President’s Lecture Series on Health Regis College Naturopathic/Integrative Medicine for Cancer Care October 25, 2017 Amy Rothenberg ND

Integrative Medicine Combines traditional western (or allopathic) and complementary approaches, but does not replace conventional therapy. In general may be used for: Managing symptoms Increasing wellness (quality of life, sense of well-being) Improving treatment efficacy http://www.mdanderson.org/education-and-research/resources-for-professionals/clinical-tools-and- resources/cimer/about-complementary-integrative-medicine/index.html. (Aug 2011)

Integrative Medicine Practiced by many different kinds of licensed providers from MD, DO, DC, ND ,PA, NP etc. Anyone can use the term. There are numerous training programs, some providers are self taught, some via internet training. Training and regulation is not consistent. Integrative medicine is increasingly offered in the Cancer Center setting.

Naturopathic Medicine Doctor level practitioner of natural medicine Diagnosis Use conventional methods to support diagnosis including: Patient history Complete & relevant physical exam Laboratory & imaging diagnostics In addition, work to gain an understanding of patient’s lifestyle with special attention to diet, exercise and other factors in context of the major stressors in the patient’s life.

Six Principles of Naturopathic Medicine 1. Like all physicians, First, Do No Harm: Utilize the most natural, least toxic natural approaches 2. The Healing Power of Nature: Trust in the patient’s inherent wisdom & capacity to heal & in the healing capacity of natural substances 3. Identify & Treat the Cause(s): Look beyond symptoms to underlying cause(s)

Six Principles of Naturopathic Medicine 4. Doctor as Teacher: educate patients in steps to attaining and maintaining health 5. Treat the Whole Person: Understand the patient as an integrated whole with physical, emotional, spiritual and cognitive dimensions 6. Prevention: Emphasis on overall health, wellness & preventive measures

Training of an ND Prerequisites similar to those needed to gain admission to medical & osteopathic school Four year, in-residence, full-time postgraduate ND medical schools recognized by the Federal Department of Education. Students eligible for federally funded student loans The Princeton Review Best Medical Colleges list includes all six North American accredited naturopathic medical schools

Why Cancer Patients Seek Integrative/Naturopathic Care To complement conventional medicine Key areas of concern: Help support efficacy of treatment Help prevent side effects Address side effects that arise Address more psychological and stress related aspects of care Help to prevent recurrence

Categories of Treatment Modalities Biologically Based Practices Herbs, vitamins, dietary supplements and other natural therapies, specific dietary strategies (ketogenic diet, macrobiotic diet, fasting) Energy Medicine Therapies such as Qi gong, Reiki or Therapeutic Touch

Categories of Integrative Medicine Manipulative and Body-Based Practices Chiropractic, osteopathic, massage and acupuncture Mind-Body Medicine Meditation, prayer, art & music therapy, counseling and support groups Whole Medical Systems Traditional Chinese Medicine, Ayurvedic Medicine, Homeopathic Medicine Adapted from http://nccam.nih.gov/health/whatiscam; May 2013

Usage of Integrative Medicine 2010 MD Anderson survey of patients seen in a dedicated Phase I clinical trials clinic; 162/309 or 52% use CAM therapies Pharmacologic (77% of users, 40% of respondents) Vitamin, herbal and other dietary supplements Non-pharmacologic (71%) Prayer, meditation, hypnosis, massage, acupuncture Both(48%) Naing A, et al. Cancer. 2011 Apr 28. doi: 10.1002/cncr.26164. 14

Goals of Integrative or Naturopathic Medicine for Cancer Patients General health support Insure proper nutrition, appropriate exercise, weight management, sleep support Pain Management Symptom management during & after treatment Address symptoms patients develop or which are aggravated with cancer treatments

Common Symptoms of Cancer Patients During or After Conventional Treatment Anxiety Peripheral neuropathy Depression Skin rash Fatigue Joint pains, Insomnia Muscle cramps Mental fogginess Restless leg syndrome Hot flashes Constipation Loss of sexual desire/function Diarrhea Gas/bloating Reflux Taste changes

Overarching Advice to Patients & Providers Use expert and trained professionals for guidance Focus on foundations of good health Keep the plan simple during active therapies (chemo, biologics, radiation) Don’t underestimate the benefits of exercise! Essential role of rest & sleep Be flexible and forgiving

To Find a Naturopathic Physician or Integrative Physician Oncology Association of Naturopathic Physicians https://oncanp.org American Association of Naturopathic Physicianshttp://www.naturopathic.org/AF_MemberDirectory.asp?version=2 Academy of Integrative Health & Medicine https://aihm.site-ym.com

Recommended Resources Five to Thrive: Your Cutting Edge-Cancer Prevention Plan Lise N. Alschuler, ND & Karolyn A. Gazella Anticancer: A New Way of Life – David Servan-Schreiber, MD Integrative Strategies For Cancer Patients: A Practical Resource For Managing The Side Effects Of Cancer Therapy Elena Ladas & Kara Kelly, MD Integrative Medicine: About Herbs, Botanicals & More Memorial Sloan-Kettering Cancer Center website http://www.mskcc.org/mskcc/html/11570.cfm Integrative Oncology – D. Abrams, MD & A. Weil, MD

Practice site: www.nhcmed.com Contact information for Dr. Rothenberg Practice site: www.nhcmed.com http://www.huffingtonpost.com/amy-rothenberg-nd/ http://www.amyrothenberg.com www.nesh.com