[MUSIC] What aspects of traditional herbal medicine use does the integrative physician need to address during the consultation with the oncology patient. How should the integrative physician approach the patient's expectation that herbal medicine can cure cancer and strengthen the body's immunity? In this next lesson we will discuss the four main issues which are related to the use of traditional herbal medicine which needs to be addressed during the integrative physician's consultation. Especially, for patients undergoing chemotherapy and other cancer treatments. The following story illustrates the challenges faced by the integrative physician and providing evidence-based guidance while at the same time maintaining a patient oriented and culturally sensitive perspective within an environment of understanding, trust, and effective communication. Kamar was a 72 year old male patient who have been diagnosed with metastatic non-small cell lung cancer. He began treatment with the chemotherapy agents Carboplatin, Pemetrexed or Alimta, and Bevacizumab, Avastin, which led to severe and debilitating symptoms, which included, fatigue, a disturbed sense of taste, and impaired appetite. His oncology nurse referred him to an integrative oncology service, which is part of a community-based oncology daycare service for relief of his symptoms. He was first seen by an integrative physician who asked Kamar to describe his symptoms. And then opened a discussion to address his health belief model of care and expectations from the complementary medicine treatments. During the conversation Kamar told the intergrative physician that he had begun to take an herbal medicinal remedy called Alanda, which is a popular treatment for cancer made from the plant Ephedra foeminea. Alanda has only recently become popular among oncology patients in Israel and the Palestinian authority. And it's prepared by boiling a handful of the plant's vines in a large pot of water, and then drinking the broth. A relative of Kamal had gathered a large bunch of Alanda vines and had prepared the remedy for him. Kamal believed that by drinking the potion he would be cured of his cancer. In order to properly address Kamal's use of this herbal remedy, the integrative physician needed to first understand Kamal's perspective of his medical condition, his health belief model, and his expectations from the complementary medicine treatment program. The oncology nurse had referred him in order to help relieve the symptoms which had been caused by the chemotherapy. However, patients like Kamal often take a one-dimensional view when asked about their expectations from integrative medicine, especially with respect to the use of herbal medicine. Many believe that these natural remedies are indeed able to destroy cancer cells or boost the immune system which is been reduced by chemotherapy. They may even quote so-called findings of scientific research which may or may not exist and may even have proven the opposite of what the effect of the herbal remedy is expected to be. Many will also quote questionable studies, which claim to understand the mechanism of the herbs actions on cancer cells and bring anecdotal examples of patients who took such and such a remedy and were cured after being told by their oncologist that there was nothing left to offer. It would be very easy to dismiss these unfounded beliefs in herbal wonder cures as just the patients need to rationalize their search for anything and everything that will cure their cancer. However, this is also a reflection of their hopes and expectations that through the use of herbal medicinal remedies they can become stronger both physically and spiritually, and overcome the disease. We tend to associate the belief and expectation that traditional herbal medicine can cure cancer with the approach of alternative medicine, an approach which was discussed in an earlier chapter. From the patient's perspective, however, the expectation for a wonder cure may be the result of the inability of conventional oncology treatments to stop or slow the progression of the disease increasing their survival. Patients are very often unfamiliar with the ability of integrative medicine, which begins with the integrative physician consultation to provide symptom relief and improve quality of life and function. It is therefore of utmost importance that the integrative physician asks the patient what they expect from the integrative medicine consultation and treatment program. In the case of Kamal, the integrative physician could ask something to the effect of, do you have any general or specific expectations from this consultation or from the complimentary medicine treatments? Asking patients about their expectations makes them more likely that other issues including the use of herbal medicine will be raised. Patients who have questions about specific herbs and their ability to destroy cancer cells may be projecting an often unrecognized yearning for some form of empowerment for feeling healthy once again, for being able to cope better with their illness and symptoms, and to function more effectively, at least on a day-to-day basis. It is during the integrative oncology consultation that the patient's expectations for a wonder cure can be reframed to more realistic goals, where complementary medicine provides relief from the side effects of the oncology treatments and improves quality of life and function. The truth is that there is no evidence that integrative medicine can stop cancer from progressing, especially when conventional biological and chemotherapy agents have been unsuccessful. However, integrative therapies such as an herbal medicine do have the ability to alleviate chemotherapy related toxicities, including symptoms such as fatigue, disturbed sleep, pain, nausea and vomiting, reduced appetite, and more. By reframing treatment objectives from providing a cure for the disease to improving quality of life, the discussion can then move to the effectiveness and safety of specific herbal remedies for this purpose. The reframing of expectations to more realistic and evidence-based treatment goals is one of the many challenges faced by the integrative physician during the integrative oncology consultation. In order to further this goal, three additional questions need to be asked. Question 1, have you ever used natural or non-conventional medications including dietary supplements or herbal remedies? This refers to the traditional alternative or complementary medical setting, and regarding intention to treat any health related concerns including those not related to the patient's cancer. Question 2, are you currently using any form of non-conventional medicine, which include herbal medicine, acupuncture, massage, meditation etc., in order to treat your cancer or to treat the side effects of your conventional oncology treatment? Question 3, have you made any changes to your diet in order to treat your cancer? For example, removing all sugar or milk products, drinking green shakes. Have you made any of these changes in order to reduce the side effects of the conventional oncology treatment? Each of these questions can and should stimulate further discussion with the patient, during which the integrative physician can identify those herbal products which are being used or being considered for use. At the same time, the goals of, and expectations from the integrative therapeutic process can be addressed. [MUSIC]
