Joey Wahler (Host): It's a supplement to traditional cancer treatment, so we're discussing Integrative Oncology also called IO. Our guest, Dr. Alan Roth. He's a Hospice and Palliative Medicine physician and Chairman of Family Medicine and Integrative Medicine at Jamaica Hospital. This is Jamaica Hospital Med Talk. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Roth, thanks for taking the time.

Alan Roth, DO, FAAFP​: Thank you. Nice to talk with you.

Host: Same here. So first, give people an idea, please, of how many people in the U. S. are being diagnosed and treated for cancer these days. How are things trending?

Alan Roth, DO, FAAFP​: So cancer is an extremely common diagnosis. There's more than 1.9 million cases diagnosed annually in this country. It's a leading cause of death. More than 610,000 people die every year. And is actually the second leading cause of death in our country. What we're also seeing is those numbers significantly rising.

And we're also seeing a rise with there's more than 18 million cancer survivors that continue to live on with that diagnosis and, you know, the fear that cancer could come back at any time. Cancer is, as I said, very common, 40 percent of all Americans will be diagnosed with some kind of cancer in their lifetime. It's equally common in men and women. Women, you know, obviously get breast cancer, lung cancer. Men get more prostate, lung cancer, and colon cancer. Women with colon cancer as well.

Host: So, obviously, those are huge numbers, to say the least, of people impacted in one way or another, directly or indirectly. So, before we delve into I.O. Doctor, remind people, please, what more traditional cancer treatments are being offered these days and how do they impact the patient and their family?

Alan Roth, DO, FAAFP​: Honestly the best kind of cancer treatment is surgery because if they could remove a cancer, that's the best way for someone to be cured. So, when there are surgical options to cure a cancer, that really is the best kind of treatment. And most other treatments are what are called adjunctive treatments, which could be, in some cases, curative, and in many cases, just palliative in nature, giving people a longer and better quality of life, things like radiation therapy, chemotherapy, some of the newer agents, which are called like biologics and immunotherapy. Many of these medications are associated with lots of side effects, and a lot of what we do in the field is treat those side effects. Living with cancer and going through cancer treatment takes a lot of time, it takes a lot of money, it's a tremendous impact on patients and their families, their work life, their home life, and certainly, you know, psychosocial issues that go along with that diagnosis.

Host: So that being said, what is, for those unfamiliar, Integrative Oncology and how can it address some of those issues with the other treatments that you just covered?

Alan Roth, DO, FAAFP​: So Integrative Oncology generally refers to using a combination of complimentary medicine therapies in conjunction with conventional cancer treatments that already exist. According to the Society of Integrative Oncology, Integrative Oncology is a patient-centered, evidence informed field of cancer care that utilizes mind and body practices, natural products and or lifestyle modifications from different traditions along with the cancer treatment.

And the aim is to optimize someone's health, their quality of life, their clinical outcomes across the entire cancer continuum, and to empower people to prevent cancer and become active participants both during and beyond their cancer treatments.

Host: And as mentioned, Integrative Oncology is indeed integrated with traditional treatment, not typically used as a replacement for it, correct?

Alan Roth, DO, FAAFP​: Correct. There are, unfortunately, we know patients that go what's called an alternative route of care. Integrative Oncology is a complementary. We complement what the surgical oncologist, the medical oncologist, the radiation oncologist are doing to ensure the best possible outcome for the patient as far as quality of life and longevity. We deal with the psychosocial issues that are dealing with that, but in no way is it meant instead of. It is complementary. Alternative instead of is something that we do not practice here.

Host: Gotcha. So what are a few of the practices in IO that are most commonly used?

Alan Roth, DO, FAAFP​: So most people are very familiar with like mind body issues related to the treatment. So things like meditation, guided imagery, hypnosis, energy healing. And then there's body therapies such as, you know, acupuncture, massage, osteopathic manipulation, various exercise things like yoga and tai chi. There's herbal remedies as well, as long as they're sought out, studied appropriately, and ensure that there's not interactions with the cancer treatment that's going on. Most of the integrative modalities are used not only to treat the symptoms of cancer, but to treat the side effects of the treatment of cancer and that it's where it works very well.

Host: And speaking of which, when you talk about mind, body and some of the other things you just mentioned, I can certainly imagine where side effects from cancer, from medication, from treatment, the things you're mentioning can provide relief in the form of relaxation, a distraction, and dealing more with, I guess, kind of the ancillary things that come along with fighting cancer that often get overlooked, right?

Alan Roth, DO, FAAFP​: Absolutely. There's a lot of things that are overlooked especially, you know, those psychosocial components that go along with a cancer diagnosis, how people are looked at by their friends and families, how they're spoken to. When it comes to things like diet, you know, one of the things I always hear patient's families say, you gotta eat. If you don't eat, you're not going to get better. And there's very few people who don't like to eat. But unfortunately, when you're going through various cancer treatments, one of the things you lose first are senses of smell and taste and the feeling of hunger, because your body's kind of breaking down.

Host: So simply put, I mean, one of the things that things we're talking about then, right doc, is the fact that when someone's fighting cancer, it's not just the cancer itself. It's some of these other things that now they're dealing with a patient is for the first time ever as a result that they're kind of fighting at the same time, right?

Alan Roth, DO, FAAFP​: A lot of people call it the fight against cancer. It's a war. I don't really like that. But the terms are used often. The symptoms associated with the disease, specifically, where is the cancer, will have different symptoms, obviously, whether it's pain or other symptoms.

