For which of the following gastrointestinal related concerns can traditional herbal medicine provide significant relief? In the following session, we will be discussing the evidence regarding the use of traditional herbal medicine in reducing gastrointestinal symptoms and related concerns which are the result of chemotherapy, and other oncology treatments. At the same time, we will examine how herbal medicine can be combined with other integrative oncology modalities for these concerns. Gastrointestinal GI symptoms and related concerns are extremely prevalent among patients undergoing chemotherapy and the other oncology treatments, and present a significant challenge to the health care professional especially when conventional treatments are limited in their efficacy and safety. The most common gastrointestinal toxicities which are frequently caused by oncology treatments can be divided into three main groups: treatment induced toxicities, such as chemotherapy induced nausea and vomiting( CINV), gastrointestinal manifestations of the cancer, particularly in advanced disease, with reduced appetite and accompanying weight-loss. And finally, gastrointestinal related concerns related to the patient's health belief model and approach to nutrition. This refers to the change in diet, some of which may be extreme with patients abstaining from a wide range of foods. Even fasting for long periods of time in order to fight the cancer, or strengthen the immune system. Patients may ask about nutrition during the integrative oncology consultations with questions such, ''Doctor, what should I eat or avoid eating to stop the cancer from spreading or returning? Which types of food will strengthen me or my immune system'' Any discussion on the use of herbal medicine and the treatment of GI related symptoms and concerns needs to assume that the integrative treatments are being provided as an adjunct conventional supportive and palliative care. The conventional approach to GI related symptoms includes the use of drugs such as anti-emetics, laxatives, or anti-diarrheals. And sometimes changes in the treatment regimen such as stopping irinotecan treatment in cases of severe diarrhea. Adverse effects of oncology treatment are monitored by the patient's oncologist, oncology nurse, and palliative care specialists if available who make decision regarding the changes in treatment regiments. Many cancer centers provide Psycho-Oncology and counseling which are provided by social workers, psychologists, art therapist, or other healthcare practitioners. The conventional supportive cancer care staff often include a clinical dietitian who can assess the patient's nutritional status, provide guidance, and monitor caloric intake and weight loss, as well as addressing GI related concerns, and an occupational therapist who can help the patient improve daily functioning including the preparation of meals, and finally a spiritual care provider who can help patients deal with existential questions on the meaning of illness and death. Integrative oncology and has much to offer patients with GI related concerns and should be included as part of, or in parallel with supportive cancer care. This is especially relevant when conventional medicine is not able to provide adequate relief from symptoms such as chemotherapy induced nausea and vomiting. In cases where standard care does not have evidence-based effectiveness for the patient symptom or concern, such as with mucositis or disturbances in the sense of taste, or in situation where conventional treatments are themselves accompanied by significant side effects such as constipation induced by anti-emetic drugs such as Ondansetron or Zofran. Integrative oncology should also be considered when the patient expresses a desire for this form of treatment in addition to, or as an alternative to conventional therapeutic options as a reflection of their cultural affinity and health belief model of care. In the present discussion on the use of herbal medicine and integrative oncology for GI related concerns, we will begin with the upper GI tract and move our way down. It is important to take a two tiered approach when presenting patients with the evidence available in the scientific literature on the effectiveness and safety of herbal and integrative oncology modalities. In an earlier session we talked about a number of herbal medicinal remedies which have been shown in clinical research to be of benefit in reducing oral toxicities of chemo and radiation therapy for oncology patients. These includes the following: The use of locally applied medicinal honey remedy which was shown to alleviate oral mucositis and reduce the severity of pain and Xerostomia, or dry mouth as a result. It is important that only standardized and approved honey based products be used for this indication especially in patients who have an emperor depressed immune system, and are thus more susceptible to serious complications from infected honey. The use of an herbal mouthwash containing Chamomile Matricaria recutita, and mint Mentha pirerita, which was shown to reduce pain, dryness and dysphagia, or difficulty in swallowing. Or products based on the herbs Achillea millefolium and turmeric, Cucuma longa, which we're able to delay the onset and reduce the severity of chemotherapy induced mucositis. And Sage T thyme peppermint hydorosal oral rinse, used in conjunction with basic oral care which was shown to reduce symptoms associated with 5-FU chemotherapy. An extract of Carob Ceratonia siliqua shown to be of benefit for mucositis among children and young adults in Northern Israel who are undergoing bone marrow transplantation. The use of herbal oral gels with either Calendula officinalis, or Silly marine, extracted from Milk thistle Silyabum marianum for the prevention of radiation induced oropharyngeal mucositis in patients with head and neck cancer. The use of a date palm pollen remedy found to be beneficial in preventing radiation and chemotherapy induced oral mucositis. The use of the homeopathic remedy Traumeel S shown to reduce pain and discomfort in children with radiation induced oral mucositis and Rhodiola algida, a popular herb used in traditional Chinese herbal medicine which was reported to improve oral ulcers in patients with breast cancer following four cycles of five fluorouracil, epirubicin and cyclophosphamide. In our integrative oncology unit, we recommend the use of a practical and traditional homemade Middle Eastern remedy for treating oral mucositis and mouth sores which was described in a paper published in a nursing care journal. The remedy consists of three components, all of which can be found in most Arabic speaking homes in northern Israel. Carob, sage, and Tahini. The first ingredient is the carob fruit extract. In Arabic, ruble hobe. The extract is spread on top of an oral patch made from a mixture of chopped dry sage leaves Salvia officinalis or Salvia fructicosa, with thick sesame paste, Tahini. The patches can be placed over the inflamed, or ulcerated area of the patient's gums up to four or five times daily.
