The American Cancer Society recommends that all cancer survivors (1) stop smoking, (2) maintain robust physical activity, (3) eat a diet rich in fruits and vegetables. Shockingly, less than 5% of patients adhere to all three guidelines. I understand that bad habits are hard to break, and that in stressful times we often backtrack on the things we should be doing, but I would have guessed that a cancer diagnosis would be sufficient for most people to make some fundamental changes. It certainly has been sufficient for me.
In my last post, I obliquely referenced “High Fidelity“, perhaps the best movie/book combination of all time. Certainly in the Top 5. Today I’ll reference it explicitly: while discussing his history of failed romantic relationships, the protagonist, Rob says: “Charlie Nicholson was the sort of girl I wanted to meet ever since I was old enough to want to meet girls.” In that spirit, I’ve just found the paper on complementary cancer treatments I’ve been looking for ever since I’ve wanted to read papers about complementary cancer treatments. It’s from a group coming out of MD Anderson, and if you have an interest in preventing cancer or delaying its recurrence, I highly recommend it.
This paper resonates with me because the authors start with the same basic frustration I’ve had for the past two months while reading this literature. Most every cancer patient dabbles in mind/body, nutritional, exercise, and alternative interventions, but the papers that have examined these approaches almost uniformly focus on quality of life issues. Don’t misunderstand me, quality of life is a big freaking deal, but what I really want to know is whether these sorts of things are going to help keep me alive. Finding evidence of efficacy is a needle in the haystack, even for someone as motivated and experienced with primary literature searches as me. Fortunately, the authors of this paper have done the hard work and neatly summarized everything relevant in Table 1. Their recommendations aren’t very surprising.
I can’t plow forward on this line of thought without the usual caveat: these approaches are necessarily complementary to suitable medical interventions, they are not alternatives. When I’m on the happy side of this cancer battle, with all the worries in the rear-view mirror, it will have been the gifted hands of Dr. Chicoine that turned the tide. My aim is to use everything else at my disposal to tilt the balance of factors towards tumor clearance and thereby delay any potential recurrence until well in the future, to give my immune system every possible chance to generate a robust T-cell response to cells bearing tumor antigens, or for molecular medicine to fix this whole glioma mess.
The few studies on mind/body interventions have typically focused on stress reduction. Most of these have been involved enrollment in supportive/expressive group therapy. The evidence of efficacy is a little thin, but there are some encouraging numbers. For example, support group therapy increased the median survival time of breast cancer patients by about 2-fold. When these studies are combined with the anecdotal evidence coming from the Simontons (among others) and the known molecular mechanisms by which chronic stress and depression inhibits normal immune surveillance (particularly that mediated by NK cells), I think it’s more than plausible that mind/body interventions are an effective way to — at the very least — decrease the influence of negative prognostic factors like depression and anxiety. Parenthetically, I wonder whether the benefits of medicinal marijuana for cancer patients are essentially via a stress reduction mechanism. In any case, whether you’re trying to prevent cancer or delay its recurrence, it’s unquestionably advisable to reduce chronic stress, especially depression and feelings of powerlessness and hopelessness.
I believe that the virtue of many of these complementary approaches comes down to their ability to make the patient feel like he/she is actively participating every single day in their healing. Participation in the decision-making process is not a concern for me, since I’ve been known to grill my oncologists on whether they’ve read this month’s Nature Genetics yet. And, on that subject, I personally think that my visualization strategy is miles ahead of the supportive group therapy that’s been tested in clinical trails. If I told you that there are direct neural connections to primary and secondary immune tissues that can be influenced by cortical activity, would you think it’s more beneficial to sit in the back of a room eating a stale bagel during supportive group therapy, or visualizing with single-minded intensity the eradication of tumor cells via legions of really aggressive immune cells? I’ve previously used these sorts of approaches to relax blood vessels during migraines, so does it really stretch the imagination to believe that one can influence the birth and trafficking of immune cells? It makes me wonder whether the migraines were really a blessing in the long run, since they forced me to take these approaches seriously and to practice them in advance of the real battle.
Related to these mind/body interventions, I’ll add cognitive fitness to the list, which improves the immune system’s resistance glioma in mice. I’ll also reiterate my conviction is that cognitive fitness will be a major facet of preventive medicine within a generation.
Here there’s no ambiguity to the data at all: being fit, slim, and active prolongs your life and reduces the risk of cancer and the likelihood of its recurrence. A study of 3,000 women with breast cancer showed that 3-5 hours per week of brisk walking was sufficient to reduce cancer mortality by 50% compared to their sedentary counterparts. Likewise, a study of ~3,000 men with prostrate cancer showed that similar exercise loads resulted in a 50% reduction in total mortality and a 60% reduction in prostate cancer mortality. Even GBM responds well to exercise: 3 hours per week of brisk exercise was sufficient to increase the median survival from 13 months to 22 months. Jing commented that this is on par with the performance of our best chemotherapies. Similar results have been shown for other cancers as well.
As an investment in my continued good health, I went to the mall last week and bought myself a pair of outrageous orange walking shoes. I’m averaging about 13,000 steps every day, which works out to be greater than 6 miles given my stride length. My friend Cheryl Broyles has a cute quote on the subject: “as long as I keep moving the cancer cells can’t catch me.” F’ing A.
I’d like to have a better understanding of the mechanism by which exercise improves resistance to cancer. Is it purely through improved immune system functioning, or is there something more complicated going on? Readers with insight, please contact me.
This one isn’t complicated either: eat your fruits and vegetables and avoid simple carbohydrates. I quote from Frenkel et al.: “Higher dietary glycemic load and total carbohydrate intake were statistically significant associated with an increased risk of recurrence and mortality“. Increased vegetable and fruit intake has been associated with hazard ratios of cancer recurrence in the neighborhood of 0.5 to 0.75. Green tea decreases the risk of breast cancer recurrence, and decreases the aggressiveness of glioma. Increased soy bean intake correlates with decreased risk of cancer and decreased aggressiveness of glioma, possibly through increasing the amount of folate.
I doubt that any of these interventions by themselves will arrest cancer, but there is some compelling evidence emerging that by combining multiple lifestyle changes, you get positive synergistic effects. My goal is to make every waking moment a gesture of defiance and resistance. By making the right choices, my hope is to turn a good prognosis into an excellent prognosis.
I’m completely shocked that only 5% of cancer patients comply with the recommendations of the ACS regarding diet and exercise. On the other hand, it’s morbidly comforting: I take some reassurance from the fact that based on the choices I’m making, I should be in the 95th percentile when I look at survivorship statistics. For the 95% of cancer patients that don’t make changes they know will improve their survival, my question is: “what will it take, if not a cancer diagnosis?” For everyone else who knows they’re not doing the things they ought to be doing to maintain their good health: “what are you waiting for?”