July 7, 2025 • 31 mins
Integrative oncology blends conventional cancer treatments with supportive therapies like nutrition, acupuncture, and mind-body practices to improve patient outcomes and quality of life. This episode outlines what pharmacists need to know about the principles of integrative medicine, how to evaluate evidence-based resources, and counseling tips for guiding patients through safe, effective complementary options. Tune in to strengthen your ability to support cancer patients with credible, compassionate, and comprehensive care.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Ginger Blackmon,PharmD
Associate Director of Clinical Initiatives
NCODA
Joshua Davis Kinsey and Ginger Blackmon have no relevant financial relationships to disclose.
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Define integrative oncology and identify its role in supporting patients undergoing conventional cancer treatment.
2. Describe how pharmacists can evaluate and counsel on evidence-based complementary therapies used in integrative oncology.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-256-H01-P
Initial release date: 7/7/2025
Expiration date: 7/7/2028
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm excited about
our conversation today.
Cancer care is no longer justabout treating the disease.
It's about supporting the wholeperson.
In this episode, we'll discussthe growing field of integrative
oncology and how pharmacistscan help patients safely
(00:25):
navigate complementary therapiesalongside conventional
treatment.
Before I introduce today's guest, I wanted to quickly mention
that we're excited to bring youthis special crossover episode
today in partnership withEncodas, the PQI podcast hosted
by Ginger Blackman.
At CE Impact, we're committedto delivering high-quality,
accredited education thatempowers pharmacy professionals
(00:48):
in every practice setting, andthis collaboration is a perfect
example of that mission inaction.
Encoda's mission is to empowerthe medically integrated
oncology team to deliverpositive, patient-centered
outcomes by providing leadership, expertise, quality standards
and best practices.
It's a privilege to team upwith Ginger and the ENCODA team
(01:08):
to share meaningful insightsthat support excellence in
oncology care.
Again, it's so great to haveGinger Blackman as our guest for
this episode, and for manyreasons not just because she's
brilliant in this space and notbecause she's just dedicated her
whole career to cancer care,but because and not because
she's just dedicated her wholecareer to cancer care, but
because Ginger and I have beenfriends for 25 years, which that
(01:30):
seems like a lot when I say itout loud, but Ginger and I went
to pharmacy school together andwe studied abroad in Europe
together.
We have great stories andmemories from that and, oddly
enough, now my husband workswith her at Encoda, so lots of
connections.
Ginger and her family are veryspecial people to us and we have
been talking about having acrossover episode for a long
(01:51):
time, since she hosts Encode'spodcast, and we finally made it
happen.
So, ginger, welcome.
Thank you so much for beinghere.
Speaker 2 (01:59):
Thank you, Josh.
I'm so excited to be here and Iwas thinking it's 20 years this
year.
Speaker 1 (02:05):
Yeah, I know, we celebrated our 20th graduation,
so we have been pharmacists for20 years.
Yeah, wild.
Speaker 2 (02:12):
It's crazy, but I also like you.
I know we're the planner, so Idon't know where our 20 year
reunion is.
Speaker 1 (02:18):
But yeah, I yeah, you know it was on me as president
of the class.
I was supposed to be planningthat 20th year.
You know what?
We'll just do a 25th, we'll doa silver and just make it really
big that sounds great.
That's the plan.
That's the plan, all right.
Well, ginger, again, thank youso much.
As I always like to do beforewe get started, I want our
(02:39):
learners to know a little bitmore about you, so know a little
bit more about you.
So, if you'll just take acouple of minutes to tell us a
little bit about your practicesite and the company and just, I
know that you have a reason whyyou're passionate about this
topic, so tell us a little bitabout that too.
Speaker 2 (02:54):
Yes, certainly so.
As you said, besides getting totravel to Europe and all those
good things with you many yearsago, I do have a passion and
background in oncology.
So soon after we graduated frompharmacy school, like within a
week, I was diagnosed withnon-Hodgkin's lymphoma, had it a
couple of times and in thatkind of shifted my path to
(03:16):
oncology from community pharmacy.
So I ended up a few severalyears later in a community
oncology practice here I'm inJacksonville, Florida, Was
pharmacy manager there at amedically integrated pharmacy
and an ENCODA member at the timefor about eight years.
And then I've been on staffwith ENCODA.
(03:37):
I'm the associate director ofclinical initiatives.
So I've been with ENCODA forfive.
During the time in the clinic Idid become certified in
aromatherapy.
I used a lot of integrativemedicine during my own treatment
and after during survivorship,helped heal a lot of things, so
(03:57):
really became a believer inabsolutely.
We have amazing, amazingoncology treatments.
Right now that landscape ischanging every day, changes so
fast, which is one reason whywhat we do at ENCODA is so fun
and unique because we get to bepart of that.
But also the need to combinethat treatment with things that
(04:18):
are more integrative andcomplementary, sometimes a
little bit more like Easternmedicine in care.
Speaker 1 (04:26):
Yeah, no, that's great.
And Ginger mentioned anotherword which I'm going to pull out
and mention to our audience,that I'm hoping to have an
episode on this soon.
But she mentioned survivorshipand that was a new thing for me
to hear about and understand inthe space of, you know, oncology
practice.
So hopefully I'll whet yourappetite a little bit as a
(04:46):
listener and you'll tune back inwhen we release an episode at
some point on survivorship.
But yes, thanks again, ginger.
Such a great story and I meanyour passion is so incredible
and it's because, like you said,you've been through it and you
really wanted to help others andto make that change and it's
(05:08):
just so great.
So let's talk about what we'rehere to talk about today.
We could reminisce, you know wecould go down the path of
reminiscing for a long time.
Speaker 2 (05:16):
We could have a three hour podcast.
Speaker 1 (05:18):
Absolutely.
If everyone wants to sit back,we could pull out old pictures
and and you know we studiedabroad before like smartphones
were things.
So when I say we have pictureslike, we have actual, like
printed out pictures.
So I was thinking about thatthe other day.
Speaker 2 (05:32):
I wanted to grab something and I realized that I
would have to take a picture ofa picture in order to like post
it somewhere yeah and then Ieven like did that bad thing and
was scrapbooking, so like someof mine, mine, I'm like oh man,
like I cut this, like everythingis cut up.
I wanted to make it look sonice so nice.
Speaker 1 (05:52):
Yeah, it's different times, yeah, we're definitely
getting old, but anyway, whatwe're here to talk about today
is integrative oncology, andwhat I want you to do first,
ginger, is to really define thatfor us, like what does that
mean?
What?
What do you mean?
When you say integrativeoncology, you've kind of hinted
to it a little bit likearomatherapy and complementary
products and things like that.
(06:12):
So if you'll tell us exactlywhat integrative oncology means,
so that we're just kind of onthat same foundation as we talk
through things today, absolutelyand I'm going to actually give
you.
Speaker 2 (06:22):
there there's a Society for Integrative Oncology
, so I will plug them and saycheck out their website.
They have a lot of theguidelines and different things
which we'll talk about shortlyfor integrative care and
oncology, but I'm going to giveyou their actual definition.
