Complementary and Integrative Therapies

 Laurl at ONS 

Welcome to the ONS Hot Topic Chats! Today’s expert is Dr, Heidi Lucas, who will be talking with us about Complimentary and Integrative Therapies. Welcome Heidi!

 heidilucas 

Good morning, thanks for having me here, looks like we have some people ready to talk.

 heidilucas 

So where is everyone from? I am here in my clinic in Seattle on this not so sunny morning.

 maureen brannon 

I am in Tulsa, Ok.

 glenvon 

I am in West Palm Beach, Florida. From the Sari Asher Center for Integrative Cancer Care.

 heidilucas 

Do you have any specific questions?

 oncnurse 

Glenvon, I’m interested in the "integrative" part of your cancer center - can you tell us what you do?

 glenvon 

I would like to know if there are any contraindications for our patients for some of our therapies. We have acupuncture, massage therapy, craniosacral massage, lymphedema therapy, etc.

 glenvon 

I am the nurse educator, I give education to cancer patients on their chemotherapy, radiation therapy, cancer type etc. I also do community outreach for early detection.

 heidilucas 

As far as massage goes, I recommend avoiding any areas of active disease; it can be so amazing for boosting immune function, circulation and decreasing the stress of treatment. Cranio-sacral and acupuncture tend to be less invasive, but again avoiding the active areas.

 heidilucas 

I do a lot of education here as well. I work with two medical oncologists, an acupunturist and nurses.

 heidilucas 

My role here is to support patients with Naturopathic modalities, nutrition, herbal medicine, supplements and stress management / meditation.

 heidilucas 

For example this morning I read an interesting study on using honey for the prevention of mucositis related to head and neck radiation- decreased occurrence significantly.

 heidilucas 

The patient takes a tablespoon 15 minutes before and after treatment, then again 6 hours later.

 glenvon 

Can you tell me where the article was from?

 heidilucas 

I will add it to the transcript.

 Laurl at ONS 

Heidi, can you tell me what are the modalities that you use most frequently in your practice?

 heidilucas 

I use a L-glutamine as a supplement for neuropathy, and turmeric in supplement and diet form for it synergy with certain treatments and anti-inflammatory properties

 Laurl at ONS 

Do you find a multi-modal approach to integrative therapies to be more effective than just supplements or body work alone? Does it depend on the disease?

 heidilucas 

Yes, there are so many things you can do to support the body.

 heidilucas 

For example, some patients will respond so well to deep breathing exercises and then others are all about nutrition.

 glenvon 

I find that the acupuncture and massage therapists are the most used therapies in our center as well as hypnotherapy. Are these treatments popular at your center? Also, how are your patients referred, is the referral from the oncologists?

 heidilucas 

Its nice to be able to offer them hope as well, that yes there are things that can be healing.

 jbaumberger 

To tag onto glenvon, are there certain symptoms that guide referrals to massage?

 heidilucas 

Yes we use acupuncture and massage, the oncologist refer them but we get a lot of patients who come here self-referred for the Naturopathic treatment.

 dvargas 

Heidi: I have to come up with a question of the month for our oncology floor meeting, I would like to ask a question that nurses should know on complementary therapies for cancer patients, any idea of a good one?

 heidilucas 

Symptoms for massage that guide referrals include poor scar tissue healing, myalgia or decreased range of motion.

 heidilucas 

RE: question for nurses: Let patients know that they need to tell their nurse what they are taking natural…

 heidilucas 

…and prescription medications. Also I would have them inquire about protein intake.

 heidilucas 

I find that the focus is often on calories and not nutrients that can help them to heal or provide building blocks for immune health and overall strength.

 glenvon 

How does each therapist stay within their scope of practice, or is there an overlapping of modalities? Example: acupuncturist giving nutrition information.

 heidilucas 

Also for nurses if you then tell the oncologist what the person is taking they may not know what to do with the information.

 jbaumberger 

Do you find that patients understand what integrative therapies are or do you use the word complementary more often?

 heidilucas 

Yes there is overlap in scope of practice; Acupuncture therapy has a whole field of nutrition as well.

 dvargas 

What are some specific good supplements and diet for AML?

 heidilucas 

Regarding names used I find some patients know integrated medicine and others use complementary -most people use the word "natural" with me.

 glenvon 

Our facility is called integrative cancer care however when describing we use the term complimentary and explain that is in addition to traditional medical treatment as opposed to an alternative to.

 heidilucas 

For AML I use fish oils; if the platelets are not too low; also whey protein.

