Integrative Naturopathic Medicine in Ovarian Cancer.

By Dr. Caitlyn Keates, ND.

On Saturday November 6th 2021, I had the pleasure of presenting as a Naturopathic Doctor at the Ovarian Cancer Canada Fall Symposium.

This year’s turnout included over 400 women and family members from across the country who have been influenced by Ovarian Cancer in some way. The presentation detailed integrative medicine – a combined approach to care, and emphasized how combining conventional treatment with complementary therapies can help to manage symptoms and side effects that are common in the ovarian cancer patient population.




To begin, a discussion around what is naturopathic medicine was explained. It is a dedication to the study and celebration of nature’s healing power that prioritizes the most natural, least invasive and least toxic therapies to treat illness, promote wellness and view the body as a whole.

Naturopathic Medicine is guided by principles rather than treatment and includes:

  1. First, do no harm
  2. The healing power of nature
  3. Identify and treat the cause
  4. Doctor as teacher
  5. Treat the whole person
  6. Prevention

Naturopathic Doctors have an undergraduate degree and attend a four-year accredited naturopathic medical institution to receive their doctorate title. This differs from a “naturopath” which is only viewed as a diploma-based program and is of importance to distinguish between, especially when seeking out a Naturopathic Doctor to support with integrative cancer care.

It is estimated that 80% of people with cancer are choosing to use natural and supportive therapies alongside their conventional treatment.3,4 Support can be provided during any phase of treatment. Either preventively, at the time of diagnosis prior to treatment beginning, during active conventional care, or post treatment to aide in recovery and prevention of recurrence. I highlight this final phase as one of the most important as there is often a large amount of fear of recurrence, lingering side effects, as well as trauma from treatment that patients need help navigating through.

What exactly would a visit look like with a Naturopathic doctor? It would often times include a 90-minute initial consult that would allow the physician to understand the patients’ goals for the visit, the conventional diagnosis and treatment plan, dietary and lifestyle routines. Natural health products and medications are currently being taken, medical and family history, sleep, digestion, allergies, mental health as well as a complete review of systems to enable to the physician to get a full body picture of the patient and create an individualized plan to match their treatment goals.

It is our goal as doctors who advocate for integrative care to respect and work in collaboration with the conventional plan to help reduce side effects, optimize conventional care and prevent recurrence by providing evidence-informed guidance on safe and effective use of natural and supportive therapies. Integrative Naturopathic Doctors look for the highest quality human data for clinical decision making when constructing treatment plans. This is of importance to prevent harm to the patient as well as provide the patient and oncologist with evidence as to why a recommendation is being made and its importance in the patient’s care.

I discussed how on numerous occasions, patients come into visits with information from forums they have read, and supplements they would like to include in their routine. Often times these treatments may not have strong evidence for support or may be contraindicated with the current conventional plan and cannot be used. It is important to outline that just because a substance is “natural”, it does not mean that it cannot cause harm and any natural health products should be monitored by a Naturopathic Doctor who has experience, knowledge and access to checking for interactions before being administered within a cancer setting.

Naturopathic Doctors have 120 hours of pharmacology training not including the additional hours when registering for a prescribing license within their respective province. We understand the pharmacological mechanism of conventional medications as well as any specific interaction or contraindication to that agent when being administered with a herbal substance. This is confirmed through interaction data bases before treatment plans are sent to patients.

When designing the treatment plan, it is easy to categorize into the six treatment principles:

  1. Do no harm:
    • Perform a complete, comprehensive intake where conventional information is noted, interactions are checked and an individualized plan is created.
  2. Identify and treat the cause:
    • Identify modifiable and non-modifiable risks to Ovarian cancer: 
      • Modifiable: Smoking, obesity (BMI > 30), vaginal douching (2x increased risk), hormone replacement therapy (estrogen alone increases risk, oral contraceptive pill decreases risk for 20+ years after discontinuation). 
      • Unmodifiable: BRCA gene, Lynch syndrome. 
    • Treat the cause
      • Understand which conventional treatment plan you are on:  
        • Neoadjuvant chemotherapy: most often include Carboplatin or Cisplatin, Docetaxel or Paclitaxel. 
        • Surgical via debulking or Oophorectomy, Salpingectomy.  
        • Adjuvant chemotherapy. 
  3. Doctor as teacher
    • We have the gift of time with 1-to-1.5-hour visits. During this time, we can explain your conventional diagnosis and treatment to you; often times patients don’t understand their diagnosis or why they are taking certain medications or side effects that may appear. We also will explain the naturopathic plan with a full informed consent discussion so the patient can make the decision. 
  4. Treat the whole person
    • A comprehensive plan will allow time to understand not just the cancer diagnosis but also other past medical and family history, the patients’ goals for therapy and any further blood work or investigative work ups that need to be completed.  
  5. Healing Power of Nature
    • Based on the phase of treatment we will create a plan to meet the patients’ goals, minimize side effects, increase quality of life and focus on the six-treatment principal prevention (of side effects or recurrence). This might include: 
      • Surgical: Pre- and post-surgical plan: 
        • Modalities: Homeopathics, Massage, Acupuncture. 
        • Supplements: Protein, tissue remodeling support, infection control. 
        • Lifestyle: Meditation, Yoga.
      • Chemotherapy:  
        • Supplements: to support a reduction in common side effects such as cardiotoxicity, hand and foot syndrome, neutropenia, nausea, fatigue, alopecia, chemo/fog brain & memory related concerns.
        • Injection therapies: IV Vitamin C and Mistletoe.   

Toward the end of the presentation a discussion around the use of IV Vitamin C and Mistletoe was introduced. IV Vitamin C has demonstrated cytotoxic effects on cancer cells without a disruption in normal cells through the generation of hydrogen peroxide. Cancer cells lack the enzymes required to convert hydrogen peroxide into water for it to escape the cell causing a cytotoxic reaction that is not present in normal cells. When examining its use in combination with Paclitaxel and Carboplatin in a clinical trial by Ma et al (2014) it improved time to relapse by 8.75 months and survival in Ovarian cancer patients.5 It also appears to have no effect on efficacy of chemotherapeutics when administered in combination and may, in fact, have additive benefit when used with chemotherapeutic agents such as Doxorubicin, Cisplatin, Gemcitabine and Paclitaxel that are often seen in conventional Ovarian cancer plans.2 

Mistletoe is known as a parasitic plant that eventually kills its host tree which parallels the progression of cancer and thus its use in integrative cancer care as an immunostimulant agent. The Visculle toxin and lectins are the components of the plant with the therapeutic and cytotoxic effects. The type of Mistletoe used varies dependent on the type of cancer. A randomized control trial from Grossarth-Maticek and Ziegler (2007) concluded its benefit in prolonged overall survival in metastatic ovarian cancer.1 Clinically, it has been observed to provide improved quality of life, neutropenic support, as well as a reduction in fatigue, bone pain and side effects related to conventional chemotherapy.  

The presentation was very well received and enjoyed, leaving 10 minutes at the end for a short question and answer period.  I will end today by leaving a few comments that were shared with me.  

“That presentation was awesome!” 

“This info is gold. Thank you for sharing”

“I have been a patient of this center and it has been an integral part of my treatment”

“Excellent Symposium. I enjoyed all of it very much! So thankful it is recorded so I can catch the sessions I missed. Thank you”

“A big THANK YOU to the organizers for all their hard work and to the speakers for their time preparing and presenting their sessions. Everything was EXCELLENT!!

References:

  1. (Arzneimittelforschung. 2007;57(10):665-78). 
  2. (Curr Oncol. 2018 April;25(2):139-148)
  3. Integrative Cancer Therapies 2017, vol. 16(1) 96–103
  4. J Clin Oncol 2000 Jul;18(13):2505-1
  5. (Sci Transl Med. 2014 Feb 5;6(222):222ra18).