September 27, 2023
Dr. med. Susanne Weber
Category 3: Sports & nutrition in cancer therapy
Who`s afraid of miles?
Cancer therapy, Yes – A reason to be afraid of miles, NO
It is well known, that exercise is effective in reducing a wide range of side effects of oncologic therapy and is also effective in primary and secondary prevention of different kinds of cancer.
For breast cancer this has been shown by a great number of studies and this is particularly true with hormone receptor positive disease (ER/PR).
Integrative oncology could and should not only have an integrative approach to research on diagnosis and developing new treatment options, but as well integrate knowledge and experience from exercise medicine and sports.
To underline this approach I would like to present the case study of an athlete, continuing with cycling throughout post-surgical interval and radiotherapy reaching a total of 1689 km (= 1049 miles) and in spite of the situation showing improvement of her aerobic capacity.
With the immense diagnostic improvement the numbers of patients with early detected of breast cancer is rising. In the same way we see more young females being diagnosed with invasive and non-invasive breast cancer including well trained females. This seems to happen despite the over all protective effect of exercise on the development of breast cancer. Because of excellent therapy strategies we also see more physically fit cancer-survivors.
The aim of this presentation is:
• Open everyone’s eyes to the positive effects of continuing with exercise
• Reduce fear of even high volumes of exercise
• Encourage Colleagues to recommend athletes to continue with training respecting the “safe zones” of their individual present athletic capacity
• Inspire Colleagues to suggest patients which are physically fit, sportive and motivated to plan an individually adapted training throughout their phases of Cancer therapy
• Explain, why this could and should be integrated into therapeutic concepts
Abstract submitted by:
Dr. med. Susanne Weber
• Fachärztin für Frauenheilkunde und Geburtshilfe Sportmedizin, Notfallmedizin, Tauchmedizin
• Individuelle Betreuung und Beratung von Kaderathletinnen, Leistungs- und Freizeitsportlerinnen aller Leistungslevel, Gynäkologische Sprechstunde
tel: 06221 4309507 (AB)
Dr. med. Andre Rotmann
Vitamin D deficiency and cancer Fact or fiction?
It is undisputed that vitamin D is one of the central hormones of our body.
Likewise, vitamin D is needed to provide minerals like calcium for your metabolism making it indispensable for bone health.
Numerous studies show that vitamin D deficiency is responsible for an increased risk of developing common diseases such as diabetes, cardiovascular diseases, or even depression.
In addition, a link with the immune system and the development of cancer is postulated.
A current PUBMED search using the terms “vitamin D” and “cancer” resulted in more than 10,000 hits!
The complementary and integrative oncologists are also increasingly concerned with the possible consequences of vitamin D deficiency and, accordingly, with substitution.
Edy Virgili, MS
Effects of diet on the breast cancer patients quality of life
During the diagnostic-therapeutic process and on health care expenditures
From January 2021 to April 2022, were enrolled 102 women aged between 33 and 83, with different types of breast cancer, different staging and different antineoplastic therapy.
All were administered the validated Mini Nutritional Assessment (MNA®) questionnaire. The results obtained from the MNA® questionnaire show a general condition of malnutrition.
The patients underwent nutritional screening through anthropometric (weight and height) and bio-impedance (BIA Akern) measurements.
About all the patients were recorded data relating to the staging of the tumour, the type of therapy and some blood chemistry parameters (blood count with leukocyte formula, lipid profile and liver enzymes).
All these patients were administered a personalized diet at time 0 and were checked again after about 30-60 days (time 1), monitoring all the parameters previously listed.
In relation to the statistical processing we have no significant improvement data on BMI, the absolute count of erythrocytes, leukocytes and platelets. Instead, for all the other parameters, the diet brings noteworthy benefits:
– Improvement of nutritional and metabolic status
-Improvement of haemoglobin, leukocytes, neutrophils, NLR-PLR ratios
-Reduction of chronic inflammation and oxidative stress
-Intestinal microbiota improvement
-Reduction of side effects of therapies
-Benefits for health professionals who will have to manage fewer side effects
-Benefits for family members
-Savings for health care
-The type of diet proposed, on the Mediterranean style, is also economical and eco-sustainable.
