Maggie McKay (Host): If you're given a cancer diagnosis, there is so much going through your head and so many questions on treatment, recovery, options, and more. So today, Dr. Yoon Hang Kim, Chief Wellness Officer, will talk about patient-centered care in Integrative Oncology and what it means.

Welcome to a podcast presented by Memorial Hospital. I'm Maggie McKay. Thank you so much for joining us, Dr. Kim.

Yoon Hang Kim, DO: Well, thank you so much. I really appreciate the opportunity to share and shed some light into this very important topic.

Host: Would you please tell us what patient-centered care in Integrative Oncology is, its role, and what kind of cancers we're talking about today?

Yoon Hang Kim, DO: So, the majority of cancer that we see here would be breast cancer. And the patient-centered care means that we want the patient fully empowered. One of my mentors, Dr. Bernie Siegel, who invented Integrative Oncology before they called it that, he said that statistics are for dead people. And as long as you're alive, the biology of the individual versus the pathology of the disease, you have to allow for the biology of individuals to be optimized. So for me, the patient-centered care means just that. We want our patients to be fully empowered and fully mindful every stage they make a decision.

Host: And what is emphasized? What kind of services are offered?

Yoon Hang Kim, DO: So, the most important actually is to understand where they are in the cancer journey. So, I had a patient that was making crucial decisions whether to have radiation therapy or not. And it became very much a discussion and education. In this patient's case, it was in the left-hand side. And when I was working at Miami Cancer Institute, I've learned that the left-sided breast cancer, that having a proton therapy has advantage because it will avoid hitting the heart. So, we discussed that. We discussed there was an article that was talking about the importance of radiation therapy starting within certain frame of time so that that person would get the best optimal results.

So, initially, I think the patient, if you just left it to her decision, would not have considered. A lot of my patients are looking for alternative to conventional treatment. What I share with them is that in stages I and II and III, utilizing the full resources of conventional medicine is helpful. So, we looked at the evidence and it was through many conversations. And the patient, I'm very proud of her, chose to go ahead and get proton therapy. And once that was done, we talked about how do we assist her immune system to give her the best chances of survival.

Host: So, it sounds like very in depth consultations.

Yoon Hang Kim, DO: It's in depth and that's why we have a nurse navigator. Ruth Ferdig is our oncology nurse navigator, who checks in with our patients and helps that communication between the patient and me.

Host: I think it's so interesting that you utilize everything, acupuncture, lifestyle medicine, resiliency training. What is resiliency training?

Yoon Hang Kim, DO: So, resiliency training is anything that helps patients to cope, survive, and thrive the experience of cancer. And acupuncture actually is a fantastic service because if the patients have nausea, if patients have fatigue, I actually have means to offer them effective pain relief, or nausea, or fatigue. So if they feel better, they're not in pain and feel better, I was told by palliative care physicians that their patients seem to live longer. So, I took a hint from that. So, what I do is just that.

And then, the resiliency portion is what Dr. Bernie Siegel-- I learned from him and that is to empower patients with things that they're willing to do, able to do. If music helps, then music can help. Acupuncture can help; breathing can help; relaxation response, which is a technique that is developed by the late Dr. Benson from Harvard, and mindfulness techniques. Really, to me, it doesn't matter. It's what gives patient the peace and the will to continue and get the best optimal results.

Host: Right. Because everybody's different and responds differently and has different interests, right? Yoga, meditation, music therapy maybe. How important is communication between the patient and the physician? Because let's say a patient is doing some alternative medicine that they don't tell you about. I mean, it seems to me you need good communication to know everything that they're doing.

Yoon Hang Kim, DO: Absolutely. So, one of the advantages I have is that they know I'm an Integrative Oncology expert. And what that means to that patient is that they feel safer to tell me what's going on. And I also don't normally discuss their treatment courses when they first come. I just want to know what they're doing and I want to know everything they're doing.

So, one example I had was that a patient from Europe was an herbalist. And when her husband had a serious cancer, she decided to use serious herb known as wolfsbane or aconite. Well, if you give it to people, they die. So, I was able to talk to her and say, "Yes, wolfsbane or aconite is very powerful. And in Chinese medicine, they process it so that people won't die. But by the way, did you know this weekend that there were two people hospitalized in San Francisco-- herbal shop-- drinking aconite. And by accident, they had some of the unprocessed aconite? One person died and one person also in critical condition." So then, she said, "Oh, I'm glad I told you. Otherwise, I was going to just not tell him and give it to him." I said, "Well, in this country that can be viewed as murder."

