In my 24 years of practicing oncology, most of it in Southern California, I have had the pleasure of being exposed to Complementary and Alternative Medicine (CAM). While not all board certified veterinarians are open to the idea of combining Eastern and Western medicine, I believe this sentiment is changing. A high percentage of the pet owning public, at least here in California, is interested in ensuring the best medical care for their pets by exploring a combination of approaches. This puts the onus on all veterinarians to be open minded and willing to explore new methodologies to maintain wellness and treat illness.
The top human cancer centers in this country have long recognized the advantages of using an integrative approach to oncologic care. Memorial Sloan Kettering, MD Anderson, Mayo Clinic…the list goes on. These are trusted resources for cancer treatment, cutting edge research and clinical trials. Therefore, the model for a collaboration of veterinary oncologists and holistic practitioners already exists; we do not have to re-create the wheel. Yet we must improve our relationships with each other in order to effectively implement this combined approach to care.
I have been working with CAM specialists for most of my career. Veterinary Cancer Group, which I founded 20 years ago, has two comprehensive cancer centers and three satellite clinics. Both our comprehensive centers have holistic practitioners on staff one day a week. We also work with quite a few established complementary small animal practices in our area. This has been mutually advantageous to all involved, though in my mind, the real winner is the patient who gets to benefit from the combined approach.
Lack of studies causing resistance
Some pushback likely stems from the paucity of evidence-based scientific studies. Both CAM veterinarians and those who practice Western medicine all started their careers with the same training. And we all have the same goals: to provide the best possible quality of life for our patients. There will always be room for using time-honored techniques we learned in the trenches or were taught to us by our mentors or during “back hall consults”. These tried and true methodologies work for us, making it less important whether or not there is a strong basis for this approach in the literature. But when faced with a treatment that is foreign to us, based on our education and training, it is much easier to accept it if there is convincing scientific evidence to support its use.
Some of the challenges we face include how to bring together Eastern and Western medicine. For example, evidence on the human side indicates that high doses of antioxidants may interfere with the mechanisms of action of radiation and chemotherapy (JNCI, 2008). This not only applies to the combination of supplements and traditional cancer treatments; for instance, we cannot use metronidazole in patients undergoing radiation therapy because this drug acts as a radiosensitizer, significantly increasing the side effects associated with radiation. Therefore, it is imperative we develop knowledge based on sound scientific principles to ensure we are doing the best for our patients, and not using treatments that counteract each other.
Here’s another example. Green tea extract (GTE) has been shown to mitigate the side effects of some chemotherapy drugs in people. Yet in a recent study in tumor-bearing mice, it negated the tumor-killing effects of the drug Velcade, used for patients with multiple myeloma. The GTE binds to the Velcade, preventing the drug from exerting its effect on its intracellular target. In other instances, GTE enhanced the tumor cell kill when combined with certain chemotherapeutics in preclinical and mouse models. Unfortunately, this means we need to be extremely cautious when we consider combining these types of treatments until well designed clinical trials can be carried out.
Clinical research – what’s being done?
The Mayo Clinic has been conducting clinical research using CAM therapies for the last 30 years. A total of 27 clinical trials have been carried out, 21 of which are published or currently in press. Many have looked at alleviating symptoms caused by cancer or conventional treatment (i.e., radiation or chemotherapy induced mucositis, incidences of hot flashes due to menopause, improved cognitive function post curative intent chemotherapy for breast cancer patients, etc.).
The experience at the Mayo Clinic shows that veterinary medicine can also conduct meaningful trials to help advance our knowledge and, ultimately, the care we are able to provide our four-legged patients.
In fact, Veterinary Cancer Group is in the process of designing a clinical trial evaluating the incidence of diarrhea in patients undergoing pelvic irradiation using a proprietary homeopathic to treat the diarrhea, since we know we cannot use metronidazole. Additional studies beg to be developed by the oncologic specialist working with the CAM specialist.
We participate in many clinical trials, most of which have full or partial funding. These have primarily been with pharmaceutical companies who are interested in evaluating a new therapy in animals in hopes of eventually being able to market the same drug to human cancer patients. We have also participated in a number of trials aimed at the development of drugs specifically for animals (e.g., Palladia). There are many supplements and nutraceuticals manufactured specifically for animals. It behooves these companies to financially back randomized, double blinded, placebo controlled studies of their products. This would especially be beneficial in combination with conventional cancer therapies.
If you are already working with an oncologist, great! If not, based on my personal experience, the bonds you develop with him/her (and s/he with you), will benefit everyone. Our patients deserve the best care we can provide. I am excited about the future of combining conventional and complementary veterinary medicine, as I truly believe we can achieve our goals by doing so. Please join me in forging improved relationships between oncologists and CAM specialists. Brainstorm ideas and challenge the manufacturers to support clinical trials. Our patients and the families who love them are counting on us!
Lymphoma in the dog is a very chemotherapeutically responsive neoplasm. Yet despite numerous studies evaluating the use of different chemotherapeutics in different combinations over different lengths of time, the survival times for this cancer have not significantly improved in 30 years. Perhaps we could improve upon these statistics if we were able to utilize higher drug doses. But if we were to employ higher doses, our incidence of side effects would increase dramatically. As a board certified oncologist, I am not willing to subject my patients to intolerable adverse events. The goal has to be quality of life, and none of us is willing to have the treatment become worse than the disease. But what if we were able to increase drug dosages without increasing side effects? Perhaps this could be achieved by the combined use of complementary therapies. Therefore, it is imperative we develop knowledge based on sound scientific principles to ensure we are doing the best for our patients, and not using treatments that counteract each other.
Mona Rosenberg, DVM, DACVIM, (Oncology) is the owner, CEO and Chief of Staff of Veterinary Cancer Group. She brings a wealth of expertise and experience to the practice. After receiving her DVM degree from the University of California, Dr. Rosenberg completed her internship and residency at the Animal Medical Center in New York. A diplomate of ACVIM in oncology since 1992, she is also an active member of Veterinary Cancer Society and SCVMA. As the head of the oncology residency program at Veterinary Cancer Group, Dr. Rosenberg plays a hands-on role in preparing the next generation of veterinary oncologists.