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You've Been Diagnosed: Now What?

You've Been Diagnosed: Now What?

As physicians, caregivers, and human beings, we fervently hope for the day when the perfect cancer treatment becomes available one that's effective, predictable, and without side effects. But despite years of research and an aggressive "war" on cancer, scientists have yet to figure out how to conquer this terrible disease once and for all.

Until they do, people with cancer must make difficult choices. Depending on the nature of their diagnosis, they have to select from among a bewildering array of conventional treatments surgery, drugs, radiation. Their task is made more difficult because they must make their choices under stressful circumstances while navigating a complex and confusing health care system. And advice flows at them from all directions: doctors, nurses, friends, neighbors, fellow patients, the media.

What is the most rational approach to this disease? How do you chart a course of treatment that combines the practical and the personal, that balances the physical and the philosophical? When your body is under attack, how can you best draw on the resources of the mind and the spirit as allies in your fight to become whole again?

Our goal is to help you answer these and other essential questions. To do so we'll draw on our years of collective experience in the field of treating cancer through natural healing strategies that support the best that modern medicine has to offer.

Realistic Expectations

Patients often ask tough questions about their expected life span; chances for cure, risk for recurrence, and so on. As we've discussed, those numbers only apply to large groups, not to individuals. Each cancer patient is unique, with different characteristics, strengths, weaknesses, and genes. Physicians talk with patients about average survival for people with their particular type and stage of cancer. Often, they will refer to the five-year survival rate. If the five-year survival rate is 50 percent, it means that half of the patients will die within five years while the other half will live more than five years. On one end of the spectrum is the patient with rapid disease progression and early death. On the other end is the patient that enjoys complete cure, long-term remission, or many years of disease-free survival. Most patients will fall somewhere in the middle between these two extremes. Our job as caregivers is to try our best to move each patient as far to the positive end of the spectrum as possible, to include them among the other long-term survivors.

To do so, we encourage them to make all the lifestyle changes necessary and to use the natural medicines we discuss throughout this book. At the same time we encourage them to take advantage of the appropriate conventional therapies for their condition. With this integrated approach, we maximize their chances, not just for longevity--a greater number of years--but for an increased quality of life during those years.

As we've noted, cancer treatments attack and destroy cancerous cells, but they have the unfortunate downside of killing many healthy cells in the process. That's a pretty big tradeoff, and sometimes the destruction of bad cells comes at too high a cost, in terms of the number of healthy cells destroyed.

For this reason, we sometimes work with patients not so much to focus on the need to eliminate all detectable cancer but more to accept the fact that the cancer is present. The goal then shifts to achieving an acceptable balance between cancerous and healthy cells in the rest of the body.

In this revolutionary approach, the ultimate idea is to think of cancer as a long-term manageable disease, somewhat like diabetes or arthritis. Treatment is then designed to minimize symptoms and control the damage from the disease process. As we've noted, some cancers, such as prostate cancer, tend to be slow-growing. Making lifestyle changes to assure that they stay slow-growing and noninvasive may be better for some men than undergoing aggressive therapy with multiple side effects. The effectiveness of this approach can be estimated by looking at prostate cancer incidence and mortality around the world. When the prostates of elderly Japanese men are examined during autopsy, they are found to have prostate cancer about as often as men in the United States. The difference is that their cancer is microscopic, causes no symptoms, and is only discovered as an incidental finding during routine autopsy. The rate of prostate cancer deaths in the two countries varies by a factor of 20. As we interpret this finding, diet, lifestyle, and genetics can be harnessed to keep existing cancer in a quiescent, noninvasive form.

The classic question after learning about a diagnosis of cancer is, "How long have I got?" No one--whether a health care practitioner, Nobel Prize-winning researcher, religious leader, or counselor-can predict exactly how long another person will live. When time runs out is really up to God, but we urge our patients to remember the old saying "God helps those who help themselves." We stress that the more changes they make in their way of living to keep themselves strong and healthy, the better their chances that they'll be one of the lucky ones who migrate to the right end of the bell curve for long-term survival.

Expectations have much to do with our experience of reality. By that we mean that our bodies often make real the things we expect to have happen. This is the basis of the so-called placebo effect and the power behind positive visualization. When people expect an outcome, it will often occur, not because they imagined it but because they expected it As a result of their powerful expectation, their body went to work manufacturing the enzymes, neurotransmitters, and blood chemicals to make that expected outcome a reality. If you expect to have a positive outcome from your cancer treatment, it is more likely to occur. By the same token, if you expect the worst, then that's what you're likely to get. We're not necessarily saying you can think your way out of cancer. But we strongly believe you can certainly point out the right direction to your body and trust that the magnificent healing machine inside you will go to work trying to make that outcome real.

Goals of Treatment with Natural Medicine

We believe that natural medicine should play a central role in the rational approach to cancer. Cancer reflects the presence of imbalance and loss of control (dysregulation) in the body. Natural medicine focuses on bringing balance back into the system, making it less vulnerable to cancer. The big goals in the utilization of natural medicine in the rational approach to cancer are to:

  • Support the whole person. You are not your disease. You are an individual who happens to have been diagnosed with a particular illness called cancer. Chapter 5 describes important guidelines to employ the tremendous healing power of the human mind and spirit.
  • Take away any factors that support cancer development. It is important to eliminate harmful dietary, lifestyle, and other pracrices that promote cancer. For example, a recent study found that the recurrence rate for colon cancer was one-tenth as high in women who had low levels of insulin than it was in those with high insulin. Insulin is a hormone whose output can be reduced by improvements in diet and exercise. The message? Eat right and stay active and you lower your risk of recurrence. The importance of dietary factors, exercise levels, maintaining healthy weight, avoidance of pesticides and radiation, and many more changes cannot be underestimated in their ability to contribute to a successful treatment outcome.
  • Utilize natural medicines to treat cancer and prevent recurrence. Regardless of the form or location of cancer, appropriate natural medicines can be used to inhibit tumor growth, boost the immune system, promote natural death of cancer cells, and boost the effect of conventional therapies while reducing their side effects.
Manage Your Response to the Diagnosis

