Holistic Cancer Treatment Report

 

Volume 51. Holistic Cancer Treatments Guide/ 1990 American Government Report (Public Domain Book)

 

Introduction

 

I found an article from 1990 that looked pretty extensive so I edited it down for this book.

 

If you want to find the original, go to scribd.com or buzzle.com and type in Unconventional Cancer Treatments.

 

This book was scanned on a scanner from print to get it to e-form so there are a lot of mistakes in it.

 

Holistic Cancer Treatment Knowledge

 

Several of the unconventional treatments include a spiritual or religious component.

 

In macrobiotics, for instance, the dietary guidelines are one aspect of a much larger philosophical and spiritual system.

 

Similarly, Anthroposophic medicine, which includes the use of the herbal preparation Iscador for cancer patients, is based on a complex religious philosophy and "spiritual science" developed by Rudolph Steiner in the late 19th and early 20th centuries.

 

Other unconventional treatments that were designed specifically for cancer patients include a spiritual component.

 

Spiritual aspects of the original Kelley regimen, for example, reflected the developer's strong religious beliefs.

 

A physician who founded the first clinic in Tijuana offering laetrile to cancer patients, Ernesto Contreras, includes a strong spiritual orientation in his regimen and often leads services for patients at a chapel he built at his clinic.

 

Patients may also seek care from traditional healers (outside their own culture), e.g., Native American healers, curanderos, shamans and others, who use a strong spiritual component in their approach to treatment.

 

Although the extent of use of traditional healing methods by U.S. cancer patients is undocumented, the popular literature suggests that some approaches have become relatively common in recent years.

 

The 'New Age' movement in the United States has popularized a number of mystical practices, such as crystal healing, channeling and 'neo-shamanism,' as well as some traditional healing practices involving curanderos, herbalists and others.

 

While most spiritual approaches treat cancer as any other disease or misfortune, some techniques with spiritual or mystical components are often associated specifically with cancer.

 

"Psychic surgery" refers to a procedure involving removal of spirits or physical manifestations of spiritual pathology from a patient.

 

Some Americans travel to the Phillipines for "psychic surgery," where it is practiced in its original context of religious and traditional healing.

 

Psychic surgeons from the Phillipines have also come to the United States, holding treatment sessions as they travel around the country.

 

They have often been pursued by legal authorities and some have been convicted of practicing medicine without a license.

 

Psychic surgery is considered by many in the unconventional community to be afringe' treatment.

 

The treatments are grouped into four general categories:

 

psychological and behavioral nutritional herbal pharmacologic and biologic.

 

These categories are not the only ones that could be devised and the groupings do not connote commonality among their elements beyond the basic nature of the treatment.

 

Since many of the treatments include a variety of components, however, assignment to certain categories was not straightforward and could have been done differently in a number of cases.

 

In general, assignment to the categories was based on the nature of the central or unique element of each approach.

 

The mainstream medical literature contains very few substantive articles for physicians and patients who want to find out about unconventional cancer treatments.

 

Very few scientific studies of these approaches have been done.

 

Most reports that make their way into medical journals concern adverse effects of particular treatments or are generally negative.

 

Some patients become frustrated when they discover there is so little concrete information about the effectiveness and safety of specific unconventional treatments.

 

Many will have been told, perhaps by a clinic itself, perhaps by other patients or advocates, that the treatment will improve their quality of life and will cause their cancer to regress and possibly disappear.

 

They may have been told by prominent national groups (e.g., ACS, FDA) that, at best, the treatment is untested and therefore unproven, or worse, that it also has dangerous side effects.

 

Based on the work done for this assessment, a common situation is that effectiveness is unknown and relevant information on adverse effects is nonexistent.

 

Patients often decide to go ahead with unconventional treatment because no reliable information confirms that the treatment doesn't work or that it would likely be harmful.

 

They may feel they have nothing to lose by trying it.

 

Since most health insurance policies-public and Private-do not cover charges for unconventional cancer treatments, patients generally pay for them directly.

 

Insurance coverage under the Federal Medicare program (for people 65 and over) is limited to care that is "reasonable and necessary,' which for drugs generally refers to those that are FDA approved and in some cases to drugs designated by NCI as "Group C" (Group C drugs have been found to have some therapeutic value in clinical trials, but have not yet been approved by FDA).

 

Most Blue Cross/Blue Shield and private insurance plans have similar restrictions.

 

Most health insurance contracts contain general language that excludes coverage of unconventional treatments and some specify particular treatments by name.

 

Chapter 1. Holistic Cancer Behavioral and Psychological Approaches

 

INTRODUCTION

 

Over the past two decades, the role that personal characteristics and behaviors might play in recovery from serious illness has become a widely discussed topic, both in the scientific and popular literature.

 

In self-help books geared toward cancer patients, for example, certain attitudes and characteristics, such as having a "cancer-prone personality," are commonly linked with hastening the course of illness or allowing it to develop in the first place.

 

Other characteristics, such as a strong "will to live" and a good coping style, are often credited with preventing illness, reversing the course of existing disease, or prolonging life.

 

Newspaper and magazine accounts of spontaneous remissions and of individuals who outlived their physicians' predictions lend widespread support to these ideas.

 

Recently, reports of spontaneous remissions from cancer have begun to be collected in an annotated bibliography intended for researchers studying psychosocial factors and interventions in cancer treatment.

 

Several popular books on the role of emotions and behavior in recovery from serious illness have helped bring this subject into the foreground of cancer treatment.

 

Some of the best known examples include Norman Cousins' Anatomy of an Illness and Head First, Bernie Siegel's Love, Medicine and Miracles and Peace, Love and Healing and the Simontons' Getting Well Again.

 

From various points of view, these books encourage patients to combat feelings of hopelessness, passivity and depression that may accompany life-threatening illness and to develop positive outlooks and effective coping strategies.

 

Along with a number of other available books on the subject, these books support the view that patients' efforts to promote physical, emotional, psychological and spiritual well-being, or healing, can enhance the environment for medical care, improve psychological and physical adjustment to the disease and in some cases tip the balance toward recovery.

 

Guided imagery, meditation, psychological counseling, support groups and other approaches are often used to help patients achieve these goals.

 

Increasingly, psychological and behavioral methods are becoming a regular part of cancer treatment, whether included explicitly as part of conventional regimens or sought out independently.

 

For the most part, the aim of these methods is to enhance quality of life.