Dr. med. Janaína Koenen
Cancer from a metabolic and lifestyle point of view
Looking at cancer from a metabolic and lifestyle point of view and trying to cover all the many aspects of this disease to help the mainstream treatments is complex. I work with a systemic view of cancer metabolic treatment, taking into account not only the metabolic energetic pathways but also other aspects: inhibiting metastasis during surgery, inhibiting and treating cachexia, stimulating apoptosis, modulating epigenetics, inhibiting cancer stem cells, modulating microbiome, stopping tumoral cell replication, modulating redox balance, improving immune response against the tumor, modulating tumor microenvironment, inhibiting epithelial-mesenchymal transition and metastasis, hormonal blocking in hormone-depending tumors, partially blocking tumor energy pathways, inhibiting signaling pathways, reversing chemoresistance and increasing radio-sensitivity. Also, it is paramount to improve quality of life, like treating pain, improving cognition and nausea. Diet prescription can change during treatment, to accomplish certain goals. Different diets, fasting and fast mimicking diet are applied. Each of the aspects above has ramifications (pathways, enzymes, transporters), and supplements and off label drugs that modulate them. I cross referenced all supplements and off label drugs in a dynamic table, studying each one and looking for promiscuous ones, meaning supplements that blocked different pathways at the same time and trying to get to a set of drugs/supplements that could be a basic protocol for all tumors, with some adaptations that would be added to different tumors, depending on specific metabolic phenotypes. I also study the drug-supplement interactions in every patient regarding chemo and immunotherapy, to make and individualized and safe prescription. After having this selection, to make it feasible, I chose supplements with human studies, or at least animal in vivo studies with safety demonstrated. I also considered bioavailability of drugs and developed together with a compound pharmacy and Dr Ahmed Elsakka solutions like transdermal creams with nanotechnology and liposomal drugs which I customize for every patient. Following the press-pulse theory, we also perform pulse therapies, like intravenous drugs, ozone therapies and sonodynamic and photodynamic therapies. I would like to bring a poster with a mind map of my metabolic protocol and to an oral presentation 2 or 3 cases in which I applied this protocol.
Dr. med. Rajesh Kumar Reddy Adapala
Prevention and Management of post-operative pain following Robotic oncological surgery
Robotic technology enables surgeons with three-dimensional vision, endowrist technology,
tremor filtering, and motion scaling, thereby improving the accuracy of complex oncological surgeries. Reduced incision size, precision in dissection and less tissue handling during robotic surgery lead to less post-operative pain. This translates into early recovery and shorter hospital stay and less cost. However, no procedure is pain free and Robot oncological surgery is not an exception. The pain in Robotic surgery is multifactorial including pain due to peritoneal distention following insufflation, visceral pain and shoulder tip pain following residual gas in the peritoneum and port site pain. There are specific challenges in prevention as well as management of post-operative pain. This presentation overviews the impact of the robotic technology on post-operative pain, intra-operative strategies to minimise post-operative pain and rational use of analgesics.
Robotic surgery, Pneumoperitoneum, Post-operative pain, Analgesics
Dr Rajesh Kumar Reddy Adapala
Consultant Uro-oncologist and Robotic surgeon
Dept of Uro-oncology and Robotic surgery
Asian Institute of Nephrology and Urology
Banjara hills, Hyderabad, Telangana, India
Dr. rer. nat. Trudi Schaper
A new approach to prevent chemotherapy- induced peripheral neuropathy (CIPN): HILOTHERAPY®
In the last decades, the prognosis for cancer patients of any entity has improved massively. New targeted therapy strategies, e.g. antibody therapy and immunologically based therapy significantly improve the therapeutic success for cancer patients. However, chemotherapy continues to be an important therapeutic regimen in the fight against cancer and is probably the most feared therapy for many patients. The fear for possible side effects is great. One of the most feared long-term complications is the chemotherapy-induced peripheral neuropathy (CIPN).
CIPN is an adverse effect of many commonly used chemotherapeutic agents such as taxanes, cisplatin, oxaliplatin, vincristine, vinblastine, vinorelbine, 5-fluoropyrimides and capecitabine. CIPN in breast cancer is often caused by taxane-based regimens (Paclitaxel, nab-Paclitaxel, Docetaxel). Seidman et al. (JCO 2008), reported incidence rates of CIPN grade 2-3 of 33% after three-week taxol administration and 51% grade 2-3 toxicities after weekly administration of paclitaxel. The peripheral neuropathy (PN) induced by taxanes may persist for several years and is negatively accociated with quality of life (Blackley et al, 2019). CIPN often results in prolonging the time schedule of chemotherapy, dose reduction or treatment discontinuation.
Data from 189 breast cancer patients using a new controlled cooling technique, Hilotherapy®, (processor-controlled device Hilotherm Chemo CareCIPN equipped with hand /foot cuffs) were collected.
Continous cooling of extremities was performed 30 minutes before starting until 30 minutes after completing drug infusion. CIPN symptoms were evaluated after each cytotoxic cycle using common terminology criteria for adverse events (CTCAE). 151 patients used the prophylactic Hilotherapy® for each cytotoxic treatment (Group: prophylactic Hilotherapy® – pHT). 42 patients were in the observation group without cooling.