The diagnosis of cancer poses a daunting challenge to the psyche and the human spirit. Many of our patients tell us that the worst part of the whole process of overcoming cancer is the time right after the diagnosis, After hearing the words "You have cancer," most people naturally experience a flood of powerful feelings as they absorb the shock and adjust to their new reality. Among these emotions are:

  • Denial ("The tests were wrong." "It can't be true.")
  • Anger ("Why did I get cancer?" "Why couldn't it have been someone else?")
  • Guilt ("Why did I smoke?" "Why didn't I take better care of myself?")
  • Depression ("It's hopeless." "I might as well give up.")
  • Fear ("There's nothing ahead for me but pain and suffering." "I'm going to die.")
Denial ("The tests were wrong." "It can't be true.") • Anger ("Why did I get cancer?" Why couldn't it have been someone else?) Guilt ("Why did I smoke?" "Why didn't I take better care of myself?") • Depression ("It's hopeless." "I might as well give up.") • Fear ("There's nothing ahead for me but pain and suffering." "I'm going to die.")

These emotions are to be expected and are in fact a normal human reaction. But they are just the starting point, step one of the healing process. The next stage in managing your response to the diagnosis usually involves accepting your new reality and deciding on a course of action. The fact that you are reading this chapter- either for yourself or on behalf of someone you love-suggests that you have reached this important stage. And that's great news, because you're taking positive action to regain control over your life. Many challenges still lie ahead. But you are laying a solid groundwork for making empowering, correct decisions.

These decisions must be right for you. That's essential, because each of us responds to the challenges of life in different ways. Some people like to charge ahead, daring life to stop them. Others proceed slowly, gathering information along the way. Still others look inward and depend on their own intuition for guidance. The truth is, most of us draw on all of these strategies, but at different times and to different degrees There's no one right way.

Whatever the strategy, the goal is the same: to overcome cancer. You have the best shot at achieving that goal if you:

  • establish a strong system of support-emotional, physical, and spiritual
  • build good relationships with your physicians and other caregivers
  • understand your particular form of cancer
  • follow the recommendations in this book to maximize your odds of beating cancer
Take Control

After they receive a diagnosis of cancer, many patients feel they have lost control-of their bodies, their lives, their destinies. No doubt much of that feeling arises from the disease itself, since cancer seems to take control of the body. But much of it also results from having to deal with the health care system. Patients must submit themselves to a series of invasive tests and procedures. In the course of treatment, they come into contact with a bewildering assortment of health care professionals, some of whom they see once and then never meet again. Decisions must be made quickly, often under the most emotional and trying circumstances. At the same time, family members and friends may appear on the scene, offering advice that's well meaning-but often conflicting or just plain wrong.

One of the most important things you can do to help your fight against cancer is to regain as much control as you feel you want to handle. We urge you to take control of your health care decisions, your choice of treatment, and the steps needed to promote your recovery. We believe that taking control improves your chances in three main ways:

  • You'll make better treatment choices-choices that are best for you, your body, your circumstances.
  • You'll get better results.
  • And you'll gain a psychological edge, an inner source of strength and courage.
UNDERSTAND YOUR DISEASE

The first step in taking control is to fully understand the type of cancer you have to know thine enemy."

After first hearing about your disease from your doctor, you'll probably want to probe a little further. If you are comfortable working your computer, you can find a wealth of valuable information on the Internet. A good place to start is Cancernet (http://cancernet.nci.nih.gov). This site was developed to provide recent and accurate cancer information from the National Cancer Institute (NCI), the federal government's principal agency for cancer research. The site is designed to serve the needs of patients, caregivers, health care professionals, and researchers, among others. The information is the best of what is available from the conventional medical circle. Here you'll find links to information on virtually every type of cancer and its treatment, recent updates on clinical trials, and other useful information. If you can't locate the information you need or do not have access to the Internet, contact the NCI's Cancer Information Service, toll-free, 800-4-CANCER (800-422-6237), to speak with a trained information specialist. Another good source is the Web site of the American Cancer Society (http://www.cancer.org). The site has information for patients and their families, discussion groups, and tips for survivors.

Keep in mind that cancer is not really a single disease. There are dozens of different forms of cancer, each with its own personality. The worst ones are aggressive and invasive, wasting no time in spreading to other parts of the body. Others are more slow-growing and may never progress to the point where they become life-threatening. Some types of tumors cause symptoms (pain, bleeding, and so on); others do not.

Many cancers come in different varieties (or subtypes). Breast cancer, for example, takes several forms, depending on where it develops and other factors. Tumors that respond to the presence of hormones (estrogen) must be treated in a different way from those that are not hormone sensitive. There are many other factors that come into play. The main point is that onces all these individual factors have been determined, it becomes increasingly possible to size up the overall strengths and weaknesses of the particular cancer you're dealing with. This, in turn, allows you to make informed choices regarding treatment decisions.

Following are some of the key questions to ask in assessing your care Cer and its potential treatment.

What type of cancer do i have?

The name of the cancer is based on the cell type and location. The major types of cancer are:

  • carcinomas (arising in cells in the surface layer or lining of an organ)
  • sarcomas (arising in connective tissue, bone, or muscle)
  • leukemias or lymphomas (arising in blood cells or lymphatic tissue)

During diagnosis, the cancer is named according to the site in which it first arises. If the cancer spreads, it remains the name of the site where it originated. Thus breast cancer that has traveled to the liver is considered to be metastatic breast cancer (not liver cancer), and it would still be treated with drugs appropriate for breast cancer.

