the value of integrative oncology in medicine: the · pdf file"the value of integrative...

"The value of Integrative Oncology in medicine:

The German model - a best practice example?“

Peter Zimmermann MD, PhDThomas Breitkreuz, MD

Lunch Meeting with Dr.Thomas Ulmer, MEP

10th May 2011

European Parliament Strasbourg, Salon LOW

IVAA, European Parliament, Strasbourg, 10.5.11

University of ArizonaStanford

University University of California , Los Angeles University of California, San

FranciscoUniversity of Colorado at

Denver School of Medicine University of

Connecticut

Yale University University of Hawaii-

Manoa

John A. Burns School of Medicine

Northwestern University Feinberg

School of MedicineUniversity of Illinois at Chicago School of

MedicineUniversity of Kansas Johns

Hopkins University

University of Maryland

Boston University School of Medicine

Harvard Medical School

Massachusetts Medical

SchoolUniversity of Michigan Mayo

Clinic

University of Minnesota University of

Medicine and Dentistry of New Jersey

University of New MexicoAlbert

Einstein College of Medicine of Yeshiva

UniversityCarolina Duke University

Forest University School of Medicine

The Ohio State UniversityGeorge

Washington University

University of Wisconsin-Madison

Oregon Health and Science University

Thomas Jefferson University of

PittsburghVanderbilt

UniversityUniversity of Texas Medical

Branch University of Vermont College

of Medicine University of Washington

George Washington University

University of Wisconsin-Madison

http://www.integrativemedicine.arizona.edu/




http://www.stanfordhospital.com/clinicsmedServices/clinics/complementaryMedicine/default

http://www.sscim.uci.edu/

http://www.sscim.uci.edu/

http://www.osher.ucsf.edu/




http://www.uch.edu/integrativemed



http://picim.uchc.edu/

http://www.cam.yale.edu/

http://integrativemed.kumc.edu/








http://www.jabsom.hawaii.edu/jabsom




http://www.nmpg.com/



http://chicago.medicine.uic.edu/departments___programs/departments/anesthesiology/news_and_events/







http://www.hopkinsmedicine.org/cam


http://som.georgetown.edu/


http://www.compmed.umm.edu/




http://www.bumc.bu.edu/

http://www.bumc.bu.edu/

http://www.osher.hms.harvard.edu/



http://www.umassmed.edu/cfm/index.aspx



http://www.med.umich.edu/umim





http://mayoresearch.mayo.edu/mayo/research/cimp/

http://mayoresearch.mayo.edu/mayo/research/cimp/

http://www.csh.umn.edu/




http://www.umdnj.edu/icam



http://hsc.unm.edu/som/cfl








http://pim.med.unc.edu/

http://pim.med.unc.edu/

http://www1.wfubmc.edu/cim/



http://www.uwcam.org/









http://www.med.uvm.edu/integrativemedicine



http://www.ohsuwomenshealth.com/services/doctors/integrative.html



http://www.med.upenn.edu/penncam



http://integrativemedicine.upmc.com/




http://www.vcih.org/




http://cam.utmb.edu/














PATHOGENETIC CONCEPT

focusses on pathogenesis

physical / biochemical intervention

biochemic blockade

analytic / quantitatively orientated

substance and space

ideal: precise intervention

addition von single factors

“as much as necessary”


SALUTOGENETIC CONCEPT

focusses on healing process

constitution / life style

stimulation of processes

holistic / qualitatively orientated

process and time

ideal: global dynamic

combination / composition of effects

„as much as possible“

Case historyMrs A. J., 54 years, breast cancer

History:Suffered breast cancer 4 years ago pT1b pN1 M0, PR+, ER+

Operation Chemotherapy Radiotherapy Hormone therapy (Tamoxifen) – stopped due to side effects

Presentation:Weakness / FatigueShortness of breathWeight loss: 7,5 kg / 5 months



www.medizin-individuell.de


http://www.anthromed.de/

Case historyMrs A. J., 54 years, relapse of breast cancer

Findings in outpatient setting: Liver metastasis Elevated tumour markers

Hospital admission:

Examinations (radiographs, computer tomography, endoscopy...)

