Many complementary therapies, used along with conventional medicine, can support cancer treatments, reduce some of the adverse effects of cancer treatment, ease tension and pain, and contribute to overall health. This is known as integrative medicine. Integrative medicine can be a part of your plan throughout the entire treatment and survivorship experience. In this webinar, we will talk about how integration can be helpful to you after a colorectal cancer diagnosis and your journey forward. Presented by Dr. Lisa Corbin: a board-certified internist, Associate Professor in the Department of Internal Medicine at the University of Colorado School of Medicine. In 2001, she helped the University of Colorado Hospital establish the Center for Integrative Medicine (TCFIM) and has served as the Medical Director ever since.

1. Welcome to Fight Colorectal Cancer’s
Webinar:
FAD or FACT. How to determine if complementary &
alternative medicine is for you.
Make Sure You Know the Latest News
About CRC Research and Treatment visit fightcrc.org
Our webinar will begin shortly.

2. Today’s Webinar:
1. Today’s Speaker: Lisa W. Corbin, MD, FACP
2. Archived Webinars: FightColorectalCancer.org/Webinars
3. AFTER THE WEBINAR: expect an email with links to the
material. Also a survey on how we did, receive a Blue Star pin
when completed
4. Ask a question in the panel on the RIGHT SIDE of your screen
5. Follow along via Twitter – use the hashtag #CRCWebinar

3. Introducing our much acclaimed:
Patient Resource Guide
Available online at:
http://fightcolorectalcancer.org/GuideInTheFight/

4. Funding Science
Established in 2006, our Lisa Fund has
raised hundreds of thousands of dollars
to directly support the innovative research
in treating late-stage colorectal cancer.
100% of the funds donated go
directly to Late-stage colorectal
cancer research.
Learn more or donate:
FightColorectalCancer.org/LisaFund

5. Disclaimer
The information and services provided by Fight Colorectal
Cancer are for general informational purposes only. The
information and services are not intended to be
substitutes for professional medical advice, diagnoses, or
treatment.
If you are ill, or suspect that you are ill, see a doctor
immediately. In an emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never recommends or endorses
any specific physicians, products or treatments for any
condition.

6. Speaker
Lisa W. Corbin, MD, FACP
Dr. Corbin is a board-certified internist, Associate Professor in the
Department of Internal Medicine at the University of Colorado
School of Medicine. In 2001, she helped the University of Colorado
Hospital establish the Center for Integrative Medicine (TCFIM) and
has served as the Medical Director ever since. Dr. Corbin works
closely with oncologists in the community and from the University of
Colorado Comprehensive Cancer Center to help their patients
manage side effects of treatment, reduce
chance of recurrence, and improve
quality of life using lifestyle approaches
and complementary / alternative
medicine therapies that align
with the patient’s values and interests.

7. Fad or Fact?
Complementary and
Integrative Medicine
Lisa W. Corbin, MD, FACP
Medical Director, Integrative Medicine
University of Colorado Hospital
Associate Professor, Internal Medicine
University of Colorado School of Medicine

8. Definitions
CAM
Complementary / Alternative Medicine
Therapies not historically part of
conventional medicine
 Chiropractic, acupuncture, massage, herbals…
Lifestyle medicine
Use of stress reduction, exercise, nutrition
for health benefits
Integrative medicine
CAM therapies and lifestyle approaches
coordinated with conventional medical
treatments

9. Who’s Using CAM?
 Nearly 50% of general public uses CAM
 70 – 85% of patients with cancer used at least one
CAM treatment
80% used spiritual practices
63% used herbs / supplements
60% used movement / physical therapies
 Reasons for use:
Feel hopeful (73%)
Boost immune system (63%)
Want control (38 - 44%)
Prevent recurrence (43%)
Aid conventional therapy / treat cancer (28 – 38%)

