Michael Smith, MD (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions. Our physicians offer tips to navigate medical decisions and build. A healthier future. Today, I'm sitting down with Dr. Jeff Hardin, and we're going to be discussing the services provided by integrative oncology.

Very, very interesting topic. But before we get started, Dr. Hardin, I always like to ask my guests what made you go down the integrative oncology pathway? What was your passion in this? 

Dr. Jeff Hardin: Thanks for having me on the show, Dr. Mike. That's a good question. So for the better part of over two decades actually, I worked in the emergency room and of course it's very exciting stuff. Very immediate feedback on success or failure. But very hands-on medicine, shall we say. But I found that my patients, although I could patch them up and maybe stop them from bleeding out or having their heart attack and dying, they kept coming back year after year with worsening conditions such as obesity, diabetes, heart disease, cancer.

And so I really wanted to look at how could these disease processes be approached in a more holistic way? How could we be preventative? How could we address the root cause of illness rather than just put on bandaid? Now bandaids are very important to stop the bleeding and if I have a heart attack or a car crash, I definitely want to go to an advanced care center.

But how can patients, and even us caregivers, take matters into our own hand to be proactive, to optimize our health, to extend our life, not just the years, but the quality. So that's a long-winded answer to your question. And then it just took many years to retool to learn the skills, go through various training programs.

I did a fellowship in integrative medicine and became board certified. And then found myself doing this job now for over two years.

Host: Fantastic. No, that was a great answer by the way. So let's move in. We're going to be talking more about integrative oncology, right? So cancer, well first of all, cancer is one of those topics that I think, we all connect with, right? For the most part, I think it's safe to say we all know or love someone who has been impacted by the disease.

So how has the treatment protocols that oncologists follow, how, how have those changed over, say the last 10 to 20 years?

Dr. Jeff Hardin: Yeah, the, they've changed quite profoundly. I would say probably 20 years or so ago, it was kind of a cookie cutter, one size fits all. We would have a certain type of cancer and we'd throw the best we had at it, chemotherapy, surgery, radiation. And over the years what we found is a more personalized approach has been

the most successful. That we tailor the treatment to fit the patient, their characteristics, and now we're able to look at this on the molecular level to identify what kind of cancer they have, what are the impacts of that cancer on their body, and how to best target it. So we have a whole range of new tools available in the last

well, decade or so, and it's become the rate of improvements seems exponential. But for example, we have immunotherapy, which uses the patient's own immune system and optimizes it to seek out the cancer, find it, and destroy it. This has been profound change. In the old days, diseases such as malignant melanoma used to be pretty much a death sentence, and immunotherapy has changed that all.

Now, it's very effective tool and many people are living long lives or even being cured. I don't know if you know this, but former president Jimmy Carter was diagnosed with malignant melanoma when he was 91 and was treated with immunotherapy, and he died just last year, not of melanoma, of another cause.

So been a real game changer. We have targeted therapies that go after molecular defects in the cancer and that have fewer side effects, more effective. So cancer treatment these days has a lot to do with tailoring the particular treatment and optimizing it to fit a particular patient.

Host: Oh, fantastic. When I was in medical school, this is back in the early nineties, the immunotherapy was just starting to come out. We were reading more about some of the preclinical research and all this kind of stuff. I just love it. I mean, you're using your own body's defenses, right, to treat. How awesome is that? You said something interesting, Dr. Hardin, you mentioned this idea of personalization. You have to take into account that person's genetics, their lifestyle, all that. Is that what you mean by personalization?

Dr. Jeff Hardin: Yeah, precisely. And, prostate cancer's an interesting example. Going back a decade or two, we used to be very aggressive with it, and now we find that we can determine certain features of the cancer that make it more prone to grow rapidly and spread versus types of prostate cancer that are slower growing.

And we can take a more, I won't say relaxed approach, but we want, don't need to be as aggressive. The treatments, of course, can have a lot of side effects where we can monitor these patients closely. And then if there's a sign that the cancer's becoming more aggressive, we can intervene at that point.

