A Few Questions For Donald Abrams

Donald Abrams, MD, is a Professor of Clinical Medicine at the University of California, San Francisco and is the Director of Clinical Programs at the UCSF Osher Center for Integrative Medicine and Chief of Hematology-Oncology at San Francisco General Hospital.  His most recent book, with Andrew Weil, MD, is Integrative Oncology, which looks at the complementary therapies patients can incororate into their cancer care.  Below, we excerpt some questions from a Q&A that Clinical Advances in Hematology and Oncology printed in their January 2007 issue.

Clinical Advances in Hematology and Oncology: What is integrative oncology?

Donald Abrams: Integrative oncology is the rational, evidence-based combination of conventional therapies used today to treat patients with cancer and complementary modalities that may be beneficial, in particular for management of symptoms related to the cancer itself or its treatment. The term “integrative medicine” is preferable to “complementary and alternative medicine” because it better describes the intent. “Alternative” implies an intervention used instead of conventional therapy. The use of alternative therapies in oncology is not being advocated by practitioners of integrative oncology. Tremendous strides have been made in the treatment of cancer with conventional therapies and their use should be continued.

Patients who come to the Osher Center for Integrative Medicine at UCSF who are interested in being treated with an alternative approach that omits chemotherapy, radiation therapy, hormonal therapy, or targeted therapy are discouraged from this pursuit. Rather, integrative oncology seeks to incorporate the best of both worlds. Complementary treatments that may not yet be as accepted as conventional interventions are recommended for integration into a patient’s overall cancer treatment regimen…

H&O: What recommendations do you make to patients in your clinic?

Abrams: I encourage patients to maintain good nutrition, following the dietary recommendations of the American Cancer Society and the American Institute for Cancer Research. The diet should be plant-based, rich in fruits, vegetables, and whole grains. Cruciferous vegetables—cauliflower, broccoli, Brussels sprouts, and kale—contain indole-3 carbinol, a compound that is currently being investigated for potential antitumor agent.

Patients are recommended to eliminate or decrease consumption of animal fats as much as possible, in particular dairy products and red meat. Evidence suggests that beef consumption may be associated with distal colon cancer and may also fuel metastatic disease. For adults of most ethnicities, the proteins and sugars present in dairy products are basically foreign allergens that can lead to chronic inflammation. Instead of promoting inflammation, the diet should include good anti-inflammatory components, including omega-3 fatty acids present in coldwater fish (eg, salmon, mackerel, herring, and sardines).

Several preclinical studies were presented at the 2006 annual meeting of the American Society of Clinical Oncology on the benefits of turmeric, a spice widely used in Indian foods. It has been noted for some time that people living on the Indian subcontinent have lower rates of many diseases, including Alzheimer disease and some malignancies. Studies in mouse models of colon cancer found that diets rich in turmeric were associated with a lower rate of tumor development and prolonged survival compared to the control group.

H&O: Is consumption of green tea recommended?

Abrams: Yes, I encourage patients to drink green tea as part of their daily nutritional regimen. I personally drink three cups every morning! Epigallocathechin gallate (ECGC) is a polyphenol with potent antioxidant activity that has demonstrated activity in in vitro and animal models of chemoprevention.

H&O: Have the benefits of these nutritional measures been confirmed in clinical studies?

Abrams: Interestingly, a Japanese study reported recently in JAMA found that green tea prolonged survival by decreasing cardiovascular events, particularly stroke, but did not seem to have any impact on cancer. However, the study points to one of the challenges regarding our understanding of the connection between nutrition and cancer: these are very difficult studies to conduct. In vitro and animal model studies provide only limited insights into possible activity in humans, and it is quite difficult to conduct, say, a placebo-controlled trial of green tea in the population sample size that would be required to confirm an associated decrease in the development of malignancies.

Our understanding about nutrition relies more heavily on epidemiologic evidence. It may be that no beneficial association was seen between green tea and cancer because those who drank green tea lived longer and thus accumulated more malignant diagnoses. We need to evaluate the literature on nutrition and cancer very carefully.

H&O: How is the use of supplements addressed in your integrative approach?

Abrams: We always review whether any supplements a patient is currently taking are appropriate and also whether there may be a potential interaction with other treatments, by way of the hepatic cytochrome P450 enzyme system which is responsible for the metabolism of many chemotherapeutic agents, as well as many botanicals. There is also the continuing controversy regarding antioxidant supplementation. Many patients increase their intake of antioxidants in order to protect against tissue damage. However, radiation therapy and many chemotherapeutic agents work by oxidative damage, and so there is some concern that though antioxidants may protect normal tis¬sue from damage from these therapeutic modalities, they may also protect the tumor. More research is definitely needed to better understand these interactions and to determine whether these fears are anything more than theoretical. Oncologists widely prescribe pharmaceutical antioxidant agents—mesna and amifostine—without concern and with the knowledge that neither interferes with tumor response to therapy…

H&O: What are some useful resources for clinicians who are interested in integrative oncology?

Abrams: The Society of Integrative Oncology is a very useful resource. This Society was formed a few years ago and has organized three international conferences, with the fourth scheduled for November 2007 in San Francisco. These conferences have attracted 300–500 attendees. The meeting’s focus is on updating attendees on the latest advances in integrative oncology research. Oncologists, other integrative physicians, and practitioners of the various modalities discussed above are present at the SIO meetings allowing for productive networking. The Society’s Journal of the Society of Integrative Oncology is also a valuable resource.

Integrative Cancer Therapies is another useful journal for those interested in the integrative approach to cancer treatment. The Memorial Sloan-Kettering Cancer center has a useful Web site with information about herbs and botanicals. The NCI also has a useful Web site. Integrative Oncology, a recently published textbook edited by Dr. Matthew Mumber, is an extremely comprehensive resource…