes prevented firm conclusions. Thymus preparations can cause severe allergic reactions and possibly serious infections when injected.

Shiitake mushroom extract — Shiitake mushrooms are among the most consumed mushrooms in the world, and they have been used in traditional Asian medicine for over 2000 years. In vitro, several polysaccharide components exhibit antitumor activity. The antitumor efficacy of a shiitake mushroom extract was tested in an open-label study in which 62 men with advanced prostate cancer received oral extracts of shiitake mushroom daily for six months. The clinical endpoint was the tumor marker, serum prostate specific antigen (PSA). By six months, 23 patients had a rising PSA, while 38 remained stable. No patient had a conventional PSA response, defined as a reduction of ≥50 percent of serum PSA over baseline. The authors concluded that shiitake mushroom extract alone was an ineffective treatment for men with clinical advanced prostate cancer.

Lycopene — Multiple studies have suggested that the carotenoid lycopene, which is particularly rich in tomatoes, may have a role in preventing prostate cancer, although this has not been established in controlled clinical trials. A detailed review of the available evidence by the United States Food and Drug Administration found that there was no credible evidence to support a relationship between lycopene intake and a reduced risk of cancer.

Vitamin C — A number of studies have examined the hypothesis that antioxidants such as vitamin C can prevent cancer by augmenting the body's ability to dispose of toxic free radicals, thereby retarding oxidative damage. Although there is little evidence to support an important role for vitamin C in cancer prevention, many patients who have cancer take supplemental vitamin C, often at high doses. High-dose intravenous vitamin C is widely used by practitioners of CAM.

 

COMPLEMENTARY SUPPORTIVE CARE — Complementary therapies are adjuncts to mainstream care that may be used to manage cancer symptoms, adverse effects of therapy or improve quality of life or even quality of death. In contrast to alternative therapies, many complementary therapies have been shown to be of benefit in patients with cancer.

Acupuncture and related therapies — Acupuncture has been studied in patients with cancer to reduce chemotherapy and radiotherapy-induced nausea and vomiting, for pain control, and to reduce vasomotor symptoms in women receiving antiestrogen treatment for breast cancer as well as in men treated with gonadotropin analogs for prostate cancer. Some reports suggest acupuncture also may have a role in patients with radiation-induced xerostomia, and for persistent chemotherapy-related fatigue.

Nausea and vomiting — Several different techniques have been used to stimulate the pericardium 6 (P6 or neiguan) site, which is commonly thought to be useful in the management of chemotherapy-induced nausea and vomiting, and possibly radiotherapy-induced nausea and vomiting. These include manual stimulation with the insertion of fine needles, electrostimulation through needles or percutaneously, and noninvasive pressure on the skin over the P6 pressure point (ie, acupressure).The potential benefits and limitations of these approaches are illustrated by two of the larger randomized trials: Low frequency noninvasive electroacupuncture at classic antiemetic acupuncture points was evaluated in a trial in which 104 women with breast cancer were randomly assigned to the active intervention, mock electrostimulation on the same schedule, or no intervention. All patients received concurrent three drug antiemetic pharmacotherapy and highly emetogenic chemotherapy. The number of emesis episodes occurring during the five days was significantly lower for patients receiving electroacupuncture compared with those receiving the mock procedure or antiemetic pharmacotherapy alone (median number of episodes, 5, 10, and 15, respectively). During the nine day follow-up period, no significant differences were observed between groups, suggesting that the observed effect had a limited duration. A lack of benefit from acupuncture was suggested in a trial in which 80 patients undergoing high-dose chemotherapy with autologous hematopoietic stem cell transplantation were randomly assigned to ondansetron plus either invasive acupuncture at P6 or non-skin penetrating placebo acupuncture. There were no significant differences between the groups in the rate of emesis or retching, nausea, or use of rescue antiemetics. A systematic review in 2005 examined the results from 11 randomized trials with 1247 patients receiving chemotherapy regimens of moderate or high emetogenicity. Overall, acupuncture-point stimulation significantly reduced the proportion of patients with acute vomiting (31 versus 22 percent). However, the mean number of emetic episodes was not significantly decreased and no benefit was apparent in the control of delayed emesis. Electrostimulation through acupuncture needles appeared to be the most effective modality. However, not all studies utilized state-of-the-art antiemetics, and the role of acupuncture and acupressure remains uncertain.

Pain control and xerostomia — Although some trials have suggested that acupuncture can be useful in ameliorating cancer pain, a systematic review concluded that the value of acupuncture has not been established. On the other hand, benefit for acupuncture after treatment for head and neck cancer was suggested in a trial in which 70 patients with pain and dysfunction three or more months after neck dissection and irradiation were randomly assigned to four weekly acupuncture treatments or usual care (physical therapy, analgesia, antiinflammatory drugs); the use of sialagogues was not described. In a preliminary report, acupuncture was associated with a significant reduction in pain and dysfunction as well as a greater improvement in patient-reported xerostomia as compared to usual care. The duration of benefit was not stated. Independent confirmation of these data is needed.