So this has been a game changer with that particular cancer. And, that's a good example of tailoring. There are other features of prostate cancer. And the type of patient that has the cancer, that's very important that we can also tune into and modify the treatment going forward.

Host: Do you see then this as, so if we understand this now that cancer, and most likely this applies, I'm not going to say to all cancers, you're the expert, but to many probably, right? That they can act differently in different people. With that said, if we know how to personalize, how has that affected the prognosis overall with treating patients this way? 

Dr. Jeff Hardin: I would say profoundly. Yeah, tailoring the treatment to fit the particular patient and their circumstances has been, as I said earlier, a game changer. Prognoses are getting better for most cancers, as treatment improves. Other factors include early detection. There's luckily more awareness, for certain screenings such as colorectal, breast cancer, prostate cancer, and skin cancer of course. That's had a huge change. Our treatments are better and we're also, and hopefully we'll get into the integrative medicine part of this, we're also able to look at supportive factors with patients. How can we optimize the patient to both not get cancer in the first place to, and if they do get cancer, how can we make it so that they tolerate treatment and have fewer side effects?

And then going forward, how can they live longer, healthier, happier lives using these supportive therapies?

Host: Definitely. Let's get into that because this was kind of the setup, right? So we're diagnosing earlier. We're personalizing treatments. People are living longer. So now, Dr. Hardin, your specialty here, integrative oncology, how does all of this now fit in with overall cancer treatment?

Dr. Jeff Hardin: Yeah. So, unfortunately I would say most patients being diagnosed with cancer in the US these days don't either have access to integrative oncology or it's kind of an off afterthought. I think Novant's done a really good job at getting the word out that we have this service here. We have two, actually, two integrative oncology offices, one in Charlotte and one in Winston-Salem. And so when we get a patient, wherever they are in their cancer journey, whether they're just starting or they've finished up treatment, we look at their whole experience. What other health conditions they have, what their preferences are in life, the lifestyle factors such as their nutrition, exercise, how are they sleeping?

How are they managing stress? What is their social connection? All of these have pretty good evidence showing that this is important not just for overall health, but for going through the cancer journey. So I see my role as essential. Maybe, maybe the surgeon who's really focused on that particular aspect of the cancer journey sees theirs as essential.

I think they're all essential, but I find, and this is really supported by research, that patients who have integrative oncology as part of their treatment plan, do better. They have better outcomes, fewer side effects, and greater quality of life on the other side of it. So I'm of course biased, but, we see a lot of, successes here and I'm pretty happy having found myself in this role.

Host: Yeah, I want to ask you because when you introduced this idea of integrative oncology to patients, I would assume some may feel a little, not so sure, a little cynical about, adopting these kind of holistic approaches as part of their protocols. What do you do? How do you speak and encourage that patient to embrace something that's new?

Dr. Jeff Hardin: So it's interesting we get the whole spectrum here of patients. There are patients who show up, sit across from me and they haven't the foggiest on why they're here to see me. All they know is they have breast cancer or lung cancer, and their doctor says, oh, that, that would be a good idea for you. And other patients come in with a list, first of all, a, a shopping bag full of supplements of vitamins and, various things they're taking.

And also a list of very, I would say, nuanced and detailed questions on how they can do their very best getting through this journey that they find themselves on. And, the ones who are, let's say, skeptical, I think this is where your question was; I have a tendency to answer questions in kind of a broad spectrum, but the ones who are skeptical, I can be very fluent with them to the degree that they want, on the research available. How does exercise, for example, influence outcomes in cancer? Well, we know this, we have a lot of research showing. It's profound. Patients who exercise regularly as they're going through treatment for cancer on average do 40% better.

Now 40% is nothing to, to sneeze at. It's amazing. You know, and you can see this in nutrition, you can see it in sleep. We have a lot of other modalities we use, such as acupuncture, massage, meditation, breathing exercises. We have, luckily at Novant, we have a large team, and we have psychotherapists because going through cancer, it is just fraught with emotional turmoil. And so we have therapists that can help with that. We have a wonderful wellness program that emphasizes exercise and nutrition for our patients, and we have acupuncturists here, licensed acupuncturists, massage therapists, yoga therapists, just a whole range of services that can optimally treat our patients.

