According to the National Cancer Institute, there are over 12 million cancer survivors in the U.S. today. And that number is expected to grow as the population ages, treatments improve and tests find the disease earlier.
Cancer survivors face a myriad of health challenges, not to mention the daunting fear the cancer will return. However, once a patient is deemed "in remission," they are typically disconnected from care -- as well as any attending support -- and told to come back in three to six months where diagnostic scans or blood tests will determine if the cancer has returned.
We suggest a far more pro-active, empowered approach: a remission maintenance plan that offers cancer survivors a personalized program to regain control of their health, restore vitality and protect against the cancer returning. At the Block Center, once a patient has completed their treatment, we personally tailor a comprehensive remission maintenance program for them that includes: therapeutic nutrition, exercise, mind-spirit care and anti-tumor therapies.
Understandably, after hearing that they are "in remission," patients may want to retreat psychologically to a "cancer-free" zone and never think about the disease again. But this is why they shouldn't: Cancer is as much a microscopic and molecular disease as it is a visible one. Thus, a patient in remission may still harbor malignant cells (ones that were resistant to chemotherapy or radiation and therefore survived the attack phase). These cells unfortunately have the ability to show up with a vengeance, even when one least suspects. Not placing far greater emphasis on containing and addressing these cells from the get-go is a significant omission of mainstream treatment. But while preemptive treatment strategies may only exist in integrative clinics, when it comes to the diagnostic side, a new technology has begun demonstrating the relevance of these virulent escape cells.
Enter CTCs (circulating tumor cells)! Over a decade ago, the Block Center was one of a few that were performing bone marrow biopsies to evaluate for malignant cells in both the marrow and in circulation. It took several years, but eventually this evolving diagnostic technology made it into conventional care. While easier to perform today and more reliable as well, we continue to use this in our clinic. This technology allows us and others the ability to measure in our patients the number of these detached cells circulating freely from the main cancer mass. Though not yet approved for all cancer, research studies have shown that an increase of these cells is prognostic of a patient's survival.
For instance, a CTC count may be a better prognostic indicator for survival among prostate cancer patients than a PSA level -- the test used presently to determine and follow the course of prostate cancer growth.
By comparing the levels of CTC in 37 men with metastatic prostate cancer, researchers at Thomas Jefferson University found that for the men with 5 CTCs or more, the median overall survival was only 8.4 months. Whereas, if these men were found to have less than 5 CTCs, the median survival was 48 months!
The relevance of CTCs is also relevant to other cancers. For instance, CTCs were measured in 151 women with metastatic breast cancer. The MD Anderson Cancer Center's researchers found that those patients with five or more CTCs had a median survival of only 13 months, whereas those with less five survived over 29 months!
Controlling, preventing or overcoming these detached and disseminating cells is possibly the biggest conundrum facing cancer scientists. While these cells are generally addressed during treatment, the first steps of recurrence prevention should start with strategies to counter the survival of these residual cells and inhibiting their potential proliferation. In fact, CTCs that have gone through the onslaught of treatment and have nonetheless survived have the potential to evolve into more aggressive clones encouraging a more virulent malignancy. So what to do?
We recommend regular monitoring of patients' status with lab tests and imaging to detect early signs of disrupted biochemistry or a recurrence of disease, especially in the year or two after remission.
Being "diagnostically aggressive" may allow us to be less invasive therapeutically. In the first years after remission, therefore, we recommend:
1. Clinical visits with your oncologist, at least every three to four months in the first and second year and every six months for the next several years
2. Scans and blood tests of tumor markers every three months.
3. Complete blood count and chemistry test every three months.
4. Nutrition status, including weight changes, body composition and albumin levels, every three months.
5. Internal terrain monitoring every three to six months for the terrain factors that are most problematic.
While monitoring, there is no reason to wait anxiously for the other shoe to drop. So immediately implement a full integrative program.
1. Make sound dietary changes toward adherence of a whole foods diet. Reduction in dietary fat has already been shown to cut recurrences in different cancers. Controlling refined flour, sugar and junk food is a necessary step to avoid the recurrence risk of elevated blood glucose and spiking insulin levels.
2. Introduce aerobics, strength and flexibility training into your daily schedule. Yoga, pilates, chi gong or any number of fitness approaches is an essential step towards recurrence prevention. Considerable research supports that risk, response, recurrence and outcomes are tied to physical care.
3. Mitigate stress through progressive relaxation, meditation or simply easing the load on an excessive work schedule. Elevated cortisol levels are associated with poorer outcomes in breast cancer patients. So do what it takes to transform less healthy patterns.
4. Get rest and adequate sleep. The more active you are in the daytime, the better you'll sleep at night. Few of us get enough sleep and the adverse consequences to an otherwise health promoting, cancer inhibitory environment can be devastating.