Exercise After a Cancer Diagnosis



Exercise may be the furthest thing from your mind after a cancer diagnosis; however, exercise that focuses on functional fitness will help you carry out the activities of daily living and return to the activities you enjoy.  A well-designed program can also decrease side effects and improve quality of life.

Each person is unique and heals differently. Moreover, there are many types of cancers, treatments and late-term side effects, each one affecting survivors in different ways. It is important, therefore, to work with a cancer exercise specialist or possibly a physical therapist who can design the best program for your unique situation and fitness level. Check with your physician or other specialist tracking your survivorship care for recommendations of qualified exercise providers.

For people who were active before surgery, it is imperative to slowly work back up to the previous level of activity. It is not wise to go back to a gym and continue with a pre-cancer exercise routine. Cancer survivors need to have patience; returning to your pre-cancer fitness level takes time and cannot be rushed. It is important to understand the implications of your particular surgery and the corrective exercises needed to improve recovery.

Some cancer survivors will need to exercise under supervision while others will be able to exercise independently. The type and scope of cancer and your overall medical condition and fitness level will determine whether a supervised program is needed. Even if you don’t need supervision, finding a program, either individual or small group, will help you to achieve your goals in a warm, friendly setting. The camaraderie and support of a small group can make taking care of your health enjoyable and fun.

Before beginning a cancer exercise program, you must receive medical clearance. But in general, an exercise routine should include aerobic exercise, strength training, stretching, and posture and balance exercises.  It is important to note that many exercises and movements may not be recommended based on a person’s fitness assessment, medical conditions, and particular surgery.

A good way to start an exercise program is through relaxation breathing, which can help reduce stress and anxiety. Inhale for five seconds and fill the torso up with air, then exhale from the lower abdomen for five seconds, pressing the navel in towards the spine. Imagine all of your tension and stress leaving your body with each exhalation.

Scapular retraction and shoulder rolls are a great way improve posture and prepare you for an exercise routineHold your arms at your sides, elbows bent to create a 90o angle. Firmly squeeze your shoulder blades together as you draw your shoulders and elbows back. Focus on squeezing your shoulder blades together as if trying to hold a walnut between them, then release to the starting position. For the shoulder roll, raise your shoulders up toward your ears, while inhaling slowly for five seconds. Slowly roll your shoulders backward and press them all the way back down, while exhaling slowly for five seconds. Increase the size of the circle with each roll.

As soon as you have medical clearance, you should start walking. Chemotherapy and radiation therapy can cause fatigue. It may seem counterintuitive, but physical activity can help boost your energy and improve your ability to tolerate treatments. You might be able to walk only a short distance at first. Every day, try to walk farther until you are able to walk for 30-45 minutes.

Once you start to exercise and have less pain, stiffness, and more energy, you will be motivated to continue. Cancer survivors who participate in exercise programs say that it is empowering and gives them a sense of control and accomplishment.

By: Carol Michaels

3D Printing and the Future of Breast Reconstruction

Many news outlets have reported recently on new research being performed just up the road in Austin, TX.  A company called TeVido is conducting research and experimenting with different 3D printing technologies and harvested human cells to create real nipples for breast reconstruction patients.

Crazy cool right?!?  For some added input, I reached out to a couple of the PRMA surgeons to get their thoughts on this new technology.

“3D printing is an emerging technology with tremendous potential.  However, this technology is still in its infancy and its applications within the medical field requires compliance with the same rigorous standards as with any other pharmaceutical or medical device before they are adopted. The current practice of nipple reconstruction using the patient’s own skin is a minimally invasive as well as a tried-and-true method used for many years with high patient satisfaction. In addition, being considered as a broadly accepted and integral component of breast reconstruction, thecurrent methods of nipple reconstruction are covered by insurance whereas experimental methods such as 3D-printed nipples, most likely, are not,” said Dr. Ochoa.

Dr. Arishita added, “Wow, this is a very exciting but a complicated, high tech way of treating a common problem. Women should also know that in some situations, their nipples can be preserved. Patients should ask their surgeon about nipple sparing surgery.

With the many options available today and the always progressing technologies, women have access to advance breast and nipple reconstruction options after cancer.

Although this innovative nipple creation technique is in the beginning stages, clinical trials could start in as little as two years.  What are your thoughts?

Chemo Infusion: Life is Good

I pulled my stool up and absently sterilized my lotion pump. She had just agreed to a foot massage. Chemotherapy dripped into the port in her chest.

Her husband tap, tap, tapped away on his computer in a chair behind me, listening without listening.

As she talked it became clear that it was the memory of past massages, long before cancer, that inspired her “yes”. She went on to explain that she was happy to receive the massage, but that the drugs had rendered her feet and lower legs essentially numb over a year ago. Her face was kind, apologetic.

“So, I don’t know that I’ll really feel anything.”

Placing my hands on her legs just below her knees, I began the session with a slow, still “hello” kind of contact.  I slid my hands down in small, deliberate movements suggesting that there was peace to be had here, even if it was only in my hands and only because we made ourselves go slowly.  I moved her pant leg up to her knee so I could apply some lotion to her lower leg and foot.

Before I completed the first stroke something shifted.

I slowed my pace even more, looking up to see what adjustment might be necessary.  What I saw brought a small swell of tears to my eyes.  She had closed her eyes and a faint, but unmistakable smile had crept across her lips and face.

I continued with my strokes.

A few seconds later, she squared her head, looked me in the eye and said. “I can feel that.” She looked off in the distance.  Searching somehow to confirm that what she had just said was true.  I waited a beat and then asked, “What’s the sensation?” It was actually a clinical question I was asking.  I wanted to understand what her nerves were telling her. Did it feel like dull pressure?…cold?…soft?…something else?

She thought for a moment and I watched her face surrender to a new expression. “Life is good.” It wasn’t a throwaway pleasantry.

It was a tender declaration, the truth of which seemed to surprise her as it came out of her mouth.

“Life is good.”, she said again wanting to be sure I understood.  Had I received it?…did I understand how hard it was to conceive of life being good, even if only in that moment, after more than a year of weekly chemotherapy and everything that goes with that? When advancing disease makes you acutely aware that every moment of “good” could be the last one?  She told me how easy it is to forget, “when you’re sick”, that life really is full of so much that’s good.  She took in a breath to say more, but instead just smiled again, choosing to stop there.

She sat back and closed her eyes, savoring the good.

I couldn’t possibly know how expansive that moment felt to her or to her dear and curious husband who sat dutifully behind me as I worked.  All I could know is that I was in the right place on this Tuesday morning in Washington, DC and that, once again, sitting still gave way to beautiful things.

PRMA Research Strives to Solve Unanswered Questions

The fields of breast cancer and breast reconstruction research have made incredible strides over recent years.  New advances in chemotherapy agents, genetics, and surgical management of advanced breast cancer continue to change the landscape of treatment on a regular basis.  Similarly, breast reconstruction research continues to significantly contribute to better patient outcomes following mastectomy.  Despite recent advances, many unanswered questions remain requiring continuous multifaceted efforts in order to provide patients with optimal results.

