OncANP Naturopathic Oncology Conference Highlights in Toronto, June 2023

By Mohamed Elsayed, MSc, PhD, ND; Erica Rizzolo, ND; Mark Legacy, BSc, CCRP.

The Oncology Association of Naturopathic Physicians (OncANP) is a professional organization with a membership of licensed naturopathic doctors (ND), naturopathic medical students, and allied health providers across North America. The mission of the OncANP is to advance the philosophy, science, and practice of naturopathic medicine in cancer care. The organization advocates for interprofessional collaboration and is dedicated to advancing the research and application of naturopathic medicine within standard cancer care. The 12th annual OncANP conference was held in Toronto, Canada from June 16-18^th, 2023. The OncANP conference is a place where integrative healthcare practitioners and researchers meet to discuss and share information about clinical practice, expand on the collective knowledge base of the profession, and present research advancements in the field of integrative oncology. This year, The Patterson Institute for Integrative Oncology Research and The Center for Health Innovation (CHI) made outstanding contributions to the conference in both research and clinical domains.

Our Research Contributions and Poster Presentations

The Patterson Institute and CHI submitted five abstracts for the conference, which were accepted as research poster presentations.

• Three literature reviews about the use of intravenous (IV) therapies in the context of cancer care: IV vitamin C (IVC), IV alpha lipoic acid (ALA), and artemisinin.
  
• Two posters included synopses of two clinical studies: the Canadian/US Integrative Oncology Study (CUSIOS), which completed recruitment in 2020 and is now currently being analyzed, and a study entitled Adjunctive Intravenous Ascorbic Acid for Advanced Non-Small Cell Lung Cancer (AIVAA), which is set to begin recruitment by the end of 2023.

The literature reviews were conducted with the goal of creating monographs targeting NDs, other health care professionals, and patients living with cancer to inform them about these therapies. Regarding artemisinin and its derivatives in cancer care, there is still a lack of evidence regarding efficacy; however, they are generally safe with appropriate use. More research is needed to explore the potential for efficacy in cancer control. Similarly, there is insufficient evidence to comment on the effectiveness of IV ALA in the context of cancer management, and more clinical research is needed. Regarding IVC, the collective results from 23 clinical trials demonstrate that IVC is generally safe and well tolerated with minimal and mild side effects. Some but not all studies have found benefits for QOL and symptom management alongside cancer treatment or as monotherapy. There is preliminary evidence that IVC given alongside conventional cancer treatments may improve tumor response or survival outcomes in advanced pancreatic cancer, non-small cell lung cancer, colorectal cancer, and ovarian cancer. More rigorous, larger, randomized trials are needed to confirm these results.

AIVAA is a blinded, randomized controlled trial (RCT) evaluating the effectiveness of IVC on the quality of life (QOL) of patients with incurable lung cancer. Patients in the treatment arm will receive routine chemotherapy plus high dose IVC for 6 months; those in the control arm will receive routine chemotherapy plus a placebo infusion for the same duration. Outcomes include QOL, symptom burden, safety, progression, and survival. We plan to enroll 90 patients who will be followed over the next 8 years. This is the first RCT on the use of IVC among patients with cancer conducted in Canada. With the promise of some of the research and its inconclusive nature, well controlled clinical research on this therapy is essential. The potential exists to influence standard of care, be supported financially by health agencies, and improve cancer outcomes.

CUSIOS was created in partnership with Bastyr University and is a North American-wide study which explores the impact of complementary care delivered by NDs for patients with advanced breast, colorectal, ovarian, and pancreatic cancer. 12 clinics across North America have recruited patients to participate in this prospective observational study to describe QOL, cancer-related costs, qualitative experiences, and survival outcomes. Results pertaining to QOL were presented at this conference. 97 patients were included in this analysis. In summary, we observed continued improvements in QOL over time, and improvements in symptom burden at 3 months which remained stable throughout the study. We cannot say for certain if these improvements were a result of naturopathic medicine as we did not have a group to compare these results to.

All five posters were presented at a reception on Friday June 16^th, 2023, and remained available for attendees to view throughout the conference. The posters gained a lot of attention amongst attendees and sparked great discussion about these and other projects. Special thanks to Dugald Seely, Mark Legacy, Erica Rizzolo, Mohamed Elsayed, and Gillian Flower for putting these posters together and presenting them during the reception.