The pathology report on your tumor (based on diagnostic tests or biopsy) often includes other details, such as the presence of certain hormone receptors and other markers of abnormality. In prostate cancer, for example, the Gleason score defines how aggressive (how fast-growing and fast-spreading) a prostate cancer tumor is.

Where is it located, and what is the extent of the spread?

Cancer can be confined to a small primary site or can spread throughout the body. Smaller, well-contained tumors are often curable by surgery alone, but tumors that have spread into neighboring tissues or metastasized to different sites in the body indicate the need for more aggressive and systemic therapy.

What stage is my disease?

Staging is the process of evaluating the spread of a cancer. To stage cancer, doctors might order biopsies or imaging tests, such as computed tomography (CT or "CAT) scans or magnetic resonance imaging (MRI) scans. They're looking for enlarged lymph nodes, masses in different sites, or small areas called hot spots that might indicate the presence of microscopic cancerous cells.

Generally speaking, the following stages apply to most cancers:

  • Stage 1: Tumor is small and localized that is, it hasn't spread beyond its original location)
  • Stage 2: Tumor is large but still localized.
  • Stage 3: Tumor is pushing against, or penetrating into, adjacent tissues.
  • Stage 4: Cancer cells have spread to tissues at other distant sites in the body

Each tumor type has slightly different criteria for the determination of stages. In colon cancer, for example, the pathologist determines how deeply the tumor has penetrated the relatively thick wall of the large in testine.

Another way of describing tumors is the TNM system, which is a somewhat more precise way of noting the extent of the disease. The letters represent various facts about the tumor: I stands for primary tumor Features: N means extent of lymph node involvement, and M indicates distant metastasis. The accompanying numbers provide additional information. For example, left breast infiltrating ductal carcinoma staged as T1,NO, MO indicates that the tumor is small, has no involved lymph nodes, and has not metastasized.

What other characteristics does this tumor have?

The presence or absence of markers of cellular irregularity may predict how aggressive a cancer will be. The less a tumor resembles normal healthy tissue, the harder it is to treat and the more aggressive your treatment plan will need to be. These markers vary according to the cancer involved. Your doctors may want to evaluate as many of these variables as possible to fully understand the nature of your disease.

What are my treatment options?

Medicine is as much an art as a science, and nowhere is that more true than in the treatment of cancer. While there are certain clearly defined protocols that many physicians opt to use, there is no "one-size-fits-all" approach. Instead, the best strategy involves carefully tailoring the treatment plan to meet the individual patient's needs. Ask your oncologist about all treatment options available to you, including those that may be available through other caregivers or even through creatment centers in another City.

Choosing one approach to treatment often leads to other decisions that wouldn't arise after choosing a different approach. For example, a breast cancer patient may undergo a lumpectomy (removal of the tumor) and elect to have radiation therapy to destroy any lingering cancer cells that still may be present in the breast. A patient who has a mastectomy (complete removal of the breast) to remove a localized tumor that has not metastasized may not need to consider radiation if all the affected tissue was removed during the surgery.

And treatments require different strategies depending on various circumstances. For example, some courses of chemotherapy require weekly intervals: others are administered three times a week or once every three weeks. Radiation might be delivered in a few large doses, or it may be fractionated (involving the use of smaller doses given more frequently). In some cases, radiation is delivered directly to the tissue by means of internally implanted radioactive seeds. Each option has a different set of benefits and drawbacks. By asking your doctor to describe all your choices, as well as the pros and cons of each, you'll be better able to pick which approach offers the best combination of safety and efficacy for your situation.

Too often cancer patients decide for or against a proposed cancer treatment after hearing stories-usually told by well-meaning relatives or friends who were treated years ago, when things were quite different, medically speaking, from what they are today. Once they hear those tales (many of which are "horror A Quick Overviewstories"), they get sidetracked in their effort to explore current treatment options and techniques. But no two cases of cancer are ever the same. And treatments are always being improved. Newer drugs and techniques and the addition of natural therapies can dramatically decrease the potential toxicity of conventional therapy and at the same time significantly improve its effectiveness.

Another way of looking at your treatment options is to consider what is fundamentally important to you in life and then to make your choice from that perspective. In general, younger people are frequently more willing to choose aggressive therapies with potentially severe side effects, since these often offer the best chance of significantly prolonging life. On the other hand, a man in his eighties may decide that he would rather spend quality time with friends and family than cope wich the major side effects of surgery or radiation. Remember, both quality and quantity of life matter. So, too, do your plans for how you spend your remaining years. If there's a positive side to cancer, it's that it often helps you get your priorities straight.

Doctors are human, and so naturally they will have their own habitual preferences. Understandably, they will usually offer the type of treatment with which they have the most experience. Surgeons like to think that surgery is the best option, while radiation oncologists would naturally urge a choice involving radiation. It is often helpful when seeking information on choices to get a second opinion from another provider. (Of course, getting a second opinion that contradicts the first can make the choice that much more complex.) For more about bias and second opinions, see those sections below.

When you speak to doctors, be sure to ask them for information about the success rate for the treatment advised. Most treatments have been well studied, and their efficacy has been documented. Still, such statistics are really only valid for large groups. A treatment's past performance doesn't guarantee how it will work in the future for a given individual.

Conventional Cancer Treatments: A Quick Overview
Surgery

Surgery is often the first approach used in treating many kinds of cancer. Surgical removal of the tumor often results in a cure, especially if the tumor is small and localized.