As nationally recognized leaders in breast reconstruction, PRMA is actively involved in various components of breast reconstruction research spanning both clinical and basic science fields.  In an effort to better characterize our broad involvement in ongoing research, a brief overview of a few of our current initiatives are presented:

Re-excision of residual cancer following mastectomy and reconstruction – In a small percentage of women undergoing mastectomy for breast cancer or pre-malignant lesions, residual cancer cells may be left behind at the previous location of the lesion(s).  Unfortunately, this is not usually discovered until thorough evaluation by a pathologist is completed a few days later.  Treatment of this residual cancer is controversial, especially after breast reconstruction has been performed immediately following mastectomy.  One option is radiation to the reconstructed breast in an effort to “kill off” any residual cancer cells.  Naturally, radiation can lead to unwanted short and long-term complications.  PRMA promotes an alternative option where patients undergo an additional surgical procedure where the residual cancer cells are directly excised.  Outcomes following this unique re-excision procedure related to reconstruction complications, cosmetic outcome, and most importantly, cancer recurrence are being submitted for publication.

Patient-reported outcomes following breast reconstruction – As reconstructive surgeons, our ultimate goal is to facilitate a patient’s recovery from breast cancer.  By providing patients with a sense of “wholeness” through breast reconstruction, patients are less likely to experience a lingering sense of loss, depression, or anxiety in social or intimate situations.  Through standardized questionnaires given to patients before and after surgery, PRMA has been able to identify specific factors such as age, body mass index, patient ethnicity, and others that are associated with obtaining a successful result from a patient’s point of view.  After all, shouldn’t success in breast reconstruction be defined by the patients themselves?

Extended lymph node evaluation – Determination of whether breast cancer has spread to surrounding lymph nodes is a critical component of proper breast cancer treatment by helping to accurately establish the “stage” of the breast cancer.  Based on the breast cancer stage, chemotherapy and/or radiation may be recommended in order to decrease the possibility of recurrence of cancer and increase survival.  Evaluation of lymph nodes in the axilla has long been considered the standard-of-care in determining lymph node involvement with breast cancer.  Although 25% of breast tissue drains into lymph nodes located along the breast bone (aka sternum) beneath the ribs, these nodes are difficult to access and are thus not routinely biopsied, potentially leaving involved lymph nodes unaccounted for and inaccurately staging patients.

In the majority of breast reconstruction surgeries that involve replacing the removed breast with the patient’s own tissue from the abdomen, thigh, or buttock area, these lymph node along the sternum are exposed and biopsied by PRMA physicians.  If cancer is identified in these lymph nodes, more accurate staging is established that may lead to changes in their cancer treatments.  PRMA is involved in determining whether these changes in cancer staging translate into improved outcomes and prolonged survival.

Radiation to the breast after immediate breast reconstruction –  Breast reconstruction at the same time of mastectomy (immediate breast reconstruction) is currently recommended only in early stage breast cancer (cancer < 5cm in diameter, < 4 lymph nodes involved).  If the breast cancer is diagnosed at an advanced stage and will require radiation even after mastectomy, reconstruction is not performed immediately but delayed until a later time (delayed breast reconstruction), which eliminates the psychosocial benefits of immediate reconstruction.  Delaying the reconstruction until radiation is completed theoretically decreases radiation injury to the flap of tissue used to reconstruct the breast.  This dogma was established many years ago when radiation delivery techniques were rudimentary and very imprecise.  Since that time, radiation delivery techniques have advanced significantly allowing only the target tissue to be treated with radiation while sparing adjacent harmless tissue such as the reconstruction flap.

Although PRMA still adheres to these recommendations, some of our patients have undergone immediate breast reconstruction with subsequent recommendations to receive radiation due to a larger-than-expected cancer or numerous involved lymph nodes identified after mastectomy.  PRMA is currently performing studies that evaluate the radiation-induced complications that are experienced by these unique patients on the side of radiation compared to non-radiated reconstructed breasts.  It is possible that due to advancements in radiation delivery techniques, radiated reconstructed breasts may have a similar complication profile than non-radiated breast reconstructions.  If true, immediate breast reconstruction could now be offered to patients with advanced breast cancer eliminating the need for delayed breast reconstruction.

Vascularized lymph node transfer – Upper extremity lymphedema is a tremendously debilitating complication of breast cancer treatment due to axillary lymph node removal.  The affected limb becomes swollen impairing function due to lack of lymphatic fluid drainage.  At PRMA, patients with lymphedema are treated with an adjunct procedure at the time of breast reconstruction where lymph nodes, normally located in the groin area, are transferred (en bloc) with the abdominal tissue into the affected axilla.  With addition of groin lymph nodes into the affected axilla, re-establishment of lymph drainage may be promoted alleviating swelling and improving function.  We are currently evaluating the objective benefit (and possible complications) of such lymph node transfer procedures.

Genetic mutations promoting hereditary breast cancer – The fields of molecular biology and genetics have contributed significantly to our current understanding of breast cancer.  With identification of mutations in certain genes, lifetime risk of development of breast cancer in affected individuals is as high as 90%.  Young women that are diagnosed with one of these genetic mutations are often undergoing preventative mastectomies in order to eliminate the possibility of developing breast cancer in the future.

Our current understanding as to how these genetic mutations predispose an individual to develop breast cancer is still lacking.  PRMA is collaborating with UT Health Science Center San Antonio in a joint investigation utilizing the latest molecular techniques on PRMA patient tissue samples in order to better elucidate the mechanism involved in the development of breast cancer.

By: Dr Gary Arishita

MAITAKE MUSHROOM: Powerful immune support

Maitake mushroom is an edible mushroom from the species, Grifola frondosa. It is consumed widely in Asia as food and has a long history of use in traditional Asian medicine for numerous health-promoting purposes. Most Basidiomycetes mushrooms contain biologically active polysaccharides in their fruit bodies, culture mycelia, or culture broth.

Mushroom polysaccharides exert their antitumor action by activation of the host immune response. Beta 1,6-glucan, a protein-bound polysaccharide, has been identified as the active ingredient. The mushroom β-glucans, resembling bacterial cell walls, complex with complement on macrophages and activate an immune response, leading to release of various cytokines that are active in tumor inhibition. An intact T-cell immune system is essential for the antitumor activity of medicinal mushrooms.

The Maitake D-fraction, a bioactive extract, is a protein-bound polysaccharide (proteoglucan) that has been most widely studied as an adjunct to conventional radiation and chemotherapy. Interest in the West in the investigation of medicinal mushrooms as potential anticancer agents was piqued by epidemiological studies from Japan and Brazil suggesting that long-term exposure to local medicinal mushroom species was associated with lower cancer mortality rates.

