Updated: Jun 29, 2019
Upstream Thinking in Veterinary Oncology
Upstream Integrative Oncology can be thought of as a lifestyle approach which aims to create the conditions which support health and healing while also working to minimize tumor burden. It is about working toward creating an "Anticancer Life".
In an Upstream Integrative approach to cancer treatment, the work isn't done once conventional treatments are completed. The real work is just beginning. This is where lifestyle changes are implemented. This is where we focus on supporting life...on thriving.
Upstream thinking, in medicine, is an approach to patient care focused on the "upstream" causes of disease, using the analogy of a river. Beyond treating a current condition or diagnosis and the symptoms associated with it, an Upstream approach specifically aims to identify and correct the underlying causes of disease development and implement preventive measures whenever possible.
In the case of cancer, for example, what situations existed prior to development of cancer which allowed the disease to grow into a tumor in the first place? We all have cancer cells in our body. Why do some of us develop life-threatening disease and others do not? Is there anything we can do to address the environment in which the cancer developed in order to make it a less hospitable ecosystem for cancer growth? These are important questions. And they are questions at the forefront of research on cancer prevention.
In this article you will find:
Perspectives on Upstream Integrative Veterinary Oncology
Western Biomedicine Oncology: Tools & Training of a Medical Oncologist - a brief summary of western medical oncology training
Integrative Oncology: Tools & Training of this Upstream Oncologist - what got me interested in Integrative Oncology and my chosen tools, training and perspective
Introduction to Epigenetics and the potential role of Herbal Medicine in cancer patient care
a list of 62 research articles related to the ideas presented here, with links to the articles for your information and resources including...
Seven research articles evaluating Yunnan Pai Yao - a chinese herbal formula used to control bleeding - in companion animals
Upstream Oncology: A Model of Cancer Treatment and Patient Care
A comprehensive approach to health and well-being focuses on supporting optimal functioning of the body's natural healing processes, optimizing health and preventing disease, as well as implementing treatments once disease has occurred.
In oncology, upstream thinking is characterized by the understanding that, beyond tumor-directed treatments, it is important to consider what steps could be taken to support the body's natural defenses against cancer and what tools we have to make the body a less friendly environment for cancer cells. And, going a step further, to consider what we can do to improve the quality of life that is lived after a diagnosis of cancer.
Integrative Oncology leverages the advances of Western Biomedicine in downsizing the cancer burden while simultaneously utilizing the tools we have available to us in other systems of medicine to make the body a less hospitable environment for cancer and support the body's natural healing processes.
While there are many approaches that can be employed toward the fulfillment of these goals based on training and preference, treatments from both our Western biomedicine paradigm and other systems of medicine which may complement or fill in gaps in our current Western "conventional medicine" therapies can be considered.
Possibilities for intervention options outside the Western "conventional" medical oncology paradigm, which is heavily weighted toward pharmaceutical interventions, are particularly relevant to explore if one considers the limited options existing in the pharmaceutical formulary at this time which support the body's natural defenses and homeostasis mechanisms outside of treatments such as hormone supplementation, synthetic vitamins, intravenous fluids, blood transfusions and certain cancer "vaccines".
Research is accumulating on how diet, vitamin levels, exercise, lifestyle, stress, herbal medicines and acupuncture impact development of and recovery from cancer in humans. Recent studies also show that the health of the gut microbiome may impact individual responses to conventional cancer therapies like chemotherapy and immunotherapy.
We already use information from human medicine to inform conventional medicine developments in veterinary medicine and new pharmaceuticals. This research on lifestyle and botanical medicine from the human literature also informs new science-based perspectives in upstream integrative veterinary care and inspires veterinary research into these aspects of health and healing.
Inspired by research findings in human medicine, there is, recently, some published research evaluating the potential correlation between vitamin D and selenium levels and certain canine cancers. And veterinary research is being published in the past few years on on Yunnan Pai Yao, an herbal medicine used to treat bleeding and infection, as well as some bench top studies on issolated herbs and canine tumor cell lines.
It is in combining the strengths of the Western biomedicine paradigm and traditional medicine paradigms, which have a long history of supportive lifestyle and natural medicine therapies, that we open the door to improving outcomes for our cancer patients.