So they define it as apatient-centered,
evidence-informed which evidencewe love field of cancer care
(06:44):
that uses mind and bodypractices, natural products and
or lifestyle modifications fromdifferent traditions.
Alongside conventional cancertreatments, integrative oncology
aims to optimize health,quality of life and clinical
outcomes across the cancer carecontinuum and to empower people
to prevent cancer and becomeactive participants before,
(07:08):
during and beyond cancertreatment.
So I would love to highlight inthat, again, like the evidence
there while we don't have enough, and we'll talk about that as
well, there is a lot of evidencetowards the integrative
medicine and different kind ofcomponents of that and also
(07:28):
patient-centered, because again,we're giving a little bit
patients a little bit of powerback into their hands through
this, but also alongsideconventional treatment.
So we're not asking anyone toforego conventional treatment,
to not listen to what theironcologist says, but these are
things that can help reallyimprove a patient's quality of
life and even some treatmentoutcomes alongside what their
(07:52):
oncologist prescribes for them.
Speaker 1 (07:54):
Yeah, and those are the exact things I would have
pulled out as well and I wantedto highlight.
So thank you for doing that.
But yeah, just to reiterate,we're not saying like, instead
of the traditional treatmentthat would actually potentially
cure you or help you through orwhatever, we're going to tell
you to go take some vitamin C.
That's not what we're talkingabout today.
(08:14):
We're talking about, again,those complementary things,
those things that have shownevidence to help support, as
Ginger said, the quality of lifeof the patient and just to kind
of make that process better.
So this is not in place of,this is in addition to and I
think that's what's reallyimportant to note as well.
Okay, so why is this relevant?
(08:36):
I feel like it's something.
It's probably not brand new,but I feel like it's gaining
traction, I would say, in thelast few years, and so you know
what has kind of built thatscope and relevance around
integrative oncology.
Speaker 2 (08:53):
So I will say, as pharmacists, sometimes we hear
it and we're a little bit afraidbecause it's not our
traditional medicine,traditional drugs.
Speaker 1 (09:02):
Well, it sounds like, oh, you know, like, oh, this is
this like witchcraft, or youknow?
Are they?
Are they telling me to, likeyou know, go out and scrape tree
bark and you know all that kindof stuff.
Like that's what we think whenwe hear, like you know,
nontraditional or complimentary.
So yeah, I completely agree,there's hesitancy sometimes.
Speaker 2 (09:19):
Yeah, I also, like we don't want to tell completely
because of that, tell patientslike no, don't do anything.
Um, it is.
There are already around 50 ofcancer patients worldwide that
are using integrative medicineor some type, something that
we'll talk about here today.
So, and that I was surprisedeven to find out like low middle
(09:39):
income and developing countriesare included in that.
So so, just everywhere thegoals are really of integrative
medicine are to improve againquality of life, clinical
outcomes, and I think thebiggest and one reason it's
gained such traction is it doesempower patient participation.
So, when you're diagnosed andyou're getting all of this
(10:04):
information and you're having tobasically do.
You know you're getting all ofthis information and you're
having to basically do.
I mean you should do what yourteam tells you.
You do feel out of control.
Um, you know you have thiscancer.
Usually you don't expect it andI feel like having the um.
Integrative medicine are thingsthat patients can control
themselves so it hands back alittle bit of a sense of that
(10:25):
control to them themselves.
So it hands back a little bit ofa sense of that control to them
, so really important and itaddresses the whole person.
So I think again, a lot oftimes with our standard drugs
we're addressing physicalsymptoms, but it can address
emotional, social, spiritualhealth.
All of these play a role and Ithink more and more evidence is
(10:47):
showing that all of the totalpackage really plays a role in
wellness and healing for apatient.
Speaker 1 (10:50):
Yeah, absolutely yeah .
I love the idea of you know wealways talk about.
You know, patients need toadvocate for themselves.
Patients need to be a part ofthe process.
You know, when we makedecisions, it needs to be
clinical decisions, with thepatient, you know, informed, to
help with that.
And so I think it's reallyimportant that we, that we call
(11:13):
out that this, that this therapydoes empower the patient and it
does, it does allow them tofeel like they do have a say in
some of the things.
Because I can, I can onlyimagine, like you said, once you
get the diagnosis and then allof these things okay, you have
to do this, you have to do that,and we're going to start on
this, we're going to do this,we're going to do that, and then
, all of a sudden, you're noteven.
You're just yes, okay, yes, yes, yes.
You're not even in control ofanything anymore.
So, yeah, so I love the factthat it brings into that that
(11:34):
the patient and makes makes itmore about them, which is great.
Speaker 2 (11:47):
Can I also add one more thing as far as, like, I
think it's really important forus to know what we're about to
talk about, like things that dohave guideline support, because,
if you think about it, if 50%of people are at least are going
to do it anyway, like you wantto make sure you're having that
conversation and asking themthat you can guide them towards
things that are at leastevidence based and not going to.
That will hopefully help andthat will not cause harm.
So you know.
I really would also encouragepeople to have have an open mind
(12:10):
as we talk about these things,because if they're going to do
it, at least as the pharmacistyou can, you know, guide them
towards the things that do havebetter evidence and that may
actually help with theiroutcomes.
Speaker 1 (12:21):
Absolutely yeah, as opposed to just they heard it on
the TV talk show.
You know whatever morning showand they they're like I'm just
going to do it.
And you know if, if they ask usabout it as a pharmacist and we
downplay it or we say thatthat's bad or whatever, it
doesn't always mean that they'regoing to shy away from it.
Like yeah, they're probably,it's probably actually going to
(12:44):
push them.
You know in the other direction.
Yeah, they're probably, it'sprobably actually going to push
them, you know in the otherdirection.
And then they're not ever goingto ask you a question again
because they don't want to wantyou to think that they're always
doing stuff off book orwhatever.
Speaker 2 (12:53):
So they're not going to tell you too.
Speaker 1 (12:56):
Exactly.
They're just not going to tellyou, and then you're not going
to have a whole picture ofwhat's going on and what your
patient is taking.
So, yeah, that's such a greatpoint to you know, even if you I
mean using the things that areevidence-based, even if you are,
you know, still not I don'tknow what the word is like sold
(13:17):
on the idea.
I don't want to say that in abad way, but you still should be
the one that's providing theinformation.
We're the experts, we're themedication experts.
That goes across.
You know supplements and otherthings like that as well, so we
should be the expert in thatspace.
So, yes, anytime they're askingabout something, if you don't
know, don't just say I don'tknow, don't do that, that's not
(13:39):
proven.
Find out before you say that,because we want to be sure that
we're keeping our patients closeto us and that they're telling
us things, all right.
So with that, let's jump intowhat are some of the
opportunities and challengesthat we see with integrative
oncology.
So, again, from the lens of apharmacist, because that's
obviously who our audience baseis and that's who we're speaking
(14:00):
to today.
So let's talk about some of thethings that they need to know,
in this space of integrativeoncology, to be aware of what
are all the components ofintegrative oncology.
So I'll let you start.
You've got listed up here.
The first one is mental healthsupport, so let's talk about
that.
Speaker 2 (14:15):
Yes, so I'm going to start the first three that we'll
talk about I do want to saycome from the ASCO, which is the
American Society for ClinicalOncology.