Host: Right. Wow. That's a good point too. How do you treat patient's pain?

Yoon Hang Kim, DO: So pain-wise, the pain is very personal, subjective experience. So, some people do well with acupuncture, some people do well with what we call self-regulation techniques like self-hypnosis, guided imagery. Relaxation response is superb also. And the other part is that pain is sensation of what we call nociceptive or irritating or that stimuli that's not pleasing.

But there's a second portion of that called the brain response, which is brain is organizing that. So, the tools, how you treat it, and then there is also a technique known as a pain reprocessing therapy, which is not helpful for acute pain phase. But if they develop chronic pain, then that's also a useful way, which is reframing within your brain to say that, "Yes, I hurt "or "No, I'm not in critical danger." And then, learning ways to communicate with pain to stand it down. So, we're not looking for a 100% pain relief. We are looking for about 50% pain relief.

Host: Dr. Kim, what's considered alternative cancer treatments? And is there evidence that it helps?

Yoon Hang Kim, DO: So, alternative is anytime someone is doing something that's not chemotherapy, that's not surgery and that is not radiation therapy. And the alternative approach to cancer, in my opinion, of what I have seen and read, there's not a systemic study that shows clear answer that something works.

And what I share with patients is that cancer is such a big problem and a big business. You have to remember things like Taxol comes from nature. It comes from Pacific yew trees. There are treatments that are products of nature that we have learned from and then improved to create answers to cancer. So, the area of oncology, the pharmacology, they are looking for answers from everywhere. So if something works, you can be sure that they've looked into it, they're looking at it. Curcumin, there was a lot of studies that show promise that turmeric product, curcumin, was helpful. And then, it was later shown that one of the researchers involved, Dr. Agarwal, was so empathetic and believed it so much that he fudged data. That sometimes happens.

And there are many examples where, in the initial studies, things look very promising. And that happens with chemotherapy too. And then, when you do a like phase III trial or multi-center trial, then it doesn't look as convincing. So, the truth about cancer is that it's not an easy disease to treat. And right now, I would say some of the more miraculous things that we have seen is like our president, the past president, Jimmy Carter, when I read that he had a metastasis to the brain, I thought that there was no way that he could make it, except I read that the molecular profile of the cancer matched a brand new medication immunotherapy known as Keytruda. And then, I said, "Aha! Now, I think his chances of making it is pretty good," and he is still surviving. So, I think that it is just really important that you have to do the right thing for that individual. And I have some patients who decide to go against and I tell them that my recommendation is at least do the surgery, because cancer does not belong in your body. And then, if you don't want to do other things, let's talk about it.

And one of the things we really talk about communication and trust is that ask your oncologists, radiation oncologists, what we call attributable risk or attributable benefit, meaning, "How much would one in my condition benefit by doing the chemotherapy, radiation therapy versus not doing it?" And they know the answer. And if you don't ask it, if you say, "How much would I benefit?" They'll say, "I don't know," because that's true. But if you say, "How much would someone like me in my position, in general, benefit from a treatment like chemotherapy, radiation therapy?" And I think that then they're better in position to say, "I think it's, you know, not you, but in general, it would be about this much. And it's not an exact number."

Host: You mentioned risk factors. Can they be modified, any of them?

Yoon Hang Kim, DO: So, I think that there are genetic cancers, but fortunately the genetic cancer versus environmental factors, I think that it is highly in favor of non-genetic cancers. So, that means that it should be modifiable. And we do know that if someone had a cancer and they're obese versus non-obese. The difference is that the likelihood the obese patient will get a metastatic disease, stage IV disease, that's usually not as likely to survive over a long time, and a local recurrence, the local recurrence is more likely in non-obese women. So, we know just that example that even a simple, I call it simple because it's very measurable, very concrete, being obese, non-obese appears to make a difference in recurrence of cancer, and we do know that. So, I think that's one example where we're seeing that behavioral lifestyle and toxin exposure all would matter.

