How to Manage Cancer
Questions from the Clinic:
Hey Doc, what is the "Special Sauce" to manage cancer?
I get this question asked in various ways many times a week and hundreds of times over this past year. I generally start with a blanket statement about the importance of general fundamentals of health, which incorporate physical topics and the emotional and spiritual equally balanced. Once again, it all goes back to the loving wisdom of a "grandma" in our life. I then acknowledge that knowledge is dynamic and fleeting, and I can only answer this with the statement, "What I know today and hold onto lightly…”.
I start with the encouragement to consider the standard of care guidelines which have survived some rigors and reviews. This generally encompasses some blend of surgical, chemotherapy, radiation, and new targeted therapies and are listed at standard patient-friendly websites such as www.nih.gov and www.nccn.org. Following that statement, I arm them with critical questions to clarify the offering to better understand the potential path and outcome in absolute numbers rather than "relative risk" reduction and other doctors' speak. I remind them that the guidelines are based on high-functioning patients under ideal conditions and inflate the study outcomes. The think tank on each oncology topic may have a few options and alternative treatment paths that get outvoted and then dropped from the final publication. Some analyses report that less than half the patients fit cleanly into a guideline recommendation. Although guidelines and "menu medicine "serve the important purpose of synchronizing standard doses and options, they may also provide a license to quit thinking. This construct fosters the gradual loss of the art of medicine needed to deal with the more common "gray" area decision-making. In the end, you need a cancer doctor with who you can have a heartfelt two-way conversation in the discussion and delivery of the standard of care component.
I mention that there is some unexplained component of why a percentage of people are successful with standard treatments and the inverse ratio are not. While we have some hints at these positive predictors, and fortunately, most of these can be added to a program with minimal downside time and cost. Today, I encourage patients to have a metabolic portion of their treatment, including nutrition and a pharmaceutical component. The nutritional part generally focuses on reduced carbohydrate intake, intermittent fasting if cachexia is not a concern, pre-chemo radiati