Treating the Whole You: Q&A With Dwight McKee, MD

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.