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10/2/2020SUPPORTIVE ANDINTEGRATIVEAPPROACHES FORPANCREATIC CANCERSeptember 30, 2020If you experience technical difficulty during the presentation:Contact WebEx Technical Support directly at: US Toll Free: 1-866-779-3239Or submit a question to the Event Producer via the Q&A Panel1THANK YOU TO OUR WEBINAR SPONSORS21
10/2/2020THANK YOU TO OUR CURRENT SCIENTIFIC & MEDICALAFFAIRS INDUSTRY MEMBERS3RICHARD T. LEE, MDASSOCIATE PROFESSORHELEN MOSS FOUNDATION-SCHOFF FAMILY PROFESSOR OF INTEGRATIVE ONCOLOGYDIRECTOR, SUPPORTIVE & INTEGRATIVE ONCOLOGY PROGRAM SEIDMAN CANCER CENTERUNIVERSITY HOSPITALS & CASE WESTERN RESERVE UNIVERSITY42
10/2/2020OBJECTIVES To understand the terms Supportive care and palliative care Alternative, complementary, and integrativemedicine. To know how a supportive & integrativeapproach may benefit you To help you build your own personalizedcomprehensive plan5OUTLINE Background & Principles Seidman Cancer Center Clinical Philosophy andModel Review the data Creating your plan 63
10/2/202077SUPPORTIVE CARE - KEY COMPONENTS Patient and family focused 4 main components PhysicalPsychologicalSocialSpiritual Initiated by the primary oncology team andthen augmented by collaboration with aninterdisciplinary team of palliative careexperts.84
10/2/2020SUPPORTIVE CARE - KEY COMPONENTS Implemented early to prevent and treatsymptoms Offers a support system to help patientslive as actively as possible until death Will enhance quality of life, and may alsopositively influence the course of illness9SUPPORTIVE & PALLIATIVECARE MODELSwww.nationalconsensusproject.org105
10/2/2020CURRENT MODELS11THE CURE FOR ALLCANCERSOUTSMART YOUR CANCERWITH ALTERNATIVE NONTOXIC TREATMENTS THATThis revolutionary therapy WORKtargets cancer cells withoutdestroying normal cells.100 Underground Curesfor Cancer126
10/2/2020COMPLEMENTARY AND ALTERNATIVEMEDICINE (CAM)National Center for Complementary andIntegrative Health (NCCIH) – National Institutesof Health (NIH)Previously the Office of Alternative Medicine (1991)and the National Center for Complementary andAlternative Medicine (NCCAM) 2014DefinitionHealthcare approaches developed outside ofmainstream Western or conventional medicine13CATEGORIES OF CAM - NCCAM1. Natural Products Dietary supplements, herbal products, shark cartilage2. Mind-Body Interventions Meditation, prayer, mental healing, music therapy3. Manipulative and Body-Based Methods Chiropractic, osteopathic, massage, manipulation4. Other - Whole Medical Systems, Energy Therapies,and Movement Therapies Traditional Chinese medicine and Reiki147
10/2/2020THE DIFFERENCE BETWEENALTERNATIVE & COMPLEMENTARY Alternative medicine is used in place ofconventional medicine. Complementary medicine is used togetherwith conventional medicine. Integrative medicine 15 The practice of medicine that reaffirms theimportance of the relationship betweenpractitioner and patient Focuses on the whole person Informed by evidence Makes use of all appropriate therapeuticapproaches, providers, and disciplines toachieve optimal health and healing168
10/2/2020COMPREHENSIVE DEFINITION Integrative oncology is a patient-centered, evidence-informedfield of cancer care that utilizes mind and body practices,natural products, and/or lifestyle modifications from differenttraditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, andclinical outcomes across the cancer care continuum and toempower people to prevent cancer and become activeparticipants before, during, and beyond cancer treatmentJNCI 2017 Nov 1;2017(52).17189
10/2/2020How do we best achieve this goal?19202010
10/2/2020WHAT ELSE SHOULD I BE TAKING 212211
10/2/2020WHAT ARE THE RISKS? Treatment Efficacy Patient Safety Doctor-Patient Relationship Understanding the patient Unmet needs Economic Time Energy232412
10/2/202025Catharanthus roseus (Periwinkle)VinblastineCamptotheca acuminata (Happy Tree)IrinotecanTaxus brevifolia (Yew Tree)PaclitaxelPodophyllum pelatum (Mayapple)Etoposide2613
