Lung Cancer and the Snake Oil School of Medicine | Oct 18 2024

Lungevity’s Virtual Conference

Over the course of two days, September 20 and 21, Lungevity held its annual lung cancer survivors’ virtual conference— thank you, Lungevity (1)! I always make time for it; they publish the agenda beforehand so you can plan your schedule. This year, I made a note to skip one of the main presentations: Integrative Oncology: Eastern Medicine Meets Western Health Care to Treat the Whole Person. There’s a lot of snake oil out there (I wrote about one example here), and I tend to paint anything outside of the oncology research lab with the same brush of disdain. (I know, I know– intolerance is so unattractive. I’m working on it.) 

I ended up attending because, well, I am working on it, right? And, it was worth it– this presentation was anything but snake oil. In fact, it supported some of my own feelings about the Snake Oil School of Medicine. So, I thought I’d share a summary, imperfect and overdue as it may be. 

The presenter. Edward Sanghyun Kim, M.D., M.B.A., has more achievements than I have time to list here. Suffice it to say, he is a bona fide Big Deal. And yet, he seemed like a regular guy. 

Kim’s goals for the presentation were threefold: 

1. Share the research that does exist;
2. Caution us about interactions;
3. Caution us about alternatives

He devoted a whole slide to reasons for cautions, i.e., samples of from the Snake Oil School of Medicine. 

Why the concern about cautions?

“Patients with lung and other poor-outlook cancers are particularly vulnerable to heavily promoted claims for unproved or disproved “alternatives.” Source:  2007  Complementary Therapies and Integrative Oncology in Lung Cancer ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)

Then he got down to business.

What is Integrative Medicine?

Alternative medicine is used in place of conventional medicine.

Complementary medicine is used together with conventional medicine

Integrative medicine is used together with conventional medicine in a coordinated manner that is personalized, evidence-based, and safe.   

Throughout his talk, Kim continued to emphasize the critical need for evidence-based, research-based, peer-reviewed information that is the applied to the specific needs of an individual patient .

Kim’s diagram of the ideal picture of medical care, above, including integrative medicine, seems like a no-brainer, right?

But integrative medicine is a field that’s very much in formation, especially in comparison to other areas involved in patient well-being and care.

The National Center for Complementary and Integrative Health (2014) defines integrative medicine as Healthcare approaches developed outside of mainstream Western or conventional medicine. There are five categories of integrative medicine: 

1. Natural products/nutrition– dietary supplements, herbal products, shark cartilage
2. Psychological interventions– meditation, prayer, mental healing, music therapy
3. Physical/Body-Based methods– Chiropractic, osteopathic, massage, manipulation
4. Combination/Mind-body — Yoga, Qi-gong, dance, tai chi
5. Other — Whole medical systems, energy therapies, movement therapies — traditional Chinese medicine and Reiki

Risks and Interactions

Kim gave examples of documented risks, which included

• Acute cyanide toxicity caused by apricot kernel ingestion
• Herbal tonics  that stimulate invitro growth of human breast cancer cells
• Hepatotoxicity from green tea
• Urothelial carcinoma associated with the use of a Chinese herb
• Ayurvedic herbal medicine and lead poisoning

Kim also offered evidence of contamination in North American herbal products. (Apologies for the low-quality screen grab.)

And, Kim offered documented interactions between specific items and specific chemo drugs:

• Beta carotene during radiation therapy
• St. John’s wort: irinotecan, docetaxel, imatinib
• Green tea: bortezomib
• Ginger, garlic, ginseng: anti-coagulation, imatinib and docetaxel

Kim said that of greatest significance is that supplement interactions with treatments are underreported, mostly because patients are afraid to tell their doctors they are taking supplements. (See link to resource to help you talk to your doctor about  supplements, below.) One big risk of supplement interaction is that any side effects might be attributed to the treatment, leading the patient to blame the treatment and stop it. 

There are other kinds of interactions, too. I once checked possible interactions between osimertinib and a supplement I’d used without a thought before cancer treatment. I discovered there was a moderate risk that the supplement would affect the amount of osimertinib in my blood. I dropped that supplement like a hot potato. (Consumer Reports and other organizations list Medscape’s interaction checker as a good tool.

And, don’t throw those OTC products out the window– there are solid studies showing that ginger is effective in dealing with chemo-related nausea, and ginseng is beneficial for patients coping with fatigue.

(To be fair, Kim also shared examples of how non-traditional substances changed the history of medicine, but I don’t find the details relevant for lung cancer survivors.)

What About Cannabis?

Look at how few ASCO recommendations exist for use of cannabis in some key areas.

Kim shared more than 3 dozen detailed slides about studies, possibilities, and recommendations for responding to pain, depression, anxiety, nausea, fear, etc., but they were presented in a manner that made it difficult to summarize here. This speaks to me about the fledgling nature of the field of integrative medicine as it weaves into traditional medicine as practiced in the U.S. Further, within information of interventions with peer-reviewed studies, lung cancer is barely represented. For example, most of the therapies Kim mentioned as being recommended relied on breast cancer research for veracity. It may be that recommendations will be verified as applying across all oncology fields, but that wasn’t clear to me from this presentation. 

