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From the Townsend Letter
August / September 2013

Naturopathic Oncology:
A Necessity for Every Patient with Cancer

by Veronica A. Stevens, ND, FABNO
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It is a long-held belief within the oncology community that the use of "natural medicines" during conventional cancer treatment is contraindicated. Often, patients are advised against the use of natural medicines and supplements because of fears (1) of interaction with chemotherapy or radiation and (2) that supplementation can provide a survivor advantage to cancer cells. Naturopathic oncologists serve a largely unmet need in cancer care as providers of safe and effective natural therapies. Naturopathic oncology is a unique offering in patient care, based on the principles of naturopathic medicine: First, do no harm; cooperate with the healing powers of nature; address the fundamental cause of disease; heal the whole person through individualized treatment; and teach the principles of healthy living and preventive medicine. In accordance with these principles, naturopathic oncologists specialize in the optimization of normal physiology and the co-management of side effects with natural nontoxic therapies during conventional cancer treatment with chemotherapy, immunotherapy, radiation, and/or surgery. Collaboration with naturopathic oncologists enables better tolerability of treatment among patients, which results in improved well-being and outcomes.

First, Do No Harm
A patient's desire to use natural therapeutics is usually disregarded because natural therapeutics are perceived to be harmful to patients with cancer. Patients often feel overwhelmed by the volume of often contradictory information found on the Internet as well as information given to them by family and friends. According to National Health Statistics Report in 2007, 38% of the adult population reported use of complementary and alternative medicine; $14.8 billion was spent out of pocket on nonvitamin, nonmineral natural products for self-care. Supervised use of natural products with cancer patients is necessary because of possible interactions which can either reduce effectiveness of antineoplastic drug agents or increase toxicity to patients via common drug metabolism pathways. Second, supervision is needed to assist patients with the selection of products that are indicated for their conditions and symptoms. Inappropriate use of natural products can cost patients financially and delay appropriate treatment. At this time, inadequate oversight of the natural products industry allows for inconsistent standards among supplement quality; contamination and adulteration of products increase patients' susceptibility to purchasing a product that may be harmful or ineffective. Because naturopathic doctors have experience in the safe and appropriate use of natural supplement products, are trained in herb-drug interactions, and are fully trained as primary care providers, they can assists patients by making safe and suitable recommendations and recognize emergent situations that necessitate medical interventions. Working with trained and skilled providers such as naturopathic oncologists enables patients to discern which natural approaches are most appropriate for them rather than disregarding the use and benefits of natural therapies. Patients feel supported in their desire to use natural therapies, improving their optimism and satisfaction without compromising safety.

Cooperate with the Healing Powers of Nature  
A principle unique to naturopathic medicine is a belief in and cooperation with the healing powers of nature. Naturopathic doctors understand that the body has natural healing power that is innate and that natural medicines work in concert with this ability. Naturopathic oncology is a perfect complement to conventional cancer treatment, which is often very devitalizing to patients, and results in suppression of natural healing ability. This suppression of the natural healing powers can be observed in patients with poor wound healing after surgery, increased susceptibility to infection during chemotherapy, or compromised skin integrity after radiation therapy. With naturopathic oncology care, the tolerability of conventional cancer treatment is enhanced with maintenance or restoration of the body's natural healing powers.

One of the more complex aspects of the healing power of nature with regard to cancer care is healing of the cancer itself. Some regard cancer as a chronic unhealed wound. Cancer is a complex disease of which we have an elementary understanding; the current cancer care model is treating only the effect of cancer, the tumor, but not the cancerous terrain or its many inducers. A commonly accepted model of carcinogenesis is the tumor initiation and progression model, which states that first a normal cell develops a mutation that allows for abnormal proliferation followed by tumor promotion of an active tumor cell population, and finally, progression in which a tumor cell develops a mutation that gives it a selective survivor advantage over other cells in the tumor population. A well-coordinated dysfunction of multiple biological systems supports this process of carcinogenesis. The science of naturopathic medicine is function- and process-focused; the development of an environment that supports carcinogenesis can be attenuated by regulating, balancing, and enhancing disordered processes and functions. In the book Five to Thrive, naturopathic oncologist Dr. Lise Alschuler and Karolyn Gazelle outline an elegant system that addresses the cancerous terrain by enhancing immune system function, clearing inflammation, balancing hormones, regulating metabolism, and improving digestion and detoxification. With naturopathic oncology care, healing of the cancerous terrain is a vital component of the cancer care strategy.

Treat the Whole Person with Individualized Treatment
There is a strong need for whole-person care in oncology; the current cancer care model is largely focused on eradication of the tumor or any manifestation of the cancer with little time for concern for the individual living with the cancer. "The Unmet Supportive Care Needs of Patients with Cancer" in the Journal of Cancer (January 2000) concluded that as many as 65% of cancer patients surveyed reported high levels of unmet needs in psychological, health systems and information, and physical and daily living concerns. The foundation of naturopathic care is to learn who, what, where, when, why, and how about the patient, followed by an individualized plan to address what is learned. Who are they and who are the important people in their story? What specifically has brought them to the clinic? Where are they in their understanding of their condition? Why are there limitations to their health and how have these limitations come about? One example of how medical oncology does not allow time for whole-person care was presented in an abstract at the American Society of Clinical Oncology Annual Meeting in 2013, which reported that among patients with breast cancer, poor sleep quality is correlated with higher recurrence rates; approximately 30% of oncologists never inquire about a patient's sleep quality. Unmet supportive care needs affect outcomes; cancer patients will benefit from whole-person care provided by naturopathic oncologists.