I know, kelly, your Kelly justhad the chance to attend that
meeting, but it's the largestoncology meeting worldwide.
So it is huge.
But so ASCO and then theSociety for Integrative Oncology
(14:38):
, which I mentioned earlier,have guidelines.
They are published Typicallyanything that's an ASCO
guideline.
Encoda has an ENCODA ASCOguideline on oral dispensing.
But you can trust those.
They're well-researched.
They're not going to publishanything.
That's not so.
The first three areas we'lltalk about come from the ASCO
(15:00):
SIO guidelines and, like yousaid, mental health support.
So, not surprisingly I think,up to 21% of patients, which I
think may even be kind of lowhave been shown to have
depression during cancertreatment, with anxiety as high
as 17.9% is the most recentnumber I found.
(15:20):
Again, I would think that that'sunderreported 100% percent, but
even higher when firstdiagnosed, which makes sense
right.
Speaker 1 (15:29):
Yep sure.
Speaker 2 (15:30):
So there are evidence-based methodologies for
integrative medicine here, andthe top ones recommended by the
guidelines are mind-bodyinterventions, yoga.
There is some evidence forhypnosis.
I will not claim to be anexpert on hypnosis, so we
probably won't talk about thatmuch.
Actually, acupuncture foranxiety, music therapy and
(15:56):
aromatherapy comes in here,which I love.
So there is some evidence aswell for lavender inhalation.
So, not ingesting.
We never want to tell patientsto ingest essential oils not
ingesting, we never want to tellpatients to ingest essential
oils but inhalation.
That could be through adiffuser or they'll be like
personal diffusers.
They can make that looks justlike a little.
(16:16):
You probably can't hear it ifit's just audio, but it looks
like a little pen or a littlelipstick almost to cap off and
you can just kind of like sniffit and that also is good for
like if they were sitting in atreatment center um, and you can
use your own personal inhalerinstead of you know, diffusing
it throughout the entire centerright, yeah, someone may be
(16:37):
allergic or something.
Speaker 1 (16:38):
Yeah it almost kind of looks like a like a roll-on
perfume or something kind of,yeah, and you just kind of take
it off and yeah, yeah, I knowwhat you're talking about.
I, I love the.
You know the idea of musictherapy, I mean something as
simple as, as you know, likethat is, and I think that we
know that like what puts you ina happy place in general, you
(16:59):
know, and I feel like music isthat for a lot of people.
So, yeah, I, I, these are great.
So, ginger, when you mentionedMBIs, the mind-body
interventions what's an examplefor the listeners on that?
What do you mean by that?
Speaker 2 (17:12):
So there are going to be things, as it sounds, that
connect your mind and body,physical and mental, but things
like guided meditation have beenshown to do wonders in this
space and I know I'll say ourteam has even tried this on
recent meetings and it's beenpretty amazing.
But he's like guided meditation.
Speaker 1 (17:33):
Okay, okay, great, all right.
So next on the list is you kindof captured these first three,
as you mentioned, so the nextone in this kind of little group
is pain management, so let'stalk about that for a little bit
.
Speaker 2 (17:44):
Yes, so pain management a lot of patients
have pain, whether it is fromtheir disease treatment or their
aromatase inhibitor can also.
Aromatase inhibitors used inbreast cancer can also cause
pain for patients.
So acupuncture has actuallybeen shown to help with AI or
(18:04):
aromatase inhibitor pain andalso just general
musculoskeletal pain.
And then also massage, and I doknow of several even community
oncology practices, in additionto your bigger academic centers,
that do have incorporatedmassage therapy for various
patients.
That can be for chronic painand also in like a hospice if
(18:33):
you're in palliative care, canhelp there as well.
Speaker 1 (18:34):
Wow, that's great.
And then another one in thatspace is cancer-related fatigue,
so let's talk about that onefor a little bit, yes.
Speaker 2 (18:38):
So cancer-related fatigue, I will say, is probably
one of the most common sideeffects Also can be very
distressing during treatment.
It's different.
It's different and I can speakto this.
It's very different from you'relike oh, I've had a.
I'm tired, I'm exhausted, Ijust want to go to bed.
(18:59):
It's persistent, it can beoverwhelming for people physical
, mental, even emotional,emotional exhaustion and it
differs again from the fatiguethat's just caused by your
everyday like exertion.
You can't just rest, rest it orsleep it away, like it's it's
around, it has sometimesdebilitating effects on your
(19:22):
quality of life.
you know, if you can't do thethings that you love, or even
that you need to do for yourfamily and sometimes your
occupation, so you know you maynot be able to get up and work,
even though you really may loveto work or be may need to work
to continue to have a source ofincome during your treatment but
(19:44):
it really like it.
I think part of the problem isthere's no like one cause of it.
It's multifaceted.
So they don't really there'snot an easy treatment solution
and it could be multiple causes.
So you know, it could betreatment and the disease itself
from all different things, buthere again mind, body
(20:05):
interventions um, which ismeditation, and things um
exercise has been shown, which II believe this fully, but has
been shown to help with fatigue.
so it may seem counterintuitiveand, yeah, like go out and run a
marathon, but like walking andyou know light, maybe weight
lifting, but exercise can helpwith that.
(20:27):
Tai Chi, and I can never saythis right, so I'm going to key
gong, you're right?
Speaker 1 (20:35):
Yeah, I think that's it.
Speaker 2 (20:37):
Like cognitive behavioral therapy.
And then actually here's whereone of our natural products
comes in.
There is some evidence forAmerican ginseng you could
recommend, I would say, andwe'll introduce the About Herbs
app.
Definitely I'm not going togive a dose on here, but that
would be something you wouldneed to evaluate the patient,
(20:57):
the medications they're on.
It's not necessarily forlong-term but in short-term.
Speaker 1 (21:04):
Okay, yeah, interesting.
So that's a great segue becauseyou kind of set it up.
As you know, one of theinterventions of cancer related
fatigue is exercise, and so thenext thing on our list is to
talk about how exercise in andof itself can help with
integrative it can be acomponent of integrative
oncology.
So what does that look like forif we're not using it in the
(21:26):
fatigue related component?
Like, what should exercise looklike for if we're not using it
in the fatigue-related component?
What should exercise look likefor a patient with cancer?
Speaker 2 (21:34):
So I think that this is one of the most.
Some studies that are comingout make this very exciting
times for exercise, because Ithink things that we know now
are actually coming to fruitionwith the evidence, studies and
trials that have gone on.
And I'll just give a personalaside here.
I'll say during, like during allof my treatment, I made sure I
(21:57):
walked whenever possible, like Ihad a stem cell transplant and
my dad, my dad will tell you hewas there at 6am, like walking
the halls with me when there wasnot a crowd around and I
believe like that got me outquickly.
Like I do believe that thathelped me keep up stamina and
really like respond to treatmentand be able to complete
(22:19):
treatment a lot more easily thanif I hadn't done that.
But there is some evidence aswell here.
So there's evidence thatstructured programs post
chemotherapy significantlyreduce recurrence and mortality.
And we just had a colon cancerstudy come out it's kind of
during ASCO times this year thatresulted in a 37% reduction in
(22:43):
risk of death.
