Naturopathic doctors specializing in oncology (cancer care) are well-qualified to help patients at all stages of cancer treatment. Contrary to popular myth, naturopathic doctors do not try to convince patients to avoid conventional therapies. In fact, naturopathic doctors actively collaborate with conventional oncologists for truly patient-centered care. NDs play a key educational role in helping patients understand the benefits of traditional cancer treatment, how using naturopathic medicine alongside them can help reduce adverse effects, and which lifestyle changes have the greatest potential to reduce cancer risk.
Those actively undergoing conventional cancer treatments are not the only people who can benefit from naturopathic oncology. Research on cancer patients using integrative medicine shows that between 22% and 91% use complementary medicine9. To learn more about how integrative oncology, which includes the naturopathic approach, can support people with cancer at all stages of care, the Institute for Natural Medicine sat down with two naturopathic doctors who are members of the Oncology Association of Naturopathic Physicians (OncANP): Dr. Shauna Birdsall, ND, FABNO and Dr. Chad Aschtgen, ND, FABNO.
Preventative Care to Reduce Cancer Risk
Many patients with a family history of cancer choose to take a proactive approach to reduce their cancer risk.
“Naturopathic doctors can bring education to patients who want to focus on cancer prevention,” explains Birdsall. “There are a lot of myths about cancer, and we can help inform patients about cancer and the process in general.”
This education also applies to patients who have not received a cancer diagnosis. “We can play a critical role in discussing the importance and the relevance of cancer screening. Frequently, patients are not particularly excited about getting a colonoscopy,” says Birdsall. “Women have a lot of concerns about mammography.”
Cancer Prevention Strategies Reduce Risk of Other Chronic Diseases
“What I love about working with this patient population is that we can make such a significant difference. Not only in helping to prevent cancer but in improving their health overall,” Birdsall explains. “All dietary strategies, exercise, focus on stress management, and improving sleep have also been shown to help prevent cardiovascular disease, type two diabetes, and Alzheimer’s. By focusing on cancer prevention, they will help prevent other chronic diseases too.”
Aschtgen agrees that cancer prevention is also health promotion, noting that the research supports making core lifestyle changes to reduce cancer risk across the board. “Reducing alcohol consumption, appropriately managing body weight, eating more vegetables and avoiding fast food, reducing smoking, and getting more exercise are the main ones,” notes Aschtgen. “National guidelines recommend approximately 150 minutes a week of exercise, including 60 to 90 minutes a week of strength training.”
Aschtgen helps his patients make small steps toward wellness instead of giant leaps. It’s about gradually reducing harmful activities while slowly increasing health-promoting ones. Not only is this still effective—it avoids causing further harm by making sudden, dramatic lifestyle changes. “The benefit is certainly in the dose, meaning incremental steps toward better wellness. Each lifestyle category provides a risk reduction and health promotion across the board in so many ways,” Aschtgen notes.
For example, one of the most troubling health issues affecting the health of North Americans is poor blood sugar management, which can contribute to an unhealthy weight, metabolic issues, and diabetes. “High blood pressure and high cholesterol are also part of the constellation of symptoms there. As we focus on cancer risk reduction, we’re also helping reduce their risk for heart attack, stroke, diabetes, and even autoimmune disease,” Aschtgen explains.
Taking a Detailed Patient History Informs Personalized Recommendations
Naturopathic doctors take the time to get to know patients as unique individuals and learn about their past and present lifestyles. According to OncANP’s 2019 Principles of Care Guideline9, an optimal patient health history includes:
- History and knowledge of current illness
- Current and past conventional treatments and the patient’s response
- Prior complementary cancer treatment and response
- Review of pertinent pathology, laboratory, and imaging studies
- Relevant family health history
- Allergies (medications, dietary, environmental)
- Lifestyle choices, including diet, sleep habits, smoking, alcohol consumption, drug use, and social history
- Environmental factors, including occupation and work environment
- Comorbid conditions and, if relevant, their potential effect on disease trajectory and treatment
- Identification of key members of the patient’s healthcare team, including medical and radiation oncologists, surgeons, primary care providers, and so on
- Consideration for the patient’s values and attitudes with respect to the current health situation and how they might affect therapeutic choices
“Taking a thorough patient history and understanding family history with cancer helps us provide very specific prevention strategies,” says Birdsall. “For a woman with a strong family history of breast cancer, we ensure that she eats cruciferous vegetables to help with estrogen metabolism and counsel on alcohol intake, as higher alcohol consumption is linked with increased breast cancer risk11. We would help her understand the importance of exercise and achieving an ideal body weight.”
