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Chapter One
Why Integrative Care WorksCancer is one of the ultimate challenges any of us can face. I tell my patients that it is like being forced to climb Mount Everest: your trek to recovery requires the same committed focus and fitness of body and mind. Many of my patients tell me this analogy not only captures how overwhelmed their illness makes them feel but also reinforces two key ideas. First, to surmount your illness, just as to climb Everest, you need know-how, planning, and preparedness. Second, all mountains are ascended one step at a time, and all illnesses are conquered one step at a time. Every new health-promoting behavior you adopt is a victory. Every improvement in your symptoms, no matter how small, is an important step toward the summit of health.
The first point: preparedness is a key to successful cancer therapy. If I dropped you onto the summit of Everest, you would be lucky to survive a few hours in the intense cold and low-oxygen atmosphere. In the same way, unprepared cancer patients often lack the reserves to carry them through treatment. Of course, no rational person would ever let himself be plopped beneath the summit of Everest unprepared. You need training, proper equipment, and time to study the routes and learn the terrain before starting your trek. En route, you pace yourself and set up camps along the way to acclimatize yourself to the altitude. If you’re smart, you also enlist an experienced guide, one who helps you navigate the trickiest terrain.
So it is with cancer. Ascending Everest is analogous to the attack phase of cancer therapy—the conventional treatment for debulking, orshrinking, the primary tumor. The better and smarter the preparation, the more likely you are to complete this treatment. Don’t worry if there is only a little time between when you receive your diagnosis and when you begin treatment such as surgery: even a little preparedness can go a long way. With an experienced guide offering strategies complementary to your chemotherapy, radiation, and surgery, treatment will be less debilitating and more effective.
If the attack phase is successful in shrinking or eliminating the primary tumor, you’ve achieved either a partial remission or a complete remission. This is like reaching the summit of Everest. What next More often than not, nothing. Current medical thinking views successful completion of the attack phase (“we got it all”) as almost synonymous with a cure. But even with remission after surgery and chemo, some residual undetectable cancer cells likely remain. It has been estimated that approximately half of all cancer patients in remission actually have metastases, malignant cells that have broken off the original tumor, traveled through the bloodstream to far-flung sites in the body, and begun the insidious process of growing into another dangerous tumor. Just because you have achieved remission through elimination of the primary tumor does not mean you are home free. Cancer is not like an infection, where you wipe it out and move on. It is a chronic condition that needs constant vigilance. While conventional cancer treatments often remove much of the disease burden —and it is critical to remove tumor bulk from your body—that is only half the battle. Even when the primary tumor is eliminated, micro- metastases may already have migrated to and seed other parts of the body. These dormant cells can rear up and reestablish themselves.
That’s why for my patients, complete remission does not mean the end of treatment. Instead, it means the start of the containment or growth control phase, when we focus on stopping or slowing further growth of any residual disease (visible tumors) or invisible metastatic cancer cells. Post-treatment is a time to be particularly aggressive.
To continue the Everest metaphor, a successful climb is not only about summiting but also about getting back down. This is where climbers often err because the potential for catastrophe—treacherous ice patches and wrong turns that send you plunging into an abyss—is so great. Similarly, for a cancer patient it is critical to look past the summit of clear scans and remission so that your preparedness carries over into the post-treatment, or remission maintenance, phase.
Unfortunately, this is the most neglected phase of cancer treatment. Conventional cancer treatment does little to prevent cells from regrouping, proliferating and forming new tumors. It also does little to help patients recover from persistent side effects and potentially life-threatening complications of attack-phase treatments. But with the right strategy these effects can be avoided or overcome: we have tools—especially diet, nutritional therapy, and experimental and off- label drug use—that can delay or block the return of cancer.
Now cancer patients part ways with mountain climbers. When mountain climbers return to base camp, their ordeal is over. They have triumphed. Not so with cancer patients who have reached the summit (achieved remission) and descended safely (kept metastatic cells in check). With cancer, you must remain attentive to self-care, taking an active role in your continued health. Rather than waiting passively for the results of your next scan or checkup, you can actively seize control of your future. This will likely entail making changes in what you eat, how you stay fit, and how you balance life’s stressors, but I can just about guarantee that the small investment will yield a huge return: not only will this new way of life decrease your risk of relapse, but it will decrease your risk of diseases other than cancer, too, and make you feel better, stronger, and more empowered every day.