Supporting a Balanced Perspective
Cancer treatment is a multifaceted challenge. At the heart of this challenge lies the human component. The emotional and psychological trauma that often accompanies a diagnosis of cancer greatly affects the development of an optimal treatment plan for an individual patient or family. Individual family circumstances, belief systems and goals for the life of a family pet must be central to a compassionate approach to patient care.
One Approach to Integrative Oncology
Incorporating Traditional Chinese Medicine Interventions
Gut microbiome health
Select vitamins and supplements
Leveraging whole fresh foods as medicine
Lifestyle factors, exercise and weight management
Emotional health and wellbeing of the pet and family
Limiting exposure to avoidable toxins and carcinogens
Appropriate and thoughtfully applied western biomedicine cancer treatments
Western Biomedicine Oncology: Tools & Training of a Medical Oncologist
In the Western biomedicine paradigm (AKA "conventional" medicine), we oncologists are trained to use tools such as surgery, radiation, and chemotherapy in an attempt to rid the body of cancer cells. In this approach, treatments are aimed at either physically removing the cancer cells from the body, or damaging them in a way that they die or "commit suicide". This can work very well for certain types of cancer. But for other types of cancer with a high rate of spread (this is called metastasis) and high mortality rates, these treatments, while often providing an effective option to slow how quickly the cancer progresses in the body, frequently fail to achieve a cure. This tells us that cancer cells survive these treatments. These cells then begin to grow into more tumors.
To try and better address this reality and improve on our cancer treatment success, Western biomedicine has developed or is currently investigating other types of therapies which attempt to bolster immune response against cancer cells, starve the blood supply to the tumor cells, or target specific pathways involved in the growth of specific tumor types.
Beyond Surgery, Chemotherapy and Radiation
1) Metronomic chemotherapy: this type of treatment aims to inhibit the process of new blood vessel formation, called angiogenesis, that tumors need in order to supply nutrients needed to grow. This treatment can also make it harder for the tumor to hide from the immune system by changing certain immune responses involved in protecting tumor cells from immune system attack.
2) Immunotherapy: this type of treatment administers cancer "vaccines", for example, which are designed to help the immune system recognize cancer cells and clear them from the body.
3) Targeted therapies: this type of treatment is aimed at blocking or inhibiting specific signaling molecules or pathways that are involved in the growth of specific types of cancer.
These treatments are becoming more widespread in human oncology, and we do have some options available for veterinary patients. Many, however, can be limited by high cost, are not widely available, are still in the clinical trial phase, or are not effective in dogs and cats due to differences in their bodies or tumor types.
Principles of Combination Cancer Therapy
The principles of combination therapy in cancer treatment are to combine
anti-cancer treatments that do not have overlapping toxicities in order to effect greater tumor control.
There is a book called The Upstream Doctors by Rishi Manchanda published in 2013. When I read this book, I was impressed by many of the perspectives he presented. It was inspiring to hear these words from a human physician who was expressing one of the main motivations that brought me into the field of oncology in the first place.
Dr. Manchanda also did an 18 minute Ted Talk. In it he says:
"We need a fundamentally different way of looking at healthcare. We simply need a health care system that moves beyond looking at the symptoms that bring patients into clinics. But instead, actually, is able to look at and improve health where it begins. And where health begins is not in the four walls of the doctor's office, but where we live and where we work, where we eat, sleep, learn and play, where we spend the majority of our lives.
"It's not that doctors don't know these are important issues. In a recent survey of over 1000 physicians in the U.S, 80% of them said they know that their patients' upstream problems are as important as their medical problems. And despite that awareness of the importance of upstream issues, only one in five doctors said they had any sense of confidence to address those issues, to improve health where it begins."
Integrative Oncology: Tools & Training of this Upstream Oncologist
Motivation and Rationale
In implementing an Upstream approach to Oncology treatment and patient care, we consider what we can do to assist the patient's natural defenses and body processes in maintaining a healthy internal environment and to correct the imbalances that are promoting cancer persistence, growth and spread. This aspect of patient care is evolving rapidly in human medicine. It is becoming easier to find research looking into some of these aspects of wellness and healing.
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