Naturopathic doctors may take the family history aspect even further by referring to a Genetic Counselor to discuss risks and benefits and identify what type of genetic testing is right for them.
Adjunctive Care to Support Conventional Treatments and Reduce Adverse Effects
Increasingly, cancer patients undergoing conventional treatments such as chemotherapy and radiation seek out naturopathic doctors to provide evidence-based therapies that support conventional treatment while improving their quality of life.
Educating Patients About Conventional and Naturopathic Cancer Treatments
Patients’ understanding of naturopathic oncology varies widely. Many of Birdsall’s patients aren’t yet sold on the fact that they need conventional cancer therapy. But if they thought Birdsall would steer them away from conventional treatments, they’re in for a surprise. “I talk to them from a naturopathic doctor’s point of view about why it’s important for them to do surgery, chemotherapy, or potential radiation,” explains Birdsall. “I thoroughly discuss my role and how I help manage side effects while working synergistically with conventional treatments. Patients who have never seen a conventional physician or taken medications have difficulty dealing with a typical conventional cancer treatment plan. “The opportunity is in knowing what the patient’s concerns are, why the conventional oncologist is recommending the treatment, and help to bridge the gap so that the patient better understands the totality of their cancer diagnosis and how the treatment is going to positively impact their prognosis.”
Aschtgen, who practices in Seattle (one of the United States’ integrative oncology hotspots), sees patients with different views of naturopathic oncology. “Fifteen years ago, it was more common for me to see patients looking for alternatives to conventional cancer treatments. What changed? Maybe it was public education campaigns or ongoing efforts to intentionally use terms like ‘complementary medicine’ and ‘integrative oncology.’” Aschtgen theorizes. “Most of the individuals we see at our on-site adjunct clinics (which include conventional medical oncologists, radiation oncologists, and surgeons) expect that we will use our naturopathic tools right beside those other therapies.”
Although their patients’ health literacy may differ, Birdsall and Aschtgen focus on the key naturopathic principle of doctor as teacher. Getting a cancer diagnosis is incredibly overwhelming. In that initial appointment with a conventional provider, they may learn about their diagnosis for the first time while trying to understand the risks and benefits of the recommended conventional treatments. “They may be a little shell-shocked. They come to see us in preparation for starting chemotherapy,” Aschtgen explains. “An individual newly diagnosed and prescribed treatment will often end up with a regimen of drug therapies they have to start very quickly. Sometimes, the entirety of one or more of our visits is answering their questions on the conventional therapies, without even introducing naturopathic tools.”
How Collaborative Care Mitigates Treatment Risk and Manages Drug-Herb Interactions
Patients undergoing conventional cancer treatments using integrative oncology have another problem: how do they ensure that all their healthcare providers are on the same page? It can be difficult enough to track and comply with the recommendations of one doctor, never mind an entire team. Research shows that while information-sharing amongst primary care providers in oncology settings is vital to high-quality, patient-centered care, communication is often lacking 3, 4, 6.
This information-sharing is where naturopathic doctors have a crucial role to play in the coordination of care. NDs can build positive relationships with other patient care team members by focusing on shared treatment goals and fostering trust through effective and clear communication1, 5. “This is a really important component of naturopathic oncology: as often as possible, I get all their conventional medical records so that I can see their oncologists’ plan,” says Birdsall. “Then, I can make certain that my naturopathic recommendations fully support patients through their treatments. Different interventions have different side effects, so I need to know their prescriptions and treatments inside out. There’s a huge safety component in naturopathic oncology because patients can blend natural therapies with conventional treatments in a way that doesn’t decrease the effectiveness of the conventional treatment at all.”
