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A New Integrative Oncology Clinic at the Veterans Affairs Pittsburgh Healthcare System
Background
Prostate cancer is a common cancer among US veterans (31.8%). Radiation/chemotherapy effects (dry mouth, fatigue, neuropathy, gastrointestinal) are worsened by hormonal effects (hot flashes, weak bones, sexual dysfunction). Conventional treatments help symptoms (reactive) while integrative oncology proactively prevents them, links complementary with conventional care. Veterans are unfamiliar with integrative services. Office of Patient-Centered Care and Cultural Transformation awarded grant funding to build an Integrative Oncology-Prostate Cancer clinic. Goals: improve surgical outcomes, lessen chemotherapy/radiation side effects, boost morale, optimize post-therapy clinical outcomes over a 1-year period.
Objective
Evidence-based integrative therapies shift our focus from treating disease to treating the whole patient. Empowering veterans to take charge of their health improves health outcomes.
Methods
Identify veterans with prostate cancer and screen for symptoms (ie, anxiety, fatigue, depression, neuropathy, nausea, vomiting, diarrhea, anorexia, constipation, sexual dysfunction, insomnia). We will perform a personal health inventory (PHI), assess stress with a Perceived Stress Score (PSS), identify the patient’s mission, aspiration, and purpose (MAP). Other measures: PROMIS-10 (measures emotional, spiritual, social support, selfmanagement); OMPRACTICE-instant feedback; HOPE-FACT-spiritual test. Consults: psychology, acupuncture, nutrition, pharmacy, social work, chaplain, creative arts, music, dance, movement, reiki, yoga, qigong, Tai-chi, rehab, pre-habilitation.
Results
Recruitment began in June 2021; we have 37 enlisted patients, 5 battlefield acupuncturists, 1 reiki instructor, 1 hypnotist, 1 dance therapist, 1 massage therapist. Other services are available by referral. Weekly Integrative Oncology meetings: Two 90-minute clinics twice weekly.
Conclusions
Interest in integrative oncology is high. Abundant resources exist. We increased awareness and accessibility. Future plans: Assess program adherence, boost patient satisfaction, and enrolment.
Background
Prostate cancer is a common cancer among US veterans (31.8%). Radiation/chemotherapy effects (dry mouth, fatigue, neuropathy, gastrointestinal) are worsened by hormonal effects (hot flashes, weak bones, sexual dysfunction). Conventional treatments help symptoms (reactive) while integrative oncology proactively prevents them, links complementary with conventional care. Veterans are unfamiliar with integrative services. Office of Patient-Centered Care and Cultural Transformation awarded grant funding to build an Integrative Oncology-Prostate Cancer clinic. Goals: improve surgical outcomes, lessen chemotherapy/radiation side effects, boost morale, optimize post-therapy clinical outcomes over a 1-year period.
Objective
Evidence-based integrative therapies shift our focus from treating disease to treating the whole patient. Empowering veterans to take charge of their health improves health outcomes.
Methods
Identify veterans with prostate cancer and screen for symptoms (ie, anxiety, fatigue, depression, neuropathy, nausea, vomiting, diarrhea, anorexia, constipation, sexual dysfunction, insomnia). We will perform a personal health inventory (PHI), assess stress with a Perceived Stress Score (PSS), identify the patient’s mission, aspiration, and purpose (MAP). Other measures: PROMIS-10 (measures emotional, spiritual, social support, selfmanagement); OMPRACTICE-instant feedback; HOPE-FACT-spiritual test. Consults: psychology, acupuncture, nutrition, pharmacy, social work, chaplain, creative arts, music, dance, movement, reiki, yoga, qigong, Tai-chi, rehab, pre-habilitation.
Results
Recruitment began in June 2021; we have 37 enlisted patients, 5 battlefield acupuncturists, 1 reiki instructor, 1 hypnotist, 1 dance therapist, 1 massage therapist. Other services are available by referral. Weekly Integrative Oncology meetings: Two 90-minute clinics twice weekly.
Conclusions
Interest in integrative oncology is high. Abundant resources exist. We increased awareness and accessibility. Future plans: Assess program adherence, boost patient satisfaction, and enrolment.
