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In this insightful podcast, Dr. Jen Green, a naturopathic doctor specializing in oncology, provides a wealth of information about integrative oncology and how it can complement conventional cancer care. Here are 5 key questions she addressed.
Explore several highlights from this podcast conversation:
How would you define integrative oncology and the terms used to describe types of therapies (complementary, integrative, alternative)?
Integrative oncology in a nutshell is the best of both worlds. It’s about safely and effectively integrating natural medicine or holistic medicine into cancer care. Over my career, when we started, most people would view naturopathic doctors as practicing alternative medicine. That quickly became extremely problematic because alternative implied that you weren’t engaging in conventional care.
The language shifted to CAM, which is complementary and alternative medicine. That was nice because it was more inclusive with the idea that you were complementing conventional options or doing something that was completely separate from it. Then we realized we need the term integrative so that we could not only be safely providing complements or adjuncts to cancer care, but that we need to go a step further and actually integrate into the research world, into hospital systems.
We don’t want to be in separate silos. We want a truly holistic view, not only of the patient going through the cancer journey, but we want a holistic view also of the field so that we’re zooming out and influencing the practice of medicine more broadly.
How do lifestyle practices (like the 7 Lifestyle Practices) fit into cancer care?
I just love the 7 Lifestyle Practices › so much for the precise reason that they clearly are describing the foundations of health. Naturopathic medicine has six principles and is invested in supporting the foundations of health: sleep, movement, exercise, healthy relationships, decreasing stress, and avoiding toxins.
These often get overlooked in medicine because it takes time to discuss with people. But they’re very, very important and very empowering for people because they’re things that they can do on their own. And that’s what I love so much about the 7 Lifestyle Practices and about CancerChoices generally is just that it’s empowering people with information in order to build their health.
We’ve been trained in some ways to be passive recipients of healthcare. And we also, even in the integrative medicine world, can have a little bit of the illusion that we can buy health with supplements, right? As opposed to building health with our relationships, with our daily movement practices, with what we choose to eat and how we choose to learn to be in the world in response to stressful situations. Regardless of whether it’s cancer care or cardiology or primary care, sleep, exercise, nutrition, and healthy relationships and stress management, those are foundations of health
How does the training and scope of practice for naturopathic doctors differ from MDs?
Naturopathic medicine is a distinct form of primary care originally. In order to become a naturopathic physician or a naturopathic doctor, you need to have finished your pre-medical studies and then complete four years full-time of naturopathic medical school. The first two years of curriculum are almost identical to MD or DO schools. But in addition, the scope is larger for naturopathic medicine when it comes to natural therapies.
We’re trained in nutrition, herbal medicine or botanical medicine, homeopathy, mind-body medicine and lifestyle counseling. We spend less time studying pharmaceuticals. The lens to which we’re studying pharmaceuticals is just focused on avoiding herb-drug interactions, which in the field of oncology is extremely important.
We’re currently designated federally as primary care physicians. But the scope really varies from state to state because there’s this strange situation where some states are licensed, some aren’t. So I can write for a script for an opiate in New Hampshire, but here in Michigan where there’s no licensing, I can’t write any scripts unless I’m using a supervising physician’s license.
How can naturopathic doctors collaborate with conventional oncologists to provide comprehensive care?
Our goal is to work together as part of the team. It’s much easier when you’re working in a cancer center. You’ve got tumor boards to go to, you’re talking in the halls. You’re able to provide a more integrated level of care that I think is actually the ideal. Now we actually have a fair number of hospital systems in the US with a naturopathic doctor on staff.
When you’re in private practice, then you’re building a network for the patient. In an ideal world, you want to have an integrative oncology provider who’s able to communicate with the conventional care team, whether that’s sending notes, faxing them to the doctor’s office or giving you an extra copy of the recommendations to give to your oncologist so that you’re not having to hide what you’re doing.
What types of research and evidence support the use of complementary therapies (for example botanicals) in cancer care?
In the field of medicine and research, the most important and valid research, the most trustworthy research is ones that are done in humans. Lots of herbs are incredibly anti-cancer when you put them next to a cancer cell in a petri dish, but when you translate that into a human study, most of the time it doesn’t translate.
Even though we don’t have large clinical trials for many complementary therapies, the way you do with pharmaceuticals or chemotherapy, the quality of the trials in terms of making them randomized and controlled has improved. We have a lot more randomized control trials on natural agents in cancer care than we ever used to see. And even if they’re small, maybe they’re only 50 or 60 people, it’s a well-constructed study and it’s a natural agent that by and large doesn’t have side effects.
Donald Abrams MD makes an argument that the level of evidence should match the level of risk ›. If you’re talking about the Mediterranean diet › or about mindfulness, do we really need to have a 500 person randomized control trial to show a benefit or is it enough to have a smaller trial or an observational study perhaps showing that it’s beneficial, because what’s your risk of harm with these interventions? Our level of evidence should match the risk involved with the therapy. Now, because there’s drug interactions, you do want to show safety of an herb with, let’s say, a chemo agent, because you’re relying on that chemo agent to do its job.
And that’s what’s so lovely about a lot of what’s represented in CancerChoices, whether it’s a mind body intervention or the Mediterranean diet or a vitamin D supplement ›, CancerChoices shares the research and safety, and even when there are secondary benefits, for cardiovascular health or for bone health or cognitive health.
Dr. Jen Green’s Bio
Jen Green is a Naturopathic Doctor (ND) who is board-certified in naturopathic oncology. She founded the Naturopathic Department at Beaumont Hospitals in 2008 and served as the department head for five years. Since then, she has been a Research Director for KNOWoncology.org, the Knowledge in Integrative Oncology Website. She provides consultations for integrative cancer care and mental wellness at Emcura Integrative Clinic in Bloomfield Twp, Michigan. Jen firmly believes that human health and the health of our planet are one.
Resources mentioned in this podcast
Explore the research for therapies mentioned in the podcast
Christine has a dynamic background in the life sciences, public health, and program operations. Her career began at the lab bench with a Gates Foundation-funded HIV Vaccine research group, which led her to graduate studies in public health epidemiology at UC Berkeley. Her research experience spans clinical epidemiology research to evaluating the impacts of community nutrition programs in Los Angeles, the Central Valley, and Oakland. Most recently she has worked in executive operations for a seed-stage venture capital firm based in San Francisco. Personally, Christine is passionate about holistic health and wellness. She is a clinical herbalist and Reiki master, and she has been practicing yoga for 15+ years. She brings a breadth of experiences to her work leading the CancerChoices program.
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