Patients receive support throughout all phases of conventional treatment. And when different conventional treatment phases involve multiple substances, naturopathic doctors put their knowledge of how pharmaceuticals interact with herbal medicines to work. “We have a lot of information on how common botanicals impact drug metabolism. We can tell patients they shouldn’t take echinacea while on a certain chemotherapy drug. There are certain things that they can and cannot do during certain phases of treatment. With our naturopathic repertoire, we have other compounds that can help support their immune function or do the other actions that we were hoping for. We ensure that it is something safe and appropriate to use with their treatment at that particular point in time.”
Adverse Effects and Naturopathic Therapies to Improve Quality of Life
People about to start a course of conventional treatment often ask how they can manage adverse effects. Naturopathic doctors can make a significant impact in improving quality of life. While some adverse effects are treatment specific (a breast cancer patient taking tamoxifen, for example, may experience hot flashes at night), there are some common effects.
“There is hardly a side effect that we can’t help reduce, if not ameliorate. These therapies can be very hard on the digestive tract, contributing to nausea, vomiting, constipation, or diarrhea,” Aschtgen explains. “Insomnia or difficulty sleeping is another common one, which could be brought on by diagnosis or treatment-related stress. Or it could result from the therapies themselves, such as when steroid therapy is given concurrently with chemotherapy.”
Birdsall points to fatigue as the number one adverse effect that cancer patients experience. For people using certain chemotherapy agents, nausea and brain fog (called ‘chemo brain’) are common side effects. Peripheral neuropathy (tingling in the hands and feet) may also come into play, significantly reducing quality of life.
Naturopathic treatments to reduce adverse effects vary based on each individual’s cancer type and treatment plan. However, Birdsall and Aschtgen find that exercise and dietary changes are the most impactful.
“The research tells us that exercise is the number one intervention for both cognitive changes and fatigue, which has significant physiological effects. Unfortunately, it isn’t just a pill that patients can swallow,” Birdsall explains. “But the evidence is so strong that the American Society of Clinical Oncology (ASCO) now has strong guidelines and recommendations that, unless they’re physically unable, all cancer patients should include exercise in their treatment plan8.”
Patients are often aware that dietary changes can reduce conventional treatment adverse effects. But they may go about this in the wrong way. Birdsall often sees patients who, having consulted Google for medical advice, engage in juicing or other strategies that harm their health and deplete nutrients. “Frequently, cancer patients are not getting enough protein. Protein and healthy fats can make a significant difference in their symptom management. Well-nourished patients tolerate cancer treatment much better than poorly nourished patients,” she notes.
Survivorship Care to Prevent Cancer Recurrence
For many cancer patients who have undergone conventional treatments, receiving the ‘all clear’ from their oncologists is one of the happiest days of their lives. But cancer remission can be scary. During celebrations with family and friends, a hidden fear lurks: will cancer return?
When Conventional Treatments Come to an Abrupt Halt
“So much emotional distress can come from the confusion and micromanagement of their disease while they’re in therapy. Frequently, the person can be in chemotherapy every two to three weeks for up to six months. Once they finish that regimen, that intense course of care comes to what seems like a very abrupt stop,” Aschtgen explains. “Patients may feel locked out in the cold, not knowing what to do next.”
“These patients can be extraordinarily anxious, lost, and confused. In regular visits with a naturopathic doctor, patients can check in about symptoms or side effects,” she explains. “If they have back pain – does that mean the metastatic disease is in their back? An ND can appropriately evaluate them, including how they manage stress and other lifestyle aspects that affect overall health.”
And finishing cancer treatments doesn’t mean adverse effects from conventional treatment immediately disappear. “They may have ongoing fatigue and brain fog that we can work through. They’re no longer getting treatment, so it’s about healing various aspects of their body that are still affected from the treatment,” says Birdsall.
In this survivorship care phase, patients don’t always get what they want from conventional oncologists. “The job of the medical oncologist, surgeon, and radiation oncologist is to help eliminate that cancer (or treat that cancer), not prevent a recurrence,” Aschtgen explains. “There are some places in the conventional oncology world where there is recurrence prevention: adjuvant therapies, hormonal therapies, and in breast cancer, tamoxifen, and aromatase inhibitors. But for the most part, there isn’t much appetite for risk reduction, only surveillance for recurrence,” which is why the care of a naturopathic doctor is so essential during survivorship. After all, a cancer patient is considered a survivor from diagnosis throughout the rest of their life9.