So I'm going to go through someof those numbers just to really
show what an impact it can have.
This three-year structuredexercise program it's initiated
soon after adjuvant chemotherapy, which adjuvant is after for
colon cancer resulted in asignificantly longer
(23:04):
disease-free survival andfindings consistent with longer
overall survival.
So in oncology too, ourendpoint like they were always
looking for is overall survivaland so this actually showed some
of that.
But, colon cancer again, is thethird leading cancer and the
second cause of cancer relateddeath.
(23:25):
It's despite the treatment therecurrent disease develops in 20
to 40% of patients, and surgeryand adjuvant chemo for colon
cancer can cause side effectsthat undermine quality of life
and reduce physical functioning.
So the population is already atrisk for, you know, decreased
(23:46):
physical functioning.
But this study showed thatexercise significantly reduced
the relative risk of diseaserecurrence, new primary cancer
or death by 28%.
The disease-free survival curvesbegan to separate at about a
year and then continued toseparate which I found really
interesting over the 10-yearfollow-up.
(24:07):
So I mean that's pretty amazing, just showing Just showing you
can continue to do well intosurvivorship.
Exercise reduced the relativerisk of death by 37%.
The overall survival curvesbegan to separate at about four
years and continued to separateover the 10 year followup.
(24:30):
So the magnitude of benefitfrom exercise delivered after
surgery and adjuvant chemo wassimilar to that of many
currently approved standard drugtreatments.
The study concluded which.
I mean that's amazing.
So the increase is theequivalent of because you'll ask
(24:50):
what does that mean?
About 45 to 60 minutes of briskwalking three to four times per
week, or 25 to 30 minutes ofjogging three to four times a
week.
So I mean that's not, when youthink about it, that's not huge
to get that kind of a benefit Toget that result.
Speaker 1 (25:08):
Yeah, yeah, that's great.
Speaker 2 (25:10):
So I know they also.
One thing mentioned in thestudy that I also found
interesting is the patients inthe exercise group receive more
social contacts with thephysical activity consultants.
So I think that was one of thethings they couldn't completely
rule out, that part of it evencould have been related to that
social interaction.
Speaker 1 (25:30):
Wow.
Speaker 2 (25:31):
And then they also concluded that you do need
behavioral support programs togo along with it.
So it's not just like tellingpatients to exercise goodbye,
it's really supporting themthrough that.
You know, having check-ins,giving them guided instruction,
things that they can do, butreally having, like that actual
(25:51):
program set up for it.
Speaker 1 (25:54):
And almost accountability and follow up
care.
Yeah, exactly, wow, that's sucha great, impactful study.
So, yeah, thank you for sharingthat.
Speaker 2 (26:04):
I imagine others would exercise.
No, I mean exercise.
Speaker 1 (26:07):
this is huge because this is a cornerstone in care
for so many disease states.
Exercise in general, you know,for diabetes, for hypertension,
for like so many of those.
And so to hear it now beingextrapolated and showing that it
helps with cancer, survivorship, like that's, it's, it's just
important, yeah, so please goahead.
Speaker 2 (26:26):
There's just no reason not to exercise.
Speaker 1 (26:28):
Yeah, exactly.
Speaker 2 (26:30):
As we're sitting in our desk chairs.
So there's also a study with anexercise show the exercise
enhanced immune infiltrationduring neoadjuvant so kind of
before surgery, chemotherapy andprehabilitation.
Exercise was associated with analtered even tumor
microenvironment and enhancedimmune infiltration.
(26:51):
So I just found that reallyinteresting some of the
preliminary studies that it made.
I mean it was affecting immunesystems.
Speaker 1 (27:00):
Yeah, which, if you think about it, it makes sense.
You're revving up your system,you're keeping it active and
it's going to be stronger andbetter to fight off things.
I especially thought about thatwhen you were talking about it
with your stem cell transplant.
Like you think about what'sinvolved with that, like it's
all about infection and you knowwhite blood cell count and like
(27:22):
all that kind of stuff like youthink about, like you were
boosting your system and I Iagree I think that that is what
gave you, you know, a quickerturnaround than others is
because you were, you werekeeping your system active.
Speaker 2 (27:34):
So, yeah, and I think we'll see with like
immunotherapy and some of thelike till, because the one thing
that it did is raise the tumor,infiltrating lymphocytes, which
is another type ofimmunotherapy that's coming out.
I think hopefully there'll besome studies in the future that
look at that and really helpingthose helping those therapies
(27:55):
utilize your immune system.
Speaker 1 (27:57):
Yeah, that's really good.
All right, so let's move intosome of the.
Getting into more of the.
I don't know what would you say.
Actual things you take, I guess, yeah the actual drugs, yeah,
the actual medications orwhatnot.
So yeah, let's start withvitamin D.
It's next on your list.
Speaker 2 (28:15):
Yes, so there have been multiple studies that have
shown support for survivalacross different types of cancer
breast, colon, lung lymphomaand there was one recent study,
which is also exciting, I think,that women with breast cancer
who were undergoing neoadjuvantchemotherapy and receiving
(28:39):
vitamin D supplementation so2000 IU had a higher
pathological complete responserate than women in a placebo
group.
So some of it the study willtalk about their levels and
different things, but if theyhad a value of greater than 20,
we're more likely to achievethat complete response.
(29:03):
So again, I think furtherstudies are needed to validate,
but really exciting.
I mean, how hard is it tosupplement vitamin D?
Yeah something really easy thata patient could do.
Speaker 1 (29:16):
Absolutely, absolutely.
So, keeping in that kind ofsupplement space and whatnot,
let's get into some of theherbal and traditional medicines
that have shown some evidenceand talk about those.
Speaker 2 (29:27):
So there are several I'm not going to really get into
like any specific ones righthere.
But I just want to point thereis evidence from traditional
Chinese medicine improvingoutcomes in advanced breast
cancer, again being used inaddition to treatment, not by
itself, and there are severalreliable sources now, but
(29:52):
probably the best that we use inpractice we used at the clinic.
We've had one of thepharmacists who runs this
website come and speak at one ofour meetings with ENCODA, but
it's Memorial Sloan Kettering,so they're a huge oncology
center out of New York but, theyhave an About Herbs app and you
can really find answers.
(30:14):
They have everything isevidence-based research there,
so that's a great place to start.
If you sign up for theirnewsletter, I know they'll send
you, like a spotlight, herb ofthe month or week.
I'm not sure what it is, butsomething like that as well.
Speaker 1 (30:29):
And to clarify on MSK's about herbs, ginger, is
that, is it strictly?
I know slum catering is big inthe cancer space Is it strictly
about cancer care or is it justin general about?
Speaker 2 (30:41):
So it's in general, but it's really going to like
focus on how things can be usedin oncology.
Speaker 1 (30:46):
Got it Okay.
Speaker 2 (30:47):
So it has that spin, but also it's going to tell but
I mean it will tell, it willgive you a good amount of
information on the herb that youcould potentially extrapolate
into some other.
Speaker 1 (30:58):
Into use in some other space.
Yeah, okay.
Speaker 2 (31:01):
Again, primarily it's oncology focused.
