Abstract
It is a pleasure to see, in this September issue of Integrative Cancer Therapies, how far the international research community has come in producing clinically relevant research for cancer patients. A growing number of studies are appearing here and in other journals that provide real guidance on questions that patients, their caregivers, and their health professionals face every day. We hope to see this trend continue and accelerate.
The issue begins with a clinical study on exercise in prostate cancer. Eva Zopf of the German Sport University Cologne and colleagues conducted the ProRehab Study as an evaluation of an exercise program offered in rehabilitative sports groups organized for prostate cancer patients in Germany. Germany has had rehabilitative exercise programs for cancer patients for 30 years; they are incorporated into the social security statutes of the country and are covered by health insurance. The effort to evaluate the benefits of this program is unusual for the long duration of the intervention—15 months—and deserves attention as an investigation of what an existing community-based exercise program is able to accomplish.
Previous clinical studies have indicated a role for American ginseng in ameliorating cancer-related fatigue. 1 American ginseng, Panax quinquefolius, is 1 of 2 well-known ginseng species. The other, Asian ginseng or Panax ginseng, has a much longer history of use for fatigue, having been used for this purpose as well as for convalescence and a large variety of other conditions for centuries. Sriram Yennurajalingam and colleagues at MD Anderson Cancer Center have conducted a preliminary evaluation of the use of high-dose Panax ginseng in fatigued cancer patients, which appears as the second article in this issue. The systematic investigation of herbal therapies with long-established safety and traditional uses that may have application in cancer is something that we applaud and are pleased to support.
Garlic is another herbal therapy with long-established traditional uses. One such traditional use is in prevention of infections. Moshe Gatt and colleagues at Hadassah Medical Center in Jerusalem explore the use of garlic as a preventive measure for febrile neutropenia in patients with hematologic malignancies receiving chemotherapy treatment. Since these patients experience febrile neutropenia at high rates (63% of placebo patients in this study), they are a population in need of safe and effective measures to control this dangerous side effect of chemotherapy. Garlic preparations would have an additional bonus of being lower in cost than most conventional drugs, which is a significant consideration in view of the increasing rates of cancer globally, including in low-income countries.
Research is clarifying the benefits of exercise for cancer patients, as we noted above. But the question also arises of whether exercise is beneficial for all cancer patients at all times. After exercise, natural killer cells typically increase markedly, one of the possible benefits of exercise. However, this increase is also followed by a decrease, with a recovery occurring over the day following exercise. We know, though, that chemotherapy and other cancer treatments can result in a long-lasting lymphopenia. Does this long-term side effect interfere with the surge in natural killer cell numbers following exercise? Is recovery after exercise impeded in posttreatment cancer patients? Elizabeth Evans of Elon University and colleagues at the University of North Carolina test whether this is the case in a study comparing posttreatment breast cancer patients with healthy control patients.
Lung cancer patients face many physical and emotional challenges in addition to their oncological challenges—and so do their family caregivers. Increasing attention is being paid to the use of exercise and supportive care for these patients. Katrin Milbury of MD Anderson Cancer Center and colleagues present a pilot study on Vivekananda Yoga for lung cancer patients and their caregivers. Vivekananda Yoga involves more physical activity than some forms of yoga, and is adaptable for couples, incorporating partner postures and guided visualizations involving the partner. To make participation easier for the patients, yoga classes were timed around radiation therapy visits. Finding ways to increase well-being of both patients and caregivers is an important contribution for families facing the difficulties of the lung cancer experience.
Another pilot study in this issue addresses the problem of sleep disturbance in cancer patients. Ana Simões-Wüst at Clinic Arlesheim in Switzerland and colleagues have performed an observational study to establish the potential of Bryophyllum pinnatum as a sleep aid for cancer patients. This plant is used as a sedative in the tropical countries where it grows and has been used in European anthroposophic medicine since the 1920s, often as a sleep aid. Laboratory studies indicate both sedative properties and inhibitory effects on cancer cells in vitro, making it a particularly interesting herbal therapy candidate for cancer patients.
Jennifer White of the Hunter Research Institute in New South Wales, Australia, along with an international team of collaborators, has been studying the use of animal-assisted therapy for breast cancer patients referred to counseling with a clinical social worker. Animal-assisted therapy, also known as pet therapy, uses the presence of therapy animals, usually dogs, as a means to complement the therapeutic process by facilitating trust between client and counselor. White and colleagues conducted a qualitative study to explore the emotional experiences of breast cancer patients as they interacted with a therapy dog during counseling sessions. Interestingly, another study on animal-assisted therapy for head-and-neck cancer patients undergoing complex chemo-radiotherapy treatment was published early this year, and documented increased patient satisfaction and well-being from interacting with therapy dogs. 2
The immune system is currently the focus of much research, creating substantial excitement in the major cancer conferences this year. Susan Fiorentino of Pontificia Universidad Javeriana in Bogota and colleagues explore whether the use of an herbal extract known to cause apoptosis in cancer cell lines and control tumors in animal models might also exert an immunological effect. Caesalpinia spinosa is a plant native to northern South America, though naturalized in many tropical areas, and is a well-known source of tannins for commercial use, especially tannins based on gallic acid. It is the gallo-tannin fraction of Caesalpinia spinosa pods that Fiorentino and colleagues use in their work.
Oral cancer is the fourth most prevalent cancer in Taiwan, and is known to be increasing among adult males in that country, especially among young and middle-aged men. It is also an important cause of cancer death. It is prone to cervical lymph node metastases. A team from Taiwan, led by Alan Lee of the National Health Research Institutes, has thus examined the versatile phytochemical curcumin for its antimetastatic properties. Both its effects on the matrix metalloproteinases and its ability to regulate markers of the epithelial–mesenchymal transition are investigated. The potential topical use of curcumin in oral cancers is an intriguing possibility, especially since the limited bioavailability of orally administered curcumin would presumably not be a problem with topical application within the mouth.