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Key points
- Clinicians need to bring a bigger medical bag with all the tools for person-centered and personalized care.
- Even minimal access to whole-person care can improve and lengthen life for those with cancer.
- We need to see cancer as a chronic disease, something to be managed holistically rather than cells only to be killed.
- The harsh treatment of cancer can lead to other conditions like neuropathy, heart disease, and other cancers.
.jpg?itok=P7KVLE4s "Source: Courtesy Dr. Wayne Jonas")
Jan comes back to her childhood home year after year. She walks by the water in the canals, by the lakes, and the ocean. She comes back to see her family, the flourishing plants, and the changing landscape. Looking for what’s the same, seeing what’s different.
It is in this place that she experienced the stresses of poverty, the daily overexposure to the sun without sunblock, and extensive pesticide exposure as the county sprayed to kill mosquitoes.
As a physician, I see her environment as the place that influenced her BARD-1 gene, a mutation that carries with it a higher risk for several types of cancer, which she would get over the next few decades.
At 34 as a young mom with young children, her first cancer arrived. Triple-negative breast cancer in a pre-menopausal woman. Statistically, not good. But she adapted. She got dose-dense neoadjuvant chemotherapy followed by surgery and radiation. She switched to a less stressful career. She entered a study of a preventive vaccine. She spent more time with her kids and more time volunteering. She ignored her cancer for 25 years, but it did not forget her.
The cancers started coming back at increasingly shorter intervals. She was treated for a second type of breast cancer, ovarian cancer, and twice for melanoma.
As ecologists learned, in the swamps of Louisiana and South Florida, that poisoning and removing an invasive species is not enough. We need to plant and cultivate a diverse ecological system that can help slow them down, too. They need to support the health of the environment in ways that will keep all the native plants strong to better control the rogue ones. This is true of Jan’s cancer as well.
The treatments she has received are not enough to keep the cancers at bay. Now she needs a bigger medical bag with more tools than her oncologists can offer.
Evidence has shown that even minimal access to whole person care can improve and lengthen life for those with cancer. It had taken six surgeries and four cycles of combination chemotherapies for Jan to realize that to benefit from the science of whole person cancer care, she would need to take things into her own hands and look beyond what her oncologists alone offered. Not to abandon what her oncologists did have, but to seek out and support additional approaches on her own.
Our job as clinicians working with patients like Jan is not to leave them alone in finding what they need for their care. We need to bring all the tools for person-centered and personalized care into our own bigger medical bag of tools. Helping patients access nutrition counseling, exercise counseling, patient support groups, spiritual services, meditation, and psycho-oncology support increases quality of life and survival odds.
This helps patients support their own wellness and personal ecology. Something that will improve their immune system, build their energy. Something that will crowd out the cancer cells, or at least slow them down, without poisoning and stripping the rest of their body. Science knows what needs to go into this toolkit, but the full set of tools are not easily accessible, not easily seen, and not integrated into regular cancer care.
We know, for example, that a variety of vegetables and fiber will nourish a healthy microbiome and help the immune system control cancer. We just don’t know what that looks like for each person. We know that certain herbs and safer drugs can change the drivers or “hallmarks” of cancer progression, but we don’t know what doses or combinations to use and how to personalize them to each patient. We know we need to talk about cancer like any other chronic disease, one with ups and downs to be managed.
Cancer is a disease that is there long before we see it and will come back after we kill it. An invasive species that is, strangely, of our own body. Even worse, its harsh treatment can lead to other conditions like neuropathy, heart disease, and other cancers.
The view of cancer as a chronic condition is hard to hold when the entire cancer industry talks about “breakthroughs” in killing cancer cells and advancing the “war” and finding “cures.” Those words and the systems they spawn keep us from seeing the true nature of the disease. Do we have a magic “cure” for any other chronic disease – obesity, diabetes, heart disease, Parkinson’s, or Alzheimer’s? Why would cancer be different?
We need to see cancer as a chronic disease – something to be managed holistically rather than cells only to be killed.
The narrow view – focusing on only the cancer cell rather than the larger environment of the whole person – is not what Jan needs and is not aligned with the science of the cancering process. These narrow tools are not working well. Chemotherapy is harsh on the body. It was developed from mustard gas after World War II. It wreaks havoc on the entire body and impacts your life in ways beyond how you feel physically. It is critical to proper cancer treatment, but it is not enough.
While there are many non-drug approaches that Jan can use in tandem with conventional medicine, they will never reach the type and level of evidence required for FDA or guideline approval. Diet, acupuncture, mind-body practices, herbs and supplements, off-label drugs, and the support for wellness behavior change make no money and get little research investment. At least not enough to drive the 16 years and $1 billion often required to reach the top level of evidence and approval.
Is it any wonder that not one oncologist in over 30 years of Jan’s treatment of multiple cancers mentioned these other tools?
That’s where we come in. We can empower our patients, inform ourselves, and change to a whole person approach to cancer. I see this as part of my life’s work – helping clinicians provide whole-person care, empowering patients to become their own advocates, and changing the system of health care through policy, payment, and process.
I invite you to consider: What are you doing to empower your patients? How are you growing your toolkit beyond conventional medicine? How are you using your voice to make change on a larger scale?