 heidilucas 

Also for AML there are some botanicals like feverfew and hibiscus- I use these sometimes in tea form.

 jbaumberger 

Heidi can you explain how these botanicals help the AML patients?

 glenvon 

Are there any particular supplements to avoid for patients receiving chemotherapy or radiation treatments? What exactly is the purpose of wheat germ and can that be used when patient is in chemotherapy treatment?

 heidilucas 

The word “Alternative” tends to make some patients feel like it is too fringe of a treatment.

 heidilucas 

In regards to the herbs for AML: they have shown some anti-cancer properties in preliminary studies. Being that these are both tolerable at low dose without side effects they make a nice addition to the green tea that most of my patients take.

 dvargas 

A recent study killed leukemia cells with grape seed extract- any input on using it?

 heidilucas 

Yes there are supplements to avoid -for example turmeric with anthracycline treatments.

 glenvon 

What is the interaction with turmeric and anthracyclines?

 heidilucas 

Wheat germ can have immune properties; some people use it as a fiber source. I use it only in its fermented form and not that often.

 heidilucas 

Turmeric has been shown to decrease to efficacy of anthracyclines.

 heidilucas 

I am familiar with the grape seed study. I have patients using the oil everyday in cooking; you can also use it in supplement form.

 Laurl at ONS 

Why only fermented wheat germ, Heidi?

 heidilucas 

Wheat is a common allergen and I only use it if there is something compelling like the product Ave.

 heidilucas 

I prefer ground flax seeds when looking at a fiber source with other anti-cancer and anti-inflammatory properties.

 Laurl at ONS 

What is your general assessment of a new pt entail, and do your recommendations differ depending on the pt?

 glenvon 

Are there any supplemental recommendations for neutropenic or thrombocytopenic patients? I had a patient tell me that grape juice kept her counts from decreasing.

 heidilucas 

My first visit looks at the overall person and the type of cancer and chemo they are on. The recommendations are specific to the disease and treatment.

 heidilucas 

I find the best thing for thrombocytopenia is sesame oil non-toasted. As far as grape juice goes... not familiar with any research and haven't seen it in practice.

 heidilucas 

But the pigments in dark berries anthocynins can be protective for immune function.

 dvargas 

Any recommendations for preventing some specific chemo toxicities? For instance a previous AML pt became deaf from toxicity of one of the chemos; any supplements to prevent say ototoxicity or peripheral neuropathy for instance?

 heidilucas 

Neuropathy, L-glutamine and alpha lipoic acid are the best. Ototoxicity, B vitaminsand omega 3 fatty acids.

 heidilucas 

With alpha lipoic acid I don't do it on the day of treatment, more out of theory than any study on interaction.

 dvargas 

Wow, thank you; how about to help prevent hair loss or mucositis?

 glenvon 

Have you heard that massages should not be given in circular motion for cancer patients but more of a stroking motion? Theory being that the circular motion will stimulate spread of cancer?

 heidilucas 

Hair loss -nothing that avoids it but I do find nutritionally that a person loses less or has it grow back faster if we check for iron deficiency and supplement with protein and omega 3 fatty acids.

 heidilucas 

Mucositis, licorice (DGL) lozenges, L-glutamine, aloe juice and honey.

 heidilucas 

I have not heard that about massage- I think the theoretical spread would happen either way.

 heidilucas 

For massage it depends on pressure, how deeply is the practitioner is going into the tissues.

 Laurl at ONS 

Heidi, where is a good place to find the research on these modalities - is there a good place to find research to confirm/refute claims of certain modalities?

 heidilucas 

I use PubMed-you can search for any of the nutritional or botanical agents.

 Laurl at ONS 

It's just a few before the end of our chat- please don’t stop asking questions! However, when you can, please take a moment after the chat to cut and paste this URL into a browser window and take our very brief survey-we’d love to hear what you think of these chats! The URL is http://research.zarca.com/k/RsTUTRsTPPsXYURUsPsP

 glenvon 

How can we access the transcript of this chat?

 Laurl at ONS 

The transcript will be available sometime tomorrow - and will be posted on the Hot Topic Webpage in www.ons.org- then go to CNE Central- then Index-chats- then you'll see the hot topic webpage. You'll see a link for current chats - it will be posted there.

 Laurl at ONS 

Thank you for your participation and thank you so much Heidi for your information!

 dvargas 

Thank you!

 Laurl at ONS 

The next chat is tomorrow night at 6pm Eastern time - please tell your friends about it!

 glenvon 

Thank you.

 heidilucas 

Thank you everyone, lots of healing to you!