Cancer Care: Mind, Body and Soul

Doctors had hoped to operate on the cancer in Rhio Weir’s lungs that January morning almost two years ago. But when Weir, a 63-year-old underwriter for a title company, awoke, he was told the tumors were in the lining of his lungs and couldn’t be removed.

“The doctor told me the news was very bad, that the only thing I could do was radiation and chemotherapy,” the Los Angeles man recalls.

But there was something else Weir could do--and did. He stepped outside the circle of conventional cancer therapy for aspects of his treatment. And he found that conventional medicine bowed to his wishes.

In addition to chemotherapy and radiation, Weir received acupuncture and took Chinese herbs, adopted an Eastern-style diet, attended a support group and saw a spiritual healer--all with varying degrees of acceptance from his doctors. His primary doctor was “very open” to alternative medicine; his oncologist was tolerant of it. And though one surgeon objected to Weir’s request to listen to soothing music on a headset during surgery, an anesthesiologist in the room intervened, saying the music “was a good idea.”

“If conventional doctors are secure in what they do, then they shouldn’t feel threatened by alternative medicine,” Weir says. “No one really said ‘no’ to me.”

What was unthinkable 10 years ago--that cancer doctors would sanctify their patients’ sojourns into alternative medicine--is today a reality in many clinics nationwide. While steadfast in their belief that science-based therapies offer people the best chance of getting well, more doctors acknowledge the gaps in their rigidly fact-based model. They concede that some cancer patients in need of emotional support, relief from unrelenting nausea, even hope, are finding it outside of traditional medicine.

“Five years ago, most conventional oncologists weren’t even thinking about these therapies,” says Dr. James Gordon, an expert in complementary medicine at the Georgetown University School of Medicine in Washington, D.C. “The interest now is certainly not universal. But young oncologists, in particular, are coming up against the limitations of what they can do. They are looking for approaches to help their patients deal with the experience of cancer.”

Last summer, Gordon offered a program to train health care professionals to become a “cancer guide,” defined as a professional who helps patients deal with all aspects of cancer care: physical, psychological, emotional and spiritual. Expecting mostly nurses and therapists, Gordon was surprised when two dozen doctors showed up for the class.

“Oncologists are recognizing that this is not an either-or phenomenon or a cultural war. It’s about: How do we create the most effective care for our patients?” says Gordon, author of the book “Comprehensive Cancer Care: Integrating Alternative, Complementary, and Conventional Therapies.”

The sheer number of cancer patients interested in complementary and alternative medical therapies is clearly the catalyst for change in oncology. According to a study published last year, 69% of cancer patients said they used some form of complementary medicine, and 89% said they would like more information on the topic. In a survey of parents of child cancer patients at Columbia University, 84% reporting using at least one alternative therapy. Surveys show that many people with heart disease, arthritis and other diseases are also interested in alternative therapies. But cancer patients, perhaps because their need for treatment is acute, appear to be especially assertive in exploring all of their options, experts note.

“The numbers of cancer patients doing this are so vast, doctors have to be more open,” says Judith Jacobson, an assistant professor of clinical epidemiology at Columbia. “Patient after patient asks about complementary and alternative medicine. And if the patient doesn’t ask, the spouse asks.”

Though many doctors still disapprove of the use of any scientifically untested therapy, signs of oncology’s acceptance of nontraditional forms of medicine are apparent. The federal government’s cancer unit, the National Cancer Institute, established its own office of complementary and alternative medicine and increased its budget from $36.6 million in 1999 to $47 million this year. Owing to such funding, studies on alternative medicine have become regular features in scientific cancer journals.

Many hospitals are hiring alternative-medicine experts or are launching departments devoted to non-Western research and treatments. Some doctors are even learning to perform alternative treatments, particularly acupuncture.

“Now is the time for that proverbial level playing field where we look at all therapies the same way and ask: What difference do they make?” says Gordon. “I think the cancer field is moving to that place.”

