Breast cancer and Integrative Medicine in the UK: Top 6 complementary therapies available on the NHS - by Sara Davenport

This week’s blog post has been written by Sara Davenport, founder of Breast Cancer Haven and holistic health blogger of ReBoot Health. Sara shares 6 top complementary therapies available on the NHS for people with breast cancer…

Twenty years ago, I set up what is now one of the UK’s leading breast cancer charities, Breast Cancer Haven. Today it has six centres across the country - in London, Leeds, Hereford, Hampshire, Solihull and Worcester. It offers support - counselling, nutrition, information and complementary therapies - to anyone affected by breast cancer, free of charge.

The Haven epitomises the successful working of integrative medicine - a partnership of complementary therapies and conventional approaches working hand in hand. In its early days, whilst hospital treatment focused on surgery, chemo and radiotherapy, The Haven had one of the widest ranges of therapies on offer under one roof anywhere in the world. Today, things have moved on and across the UK hospital oncology units and CAM (complementary and alternative medicine) are working together to benefit patients with all types of cancer.

In the topsy-turvey frightening months that follow a breast cancer diagnosis, complementary therapies have been shown, in research studies and in practise, time and time again, to make a quantifiable difference to the side effects of conventional medical treatment and to the quality of life of the people who used them alongside those treatments. The Haven Programme has repeatedly been described as ‘life-changing’ by the tens of thousands of people who have benefited from the charity’s work. Without it, people felt their recovery would have been infinitely harder.

I am a fervent believer in the power of combining both approaches following any diagnosis of breast cancer. The hospitals and oncologists have a range of medical approaches on offer - drugs, surgery, radiotherapy and chemotherapy to address the cancer - but there is a world of gentler, kinder yet still effective options that can also play a part in your healing and make a substantial difference to your recovery.

Complementary therapy can support you physically, mentally and emotionally during what is often a difficult journey. The importance of feeling you are playing a part in your own recovery cannot be understated, replacing the debilitating feeling of powerlessness that is often reported when you hand over all control to the hospital.

Many breast cancer units now offer some or all of the following therapies as part of their protocol:

Counselling

Releasing emotional stress is an important part of your healing and one that people often under-rate. You may be offered a series of sessions with your hospitals counsellor or psychotherapist and I would encourage you to take up the offer. I have so often heard people say that they don’t feel ‘counselling’ is for them, but the breast cancer path can often be a lonely one.

Your family and those closest to you are often in shock themselves, perhaps feeling powerless about what to do and what to say to best support you. They want you to be ‘OK’ as you go through treatment, when ‘OK’ is the last thing in the world you may be feeling. You may as a result, not feel you can show your true feelings, that you have to pretend to be fine to re-assure them, when inside the fear and the grief are often overwhelming and you are anything but.

Having someone to talk to who understands what you are going through and with whom you can safely and fully express your feelings can be life-changing - and, vitally, help you to feel less alone. Breast cancer brings many difficulties with it and can strike cruelly and directly at the heart of your femininity - the removal of a breast, the resulting scarring, the loss of your hair and the effects of the drugs on your libido are hard to deal with whatever the circumstances, but even harder alone.

Nutrition

Make cleaning up your diet a priority as you go through treatment. Many hospitals offer consultations where a trained nutritionist will go through your eating habits with you, recommending changes alongside a programme of specific supplements to take that will help your body to stay strong and boost your immune system to work more effectively.

Immunotherapy

The latest cutting-edge cancer treatment – works with the immune system to boost its abilities to destroy your cancer cells. Cutting out certain foods, and replacing them with others has also been shown to minimise the unwelcome side effects of many of the prescribed drugs, reducing hot flushes, muscle and bone aches and rashes.

Acupuncture 

Has been shown to help breast cancer patients with the side effects of chemo, radio, surgery, hormonal drug treatments, reducing hot flushes, night sweats rashes and the intensity of muscle and bone aches.  It helps with tiredness, vomiting and feelings of nausea. You may be offered one to one acupuncture sessions, or ear acupuncture in a group.

Reflexology

Reflexology is based on the idea that stimulating specific points on your feet can improve the functioning of corresponding organs, glands, and other body parts. A recent study has found that reflexology helped ease some side effects from chemotherapy and hormonal therapy treatments in women being treated for metastatic breast cancer. In particular it eased shortness of breath which is sometimes a side effect of the treatment for breast cancer.

Massage

Aromatherapy massage, using specially chosen essential oils, combines the healing power of touch with specially chosen scented essential oils that have been shown to trigger deep emotional release, and change and boost your moods. If you are currently having chemotherapy, however, you may become highly sensitive to scents and smells so if possible delay any appointments until after your treatment has finished.