Naturopathic Strategies to Prevent Cancer Recurrence
In addition to managing lingering adverse effects from conventional treatment and providing emotional and stress support, naturopathic doctors use evidence-based strategies to reduce the risk of cancer recurrence.
“Where does the data point to the greatest benefit? We often start with lifestyle, nutrition, weight management, exercise, and stress management. And then we add other therapies supported by scientific evidence,” explains Aschtgen. “Many NDs and other health care professionals test for vitamin D and bring it within the normal range if it’s low. There’s a tremendous amount of data2 that can help to reduce the risk of cancer recurrence. We also look at data that addresses herbal items such as green tea10 or curcumin7 extract from turmeric, and many others that can help reduce cancer risk for a variety of different tumor types.”
Another benefit is that NDs can monitor symptoms to assess whether it may be time to call their medical oncologists back in. “I see NDs as both a support and a bridge for the patient, providing long-term care, prevention of recurrence, and helping to optimize survivorship strategies,” notes Birdsall.
End-Of-Life Care to Ease the Transition
In the final stages of life, naturopathic oncology strongly supports patients, caregivers, and their families during this challenging transition.
Education, Comfort, and Support
“We have many patients with a persistent disease, so the medical oncologists may not have any further options. When the individual moves into palliative care or hospice care, we are a resource for not only the patient but also the caregivers of patients to help them give the best care to the individual who’s suffering,” notes Aschtgen.
The patient’s family and friends can also benefit. “Naturopathic oncology can provide a lot of comfort and support. The patient and their caregivers, friends, and family have a lot of questions. They may have already asked the conventional health team members some of these questions, but maybe they were too stressed and didn’t understand the answers,” says Birdsall. “Naturopathic doctors can provide both educational and emotional support. Involving patients’ caregivers is always important, but at this time, it’s really critical.”
From the patient’s support network, Birdsall gets questions like: what does the dying process look like? How do we know when we’re reaching the end? While patients may say, “I can’t say this to my family. But can I talk to you about how scared I am?”
How do the services of a naturopathic oncologist differ at the end of life when compared to other stages of the cancer journey? “Our services are the same, helping individuals feel as comfortable as possible and deal with their adverse effects such as constipation, diarrhea, nausea, insomnia, pain, and neuropathy. There are a large number of symptoms an individual will be experiencing post-treatment or possibly due to cancer itself. We help them experience a higher quality of life as they move through those final stages,” says Aschtgen.
Naturopathic doctors may even refer patients to additional members of a care team. “Acupuncture, massage, and musical therapy can be very supportive during this time and even during the dying process. As in all other stages of cancer care, we help patients and their family members understand all their options,” says Birdsall.
The Oncology Association of Naturopathic Physicians (OncANP) advances naturopathic oncology’s philosophy, science, and practice. Established in 2004, OncANP is a professional organization with a membership of licensed Naturopathic Doctors (NDs), naturopathic medical students, and allied providers across North America. With the vision of enhancing survival and quality of life for people living with cancer through the integration of naturopathic medicine into cancer care, they advocate for collaboration with conventional providers. They are dedicated to advancing the science and application of naturopathic medicine within the field of standard cancer care and treatment.
- American Academy of Family Physicians (aafp). Continuity of Care, Definition of [Web page]. Leawood, KS: aafp; 2015. [Available online at: http://www.aafp.org/about/policies/all/definition-care.html; cited 1 December 2018]
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- Carlberg, C., & Muñoz, A. (2022). An update on vitamin D signaling and cancer. Seminars in Cancer Biology, 79, 217–230. https://doi.org/10.1016/j.semcancer.2020.05.018
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More Resources from the Institute for Natural Medicine
Our podcast, The ND Will See You Now, includes a number of episodes featuring naturopathic doctors working in integrative oncology. Access audio-only, video, and written transcripts here.