Vasomotor symptoms — Acupuncture has been studied as a potential therapy for hot flashes, but its value is unproven. In a meta-analysis of five trials comparing acupuncture to sham acupuncture in menopausal women with vasomotor symptoms, reductions in severity and frequency of hot flashes were seen with both therapies, but there were no significant differences between the two groups.

In men receiving gonadotropin analogs for prostate cancer, a small pilot study suggested that acupuncture decreases hot flashes, but there are no data from a randomized trial.

 

Hypnotherapy — Several (mostly small) randomized, controlled trials have demonstrated the usefulness of hypnotherapy in palliative cancer care, with efficacy in controlling pain and nausea/vomiting in various settings. A systematic review of hypnosis may be particularly useful for reducing the anticipatory emesis associated with chemotherapy. In addition, hypnosis can be useful in children for preventing anxiety and pain due to procedures such as lumbar puncture or bone marrow aspiration. The use of hypnotherapy has also been evaluated as an adjunct to radiation therapy in a randomized study. In a study of 69 patients undergoing curative radiotherapy for a variety of cancers, benefit could not be documented with formal instruments assessing anxiety and quality of life, although patients reported an improved sense of both overall and mental wellbeing.

It is unclear to what extent these effects are due to specific or nonspecific (placebo) effects. An older review that summarized published clinical trials of hypnotherapy concluded that there is encouraging, albeit not compelling, evidence to suggest that hypnotherapy is helpful for controlling anxiety and pain as well as nausea and vomiting in cancer patients. A later systematic review of randomized trials of self-care strategies for managing common chemotherapy-related adverse effects concluded that randomized trials of reasonable quality provided limited support for the benefit of hypnosis in reducing nausea and vomiting.

 

Behavioral intervention — Behavioral intervention encompasses a number of techniques, which have been applied separately and in combination. In a randomized trial with 115 patients, a structured multidisciplinary program including cognitive, emotional, physical, social, and spiritual interventions was useful in patients receiving radiation therapy for advanced cancer. Those receiving the active intervention were able to maintain their quality of life during the four week treatment period, while the control group who did not receive this adjunctive treatment had a significant decrease in quality of life.

Relaxation therapy — Relaxation techniques such as imagery, breathing exercises, manual massage, music therapy, art therapy, yoga, medical Qigong and reflexology  have been used to reduce symptoms (such as nausea and vomiting, fatigue) and improve mood, sleep, and quality of life in cancer patients. The systematic review discussed above concluded that there was limited evidence to support a benefit for relaxation and exercise to reduce nausea and vomiting, with some benefit for this practice seen in 10 of 13 published randomized trials. The benefit of yoga for reducing fatigue and improving sleep quality has been demonstrated in a randomized trial. The impact of relaxation therapy on mood and quality of life are less certain. In one randomized study, 96 women receiving chemotherapy for newly diagnosed breast cancer were assigned to receive either regular relaxation training and imagery or standard care only. The experimental group experienced better quality of life than the control group. However, another trial of relaxation therapy in women with early breast cancer and hot flashes found no benefits in terms of anxiety or quality of life.

Manual massage therapy can convey intensive relaxation to both the body and the mind, but benefits are usually transient: In a retrospective series of 1290 cancer patients in whom pain, fatigue, anxiety, and nausea were assessed before and after massage therapy, moderate to severe symptoms decreased by approximately 50 percent. Therapeutic benefits persisted for at least 48 hours in outpatients, although the total duration of benefit was not reported. Massage therapy was compared to simple touch in a randomized trial involving 298 persons with advanced cancer. Massage was associated with significant immediately beneficial effects on pain and mood (just after the treatment session), but they were not sustained in the following weeks.

Not all behavioral interventions have been shown to be effective. Although many studies are encouraging, we need to determine which approaches are best for what type of patient and to establish how these interventions compare to conventional methods used in palliative care.

Aromatherapy — Aromatherapy uses various aromatic oils, often in conjunction with massage, to treat symptoms of anxiety and depression. This approach has been widely used, and evidence from small trials suggests that it may have some benefit in relieving self-reported symptoms. Aromatherapy massage was assessed in a multicenter trial in which 282 cancer patients were randomly assigned to aromatherapy weekly for four weeks or to a control arm. No benefits were present at 10 weeks after treatment, the primary endpoint of the trial. Although patients experienced improvement two weeks after treatment, these benefits were no longer present at six weeks after therapy.