So usually what I say to patients is give it a try. You know, you don't have to incorporate all of these, but just pick one of the suggestions of eating healthier or getting more exercise, working on good sleep, getting good quality and quantity sleep. Try one of these and see what results you have and if it's working for you, then come back and we'll try something else on for size.

Host: Yeah. So what is the result of all this work that you're doing? If somebody is cynical and you, just say, Hey, just try one thing or two things, whatever that is. How many of them really buy into this now that this is something that's crucial to their treatment protocol?

Dr. Jeff Hardin: Well, it's hard to know for sure. I mean, a lot of this just like we started this conversation is so personalized and patient specific. There are some patients who have very hectic lives. They work through treatment, they are raising their families. They don't have a lot of bandwidth for going to the gym.

Or shopping and preparing healthy food. So in those cases, we continue to meet the patient where they're at, to provide them whatever help we can. Sometimes just information and they might not be ready at that time to use our other services. But we find that in the patients that come to see us, the majority of them do adopt healthier lifestyles.

If they, they're not, for example, some patients are still smoking and they get diagnosed with lung cancer or some other condition, and we have supportive services to help them quit. We let them know, we're going to work with them. No judgment, we just want you to be optimally healthy.

So I think we have a pretty good track record here. Of course, we can't always keep track of the numbers, but patients come back year after year.

Host: Very nice. So, I wanted to ask you about the fact that it, at least it seems in the data that, younger and younger people are being impacted with a cancer diagnosis. Where do you see integrative oncology playing a role in that and moving in the future?

Dr. Jeff Hardin: Dr. Mike, I'm glad you brought this up. Yeah, it's been a little bit disconcerting for us in the oncology field to see younger and younger people getting cancer, you know, especially breast cancer, colorectal cancer and other cancers as well. And so the good news is that we have more and more techniques for early detection.

We have more and more treatments that are tailored for the younger population. And then the integrative medicine, I think is a really important support service because we find that the treatments can be tough and also can predispose patient survivors of cancer to have other complications, whether it in their heart, with other cancers, some conditions such as peripheral neuropathy, brain fog, chronic fatigue, all of these can come out of treatment for cancer.

And so patients who can employ some of these techniques often do better. We always, with our younger, well with any population, but especially the younger ones, want to continue to keep them in the system so we can follow them, make sure there's not a recurrence of their cancer or a different cancer.

Host: To wrap all this up, what would you like to say to the listening audience about integrative medicine in general and integrative oncology? What's your take home message for people listening?

Dr. Jeff Hardin: Well, I would just say that it's pretty clear now whether we're talking about cancer, heart disease, diabetes, obesity, or just aging, that integrative care is really the way to go. I mean, yes, we can put you on a lot of medications and yes the cancer treatments are improving year after year. But what if we could somehow decrease our chances of getting cancer or other chronic diseases, improve our overall wellness.

So all of these lifestyle things we talk about, not don't just service our longevity and our health in the moment, we feel better when we eat well, when we exercise, when we get good sleep, we know this. So I would say integrative oncology is growing and expanding. We're seeing it more and more at a lot of cancer centers. It certainly has a strong foothold, shall we say, in at Novant. But I think it's really when I have a family member or friend who gets cancer, let's say out of state, and one of the first things I say to them is you got to find integrative medicine in your area to optimize your journey through this. And the message is getting out. There's a lot of people who use integrative medicine for their health and their wellness.

Host: Dr. Hardin, this was fantastic information. Thank you so much for coming on the show today.

Dr. Jeff Hardin: Thank you, Dr. Mike. I've enjoyed it.

Host: To find a physician, you can visit novanthealth.org and for health and wellness information from our experts, visit healthyheadlines.org. Thanks for listening.