New surgical techniques can also improve outcomes. During a lumpectomy, for example, sentinel node biopsies can be performed. These allow physicians to analyze one or two lymph nodes during the procedure to determine how far the disease has spread. Removing just the nodes involved avoids the more extensive axillary node dissection (removing a long section of nodes), thus reducing the risk of serious, sometimes debilitating side effects such as chronic lymphedema (swelling).

Radiation Therapy

New developments in radiation therapy equipment and techniques over the last few years have made it possible for physicians to deliver more radiation to smaller areas while causing less damage to healthy tissue. Drugs such as amifostine, newly available by prescription, help reduce the side effects from certain types of radiation treatment. Many natural therapies can also limit side effects while simultaneously improving response rates (for more information, see Chapter 12).

Advanced scanners and radiation technology make it possible for doctors to plan and administer treatments with a degree of precision never before achievable, increasing effectiveness while minimizing side effects. Such machines are not yet widely available, however, so patients desiring these treatments may need to travel to facilities with the most up-to-date equipment.

Chemotherapy

Chemotherapy is a general term covering scores of different cancer drugs, available in hundreds of different combinations that can be administered in many different ways. And the type and severity of side effects from those drugs will vary greatly, depending on the agent, its dosage, and its method of administration. Chemotherapy is probably the conventional cancer treatment that generates the most questions and concerns from patients. Opponents often deride chemotherapy as “toxic waste being pumped throughout your body." Such images would frighten anyone and, besides being inaccurate, are not helpful.

Not all chemotherapy regimens are alike. Therefore, questions about chemotherapy effectiveness and side effects need to be very specific to both the drugs being considered and the type of cancer being treated.

What are the likely side effects?

The problem with cancer is that it affects cells, and treatment that destrovs unhealthy cells often destroys normal cells in the process. Military specialists refer to this as collateral damage, while doctors call these side effects. The potential benefits of any treatment-cure, increased survival time, and so on must be weighed against the possible risks of treatment.

In making your choice, remember that there are many steps you and your caregivers can take to prevent side effects or at least minimize their impact. For example, many chemotherapy drugs cause nausea, but new antinausea medications have dramatically reduced the seriousness of this problem. Many natural therapies can also help to limit side effects such as fatigue and nerve damage. More information on this topic appears in Chapter 13.

If you read the package inserts that accompany cancer drugs (or any prescription medications, for that matter), you'll no doubt discover a seemingly endless list of potential adverse effects from the therapy. Please don't let this list alarm you or play a big role in your treatment decisions. Remember that these are potential side effects. They have been reported in a certain percentage of patients, and the drug manufacturer is required to list them. But most of the problems on those lists occur only rarely (that is, in less than 1 percent of cases). Just because a drug may cause an adverse reaction, doesn't mean it necessarily will in your case.

For peace of mind, be sure to ask your doctor, nurse, or pharmacist what problems are most likely to occur with a given therapy and what steps can be taken to minimize their impact.

What are the long-term risks of this treatment?

Some treatments carry long-term risks, such as the danger of heart damage or nerve damage from chemotherapy. Unfortunately, some treatments even increase the risk of developing another (secondary) cancer. Knowing about such risks may help you decide between two seemingly similar options, one of which may carry fewer or less serious long-term complications.

Remember in all this discussion that the risks of the treatment must always be weighed against the risks of the disease itself and the cost of doing nothing. which could include medical complications, unnecessary pain, and even death.

How do I know which treatment gives me my best chances?

Conventional medical doctors often refer to the outcomes of cancer treatment in terms of the percentage of patients who survive 5, 10, or more years after therapy. Such information can be highly valuable in helping you decide which course of treatment to follow. Here are the key questions to ask as you make your decision:

  • What is the difference in survival rates among the various treatment options?
  • What are the differences in risks of side effects and toxicity
  • What impact on my quality of life will each of the treatments have?
  • What is the difference between response and survival rates? (Many tumors are called responsive because they get smaller with treatment, but that change may not result in improved survival times or enhanced quality of life.)
  • What is my outlook if I choose to have no treatment at all?

In cancer care, as in all medicine, the risks of treatment must be weighed against the possible benefits. Here's an example of what this means.

Mary, a 55-year old woman, learns that, in her case, surgery alone will give her a 70 percent chance of living another 5 years and a 50 percent chance of living 10 years. If she also undergoes radiation and chemotherapy, her odds improve a little: Her chances of five-year survival rise to 80 percent and her ten-year chances to 60 percent. In her case, she decides that the possible adverse effects of additional therapy aren't worth the small increase in her odds. John, a 40-year-old man, has a different scenario. In his case, surgery will give him a 50 percent shot at five-year survival and a 30 percent chance of living another ten years. Having radiation and chemotherapy increases his chances to 80 and 60 percent, respectively. Clearly, it's in his best interests to go for all three forms of treatment.

Of course, it's worth keeping in mind that the survival rates your physician will discuss with you probably do not take into account the potential benefits of alternative and complementary therapies. We believe that appropriate use of these modalities will significantly improve the outcome, in terms of longevity, quality of life, and reduced risk of recurrence.

How can I best prepare for this treatment?

Having access to a full and balanced care team allows you to draw on the expertise of many providers and viewpoints. This team might include your oncologist; the nursing staff; your naturopathic doctor. acupuncturist, and nutritionist; and trusted friends.

Consult with the team to learn how best to pre-treat yourself to reduce the likelihood of potential complications. Such strategies, discussed in more depth in Part 3 of this book, can include improved diet, prescription medications to control nausea, stress reduction, lifestyle and job changes, getting adequate rest and exercise, and steps taken to improve your overall health and spiritual sense of well-being.