Speaker 1 (31:04):
Sure, sure, okay, and that's all the time we have for
today's episode.
But don't worry, we're justgetting started.
There's so much more to explorein the world of integrative
oncology and we'll pick up thisconversation right where we left
off in part two.
Be sure to join us for the nextepisode, as we continue
unpacking practical strategiesand insights for pharmacists
(31:26):
supporting patients throughcancer care.
Ginger and I look forward toseeing you back here again next
week.
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm excited about
our conversation today.
Cancer care is no longer justabout treating the disease.
It's about supporting the wholeperson.
In this episode, we'll discussthe growing field of integrative
oncology and how pharmacistscan help patients safely
(00:25):
navigate complementary therapiesalongside conventional
treatment.
Before I introduce today's guest, I wanted to quickly mention
that we're excited to bring youthis special crossover episode
today in partnership withEncodas, the PQI podcast hosted
by Ginger Blackman.
At CE Impact, we're committedto delivering high-quality,
accredited education thatempowers pharmacy professionals
(00:48):
in every practice setting, andthis collaboration is a perfect
example of that mission inaction.
Encoda's mission is to empowerthe medically integrated
oncology team to deliverpositive, patient-centered
outcomes by providing leadership, expertise, quality standards
and best practices.
It's a privilege to team upwith Ginger and the ENCODA team
(01:08):
to share meaningful insightsthat support excellence in
oncology care.
Again, it's so great to haveGinger Blackman as our guest for
this episode, and for manyreasons not just because she's
brilliant in this space and notbecause she's just dedicated her
whole career to cancer care,but because and not because
she's just dedicated her wholecareer to cancer care, but
because Ginger and I have beenfriends for 25 years, which that
(01:30):
seems like a lot when I say itout loud, but Ginger and I went
to pharmacy school together andwe studied abroad in Europe
together.
We have great stories andmemories from that and, oddly
enough, now my husband workswith her at Encoda, so lots of
connections.
Ginger and her family are veryspecial people to us and we have
been talking about having acrossover episode for a long
(01:51):
time, since she hosts Encode'spodcast, and we finally made it
happen.
So, ginger, welcome.
Thank you so much for beinghere.
Speaker 2 (01:59):
Thank you, Josh.
I'm so excited to be here and Iwas thinking it's 20 years this
year.
Speaker 1 (02:05):
Yeah, I know, we celebrated our 20th graduation,
so we have been pharmacists for20 years.
Yeah, wild.
Speaker 2 (02:12):
It's crazy, but I also like you.
I know we're the planner, so Idon't know where our 20 year
reunion is.
Speaker 1 (02:18):
But yeah, I yeah, you know it was on me as president
of the class.
I was supposed to be planningthat 20th year.
You know what?
We'll just do a 25th, we'll doa silver and just make it really
big that sounds great.
That's the plan.
That's the plan, all right.
Well, ginger, again, thank youso much.
As I always like to do beforewe get started, I want our
(02:39):
learners to know a little bitmore about you, so know a little
bit more about you.
So, if you'll just take acouple of minutes to tell us a
little bit about your practicesite and the company and just, I
know that you have a reason whyyou're passionate about this
topic, so tell us a little bitabout that too.
Speaker 2 (02:54):
Yes, certainly so.
As you said, besides getting totravel to Europe and all those
good things with you many yearsago, I do have a passion and
background in oncology.
So soon after we graduated frompharmacy school, like within a
week, I was diagnosed withnon-Hodgkin's lymphoma, had it a
couple of times and in thatkind of shifted my path to
(03:16):
oncology from community pharmacy.
So I ended up a few severalyears later in a community
oncology practice here I'm inJacksonville, Florida, Was
pharmacy manager there at amedically integrated pharmacy
and an ENCODA member at the timefor about eight years.
And then I've been on staffwith ENCODA.
(03:37):
I'm the associate director ofclinical initiatives.
So I've been with ENCODA forfive.
During the time in the clinic Idid become certified in
aromatherapy.
I used a lot of integrativemedicine during my own treatment
and after during survivorship,helped heal a lot of things, so
(03:57):
really became a believer inabsolutely.
We have amazing, amazingoncology treatments.
Right now that landscape ischanging every day, changes so
fast, which is one reason whywhat we do at ENCODA is so fun
and unique because we get to bepart of that.
But also the need to combinethat treatment with things that
(04:18):
are more integrative andcomplementary, sometimes a
little bit more like Easternmedicine in care.
Speaker 1 (04:26):
Yeah, no, that's great.
And Ginger mentioned anotherword which I'm going to pull out
and mention to our audience,that I'm hoping to have an
episode on this soon.
But she mentioned survivorshipand that was a new thing for me
to hear about and understand inthe space of, you know, oncology
practice.
So hopefully I'll whet yourappetite a little bit as a
(04:46):
listener and you'll tune back inwhen we release an episode at
some point on survivorship.
But yes, thanks again, ginger.
Such a great story and I meanyour passion is so incredible
and it's because, like you said,you've been through it and you
really wanted to help others andto make that change and it's
(05:08):
just so great.
So let's talk about what we'rehere to talk about today.
We could reminisce, you know wecould go down the path of
reminiscing for a long time.
Speaker 2 (05:16):
We could have a three hour podcast.
Speaker 1 (05:18):
Absolutely.
If everyone wants to sit back,we could pull out old pictures
and and you know we studiedabroad before like smartphones
were things.
So when I say we have pictureslike, we have actual, like
printed out pictures.
So I was thinking about thatthe other day.
Speaker 2 (05:32):
I wanted to grab something and I realized that I
would have to take a picture ofa picture in order to like post
it somewhere yeah and then Ieven like did that bad thing and
was scrapbooking, so like someof mine, mine, I'm like oh man,
like I cut this, like everythingis cut up.
I wanted to make it look sonice so nice.
Speaker 1 (05:52):
Yeah, it's different times, yeah, we're definitely
getting old, but anyway, whatwe're here to talk about today
is integrative oncology, andwhat I want you to do first,
ginger, is to really define thatfor us, like what does that
mean?
What?
What do you mean?
When you say integrativeoncology, you've kind of hinted
to it a little bit likearomatherapy and complementary
products and things like that.
(06:12):
So if you'll tell us exactlywhat integrative oncology means,
so that we're just kind of onthat same foundation as we talk
through things today, absolutelyand I'm going to actually give
you.
Speaker 2 (06:22):
there there's a Society for Integrative Oncology
, so I will plug them and saycheck out their website.
They have a lot of theguidelines and different things
which we'll talk about shortlyfor integrative care and
oncology, but I'm going to giveyou their actual definition.
So they define it as apatient-centered,
evidence-informed which evidencewe love field of cancer care
(06:44):
that uses mind and bodypractices, natural products and
or lifestyle modifications fromdifferent traditions.
Alongside conventional cancertreatments, integrative oncology
aims to optimize health,quality of life and clinical
outcomes across the cancer carecontinuum and to empower people
to prevent cancer and becomeactive participants before,
(07:08):
during and beyond cancertreatment.