Mechanism of Action in Cancer Care and Clinical Trials

Maitake mushrooms and the Maitake D-fraction prepared from them contain a type of polysaccharide (a large molecule formed by multiple sugar molecules linked together), called beta glucan (sometimes called beta glycan). Beta glucan is found in several mushrooms, yeasts, and other foods. A polysaccharide is a large and complex molecule made up of smaller sugar molecules. Beta glucan is believed to stimulate the immune system and activate certain cells and proteins that attack cancer, including macrophages, cytotoxic T-cells (Tc), natural killer cells, interleukin-1 and -2 and lymphokines. The end result is an increased defense against infections, AIDS, and cancer.

Maitake D-fraction in particular seem to have a specific antitumor action, potentially slowing the growth of tumors in the colon, lungs, stomach, liver, prostate, brain, breast and other organs. (It should be noted that any research references to the D-fraction also apply to the MD-fraction, as they are the same beta 1,6/ 1,3 glucan derived from Grifola frondosa.) Centers in the United States have begun to treat cancer patients with the D- and MD-fractions. For example, in February 1998, the U.S. Food and Drug Administration approved an Investigational New Drug Application (IND 54,589) for researchers to conduct a Phase II pilot study on the D-fraction’s potential effects on advanced breast and prostate cancers.

Maitake researchers have identified several ways Maitake can counter cancer:

1) By protecting healthy cells from becoming cancerous
2) By helping to prevent cancer metastasis
3) By slowing or stopping the growth of tumors

Studies have confirmed all three of these potential benefits. Preliminary but unpublished clinical data from a non-controlled study also suggest a fourth potential benefit: Maitake may work in conjunction with chemotherapy to lessen its side effects, such as hair loss, pain, and nausea, and to boost its positive effects.

The presumed mechanism of action of the Maitake mushroom has been assumed to be that of a biologic response modifier, providing T-cell dependent immune enhancement and activation that enhanced antitumor effect. Moreover, Maitake has also been to shown to effectively inhibit angiogenesis by blocking VEGF signaling. Most of the research on Maitake D-fraction has been done in Japan using an injectable form of the extract. A 1997 study published in the Annals of the New York Academy of Science found that Maitake D-fraction was able to enhance the immune system and inhibit the spread of tumors in mice implanted with breast cancer. In a 1995 report published in the same journal, researchers concluded that Maitake D-fraction was able to activate the immune systems of mice that had been injected with liver cancer cells. The extract seemed to prevent the spread of tumors to the liver and prevent the development of cancer in normal cells.

When Maitake D-fraction was given to patients receiving chemotherapy for a number of different cancers, response rates reportedly increased from 12% to 28%. Various chemotherapy side effects were also said to be ameliorated in patients receiving Maitake D-fraction. In the absence of toxicities, it is felt to be a useful adjuvant to chemotherapy. A recent study suggests a direct antitumor effect of Maitake D-fraction with induction of apoptosis observed in breast cancer cell lines. A trial of Maitake extract as treatment for breast cancer is also in progress.

Safety and Side Effects

The Maitake mushroom is edible and generally regarded as safe. There are no reported side effects of the mushroom extracts or the Maitake D-fraction. As Maitake may lower blood sugar, it should be used with caution in patients with diabetes on hypoglycemic agents with careful monitoring of glucose levels while a stable dose is being established. Patients with lymphoproliferative disorders should avoid taking this.

About the Author

Jonathan C. Cheng, M.D., Ph.D. is a board-certified radiation oncologist, who serves on the scientific board of advisors for ONCUCARE. He specializes in integrative oncology, which uses complementary therapies in concert with medical treatment to enhance its efficacy, improve symptom control, alleviate patient distress and reduce suffering.

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    By Dr Jonathan Cheng

One Not-So-Fun Winter in the Life of a Cancer Survivor

Malingering, Moribund Malaise Or,One Not-So-Fun Winter in the Life of a Cancer Survivor

Sheepish admission: It’s been awhile since my last column.  I’ve started and discarded several topics in the past few months. I’d talk out my idea, scribble down some notes, and write a few paragraphs, but ultimately I lacked the necessary enthusiasm to finish anything. My righteous indignation flared up half-a-dozen times but the fires never held and my writing synapses remained dull and dormant.

The long, cold winter didn’t help, but that’s just a handy excuse.  Truth is, my mental and physical well-being haven’t been the greatest. After a long stretch of relative calm, I’ve settled back into my ugly Post-Cancer Cycle:  Feeling good and healthy and physically strong and then BAM…. A few weeks of back pain or other physical symptoms and I catapult back into depression and anxiety. For me, the component of exercise = wellbeing is so strong that any period of physical inactivity brings me down.

For six weeks I struggled with intermittent lower back and shoulder pain. To determine if my deep, hip-opening pigeon pose was contributing, I stopped yoga for a month. NOT easy for an exercise junkie.  Instead of yoga, I binge watched “Dexter” and swore I could feel my thighs expanding as I joined the cat on the sofa, a jar of peanut butter in hand. Worse than my physical state was my mental state as I was convinced cancer was seeping into my bones.

By mid-December my body felt much better and I was optimistic.  For a month and a half I was at the top of my game: ice climbing, snow shoeing, and ice skating. I felt awesome and powerful. Then…. Booooom. In early February, I strained my surgery arm while ice climbing. Nothing serious, but it took longer than I thought it should to heal.

Again I was sidelined from yoga (aggravated by my monumental mistake of deciding that the arm pain was really just my body “needing yoga.” Ouch, ouch, ouch, OUCH. Can chemo brain also make you stupid??).  The familiar twinge in my lower back returned, compounded by a worsening of chronic arthritis in my knee from past knee surgeries. Suddenly, on top of everything else, I was limping enough that coworkers commented on it.

The aches and pains weighed on me, and worse, my paranoid subconscious seized on them and started to drag me back into anxiety.  Were the cumulative effects of Tamoxifen finally kicking in after three years? Was the drug contributing to my knee issues?  Were my lower back and shoulder pains from something more insidious than athletic strain? Was my cat just using me for food?? I had seen my oncologist at the end of January when I felt great and had no complaints. Now, mere weeks later, my mind quickened with foreboding.

By early March I was feeling better on all fronts… and THEN I caught a cold that turned into a three-week sinus infection, complete with fever and nasty cough. 2015 had officially gone off the rails. Excepting work, I barely moved off the sofa for two weeks. The cat and I snuggled and finished all 8 seasons of “Dexter” (with both of us hating the ending), but as March, the winter, and I all limped along, I felt darkness. (The good news: not doing any exercise whatsoever made my back and shoulder pain disappear.)

At the tail end of this, I received a message from 4Wholeness, asking if I had anything percolating in my brain for a column.  Since I’d been about as productive as a slug for a month, the e-mail smarted, especially when I read: “If you are moving on to health and vitality and the BC trauma is no longer something you put energy into, that is super as well.”