Because cancer therapy can reduce your immune function, oral infections are a common consequence of treatment. For this reason, we urge our patients to visit their dentists for a complete checkup and, if time permits, to have any dental work completed before treatment begins.

Are there support groups or information services available for my type of cancer?

Absolutely. Most hospitals and oncology offices have support groups for cancer patients. These groups are invaluable in helping you to understand the bewildering medical whirlwind you're caught up in. They allow you to meet others who have been through the same process and who have valuable experiences and insights to share. Several years ago a breakthrough study conducted at Stanford University's School of Medicine convincingly showed that cancer patients (in this case, breastcancer patients who attended regular weekly support groups doubled their chances of survival. Subsequent studies have shown that group psychotherapy not only increases survival but also significantly improves the quality of life.

In addition to general cancer support groups, there are groups for specific cancers such as breast cancer, prostate cancer, bone marrow transplant patients, and so on. These targeted groups often lead to strong bonds among members, because everyone present has had similar experiences and problems. They may also be able to offer more specific and helpful suggestions than those provided by a “mixed” group of cancer survivors.

There are even support groups for family members and care providers to help them find better ways to help their loved ones and to emphasize the importance of taking care of themselves during the treatment process.

In addition to support groups, many patients have found it helpful to set up a "caring circle" of four to six close friends who agree to help you during your treatment. Such help could be in the form of driving you to appointments, helping with housework, preparing meals, walking the dog, or running errands. Putting such a system in place before you begin treatment makes it easier for you to ask for help and provides a welcome outlet for the love and concern those around you feel at this time.

Are there any new drugs or treatments available for people with my type of cancer?

In this country, drugs are approved by the federal government for use in specific conditions. The purpose of the drug, called its indication, is listed in the prescribing information that comes in the package. Often, however, researchers discover that a certain drug may offer some benefits for conditions that are not specifically listed on the package insert. These are known as off-label indications. Doctors have the right to use their judgment in prescribing any medication for any reason they see fit. Sometimes patients have benefited greatly from receiving such treatments, which have gone on to become standard therapy for those conditions. We encourage you to ask your doctor whether other treatments are available.

One approach is to consider taking part in clinical trials-scientific studies designed to evaluate the safety and efficacy of new drugs or to see if previously approved drugs might offer some benefit in different indications. Of course, many drugs tested in such trials end up offering no benefit, or they turn out to be unsafe. Reasons for taking part in clinical trials range from being a willing volunteer to see if a treatment works to grasping at any straw that might offer hope of a cure. Whether you decide to participate in a clinical trial is a difficult and personal is sue.

Where should I go to get the best treatment?

Many cancers can be adequately treated in local oncology centers. In more advanced cases, or in rare cancers, there may be a particular "center of excellence" offering a higher degree of expertise in your illness. Your doctor may refer you to one of these sites or you may find out about it by researching Cancernet (http://cancernet.nci.nih.gov). There may also be newer procedures or equipment that produce greater efficacy with a lower risk of adverse effects and that are only available in a few centers around the country. An example is high dose rate (HDR) brachytherapy for prostate cancer. The procedure uses brief exposure to higher doses of radiation inside the prostate rather than lower doses administered over a longer time through the use of permanenty implanted radioactive seeds. Sometimes your caregivers know about treatment options available in your area but may not be aware of valid therapies available in more distant care centers. You may need to be more aggressive in your research to find out about the latest treatments and where they can be obtained. Organizations such as the National Cancer Insticute can be helpful in this regard.

Surgery is another situation that calls for doing a little homework. Studies have shown that the rate of complications---for example, impotence and incontinence after prostate surgery—is lower at university centers where more of these procedures are performed. It is only reasonable to expect that doctors who do high numbers of certain procedures will have more practice and get better at it. Ask your doctors to refer you to the surgeon or the center that they would go to if they had this illness.

Get a Second Opinion

In most cases, you'll want to get a second opinion, both about your diagnosis and about your treatment options. Confirming the diagnosis is essential, since cancer-a wily disease that appears in many forms and whose nature can change rapidly in just a short time-can often mislead even the most highly trained professionals. For example, one of the deadliest forms of cancer, malignant melanoma, can look just like some noncancerous conditions, such as moles or pigmented lesions. Unfortunately, misdiagnosis does occur, and delays in identifying the disease correctly can prevent patients from receiving timely, appropriate care.

In some cases, getting a second opinion might mean speaking to a physician in the same general field of medicine as the one who provided your initial diagnosis. Or it might mean seeking guidance from someone who can add new information to the mix, such as a naturopathic physician or other alternative medicine provider. Ideally, you'll consider both strategies. Whatever your approach, the goal is to broaden your perspective concerning your disease and the choices available to you.

Making Your Choice

After asking all these questions, you'll ultimately come to the moment when you need to make some decisions about treatments. In many cases there is no "right" decision. You may have to choose from among a bewildering array of options. And you'll probably have to make some choices based on technical medical data, much of which may be confusing and a little scary.

For many people, the hardest part of the decision is realizing that there are very few absolutes. Your doctors usually won't be able to promise that they "got it all" or that there's no chance you'll experience a certain side effect. Realistically, the best your doctors and advisers can do is talk about statistics and percentages. Trouble is, these statistics don't really apply to an individual. There might be only a 1 percent chance that you'll experience Adverse Effect X—but if you're the l out of 100 who has that side effect, the fact that a treatment is "99 percent side-effect-free" won't mean much to you.

There are several strategies we urge our patients to use to help with their decision making.

Majority rules:

In this technique the patient seeks a second, third, and sometimes even fourth opinion from experts. If everyone agrees on a single treatment, the patient will go forward with that. If one gets as many opinions as consultations, then there is obviously no "best" answer, and other strategies may need to be considered.