Background
Prostate cancer is a common cancer among US veterans (31.8%). Radiation/chemotherapy effects (dry mouth, fatigue, neuropathy, gastrointestinal) are worsened by hormonal effects (hot flashes, weak bones, sexual dysfunction). Conventional treatments help symptoms (reactive) while integrative oncology proactively prevents them, links complementary with conventional care. Veterans are unfamiliar with integrative services. Office of Patient-Centered Care and Cultural Transformation awarded grant funding to build an Integrative Oncology-Prostate Cancer clinic. Goals: improve surgical outcomes, lessen chemotherapy/radiation side effects, boost morale, optimize post-therapy clinical outcomes over a 1-year period.
Objective
Evidence-based integrative therapies shift our focus from treating disease to treating the whole patient. Empowering veterans to take charge of their health improves health outcomes.
Methods
Identify veterans with prostate cancer and screen for symptoms (ie, anxiety, fatigue, depression, neuropathy, nausea, vomiting, diarrhea, anorexia, constipation, sexual dysfunction, insomnia). We will perform a personal health inventory (PHI), assess stress with a Perceived Stress Score (PSS), identify the patient’s mission, aspiration, and purpose (MAP). Other measures: PROMIS-10 (measures emotional, spiritual, social support, selfmanagement); OMPRACTICE-instant feedback; HOPE-FACT-spiritual test. Consults: psychology, acupuncture, nutrition, pharmacy, social work, chaplain, creative arts, music, dance, movement, reiki, yoga, qigong, Tai-chi, rehab, pre-habilitation.
Results
Recruitment began in June 2021; we have 37 enlisted patients, 5 battlefield acupuncturists, 1 reiki instructor, 1 hypnotist, 1 dance therapist, 1 massage therapist. Other services are available by referral. Weekly Integrative Oncology meetings: Two 90-minute clinics twice weekly.
Conclusions
Interest in integrative oncology is high. Abundant resources exist. We increased awareness and accessibility. Future plans: Assess program adherence, boost patient satisfaction, and enrolment.
Complete Remission of Metastatic Renal Cell Carcinoma after COVID-19 Vaccination
Clinical Presentation
A 58-year-old male was diagnosed 6 years ago with stage IV clear cell renal carcinoma (multiple lung nodules and mediastinal adenopathy). He was offered sunitinib, a tyrosine kinase inhibitor, and achieved a partial response with stable disease. Five years later his scans showed worsening disease. Cabozantinib was offered but was poorly tolerated. He tried ipilimumab plus nivolumab but ipilimumab was dropped after 4 cycles due to diarrhea. His scans improved with 4 more cycles of nivolumab but he had to stop immunotherapy due to hypophysitis, diarrhea, and severe jaw pain. He received a COVID-19 booster vaccine and noticed profound fatigue and anorexia soon after. Over 8 weeks he lost 56 lbs (267 to 211 lb). Relapse was suspected but PET CT showed complete resolution of his lung nodules and multiple areas of adenopathy. Asymptomatic and in remission 6 months after vaccination.
Relevant Literature
Clear cell renal carcinoma is resistant to standard chemotherapy/radiation, which usually offers partial responses. Complete remissions are few. Low glycemic diets in animal models have anticancer activity. HIV causes B cell apoptosis. Coxsackievirus A21 oncolytic properties lyse myeloma and CD138+ plasma cells via intercellular adhesion molecule interaction. SARS-CoV-2 (COVID 19) proteins have oncolytic properties.
Intervention
The patient eliminated sugary food from his diet 6 years ago. Stopped bread 2 years ago. Sunitinib 37.5 mg daily × 5 years. Cabozantinib—poorly tolerated. Ipilimumab + nivolumab × 4 cycles followed by nivolumab × 4 cycles. Stopped treatment; immune side effects. COVID-19 booster.
Outcome
15 lb weight loss due to a low glycemic diet, which began since diagnosis. After 4 years he stopped eating bread. After COVID-19 vaccine had a rapid 56 lb. weight loss, fatigue, and nausea over 8 weeks. No evidence of disease. Asymptomatic, off therapy, weight is ideal (219 lb) 6 months after the vaccine.
Implications for Practice
Effects of SARS-CoV-2 (COVID-19) on cancers remain unknown. A few case reports of cancer remissions after infections are emerging. This is the first case of complete remission after COVID-19 vaccination in a patient on immunotherapy/low glycemic diet. Research is needed to study the contribution of a COVID-19 inflammatory response.