 

In some cases, however, claims of tumor regression or prolonged survival are made, based largely on case reports and uncontrolled studies.

 

Although initial attempts at controlled studies evaluating psychosocial interventions have recently been made, the efficacy of psychological and behavioral approaches in improving the course of cancer is still uncertain.

 

This chapter focuses on the use of psychological and behavioral methods for modifying the disease process itself-in other words, as unconventional cancer treatment.

 

Conventional uses of psychological interventions in enhancing quality of life are summarized first, followed by a brief discussion of current research on relationships among emotions, immunity and cancer.

 

The next section of this chapter describes three of the most popular psychological interventions for which claims of tumor regression or life extension have been made.

 

The final section summarizes the available information from studies attempting to evaluate the efficacy of various psychological and behavioral interventions in altering the course of cancer.

 

PSYCHOSOCIAL SUPPORT FOR CANCER PATIENTS

 

In the past decade, demand by cancer patients and survivors for psychosocial support services has grown.

 

Community organizations, patients, treatment centers and professional societies have worked together to develop support services for an estimated 5 million U.S.

 

cancer patients and survivors.

 

A variety of psychological and behavioral interventions are being used to address physical and psychosocial needs of cancer patients and long-term survivors.

 

Some of these interventions are incorporated into conventional treatment programs, while others are offered outside of medical settings, e.g., as part of cancer support group activities.

 

For the most part, these interventions are designed to help patients reduce pain, control nausea and vomiting associated with chemotherapy and cope with other physical or mental disorders that the disease and its treatment may bring about.

 

Examples of interventions used to reduce distress associated with cancer and chemotherapy include hypnosis, progressive muscle relaxation training with guided imagery and systematic desensitization.

 

Increasingly, psychological approaches are also being used to address broader emotional and social issues among cancer patients and their families.

 

Patients may seek help in changing their lifestyles, in reducing stress, in reexaminingg their relationships with others, or in planning for the future.

 

There is a wide variety of hospital-based and independent support groups and peer support programs for patients and their families.

 

These groups differ in scope, components and approach.

 

Some are sponsored by the American Cancer Society (ACS), including CanSurmount, Reach for Recovery and Candlelighters Childhood Cancer Foundation.

 

Patients calling ACS's Cancer Response System telenumber can be referred to local ACS support groups, hospital-based groups, or affiliated groups.

 

A number of others are associated with the National Coalition for Cancer Survivorship, an Albuquerque- based organization that encourages the development of local support groups, provides information for patients and researchers and assists patients with problems in job discrimination, insurance coverage and doctor-patient communication.

 

The psychosocial support offered by the groups described below is based on the idea that cancer patients can improve the quality of their lives and perhaps contribute to their treatment and recovery by becoming actively involved in the fight against their cancer.

 

Unlike self-help groups that also act as advocates of either mainstream or unconventional cancer treatments, these groups are relatively autonomous.

 

They are not affiliated with facilities or organizations that provide medical care or advocate particular types of cancer treatment.

 

They all, however, see their programs as complementary to ongoing medical care.

 

While there is a growing population of cancer patients who wish to become actively involved in the fight against their illness through these sorts of programs, it is estimated that only about one in ten patients follow this route.

 

It is possible that more cancer patients will choose to pursue these approaches if they become more widely known and readily accessible (e.g., through oncologists or hospitals).

 

One of the best known programs offering psychosocial support is the Wellness Community, which was founded by Harold Benjamin in 1982 in Santa Monica, California and is expanding, through patient demand, to other parts of the country.2 The Wellness Community's program, which is free to participants, is intended to encourage cancer patients and their families to participate actively in the fight for recovery, thereby improving the quality of their lives and possibly enhancing their chances of long-term survival.

 

Since its beginning, it has attracted more than 8,000 cancer patients and family members.

 

The Wellness Community explicitly states that its approach to patient care is in support of, not a substitute for, mainstream medical care.

 

Many cancer patients are reportedly referred to the program by their oncologists.

 

Oncologists also serve on the centers' Professional Advisory Boards, which have direct input to the staff of State-licensed psychotherapists at each center.

 

The size of the staff at each facility varies according to the community; as of 1987, the program in Santa Monica was staffed by seven psychotherapists and seven psychotherapy interns.

 

The central elements of the Wellness Community are the mutual aid groups that focus on cancer patients' feelings and that teach self-help techniques with the idea that "positive emotions and positive mental activities may improve the possibility of recovery from cancer".

 

Other group activities include lectures for patients (on topics ranging from self-esteem to nutrition), potluck dinners, charade nights, joke festivals, picnics and other group activities designed "to bring smiles and laughter into the lives of cancer patients".

 

In addition, members may also have one-on-one sessions with the staff psychotherapists.

 

Another widely known support group is the Exceptional Cancer Patients (ECaP) program founded in 1978 by Bernie Siegel, M.D. in New Haven, Connecticut.

 

The program is said to be based on "care frontation," described as a loving, safe, therapeutic confrontation, which facilitates personal change and healing.

 

Siegel's program includes individual and group support that makes use of patients' dreams, drawings and images in an effort to "make everyone aware of his or her own healing potential" and to become anexceptional cancer patient,' which Siegel defines as one who gets well unexpectedly.

 

Patients are charged for an initial, intensive, intake session and for group and individual sessions thereafter.

 

ECaP states that its psychotherapy is in addition to, not in place of, mainstream medical care and that no medical advice is offered to participants.

 

ECaP also seines as an information resource; according to its patient literature, more than 750 people from all over the country write or call ECaP each week seeking information.

 

It can supply books, audio- and videotapes and reading lists.

 

ECaP also keeps track of other centers that offer similar services and may refer callers to facilities in their vicinity.

 

In an effort to further expand the availability of its services, about once a month ECaP offers intensive, 2-day training sessions for people interested in setting up similar groups (which can be called ECaP-like groups, as there is only one ECaP center).

 

As of early 1990, approximately 160 people had received this training.

 

Another model support program is the Commonweal Cancer Help Program, which was started in 1985 in Bolinas, California.

 

Michael Lerner, Ph.D., Commonweal's President and Rachel Naomi Remen, M.D., medical director, organize groups of 8 to 12 patients for intense, week-long sessions aimed at helping patients cope with stress and resolve fears and anxieties (particularly about pain, illness and death) and improve the quality of their lives.