10. Case Vignettes
• MS, a 54 year old woman with metastatic colon
cancer. Was able to keep it “in check” with
chemotherapy, but was so sick every 3 weeks for 1.5
weeks that she had to quit work as a medical
technician. She came to us stating it was a last
resort, she was planning to take a “last hurrah” trip to
Greece. After discussion, she agreed to try
acupuncture before chemotherapy, and this worked
so well for her that she was able to continue getting
the life sustaining chemo and even went back to work
for four years

11. Case Vignettes
• MK, a 60 year old female runner, had colon cancer
treated with chemotherapy, radiation, and surgery.
Was dismayed that after treatment she was still
fatigued and could “only” run 3 miles (prior 10+). We
discussed exercise and local programs for cancer
survivors, she worked with a dietician to improve diet,
she worked with a psychologist on mind/body
strategies for fatigue management. Gradually she
was able to increase her tolerance and was back to
running half-marathons within 18 months.

12. Case Vignettes
• SS, a 62 year old male with rectal cancer just starting
treatment with chemotherapy. Family insisted that he
take herbs and change his diet; some told him the
chemotherapy was toxic and “would kill him, not the
cancer”. He was understandably anxious about
treatment and by family recommendations. He had
persistent pain at the site of a surgical procedure.
We suggested working with the psychologist for
anxiety reduction and how to respond to well-meaning
family. He began massage therapy for
anxiety and pain reduction. He discussed
supplements and diet with a dietician. He used
acupuncture during chemotherapy and came through
his treatment better than he had expected.

13. Using an Integrative Approach
Avoid harmful practices
 Don’t overlook lifestyle / self-care
Sleep
Exercise
Mind / body techniques
Nutrition
 Consider safe, plausible CAM
therapies
Herbs / supplements
Acupuncture
Massage

14. Harmful Therapies
• Colonic hydrotherapy
• Chelation therapy
• Ionic foot baths
• Restrictive diets
• Some supplements
• Financial toxicity!
• Anything used IN PLACE OF a curative
conventional treatment

15. Ionic Foot Baths

16. Ionic Foot Baths
http://www.wikihow.com/Test-a-Detox-Foot-Bath

17. Detoxification
 Human body is evolved to get rid of toxins
Skin
Lungs
Colon
Kidney
Liver
 Be natural – let the body do what it’s good
at! Support the processes:
Drink plenty of fluids
Exercise
Don’t put a lot of toxins in in the first place!

18. Helpful Therapies
• LIFESTYLE
– Sleep
– Exercise
– Mind / body techniques
– Nutrition
• CAM APPROACHES
– Supplements
– Acupuncture
– Massage

19. Why Lifestyle Approaches?
 Gives you more control over your
health and an active role in your care
 Low / no cost
 Can help current cancer-related
concerns, also to help prevent future
illness

20. Get Some Sleep!
 Restorative sleep improves pain, fatigue,
mood
 Sleep deprived “normals” develop chronic
pain
 Links: breast cancer, weight gain
 Behavioral approaches:
Don’t eat, drink, exercise just before bed
Avoid late day caffeine, too much alcohol
Get consistent exercise earlier in the day
Pay attention to room environment
Establish consistent sleep times
Get out of bed if not tired
Don’t nap

21. Exercise for Prevention
• Primary prevention
– Most versus least active = 27% reduction in
colon cancer
– Being generally active likely helps, too

22. Exercise for Prevention

23. Exercise During Treatment
• Prevents weight gain
• Decreases fatigue
• Improves stamina
• Helps balance
• Decreases anemia during
radiation
• What to “take” for my
immune system?
EXERCISE!

24. Exercise Can Help Symptoms
• Improves pain in general
• Helps memory and concentration
• Improves sleep, depression
• Good for the rest of life, too:
– Helps high blood pressure, diabetes,
cholesterol, improves bone mass
Unlike late night TV claims, this
product CAN help you lose 20
pounds and improve your sex life!