Hospitals also offer sessions with specialist oncology massage therapists, who are highly experienced and understand exactly what is needed after surgery and cancer treatment. If you have had lymph nodes removed there is a risk of developing lymphoedema, so look for a therapist who understands the lymphatic system and knows how to drain excess fluid away from the affected arm and breast area. 

You can follow Sara's fantastic blog, ReBoot Health, here.

The Gut Microbiome, Cancer And Immunotherapy - by Dr Lauren MacDonald

This week we have another insightful piece from Lauren, a 29 year old junior doctor when she was diagnosed with stage IV cancer, who is now celebrating one year NED. Here she discusses her obsession with gut health and why it is so important...

I thought I’d write another post on my favourite subject, “Gut Health”, but this time I’ve gone into the science behind why I’ve been banging on about the importance of looking after your gut microbiome for the past few years. I hope it’s helpful for anyone not yet up-to-speed on this fascinating area of research. 

Over the past few months several human studies have supported the idea that our intestinal bacteria (the gut microbiome) plays a significant role in determining whether cancer patients respond to certain treatments. In the latest research study, Dr. Wargo (a doctor and research scientist in the USA), revealed that the composition of a patient’s gut can significantly influence whether someone responds to the type of cancer immunotherapy I’ve been receiving for the past 22 months (pembrolizumab, an anti-PD1). Interestingly, what seemed to matter most in the studies wasn’t the level of a specific gut microbe, but rather the overall diversity of the gut microbiome. Let’s take a look at the evidence so far…

Where My Obsession With My Gut Health Began

Prior to 2015 I’d never considered the state of my gut microbiome. I hadn’t tried kefir, I didn’t take a regular probiotic and I’d never experienced the joys of eating Jerusalem artichokes (you’ll know what I mean if you’ve tried them!). Then in October 2015 I was diagnosed with stage IV melanoma, a cancer which is notoriously chemotherapy and radiotherapy resistant, and which previously had a 5-year survival rate of around 15%. Fortunately, a new immunotherapy drug was approved by the NHS at the beginning of 2016, just six weeks after I’d received the stage IV diagnosis. Although this was incredible news – and the idea of a “game-changing cancer drug” made for sensational headlines – it transpired that only a small group of patients had responded to the treatment during the clinical trials. The drug I was about to start had a response rate of around 30-40% (meaning patients had their tumours stabilise or shrink) with only 15% having a complete response (achieving no evidence of disease). I was determined to find myself in the latter group so I began researching how I could swing the odds in my favour.

My research began by examining the gut-brain axis, specifically the gut microbiome and its impact on health. I then looked at the way in which stress and anxiety could be impacting on my immune system. This lead me to further explore the growing field of psychoneuroimmunology and the research highlighting the value of mind-body therapies. It soon became apparent that there was a huge area of medicine that had been largely ignored during my medical degree. I felt relatively knowledgeable about “the mind” due to my Psychology degree and “the body” due to my medical degree, but there was a gap in my knowledge at the interface between the body and mind. I became fascinated by the gut-brain axis and, specifically, the impact the gut microbiome has on both mental and physical health.

Prior to becoming a stage IV patient, I’d already had four operations over the past 18 months in an attempt to “cure” me and prevent the cancer from spreading. Along with conventional surgery, I’d also addressed my diet, started juicing, added in supplements and began a regular yoga practice. But nothing seemed to be helping. The cancer kept coming back, again and again. Over Christmas 2015 I could visibly see new tumours growing above my right breast and a scan had already confirmed I had tumours in my lung and adrenal gland. Consequently I started looking for other ways in which I could support my body to either fight cancer cells directly or slow down/prevent angiogenesis (the formation of new blood vessels – which helps “feed” tumours).

The Initial Gut Microbiome And Immunotherapy Research (2015)

Shortly after I started looking at the the gut-brain axis I came across some research which had just been published by the University of Chicago (back in November 2015). They’d found that by introducing a particular strain of bacteria into the gut of mice with melanoma, they were able to boost the ability of the animal’s immune system to attack tumour cells. The combination of oral doses of “good bacteria” and infusions with anti-PD-L1 immunotherapy nearly abolished tumour growth. Around the same time another group of researchers compared the effects of bacterial transfer (via fecal transplant) against immunotherapy (anti-PD-L1). They found that introducing the bacteria was just as effective as treating mice with anti-PD-L1 alone – resulting in significantly slower tumor growth. Furthermore, combining the benefits associated with the “good bacteria” with anti-PD-L1 treatment dramatically improved tumour control.