Way to kick a girl when she’s down! This particularly stung, because as any reader can tell, I had sunk into a bit of a depression…. with lingering BC trauma the root cause. Three-and-a-half years out of my diagnosis, I’m still far away from “moving on” from breast cancer.

This could easily be my own personal sad sack story as a cancer survivor…. Except it’s not.  I know and speak to many women who struggle with the enduring effects of a cancer diagnosis and of cancer treatments. I am not alone in this lingering malaise. It’s no stretch to say we suffer from a form of post-traumatic stress disorder.

Cancer is the ultimate mind fuck. If cancer “only” stole my breast and my fertility; only ruined my finances for a few years; and only left me with permanent scars and residual physical effects from chemo… I’d be cool with that.   Really!!!  No one lives unscathed by tragedy and this is mine.  I’d even be okay taking tamoxifen for ten years. Chemical and/or early menopause ain’t for the faint of heart, but it’s manageable.

But cancer is insidious. It doesn’t just burn like a flash fire, never to return. It can hide and linger, as stealthy and as deadly as a ninja. It can lurk in hiding and rear its ugly head in your body years after initial diagnosis. And that’s the mind fuck. Some cancers have a five-year survival mark when the chances of reoccurrence go down markedly once the patient is five years past initial diagnosis.  Not so with ER/PR positive breast cancer. The risk will always be there. Better put: the fear of reoccurrence will always be there. And with almost a third of all breast cancers eventually going metastatic, I really struggle with this fear. When I was first going through treatment and thinking a lot about mortality, I used to shrug and say, “Well, I could get hit by a bus tomorrow, too!”  Now I know better. It isn’t the thought of a quick and nonsensical death that haunts me, it’s the thought of being sick again, permanently, which haunts me.

Friends ask how I’m doing and I almost always say “Fine” or “Okay” with no embellishment. Experience has taught that “normal” friends neither understand nor frankly want to hear about my aches and pains and my fears. I don’t fault them for it, but I do feel alone.

Because I’m not always fine or okay and sometimes I am not doing well at all. And even though I have so much to be thankful for and I live a full life, I cannot snap my fingers and “get over it.” Instead, I plod along…  sometimes persevering and prospering, sometimes barely coping.  The mantras extolling “live in the moment” elude me, as does my former, carefree self (if she ever existed at all). She is forever gone.  But as the memory of winter wanes and spring blossoms in the warm breeze, my body heals and I feel the pulse of movement again…. Invigorating, intoxicating, and healing. I breathe and I hope. For all of us who tread this uneven path of survivorship.

 

Jennifer Jaye is an editor, writer, actress, yogini, former karate instructor, and in her newest role, a cancer survivor. She lives, works, and plays in New York City as she attempts to navigate life as a young survivor of breast cancer.  

 

The Year of Living Vulnerably

To run from vulnerability is to run from the essence of our nature, the attempt be invulnerable is the vain attempt to become something we are not…       –David Whyte

My heart is broken. I am tired of pretending that it isn’t. It breaks regularly or at least it cracks and I push hard against it to hold it together.

Last Wednesday, two dear friends and I scheduled a 6-hour retreat for ourselves.  Nothing extravagant.  Just the three of us, some silence in one of their living rooms and a few very simple, but potent heart-centered exercises.

I had been looking forward to this for weeks, but when my alarm went off on Wednesday morning it took every ounce of courage I could muster just to get out of bed.  I have done enough retreats to know that if you really show up, you will meet yourself and there will be no lying about what you see.  How painful that experience is depends on just how far I am from myself at the time.

I woke up Wednesday morning afraid.  I was not prepared to feel. I didn’t have time for it.

The feeling in my gut was unmistakable and it was quickly followed by an incredulous realization. “Wow.  You’ve really gotten away from yourself, haven’t you? Are you sure you want to do this?” The thing is that it doesn’t matter how many times you walk that path back to yourself.  It never gets worn.  You have to take your machete every time and blaze that trail again. A big part of me was very very afraid of that.  My hands were gently taken and I was hoisted out of bed by some much wiser, deeper part of me that was more clear than fear.

When I arrived at our wee retreat, the sight of my friends’ faces began a reluctant thaw. I showed up protected.  Arms crossed, but the warmth of gratitude for these two women who have become so important to me as friends, advisers and expert laughers and joke tellers crept around the edges of my heart.   Fingers of vulnerability spread out in all directions threatening to crash straight to the ground all that I had been holding up.  A softness wanted to be allowed.

We went to our cushions to meditate.

My mind growled and sniffed and salivated like a junkyard dog.  The time flew by as my thoughts raced.  It did not occur to me a single time to “go back to the breath”.  It felt like an endurance race and I had eaten a Twinkie and a Coke for breakfast.  Just. Sit. Still.

As we shared about our sitting it became clear that I was not alone.  Fear had come along on some level for all of us.  It wanted to be heard.  It was getting too big.

Over the next hour, each of us took a turn being asked by another, repeatedly, tenderly, persistently “What are you afraid of?”. Over and over.

It always starts a bit small with this technique.  “Spiders.” “Dying.” “Whatever.”.…but by the 5th minute or the maybe the 9th, truth was just spilling from my face. Pieces of my broken heart were flying out of my mouth as tears streamed down my cheeks.

I’m afraid that I am going to make the wrong choice about what to do next. I’m afraid of being hurt by people I trust. I’m afraid of wasting time, of letting others down, of being “so fucking little!”, of being in debt for the rest of my life, of working, working, working so hard until I just die and there’s hardly enough left of me to bury or burn.  I’m afraid that someone I love and trust will molest my son and I won’t know about it until years later. I’m afraid my body will fail. I’m afraid that my son will remember his childhood as an endless stream of mama saying, ‘I’ll be right there.’.  I’m afraid that my family will get so used to me being away for work that they’ll decide it’s better without me. I’m afraid of not really knowing my parents before they die. I’m afraid that everyone will find out that I can’t really be trusted with anything at all.

As it turns out, I feel fearful. A lot.

What’s more important than the fear itself is my relationship to it. When I got home?…after naming and sharing all of that fear?…I felt lighter.  I felt a vague freedom. Then something bigger and more concrete happened. I started noticing all of the places where I am making my life harder. Where I am denying myself access to creativity and flow because I’m afraid to be vulnerable.  Everything I fear boils down to the inescapability of vulnerability. All of it.

This is not for fixing. Please resist any urge to offer me kind words of support unless they are, “Me, too.  I feel fearful, too.”

This is what it is to be human. This doesn’t meant that I don’t live or that I live in fear.  It doesn’t mean that I just accept “wasting time” or that I wallow in my physical and relative smallness in this enormous world.

It means the end of pretending that I’m not afraid.  It means when I feel fear I will get out my flashlight instead of looking the other way. I will not neglect it and hope it goes away. It means no more propping up. It means embracing a new kind of affirmation.