25. Simple Exercise Prescription:
FIT
 F requency
Exercise every day
 I ntensity
Break a sweat; increase difficulty of exercise
 T ime
Start with 5 minutes daily, increase by 1
minute daily each week; goal 30 minutes
(Final goal - 30 min vigorous or 60 min moderate activity daily)

26. Why Mind-body?
 Help restore locus of control
 Mind-body therapies are generally safe
 Perception of symptoms requires
processing by the mind; mind-body
therapies can alter perception
 Decrease pain, stress, anxiety
 Often covered by insurance

27. Mind-body Therapies
 Cognitive Behavioral Tx
 Relaxation techniques
 Breathing techniques
 Biofeedback / heart math
 Art, music, pet therapy
 Mindfulness / Meditation
 Imagery / visualization
 Yoga / tai chi
 Hypnosis

28. Mindfulness-Based Stress Reduction
• Promotes relaxation through nonjudgmental
awareness of sensations, experiences, and
reactions: being “present”, “in the moment”
• Randomized wait-list vs MBSR in 107 cancer
patients
– Improvement in mood and stress
– Effect maintained 6 months after program ended

29. Yoga
• Combines physical movement, breath
control, and meditation
• Promoted for patients with cancer
• Studied in breast cancer; recent study in
Germany just completed for colon
cancer

30. Support Groups
• Andersen and colleagues RCT
– psychologist-led group support
resulted in improvements in QoL, in
aspects of immune function, and in
life expectancy.
Cancer 2008; 113: 3450 – 8.

32. Diet / Nutrition
Estimated percentages of cancer due to
selected factors:
• Diet* 35-60%
• Tobacco 30%
• Air & water pollution 1-5%
• Alcohol 3%
• Radiation 3%
• Medications 2%
* Primarily obesity

33. Body Weight and Cancer

35. Specific Dietary Factors
• Fruits/ vegetables
• Inconsistency in studies showing protection
• 50% reduction in one study, no association
in another
• If valuable, probably most of risk reduction is in
increasing over 100 g / day (easily get this in
reasonably well balanced diet – apple is 200 g!)
• Red meat / animal fat / cholesterol
• Increased risk 3x for highest intake vs lowest intact
• Fiber
• 4 large studies show decreased risk, 2 no
association

36. Nutrition: Summary
• Plant based diet, less
meat and dairy
• 5 + fruits / vegetables
• 7 + high fiber complex
carbohydrates
• Low saturated/trans fat
• Less n-6, more n-3 FA
• Limited alcohol
Excellent resource: AICR

38. Real Nutrition Questions
Should I take
supplements?
Do I have to
eat organic?
Is soy good for me?
Does “sugar
feed the tumor”?

39. Herbs and Supplements
 Three types of medicines:
Prescription (Rx)
Over-the-counter (OTC)
Dietary Supplements
 Unlike Rx and OTC, supplements:
Are not required to prove safety, efficacy
Are not required to enforce quality control
Can vary in concentration of ingredients
 Over 60% of cancer patients use
supplements

40. General Advice: Supplements
• Natural  safe
• Use extra caution with prescriptions
• Use trustworthy resources for information
– Health food store, internet notoriously suspect
– Good: NMCD, ODS
• If you choose to take a supplement:
– Look for a well-labeled brand
– Avoid combination products, MLM sales
– Watch for red flags:
– Direct mail, infomercial, ads disguised as news articles, back
of the magazine ads, testimonials
– Claims a “cure”
– “Secret ingredients”, “one manufacturer”

41. Manufacturers More Likely to
Produce Quality Products
 Nature’s Way
 Nature’s Made
 Nature’s Bounty
 Costco (Kirkland)
 Walmart (Equiline)
 Phytopharmica
 Puritan’s Pride

42. In General:
Avoid Supplements During Treatment
• Antioxidants may decrease effect of
some chemo, radiation
• Some supplements directly inhibit
some chemotherapy (St. John’s wort)
• Some supplements may increase risk
of bleeding during surgery or interfere
with anesthesia

