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From the Toronto Star, Special Supplement on Breast Cancer

Complementary and alternative medicine in breast cancer
The goal is to raise their general levels of health, giving them more stamina...

Chris Atack
Special to the Star

They may take multi-vitamins or Chinese herbs. They may experiment with massage, reiki or acupuncture. One way or the next, an awful lot of women with breast cancer are turning to complementary and alternative medicine (CAM) to supplement conventional cancer treatments.

Sometimes their goal is to raise their general levels of health, giving them more stamina to fight off their disease and endure the ravages of chemotherapy. It's a point of view that makes sense to Dr. Jennifer Green, a Toronto-based naturopathic doctor who treats many patients with breast cancer.

"In most cases these women are also being treated by physicians, so we are really offering complementary care in the true sense of the term," says Green. "We focus on keeping women healthy and strong so they can tolerate chemotherapy and radiation therapy better."

To do that, Green prescribes a combination of nutrition, gentle exercise, stress management, meditation, visualization, homeopathy, Chinese herbs and acupuncture. Sometimes her recommendations are endorsed by physicians, sometimes not.

"Because oncologists have such differing philosophical approaches, it"s a dance," says Green. "In some women I can do supplementation during chemotherapy, in some I"m limited by what the oncologist decides."

Green breaks treatment into two distinct phases: during and after conventional cancer therapy. "When my patient is receiving chemotherapy or radiation, I"ll use acupuncture, not only for management of nausea but also to keep the immune system strong," she says. "I"ll also recommend Chinese herbs and nutritional supplements to support the immune system and the digestive tract. "

After chemotherapy, Green"s focus switches to rebuilding the patient"s body and detoxifying the liver. "The post-chemotherapy period is a very important, very challenging time for women," she says. "Everything"s trying to bounce back. There tends to be a lot of fatigue, forgetfulness, memory issues. That"s when I can make a big difference, helping women to bounce back."

Conventional treatment for breast cancer can leave a residue of health problems, including pain . Some patients seek relief at the Pain Clinic run by Saint Joseph"s Health Centre.

"We see a number of breast cancer patients after surgery," says Dr. Richard Cheng, a family physician and acupuncture expert who works out of the Pain Clinic. "Often, they have nerve damage, or pain and swelling in the arm. Acupuncture seems to help relieve the swelling and pain. About 70 or 80 per cent of patients have relief for a day or two. For some, the effects of treatment can last one week or more. We also find acupuncture can help relieve emotional stress and insomnia for some breast cancer patients."

Another unwanted after-effect of surgery is a condition known as lymphodema. In breast cancer surgery, doctors usually remove of one or more lymph nodes in the armpit under the affected breast. These tiny nodes filter lymph, a clear fluid that circulates through the body removing toxins and bacteria. When lymph nodes are removed, lymph tends to accumulate, causing swelling in the arm or lymphodema.

Pam Hammond, a Registered Massage Therapist (RMT), specializes in treating women with this disorder. "Lymphodema can be very painful," says Hammond. "It can make the arm swell to two or three times its normal size. Some women actually have torn ligaments because their arms get so heavy."

To treat the condition, Hammond does a very gentle type of massage. "I try to move the swelling and fluid from the affected arm across the chest to the other underarm nodes or down to the abdominal nodes," she says. "Often this gives relief."

About 75 per cent of Hammond"s patients are there primarily for relief of their lymphodema. Some, however, also want the relaxation which massage can offer. "I"ll ask patients, "do you want me to massage your head, neck and shoulders""" says Hammond. "For some breast cancer patients, especially those with advanced disease, I"ll do reiki, which is like therapeutic touch. It offers them a way to relax and relieve stress."

While CAM therapies of all sorts are becoming increasingly popular, the medical community is not yet sure which practices truly do help patients, and which are less useful.

"People often turn to alternative therapies when conventional medicine can"t help them," says Dr. Heather Boone, Assistant Professor in the Faculty of Pharmacy at University of Toronto. "If patients are told "look, we can"t cure you," of course they"ll look for options. But there"s a built-in potential for abuse here, because if someone claims they have a cure, people will come to them.

"There are lots of claims for cancer products and not a lot of evidence. Patients are really hoping for a miracle. If doctors don"t have drugs that will touch a disease, it"s unlikely herbs or a certain practice will. Beware of miracle cures."

Green is certainly not offering miracle cures. Her goal is to support women, and help them endure conventional breast cancer therapy. Within that framework, she is cautiously upbeat about the value of what she does.

"My sense is that I really help women tolerate conventional options," she says. "Beyond that, when conventional options are done, I give them naturopathic options to continue with, so they can adopt a healthy lifestyle that will be preventative. We work to get their bodies back on track, because chemotherapy and radiation are hard on the system."

One enthusiastic advocate of Green's approach is Susan Harley (not her real name), who was diagnosed with breast cancer in January 2001, at age 34. Harley started consulting Green a few weeks after her diagnosis.

"At that time I was deciding whether to do chemotherapy or not," says Harley. "She was very instrumental in my deciding to do it. Not that a naturopathic doctor's goal is to get you to do what they want you to do. Their goal is to try and get you to understand how to make decisions and become more intuitive in making them. My oncologist, on the other hand, didn't really help me to make that decision. He just basically said, "this is what I"m recommending.""

When Harley decided to go ahead with chemotherapy, Green put on her a regimen which included Chinese herbs, a specialized diet including lots of organic foods, exercise, yoga, meditation and visualization exercises.

For Harley, the naturopathic approach has been an unqualified success.

" I wouldn't have had it any other way," she says. It"s a more holistic approach. On my first day of chemotherapy I got an email from my naturopathic doctors wishing me good luck. It was the personal touch, I felt like we were working together as a team."

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