So I would love to highlight inthat, again, like the evidence
there while we don't have enough, and we'll talk about that as
well, there is a lot of evidencetowards the integrative
medicine and different kind ofcomponents of that and also
(07:28):
patient-centered, because again,we're giving a little bit
patients a little bit of powerback into their hands through
this, but also alongsideconventional treatment.
So we're not asking anyone toforego conventional treatment,
to not listen to what theironcologist says, but these are
things that can help reallyimprove a patient's quality of
life and even some treatmentoutcomes alongside what their
(07:52):
oncologist prescribes for them.
Speaker 1 (07:54):
Yeah, and those are the exact things I would have
pulled out as well and I wantedto highlight.
So thank you for doing that.
But yeah, just to reiterate,we're not saying like, instead
of the traditional treatmentthat would actually potentially
cure you or help you through orwhatever, we're going to tell
you to go take some vitamin C.
That's not what we're talkingabout today.
(08:14):
We're talking about, again,those complementary things,
those things that have shownevidence to help support, as
Ginger said, the quality of lifeof the patient and just to kind
of make that process better.
So this is not in place of,this is in addition to and I
think that's what's reallyimportant to note as well.
Okay, so why is this relevant?
(08:36):
I feel like it's something.
It's probably not brand new,but I feel like it's gaining
traction, I would say, in thelast few years, and so you know
what has kind of built thatscope and relevance around
integrative oncology.
Speaker 2 (08:53):
So I will say, as pharmacists, sometimes we hear
it and we're a little bit afraidbecause it's not our
traditional medicine,traditional drugs.
Speaker 1 (09:02):
Well, it sounds like, oh, you know, like, oh, this is
this like witchcraft, or youknow?
Are they?
Are they telling me to, likeyou know, go out and scrape tree
bark and you know all that kindof stuff.
Like that's what we think whenwe hear, like you know,
nontraditional or complimentary.
So yeah, I completely agree,there's hesitancy sometimes.
Speaker 2 (09:19):
Yeah, I also, like we don't want to tell completely
because of that, tell patientslike no, don't do anything.
Um, it is.
There are already around 50 ofcancer patients worldwide that
are using integrative medicineor some type, something that
we'll talk about here today.
So, and that I was surprisedeven to find out like low middle
(09:39):
income and developing countriesare included in that.
So so, just everywhere thegoals are really of integrative
medicine are to improve againquality of life, clinical
outcomes, and I think thebiggest and one reason it's
gained such traction is it doesempower patient participation.
So, when you're diagnosed andyou're getting all of this
(10:04):
information and you're having tobasically do.
You know you're getting all ofthis information and you're
having to basically do.
I mean you should do what yourteam tells you.
You do feel out of control.
Um, you know you have thiscancer.
Usually you don't expect it andI feel like having the um.
Integrative medicine are thingsthat patients can control
themselves so it hands back alittle bit of a sense of that
(10:25):
control to them themselves.
So it hands back a little bit ofa sense of that control to them
, so really important and itaddresses the whole person.
So I think again, a lot oftimes with our standard drugs
we're addressing physicalsymptoms, but it can address
emotional, social, spiritualhealth.
All of these play a role and Ithink more and more evidence is
(10:47):
showing that all of the totalpackage really plays a role in
wellness and healing for apatient.
Speaker 1 (10:50):
Yeah, absolutely yeah .
I love the idea of you know wealways talk about.
You know, patients need toadvocate for themselves.
Patients need to be a part ofthe process.
You know, when we makedecisions, it needs to be
clinical decisions, with thepatient, you know, informed, to
help with that.
And so I think it's reallyimportant that we, that we call
(11:13):
out that this, that this therapydoes empower the patient and it
does, it does allow them tofeel like they do have a say in
some of the things.
Because I can, I can onlyimagine, like you said, once you
get the diagnosis and then allof these things okay, you have
to do this, you have to do that,and we're going to start on
this, we're going to do this,we're going to do that, and then
, all of a sudden, you're noteven.
You're just yes, okay, yes, yes, yes.
You're not even in control ofanything anymore.
So, yeah, so I love the factthat it brings into that that
(11:34):
the patient and makes makes itmore about them, which is great.
Speaker 2 (11:47):
Can I also add one more thing as far as, like, I
think it's really important forus to know what we're about to
talk about, like things that dohave guideline support, because,
if you think about it, if 50%of people are at least are going
to do it anyway, like you wantto make sure you're having that
conversation and asking themthat you can guide them towards
things that are at leastevidence based and not going to.
That will hopefully help andthat will not cause harm.
So you know.
I really would also encouragepeople to have have an open mind
(12:10):
as we talk about these things,because if they're going to do
it, at least as the pharmacistyou can, you know, guide them
towards the things that do havebetter evidence and that may
actually help with theiroutcomes.
Speaker 1 (12:21):
Absolutely yeah, as opposed to just they heard it on
the TV talk show.
You know whatever morning showand they they're like I'm just
going to do it.
And you know if, if they ask usabout it as a pharmacist and we
downplay it or we say thatthat's bad or whatever, it
doesn't always mean that they'regoing to shy away from it.
Like yeah, they're probably,it's probably actually going to
(12:44):
push them.
You know in the other direction.
Yeah, they're probably, it'sprobably actually going to push
them, you know in the otherdirection.
And then they're not ever goingto ask you a question again
because they don't want to wantyou to think that they're always
doing stuff off book orwhatever.
Speaker 2 (12:53):
So they're not going to tell you too.
Speaker 1 (12:56):
Exactly.
They're just not going to tellyou, and then you're not going
to have a whole picture ofwhat's going on and what your
patient is taking.
So, yeah, that's such a greatpoint to you know, even if you I
mean using the things that areevidence-based, even if you are,
you know, still not I don'tknow what the word is like sold
(13:17):
on the idea.
I don't want to say that in abad way, but you still should be
the one that's providing theinformation.
We're the experts, we're themedication experts.
That goes across.
You know supplements and otherthings like that as well, so we
should be the expert in thatspace.
So, yes, anytime they're askingabout something, if you don't
know, don't just say I don'tknow, don't do that, that's not
(13:39):
proven.
Find out before you say that,because we want to be sure that
we're keeping our patients closeto us and that they're telling
us things, all right.
So with that, let's jump intowhat are some of the
opportunities and challengesthat we see with integrative
oncology.
So, again, from the lens of apharmacist, because that's
obviously who our audience baseis and that's who we're speaking
(14:00):
to today.
So let's talk about some of thethings that they need to know,
in this space of integrativeoncology, to be aware of what
are all the components ofintegrative oncology.
So I'll let you start.
You've got listed up here.
The first one is mental healthsupport, so let's talk about
that.
Speaker 2 (14:15):
Yes, so I'm going to start the first three that we'll
talk about I do want to saycome from the ASCO, which is the
American Society for ClinicalOncology.
I know, kelly, your Kelly justhad the chance to attend that
meeting, but it's the largestoncology meeting worldwide.
So it is huge.
But so ASCO and then theSociety for Integrative Oncology
(14:38):
, which I mentioned earlier,have guidelines.
They are published Typicallyanything that's an ASCO
guideline.
Encoda has an ENCODA ASCOguideline on oral dispensing.
But you can trust those.
They're well-researched.