Out of 151 patients who used pHT, 141 patients (93%) developed no or mild symptoms of CIPN (grade 0-1). 9 patients (6 %) reported grade 2, 1 patient grade 3 (0,8%) toxicity. 4 weeks after last chemotherapy, no patient suffered grade 3 CIPN; grade 2 toxicities have been reduced to 7 patients (6% to 4,7%). 69% (n=103) described no symptoms (grade 0), 26,4% ( n=39) mild symptoms of CIPN (grade 1). 4 – 10 months after chemotherapy 98% of patients had no CIPN >grade 1. To evaluate the sustainability of the results follow up data are currently collected.In the observation group, 90% of the patients developed CIPN symptoms grade 1-3. 45% had grade 3 /2 CIPN. Using Hilotherapy® for all remaining chemotherapy treatments, progression of CIPN was stopped and reduction of toxicities was seen.
The controlled cooling technique Hilotherapy® is an effective approach to avoid CIPN and is a significant contribution to maintaining the quality of life for long term cancer survivors.
PD. Dr. med. Ralf Mücke
Integrative management of side effects resulting from oncological therapies in a network
Increasingly, patients with cancer are asking for additional, complementary therapy options to treat the side effects of oncological therapy. The members of the Nahe Breast and Bowel Center at the Sankt Marienwörth Hospital Bad Kreuznach have therefore decided to define the contents of such a consultation for patients prior to treatment.
In 2018, a team of internal oncologists, gynecologic oncologists, radiation oncologists, nutritionists, psychooncologists, and study nurses met several times to define the contents of the counseling. An intensive literature review was conducted to inform the team. At the beginning of 2019, the participants of the content-related consultation meetings decided to establish the Complementary Oncology Network Rheinhessen-Nahe.
Consultation content on complementary treatment options for the most common side effects of oncological therapies was established. The consultations were formulated as frontal lectures, which are held at regular intervals for patients and relatives. These lectures are highly appreciated by patients. The main complementary therapeutic approaches presented in our lectures are based on data from randomized trials, meta-analyses, clinical trials, and reviews. In addition, the lectures include recommendations from nutritional counseling based on years of experience managing tumor patients. These recommendations contain specific advice, including appropriate counseling for patients with specific symptoms such as mucositis, xerostomia, mucus, loss of appetite, and nausea. Information flyers for the individual side effects have also been developed for the patients and are available in the hospital and in the practices.
The common approach in a network is very positively received by patients. This counseling content improves patients’ understanding of both beneficial and harmful complementary measures that they should not use.
Treatment of cancer-related fatigue with mistletoe extracts: A systematic review and meta-analysis
Introduction: Cancer-related fatigue is one of the most common and distressing symptoms in cancer patients . Several clinical trials have reported beneficial effects of subcutaneously-injected aqueous extracts of European mistletoe (Viscum album L.) on cancer-related fatigue .
Aim: To determine the effect size of mistletoe extracts in the treatment of cancer-related fatigue in a meta-analysis.
Methods: Randomised controlled trials (RCTs) and non-randomised studies of intervention (NRSIs) with cancer patients were included in which the effect of treatment with mistletoe extracts on a fatigue scale was compared with a control group. The literature search was performed in Medline, Embase and the Cochrane Library databases. Risk of bias was evaluated using the Cochrane Risk of Bias tools for RCTs and NRSIs.
Results: The first meta-analysis included 12 RCTs with 1494 participants, the second included seven retrospective NRSIs with 2668 participants. Most studies had a high risk of bias. Two RCTs were placebo-controlled and 10 were open-label. In 17 studies, treatment with mistletoe extracts took place in parallel with antitumour therapy. A random effects model yielded a standardised mean difference of -0.48 (95 % confidence interval -0.82 to -0.14; p=0.006) for the RCTs and an odds ratio of 0.36 (95 % confidence interval 0.20 to 0.66; p=0.0008) for the NRSIs.
Discussion: Treatment with mistletoe extracts has a medium-sized effect on cancer-related fatigue, of similar magnitude to physical activity . These results need to be confirmed by further placebo-controlled trials. Future studies should investigate the effect of mistletoe extracts on fatigue in cancer survivors after completion of their antitumour therapy.
1. Fabi A et al. Ann Oncol 2020; 31(6): 713-723
2. Loef M et al. BMC Complement Med Ther 2020; 20(1)
3. Mustian K et al. JAMA Oncol 2017; 3(7): 961-968