Self-awareness:

Many people have long-held opinions or feelings about themselves or a certain treatment, and such opinions may affect their decisions. For example, some women would agree to any form of drug or radiation treatment to avoid losing a breast through mastectomy. Some men would do the same to avoid the risk of impotence following surgery for prostate cancer. As long as there is an equally viable treatment to choose from, basing decisions on your awareness of your needs and priorities is a solid way to make decisions. Just be sure that you don't rule out the treatment most likely to save your life because of old preconceptions or fears.

Intuition:

Trusting to intuition is a way to get in touch with your inner feelings and may help clear the way to making a decision. People do this in various ways. For you it may mean keeping a journal of your feelings,writing down your dreams, meditating on a question, or actively seeking out your own innate knowledge. Each of these is a way to filter through and sort out the information you are collecting. Sometimes one path will just resonate as the right one to take. It often pays to listen to these gut feelings. But we urge our patients to be sure that the answers that come to you address your highest good and that you're not just giving yourself an easy answer, the one you wanted most to hear. Sometimes the hardest path to follow is the one that provides the greatest rewards at the end.

Regret minimalization:

One of our patients told us about this technique. It involves looking forward into the future, seeing all the possible outcomes of each decision, and experiencing the emotions you would feel if that particular outcome were to become a reality. In her case, she knew she'd found the right decision when she imagined an outcome that might have been less than ideal but that still allowed her to feel she'd made the right decision based on what she knew at the time.

Imagine success:

Once you've made your decision, there's another step to take that we believe is essential for achieving the optimal outcome. Simply put, that step is to imagine success. Prepare yourself to be as healthy as possible and go forward trusting in the ability of your body and your spirit to survive with the help of your caregivers and your loved ones. Remember that you are always in control at all stages of this process. In most cases, if the initial plan isn't working, you can revisit the decision and make another choice.

It is also helpful to realize that with most cancers, you have some time to educate yourself as thoroughly as you wish about your illness and treatment choices. Although receiving a diagnosis often leads to a sense of urgency-and in some cases there truly is an urgent need to act--the reality is that by the time a cancer has been diagnosed, it has probably been present in the body for several years.

Unless the tumor is causing acute symptoms, taking a few weeks to allow time for learning, introspection, and decision making will actually improve your chances. You'll have a better grasp on your options and will make smarter choices. This learning time can also allow you to come to terms with emotional issues such as sadness about possible loss of body function, fears about mortality, and so on.

Time spent in such preparation is not wasted. For one thing, it helps you achieve a greater sense of emotional balance. That helps your immune system function better-remember that your immune system is a vital link to the process of healing from cancer and its treatment. Haying a good understanding of what is to come, and having taken an active part in the decision process, is itself therapeutic. This is also the time to improve your dietary and lifestyle habits to physically prepare for treatment.

Choose the Physician Who's Right for You

Even in this era of managed care, most cancer patients have some control over whom they go to for care. Unfortunately, in some cases patients get stuck working with doctors who are not a good match for them on a personal level.

By reading this book, you are making a strong statement that you are interested in using natural medicine to help you fight cancer. If you find that your physicians believe that you should not use these strategies, then you may need to keep looking. It's probably easier to find a doctor who supports you than to try to change someone's mind on the subject.

Fortunately the situation is improving. Today many conventional oncologists recognize that natural medicine does have its place in conventional cancer care. This book is written as much for them as it is for you.

Build a Good Relationship with Your Caregivers

To get the most out of your treatment, it's necessary to develop a relationship of trust and confidence with your caregivers-physicians, nurses and staff, therapists, and others. That may seem like a difficult task, but it can be done.

Try to be as organized as possible. Time is as valuable to your doctors as it is to you. There are only so many hours in a day, and the health care system today puts pressure on physicians to keep visits as short as possible.

You can make your experience more valuable by bringing with you a list of questions or issues that you want to discuss. If the list is long, schedule a longer consultation visit so that there will be time to fully understand the answers.

Take notes or even tape-record your session. Keeping track of such information during the visit can help bring all the members of your support network up to date.

We encourage you to bring someone with you to doctor appointments, chemotherapy treatments, and hospital visits. Such a person acts as your advocate someone who is there to support you and help take action on your behalf. Advocates are useful for several reasons. People coping with illness often find it hard to absorb everything that happens to them during a medical visit. There are so many questions to be answered, facts to learn, choices to be made. It's hard to grasp all the details. An advocate helps ensure that you get all you need from these encounters. Having a second set of ears to listen, take notes, and review the visit with you afterward means you're less likely to miss some important point because of information overload.

It is especially important to have a knowledgeable and informed advocate available during a stay in the hospital. At the very least, having an advocate can make a trip to the hospital seem less frightening and overwhelming. This person can help assure that you receive the best care and can reduce the possibility of complications and mistakes. Because of budget constraints, hospitals today have fewer nurses on staff. Many services are provided by overworked paraprofessionals. Sad to say, such a situation can lead to mistakes in medications or provision of care. Your stay will be more pleasant and you will recover more quickly with fewer complications if your advocate is there to verify that your medications are given at the right time, that it is the medication you should be taking, and that your safety and comfort needs are being met.

We urge our patients to nominate one, or at most two people as advocates. Having the same person involved when needed at different steps along the way helps provide consistency and oversight concerning your medical care. What's more, a regular advocate is more likely to notice changes in treatments, such as different medications or dosing, and confirm with health caregivers that such a change is intended.

Watch for Bias

You might have heard the old expression "When the only tool you have is a hammer, then every problem looks like a nail." Applied to the medical profession, this means that specialists offer the solutions that reflect their particular area of expertise. That's certainly understandable. Daca tors are like all of us: If we're not up on something, we tend to be down on it. Historically, all that they ever learned in medical school about complementary medicine was to instruer patients to stay away from it.