They're not going to publishanything.
That's not so.
The first three areas we'lltalk about come from the ASCO
(15:00):
SIO guidelines and, like yousaid, mental health support.
So, not surprisingly I think,up to 21% of patients, which I
think may even be kind of lowhave been shown to have
depression during cancertreatment, with anxiety as high
as 17.9% is the most recentnumber I found.
(15:20):
Again, I would think that that'sunderreported 100% percent, but
even higher when firstdiagnosed, which makes sense
right.
Speaker 1 (15:29):
Yep sure.
Speaker 2 (15:30):
So there are evidence-based methodologies for
integrative medicine here, andthe top ones recommended by the
guidelines are mind-bodyinterventions, yoga.
There is some evidence forhypnosis.
I will not claim to be anexpert on hypnosis, so we
probably won't talk about thatmuch.
Actually, acupuncture foranxiety, music therapy and
(15:56):
aromatherapy comes in here,which I love.
So there is some evidence aswell for lavender inhalation.
So, not ingesting.
We never want to tell patientsto ingest essential oils not
ingesting, we never want to tellpatients to ingest essential
oils but inhalation.
That could be through adiffuser or they'll be like
personal diffusers.
They can make that looks justlike a little.
(16:16):
You probably can't hear it ifit's just audio, but it looks
like a little pen or a littlelipstick almost to cap off and
you can just kind of like sniffit and that also is good for
like if they were sitting in atreatment center um, and you can
use your own personal inhalerinstead of you know, diffusing
it throughout the entire centerright, yeah, someone may be
(16:37):
allergic or something.
Speaker 1 (16:38):
Yeah it almost kind of looks like a like a roll-on
perfume or something kind of,yeah, and you just kind of take
it off and yeah, yeah, I knowwhat you're talking about.
I, I love the.
You know the idea of musictherapy, I mean something as
simple as, as you know, likethat is, and I think that we
know that like what puts you ina happy place in general, you
(16:59):
know, and I feel like music isthat for a lot of people.
So, yeah, I, I, these are great.
So, ginger, when you mentionedMBIs, the mind-body
interventions what's an examplefor the listeners on that?
What do you mean by that?
Speaker 2 (17:12):
So there are going to be things, as it sounds, that
connect your mind and body,physical and mental, but things
like guided meditation have beenshown to do wonders in this
space and I know I'll say ourteam has even tried this on
recent meetings and it's beenpretty amazing.
But he's like guided meditation.
Speaker 1 (17:33):
Okay, okay, great, all right.
So next on the list is you kindof captured these first three,
as you mentioned, so the nextone in this kind of little group
is pain management, so let'stalk about that for a little bit
.
Speaker 2 (17:44):
Yes, so pain management a lot of patients
have pain, whether it is fromtheir disease treatment or their
aromatase inhibitor can also.
Aromatase inhibitors used inbreast cancer can also cause
pain for patients.
So acupuncture has actuallybeen shown to help with AI or
(18:04):
aromatase inhibitor pain andalso just general
musculoskeletal pain.
And then also massage, and I doknow of several even community
oncology practices, in additionto your bigger academic centers,
that do have incorporatedmassage therapy for various
patients.
That can be for chronic painand also in like a hospice if
(18:33):
you're in palliative care, canhelp there as well.
Speaker 1 (18:34):
Wow, that's great.
And then another one in thatspace is cancer-related fatigue,
so let's talk about that onefor a little bit, yes.
Speaker 2 (18:38):
So cancer-related fatigue, I will say, is probably
one of the most common sideeffects Also can be very
distressing during treatment.
It's different.
It's different and I can speakto this.
It's very different from you'relike oh, I've had a.
I'm tired, I'm exhausted, Ijust want to go to bed.
(18:59):
It's persistent, it can beoverwhelming for people physical
, mental, even emotional,emotional exhaustion and it
differs again from the fatiguethat's just caused by your
everyday like exertion.
You can't just rest, rest it orsleep it away, like it's it's
around, it has sometimesdebilitating effects on your
(19:22):
quality of life.
you know, if you can't do thethings that you love, or even
that you need to do for yourfamily and sometimes your
occupation, so you know you maynot be able to get up and work,
even though you really may loveto work or be may need to work
to continue to have a source ofincome during your treatment but
(19:44):
it really like it.
I think part of the problem isthere's no like one cause of it.
It's multifaceted.
So they don't really there'snot an easy treatment solution
and it could be multiple causes.
So you know, it could betreatment and the disease itself
from all different things, buthere again mind, body
(20:05):
interventions um, which ismeditation, and things um
exercise has been shown, which II believe this fully, but has
been shown to help with fatigue.
so it may seem counterintuitiveand, yeah, like go out and run a
marathon, but like walking andyou know light, maybe weight
lifting, but exercise can helpwith that.
(20:27):
Tai Chi, and I can never saythis right, so I'm going to key
gong, you're right?
Speaker 1 (20:35):
Yeah, I think that's it.
Speaker 2 (20:37):
Like cognitive behavioral therapy.
And then actually here's whereone of our natural products
comes in.
There is some evidence forAmerican ginseng you could
recommend, I would say, andwe'll introduce the About Herbs
app.
Definitely I'm not going togive a dose on here, but that
would be something you wouldneed to evaluate the patient,
(20:57):
the medications they're on.
It's not necessarily forlong-term but in short-term.
Speaker 1 (21:04):
Okay, yeah, interesting.
So that's a great segue becauseyou kind of set it up.
As you know, one of theinterventions of cancer related
fatigue is exercise, and so thenext thing on our list is to
talk about how exercise in andof itself can help with
integrative it can be acomponent of integrative
oncology.
So what does that look like forif we're not using it in the
(21:26):
fatigue related component?
Like, what should exercise looklike for if we're not using it
in the fatigue-related component?
What should exercise look likefor a patient with cancer?
Speaker 2 (21:34):
So I think that this is one of the most.
Some studies that are comingout make this very exciting
times for exercise, because Ithink things that we know now
are actually coming to fruitionwith the evidence, studies and
trials that have gone on.
And I'll just give a personalaside here.
I'll say during, like during allof my treatment, I made sure I
(21:57):
walked whenever possible, like Ihad a stem cell transplant and
my dad, my dad will tell you hewas there at 6am, like walking
the halls with me when there wasnot a crowd around and I
believe like that got me outquickly.
Like I do believe that thathelped me keep up stamina and
really like respond to treatmentand be able to complete
(22:19):
treatment a lot more easily thanif I hadn't done that.
But there is some evidence aswell here.
So there's evidence thatstructured programs post
chemotherapy significantlyreduce recurrence and mortality.
And we just had a colon cancerstudy come out it's kind of
during ASCO times this year thatresulted in a 37% reduction in
(22:43):
risk of death.
So I'm going to go through someof those numbers just to really
show what an impact it can have.
This three-year structuredexercise program it's initiated
soon after adjuvant chemotherapy, which adjuvant is after for
colon cancer resulted in asignificantly longer
(23:04):
disease-free survival andfindings consistent with longer
overall survival.
So in oncology too, ourendpoint like they were always
looking for is overall survivaland so this actually showed some
of that.