Turning My Attention To My Gut Health Before Starting Immunotherapy

Given these two fascinating studies I decided to do everything I could to get my gut in the best possible shape before starting immunotherapy. During one of my appointments I mentioned the research to my Oncologist (and explained my intention to diversify my microbiome) but, understandably, he was hesitant to support my plan. The microbiome is, of course, inordinately complex – with trillions of bacteria working in tandem to produce multivariate responses. Although the research in the initial mouse studies had been promising, it might have been the case that altering the gut microbiome in humans would have a different outcome – an idea that has recently been supported by a study which found that certain chemotherapies used to treat colorectal cancer actually become toxic to patients in the presence of certain gut bacteria.

Despite my Oncologist’s reservations, I set about diversifying my gut bacteria in the hope that I might help to push myself into the “complete responder” group. Along with having a diverse microbiome, I knew it was also important to have the right cocktail of bacteria. I didn’t have much to go on – just those two initial mouse studies – so I purchased probiotics which contained the specific bacteria which had helped the mice to survive (Bifidobacterium – although the probiotic I took actually contained several other strains too). I also changed my diet to include as many pre- and probiotics as possible.

Key Diet Changes

I know I’ve shared lots of blog posts about this subject during the past two years, but just to remind you once again…

• The best way to keep your gut microbiome healthy is to make sure you’re getting a healthy mix of probiotics and prebiotics in your diet.
• Although taking a probiotic supplement is also helpful, there are plenty of studies that suggest oral probiotics struggle to make a huge difference to the microbiome (compared to the impact of fecal transplants).
• Simply changing our diets to include plenty of fibre, reducing refined sugars and not eating processed foods, can help improve the balance of bacteria in the gut.
• You can easily load up on probiotics by eating certain foods (e.g. sauerkraut, kefir, miso, apple cider vinegar, sourdough bread).
• Prebiotics are things like garlic, leeks, chicory root, Jerusalem artichokes, asparagus and under-ripe bananas.
• Research also suggests that omega-3 fats (found in oily fish) affect the microbiome in positive ways.
• It’s a great idea to try and fast for at least 12 hours overnight too. There’s lots of evidence to suggest this helps support a healthy gut microbiome.

The Latest Research (2017)

Dr Wargo teamed up with Gopalakrishnan and other researchers to collect faecal samples from more than 100 people with advanced melanoma before they began treatment with anti-PD-1 immunotherapy drugs. The scientists found that those who had the most diverse gut microbes were most likely to respond to the immunotherapy. The type of microbe was also linked to differences in responses to treatment. For example, people whose guts contained a lot of bacteria from a group called Clostridiales were more likely to respond to treatment. A second study showed that people who received antibiotics to treat infections shortly before or after starting immunotherapy did not respond as well to PD-1-blocking therapies. The researchers also found that the presence of the bacterium Akkermansia muciniphila was linked to better responses to immunotherapy. Responders had a far greater density of killer T cells – which are largely responsible for attacking cancer. The researchers found that the presence of the Faecalibacterium and Clostridiales bacteria seemed to account for the difference in T cell density. When these bacteria were given to cancer patients via a fecal matter transplant, they were more likely to respond to treatment and live longer without their tumour recurring or worsening.

The Microbiome: The Future Of Cancer Treatment?

I am under no illusion that the only reason I’m sitting here writing this post is because I’ve been on the receiving end of cutting-edge cancer treatment. I started immunotherapy in January 2016 and by August 2016 my scans revealed “no evidence of disease”. During the previous 10 months I’d become *OBSESSED* with looking after my gut but, of course, I have no way of knowing whether this made any difference to how I responded to immunotherapy. It might have been that I would have responded in exactly the same way, whether or not I’d changed my diet and started taking a daily probiotic supplement. Having said that, the 2015 studies and the new 2017 human studies suggest a big role for gut microbes in determining the cancer-killing potential of immunotherapies. Yet there are still plenty of questions, namely how, exactly, certain bacteria may help the immune system to fight cancer and if there are side-effects or potential dangers of manipulating the microbiomes of cancer patients. It will be fascinating to follow this research in the future. WATCH THIS SPACE!

I hope I’ve inspired you to look after your gut health – whether you are a fellow cancer patient or just someone looking to support their health and wellbeing.

Sending you lots of love and good health.

Lauren x

You can read more inspirational and informative posts on Lauren's blog, www.laurencara.com.

Please make sure you tell your own doctor before you start taking a daily probiotic – especially if you are undergoing cancer treatment.