 

The main purpose of the sessions is to help cancer patients "discover those inner and outer conditions under which they may best maximize their health and wellbeing".

 

Commonweal retreats are held in a rustic ocean- side center about an hour drive north of San Francisco.

 

The retreat staff includes the director, a co-director who is a psychologist trained in cancer work, a yoga teacher, a vegetarian cook and art teacher and a massage staff.

 

The program includes a cognitive or informational component and a multifaceted lifestyle component.

 

Commonweal offers participants access to its library of books and articles from the medical and popular literature dealing with cancer treatment and research.

 

The remainder of its program offers patients a daily regimen designed to release stress and encourage personal expression of feelings.

 

The program includes small group sessions, lectures, massage, yoga, training in relaxation and stress reduction techniques, meditation, imagery, walks in nature, journal and dream work, reflection and other forms of artistic expression and personal exploration.

 

Commonweal's directors believe that these activities- exercise, healthful diet, deep relaxation, opportunity for personal expression, access to information and caring support-release fear and stress and enable patients to identify lifestyle and healing path that is best for them.

 

The majority of the participants in the program have been women and the relatively low cost of the retreat has allowed people from varying backgrounds to attend.

 

Generally, participants have heard about the program through physicians, other health care providers, or previous participants.

 

People interested in the program are screened by the coordinator to ensure that they understand the nature of the program, can work well with a small group and ace able to take care of themselves.

 

Participants must also be under the care of a physician and understand fully that the program is not itself a complete treatment.

 

PSYCHONEUROIMMUNOLOGY

 

It is often suggested in the popular literature that various types of behavioral intervention designed to reduce stress or to promote positive mental images act by enhancing the immune system.

 

Since the immune system is the body's primary defense against many diseases, its enhancement is commonly linked with reducing the susceptibility to cancer or with enhancing the ability to fight cancer.

 

Unfortunately, the actual relationships among emotions, immunity and disease are still poorly understood, despite a large body of literature on the subject spanning several decades.

 

Within the last 10 years, however, new evidence has emerged concerning the biological basis of interrelationships among personality, emotion, behavior, immune alterations, neuroendocrinology and the onset and progression of disease.

 

The relatively new interdisciplinary field of psychoneuroimmunology (PNI) encompasses these diverse areas of research.

 

One of the catalysts for the recent interest in PNI research was the discovery by Ader and colleagues that immune functions in experimental animals could be altered by behavioral changes (13).

 

That observation provided evidence that the immune system did not function completely autonomously, as was previously thought, but that other biological processes, e.g., necrologic and endocrine factors, could directly modulate immune function.

 

Recent PNI research has revealed a number of biochemical and neurological connections between the immune system and the central nervous system.

 

Their clinical significance, however, is still unclear.

 

For many years, certain types of cancer have been thought to be influenced by immune processes, although the nature and extent of these influences are still only partially understood.

 

Experimental animal data suggest that tumors induced by viruses or ultraviolet radiation appear to elicit immune responses (via antigen-specific T-lymphocytes) that act against those particular tumor cells.

 

However, the majority of cancers of internal organs (not induced by viruses or ultraviolet radiation) are apparently not affected by T-cell-mediated immunity, although they could be susceptible to other immune processes in ways that are also poorly understood.

 

Burnet's widely known immune surveilance theory, which proposes that one function of the immune system is to recognize and destroy malignant cells as they arise, has gradually been modified and expanded to take into account broader possibilities for additional types of immune action against malignant cells.

 

Attempts to measure and interpret alterations in immune function are central elements of many current PNI studies.

 

Investigators have tried various ways of testing the hypothesis that the immune system mediates among emotions, personality, behavior and disease onset and progression.

 

However, a major difficulty in interpreting the significance of alterations in particular immune functions is that the clinical implications-benefit or impairment with regard to disease-are not yet known.

 

A statistically significant increase in circulating levels of disease-fighting cells could, for instance, reflect normal variability, or could have only short-term effects, or could be compensated for by changes in other immune processes.

 

The critical associations needed to interpret immune system alterations and changes in cancer onset or progression have not been demonstrated.

 

For the most part, PNI research has focused on correlations between psychosocial characteristics, such as personality, emotions and stress and specific biochemical measures of immune function, or between psychosocial characteristics and disease onset and progression.

 

A handful of studies have been carried out to assess possible effects of psychological interventions on immune function or on disease onset and progression.

 

So far, PNI research on links between psychosocial characteristics and disease has suggested that stress, or the ways in which individuals cope with stress, may influence immune function.

 

It is not known if stress acts directly, via physiologic processes, or indirectly, via altered health-related behaviors, such as alcohol drinking, a poor diet, lack of exercise, etc.

 

Of critical importance, it is not known whether these altered immune responses are directly linked to the onset or progression of cancer.

 

Other studies have examined effects of psychosocial factors on the risk of disease onset.

 

There are conflicting data on relationships between psychosocial factors, e.g.

 

"cancer-prone personalities and cancer onset and progression.

 

For instance, clinical depression has been found to have little or no effect on the risk of developing cancer in large segments of the population.

 

A recent review of these studies concluded thatthe results of prospective studies [on psychosocial risk factors and cancer onset] do not yet permit firm conclusions about the cancer-prone personality.

Many studies have examined effects of psychosocial factors on the course of cancer, with mixed results.

 

In general, four types of factors have been examined: adjusting to illness, emotional expression, will to live and emotional stress.

 

A number of studies have reported correlations between one or more of these factors and cancer outcome.

 

A recent study of 36 women with recurrent breast cancer found that signs of joyful attitudes were associated with longer disease-free intervals.

 

Two other recent studies did not find a correlation between psychosocial factors and length of survival or time to relapse in patients with advanced disease.

 

At present, one of the most controversial areas of PNI research concerns effects of behavioral interventions on immune function and cancer.

 

Preliminary evidence suggests that some psychological or behavioral interventions, such as hypnosis and relaxation, can alter immune function in healthy individuals.

 

Another study in progress is examining effects of relaxation and imagery techniques on immune function in cancer patients.

 

Whether psychological and behavioral methods may influence the onset or progression of cancer is still an open question.

 

Studies that have approached this issue are discussed in the last section of this chapter.

 

UNCONVENTIONAL USE OF PSYCHOLOGICAL AND BEHAVIORAL APPROACHES IN CANCER TREATMENT

 

Psychological and behavioral interventions for which an assertion of tumor reduction or life extension is made involve relatively few techniques.