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10/2/202029SUPPLEMENTS VS PRESCRIPTIONSSupplementsOver-the- CounterVariablePrescription VariableGeneralClinical ResearchSpecificFDA ApprovalSpecificSafetyUnclearDocumentedMechanism of ActionUnclearGenerally CharacterizedHistoricalClinical TrialsAvailabilityCostSource of KnowledgeDosingQualityIndicationClinical EffectO’Hara Arch Fam Med 19983015
10/2/202031LEVELS OF EVIDENCE3216
10/2/2020DEVELOPMENT OF METHOTREXATE33HERBS & SUPPLEMENTS - BENIGN?Folate & MethotrexateBeta Carotene & Vitamin EIncreased risk of cancer and deathVitamin E & Beta CaroteneH&N radiation treatmentGoodman, GE et al., JNCI 2004; Bairati, I et al, JNCI 20053417
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10/2/2020B12Iron37PATIENT SAFETYSerious side effectsKava kavaContaminationHeavy Metals in Traditional Chinese HerbsPC-SPESDrug interactionsSt. John’s WortGrapefruit JuiceClouatre D., Toxic Lett. 2003; Ernst E, et al., Clin Pharm Ther 2001; Sparreboom A, et al., JCO 20043819
10/2/2020POTENTIAL RISKS39404020
10/2/202041NATURAL PRODUCTS FOR PANCREATIC CANCER Curcumin Phase I & II trials – limited benefit Mistletoe Phase III trial – limited benefit (4.8 v 2.7months) Proteolytic Enzyme Therapy (Gonzalez) No benefit compared to chemotherapy (14.0 v4.3 months)4221
l43SurgeryXRTChemoStem PalliativeMedIntegrative laincy4422
10/2/2020Supportive Integrative OncologyProgram Clinical ModelPhysical DomainPsychological DomainPalliative MedicineNutritionExercisePhysical TherapyOccupational TherapySexual HealthCancer GeneticsSpeech TherapyAcupunctureMassage TherapyPsychiatryPsychologyMusic TherapyArt TherapyYogaMeditationSurgeryRadiationTherapyStem CellTransplantSpiritual DomainChaplaincySpiritualitySacred ocial DomainSocial WorkPatient NavigatorsPatient EducationSupport GroupsFinancial Counseling45NUTRITION & PHYSICAL ACTIVITY4623
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10/2/2020Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010, 2019(*BMI 30, or about 30 lbs. overweight for 5’4” person)2000199020192010No Data 10%10%–14%15%–19%20%–24%25%–29% 30%495025
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10/2/2020 Healthy body weight (normal BMI) Exercise regularly – 150 minutes/week ofmoderate intensity or 75 minutes of vigorousactivity 5 servings of fruits and vegetables per day Limit processed meat, red meat, and refinedgrains Limit alcohol5959 80% versus 58% still walking at the end ofthe study Walking 2 miles versus 1 mile Improvements in fatigue, pain, andphysical symptoms6030
alBackgroundSleepAnxiety6231
10/2/2020SYMPTOM CLUSTER Pain, fatigue, gastrointestinal, andpsychological distressPainPsychologicalGIIssuesFatigue63PAIN Celiac plexus Celiac plexus block Neuropathic medications Don’t wait until the pain is severe Are you able to do your daily activities or get a full night of sleep6432
10/2/2020GASTROINTESTINAL & NUTRITION Nausea, vomiting, poor appetite Be proactive Stay hydrated Pancreatic Insufficiency Dietician65FATIGUE Causes: malnutrition, poor sleep,treatment-related, pain, psychologicaldistress Evaluate for reversible causes Nutrition Thyroid, B12, Iron levels Exercise is one of the best therapies6633
10/2/2020PSYCHOLOGICAL DISTRESS Depression, anxiety/stress, worry, andothers Associated factors Financial, family, employment, lack of family orcaregivers Seek help Support groups Social work, psychology, and psychiatry676834
10/2/2020MIND-BODY PRACTICES Stress (A) Mood Disturbance (A) Depression Quality of Life (A) Insomnia (C)697035
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10/2/2020ACUPUNCTURE Nausea (B) Pain (C) Xerostomia (C) Hot Flashes (C) Fatigue (C) Neuropathy (C) Insomnia75JAMA Vol 284, No. 21; 20007638
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10/2/202079MUSIC THERAPY8040
10/2/2020MUSIC THERAPY Stress & Anxiety (B) Mood Disturbance (B) Depression Quality of Life (C) Pain (C)818241