Overview of Conference Content and Highlights

Colleagues in the field of naturopathic oncology gave presentations on a range of topics within integrative cancer care, including clinical implications of acupuncture and IV therapies, the use of modalities such as nutrition and botanical medicine in the management of lymphedema and cachexia (weight loss >5% of body weight), and treating side effects of conventional drugs. There was also a two-part panel discussion on commonly used and newer repurposed drugs, which one of The CHI’s nurse practitioners (NP), Jamie Batsch, spoke on.

Dr. Amy Rothenberg, ND, and author of “You finished treatment, now what?” presented a talk on orchestrating patients’ post-treatment plan. A large gap in cancer care is ‘aftercare,’ and as Amy put it, “many survivors feel lost and abandoned when cancer care ends.” Some of the tools discussed to support patients were basic nutritional recommendations, exercise, stress reduction, minimizing toxin exposure, the importance of restful sleep, and supplement/medication interventions. Another well-known intervention is acupuncture. Dr. Kin Leung, ND, presented on the use of acupuncture in cancer care and supporting research, including its use in treating xerostomia (dry mouth), peripheral neuropathy, and nausea and vomiting. In a highly relevant presentation given by Dr. Sheba Shamim Roy, ND, health disparities in cancer care were also discussed, particularly how this can affect treatment choices and negative health outcomes as a result of inaccessible care, but also how clinicians can address these disparities in care.

Being such a large part of naturopathic practice, nutritional interventions and considerations were discussed for a variety of applications. Dietary strategies for lymphedema were presented by Jean LaMantia, RD, including reducing sodium intake, weight loss, increasing protein intake, and the anti-inflammatory diet. Dr. Heidi Lucas, ND, gave an update on the research behind organic vs conventional food nutrient contents, and interesting “farm to table” tips on growing, brewing, and cooking practices and food choices in order to increase nutrient content and absorption of various compounds, such as curcumin, resveratrol and sulforaphane. Lastly, Dr. Elise Hoffman, ND gave an excellent talk on how fat and muscle mass impact patient outcomes, and the importance of measuring these accurately (i.e., not just going by weight). The difference between sarcopenia (loss of muscle mass) and cachexia (total weight loss), including interventions such as increasing protein intake to help increase or maintain muscle mass, were also discussed.

The Knowledge in Integrative Oncology Website (KNOW) database is a research database created by the OncANP. Two of the research directors of KNOW, Dr. Jen Green, ND and Dr. Heather Wright, ND, held a session reviewing how to navigate the database for new clinicians, how to review and share findings with other health care providers and patients and updating members on new features of the database, including a new search provider network. If you would like to search for a naturopathic practitioner focused in cancer care in your state or province, the link can be found here: https://www.knowintegrativeoncology.org/providers.

The conference also included topics on conventional treatments, such as immunotherapy and targeted therapies in cancer care, emphasizing pharmacological aspects and the role of naturopathic medicine in managing related side effects. Other topics presented included lectures on the mechanism of action of nicotinamide adenine dinucleotide (NAD) and avocado bioactives, the role of estrogen signaling in oncology, and a case series on triple IV therapy. Talks were also given on certain aspects of the cancer patient’s journey, such as managing peripheral neuropathy and the lack of stratification around intimacy and sexual health among patients with cancer. Finally, recent research highlights on naturopathic oncology were presented in a specialized comprehensive talk and it was a good place to wrap up the conference focusing on the most up to date evidence available.

Expert panel on repurposed drugs in cancer care featured our nurse practitioner, Jamie Batsch

Part of the conference included an innovative discussion on newer and commonly used repurposed drugs in cancer care from a panel of experts. Among those on the panel was one of the nurse practitioners (NP) at the CHI, Jamie Batsch. Jamie has worked at the CHI for 4 years, seeing patients with cancer as well as those with other health concerns, and has a great deal of experience using repurposed drugs in cancer care. ‘Repurposed drugs’ refers to the use of drugs outside the scope of what they are currently approved for (i.e., off-label use). For example, metformin is a very well-known drug used to treat diabetes, and it has been ‘repurposed’ (i.e., used off-label) as an anti-cancer agent. Eleven drugs were presented and discussed among the panel, including metformin, low dose naltrexone, and doxycycline. Jamie shared her thoughts and experience using these medications in an integrative cancer care setting.