 

As discussed above, these same approaches are also used for helping patients reduce pain or distress and inmost of these cases are not claimed to have a direct anticancer effect.

 

Given the popularity of psychological interventions for a wide range of purposes, the unconventional use of these methods appears to be a relatively small, but quite visible, part of the overall field.

 

This section summarizes information on the psychological approaches that are most prominently associated with direct anticancer claims in the popular and professional literature.

 

Three techniques are discussed: the psychotherapeutic method developed by Lawrence LeShanj meditation as described by the late Ainslie Meares and imagery and visualization as developed by the Simontons.

 

These approaches are the best documented examples and are the ones cancer patients are most likely to hear about, even though many other practitioners have adopted and modified them.

 

There is overlap in practice among imagery, meditation and a variety of other self-regulation techniques, such as relaxation, hypnosis and biofeedback.

 

Hypnosis, for instance, is probably very similar to meditation and imagery in its effect on consciousness.

 

It is commonly stated in the popular literature that these psychological techniques facilitate the achievement of a particular state of consciousness and thereby enhance the immune system and the body's natural healing abilities.

 

As discussed in the previous section, PNI research is just beginning to address this issue.

 

LeShan's Psychotherapy

 

One of the most prominent examples of an unconventional psychological approach is a form of one-on-one psychotherapy developed by Lawrence LeShan, a researcher and clinical psychologist, as an adjunct to conventional treatment for cancer patients.

 

LeShan's two most prominent books explain the basis for his view that patients with advanced, metastatic disease can sometimes undergo tumor regression and can sometimes increase the length and quality of their lives under his psychotherapeutic regimen.

 

His conclusions are based on personal experience over several decades with patients he has treated.

 

LeShan received his Ph.D. from University of Chicago and began clinical research in 1952 at the Institute for Applied Biology in New York.

 

He has published widely in psychological literature.

 

For many years, his research focused on relationships among personality factors, traumatic life events and cancer onset and progression.

 

In his earlier research, he focused on the notion of a "cancer-prone personality" and concluded that the interplay between personality and events can so weaken the body's cancer defense mechanism that a cancer is likely to appear.

 

The approach LeShan describes in his 1989 book, Cancer as a Turning Point, is a psychotherapeutic process used to identify the creative potential and self-healing ability of each patient.

 

LeShan attempts to develop "the perception and the expression of the individual's special song to sing in life" andthe cause of his or her loss of contact with enthusiasm and joy'.

 

He describes his method as a process of self-examination and growth that delves deeply into the patient's past in order to "analyze the blocks that keep the patient from being able to live out his or her true nature".

 

Rejecting a traditional Freudian psychoanalytic approach early on in his career, LeShan chose instead to find ways of helping cancer patients make their disease a "turning point" in their lives, an opportunity to fulfill their dreams.

 

LeShan explains this guidance toward inner development and fulfillment in the following way:

 

What is right with this person? What are his (or her) special and unique ways of being, relating, creating, that are his own and natural ways to live? What is his special music to beat out in life, his unique song to sing so that when he is singing it he is glad to get up in the morning and glad to go to bed at night? What style of life would give him zest, enthusiasm, involvement?

 

How can we work together to find these ways of being, relating and creating? What has blocked their perception and/or expression in the past? How can we work together so that the person moves more and more in this direction until he is living such a full and zestful life that he has no more time or energy for psychotherapy?

 

Leshan believes that some cancer patients have undergone tumor regression and have increased the length of their lives as a result of his psychotherapeutic approach.

 

He states his conclusion this way:

 

Ever since I learned how to use this approach some twenty years ago, approximately half of my "hopeless, terminal," patients have gone into long-term remission and are stiIl alive.

 

The lives of many others seemed longer than standard medical predictions would see as likely.

 

Nearly all found that working in this new way improved the "color" and the emotional tone of their lives and made the last period of their lives far more exciting and interesting than they had been before starting the therapeutic process.

 

Speculating that the psychotherapy might bring about changes inpatients' immune function, LeShan writes that his treatment is often "sufficient to halt or reverse the direction of growth of a serious neoplasm." He believes thatif we recover our hope for the ability to live our own life our "cancer-defense mechanism [will] recover its strength and come to the aid of the medical program."

 

As we move toward living this life, [our] own self-healing powers [will] act more strongly and raise our 'host-resistance' to the cancer.

 

Meditation

 

Meditation can be defined asany activity that keeps the attention pleasantly anchored in the present moment.

 

Although there are many forms of meditation, one common feature is the absence or near absence of logical thought and emotional experience.

 

Different approaches to meditation may consist of quieting the mind, concentrating on a single subject such as breathing or a repeated word, observing passing thoughts, or visualizing active healing processes (a Process similar to the practice of imagery, described below).

 

The purpose of meditating is not primarily to relax, although relaxation may be a side effect of meditating, but to raise awareness, which is seen as the prerequisite togetting the mind back under control (92).

 

By calming the body and fixing the mind through 'dropping the anchor of attention,' meditation is believed to be an important tool of self- healing and self-regulation.

 

In the 1970s and early 1980s, meditation directed against tumors received public attention as a result of the work of the late Ainslie Meares, an Australian psychiatriSt.

 

Meares used a form of meditation aimed at producing a profound stillness of mind.

 

He characterized the practice as one of simplicity and naturalness.

 

Cancer patients reportedly experienced "a profound and prolonged reduction" in anxiety and a nonverbal understanding of life and death.

 

Meares believed that intensive meditation "enabled the immune system to function more effectively by inducing changes in blood supply to particular parts of the body and in endocrine function and neural activity".

 

Based on his experience treating 73 patients with advanced cancer who attended at least 20 sessions of intensive meditation, Meares believed his treatment reduced anxiety, depression, discomfort and pain in about half his patients.

 

Meares believed that intensive meditation was associated with tumor regression in at least 10 percent of the advanced cancer patients he treated.

 

He also published a number of case reports of regression of cancer after intensive meditation and in the absence of conventional treatment.

 

Imagery and Visualization

 

Imagery refers to various psychological techniques that involve the creation and interpretation of mental images.

 

It has been described as a tool for communicating with the subconscious mind.

 

Imagery can be used as a tool for articulating ideas, beliefs and experiences and for replacing fears and negative expectations with positive ideas and beliefs.