The Beginnings of Life Over CancerCancer entered my life long before I went to medical school. As a teenager, I watched my grandmother, my grandfather, and an uncle all die of cancer. They all suffered great pain toward the end, not just from the disease but from the treatments they endured. It was as if the quality of their lives were irrelevant, as if it no longer mattered how they felt once their doctors had proclaimed that there was nothing more that could be done. Though I had no medical training, I couldn’t believe there was nothing more that could be done —at least to improve their quality of life as they underwent treatment.
I remember sitting at my grandmother’s sickbed, watching helplessly as her cancer progressed and she became increasingly frail and thin. Her body was betraying her, but so were her physicians. Only sixteen, I was undergoing intensive physical training for high school football. I wondered: why weren’t her caregivers encouraging her to exercise Logic told me that keeping her muscles active might help her resist some of the wasting syndrome she suffered.
After my grandmother passed away, I kept thinking about all the things I might have done had I been her doctor. (This was one of the experiences that motivated me to become a doctor.) I was certain she could have lived the remainder of her life, even with her cancer, with far more awareness, dignity, and well-being had she been given a whole other level of care. This experience also made me resolve to be a different kind of doctor, one who did more than run tests and administer standard treatments. I wanted to tend to my patients’ emotional and physical well-being, too.
That resolve only grew stronger. As an intern, I sometimes followed an attending physician as he made his rounds at the hospital. One day I was following a doctor who was notoriously a morning person, beginning his rounds at 6:30 a.m. sharp, regardless of the patients’ sleep schedule. His first stop that chilly dawn was the bedside of a Chicago bus driver in her mid-forties. Admitted the previous night, she had an advanced case of cancer. This physician, whom she had never laid eyes on, was the first doctor to speak to her. He sailed into the room and woke her up. With no preamble, he declared, “I am sorry to tell you that you have colon cancer, and it will probably take your life shortly.” He turned with a squeak of shoe leather and left the room, followed by his entourage.
I stayed behind, unable to move a muscle, rooted to the spot where I’d stood as the attending pronounced judgment. The color had drained from the face of this poor woman, and her jaw was slack from the shock. Her entire body appeared frozen in terror. And no wonder. She had just been awakened in a strange bed in a strange hospital by a man who coldly informed her that she was doomed. I found myself in shock as well—not by what he’d said but how. I stayed with her for over an hour, returning for long periods in the days and weeks that followed, doing what I could to restore her shattered will to live.
When I founded the Block Center for Integrative Cancer Treatment in 1980, I knew it would be essential to provide an environment of hope and authentic caring. We would of course offer the best treatments from mainstream oncology to shrink or eliminate tumors. Although I was intrigued by anecdotal reports of success with purely alternative therapies, there was not enough solid evidence of their effectiveness to employ them alone. In the Life Over Cancer plan, it is crucial to eliminate the bulk of the tumor, freeing the body’s natural defenses for the job of ridding the body of residual or microscopic disease. We recognized that it was asking too much of our body’s immune system and other anti-cancer defenses to destroy or even shrink large, established tumors. It was clear to me that with rare exceptions, patients need and can benefit from established conventional therapies.
But conventional cancer treatment, while necessary, is not sufficient. Also crucial are nutrition (the quickest and surest way to affect one’s biochemistry), natural medicines (since, with a few rare exceptions, the pharmaceutical industry has not produced a true cure for any cancer), exercise, and mind-spirit care (including support and therapy to alleviate the terror associated with cancer treatment). These would be among the most important components of the care we offered. Just to be clear, we use nutrition, exercise, and mind-body treatments to enhance standard cancer treatments, not replace them.
The term did not exist then, but our approach was the first truly integrative cancer treatment in North America. Through innovative interventions and therapies, custom-tailored to the clinical, psychological, biochemical, and molecular characteristics of each patient, we treat the whole person, not just the cancer. Throughout, patients are active participants in their care, as we explain what we are prescribing and why, and what they need to do to have the greatest chance of success.
