Key Insights From an Integrative Oncologist

With integrative oncology we can address unique challenges faced by patients diagnosed with cancer, said Lise Alschuler, ND, FABNO, at the 2023 Integrative Healthcare Symposium in New York City.

Integrative oncology is both a science and philosophy focused on providing complementary therapies to those with cancer to use alongside conventional care, said Alschuler, associate director of the Fellowship in Integrative Medicine at the University of Arizona Andrew Weil Center for Integrative Medicine.

Not be confused with “alternative” therapies, which are often offered as a substitute for conventional medicine, integrative therapies, Alschuler explained, are evidence-based, nonsurgical, and nonpharmaceutical approaches used in tandem with traditional care to facilitate health.

For her presentation, Alschuler listed ten fundamentals of integrative oncology, which she called “clinical pearls”, to help the audience become familiar with integrative strategies for addressing the problems of cancer patients and learn about their benefits.

Optimizing immunity in patients with hematological malignancies

Alschuler’s first clinical pearl of integrative oncology involved optimizing immunity in patients’ hematological malignancies, cancers that begin in the blood and blood-forming tissues. Characterized by insufficient immunity and increased risk of infection, the types of hematological malignancies are leukemias, lymphomas, and multiple myelomas.

According to Alschuler, a key therapy to enhance the immune regulation in patients with these cancers is melatonin supplementation. Several studies have shown an association between melatonin deficiency and hematological malignancies.

Melatonin exerts differential effects in leukemic cells by selectively increasing reactive oxygen species (ROS), leaving healthy cells unaffected, she explained. In addition, melatonin works in synergy with other chemotherapeutics and increases their effects in leukemia cells.

“This differential is really key to understanding why melatonin acts differently in malignant cells than it does in healthy cells,” said Alschuler.

Melatonin, said Alschuler, restores neutrophil functions like phagocytosis, degranulation, and neutrophil extracellular traps, all activities essential to reducing infections in glutathione and glutathione reductase activity-deficient neutrophils.

Various studies on melatonin and hematological malignancies have shown promising results. One study found daily administration of melatonin resulted in a survival index of 30 to 40 percent in mice bearing mid-stage leukemia compared with zero percent in untreated mice. In addition, Alschuler cited a phase two study published in Cancer Research that found daily low-dose melatonin was associated with suppressed tumor progression in 67 percent of patients and the median rate of survival was extended by 21 months.

Alschuler also explained that mushrooms may be effective in improving cytotoxic immunity. Mushrooms, she said, increase T helper type 1 (TH1) cell production and downregulation T helper type 2 (TH2) cell cytokines which leads to induced apoptosis and differentiation in tumor cells. In addition, mushrooms can increase natural killer cell and macrophage activity.

“All the studies are consistent,” she said. “When you add a mushroom or mushroom extract to conventional treatment, what you see is that there’s more cell death in leukemia cells and there’s enhanced immune activity in healthy cells.”

In addition, Alschuler said that patients with chronic lymphocytic leukemia (CLL) are prone to Shingles, yet they are not candidates the vaccine. For these patients, she recommended lysine.

For patients with hematological malignancies and immunodeficiency at risk for infection, Alschuler suggested 20 milligrams of every night along with 1.5 grams of mushroom extract like coriolus, agaricus, and maitake two times per day.

Treating chemobrain

For her third clinical pearl, Alschuler discussed integrative therapies for “chemobrain”. Around half of people receiving chemotherapy are afflicted by chemobrain, cognitive impairment that impacts visual memory, visuospatial function, verbal learning, and multitasking, she explained.

“This can be very significant for people and certainly a quality-of-life issue,” said Alschuler.

Associated with elevated inflammatory cytokines, it’s hypothesized that chemobrain may represent a form of neuroinflammation. To help control neuroinflammation due to chemoradiation, Alschuler listed several supplements backed by empirical data that she uses in her own practices, including:

• Curcumin
• Bacopa monerii
• Ginkgo biloba
• Melatonin
• Citicoline
• Hericum erinaceus

“Of this list I’d say citicoline is the heaviest hitter,” said Alschuler, and recommended to use citicoline in addition to another one of these supplements. “I guarantee that if you use a combination of these thing, your patients will improve significantly,” she said.

In addition, Alschuler suggests moderate physical exercise to patients suffering from chemobrain. Studies of patients undergoing chemotherapy have found changes in the microstructure of the white matter, a dynamic structure in the brain involved in learning and information processing. According to Alschuler, exercise increases white matter integrity thus improving cognitive function.

“It’s something you want to nip in the bud as fast as possible,” said Alschuler. “The sooner you get to this chemobrain issue, the more brain function you’ve preserved.”

Other integrative approaches for cancer Alschuler discussed included, optimizing vitamin D levels for reduced risk of breast cancer and colorectal cancer, maintaining circadian health to help slow and/or prevent cancer progression, and using natural supplements to manage hot flashes during endocrine therapy in patients with breast cancer.  

Navigating difficult conversations with patients

For her last clinical pearls, Alschuler discussed guidelines for difficult conversations with patients undergoing cancer treatment. As a practitioner, she said, you must recognize that a cancer diagnosis is a seismic shift for patient. Upon diagnosis they’re met with terror and uncertainty and many of their questions are not cut and dry.

“Every patient with a cancer diagnosis at some point with ask, ‘why me? I think it’s best to reframe the question and ask, ‘why not me,” said Alschuler. “What can they do in life to achieve a greater sense of wellness and wellbeing in their day-to-day practices?”

To manage questions concerning the possibility of death, Alschuler said to suggest that patients try to live in the now and hold both possibilities of living and dying. She said it’s important to be kind, clear, and honest. She said to monitor, acknowledge, and adjust their expectations without displacing hope.

“No sugar coating; no daggers,” she said. “At the same time, you don’t want to be disingenuous. As an oncologist you want to help them make practical decisions.”