Complementary Therapies for Mesothelioma presented by Kathleen Wesa, MD, of Memorial Sloan-Kettering Cancer Center at the Mesothelioma Applied Research Foundation's conference in New York, NY on September 28, 2012. www.curemeso.org

1. Integrative Oncology:
Complementary Therapies for
Mesothelioma
Mesothelioma Applied Research Foundation
New York, NY
September 28, 2012
Kathleen Wesa, MD
Integrative Medicine Service
Memorial Sloan-Kettering Cancer Center
New York, USA

2. Alternative vs Complementary
Alternative Therapies
• Promoted for use instead of mainstream
treatment for cancer & other serious illnesses
• Usually biologically invasive
• Costly; potentially harmful
Complementary Therapies
• Used WITH mainstream care for serious illnesses
• Non-invasive
• Inexpensive; safe; evidence-based

4. Seven Signs of Voodoo Medicine &
Science
1. Proponent pitches claim directly to media.
2. Claims a powerful establishment is
suppressing his work.
3. The effect is at the very limit of detection.
4. Evidence is anecdotal.
5. He works in isolation.
6. Says a belief is credible because it has
endured for decades or centuries.
7. Proposes new laws of nature to explain
how it works.
From “Seven Signs of Voodoo Science” by Robert Park, physicist, 2003.

5. Integrative Oncology
Combines the best of
complementary and
mainstream care

6. Complementary Therapies
control many symptoms experienced by
patients and by people generally
• Pain
• Hot flashes
• Sexual dysfunction
• Urinary problems
• Fatigue
• Xerostomia (dry mouth)
• Anxiety, depression, stress
• Osteoarthritis
• Neuropathy

7. 2- Fitness/Physical Activity
Essential per data on
activity and cancer outcome

8. When will we treat physical
activity as a legitimate medical
therapy… even though it does not
come in a pill?
Church T, Blair SN. Br J Sports Med 2008 Oct 16.
8

9. Summary of Exercise-Induced Changes
INCREASED DECREASED
• Muscle mass, • Nausea
strength & power • Body fat
• CV fitness • Fatigue
• Max walk distance • Symptom Experience
• Immune system • Duration of
capacity hospitalization
• Physical functional • HR
ability • SBP
• Flexibility • Psychological &
• QOL emotional stress
• Hemoglobin • Depression & anxiety

10. ACS/ASCM Physical Activity
Recommendations
for Cancer Survivors
• 30+ minutes of moderate to vigorous physical
activity, above usual activities, on 5+ days/ wk
• 45 to 60 minutes physical activity is preferable
• If sedentary, begin with 10 minutes fitness and add
10-15% each wk, total 30 min continuous/5 days
per wk
ACSM New Guidelines Presented at ASCO June 6, 2010

11. 3-Nutrition Recommendations

12. WCRF/AICR Recommendations
1-Be as lean as possible w/o 5-Alcoholic Drinks
being underweight • ≤ 2 drinks/day for men and
2-Limit consumption of ≤ 1/day for women
energy-dense foods
• Avoid sugary drinks 6-Preservation,Processing,
Preparation
3- Plant Foods • Limit salt, avoid moldy cereals
• 5+ servings of non-starchy
veg and fruits every day 7-Dietary Supplements
• Meet nutritional needs through
4-Animal Foods
diet alone
• Limit intake of red meat • Dietary Supplements not
and avoid processed meat
recommended for cancer
prevention

13. Dietary Supplements?
13

14. Or Substitution?

15. 4- Botanicals and Nutritional
Supplements
• 28+ BILLION dollars are spent each year in
the USA on vitamins and nutritional
supplements
• Antioxidants are highly marketed and are of
uncertain benefit, can interact directly with
cancer treatments
• Wheat grass, Gogi, Noni, AÇAI,
Pomegranate, Mangostin, EGCG/green tea,
resveratrol, Vitamin A, C and E, selenium

16. Herbs and Other Botanicals
Benefits and Problems
• Faulty Assumptions
Natural = safe; Long-term use = effective
• Botanicals are unrefined pharmaceuticals
• OK for general public, probably not for many
cancer patients
• Concerns: contamination, toxicity,
standardization, bioavailability, proper doses, and
adverse herb-drug interactions
• Vitamin D may provide benefits aside from
osteoporosis prevention and bone health, studies
are in progress

17. Web site about herbs, botanicals,
vitamins, etc.
www.mskcc.org/aboutherbs

21. Astragalus
• Used in TCM for lung ailments
• Modern scientific studies show potent
immunostimulating effects and cytostatic activities
• Chinese herbal medicine containing Astragalus
can increase effectiveness and reduce side
effects of chemotherapy
(McCulloch M. J Clin Oncol. 2006., Taixiang W. Cochrane Database
Syst Rev. 2005)
• May affect the function of immunosuppressant
drugs (Chu DT. J Clin Lab Immunol. 1988)

23. Application in Cancer Patients
• Pain
• Xerostomia (dry mouth)
• Neuropathy
• Nausea
• Fatigue
• Hot flashes
• Stress/Depression
• Bowel Irregularity
• Lymphedema

24. Acupuncture Needles

26. 26

27. 6-Types of Mind-Body practices
• Meditation- includes mantra, mindfulness
and relaxation techniques
• Yoga
• Tai Chi and Qi-Gong
• Hypnosis
• Guided Imagery
• Breath Awareness
• Music Therapy

28. Massage Therapy

29. Symptom scores before and immediately after
massage therapy
N=1,290
Mean symptom score (0 - 10)
8
7
6
5
4
3
2
1
0
Pain (n=625) Fatigue (n=819) Stress (n=786) Nausea (n=222) Depression
(n=378)
Pre-treatment Post-treatment
Cassileth BR, Vickers AJ. Massage therapy for symptom control: outcome study at a
major cancer center. J Pain Symptom Manage 2004; 28:244-249

31. Complementary Medicine at the NIH
• Website for Office of Cancer
Complementary and Alternative
Medicine www.cancer.gov/cam
• National Center for Complementary
and Alternative Medicine
http://nccam.nih.gov

32. Summary
Eat food
Not too much
Mostly plants
Be physically active every day
Discuss all botanical/supplement use
Acupuncture can benefit many symptoms
Don’t forget the Mind-body interventions

33. Thank you for your attention!