The Life Over Cancer program was not set in stone in 1980. We have continuously made changes as we learned from patients’ experiences, and adopted novel treatments supported by the burgeoning medical literature in cancer therapy, both mainstream and complementary. Full- time staff members stay on top of the latest research, as well as plan and conduct studies of new therapies. As a result, the Life Over Cancer program has improved with time as we’ve learned in the clinic what works and what doesn’t, and as research breakthroughs have emerged. Put simply, if a new treatment holds promise and is safe and effective, we consider including it.
Way back in 1984, I discussed some of our cases of advanced metastatic cancers at a cancer seminar at the University of Chicago. I showed X-rays indicating that the disease had spread to many distant sites in the body—yet these patients had all experienced regressions of their disease and were still alive, many years later. That astonished these specialists. Indeed, a number of patients who have been referred to our center and were considered “hopeless” or “terminal” have stunned even me as they lived and thrived years longer than expected. It was a few years after this talk that I first pointed out that false hopelessness—which conventional approaches may implant in the minds of patients—is fully as dangerous as the “false hope” that some alternative therapeutic claims may stimulate.
No matter how impressive, however, anecdotes are not proof of the effectiveness of the Life Over Cancer program. Starting in the mid-1980s, therefore, we devoted ourselves to collecting voluminous data on two groups of our sickest patients—those with metastatic breast cancer or prostate cancer—in order to determine whether the Life Over Cancer program of intensive integrative oncology helps cancer patients live better and longer lives compared with patients relying solely on the best mainstream treatments.
Evidence of Longer SurvivalIn ninety women with metastatic breast cancer, the disease had spread to the liver, lungs, brain, bones, or other organs. (Why one kind of primary tumor metastasizes to one set of organs while another kind spreads to a different set remains one of the enduring mysteries of cancer biology.) This is called stage IV metastatic breast cancer. All the women participated in the full Life Over Cancer (LOC) program, including our tailored diet, supplements, exercise, and mind- spirit programs. Eighty percent of them received multiple chemotherapy regimens after they came to us; this was sometimes their third, fourth, or even fifth round of chemo. We compared the survival of our patients with those from other studies conducted by leading researchers in the United States in which the patients received hormonal and/or chemotherapy treatments. Our breast cancer patients lived roughly twice as long as patients getting standard treatments alone as we reported in a study published in 2009 in The Breast Journal. Our median survival was thirty-eight months, compared to fifteen to twenty-three months in the comparison studies of other stage IV patients. Moreover, our patients were 33 percent more likely to be alive at five years than patients getting standard treatment alone.
This edge held even in women with the worst metastases. Our patients with bone metastases lived almost twice as long (forty months versus twenty-three months) as non-LOC patients with bone metastases receiving standard therapy. Our patients with liver metastases lived ten months longer (twenty-three months versus thirteen months) than non-LOC patients with liver metastases receiving standard therapy. Our patients with lung metastases lived more than twice as long (forty-three months versus eighteen months) as non-LOC patients with lung metastases receiving standard therapy. In sum, our metastatic breast cancer patients on the Life Over Cancer program had doubled survival times, increased five-year survival rates, and dramatically better long-term outcomes than patients on standard therapy alone.
We also studied twenty-seven men with metastatic prostate cancer. The disease had spread to their bones or visceral organs, meaning they had stage D2 cancer. All received the standard treatments, called combined androgen blockage, from either our center or their original oncologist to halt production of the male hormones that stimulate the growth of prostate cancer. The patients also all received a drug designed to block the further spread of the cancer. In addition, they received our whole package of integrative treatments, including our dietary plan, select nutritional supplements, a therapeutic exercise program, and a mind-spirit regimen for psychological and spiritual well-being. We compared our patients’ results with results for stage D2 patients from four different studies who underwent treatment at leading cancer centers such as the Johns Hopkins University Medical Center and to patients whose cancer was less advanced (stage C, having spread from the prostate to the local surrounding tissue, but not to the bones or other organs).
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