Clearly, some doctors are motivated to learn about alternative medicine out of fear that their patients will engage in therapies that could harm them. For example, some herbs may interfere with the effectiveness of chemotherapy.

But others are choosing to look at alternative medicine for its potential value. Treatments such as acupuncture and some herbal remedies are backed by evidence showing they work.

When Zelde Malevitz, 52, was unable to cope with the side effects of chemotherapy, she turned to acupuncture--with her doctor’s endorsement. Malevitz, who lives in Los Angeles, was no stranger to the shortcomings of Western medicine. Thirty years ago, her mother had carted her off to England for acupuncture treatments for a severe pain condition that American doctors had been unable to help. Acupuncture was illegal in the United States at that time.

“Alternative medicine is only alternative in this country,” says Malevitz. “After experiencing the first two chemo treatments, the effects were so profound I felt like I needed something to make it more bearable.”

Now, when Malevitz checks into Cedars-Sinai Medical Center for two-day infusions of chemo, she usually makes the short walk to the Cedars-Sinai Medical Office Towers next door, her chemo bag strapped to an IV pole rolling alongside her, for an acupuncture treatment at the office of Evan Ross, a doctor of acupuncture and Asian medicine. Malevitz’s oncologist referred her to Ross.

“I think people are acknowledging that there are limitations to [Western] medicine,” says Ross, who regularly consults with Western doctors to plan a patient’s treatments. “Conventional medicine has finally created enough space in its model for someone like me to exist.”

Though trained to possess a laserlike focus on cure, cancer doctors are beginning to value therapies that, while not able to halt the disease, improve a patient’s life.

“Cancer patients have specific side effects: fatigue, lymphedema [swelling], nausea and other long-term problems that, very often, their conventional medical doctors are not addressing. Or they are addressing in a way that--from the patient’s perspective--is over-medicalized,” says Jacobson. “Patients are looking for a more gentle, easier way to deal with things.”

Doctors are also intrigued by alternative therapies that may augment their own treatments, says Lorenzo Cohen, head of alternative medical research at Houston’s M.D. Anderson Cancer Center.

Cohen, for example, is examining whether relaxation therapy before surgery may improve the outcome.

“Physicians who look closely might see that their patients who are engaged in some type of mind-body-spirit program are handling the whole situation better,” he says.

After struggling with advanced colon cancer, Dr. R. Scott Hitt says he has altered the way he treats his own patients. Hitt specializes in treating people with HIV.

“Now, when someone is diagnosed with HIV, the first things I do is order a T-cell blood count and tell them to get some help in the mental area,” says Hitt. “I think that should be done in oncology.”

Facing a recurrence of colon cancer that had spread to his liver, Hitt last spring turned to hypnosis to alleviate the side effects of chemotherapy and a support group to help him cope with his emotions.

“It was such an ‘aha’ moment when I was in my first support group meeting,” says Hitt. “I could talk about my fears. Anxiety and depression can have profound effects on health. I think anything that lowers anxiety is a good thing.”

Even the acceptance of patient support groups signals a major shift in oncology, says Dr. Wendy Harpham, a Dallas internist.

“Many doctors accept the value in it,” she says. “Ten years ago, many doctors said, ‘If you go to a support group, you’ll have to find a new doctor.”’

Unlike their predecessors 30 years ago, who declared an audacious “war on cancer,” doctors today are more likely to see cancer as a complex disease that, depending on the type and stage, can be difficult or impossible to cure.

Given a slim chance of surviving, Weir, the title company underwriter, says he viewed his cancer as “a wall that I would throw everything at and hope something stuck.” The Los Angeles man has recovered and has been given a good prognosis.

His doctors, he says, could hardly argue with that.

“I never put anyone on a pedestal,” Weir says. “No one was a god. Western doctors don’t have all the answers. Eastern doctors don’t have all the answers.”

When told to “get their affairs in order” or given some other dark appraisal, it is hardly surprising that the sickest patients often turn to alternative medicine--a phenomenon that doctors are beginning to grasp, says Harpham.