43. Specific Supplements
• Consider:
– Omega 3 fatty acids (fish oils): anti-inflammatory
– Glutamine
– Probiotics (decrease diarrhea, may break
down carcinogens)
– Ginger (for nausea)
– Melatonin (consider if also sleep deprived!)
– Other chinese herbals may improve
response rate according to 2012 Cochrane
review

44. Acupuncture
Chinese Medicine Background
Health = balance of yin and yang
Qi = energy force created by interaction
of yin and yang
Meridians = channels that carry qi throughout the
body; each corresponds with a specific organ
Excess, deficiency, or stagnant flow of qi results in
disease
Examples of TCM diagnoses:
 Yin deficiency and yang predominance with reduced kidney
qi
 Stomach qi rebelling

45. Acupuncture
Western Medicine Background
Osler, 19th century
“best treatment for lumbago”
James Reston, China, 1971
Biological effects
 Local nerve activation
 Endorphins, ACTH, endogenous opioids (reversal
of analgesia with naloxone)
SPECT scanning: increased activity and
reversal of asymmetry in chronic pain
patients in thalamic and prefrontal cortex
during acupuncture over baseline

47. General Advice: Acupuncture
 Acupuncture is generally safe
Adverse events: minor or rare (pain, bleeding,
fatigue)
Disposable needles, alcohol wipes avoid infection
 Practitioners
Must have a license in CO (LAc); scope of practice
for MD, DO, DC
TCM: National Certification Commission for
Acupuncture and Oriental Medicine
(www.nccaom.org)
MD: American Academy of Medical Acupuncture
(www.medicalacupuncture.org)
 Costs
Initial / follow up: $100 / $55 for LAc
Covered by some insurances

48. Benefits: Acupuncture
• Reduces nausea / vomiting due to
chemo
• May help return of bowel function post-op
• Decreases neuropathy
• Pain control
• Helps depression
• May stimulate immune system
• Recommended for dry mouth

49. Massage Therapy
 Developed by almost
all cultures
 Many different forms
 Emphasis on
improving circulation,
releasing muscle
tension, calming and
relaxing patient

51. Massage Therapy: Facts
 Over 20% of patients with cancer use
massage therapy
 Many patients remain unaware of the
potential benefits of massage
 Some patients are mistakenly told to avoid
massage if they have cancer

52. General Advice: Massage
 Generally safe. Use caution with:
Congestive heart failure
Infections
Blood clots / bleeding disorders
Osteoporosis or bone metastases
Pregnancy
Does NOT spread tumor
 Requirements for licensure or registration vary by
state
 Look for involvement in AMTA
(www.amtamassage.org)
 Extra training for oncology available
 $60 - $120 / hour, occasionally covered

53. Massage Therapy: Benefits
 Relaxation, improved QOL
 Depression, anxiety, sleep
 Post-operative wound healing
 Lymphedema treatment
 Pain management

54. Finding a Good Provider
 Training and licensure
 Experience with cancer
 Expected benefits
 Risks
Direct risks or side effects,
interactions?
 Costs / reimbursement
 Time frame / progress assessment
 Ability to work with conventional providers

55. Summary
• CAM treatments can be safely integrated
with conventional treatments
– Don’t use harmful therapies
– Use therapies shown to be beneficial
• Lifestyle approaches often overlooked
• If it sounds too good to be true…
– Consider safe, plausible therapies
• If they help you, they are beneficial!
• Find good practitioners, use good
resources

56. “Be open minded, but not
so open minded that your
brains fall out”
Widely attributed

57. Internet Resources
• CU Integrative Medicine: www.uch.edu/integrativemed
• NCI (follow links for CAM):
www.cancer.gov/cancer_information/ or
http://occam.nci.nih.gov
• ACS: www.cancer.org
• ASCO patient information:
www.PeopleLivingWithCancer.org
• Nutrition - AICR: www.aicr.org
• Supplements: http://ods.od.nih.gov/
• Consortium of Academic Health Centers for Integrative
Medicine: www.imconsortium.org
• NCCAM: http://nccam.nih.gov/

58. Question & Answer Time . . .
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59. Contact Us
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