Treating the Whole You: Q&A With Dwight McKee, MD
Dwight McKee answers questions about integrative cancer care in this Q&A. Sign up for our event Treating the Whole You: Integrative Care and Breast Cancer, to hear more from Dr. McKee.
Breast cancer and its treatments can dramatically impact your physical and emotional health. This is where integrative cancer therapies can help.
If you’re never heard of these practices, here’s an overview: Integrative cancer treatment combines conventional treatments like chemotherapy, radiation therapy and surgery with supportive therapies – including nutrition, exercise, supplements and more – to help improve your quality of life while also increasing your sense of control over your health.
In anticipation of our event, Treating the Whole You, on November 15 one of our guest panelists Dwight McKee, MD, a leader in the field of integrative oncology and co-author of After Cancer Care, spoke with LBBC’s Josh Fernandez about the biggest misconception about integrative therapies, insurance coverage, integrative practices for beginners and more.
Josh: What inspired your career in integrative medicine for people with cancer?
Dr. McKee: After standard post-graduate training, I joined the first holistic health center on the east coast in Putnam, Connecticut called Integral Health Services. I practiced there and in Boulder, Colorado as well as other places for 12 years. I explored a lot of holistic medicine and also alternative cancer therapies during that time. I then decided I wanted to become an oncologist.
I went back into training which involved a 3 year Internal Medicine residency followed by a 3-year fellowship in hematology and oncology. I finished that in 1995 and then practiced integrative oncology in a hospital-based oncology practice in San Diego, and then in Montana, putting together for the first time those two worlds that I had inhabited – integrative therapies and conventional cancer care.
I then shifted to writing and integrative cancer consultations for other doctors. The demand for integrative cancer care consultations grew so much that I couldn’t figure out how to triage it, so in 2013, I started teaching, writing, and participating in public speaking engagements. I increased my activity training other doctors in what I knew and continued studying and learning from others in the field.
Josh: What's the biggest misconception about integrative care?
Dr. McKee: I think the biggest misconception is that it’s only for the wealthy.
A lot of providers, me included, use a number of nutritional and botanical supplements as part of their program and those are not covered by insurance.
It can be expensive, because of lack of insurance coverage, but there are many things people with cancer can do to enhance their response to treatment and recovery from treatment and reduce risk of recurrence that aren’t expensive. Dr. Mehta, Dr. Lemole and I outline many of those approaches in our book After Cancer Care.
Josh: Can you tell me more about insurance coverage and integrative care? Why won’t insurance companies pay for these therapies? What will it take for policies to cover these practices?
Dr. McKee: I think what it would take are randomized controlled clinical trials that show improved outcomes. That level of evidence doesn’t exist because it requires a lot of funding to get to that point and there just haven’t been many sources of funding for large clinical trials of integrative cancer care. Even when there is funding, it can be challenging, because its difficult to study complex multi-factorial interventions. There are more studies of the ‘soft’ interventions like yoga, exercise, meditation and other stress reduction techniques.
The challenge that I have run into in doing clinical trials with botanical and nutritional supplements is related to the Institutional Review Boards (IRBs), which are required for approval of clinical trials at major centers that are capable of doing those randomized controlled clinical trials. It’s become standard to have a lot of these IRBs made up of professionals from different backgrounds and perspectives, including pharmacology. Pharmacists use large databases on drug interactions with herbs and supplements and they worry a great deal about those botanical and conventional cancer care interactions, but the vast majority of them are either theoretical (based on laboratory research, or on case reports of interactions, which are scientifically speaking, of very poor quality.
Having had a lot of clinical experience with herbs, nutrient supplements and conventional cancer therapy, I can tell you the vast majority of those theoretical interactions are not clinically relevant. Recently, there’s new life breathed into this; there are some in large academic institutions who are interested in seeing research on integrative cancer care happen. The only thing standing in the way of a pilot trial is that nothing like it has been done.
Josh: What are the two or three integrative care practices you would recommend for people who are new to this kind of cancer care?
Dr. McKee: I’d recommend exercise first. It has benefits in terms of mood and energy, and studies have shown that it’s associated with up to 50% of reduced risk of recurrence. It’s also a stress management technique by itself. It covers a lot of bases.
The paradox for cancer patients is that they are fatigued from treatment. As a result, they don’t feel like exercising. If you force yourself to do it, exercise is the only intervention that’s been shown to have major impact on cancer treatment-induced fatigue. (American Ginseng root showed minor benefit on cancer induced-fatigue.)
Right behind that I’d recommend one of the major stress management techniques that have been studied the most, which is progressive muscle relaxation. Often taught at end of a yoga class, this practice has you go through the body, intentionally maximally contracting muscle groups starting with your feet and working your way up the body, contracting and then relaxing major muscle groups.. Researchers at Ohio State University’s Comprehensive Cancer Center found that breast cancer patients participating in this program reduced their risk of disease recurrence by more than 50%.
Another practice is diet. There’s an association of reduced risk of recurrence with increased intake of fruits and vegetables, especially those in the cruciferous family (vegetables like broccoli, kale, cauliflower) and fruits and veggies that are brightly colored. We talk about “eating the rainbow” because each color provides different nutritional benefits.
In After Cancer Care, we encourage readers to try different approaches for a period of time and do the ones they enjoy the most. If you don’t enjoy it, it won’t be a sustainable regular practice.
Josh: Is there anything else about integrative care you’d like to share?
Dr. McKee: So many practitioners have said this about both conventional and integrative care: the patients who do the best are those who’ve taken an active role in decisions about treatment rather than just accepting what an oncologist offers. Consider all your options.