Therapeutic or healing touch — Several clinical trials have tested the effectiveness of therapeutic or healing touch (HT) to reduce anxiety, improve wellbeing or quality of life, or reduce pain in cancer patients. Some of these studies have yielded positive results. Due to weaknesses in study design, however, it is unclear whether the observed effects were due to specific therapeutic or nonspecific effects.

Ginseng and fatigue — A beneficial effect of ginseng on chemotherapy-induced fatigue was suggested by a pilot double-blind trial of 20 patients who were randomly assigned to ginseng supplements or placebo (from the same manufacturer) during chemotherapy. A second trial, involving 282 patients, randomly assigned patients to placebo or one of three doses of ginseng. Preliminary results of that trial also suggested some activity in treating cancer-related fatigue. Additional trials are required to determine whether ginseng has a role in treated cancer-related fatigue.

Fish oil for symptom control — Fish oil, which contains alpha-3 omega fatty acids, has been studied as a pharmacologic treatment for cancer-related anorexia/cachexia. At least one trial has examined the benefit of fish oil for control of cancer-related symptoms in addition to anorexia. Sixty patients with a variety of cancers were randomly assigned to fish oil capsules or placebo in addition to their conventional treatments. Among the 60 patients who both began and completed two weeks of their allotted therapy (27 dropped out during treatment because they could not tolerate the regimen), supplemental fish oil did not influence appetite, fatigue, nausea, weight loss, caloric intake, nutritional status or sense of wellbeing.

While the importance of cancer prevention has moved into the forefront of public consciousness, due to intense awareness campaigns by the cancer societies, the areas that include diagnosis, therapy and follow-up need to achieve similar recognition. Widespread passive follow-up ought to be replaced by an active treatment plan tailored to the respective indications of the patient's disease. In order to reach this goal, oncologists should aim to expand on proven complementary medicinal approaches and optimize the timing and the benefits of therapy.

 

Overview of Complementary Therapies in Oncology

Complementary medicine should primarily be regarded as an addition to or enhancement of current standard treatment options in oncology.

Nutrition

The National Cancer Institute (NCI) of the United States attributes about 35% of all types of cancer to malnutrition. The potential for prevention of cancer is thus large and general nutrition guidelines for primary and secondary prevention are of much value, according to the German Society of Nutrition (DGE) and the International Society for Nutrition and Cancer (9).

It is striking to see that both fruit and vegetables play a prominent role in the prevention of cancer. For almost every type of cancer, there is evidence of protective nutritional factors. Among the cancer promoting factors, obesity plays a major role in addition to smoking and alcohol. The role ofanimal fats as a carcinogenic factor remains unclear. Although fats are considered to increase the risk of cancer, there is neither compelling evidence from epidemiological studies nor any other indication that a causal relationship exists. This statement does not address the role of fats as an energy source or their possible role in the development of obesity.

Once cancer becomes apparent, the success of therapy and the healing process, are decisively determined by the patients nutritional state. Fundamentally, a specific advisory for the patient's optimized nutrition is of great importance at this point, since malnutrition and cachexia can have a significant effect on the quality and duration of life. Malnutrition increases cancer mortality by about 30%  and cachexia worsens the prognosis of disease significantly, since it is associated with reduced response to treatment, more complications from and adverse reactions to the treatment and prolonged hospitalization.

 

 

Exercise, Physical Activity

Exercise in the form of “moderate endurance training” (such as walking, jogging, swimming and cycling, all under strict aerobic conditions) and “focused gymnastics” (such as stretching, functional, water, spinal column gymnastics) have proved to be beneficial in the prevention and follow-up of cancer as well as during cancer destructive therapies.

Cancer imposes an enormous psychological and physiological stress on those afflicted, weakening the immune, hormone and other metabolic systems. Exercise, in contrast, ensures a certain tolerance to stress which can be developed particularly through endurance training. The diagnosis and therapy of cancer exert a maximum of stress that is processed in a variety of ways. Stress entails an adaption syndrome of neurovegetative and psychoimmunological regulatory circuits as a result of an acute or chronic challenge to the physical and psychological capabilities of the afflicted person. The patient can be trained to adapt to this burden by means of a coping strategy which includes physical activity.

Endurance exercise induces stress resistance and has beneficial effects on the psyche, thereby strengthening immune defences and the cardio-vascular, hormone and metabolic systems. Recently published clinical studies (RCTs, representing level I of the Evidence-based Medicine classification) proved in vivo the beneficial effects of moderate endurance exercises to cancer patients in the follow-up period and during standard therapies; significantly reduced frequency and severity of fatigue syndrome and other therapy related adverse reactions.