Clinical Presentation
A 58-year-old male was diagnosed 6 years ago with stage IV clear cell renal carcinoma (multiple lung nodules and mediastinal adenopathy). He was offered sunitinib, a tyrosine kinase inhibitor, and achieved a partial response with stable disease. Five years later his scans showed worsening disease. Cabozantinib was offered but was poorly tolerated. He tried ipilimumab plus nivolumab but ipilimumab was dropped after 4 cycles due to diarrhea. His scans improved with 4 more cycles of nivolumab but he had to stop immunotherapy due to hypophysitis, diarrhea, and severe jaw pain. He received a COVID-19 booster vaccine and noticed profound fatigue and anorexia soon after. Over 8 weeks he lost 56 lbs (267 to 211 lb). Relapse was suspected but PET CT showed complete resolution of his lung nodules and multiple areas of adenopathy. Asymptomatic and in remission 6 months after vaccination.
Relevant Literature
Clear cell renal carcinoma is resistant to standard chemotherapy/radiation, which usually offers partial responses. Complete remissions are few. Low glycemic diets in animal models have anticancer activity. HIV causes B cell apoptosis. Coxsackievirus A21 oncolytic properties lyse myeloma and CD138+ plasma cells via intercellular adhesion molecule interaction. SARS-CoV-2 (COVID 19) proteins have oncolytic properties.
Intervention
The patient eliminated sugary food from his diet 6 years ago. Stopped bread 2 years ago. Sunitinib 37.5 mg daily × 5 years. Cabozantinib—poorly tolerated. Ipilimumab + nivolumab × 4 cycles followed by nivolumab × 4 cycles. Stopped treatment; immune side effects. COVID-19 booster.
Outcome
15 lb weight loss due to a low glycemic diet, which began since diagnosis. After 4 years he stopped eating bread. After COVID-19 vaccine had a rapid 56 lb. weight loss, fatigue, and nausea over 8 weeks. No evidence of disease. Asymptomatic, off therapy, weight is ideal (219 lb) 6 months after the vaccine.
Implications for Practice
Effects of SARS-CoV-2 (COVID-19) on cancers remain unknown. A few case reports of cancer remissions after infections are emerging. This is the first case of complete remission after COVID-19 vaccination in a patient on immunotherapy/low glycemic diet. Research is needed to study the contribution of a COVID-19 inflammatory response.
Clinical Presentation
A 58-year-old male was diagnosed 6 years ago with stage IV clear cell renal carcinoma (multiple lung nodules and mediastinal adenopathy). He was offered sunitinib, a tyrosine kinase inhibitor, and achieved a partial response with stable disease. Five years later his scans showed worsening disease. Cabozantinib was offered but was poorly tolerated. He tried ipilimumab plus nivolumab but ipilimumab was dropped after 4 cycles due to diarrhea. His scans improved with 4 more cycles of nivolumab but he had to stop immunotherapy due to hypophysitis, diarrhea, and severe jaw pain. He received a COVID-19 booster vaccine and noticed profound fatigue and anorexia soon after. Over 8 weeks he lost 56 lbs (267 to 211 lb). Relapse was suspected but PET CT showed complete resolution of his lung nodules and multiple areas of adenopathy. Asymptomatic and in remission 6 months after vaccination.
Relevant Literature
Clear cell renal carcinoma is resistant to standard chemotherapy/radiation, which usually offers partial responses. Complete remissions are few. Low glycemic diets in animal models have anticancer activity. HIV causes B cell apoptosis. Coxsackievirus A21 oncolytic properties lyse myeloma and CD138+ plasma cells via intercellular adhesion molecule interaction. SARS-CoV-2 (COVID 19) proteins have oncolytic properties.
Intervention
The patient eliminated sugary food from his diet 6 years ago. Stopped bread 2 years ago. Sunitinib 37.5 mg daily × 5 years. Cabozantinib—poorly tolerated. Ipilimumab + nivolumab × 4 cycles followed by nivolumab × 4 cycles. Stopped treatment; immune side effects. COVID-19 booster.
Outcome
15 lb weight loss due to a low glycemic diet, which began since diagnosis. After 4 years he stopped eating bread. After COVID-19 vaccine had a rapid 56 lb. weight loss, fatigue, and nausea over 8 weeks. No evidence of disease. Asymptomatic, off therapy, weight is ideal (219 lb) 6 months after the vaccine.
Implications for Practice
Effects of SARS-CoV-2 (COVID-19) on cancers remain unknown. A few case reports of cancer remissions after infections are emerging. This is the first case of complete remission after COVID-19 vaccination in a patient on immunotherapy/low glycemic diet. Research is needed to study the contribution of a COVID-19 inflammatory response.