 

In cancer treatment, guided imagery often consists of visualizing the symbolic destruction of cancer cells and has been used to reinforce patients' beliefs in their ability to recover.

 

Other imagery techniques used in cancer treatment, e.g., gentle imagery, focus on imagining peaceful, pleasant scenes.

 

Imagery is often used along with relaxation, meditation, or hypnosis.

 

A broad psychological approach to cancer treatment centering on the use of imagery was popularized in the 1970s by O. Carl Simonton, a radiation oncologist and Stephanie Simonton-Atchley, a psychotherapist.

 

The Simontons' best-selling 1978 book, Getting Well Again, described their clinical experience treating cancer patients with imagery and other psychological approaches at the Cancer Counseling and Research Center in Dallas (continued now at the Simonton Cancer Center in Pacific Palisades, CA).

 

Their regimen was described as awhole-person approach to cancer treatment' and included interventions designed torestore the physical, mental and emotional balance so that the whole person returns to health'.

 

The rationale was reportedly based on theories concerning the role of personality characteristics and psychological factors in the etiology of cancer.

 

Relaxation and mental imagery were presented as tools for cancer patients to motivate themselves to recover their health and to make creative changes in other areas of their lives.

 

overall, the regimen was presented as an adjunctive approach to conventional cancer treatment, but claims for direct antitumor effects were also made.

 

The process of imagery, as outlined by the Simontons, begins with a period of relaxation.

 

The patient is then instructed to visualize the tumor as a weak, disorganized, soft mass of cells.

 

Conventional treatment is visualized as powerful and effective, capable of shrinking tumors and helping the patient overcome the disease.

 

The patient is encouraged to visualize defending himself or herself against cancer through a strong and aggressive immune system, a symbol of the body's natural healing processes.

 

White blood cells are visualized as a vast army of defenders easily overwhelming the weak malignant cells.

 

Dead and dying cells are visualized as being flushed out of the body by natural processes, until no more tumor cells remained.

 

The patient is then instructed to imagine himself or herself as healthy, energetic and fulfilled.

 

The Simontons recommended that cancer patients repeat the process three times a day.

 

According to the Simontons, the process of relaxation and imagery reportedly helped patients lessen fears, tension and stress; change attitudes; strengthen the will to live; confront depression, hopelessness and helplessness; and gain a sense of confidence and optimism.

 

It was also believed that relaxation and imagery could effect physical changes, enhancing the immune system and altering the course of a malignancy.

 

The Simontons claimed significant life extension as a result of relaxation and imagery techniques.

 

The claim was apparently based on a preliminary analysis of their patients compared with national statistics, as explained in the following excerpt from Getting Well Again:

 

In the past four years, we have treated 159 patients with a diagnosis of medically incurable malignancy.

 

Sixty-three of the patients are alive, with an average survival time of 24.4 months since the diagnosis.

 

Life expectancy for this group, based on national norms, is 12 months.

 

A matched control population is being developed and preliminary results indicate survival comparable with national norms and less than half the survival time of our patients.

 

With the patients in our study who have died, their average survival time was 20.3 months.

 

In other words, the patients in our study who are alive have lived, on the average, two times longer than patients who received medical treatment alone.

 

Even those patients in the study who have died still lived one and one-half times longer than the control group.

 

In a 1980 paper describing an uncontrolled, exploratory study, the Simontons used a similar approach to describe outcomes in another, possibly overlapping, series of cancer patients.

 

Out of 130 patients with breast, lung, or colon cancer, 75 patients with advanced disease were included in the analysis.

 

Median survival time (the time at which half have died and half are still alive) since diagnosis was 35 months for the 33 breast cancer patients, 21 months for the 18 colon cancer patients and 14 months for the 24 lung cancer patients.

 

These survival times were compared to published data on other groups of metastatic breast, colon and lung cancer patients: 16, 11 and 6 months, respectively.

 

The Simontons noted that their patients lived twice as long as those reported in the literature and speculated that better patient motivation, greater confidence in the treatment and overall positive expectancy as a result of their regimen may have contributed to the results.

 

The design of the Simontons' study was such that valid conclusions could not be drawn from it about increased survival as a result of relaxation and imagery, since other possible intervening variables were not accounted for.

 

It is not known how the Simonton patients might have differed in physical and psychological characteristics from the patients with whom they were compared.

 

Chapter 2. Holistic Cancer Dietary Treatments

 

Dietary Introduction

 

A specified diet is the primary component of some unconventional cancer treatments.

 

This chapter reviews three examples of unconventional treatments with dietary regimens as the primary or central component: the treatment regimen developed by the late Max Gerson, M.D currently offered at a clinic in Tijuana, Mexico; the treatment regimen developed by William Kelley, D.D.S and recently modified by Nicholas Gonzalez, M.D who treats patients in New York; and the macrobiotic regimen, whose educational resources and specialized food products are widely available to patients in the United States.

 

Coffee enemas are included in two of these regimens.

 

In other chapters of this report, treatments are described that also include dietary elements, but in those cases, the diet may be one of several major elements in the approach, with a non-nutritional treatment usually considered primary in the regimen.

 

In the Livingston-Wheeler regimen, dietary guidelines are specified, but the regimen is centered on its original anti-infective treatment.

 

In addition, many of the clinics in the United States and Mexico that promote "metabolic" treatment for cancer specify particular foods to include or avoid as part of a regimen that also includes pharmacologic and biologic agents, exercise and spiritual and psychological components.

 

Other dietary approaches used in unconventional cancer treatment for which more limited information is available are not covered in detail in this chapter.

 

One of these is wheatgrass, a component of a regimen that has been available for several decades in the United States.

 

Originally developed by Ann Wigmore, the wheatgrass regimen is advocated for prevention and treatment of a variety of conditions and for general health maintenance.

 

Individuals attending one of three U.S. centers that offer instruction in following the wheatgrass regimen are taughtan enlightened approach to the understanding of health and various cleansing and rebuilding techniques to restore and/or maintain a vigorous life, according to promotional literature.

 

One of the centers, the Hippocrates Health Institute in Florida, describes itself as a health resort offering "a multi-dimensional program for the serious health seeker".

 

The wheatgrass diet is described as a "nutritional lifestyle that embraces an all natural way of eating".

 

Using books and products commonly available in health food stores and through mail order houses, patients can also follow the wheatgrass regimen on their own.