Host: How do you feel about hypnosis and support groups? Useful?

Yoon Hang Kim, DO: So, there is a study by Dr. Spiegel in Stanford University when stage IV cancer patients were attending support group. They got to live, I believe, about a year longer than people who aren't doing that. So if you had a brand new medication that said, "If you take this, you'll live longer, there's no side effect, you'll feel better, you'll make some friends," you would think that people would be really, really enthusiastic. But I think that in our society, these support groups, not always successful. So, there's evidence, not very strong evidence, but there's some evidence that support group for cancer patients may be helpful. And then for hypnosis, I'm not aware of trials they've done, but I use hypnosis for discomfort. So for example, I had a patient that got deathly ill of going into machines, and it got in the way of his radiation therapy. So, we did self-hypnosis. We taught him how to do self-hypnosis, and he didn't have any issues with that.

Host: Wow. So, he could do the tests after that?

Yoon Hang Kim, DO: He could get his radiation therapy without being in a massive panic attack , because you can't move. If you move, other things will get burned. So once we did acupuncture and we taught him how to do self-hypnosis, he did fine.

Host: That's amazing. Talk about stress a little bit. I mean, of course we know it affects everything, but how can we limit it if we're going through treatment?

Yoon Hang Kim, DO: So, I think that resiliency training is really helpful. I think that having a team that you know you have faith and trust, I think it's helpful. The resiliency training begins with maybe receiving acupuncture, addressing the emotional distress, and then teaching them how to do breathing techniques or relaxation response or mindfulness exercises. That's just the beginning. And some people may benefit. Actually, there are therapists who are specialists in working with cancer patients. And I think that can be helpful.

But like I said earlier, I think if it was a medication form, people would say, "Oh, give it to me." But in terms of patients availing this, I think that I've noticed that patients who are what Dr. Bernie Siegel calls exceptional cancer patients or like fully self-empowered patients, those patients I think do better, and they will make avail of all these tools. It's the other patients who are not able to fully engage that having therapists, having support groups that in our case, one-on-one nurse navigation, I think, can be very helpful.

Host: It sounds like if you're not open to everything possibly available to you, that maybe you don't have as good a chance. Is that fair?

Yoon Hang Kim, DO: Yeah. What I share with people is that it's like going to school. If you go to school or your child or grandchild goes to school and the child decides that, "I'm not going to do any homework, I'm not going to attend classes," would you be surprised if that person flunks out? No. Would you be surprised if the kid says, "Hey, I talked to the teacher. I let the teacher know that I want to do well in this class. I asked the teacher what I need to do, what the expectation is. And before going there, I do my preview, I listen, and take notes, and I do review, and I study. And what I don't understand, I ask my teacher." Of the two people, you would say the latter has a better choice, yet I think we have a hard time believing that patients who possess capability, capacity of latter patients would do better, and that surprises them. But in life, it shouldn't surprise you. That's what I think.

Host: Good point. What about cancers that can't be cured, but they can be treated as chronic diseases? How do you deal with that?

Yoon Hang Kim, DO: Again, looking at the advancement, there is a certain form of blood cancer with a medication called Gleevec, the cancer goes into remission. So, that time about 20 years ago, MD Anderson talked about the idea that cancer can be a chronic illness. And I think we're seeing more of that where it cannot be fully cured. And certainly, I have had patients who communicate with me, "It's been six years. I'm still alive, stage IV cancer. It's been six years, no evidence of disease," and times five more years, they're in remission. So, I think that the idea is that outcome is not always positive, and outcome of life is death.

What cancer does it compresses lifetime into much shorter amount of time, and it forces you to think about the mortality. So, I think that people who can embrace that and still want to get everything they can get out of it, those people tend to do better. So, what I'm looking for: are they proactive? Do they have the self-discipline? If they don't have it, are they willing to get it?

Host: Through therapy?

