Current progress in Complementary medicine & Adjuvant Practice for Integrated Cancer Treatment

1. Mr. LEE Chee Cheow (M.Sc.)
Principal CAM Consultant, Chief Scientific Officer,
International Advanced Bio-Pharmaceutical Industries Pte Ltd.
Cancer Malnutrition
Current Progress in
Complementary Medicine
& Adjuvant Practice

2. Cancer therapy
Current multi-modality therapy
including intervention with
• Complementary therapy
• Nutrition therapy
• Lifestyle and diet changes
Six Established Rx Modalities:
• Surgery
• Radiotherapy
• Chemotherapy
• Endocrine therapy
• Immunotherapy
• Targeted therapy

3. Radiation Therapy side effects
Short term side effects
• Fatigue
• Low blood counts
Radiation therapy can cause side effects by damaging
normal, healthy cells near the cancer.
Long Term side effects
• Chest area may damage the lungs or heart
• Abdomen or pelvis can lead to bladder, bowel, fertility or sexual problems
• Lymph nodes can lead to fluid build-up and swelling in parts of the body
• Risk of getting a second cancer many years later
Localized side effects
• Diarrhea: side effect of radiotherapy to
the abdomen or pelvic area
• Stiff joints & muscles in treated area

4. Chemotherapy (drugs Toxicities)
Organ system Toxic side effects
Cardiotoxicity
(Heart)
hypotension, hypertension, arrhythmias,
myocardial infarction, congestive cardiac
failure, cardiomyopathy, myocarditis, and
pericarditis,
Gastrointestinal
toxicity
nausea and vomiting; diarrhea
Hepatotoxicity
(Liver)
necrosis, steatosis, fibrosis, cholestasis
Nephrotoxicity
(Kidney)
acute or chronic renal failure; long-term
higher incidence of hypertension
Neurotoxic
(Nerves)
peripheral neuropathy, muscle pain, cranial
neuropathy, and seizures
Pulmonary toxicity
(Respiratory)
dry cough, Pneumonitis, pulmonary fibrosis

5. • Anorexia (loss of appetite)
• Mouth sores / Trouble swallowing
• Nausea / Vomiting
• Diarrhea / Constipation
• Depression & Anxiety
• Pain
Cancer Treatment side effects
that affect eating:

6. Malnutrition in Cancer
Cancer Type
Incidence of
malnutrition
Testicles 25%
Breast 36%
Sarcoma 39-66%
Colon 54-60%
Prostate 56%
Lungs 60-66%
Esophagus 79%
Gastric 83%
Pancreas 83%
Head & Neck 72%
Diffuse Lymphoma 55%
Source: Laviano & Meguid, 1996

7. Cancer cachexia
Clinical manifestations of cancer cachexia are:
• Muscle & weight loss
• Anorexia (loss of appetite or desire to eat)
• Asthenia (loss of strength & energy; weakness)
• Anemia (low red blood cells count)
• Cancer cachexia is a wasting syndrome
• Affects more than 80% of advanced cancer patients
• The cause of death in more than 20% of all cancer patients
Cancer Patient suffer Considerable alterations in metabolism:
Patients remain in a hypermetabolic state as the tumour burden increases.

8. Nutritional
Therapy
Goals of Nutritional Therapy in cancer treatment :
• Prevent or treat nutrition problems, including preventing
muscle and bone loss.
• Decrease side effects of cancer treatment.
• Keep up the patient's strength and energy.
• Help the immune system fight infection.
• Help the body recover, keep up or improve the quality of life.