Things are scary.  I am breakable. There is no control. I’m exhausted by my own lying about these truths.

I will smile at and acknowledge fear when it comes to sit at my table.  I will let it sit next to me as I get on a plane to Australia because my fear of dying in a plane crash is not as important as my desire to spend my time well, but I will still be afraid. It means asking my friends and my family real questions and waiting for real answers, even though I’m afraid of scaring them and myself.

It means no more small talk. It means juicy, real minutes that mean something and not because I am inventing meaning for them because it hurts too much to do anything else, but because I’m paying close enough attention to feel what’s there, even when it does hurt too much or if that meaning lies in the counter-pressure provided by fear.

No more pretending.  No more staying busy to avoid feeling.  No more being angry to cover up hurt. No more “Well, if they wanted to see me, they’d call me.”

No more defending my position.

I hereby declare 2015 The Year of Living Vulnerably. I’m going to seek out opportunities to experience and embrace vulnerability. I won’t have to look far.  I’m going to say what’s true and take a ringside seat at the constant breaking of my own heart. Curiosity. Surprise. Pants-down-in-front-of-a-crowd-of-strangers vulnerability. I totally don’t get the joke vulnerability. Broccoli in my teeth at a fancy party vulnerability.

It’s time to put my softest, most breakable foot forward.

Happy New Year!

By: Lauren Cates

Cannabis and Cancer: Prescribe 5 different drugs or simply one botanical…your choice

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This is a completely non-political blog entry on the science of the medical efficacy of Cannabis (marijuana) in oncology.  Cannabis is plant that is classified in the U.S. as a controlled substance with an “increased potential for abuse and no known medical use” (Schedule 1). By federal law, possessing Cannabis, is illegal in the U.S.  Although U.S. federal law prohibits the use of Cannabis, 16 states and the District of Columbia permit its use for certain medical conditions with a physicians’ prescription. That said, doctors in these states may not legally do so without violating federal law and can lose their federal license to prescribe drugs and be prosecuted. Presently, 3 states (Colorado, Maine, and New Mexico) license producers and distributors of medical cannabis. Now that I have established that, let’s learn more.

WHAT ARE THE ACTIVE COMPOUNDS IN CANNABIS?

There are over 400 chemical compounds that have been discovered within the Cannabis plant. The phytocannabinoids (or simply,” cannabinoids”) are the main chemical components that exert most of the pharmacological activity of the plant. There are more than 60 identified cannabinoids, but the 4 most well-studied and characterized cannabinoids are delta-9-tetrahydrocannabinol (d-9-THC), cannabidiol (CBD), cannabinol (CBN), and tetrahydrocannabivarin (THCV).cannabinoid molecules

Cannabinoid compounds are currently available as either synthesized chemicals or whole plant extracts, including:

Interesting references:
  • Here’s a great article on the development of Sativex. (Mother Jones)
  • Review articleon the differences between Marinol and Cannabis (NORML.ORG):
    • Summary of key points: 1) Marinol lacks several of the therapeutic compounds available in Cannabis, 2) Marinol is more psychoactive than Cannabis, 3) Cannabis vaporization offers advantages over orally administered THC, 4) Marinol is more expensive than Cannabis, 5) Patients prefer Cannabis to Marinol

WHAT IS THE ENDOCANNABINOID SYSTEM?

Perhaps the most exciting area of cannaboid research involves the discovery of the body’s endocannabinoid system. Incredibly, our bodies make their own cannabinoid chemicals which interact and stimulate cannibinoid receptors on our cells. Studies continue to uncover the numerous functions of our endocannabinoid system, including:

  • anti-inflammatory activity: anticancer
  • antioxidant activity: anticancer
  • inhibiting tumor cell growth (apoptosis): anticancer
  • inhibiting blood vessel growth to tumors (anti-angiogenesis): anticancer
  • antiviral activity
  • involved in learning and nervous system plasticity
  • pain processing
  • neuroprotective effects
  • visual perception
  • immune system modulation: anticancer
Learn more about the endocannabinoid system (Nature Reviews)

ROUTES OF USE OF CANNABIS:

pax vaporizerCannabis may be taken by mouth (i.e. baked products, butters, teas, liquid sprays and tinctures, gum, beer, etc.) or may be inhaled, through smoking or vaporizing (read my blog entry on vaporization). One of the most safe and consistent methods of obtaining a controllable dose of active drug when using Cannabis is through vaporization.

It takes over one hour for Dronabinol (Marinol) to reach full systemic effect, compared to minutes for smoked or vaporized cannabis.

Is Smoking Marijuana Safe? A new research study has found that habitual use of marijuana DOES NOT appear to lead to  abnormalities in lung function, nor does it increase the risks of COPD (chronic obstructive lung disease) or either lung or upper airway cancer. It is associated with an increase in symptoms of chronic bronchitis; however the symptoms go away upon discontinuation of use.

That said, I still would prefer that my patients vaporize versus inhale smoke.

USES OF CANNABIS IN ONCOLOGY:

As an integrative oncologist, I recommend the use of various methods for helping patients manage commonly encountered side effects and symptoms of cancer treatment and the cancer itself. Whenever possible, I start by suggesting non-pharmacologic therapies that have been shown to be effective, safe and are inexpensive. If the symptoms are moderate-to-severe or unlikely to be able to be controlled with non-pharmacologic approaches, this is when I will recommend using natural botanical products and/or pharmaceutical drugs.

5 commonly experienced symptoms in cancer patients are:

  • nausea
  • diminished appetite (and associated weight loss)
  • pain
  • sleeping difficulties
  • psychoemotional distress (i.e. anxiety, stress and depression).

Cannabis (as the whole plant compound) and the synthetic and extracted delta-9-tetrahydrocannabinol (d-9-THC) and cannabidiol (CBD) have all been shown to have significant efficacy in improving these 5 common symptoms in clinical trials.

Your physician would need to prescribe 5 different drugs to (with the associated side effects and costs) to manage these symptoms…or you they can prescribe one drug which improves all 5 symptoms.

If only one or two of these symptoms are causing significant problems, I typically don’t recommend using a cannabinoid since other pharmacologic options may be more effective in treating those individual symptoms. Unfortunately, it is quite common to see patients with the majority of these symptoms manifesting at once (particularly in advanced stages of disease and treatment). For these patients, I think it is very appropriate to recommend a cannabinoid or Cannabis by itself or in combination with other pharmacologic (i.e. Megace for poor appetite, Zofran for nausea, etc.) and non-pharmacologic therapies (i.e. mind-body therapies, etc.)

Recently reported data indicate that the combination of inhaled Cannabis (via vaporization) with opioid pain medications leads to a synergistic affect, which decreases the amount of opioids needed for pain control. This synergistic action helps patients by reducing the side effects of higher dose requirements of opioids (i.e. sedation and nausea).