 

The wheatgrass regimen eliminates all meat, dairy products and cooked foods from the diet, while emphasizing "live foods" including uncooked sprouts, vegetables, fruits, nuts and seeds, wheatgrass juice, "detoxification" enemas and high colonies, enzyme supplements and chlorella (green algae tablets.

 

Proponents believe that wheatgrass is the key element of the program and claim that it bolsters the immune system, kills harmful bacteria in the digestive system and rids the body of waste matter and toxins.

 

Anecdotal case reports of tumor regressions and life extension among cancer patients who followed the wheatgrass regimen have been published in the proponent literaturesee, e.g, but thus far, no studies of its clinical role in the treatment of cancer have been reported.

 

By relying for the most part on vegetarian, low-fat, high-fiber foods, the dietary regimens described in this chapter share certain characteristics with the kinds of foods currently recommended by mainstream groups for lowering the risk of developing cancer and heart disease.

 

Recent American Cancer Society ACS guidelines for cancer prevention, e.g suggest reducing the intake of fat, alcohol and salt-cured and smoked foods, while increasing the intake of fruits, vegetables and whole grains.

 

One way they differ, however, is that the unconventional cancer treatment diets may emphasize a few particular foods and limit or totally eliminate others.

 

The macrobiotic regimen, e.g advises against consuming vegetables and fruits that are not grown locally, such as bananas and other tropical fruit and against certain types of vegetable, such as those in the nightshade familyincluding tomatoes, green peppers, eggplants, e.g.

 

The wheatgrass diet excludes all cooked vegetables and fruits in favor of raw foods exclusively.

 

The Kelley regimen emphasizes certain categories of food, e.g vegetables or red meat, over others, on an individual basis.The Kelley diet does not necessarily conform to current mainstream dietary recommendations.

 

It has been noted that in some circumstances, cancer patients who follow overly restrictive diets of any kind, whether unconventional or not, maybe at risk for malnutrition and uncontrolled weight loss.

 

It has also been noted that diets that may be useful in preventing cancer are not necessarily effective in treating cancer, since substances in food that may play a role in the initiation of cancer may be different from those that may contribute to tumor progression.

 

The goals of the unconventional dietary treatments also overlap with the goals of conventional nutritional support for cancer patients in that both try to counteract the metabolic and nutritional effects of the disease and of some forms of treatment.

 

The unconventional treatments go beyond the conventional support measures, however, by claiming to reverse the course of the disease, to enhance host function and to improve quality of life.

 

The fact that the unconventional treatments particular dietary regimens for cancer patients at all, regardless of their condition, stage of disease, or type of tumor, separates them from mainstream cancer treatment.

 

Nutritional support has a well- established place in conventional cancer treatment, but generally does not include dietary recommendations for patients with cancer.

 

At present, no diet is recommended publicly by NCI or ACS for use in cancer treatment.

 

In practice, patients are not commonly given nutritional advice at the time of diagnosis or initiation of treatment by mainstream physicians.

 

Nutritional support in mainstream oncology focuses instead on the provision of nutrients under special and usually more extreme circumstances.

 

Nutritional support given in conjunction with conventional cancer treatment often involves the use of total parenteral nutritionnutrient solutions given intravenously or enteral nutritionnutrient solutions provided.

 

These measures are normally limited to cachexic patients in advanced stages of disease, to patients who have particular cancer- or treatment- related nutritional problems that prohibit normal intake of food, or to malnourished patients undergoing major surgery.

 

It is well accepted that cancer and its treatment can cause malnutrition and that malnutrition itself predicts a poor outcome.

 

A number of physiologic factors associated with cancer are believed to contribute to malnutrition, including the metabolic state of the tumor and its effects on the body's metabolism, catabolic effects of conventional treatment and physiologic stress associated with rapid tissue growth and cell destruction, although the ways in which these factors influence nutritional status are still poorly understood.

 

The issue of how to ensure that patients obtain an optimal daily intake of nutrients and calories in order to preserve lean body mass without stimulating tumor growth is considered unresolved.

 

Total parenteral nutrition has been found to be of limited use and in some cases even detrimental.

 

In general, oral dietary treatments have not been evaluated for possible prevention of malnutrition or for possible effects on the course of the disease in cancer patients, although the initial stage of a multicenter study involving a low fat dietary intervention in patients with breast cancer was recently begun.

 

The unconventional dietary treatments for cancer described in this chapter are also distinct from the adjunctive use of dietary treatment in other contexts, e.g in the more numerous and diverse practices where physicians and other practitioners offer what is often referred to as "alternative" or "holistic" health care.

 

The issue of dietary treatment in conjunction with conventional treatment by these practitioners is commonly raised in the popular literature, but detailed information is scarce.

 

The actual dietary regimens, their rationales and the outcomes have not yet been reported, so the extent and nature of their use cannot be characterized precisely.

 

A program developed over the past years by Keith I. Block M.D illustrates one approach to nutritional treatment that can be used in conjunction with mainstream cancer care.

 

The program, as described by its developer, is intended to be used adjunctively and not as a substitute for medical treatment.

 

At present, it is used in Block's private medical practice in Evanston, Illiniois and at an independent medical center in Chicago.

 

According to Block's protocol, individualized dietary guidelines and nutritional treatment are used in combination with mainstream cancer treatment, exercise and psychosocial support strategies for stress reduction.

 

Overall dietary guidelines are made on the basis of nutritional assessments, including the use of body composition analysis, blood and laboratory studies, determinations of nitrogen balance and other biochemical and clinical evaluations.

 

Patients are given a range of food choices within an overall framework that covers five food groups cereal grains, vegetables, fruits, fats and proteins.

 

Foods are divided into exchange lists so patients can select foods according to their tastes while still satisfying the overall nutritional requirements of the program.

 

The semivegetarian diet Block recommends consists of high-fiber, low-fat, protein-restricted foods along with specific items such as soybean products, shiitake mushrooms and sea vegetables.

 

In general, Block recommends that 10 percent of calories be derived from complex carbohydrates, 10 percent of calories from fat and the remainder from protein sources.

 

The diet, which is modified on an individual basis, emphasizes foods high in vitamins, trace minerals and substances thought to reduce cancer risks.

 

Developed in part from macrobiotic principles, the diet has been modified to incorporate information from other sources, primarily experimental data from the scientific literature on substances that maybe active in inhibiting tumor growth or stimulating immune responses.