As a result, there has been an inherent bias against the use of natural approaches to cancer and other diseases. Many experts refuse to con sider or incorporate promising strategies that lie outside their immediate realm of experience. As a patient coping with today's complex health care system, it is your responsibility to carefully weigh the advice you're given. There's another old expression that applies here: "When given advice, consider the source."

Use Natural Medicines

Currently, standard approaches to cancer treatment produce a cure only about 50 percent of the time. Anything that we can do to enhance success rates, without increasing the risk of side effects, is clearly needed. As naturopathic physicians, we recommend to our cancer patients a wide spectrum of natural products to help them win the battle.

The ultimate aim of both natural and conventional medicine is the same: to treat and cure cancer. But the approach we prefer to take as naturopathic physicians is different. Instead of trying to destroy cancer cells directly by toxic means such as chemotherapy agents or radiation alone, our main strategy is to strengthen and activate the body's own natural cancer-fighting mechanisms as well.

The main strategies of natural medicine are to:

  • Support immune function. A healthy immune system is better able to recognize cancer cells as abnormal and destroy them before they produce tumors.
  • Inhibit tumor growth. Tumors cells are abnormal because they do not respond to signals that regulate their growth, the way healthy cells do. Many natural compounds partially restore cell respon siveness, thereby slowing the uncontrolled growth of a tumor.
  • Support normal cell differentiation. Normal mature cells have features that make them look and act differently from immature cells. Scientists refer to cancer cells as undifferentiated because they lack these mature features. Lack of differentiation makes it possible for cancer cells to evade the signals that normally control growth. Some natural medicines promote the differentiation of cancer cells into more normal cell types.
  • Promote programmed cell death (apoptosis). By restoring the normal function of important cellular regulators, we can enhance the cell's natural ability to destroy itself if it becomes damaged or cancerous.
  • Inhibit the spread of cancer. By preventing the tumor from spreading (metastasizing), we help the immune system deal more effectively with the primary tumor instead of having to combat cancer at multiple sites.
  • Inhibit formation of new blood vessels. Unless they have blood vessels to supply them with nourishment, tumors cannot grow much larger than a sesame seed. Tumor cells are capable of stimulating the growth of new blood vessels, a process known as angiogenesis. Compounds that inhibit such growth are called antiangiogenics and are some of the most exciting and promising in cancer research. Through this strategy, the goal is not to kill cells directly but to starve them and keep the tumor from growing larger. Natural medicine can help achieve this important goal.
  • Reduce the likelihood of recurrence or future mutations. Unfortunately, many conventional cancer treatments can actually cause new cancers to occur. Our goal with natural medicine is to avoid this tragic complication.
Discuss Natural Medicines with Your Doctor

The fact is, most of the 2.5 million patients diagnosed with cancer each year will use some form of alternative therapy. Despite this, roughly 70 percent of these patients never tell their oncologist about the alternative and complementary therapies they may be using. Such secrecy is at best unfortunate and at worse downright dangerous because of potential interactions--but it's also understandable. Many of our patients have told us that conventional physicians and oncologists have reacted negatively when they hear that their patients are using these other approaches. These doctors make derogatory comments or deride advice from health care professionals who may have another valuable perspective to bring to bear on the treatment of cancer. Such reactions only confuse the picture.

The negative reaction arises in large part from the wild, unsubstantia ated claims of cancer cures made over the years by unqualified alternative therapy enthusiasts. Such claims have made many physicians reluctant to consider whether natural measures that are rational and well supported by data from scientific research might play a role in a complete strategy for fighting cancer.

Nonetheless, it is essential that you talk to all members of your cancer care team about the alternative strategies you are using. Here are some guidelines for discussing with your physician the use of natural medicine in conjunction with conventional care:

  • Do your research and be prepared.
  • Be open and nonconfrontational.
  • Make sure that your advocate is present.
  • Stress that you are not choosing an "alternative "to conventional care, but rather tell your physician, "I want to allow conventional care to work more effectively for me while reducing side effects by following the guidelines of How to Prevent and Treat Cancer with Natural Medicine"
  • Take this book with you to your appointment and show your physician the letter from the authors of this book (see Appendix F).
  • Be sure to tell them that your goal is identical to theirs- you want an excellent treatment outcome-and you would do nothing to jeopardize that goal. Emphasize that it's important to you that you both must be on the same team.
Breaking the News

For many people, one of the hardest parts of dealing with a diagnosis of cancer is having to share the news with their loved ones, especially children. But telling them about your situation is a crucial step in enlisting their support and their prayers. We recommend being as direct and honest with spouses and adult loved ones as possible. Allow them to share your emotions and offer you the support you deserve.

Telling Children

Many parents wonder if they should keep the news of their illness from their children. That's an understandable impulse. Children are so innocent and vulnerable. We want to protect them from fear and worry as much as possible.

But the truth is, children are more perceptive than we may think. When bad news strikes, children will sense the tension in the house. They know chat something is wrong, Our advice is to tell children what's happening, Presenting them with simple facts builds their sense of trust in you. Opening a channel of communication with them helps prevent their active imaginations from picturing something worse. Just as important, it gives them a chance to show you the love you truly need right now.

Exactly what to tell children will vary with their age and developmental level. Young children in particular often have a difficult time when a parent is sick. Besides worrying about losing the parent, they may resent the lack of attention, and they may be confused by changes in toutine. To help them overcome these feelings, you may want to consider asking family members or trusted friends to devote time and attention to younger children while you are ill. For example, occasional trips to parks or amusement places can provide welcome diversion Even bringing the kids along on errands can become an adventure. Simply having play dates at home can be both divercing and reassuring.