IS THERE ANY VALIDITY IN THE USE OF CANNABIS AS AN ANTICANCER AGENT?

marijuana scienceThere are no quality clinical studies in humans that have been done for us to know if Cannabis or any of the cannabinoids are able to improve cancer-specific outcomes (i.e. survival, recurrence, progression).

There are interesting and promising preclinical studies (using cancer cells or animal studies) that demonstrate the anticancer activity of cannabinoids:

(from the U.S. NCI PDQ: Cannabis and Cannabinoids):

  • “Studies in mice and rats have shown that cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels needed by tumors to grow.”
  • “Laboratory and animal studies have shown that cannabinoids may be able to kill cancer cells while protecting normal cells.”
  • “A study in mice showed that cannabinoids may protect against inflammation of the colon and may have potential in reducing the risk of colon cancer, and possibly in its treatment.”
  • “A laboratory study of delta-9-THC in hepatocellular carcinoma (liver cancer) cells showed that it damaged or killed the cancer cells. The same study of delta-9-THC in mouse models of liver cancer showed that it had antitumor effects. Delta-9-THC has been shown to cause these effects by acting on molecules that may also be found in non-small cell lung cancer cells and breast cancer cells.”
(from NORML.ORG)
  • Glioma and other cancer cell types: 
    • “In addition to cannabinoids’ ability to moderate glioma cells, separate studies demonstrate that cannabinoids and endocannabinoids can also inhibit the proliferation of other various cancer cell lines, including breast carcinoma,[11-15] prostate carcinoma,[16-18] colorectal carcinoma,[19] gastric adenocarcinoma,[20] skin carcinoma,[21] leukemia cells,[22-23]neuroblastoma,[24] lung carcinoma,[25-26]uterus carcinoma,[27] thyroid epithelioma,[28] pancreatic adenocarcinoma,[29-30], cervical carcinoma,[31]oral cancer,[32] biliary tract cancer (cholangiocarcinoma)[33] and lymphoma.[34-35]
  • Colon cancer:
    • “Although cannabidiol has been shown to kill glioma cells, to inhibit cancer cell invasion and to reduce the growth of breast carcinoma and lung metastases in rodents, its effect on colon carcinogenesis has not been evaluated to date. This is an important omission, since colon cancer affects millions of individuals in Western countries. In the present study, we have shown that cannabidiol exerts (1) protective effects in an experimental model of colon cancer and (2) antiproliferative actions in colorectal carcinoma cells.”
  • Breast cancer:
    • “The administration of THC reduces the tumor growth of metastatic breast cancer and “might constitute a new therapeutic tool for the treatment” of cancerous tumors, according to preclinical data published online in the journal Molecular Cancer.”

So, when asked by my patients if using Cannabis or cannabinoids can help improve their cancer-specific outcomes I can only point to preclinical data on that question. We know that many seemingly amazing outcomes have been reported in preclinical studies, only to later have no effect in human studies. Therefore, it is important to recognize the limitations of projecting preclinical outcomes to human study outcomes.

WhatIfCannabisCuredCancer-posterHere’s a fantastic 50-minute documentary (What if Cannabis Cured Cancer). Dr. Andrew Weilwrites “What If Cannabis Cured Cancer summarizes the remarkable research findings of recent years about the cancer-protective effects of novel compounds in marijuana. Most medical doctors are not aware of this information and its implications for prevention and treatment. This documentary presents compelling evidence that our current policy on cannabis is counterproductive and foolish. An excellent film.”

SAFETY OF CANNABINOIDS:

According to a 1995 review prepared for the World Health Organization, “There are no recorded cases of overdose fatalities attributed to cannabis, and the estimated lethal dose for humans extrapolated from animal studies is so high that it cannot be achieved by … users.”

In 2008, investigators at McGill University and the University of British Columbia reviewed 23 clinical investigations of medical cannabinoid drugs (typically oral THC or liquid cannabis extracts) and eight observational studies conducted between 1966 and 2007. Investigators “did not find a higher incidence rate of serious adverse events associated with medical cannabinoid use” compared to non-using controls over these four decades.

Pharmacologic studies indicate that a human would need to eat 1,500 pounds of Cannabis within 15 minutes to achieve lethal levels of cannabinoids.

That said, cannabinoids are active drugs with potential side effects and risks.

Potential side effects of cannabinoids may include (from the NCI PDQ):

  • Rapid beating of the heart.
  • Low blood pressure.
  • Muscle relaxation.
  • Bloodshot eyes.
  • Slowed digestion and movement of food by the stomach and intestines.
  • Dizziness.
  • Depression.
  • Hallucinations.
  • Paranoia.

Both Cannabis and cannabinoids may be addictive. Symptoms of withdrawal from cannabinoids may include (from the NCI PDQ):

  • Restlessness.
  • Hot flashes.
  • Nausea and cramping (rarely occur).

References on safety and risks:

Clinical Trials of Cannabis or Cannabinoids in Cancer

In preparing this blog entry, a search of the U.S. NCI Clinical Trials website (with search keywords: cannabis, cannabinoid, THC) identified 5 registered phase 2 and phase 3 clinical trials that are currently active or approved for studying the effects of these agents in patients with cancer. Unfortunately, none of these studies involves the use of the whole plant (Cannabis).

CLEARING THE SMOKE: THE SCIENCE OF CANNABIS

MontanaPBS’s new documentary, Clearing the Smoke, reveals how cannabis acts on the brain and in the body to treat nausea, pain, epilepsy and potentially even cancer. Extensive interviews with patients, doctors, researchers and skeptics detail the promises and the limitations of medicinal cannabis. (57 minutes. February 2011)

 

The Science of Medical Cannabis: A Conversation with Donald Abrams, M.D.

Donald Abrams, M.D. is chief of Hematology and Oncology at San Francisco General Hospital and the co-author with Andrew Weil of Integrative Oncology (Oxford University Press). Abrams has extensive experience working with cancer and HIV/AIDS patients and is a pioneer in the field of medical cannabis research.

Dr Sanjay Gupta: Why I Changed My Mind On Weed (CNN)

Dr. Sanjay Gupta says we have been “systematically misled” on marijuana. Watch the video.

 

MARIJUANA GATEWAY TO HEALTH: HOW CANNABIS PROTECTS US FROM CANCER AND ALZHEIMER’S DISEASE

marijuana gateway to healthClint Werner is a recognized expert in the science, history and politics of Cannabis. This excellent book is a review on everything you ever wanted to know on this subject. It is up to date, scientific and factual, which appealed to me over a biased rant. (published: September 2011).

 

 

 

 

 

 

 

I recently found this well-written article reviewing the commonly asked questions about whether cannabis has anti-cancer efficacy, safety issues, conspiracy theories and legalization. 