 

Nutritional analysis has reportedly shown Block's nutritional program to be nutritionally adequate; the Recommended Daily Allowances RDAs were met or exceeded for almost all nutrients for which RDAs have been established and for which nutrient analyses are available and the diet reportedly exceeds requirements for vitamins A, C and B, calcium, iron, magnesium and several other elements.

 

Block's use of an adjunctive dietary program for cancer patients has several goals, some of which he believes have been met in many cases, based on observations of patients treated with this regimen.

 

One goal is to maintain adequate nutritional support through oral feeding as much as possible, in order to improve patients' quality of life and help them retain 'a sense of self-empowerment and clinical autonomy.He notes that few of the cancer patients on his program experience weight loss, except those with anorexia in late stages of disease, or experience hair loss during chemotherapy.

 

Another goal is to enhance patients' resistance to the disease by focusing on improving immune function and inhibiting tumor growth through the provision of a low-fat diet, which may decrease the intake of tumor-promoting substances.

 

The high intake of vitamin A-containing vegetables in the diet is believed to enhance patients' responses to conventional cancer treatment.

 

Overall, Block believes his program to be of benefit in diminishing the side-effects of conventional treatment and in improving patients' quality of life.

 

The treatment protocol has been described in some detail in unpublished manuscripts, but thus far, it has not been studied systematically so that its effects on patients cannot be judged adequately.

 

The Gerson Treatment

 

The Gerson treatment, consisting of a low sodium, high potassium, vegetarian diet, various pharmacologic agents and coffee enemas, is one of the most widely known unconventional cancer treatments.

 

As one of the first unconventional approaches now commonly referred to as ''metabolic," it may have spawned the development of many other currently used unconventional dietary and pharmacologic approaches.

 

Max Gerson, M.D a German-born physician, spent the last years of his medical career in the United States.

 

He died leaving no apparent system in place to continue his treatment program.

 

Gerson's daughter, Charlotte Gerson Straus, co-foundedwith Norman Fritz the Gerson Institute now based in Bonita, California.

 

The Institute oversees a clinic in Tijuana, Mexico, where the Gerson treatment is offered.

 

According to one outside report, that clinic treats approximately patients per year.

 

Background and Early Use

 

Max Gerson was born in Germany and graduated from the University of Freiburg medical school.

 

He practiced medicine in Germany, Austria and France before emigrating to the United States.

 

He received his New York medical license and his U.S. citizenship.

 

He opened a private medical practice in New York City and also began treating patients at nearby Gotham Hospital.

 

Gerson was a member of the American Medical Association (AMA, the New York State Medical Society and the Medical Society of the County of New York.

 

After a long investigation, the Medical Society of the County of New York suspended Gerson's membership.

 

The Society charged that Gerson's participation in a radio broadcast, during which the show's commentator, Raymond Gram Swing, described beneficial results of Gerson's treatment for cancer, constituted personal advertising.

 

Gerson reportedly also lost his hospital privileges and malpractice insurance (although no details of these actions are available.

 

During a hearing on a proposed bill to authorize increased Federal support for cancer research in general, Gerson testified before a subcommittee of the Senate Committee on Foreign Relations.

 

In his statement to the subcommittee, Gerson described his background, the development of his treatment for cancer and submitted written case histories of patients treated with his regimen,

 

of whom were questioned in person at the hearing.

 

Gerson claimed that these patients were cured of advanced cancer as a result of his treatment.

 

Both Gerson's testimony and radio appearance drew national attention.

 

The same year, an editorial appeared in The Journal of the American Medical Association in response to numerous requests for information about Gerson.

 

The editorial criticized Gerson and his sponsors at the Robinson Foundation, New York, for promotion of an unestablished, somewhat questionable method of treating cancer.

 

The editorial stated AMA's view that Gerson had provided only clinical impressions as to benefits secured but nothing resembling scientific evidence as to the actual merit of the method.

 

A report of the AMA Council on Pharmacy and chemistry reiterated AMA's view of the Gerson treatment, concluding thatthere is no scientific evidence whatsoever to indicate that modification in the dietary intake of food or other nutritional essentials are of any specific value in the control of cancer.

 

The American Cancer Society's Committee on Unproven Methods of Cancer Management published its first statement on the Gerson treatment.

 

While certain aspects of Gerson's regimen-e.g the intake of fresh fruits and vegetables and the reduction or elimination of sodium and fat-are consistent with current knowledge about reducing the risk of contracting certain types of cancer and other illnesses, Gerson's thesis that regression of cancer can result from dietary treatment and "detoxification" is unconfined.

 

Rationale for the Treatment

 

Gerson developed his dietary treatment over the course of several decades.

 

His approach was largely empirical.

 

By his own account, he tried variations and combinations of foods and other agents on his patients, noted the ones that reacted favorably and adjusted subsequent patients' regimens accordingly.

 

All along, he reasoned why some agents seemed to work while others did not and developed hypotheses to account for his observations.

 

Gerson described the development of his treatment regimen and presented case histories of patients he believed were treated successfully in his

 

book, A Cancer Therapy: Results of Fifty Cases and in a number of published articles in German and in English.

 

By the late s, Gerson had produced an overall approach and rationale for treating cancer that diverged significantly from conventional medical thought and practice.

 

It is unknown whether Gerson's formal medical training included study of the therapeutic use of diet.

 

Early on in his medical career, he devised a dietary regimen to treat his own severe migraine headaches.

 

After reported success with his condition, he used his diet in the treatment of a variety of other disorders, including skin tuberculosislupus vulgaris, asthma, pulmonary tuberculosis and arthritis.

 

In, he began treating cancer patients with the diet he used on tuberculosis, at the insistence of a patient with cancer of the bile duct, who reportedly recovered following Gerson's treatment.

 

By the time he established his practice in New York in the mid-s, he concentrated on treating cancer patients.

 

His frost paper published in English on dietary treatment for cancer appeared in.

 

In that paper, Gerson outlined his high potassium, low sodium,' fatless diet regimen, which included foods, mineral and vitamin supplements and crude liver injectionspreparations of raw calves liver.

 

He reported on patients treated with the regimen in whom he observed improvements in "general bodily health" and, in some cases, tumor reduction.

 

In a subsequent publication, Gerson described other agents that he added to the regimen, including an iodine solution Lugol, thyroid extract, potassium solution, pancreatic and vitamin C.