9. Nausea
How to control nausea:
• Eat before cancer treatments.
• Rinse out the mouth before and
after eating.
• Eat foods that are bland, soft &
easy-to-digest.
• Eat small meals several times a
day rather than heavy meals.
• Stay away from spicy foods,
greasy foods & foods that have
strong odours
• Sit up or lie with the upper body
raised for one hour after eating.
Cancer treatments cause Nausea
Acupressure Point
Pericardium 6 (P6)
for nausea
内关

10. Nutritional Therapy for Anorexia & Nausea
Nutriceutical
Foods
Common Herbal Remedies
Ginger
Herba Pogostemonis
藿香
Cinnamon
Pericarpium Citri Reticulatae
橘皮
Pepper
Evodia rutaecarpa
吴茱萸
Herbal Drink for Nausea
Licorice Ginger Tea 甘草姜茶:
• Fresh ginger 生姜 25g (克)
• Honey-fried licorice root 炙甘草 3g (克)

11. Low Blood Count:
Side effect of cancer treatment

12. Low White Blood Cell Counts
Keep Good Food Hygiene Habits
• Stay away from:
 Raw eggs or raw fish.
 Food sold in open bins or containers.
 Salad bars and buffets.
• Thaw foods in the refrigerator or microwave.
• Never thaw foods at room temperature.
• Cook foods immediately after thawing.
• Keep hot foods hot and cold foods cold.
• Cook all meat, poultry & fish until well done.
Caused by radiation therapy, chemotherapy, or the cancer itself
•A low white blood cell count have
an increased risk of infection.

13. Nutritional therapy for Low Immunity:
TCM
Herbal
Adjuvant:
Serving Size 1 sachet 3 g
Amount per serving
Antrodia camphorata mycelium 1.35g
Phellinus linteus mycelium 1.05g
Coriolus versicolor polysaccharide 300 mg
Extractum curcumae longae 300 mg
Functional Foods Herbal Remedies
• Broccoli
• Garlic
• Mushrooms
• Spinach
• Sweet Potato
• Wheat Germ
• Seaweeds
• Antrodia camphorata 樟芝
• Coriolus versicolor 云芝
• Phellinus linteus 桑黄
• Cordyceps 冬虫夏草
• Acai Berry
• Elderberry
• Grapefruit
• Watermelon
• Astragalus membranaceus 黄芪
• Curcumin from Turmeric 姜黄
• Polyporus umbellatus 猪苓
• Poria cocos 茯苓
Antrodia
Camphorata
Phellinus
Linteus
PSP
Curcumin

14. Low Red Blood Cell Count :
Clinical manifestation:
• Fatigued, Weak
• Short of breath
• Increase in heart rate
• Dizzy or lightheaded when
change positions quickly
• Chest pain
• Increase risk of Heart attack
• Nearly 1/3 of patients with cancer develop anemia
• A common cause of Cancer Related Fatigue.
Anemia & Fatigue

15. 四物湯
熟地12克 ; 当归10克
白芍12克 ; 川芎 6克
Functional Foods Herbal Remedies
High Protein Diet:
Beans; Prunes;
Meat; Liver ?
Rehmannia 熟地
Paeonia lactiflora白芍
Angelica sinensis 当归
Supplementation:
• Iron supplement
• Vit B complex
• Multivitamin
Astragalus membranaceus 黄芪
Codonopsis pilosula 党参
TCM Herbal
Adjuvant:
補血经典药方
Nutritional Therapy for Anemia
Heart
Kidney
Blood
Astragalus
membranaceus
Hawthorn berry
extract
Panax ginseng
CoQ10 + Se
Serving Size 1 capsule 510 mg
Amount per serving
Astragalus membranaceus root extract 150 mg
Hawthorn berry extract 150 mg
Panax ginseng extract (80%
ginsenosides)
90 mg
Selenium Yeast (1,200ppm Se) 90 mg
Coenzyme Q10 (Ubidecarenone) 30 mg
Synergistic targeting all axis of
Cardio-Renal-Anemia
Syndrome

16. Low Platelets:
Poor clotting, Bleeding
Risk & complication:
• Dangerous internal bleeding can occur
• Can delay your treatment with chemotherapy
or to have surgery
Symptom:
Increased bruising or bleeding
Spontaneous bleeding

17. Nutritional Therapy for Low Platelets
Functional
Foods
Herbal Remedies
Papaya
Panax notoginseng
三七 / 田七
Pomegranate
Bletilla striata
白芨
Panax
notoginseng
powder
TCM Herbal Adjuvant:
for internal bleeding
散瘀止血经典药方Serving Size 1 softgel 300 mg
Amount per serving
Natto Extract
natural Vitamin K2 as MK7
30 mg
90 mcg
Vitamin D3 150 IU
Vitamin E 10 mg
Vitamin K functions: Regulate normal blood clotting
Supplementation for poor blood clotting
血液凝固不良补充