By Dr. Brian Lawenda

Vulnerability: Saying Unpopular Things

“Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” –Susan Sontag

“How are you today?”, I ask as she pushes through the door into my office.  She scolds herself, “I’m flunking cancer.” and slumps onto the couch in my office.  I try to maintain a purely curious and interested expression as I resist the urge to suggest that this assessment of her situation is impossible lunacy.  She goes on to tell me that she doesn’t “feel very pink” and “there are a lot more moments when I’m afraid or tired or something other than hopeful.”

This is how she’s “flunking” cancer.  She’s not doing it like she’s “supposed to”.

Strolling through CVS later that day, I’m stopped in my tracks by a close-up of yet another smiling celebrity’s bald head and professionally made up face on the cover of a popular magazine declaring “I will beat this!”  And there you have it.  The origin of my client’s story about how she is “supposed to” do cancer.  Certainly not this particular magazine cover, but the thousands of others just like it that fill the world with beauty and safety and the illusion of ground under our feet.

These messages are for the well.  They give birth, over and over, every day, online, on magazine racks, on TV, to our favorite shared delusion that a positive attitude can overcome any medical reality and that death never takes someone while they’re smiling.  Trouble is, when fate and biology conspire down the road and extend a hand with a Sick passport and ask us to turn in the Well one, we take with us these lessons we learned when we knew it would never happen to us.

No tired.  No scared.  No pale or nauseated.  We should smile and make broad, hopeful declarations about how we’ll prevail.  Because, after all, isn’t this how it’s done?  If I die?…that’s on me.  Fight to win.

Dear popular media, please stop.  You’re not qualified to address this experience.  Cancer, cancer treatment and all of its layers and deeply textured emotional, physical and spiritual landscape are out of your league.  You’re dating up.  It’s making you look bad and it’s making real people feel worse.  Your pretty, hopeful images are shaming people who are not so pretty or so hopeful and who, quite frankly, are really busy trying to hold down jobs, raise kids, maintain marriages, care for pets and make the most of treatment so they can just live.

I’m open to the possibility that I’m cranky because it feels like cancer is punching people I love in the stomach right now, but I’m exhausted by the subtle tyranny of smiling faces on bald heads declaring the right way to face scary things.

Stephen King’s treatise on fear, Danse Macabre, invites us to consider that “Nothing is so frightening as what’s behind the closed door.” Fear and hope are powerful. I’ve never been diagnosed with cancer, so maybe I’m woefully unqualified to weigh in on this at all, but it seems that being diagnosed with cancer is not unlike being marched, at gunpoint, up to a closed door that doesn’t look like any other door through which you have ever had to walk. This is a frightening proposition.

Fear motivates us and paralyzes us. It stifles us and enlivens us.

Fear is essential to our nature, yet we fear fear. Most of us take our fear of fear and habitually, automatically replace it with something, anything.  We cover it with hope.  Like pinballs, we bounce off of fear.  We keep moving.  Fast as fast can be, you can’t catch me.

It’s a hit and run.  The injustice of the whole thing…treatment or the disease itself, take your pick…is so shocking, so unthinkable, it leaves most of us gasping, despite its ubiquity.  We make it pink (or orange or green or whatever ribbon of hope is assigned) and believe this sales pitch will let us take a full, deep breath from a safe distance. Then we look around nervously to see who’s buying.

When I look into the eyes of these cancer cover girls, I see fear…and many other things in addition to hope.  I see it because it’s there and I see it because I’ve seen it in the eyes of hundreds of people over the years working through cancer.  And why shouldn’t there be fear?…but that fear is reduced to a sound byte.  A simple nuisance.  It’s usually something along the lines of, “Sure, there’s fear, but you can’t let that rule you.  You have to stay positive.”

Ok.  Sure.  That’s one way to spin it…and that way works for people with amazing lung capacity who can hold their breath for a year or three or six or 60, but what about my clients who come in looking like they’ve seen a ghost?…the ones who awoke at 3am and, in those surreal hours of the dark morning, became utterly convinced that they were going to die from cancer or a blood clot or that their children were going to lose their mother?…the ones who, despite having a husband or wife in bed next to them at that 3am wake-up, tell me about having felt more alone than they ever have in their whole lives?  Those are the stories I hear.  These are the scenarios that seem to be happening to people who aren’t on magazine covers or going viral on the internet.

I want someone to say, “Let me tell you more about fear, about anticipation, about waiting for shoes to drop, about the moment my port came out and I rang the bell.  There’s a taste.  This thing has a texture.  It has legs and arms.  I’ve looked into its eyes.  Its gaze is not broken by hope.”

Fear is rich, real and human. And, like all emotions, fear is temporary if we let it out in the light of day.  This is where the rubber of the dual citizenship of sick and well meets the road.  We don’t like to admit it, but well people fear sick people and they fear them more when they’re “not being very good at being sick”.  And sick people are afraid of “letting down” well people  and their illusions by “doing it wrong”. Then the sick and the well get in the car together, eyes on the road, riding along silently hoping there’s enough gas to get to their destination…wherever that is.

Cancer is scary for a lot of people.  Me?…I’d buy 10,000 copies of the first mainstream magazine that shows a pale, tired, uncertain face above the headline, “I have no idea how this is going to turn out.”

Here’s what I know. This is not an either/or proposition. Owning fear and taking away hope are not the same.

We can have hope while also being honest about fear and all of its shades and disguises. It is not a failure to give all of our feelings a fair hearing. It’s imperative.  On any given day my own emotional pedometer would easily show 20,000 steps along the continuum between hope and fear and I don’t even have cancer.  I’m not broken. I’m not sad. I’m real and I have no idea what I would do if I was diagnosed with cancer. Please show me that, if that day comes, people who have walked that path before me had feelings…lots of different ones.

By Lauren Cates

CURCUMIN: Nature’s anti-inflammatory wonder

Curcumin is the major component of the Indian spice turmeric (Curcuma longa).  It has been used for thousands of years in the Orient as a healing agent for variety of illnesses. The ancient texts of Ayurveda (the science of long life) and traditional Chinese medicine describe the use of turmeric for the prevention and cure of several health problems and to improve general well-being.

It has attracted enormous interest because of its anti-inflammatory and chemopreventive activities. Epidemiological evidence indicates that the incidence of certain cancers is less in people who consume Curcumin than in those who do not. Basic science research and clinical studies demonstrated that Curcumin is a potent anti-inflammatory agent with strong therapeutic potential against a variety of cancers.

Mechanism of Action in Cancer

Curcumin has been shown to prevent a large number of cancers in animal studies. Laboratory data indicate that Curcumin can inhibit initiation, promotion, invasion, angiogenesis, and metastasis of tumors. Curcumin has been shown to interfere with multiple cell signaling pathways, including cell cycle (cyclin D1 and cyclin E), apoptosis (activation of caspases and downregulation of antiapoptotic gene products), proliferation (HER-2, EGFR, and AP-1), survival (PI3K/AKT pathway), invasion (MMP-9 and adhesion molecules), angiogenesis (VEGF), metastasis (CXCR-4), and inflammation (NF-κB, TNF-α, interleukin [IL]-6, IL-1, COX-2, and 5-LOX).