In 1990, Harpham was diagnosed with non-Hodgkin’s lymphoma that was treated but recurred a year later. As her hopes of surviving dwindled, she began looking into several alternative therapies that she had once summarily rejected. While conventional medicine seemed “impotent ... poised only to react to the first signs of recurrence, alternative therapies tempted me with the promise of taking charge, of doing something,” says Harpham.

Her soul-searching led her to ask: “Am I willing to bet my life on conventional medicine?”

Ultimately, she rejected alternative therapies because of their lack of scientific scrutiny and opted for an experimental antibody therapy. But after her disease went into remission, Harpham gave up her practice and devoted herself to helping doctors understand the forces that attract people to alternative therapies.

Harpham frequently speaks to professional audiences and writes journal articles on alternative medicine. She says her audience is growing.

“I think there are conventional doctors who are looking at the phenomenon and saying, ‘What is it about these therapies that attracts patients?”’

One of Harpham’s messages to her peers is that conventional cancer therapy frequently fails to support patients emotionally.

“I don’t think doctors are saying maybe our model--the science of medicine--is wrong,” she says. “But that is distinguished from the art of medicine: how we deliver medicine, how we relate to our patients, how we nourish hope.”

Cancer patients who turn to alternative medicine may be doing so because their doctors are not hopeful or caring, according to a recent article in the Journal of Clinical Oncology. The study, by an Israeli doctor, found that 41% of cancer patients using alternative therapies felt that conventional medicine did not meet their needs, compared with 17.6% of patients who didn’t use alternative medicine.

“The issue of unmet needs is a recurrent theme in research in alternative therapies in cancer,” said Dr. Ora Paltiel of the Hadassah Medical Center in Jerusalem. “Conventional cancer care may be lacking in spiritual elements, the provision of hope, the encouragement for self-care and the laying on of hands.”

After being diagnosed with breast cancer, Mira Haimovich, 42, looked for practitioners who acted as if they cared. Her oncologist, she says, inquired about her feelings. Her radiologist, she says, “would always ask me how I’m doing, what’s going on. He never seemed to be in a hurry.”

Her standards applied to alternative practitioners as well. Haimovich dumped one acupuncturist because “I didn’t feel I was getting that nurturing.”

In choosing his health care team, Weir, too, says he looked for optimism.

“All my doctors expressed hope.” he says. “And it was really important to me that I liked my doctors.”

That doctors are recognizing the need to polish their bedside manners is somewhat ironic in an age when spectacular advances have elevated the science of oncology to its highest point, notes Harpham. Sixty percent of cancer patients today survive at least five years, compared with 20% in the 1930s.

“It’s a paradox, because advances are occurring,” she says. “We are really very close to understanding what is happening on the genetic level. At the same time, we’re realizing that cancer is a very personal experience that is very much affected by emotions. Our job as modern healers is to not only rid the body of cancer cells, but to comfort the patient and get him or her through the experience.”

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Physicians Respond to Growing Awareness

Not so long ago, doctors could largely ignore the field of alternative and complementary medicine because it had little effect on their practices or patients. But that has changed as an increasing number of patients seek alternative therapies. Today, some prominent cancer doctors are urging their colleagues to become familiar with alternative medicine. Here are some of the reasons these doctors cite:

* Patients are seeking information about complementary and alternative medicine not only from their doctors but also from other sources.

* Doctors need to determine which alternative therapies are useful and should be incorporated into standard practice.

* Some alternative therapies are potentially harmful.

* Government agencies are funding research into certain alternative medicine therapies.

* Segments of the alternative medicine business, such as herbal products and other dietary supplements, are largely unregulated by the government.

* Alternative medical practitioners are aggressively marketing their services to patients.

* There are no cures for some types of cancer.

* Frustrated with a difficult-to-navigate health care system, Americans are becoming more adept at choosing and managing their own care.

* Media coverage has increased public awareness of alternative medicine.

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Sources: Dr. Maurie Markman, Dr. David S. Rosenthal, American Society of Clinical Oncology annual meeting and Journal of Clinical Oncology.