We recommend that you speak with people you trust-physicians, nurses or other caregivers, therapists, religious advisers-about the best way to handle your particular situation. Family counseling may be appropriate. There are also a number of books available to help children understand when a parent has cancer. Among the ones we recommend are:

For children 4 to 7 years of age:

  • Tickles Tabitha's Cancer-tankerous Mommy, by Amelia Frahm and Elizabeth Schultz. Nutcracker Publishing Co., 2001.
  • Becky and the Worry Cup: A Children's Book About a Parent's Can cer, by Wendy Schlessel Harpham. HarperCollins, 1997.
  • Once Upon a Hopeful Night, by Risa S. Yaffe and Troy Cramer. Oncology Nursing Press, 1998.

For children ages 7 and older:

  • Cancer in the Family: Helping Children Cope with a Parents llness, by Sue P. Heiney, Joan F. Hermann, Katherine V. Bruss, and Joy 1. Fincannon American Cancer Society.

For parents:

  • When a Parent Has Cancer A Guide to Caring for Your Children, by Wendy Schlessel Harpham. HarperCollins, 1997
Telling Others

What you choose to tell friends, neighbors, and coworkers will vary with how close you are to them. Only you can determine what makes you comfortable. Some patients complete their cancer treatment with out revealing anything about their illness to coworkers, while others are far more open about the situation. Generally, though, we recommend letting others know so that you can continue to develop your support network. Many people we know who at first were reluctant to tell others about their condition have been pleasantly surprised by the concern and caring that these people show for their well-being.

Often, when people find out you're sick, they say, "Let me know if there's anything I can do." In our experience, they mean what they say, They are willing to donate a little time and effort to help you in your moment of need. Don't hesitate to take advantage of their offer. Let people know what kind of help you need most. That might mean asking someone to sit with you while you recover from surgery or chemotherapy. Other times it might mean having someone prepare meals, run errands, take the kids to school, help with housework, or make small home repairs. Some patients have developed deep friendships with those who became close during their illness. You may feel reluctant to ask for help or to "impose" on others. Just keep in mind that by getting better, you'll be around to repay their kindness with your ongoing friendship

While in treatment, most cancer patients prefer to maintain their normal routines to the greatest extent possible. If for you this means going to work, then by all means do so. Feeling useful and productive can be an essential aspect of healing. But don't feel you have to push your self. Remember, you are dealing with a serious illness, and you need to make recovery your priority. Speak to your employer about options. Being forthright with your boss can be especially important if you need to take time away and need others to share your responsibilities in your absence. Explore creative solutions to the situation. Consider working half-time, taking different shifts, or scheduling time off to bounce back from chemotherapy or radiation treatments.

Many patients have told us that the experience of cancer was a great teacher. It enabled them to figure out what is most important in their lives, and it showed them who their true friends were. They felt as it they were stronger and happier people because of the changes they made while fighting to get better.

Many people have found it useful to ask one person to be the central point of contact during cancer therapy. Those who are concerned can call that person to get the latest updates. This approach reduces stress on the patient while making information available to concerned friends and family.

Having cancer can be a very isolating experience. But remember you are not alone. Thousands of patients have come before you and found some solutions that have worked for them. You can benefit from their expertise. Use as many resources as possible to prevent that sense of being alone in a scary and confusing world. Support groups, family and friends, and church groups all can help keep your spirits up when the situation becomes stressful. Contact the American Cancer Society (800-227-2345: www.cancer.org) and the National Coalition for Cancer Survivorship (310-650-8868; www.canceradvocacy.org) for information about all the stages of your illness and treatment, and about what coping strategies have worked for others.

Workplace Issues

During some phases of treatment, such as surgery or radiation, it is unavoidable that you will miss some work. At other times, such as during chemotherapy, you may feel too weak or tired to work full-time. A successful recovery demands that you avoid becoming exhausted. We frequently suggest that our patients consider working part-time during active treatment. Depending on company policy, this strategy usually allows them to maintain insurance benefits while getting adequate rest. Some patients find that if they take their chemotherapy on Friday, they can rest over the weekend and will feel up to working the rest of the week. Other patients feel that going to work helps to preserve a sense of living normally. They enjoy their job and coworkers and feel that the contact is beneficial.

One concern about working is potential exposure to infections from coworkers or the public. When your white blood counts are low because of chemotherapy or radiation, you will be more susceptible to infections and need to take more precautions. Wash your hands regularly (especially if you handle materials such as money). Urge coworkers who are ill to stay away from your work area, and try to minimize contact with the public when your white counts are low.

Another concern in the workplace is potential exposure to harmful chemicals. If your job involves working with strong chemicals, pesticides, or solvents, you may find yourself more sensitive to these compounds during treatment. Sometimes even benign substances such as perfumes can trigger nausea. Certain compounds may overwork your liver's detoxification system, which is already working hard to process all your medications and chemotherapy. At worst, organic chemicals may increase your risk for certain cancers, especially non-Hodgkin's lymphomas and breast cancer. Consider asking for a transfer to a position with less exposure to these compounds.

Many people, when dealing with cancer, claim that one of the valuable lessons they learn is the importance of making every day of their lives as fulfilling as possible. Often during treatment patients realize that their jobs may not be as meaningful as they might wish. But they feel trapped, because they depend on their insurance benefits to pay for their treatment. We urge our patients in this situation to use the opportunity to begin considering other scenarios: explore new job options, take classes to learn new skills and to prepare for a career change, or explore other careers within the same company.

During economic downturns many companies offer early retirement options. One advantage of this is that your insurance benefits will often continue when you retire, and there is frequently a buyout package of cash and incentives that may be especially appreciated with all the med