 

Gerson noted that in six additional patients his treatment appeared to reduce inflammation around tumors, relieve pain, improve psychological condition and provide at least temporary tumor regressions.

 

Gerson first published explanations of the components of his regimen and the rationale for their use, along with some of the clinical outcomes he observed.

 

Gerson described cancer as a ''degenerative disease," fundamentally similar to many other disease states; he believed that an "impaired metabolism" was the underlying problem in degenerative disease and that proper liver function was critical to maintaining metabolic order.

 

He believed that several physiologic functions were impaired in cancer patients, including the metabolism of fats, proteins, carbohydrates, vitamins and minerals; the activity of oxidative enzymes; and the activity of intestinal bacteria.

 

Gerson believed that the impairment in these functions created an internal climate favorable to the growth of malignant cells.

 

Gerson believed that his treatment regimen reversed the conditions he thought necessary to sustain the growth of malignant cells.

 

He attached great importance to the elimination of 'toxins' from the body and to the role of a healthy liver in recovery.

 

Gerson noted that if the liver were damaged, e.g by cancer or cirrhosis, the patient had little chance of recovery on his treatment regimen.

 

He observed that patients who died showed a marked degeneration of the liver, which he presumed was due to unspecified toxic factors released into the bloodstream by the process of tumor regression.

 

He believed that these toxic tumor breakdown products poisoned the liver and other vital organs.

 

According to this view, Gerson believed that detoxification-preventing patients from dying of self-poisoning -was the most important frost step in treatment.

 

In support of detoxification, he cited a passage from Hippocrates that described drinkmg a "special soup" and administering enemas.

 

Gerson prescribed coffee enemas as part of his cancer treatment regimen.

 

He maintained that the coffee enemas helped to stimulate the flow of bile, thereby increasing the rate of excretion of toxic products from the body.

 

Gerson believed that the need to detoxify resulted not only from the internal generation of poisonous substances but also from the external supply of toxins created by the use of insecticides and herbicides in commercial agriculture.

 

Accordingly, his dietary regimen emphasized the use of food grown organically.

 

He reasoned that treatment for cancer must replenish and detoxify the entire body to allow its innate healing mechanisms to be restored.

 

Another central component of Gerson's approach concerned the balance of potassium and sodium in the body.

 

An imbalance in the concentration of these substances contributes to the internal environment supporting the growth of tumors, Gerson believed.

 

He sought to eliminate sodium in patients' diets and to supplement with potassiumin the forms of potassium gluconate, potassium phosphate and potassium acetate.

 

Several papers published since Gerson's death have elaborated on Gerson's ideas regarding physiologic implications of the potassium-sodium balance in cancer states.

 

Those papers suggest various biological and theoretical rationales for Gerson's theory that potassium supplementation and sodium restriction act against tumor formation (.

 

The role of oxidation in the treatment of cancer was another central element of Gerson's theory.

 

He believed that tumor cells thrive in an environment depleted of oxygen and can be destroyed when oxidative reactions occur.

 

He believed it was essential to supply intact oxidative enzymes in the diet, in the form of vegetable and fruit juices prepared by a stainless steel grinder and pressrather than by centrifugal juicers or liquefiers, which he believed destroyed the foods' oxidative enzymes.

 

He also recommended avoiding food that had been canned, processed, bottled, powdered, frozen, or cooked in aluminum pots.

 

The combined effect of these treatment components was intended tonormalize the biological function of damaged cells.

 

Gerson wrote:

 

the end result is to return the body to its physiologic functions as they existed before the development of malignancies.

 

In this state of the normal metabolism, abnormal cells are suppressed and harmless again.

 

Current Gerson Treatment Regimen

 

Current patient literature from the Gerson clinic states that the treatmentrestores the patient's healing mechanism so that the body can heal itself and overcome degenerative disease.

 

In addition to treating patients with cancer, heart disease, diabetes, arthritis, multiple sclerosis and other diseases, the clinic also treats some people with no apparent serious disease [who] come to the Center simply to detoxify and build themselves up in order to feel good, to improve their health and to prevent disease.

 

The regimen is said to have two main components: "an intensive detoxification program to help the body eliminate toxins and waste materials which interfere with healing and metabolism" and an intensive nutrition program which floods the body and its cells with easily assimilated nutrients needed for improving the metabolism and healing.

 

After a period of treatment at the clinic, each patient is instructed to continue the regimen at home ''until the liver, pancreas, oxidation, immune and other systems have been restored sufficiently to prevent the recurrence of cancer and other degenerative diseases".

 

At present, the dietary part of the Gerson treatment offered at the clinic consists of low-sodium, low-fat, low-animal protein and high-carbohydrate foods, with vitamin and mineral supplements.

 

The diet relies on large amounts of fresh and raw fruits and vegetables.

 

Until late, raw fresh calves liver juice was included in the regimensee discussion below.

 

The current patient brochure lists the dietary components as: glasses daily of various fresh raw juices prepared hourly from organically grown fruits and vegetables and three full vegetarian meals, freshly prepared from organically grown vegetables, fruits and whole grains.

 

The Gerson treatment also consists of a variety of other substances, including potassium supplements, thyroid hormone, Lugol's solutionan inorganic solution of iodine plus potassium iodide, injectable crude liver extract with vitamin B, pancreatic enzymes and enemas of coffee or chamomile tea.

 

Other treatments, beyond the ones Gerson specified, have been added to the current protocol in recent years.

 

According to materials distributed by the Gerson Institute, these substances include:

 

ozone treatment given by enema

 

or via infusion in autologous, heparinized blood or directly into patients' blood vessels;

 

hydrogen peroxide topically, rectally, or orally.

 

intravenous ''GKI drip" glucose, potassium and insulin solutions;

"live cell therapy";

 

castor oil;

 

clay packs;.

 

Lincoln bacteriophagea vaccine made from killed Staphylococcus aureus bacteria and influenza virus vaccine, both reportedly to stimulate allergic inflammation, a process Gerson believed contributed to healing;

 

laetrile.

 

The Gerson treatment is time-consuming and restrictive and can be difficult to follow in areas where fresh fruits and vegetables are not widely available.

 

To assist with the rigors of the treatment, the clinic advises patients to have a helper since patients need time and energy and rest to heal and if they do the therapy alone it will reduce their chances of healing.