Yoon Hang Kim, DO: Whatever means. It doesn't have to be therapy, it can be prayer. And the other part is that it has to be mindful. I think that I've only seen one patient who had blind faith that worked. And it's a bit humorous, because the patient told me that he doesn't have cancer. So, I said, "Why do you take the chemotherapy?" "Well, I trust my doctors and they say I should take it. So, I take it. But I don't have cancer." "So, what's your plan?" "I'm going to hunt and fish until I die." And he did not die. He had stage IV disease. But he's like, "No, no, I'm in denial. I don't have cancer. They are wrong about this." But in behavior, he's still taking the chemotherapy. It's like, "Why are you doing this again?" He says, "Because I trust my doctor, but I do not have cancer. And I'm going to do hunting and fishing because that gives me happiness."

Host: There you go. The ultimate mind over matter, right? Dr. Kim, can we just talk real quick about some myths and what's true, what's not? We hear a lot about soy for maybe breast cancer patients or prevention. What's the story on that?

Yoon Hang Kim, DO: Soy is a bit complex. If you get exposed to soy early in your life as a woman, it seems to be protective. Overall, soy appears to be protective. So, I would say soy is protective if you have estrogen-positive cancer. The reason is that soy or component of soy works as a weak phytoestrogen, estrogen from plant. So, soy can be used if a woman has no estrogen. Eating enough soy can give them relief from lack of estrogen. The concern is that estrogen-positive is using weak estrogen-like soy going to stimulate the cancer. The evidence so far suggests otherwise, so I don't put restrictions. The only thing I do ask is if you're going to eat soy, eat the real food, not the soy protein. I think that whole food closest to natural form has more benefit and less side effect.

Host: So, don't get the processed. I mean, for years, we've been hearing about turmeric or tumeric, people say that differently. Is that still a good anti-inflammatory or is it helpful for prevention and cancer?

Yoon Hang Kim, DO: So, actually, my team and I, while I was with Miami Cancer Institute, we've written an article, published it, talking about does curcumin, which is believed to be active component of turmeric, can we use that to treat cancer? And the answer was that there were many studies, but none of them were convincing. One of the things that looked interesting is that curcumin did look like it may be protective for GI cancer. Protective, but not for treatment. There were some interesting studies. So, it'll be interesting to look at it, and they're looking at derivatives of curcumin or making curcumin more bioavailable, meaning more, active in the body, because one of the difficulties with curcumin is it's not very bioavailable, but it's safe. You can take up to eight grams a day.

Host: Is it a good anti-inflammatory in general, even if you don't have cancer?

Yoon Hang Kim, DO: I think it's an excellent anti-inflammatory. In my coffee, I used to put turmeric and cinnamon, cinnamon for blood sugar control properties; turmeric for the properties of anti-inflammatory.

Host: We're hearing a lot about medicinal mushrooms. What is the real story?

Yoon Hang Kim, DO: Medicinal mushrooms, there are many, many groups, but the story is very interesting. It's very interesting because it appears to modulate the immune system. So if the immune system is too active, it has the capacity to make it more towards normal, and the immune system is not working as well, then you can utilize medicinal mushrooms to stimulate. I think that it's one of the most promising along with curcumin. Promising, but not necessarily proven.

But for my patients, I do recommend both, especially when they're done with active treatment. Curcumin to reduce inflammation and medicinal mushrooms to modulate. And then, there's one more thing, which is low-dose naltrexone, which I recommend to all my cancer patients, because I think that does the same thing, which is it modulates the immune system, calms down the immune system if it's hyperactive. And if it's not functioning as well as it should, then it stimulates it.

Host: Well, this is a lot of useful information to digest. Is there anything else you'd like to add that maybe we didn't cover?

Yoon Hang Kim, DO: Yes. What I recommend is that look for an Integrative Oncology expert in your area. And for our services, Memorial Hospital located in Carthage, Illinois, we take insurance to make it accessible. If you go to MD Anderson, they have Integrative Medicine services. If you go to MSK, they offer Integrative Medicine services. So, more and more Integrative Oncology is standard of care. So, look for it, ask, and be committed to your own outcome.

Host: Thank you so much for shedding some light on Integrative Oncology and treating the whole patient. We really appreciate your time.

Yoon Hang Kim, DO: Well, thank you for the opportunity.

Host: Again, that's Dr. Yoon Hang Kim. If you'd like to learn more, please visit mhtlc.org. And if you found this podcast helpful, please share it on your social channels. And check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening. This is a podcast from Memorial Hospital.