18. Cancer Treatment Side Effects:
Diarrhoea
Causes:
• cancer treatments
• surgery on GI tract
• radiation treatment for
abdominal cancers
• diseases of the pancreas
• emotional stress
Diarrhoea may lead to dehydration or low
levels of salt and minerals needed by the body.
A Symptoms of Malabsorption

19. Nutritional therapy for Diarrhea
Nutriceutical Foods Herbal Remedies Supplementation
• Porridge.
• Drink plenty of clear liquids
• Avoid caffeine & alcohol
• Coptis chinensis 黄连
• Poria cocos 茯苓
• Sophora flavescens 苦参
Probiotic
minimum 15-20 Billion CFU
/serving
To control diarrhea:
 Porridge / congee are excellent source of anti diarrhea meal.
 Eat soups, bananas, and canned fruits to help replace salt and potassium lost by
diarrhea. Sports drinks can also help.
 Drink plenty of fluids.
 Stay away from Greasy foods, Caffeine drinks, Milk and milk products, Foods &
beverages that cause gas such as peas, lentils, cruciferous.

20. General supplementation
for cancer patient
French oncology guidelines*: require systematic screening for malnutrition and
recommendations include oral supplementation as well as “immune-enhancing diets”.
* Source: Senesse P. Nutrition and Oncogeriatry. Cancer Radiother. 2009 Oct; 13(6-7):628–31. Epub 2009 Aug 18.
Affected system Common Supplementation
Cardiotoxicity (Heart)
• CoQ10
• Astragalus membranaceus
• Gingseng
Hepatotoxicity (Liver)
• Antrodia camphorata
• Curcumin
Nephrotoxicity (Kidney)
• Fucoidan
• Cordyceps
Neurotoxicity (Nerves)
• Vitamin E Trocotrinols
• Acetyl-L-Carnitine
Osteoporosis (Bones) • Vitamin K2

21. Modality Goals of Adjuvant Medication
Cancer
Surgery
 Surgery recovery
 Improve blood counts
 Improve Immunity
 Wound healing
Radiation
Therapy
 Anti Fatigue
 Improve blood counts
 Improve Immunity
Chemo
Therapy
 Helps potentiate the efficacies of
existing anti-cancer drugs
 Helps reduce chemo drug resistance
 Avoidance of drug toxicity
 Helps alleviate symptoms
 Improve immunity
Goals of
Adjuvant & Complementary Therapies
Increased survival and improved quality of life

22. IMMUNO CPX
Pharmacological Functions
Immune Regulation &
Anti infections
Cancer Chemotherapy &
Radiotherapy resistance
Hepatoprotection
& Anti inflammation
Cancer Adjuvant Medication:
Antrodia camphorate
牛樟芝
1.35g/3g sachet
Coriolus versicolor PSP
云芝多糖肽
0.30g/3g sachet
Phellinus linteus
桑黄
1.05g/3g sachet
Curcumin
姜黄
0.30g/3g sachet

23. Cancer Adjuvant Medications
• Alleviated Drug Toxicity
• Improved Blood Profile & Immunity
• Improved Treatment Response
When use in conjunction
with main stream cancer
treatments, Present to
patient as the option with
• Increased Survival
• Improved Quality of Life

24. AREAS OF ADVISORY
Complementary Cancer Therapy:
● Adjuvant chemotherapy
● Neo Adjuvant chemotherapy
● Alternative chemotherapy
Chemo prevention:
● Cancer survivor
● Post cancer therapy
● High cancer risk prevention
Nutriceutical recovery:
● Post surgery
● Post chemotherapy
● Post radiation therapy
Chronic Diseases Management
Principal Consultant
Mr Lee Chee Cheow M.Sc. Dip CMP
Centre for Integrated & Adjuvant Medicine
Service Hot Line:
Tel. +65 6873-8693
Fax. +65 6873-8694
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