One of my takeaways: It seemed that the most research-based interventions involve the physical body; supplements and other ingested substances have the least amount of research-based evidence about either risk or efficacy. An early slide in Kim’s presentation included these stats from the CDC, showing the prevalence of use of body-specific therapies:

• Natural product  17.7%
• Deep breathing  10.9%
• Yoga, tai chi, qi gong 10.1%
• Chiropractor  8.4%
• Meditation  6.9%
• Special diets  3.0%
• Acupuncture 1.5%

From My Notes

• There is almost NO REAL DATA CURRENTLY about the efficacy or safety of mushroom extracts, CBD, or THC. 
• CBD has reportedly been helpful in coping with sleeping difficulties and anxiety. “The rule of thumb with CBD is start low and go slow,” Kim said. 
• The Keto diet seems to be popular among lung cancer survivors. Yet, when I asked about the Keto diet, Kim waved a dismissive hand. He basically said, there’s no point talking about diet right now; people’s physiologies are simply too different to make blanket statements. Eventually, it will be one of things that’s designed for each individual patient.

Want to Take a Deeper Dive?

Here are some links. 

Complementary Therapies and Integrative Medicine in Lung Cancer, published in 2023, contains a summary and discussion of general guidelines.  Citation: Complementary Therapies and Integrative Medicine in Lung Cancer Deng, Gary E. et al. CHEST, Volume 143, Issue 5, e420S – e436S  Link to PDF

Don’t Believe Everything You Read  from the Society of Integrative Oncology, the professional organization Kim referenced throughout his presentation. This is a great overview on assessing medical information you’re getting from the web. An excerpt:

The internet is an incredible resource that provides easier and more immediate access to medical information than ever before. However, keep in mind that unlike peer-reviewed scientific publications, much of what is written on the internet is biased in terms of what information is selected for presentation, and is not reviewed by experts for accuracy. Hence, it is important to use critical thinking and discernment when consulting with “Dr. Google”. We at the Society of Integrative Oncology (SIO) are advocates for patient education and informed decision making, so we prepared this article to help sharpen your ability to retrieve accurate information from the internet. Source: Society of Integrative Oncology, 

How To Find Information About Complementary and Integrative Health Practices on PubMed NCCIH (National Center for Complementary and Integrative Health)

Overview of Integrative, Complementary, and Alternative Medicine  byDenise Millstine, MD, Mayo Clinic. (Reviewed/Revised Dec 2023)

Safe Use of Complementary Health Products and Practices NCCIH 

Workbook: how to talk to your provider about using CAM [Complementary and Alternative Medicine] (Source: www.cancer.gov) This seems especially useful if you use supplements or other non -Western therapies.

Where Have I Been?

A combination of big family events and travel have kept me away from posting. Our recent trip to London was eventful! We saw All The Things, heard some wonderful music, and caught a special Monet exhibit. A real highlight was having lunch with a Lungevity friend who lives in London.

The low point of the trip turns out to be a quintessential London experience. My cell phone was snatched; one is stolen every 6 minutes in the city. I had chats with police and lots of Londoners who tried to help me track the phone. Lovely people, those Londoners, but 0/10 on the scale of awesome vacation experiences.

Of note: I wore a mask on transit and in most public spaces. My family members did not. They tested positive for Covid two days after we returned. I did not. After the lingering asthma my last bout with Covid provoked, my new philosophy is live my life and minimize risk. That means going to a concert tonight, and wearing a mask.

Oh! I was so flustered by the theft of my phone, I dashed out of the coffee shop and left behind my water bottle, part of my osimertinib swag. (I wrote about is here.) I suppose that means hope is lost, but maybe it’s just one more sign that hope is increasingly woven in to daily living.

Finally, here’s a cake, one of my first bakes since being sidelined by Covid early in the summer. I used AI to generate the image.

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Thanks for reading. I hope your days are full of adventure and hope. And cake.

Note

1. The main sessions were all recorded and will available on the platform until December. Because the link to register is still live, I’m betting you can still register and have access to the recorded sessions.
2. City of Hope recently received a $100 million gift to begin a research and integrative health integrative care center. (Not pocket change!) Kim is so excited about creating a leading integrative medicine center there. that he spent a fair a mount of time describing his ambitious goals for the center.  You can get a great summary of the grant from the City of Hope’s announcement of the grant. Here’s a summary:

An estimated 40% of cancer patients use integrative therapies annually to address disease and chronic issues, such as pain. Studies show integrative therapies can support better health, improved quality of life and optimal clinical outcomes. However, few health care organizations — let alone cancer centers — provide access to integrative therapies under physician supervision, much less use them holistically in treatment for patients with cancer. City of Hope will make integrative oncology an evidence-based, interwoven standard of care that supports optimal cancer treatment and survivorship.