Address the Fundamental Cause of Disease
Addressing the fundamental cause of disease is a compass for naturopathic medicine; this compass helps to determine the most appropriate direction to reach the goal of decreased limitation to health. A disease was defined in an online dictionary as a "disordered or incorrectly functioning organ, part, structure or system of the body resulting from the effect of genetic or developmental errors, infections, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors." Naturopathic oncology has the privilege of addressing the fundamental causes of disease with every treatment plan. The goal of naturopathic oncology care is to support patients in living the most normal life possible without limitations from disease. For example, when a patient with pancreatic cancer is experiencing fatigue that results from nutritional imbalance that is secondary to chronic diarrhea from pancreatic insufficiency, a naturopathic oncologist will correct the digestive imbalance with supplemental digestive support and supplement the nutrient imbalance. In this example, the symptom of fatigue was a consequence of the fundamental cause of nutrient imbalance created by digestive insufficiency. The patient's diarrhea could have been corrected with antidiarrheal medication, but the nutritional imbalance would not have been corrected, and the fatigue would likely persist. One could argue that the fundamental cause of the fatigue was the primary illness of pancreatic cancer, but the cause of digestive insufficiency was the most direct dysfunction causing the fatigue, not the diarrhea or the primary illness. This principle is a unique aspect of naturopathic oncology that benefits patients because the primary goal of care is improved health; the eradication of symptoms is a secondary consequence of improved health. The treatment for the same symptom will vary greatly from person to person when the goal is improved health and not simply symptom relief. The use of the compass to address fundamental limitations to healthy function is an important reason for every patient with cancer to have a naturopathic oncologist.

Diseases resulting from the toxicity of cancer treatment are common causes of limitation among patients with cancer. A part of naturopathic oncology education and training is focused on how antineoplastic agents and treatments work and their impact on normal healthy tissue and physiology. Naturopathic oncology strives to optimize function of normal physiology by supporting digestive function, protecting kidneys, liver, heart, bones, and immune system from toxicity of primary treatment without attenuating the antineoplastic action on malignant cells. For example, a breast cancer patient receiving Herceptin, which is known for its cardiotoxicity, will have cardioprotective supplemental support to protect and improve the heart function. The kidney toxicity commonly seen in platinum-based antineoplastic agents can be managed with the appropriate dose of intracellular antioxidants. Bone health can be supported with appropriate mineral and immune supplements. Naturopathic oncologists have specialized training in the understanding of the mechanism of action, metabolism, and organ systems impact of antineoplastic agents and therapies with the sole purpose of reducing the development of treatment-related disease among cancer patients.

Teach the Principles of Healthy Living and Prevention
Teaching has always been a responsibility of the doctor; in fact, the Latin word for teacher is docere. Patients need to learn about their cancer and cancer care to be able to make truly informed decisions. This includes medical vocabulary, names and actions of treatment agents, diagnosis and pathology language, the natural history of their condition, the statics about their condition, and how this experience will affect their lives. With only 20% of cancers having genetic origins and the large majority of cancers having some correlation to living standards and lifestyles, teaching principles of healthy living has an important place in cancer care and prevention. While under the care of a naturopathic oncologist, patients learn how healthful diet, supplements, exercise, and a host of lifestyle factors affect their quality of life and treatment outcomes. For example, currently, there is a lot of attention on eating soy foods and using soy supplements in patients with breast cancer. Many breast cancer survivors avoid soy because of the confusion in the media, but several long-term epidemiological studies concluded that soy in its whole food form is beneficial for breast cancer patients. This is a perfect illustration of lifestyle and prevention education that benefits patients under naturopathic care.

The Future of Cancer Care
My experience as a naturopathic oncologist has taught me that caring for patients with cancer requires more than antineoplastic therapy. Several of my patients have expressed to me that the attention paid to their spirit and their well-being was the most significant for them in their cancer treatment journey. One of my most cherished memories from practice came from a patient who had treatment-induced diarrhea that had not been controlled in 8 months. By the time he came into my care, he was emaciated and had a life expectancy of less than a month. With naturopathic oncology supportive care, his diarrhea was controlled within 24 hours. When I walked into his room and asked about the diarrhea, he gave me a thumbs-up and a big smile. The diarrhea never returned. He died several weeks later with dignity.

Significant progress has been made in cancer care in the last 50 years; however, cancer still remains at a 50% mortality rate. Changing cancer to a chronic livable condition will require expansion of cancer care beyond its large focus on antineoplastic therapy. This expansion can begin with fully embracing naturopathic oncology as part of the treatment ladder in oncology care. Naturopathic oncologists serve an unmet need as providers of safe and effective natural therapeutics; they provide patient care from a unique perspective that focuses on whole-person care and enhancing the body's innate healing abilities with the goal of improving quality of life and well-being. This approach brings a much-needed expanded view and balance to conventional oncology care.

Veronica StevensDr. Stevens currently splits her time between Washington, DC, and Philadelphia, Pennsylvania where she works at Eastern Regional Medical Center as staff physician specializing in naturopathic oncology.  Dr. Stevens selected naturopathic medicine as a profession because it resonated with her desire to contribute to society in a manner that changes lives and advocates for people to live freely, without mental and physical limitations.

Dr. Stevens attended National College of Natural Medicine in Portland, Oregon, where she earned a doctorate degree in naturopathic medicine. After graduating from NCMN, she completed a two-year residency in naturopathic oncology at Eastern Regional Medical Center. Upon completion of the residency, she joined the staff in 2011 as a naturopathic oncology consultant and became board certified in naturopathic oncology in 2013.

In addition to Dr. Stevens's formal education and clinical work, she has made a commitment to public outreach through community health education. She has spoken about health education and the value of naturopathic medicine on several local news programs and at community events.


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