In patients with colorectal cancer, oral Curcumin administered during the pre-surgery waiting period improved cachexia and the general health of patients. In a phase II trial of oral Curcumin in patients with advanced pancreatic cancer, no treatment-related toxic effects were observed and clinically relevant biological activity was seen in two patients despite limited absorption. More recently, a study from Zheijiang Provincial People’s Hospital in Zheijiang, China indicates that Curcumin is capable of inducing apoptosis (cell death) within triple negative breast cancer cells. Triple negative breast cancer (TNBC) is a type of cancer that generally defies conventional therapy.

Curcumin also acts as a potent chemosensitizer and radiosensitizer for tumors in some cases. Curcumin has also been shown to protect normal organs such as liver, kidney, oral mucosa, and heart from chemotherapy- and radiotherapy-induced toxicity. In fact, the consumption of Curcumin during radiotherapy reduced the severity of radiation dermatitis in breast cancer patients. The activity of Curcumin reported against leukemia and lymphoma, gastrointestinal cancers, familial polyposis, pancreatic cancer, genitourinary cancers, breast cancer, ovarian cancer, head and neck squamous cell carcinoma, lung cancer, melanoma, neurological cancers, and sarcoma reflects its ability to affect multiple targets.

Clinical trials are under way to investigate Curcumin as a way to prevent cancer in people with precancerous conditions, as a cancer treatment, and as a remedy for signs and symptoms caused by cancer treatments.

Safety and Side Effects

Curcumin has been used for centuries as a spice and food additive with minimal adverse effects, and the FDA is considering it as a GRAS (Generally Recognized as Safe) supplement. Curcumin may cause an upset stomach, especially in high doses or if given over a long period of time. Patients with gallbladder problems should be cautioned about the use of Curcumin due to the fact that Curcumin is capable of contracting the gallbladder and might exacerbate gallbladder disease. Historically, Curcumin has been considered safe when used as a spice in foods during pregnancy and breastfeeding. However, Curcumin has been found to cause uterine stimulation and to stimulate menstrual flow, and caution is therefore warranted during pregnancy. Animal studies have not found Curcumin taken by mouth to cause abnormal fetal development.

References

  1. Anand P, Sundaram C, Jhurani S, Kunnumakkara AB, Aggarwal BB. Curcumin and cancer: an “old-age” disease with an “age-old” solution. Cancer Lett. 2008;267:133-164.

  2. Bayet-Robert M, Kwiatkowski F, Leheurteur M, et al. Phase I dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer. Cancer Biol Ther. Jan 2010;9(1):8-14.

  3. Belcaro G, Hosoi M, Pellegrini L, Appendino G, Ippolito E, Ricci A, Ledda A, Dugall M, Cesarone MR, Maione C, Ciammaichella G, Genovesi D, Togni S. A Controlled Study of a Lecithinized Delivery System of Curcumin (Meriva®) to Alleviate the Adverse Effects of Cancer Treatment. Phytother Res. 2013 Jun 15.

  4. Cruz-Correa M, Shoskes DA, Sanchez P, et al. Combination treatment with curcumin and quercetin of adenomas in familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2006;4:1035-1038.

  5. Dhillon N, Aggarwal BB, Newman RA, et al. Phase II trial of curcumin in patients with advanced pancreatic cancer. Clin Cancer Res. Jul 15 2008;14(14):4491-4499.

  6. Frenkel M, Abrams DI, Ladas EJ, Deng G, Hardy M, Capodice JL, Winegardner MF, Gubili JK, Yeung KS, Kussmann H, Block KI. Integrating dietary supplements into cancer care. Integr Cancer Ther. 2013 Sep;12(5):369-84. Epub 2013 Feb 25.

  7. Goel A, Aggarwal BB. Curcumin, the golden spice from Indian saffron, is a chemosensitizer and radiosensitizer for tumors and chemoprotector and radioprotector for normal organs. Nutr Cancer. 2010;62:919-930.

  8. Gupta SC, Kim JH, Kannappan R, Reuter S, Dougherty PM, Aggarwal BB. Role of nuclear factor-{kappa}B-mediated inflammatory pathways in cancer-related symptoms and their regulation by nutritional agents. Exp Biol Med (Maywood). 2011;236:658-671.

  9. Hanai H, Iida T, Takeuchi K, Watanabe F. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006;4:1502-1506.

10. He ZY, Shi CB, Wen H, et al. Upregulation of p53 expression in patients with colorectal cancer by administration of curcumin. Cancer Invest. Mar 2011;29(3):208-213.

11. Karin M, Greten FR. NF-kappaB: linking inflammation and

immunity to cancer development and progression. Nat Rev Immunol. 2005;5:749-759.

12. Kaur C, Kapoor HC. Anti-oxidant activity and total phenolic content of some Asian vegetables. Int J Food Sci Technol. 2002;37:153-161.

13. Kunnumakkara AB, Anand P, Aggarwal BB. Curcumin inhibits proliferation, invasion, angiogenesis and metastasis of different cancers through interaction with multiple cell signaling proteins. Cancer Lett. 2008;269:199-225.

14. Ryan JL, Heckler CE, Ling M, Katz A, Williams JP, Pentland AP, Morrow GR. Curcumin for radiation dermatitis: a randomized, double-blind, placebo-controlled clinical trial of thirty breast cancer patients. Radiat Res. 2013 Jul;180(1):34-43.

15. Shishodia S, Chaturvedi MM, Aggarwal BB. Role of curcumin in cancer therapy. Curr Probl Cancer. 2007 Jul-Aug;31(4):243-305. Review.

16. Sun XD, Liu XE, Huang DS. Curcumin induces apoptosis of triple-negative breast cancer cells by inhibition of EGFR expression. Mol Med Rep. 2012 Dec;6(6):1267-70.

17. Thamlikitkul V, Bunyapraphatsara N, Dechatiwongse T. Randomized double blind study of Curcuma domestica Val. for dyspepsia. J Med Assoc Thai. 1989;72:613-620.

18. Vadhan Raj S, Weber D, Giralt S, et al. Curcumin downregulates NF-KB and related genes in patients with multiple myeloma: results of a phase1/2 study [abstract]. Paper presented at: 49th American Society of of Hematology Meeting; December 8-11, 2007; Atlanta, GA

By: Dr Jonathan Cheng

Jonathan C. Cheng, M.D., Ph.D. is a board-certified radiation oncologist, who serves on the scientific board of advisors for ONCUCARE. He specializes in integrative oncology, which uses complementary therapies in concert with medical treatment to enhance its efficacy, improve symptom control, alleviate patient distress and reduce suffering.