Start constitutional (salutogenic) anthroposophic treatment(fatigue, appetite, anxiety / depression)


Multimodal approach I: Medical intervention / Diagnostic tools

Intensive Care

Endoscopy, catheterization, diagnosticinterventions (i.e. biopsy techniques..)

Oncology: Surgery provided, chemotherapy provided

No difference to other hospitals

Staff is well-trained with „double competences“

AM as an integrative, not „alternative“ medicine


Findings in physical examinations: Liver metastases Pleural effusion causing shortness of breath Lymph node metastases (chest, abdomen)

Other findings: Vitality: weakness / fatigue; disturbed sleep; difficulty to

stand up and move; loss of appetite; disturbed circulationand heart rate

Psychological: anxienty / depression Biographical: excessive demands at work / job strain;

family conflicts; deep questions on meaning of life



Medical Treatment: Start with mistletoe therapy (first intravenously, continue

with injections) Strengthen vitality with AM medicines (Levico comp.

injections, Stibium met praep D6 intravenously, Hepatodoron Tablets

Puncture of pleural effusion / mistletoe pleurodesis Start with hormone treatment (Femara)

Nursing and physical therapies: Liver compresses with milfoil (common yarrow) extract Rhythmic massage



www.mistel-therapie.de

Study data: overview of prospective studies (10/2010)

Prospective comparative studies

30 RCT´s, Σ = 3396 patients

18 N-RCT´s, Σ = 4068 patients

Results: ✔ survival (OS) : 16 studies: significantly positive 16 studies: positive trend

2 studies without significant results

✔ QoL : 13 studies: significantly positive 2 studies: positive trend


Study data: overview of retrospective studies (10/2010)

Retrospective comparative studies

42 studies, Σ = 7571 patients

parameter examinded:survival, QoL, remission / PFS, reduction of adverse effects of

Cx / Rx

Results: ✔ advantage mistletoe „overall“: 39/42

studies

✔ advantage mistletoe in high quality studies: 12/13 studies


Multimodal approach II: AM Medication

Wide range of AMP´s (>2000)

Parenteral application of particular impor-tance (about 25% of total prescriptions)

AM pharmaceuticals used in intensive care as well as for chronic disease

Indication / selection:

medical condition

affected organs

individual constitution

process-related

„individualized therapy“


www.bfarm.de


www.escamp.org

Multimodal approach III: Nursing and physical therapies

Compresses

Medical washings / medicinal baths

(whole body, foot bath)

Rhythmic massage (oil, ointment)

Inhalation

specific AM techniques

AM pharmaceuticals for external use

very effective in acute medical conditions

differentiated therapy, not wellness!


Active therapies: Eurythmy: movement therapy. Helps to activate healing

forces, helps to overcome fatigue, find new active relationto own own physical vitality

Art therapy (painting): express inner psychologicaldynamics, helps to find individual ways of coping with thedisease


Multimodal approach IV:

Art therapy / Eurythmy therapy

Art therapy: Painting / design

Speech therapy

Sculpture

Music therapy

Eurythmy therapy: movement therapy

Patient is active in the healing process

based on psycho-somatic interaction:

creativity impression and expression physiological functions

available in bedside setting


Hospital discharge after 12 days: Strengthened vitality, good appetite, regained 2 kg No shortness of breath, effective pleurodesis New ideas for every day life Learned mistletoe injection technique

Course after 2 months: Rapidly growing lymph node metastasis Liver / lungs: stable Decision to start short course of chemotherapy in

combination with whole-body-hyperthermia


Case



Chemotherapy / hyperthermia / mistletoe therapy: 3 months of treatment with 4 courses of epirubicin (3 week

interval) Reduction of metastases (complete: liver; partial: lymph

nodes) No side effects during therapy

Continues AM therapy (mistletoe, constitutional, eurythmy therapy: Completely regained weight and vitality Active at work, changed every day life, positive attitude

towards life Clinically stable since 3 years



www.uni-wh.de/gesundheit/anthroposophische-medizin-ibam/

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