But the treatments are really, really tough, especially, traditional chemotherapies with nausea and vomiting and diarrhea. People get what's called neuropathic pain from the chemotherapy, where they get like electric shocks and numbness and tingling in their extremities. Things like, extreme fatigue, hair loss, anxiety, depression, like, there's so many things that go along with it.

Something like radiation therapy, much better tolerated. Most people just get fatigue and things like that, but we're treating the symptoms of the cancer and the symptoms of the treatment at the same time.

Host: So let me ask you a little bit more about a few of those things you mentioned. When we talk about dietary counseling, you mentioned sometimes people don't eat or I would imagine often when they're trying to recover, they can't eat many of the same things that they love to normally. So what do you and yours do about that?

Alan Roth, DO, FAAFP​: So, diet therapy is extremely important. It's extremely important to maintain adequate calorie intake. Many of the treatments, you'll burn up a lot of calories in the treatment, cancer burns up a lot of calories, breaks down tissue, and often when we're, quote, fighting the cancer with chemo and radiation, we're killing more tissue, along with that's damaged by the cancer.

So a healthy diet is really, really important. I generally stress to the patients, what we commonly know as an anti inflammatory diet, less dairy products. Lots of fresh fruits and vegetables, nuts and grains. Berries are wonderful. So, many of the kinds of berries. We don't want to fry our foods. We don't want greasy foods. Most patients with cancer don't want things with a lot of sauces and gravies and things like that. So the nutrition piece is huge.

The exercise piece is huge, so keeping people physically fit and active. They don't need to go to a gym, but walking or a treadmill at home or a bike, keeping active and physically fit, along with the mindfulness activities we talked about, has been shown in multiple studies to improve, not only the quality of someone's life, but improve their longevity as well.

So we know that patients who go into cancer treatments, who have better nourishment, better nutrition and a better mindfulness set to begin with, are going to live better and longer and deal with the cancer treatment much better.

Host: Absolutely. Couple of other things. You mentioned also that naturally, in addition to the physical toll, there's a psychological impact for cancer patients as well. They might be worried about how they feel, how they look, how others see them, all these changes in their lives. There might be new debt as a result of paying for some of the treatments.

So when someone's going through all that, how does IO address the psychological impact on these people?

Alan Roth, DO, FAAFP​: So it's a huge component and when you bring up the financial, you know, many people can't work. People have loss of income, disability doesn't go as far as most people's salaries to be able to do it. But it's gotta be a whole person patient centered approach to this care.

It's gotta be in combination with as aggressive a curative kind of plan that could go along, combining it with the complementary modalities that we've talked about, whether it's mind or body and herbal things and the lifestyle things as far as nutrition and exercise. And then the mental health piece is huge.

So, cancer is probably one of the hardest illnesses that someone could go through in their life. So the field of psycho oncology, for example, therapy, counseling, peer counseling through working with patients who have been through cancer treatments are all an essential part of a comprehensive approach to cancer care.

Host: And so in summary, Doc. How would you say overall Jamaica Hospital incorporates I.O. into its oncology program overall? What type of a piece is it in the overall journey that these patients are going through?

Alan Roth, DO, FAAFP​: It's an essential piece. We have a cancer center in collaboration with Memorial Sloan Kettering Cancer Center that involves a multidisciplinary approach to cancer care. So within the same center in our hospital, we have our medical and surgical oncologists, our radiation oncologists come and see the patients.

So they're getting the aggressive forms of care there. We have the nursing component there. We have psycho oncology within the site. We have the integrative modalities, some of which can be done in the site and some of which is done in different sites in the hospital where we don't have all the capabilities to do all the therapies such as yoga and tai chi, but even during chemotherapy chemotherapy sessions, we have the availability to do acupuncture, massage therapy, aromatherapy, music therapy on our patients, and we also involve what is called our supportive care providers, that is unfortunately, as people get sicker, some of them need more aggressive kinds of palliative care.

We continue the integrative approaches there, but sometimes more pharmacologic management. But I would say the best way to describe it is a fully multidisciplinary team that includes physical therapists, nutritionists, exercise physiologist, the psycho oncologist and the medical providers all working together under one roof to be able to give deliver comprehensive whole person cancer care.

Host: And Doctor, finally here, when so many people are affected by cancer, as you talked about at the outset, and you're able to offer this wide array of things under one roof, as you just pointed out, when you do have the success stories of people that pull through to the other side, so to speak, that see these treatments, to the point where they're effective and they're able to do the job that they're intended to do; how rewarding is that for you and your team?

Alan Roth, DO, FAAFP​: It's the most rewarding. And, fortunately, many cancers don't end badly. As I said, you know, we have 18 million cancer survivors living in this country right now that have long and ongoing treatments and will have to think about this for their whole life.

But, we, as a team, get together, when someone completes a course of therapy and is in remission; when they're leaving the center that day, they actually ring a bell, with the entire team there that's available to congratulate them on a successful treatment and hopefully a long and healthy life in the future.

Host: Absolutely. Well, folks, we trust you're now more familiar with Integrative Oncology. Dr. Alan Roth, a pleasure. Keep up the great work and thanks so much again.

Alan Roth, DO, FAAFP​: Thanks for having me.

Host: And to learn more about Integrative Oncology at Jamaica Hospital Medical Center, please visit jamaicahospital.org or call 718-206-6742.

 If you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for listening to Jamaica Hospital Med Talk.