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10/2/2020Oncology Massage Therapy Mood Disturbance (B) Depression Anxiety & Stress (C) Pain (C) Constipation (C) Neuropathy85WALTON PRESSURE SCALELevel 1Level 2Level 3Level 4Level ressureDeepPressure8643
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10/2/2020 Meditation & Yoga Stress and anxiety Mood disturbance and depression Acupuncture Nausea and vomiting Music Therapy Stress and anxiety Mood disturbance and depression89NCCN GUIDELINES FORPALLIATIVE CARE Pain Acupuncture, MBSR, relaxation therapy Nausea & Vomiting Acupuncture, hypnosis, and CBT Dyspnea Stress management and relaxation therapy9045
10/2/202091NATIONAL CANCER INSTITUTE Physical. Common physical symptoms include pain, fatigue, loss ofappetite, nausea, vomiting, shortness of breath, andinsomnia. Many of these can be relieved with medicines or byusing other methods, such as nutrition therapy, physicaltherapy, or deep breathing techniques.9246
10/2/2020NATIONAL GUIDELINES NCCNAnn Int Med 2017939447
10/2/2020Supportive Integrative OncologyProgram Clinical ModelPhysical DomainPsychological DomainPalliative MedicineNutritionExercisePhysical TherapyOccupational TherapySexual HealthCancer GeneticsSpeech TherapyAcupunctureMassage TherapyPsychiatryPsychologyMusic TherapyArt TherapyYogaMeditationSurgeryRadiationTherapyStem ual DomainChaplaincySpiritualitySacred SpacesImmunoTherapySocial DomainSocial WorkPatient NavigatorsPatient EducationSupport GroupsFinancial Counseling95BASIC PRINCIPLES “Real” Natural Options Balance – Yin/Yang More is not necessarily better9648
10/2/2020BASIC PRINCIPLES Small Steps & Goals, Big Vision & Goals Dose & Quality Enjoyment97ASSESS YOUR NEEDSWORK WITH YOUR MEDICAL TEAMSSET GOALS9849
10/2/2020COMMON NEEDS Physical: Nutrition Physical Activity Symptoms Mind-Spiritual Stress & Anxiety Finding Meaning Social Support Connecting with others99NUTRITION PRINCIPLES 2 HQ’s Healthier Choices Quality Sources How are you eating food Quantity10050
10/2/2020NUTRITION Fruits & Vegetables (5-6 servings per dayminimum) Protein Carbohydrates Fats & Oils Limit Processed Foods High Calorie, Low Nutrition Value Limit Alcohol101NATURAL VITAMINS10251
10/2/2020HOW MANY CALORIES?10310452
10/2/2020PHYSICAL DOMAIN Symptoms – pain, fatigue etc. Supportive/Palliative care Nutrition Dietician Physical Activity Physical/Occupational Therapy105PHYSICAL ACTIVITY 3 hours of cardiovascular exercise per week 30 minutes a day Resistance/Weight Training Consider Supervision Monitor Your Progress10653
10/2/2020PSYCHOLOGICAL & SPIRITUAL Build from existing strengths Prayer, yoga, etc. Consider something new Psychiatrist or psychologist Take a class Practice 15-30 minutes 3-5 per week107SOCIAL HEALTH Stay active Consider meeting your social worker Consider something new Support group Try a new hobby Volunteer10854
10/2/2020109THE CONTINUUM OF CANCER CAREDiagnosis SurgeryPreventionChemotherapyActive TreatmentRadiationSurvivorsMeditationDiet & ExerciseAcupunctureMusic Therapy11055
10/2/2020SUMMARY – INTEGRATIVE MEDICINE Build a Comprehensive Care Plan Physical-Psychological/Spirit-Social Dimensions Team Approach Optimal Health and Healing Improve Outcomes – Cancer Control, Symptoms,Function Personalized, Evidence-based, Safe111Integrative Oncology – The Science of LivingWell with CancerCo-Hosted BySAVE the DATESeptember 2021Renaissance Baltimore Harborplace HotelBaltimore, MD11256
10/2/2020THANK YOU113THANK YOU FOR YOUR PARTICIPATIONIf you have questions, please contactPatient Central: 877-2-PANCAN or e-mail patientcentral@pancan.orgpancan.org11457
INTEGRATIVE APPROACHES FOR PANCREATIC CANCER September 30, 2020 THANK YOU TO OUR WEBINAR SPONSORS 1 2. . Mind-Body Interventions Meditation, prayer, mental healing, music therapy 3. Manipulative and Body-Based Methods . Resistance/Weight Training Consider Supervision Monitor Your Progress 105 106. 10/2/2020 54