But, colon cancer again, is thethird leading cancer and the
second cause of cancer relateddeath.
(23:25):
It's despite the treatment therecurrent disease develops in 20
to 40% of patients, and surgeryand adjuvant chemo for colon
cancer can cause side effectsthat undermine quality of life
and reduce physical functioning.
So the population is already atrisk for, you know, decreased
(23:46):
physical functioning.
But this study showed thatexercise significantly reduced
the relative risk of diseaserecurrence, new primary cancer
or death by 28%.
The disease-free survival curvesbegan to separate at about a
year and then continued toseparate which I found really
interesting over the 10-yearfollow-up.
(24:07):
So I mean that's pretty amazing, just showing Just showing you
can continue to do well intosurvivorship.
Exercise reduced the relativerisk of death by 37%.
The overall survival curvesbegan to separate at about four
years and continued to separateover the 10 year followup.
(24:30):
So the magnitude of benefitfrom exercise delivered after
surgery and adjuvant chemo wassimilar to that of many
currently approved standard drugtreatments.
The study concluded which.
I mean that's amazing.
So the increase is theequivalent of because you'll ask
(24:50):
what does that mean?
About 45 to 60 minutes of briskwalking three to four times per
week, or 25 to 30 minutes ofjogging three to four times a
week.
So I mean that's not, when youthink about it, that's not huge
to get that kind of a benefit Toget that result.
Speaker 1 (25:08):
Yeah, yeah, that's great.
Speaker 2 (25:10):
So I know they also.
One thing mentioned in thestudy that I also found
interesting is the patients inthe exercise group receive more
social contacts with thephysical activity consultants.
So I think that was one of thethings they couldn't completely
rule out, that part of it evencould have been related to that
social interaction.
Speaker 1 (25:30):
Wow.
Speaker 2 (25:31):
And then they also concluded that you do need
behavioral support programs togo along with it.
So it's not just like tellingpatients to exercise goodbye,
it's really supporting themthrough that.
You know, having check-ins,giving them guided instruction,
things that they can do, butreally having, like that actual
(25:51):
program set up for it.
Speaker 1 (25:54):
And almost accountability and follow up
care.
Yeah, exactly, wow, that's sucha great, impactful study.
So, yeah, thank you for sharingthat.
Speaker 2 (26:04):
I imagine others would exercise.
No, I mean exercise.
Speaker 1 (26:07):
this is huge because this is a cornerstone in care
for so many disease states.
Exercise in general, you know,for diabetes, for hypertension,
for like so many of those.
And so to hear it now beingextrapolated and showing that it
helps with cancer, survivorship, like that's, it's, it's just
important, yeah, so please goahead.
Speaker 2 (26:26):
There's just no reason not to exercise.
Speaker 1 (26:28):
Yeah, exactly.
Speaker 2 (26:30):
As we're sitting in our desk chairs.
So there's also a study with anexercise show the exercise
enhanced immune infiltrationduring neoadjuvant so kind of
before surgery, chemotherapy andprehabilitation.
Exercise was associated with analtered even tumor
microenvironment and enhancedimmune infiltration.
(26:51):
So I just found that reallyinteresting some of the
preliminary studies that it made.
I mean it was affecting immunesystems.
Speaker 1 (27:00):
Yeah, which, if you think about it, it makes sense.
You're revving up your system,you're keeping it active and
it's going to be stronger andbetter to fight off things.
I especially thought about thatwhen you were talking about it
with your stem cell transplant.
Like you think about what'sinvolved with that, like it's
all about infection and you knowwhite blood cell count and like
(27:22):
all that kind of stuff like youthink about, like you were
boosting your system and I Iagree I think that that is what
gave you, you know, a quickerturnaround than others is
because you were, you werekeeping your system active.
Speaker 2 (27:34):
So, yeah, and I think we'll see with like
immunotherapy and some of thelike till, because the one thing
that it did is raise the tumor,infiltrating lymphocytes, which
is another type ofimmunotherapy that's coming out.
I think hopefully there'll besome studies in the future that
look at that and really helpingthose helping those therapies
(27:55):
utilize your immune system.
Speaker 1 (27:57):
Yeah, that's really good.
All right, so let's move intosome of the.
Getting into more of the.
I don't know what would you say.
Actual things you take, I guess, yeah the actual drugs, yeah,
the actual medications orwhatnot.
So yeah, let's start withvitamin D.
It's next on your list.
Speaker 2 (28:15):
Yes, so there have been multiple studies that have
shown support for survivalacross different types of cancer
breast, colon, lung lymphomaand there was one recent study,
which is also exciting, I think,that women with breast cancer
who were undergoing neoadjuvantchemotherapy and receiving
(28:39):
vitamin D supplementation so2000 IU had a higher
pathological complete responserate than women in a placebo
group.
So some of it the study willtalk about their levels and
different things, but if theyhad a value of greater than 20,
we're more likely to achievethat complete response.
(29:03):
So again, I think furtherstudies are needed to validate,
but really exciting.
I mean, how hard is it tosupplement vitamin D?
Yeah something really easy thata patient could do.
Speaker 1 (29:16):
Absolutely, absolutely.
So, keeping in that kind ofsupplement space and whatnot,
let's get into some of theherbal and traditional medicines
that have shown some evidenceand talk about those.
Speaker 2 (29:27):
So there are several I'm not going to really get into
like any specific ones righthere.
But I just want to point thereis evidence from traditional
Chinese medicine improvingoutcomes in advanced breast
cancer, again being used inaddition to treatment, not by
itself, and there are severalreliable sources now, but
(29:52):
probably the best that we use inpractice we used at the clinic.
We've had one of thepharmacists who runs this
website come and speak at one ofour meetings with ENCODA, but
it's Memorial Sloan Kettering,so they're a huge oncology
center out of New York but, theyhave an About Herbs app and you
can really find answers.
(30:14):
They have everything isevidence-based research there,
so that's a great place to start.
If you sign up for theirnewsletter, I know they'll send
you, like a spotlight, herb ofthe month or week.
I'm not sure what it is, butsomething like that as well.
Speaker 1 (30:29):
And to clarify on MSK's about herbs, ginger, is
that, is it strictly?
I know slum catering is big inthe cancer space Is it strictly
about cancer care or is it justin general about?
Speaker 2 (30:41):
So it's in general, but it's really going to like
focus on how things can be usedin oncology.
Speaker 1 (30:46):
Got it Okay.
Speaker 2 (30:47):
So it has that spin, but also it's going to tell but
I mean it will tell, it willgive you a good amount of
information on the herb that youcould potentially extrapolate
into some other.
Speaker 1 (30:58):
Into use in some other space.
Yeah, okay.
Speaker 2 (31:01):
Again, primarily it's oncology focused.
Speaker 1 (31:04):
Sure, sure, okay, and that's all the time we have for
today's episode.
But don't worry, we're justgetting started.
There's so much more to explorein the world of integrative
oncology and we'll pick up thisconversation right where we left
off in part two.
Be sure to join us for the nextepisode, as we continue
unpacking practical strategiesand insights for pharmacists
(31:26):
supporting patients throughcancer care.
Ginger and I look forward toseeing you back here again next
week.
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