 

 

Psycho-oncological Support

Psychotherapeutic measures should be an integral part of any acute treatment or rehabilitation of cancer patients. It is widely known that disabilities may lead to psychosomatic diseases and that these can be relieved or even cured with appropriate psychological aid or therapeutic modalities. In addition, psychotherapeutic measures are indicated for dealing with the following types of problems or symptoms: emotional disturbances, such as fear or depression; conflicts within a relationship or family; impairment in social behaviour; social withdrawal tendencies; psychological impairment with physical decline or deterioration; problems in accepting the disease; discrepancies between therapeutic expectancy and actual treatment options and inadequate behaviour towards the disease.

Psychotherapy is an integral part of acute and rehabilitative treatment in oncology and it has proved its beneficial effects (for example improvement of quality of life and prolongation of disease free intervals) especially for breast cancer patients in well designed RCTs. Psycho-oncological treatment options (such as visualization, relaxation, creativity training and discourse) should be recommended individually and have recently been published.

Balanced Vitamin/Trace Element Mixtures

Cancer patients have an increased requirement for essential micronutrients that are rarely adequately supplied even through a wholesome and balanced diet. This especially holds true before or during cancer destructive therapy, since the need for micronutrients in these phases is increased due to side-effects such as reduced appetite, nausea, vomiting, diarrhea, and perspiration. It has been demonstrated that a deficit in micronutrients (vitamins, trace elements and minerals) results in a reduced tolerance of current standard cancer therapy.

 

For further study: http://www.uptodate.com/contents/patient-information-complementary-and-alternative-medicine-treatments-cam-for-cancer?source=see_link

Friday
Sep172010

Weird symptoms, helpless doctors. A lifetime of avoidable suffering in a young mother and her daughters

A young American mother with autoimmune hypofunctioning of her thyroid gland presents with typical symptoms such as tiredness, being cold, weight gain, chronic constipation, and menstrual irregularities. Once diagnosed, this condition is easy to treat by daily oral replacement therapy with the thyroid hormones levothyroxine T4 or triiodothyronine T3, or combinations of T4 with T3.
However, this lady proves resistant to therapy, her thyroid hormone levels in blood cannot be brought back to normal. Following years of crippling symptoms, an odyssey from renowned specialist to renowned specialist, her symptoms turn more and more weird, and weird symptoms become noticeable in two of her three daughters as well. In fact, the girls become even sicker than their mother complaining of bulky stools and abdominal bloating, accompanied by drastic mood swings and exhaustion, as well as neurological or behavioral symptoms such as anxiety, facial and vocal tics, one girl develops pica, an unusual craving for specific foods. Mother and daughters also suffer from skin manifestations, itchy skin eruptions, dry hair, dryness of the throat.

It took a simple blood test (a family doctor or nurse can do this test), followed by a gastroscopic biopsy for examining a sample of the lining of the small intestine with a microscope, to make the correct diagnosis of celiac disease in mother and daughters.

Celiac disease is an inherited condition that typically causes symptoms like diarrhea or constipation, weight loss, and a lack of appetite. These symptoms occur because the immune system responds abnormally to a protein found in certain foods, like wheat, rye, barley, and prepared foods. These proteins are called gluten. Celiac disease is also known as gluten-sensitive enteropathy, celiac sprue, and nontropical sprue.

The small intestine is responsible for absorbing food and nutrients, such as iron, or medicines such as thyroid hormones. Thus, if the immune system damages the lining of the small intestines, this can lead to problems absorbing important nutrients from foods; this problem is referred to as malabsorption.
Although celiac disease cannot be cured, avoiding foods that contain gluten usually stops the damage to the intestinal lining and associated symptoms.

The mother already greatly improved after a few months of gluten-free diet, she feels reborn and reports a surge of energy, her thyroid hormone levels are back to normal with usual dose oral levothyroxine T4 replacement. Her daughters will start the gluten-free diet in the next few days. Strict avoidance of gluten is necessary. Eating even small amounts of gluten can cause intestinal damage, allowing symptoms to come back. Eating a gluten-free diet can be challenging because it requires adjustments for both parents and children.

Convalescing child. Painted by Luigi Nono, 1889. (Finarte, Milano).

Always test for celiac disease in unexplained tiredness, weird symptoms of different organ systems that do not appear to be related, in children who have the following symptoms: Shortness or underweight for age, diarrhea for more than a few weeks, chronic constipation, recurrent abdominal pain, or vomiting, certain tooth problems, if puberty has not begun at the expected time, if iron deficiency has not improved with iron replacement.

For further study:
WARD, Laura S.. The difficult patient: drug interaction and the influence of concomitant diseases on the treatment of hypothyroidism. Arq Bras Endocrinol Metab [online]. 2010, vol.54, n.5, pp. 435-442. ISSN 0004-2730. http://www.scielo.br/pdf/abem/v54n5/02.pdf
http://www.thyroid.org/patients/ct/index.html
http://www.celiac.org/
http://www.csaceliacs.org/
http://www.cdhnf.org/wmspage.cfm?parm1=14