What Now? Navigating Cancer Treatment During A Possible COVID-19's Second Wave
Dr. Eugene Ahn is a board-certified oncologist who graduated from Yale College in 1993. He completed his medical school education at the University of Miami Miller School of Medicine and an Internal Medicine residency at the University of Utah. He also completed an Infectious Disease, Hematology/Oncology & Microbiology/Immunology Fellowship at the University of Miami. In addition to his extensive medical training with expertise in two medical specialties, Dr. Ahn practices a unique approach to medicine with a focus on Integrative Oncology. He shares with us some insights about his unique skills and approach to patient care as well as tips for helping oncology patients navigate these unprecedented times.
What is Integrative Oncology?
myDoqter: The Covid Pandemic has certainly impacted every aspect of our society in 2020 so we thank you for joining us to share your expertise on how the pandemic has affected oncology patients, Dr. Ahn. Before we get to specific issues around Covid, can you share with us your background and your emphasis on an integrative approach to treating patients?
Dr. Ahn: I'm a breast oncologist and have a breast cancer practice with Cancer Treatment Centers of America Chicago and also serve as the deputy director of clinical research at CTCA enterprise wide. I joined CTCA because they truly have been the industry's pioneer in providing the purest in integrative oncology care. But for those reading, what is integrative oncology exactly? I serve as a co-chair for the Communications Committee in the Society of Integrative Oncology - so I feel an obligation to share the official definition:
Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.
In other words, it's just outstanding, 5-star, comprehensive treatment of the individual with a cancer diagnosis. Unfortunately, since we are in a country led by reimbursement-based medicine, very few patients today will experience true integrative oncology care unless they assemble their own team and pay out of pocket for a lot of services, often with providers at other locations/organizations.
For example, as a breast cancer patient, you are far more likely to hear an oncologist suggest you take an antihormonal therapy to reduce risk of breast cancer by 50% than increase your exercise by 10-20% over baseline for a 45% reduced risk. Both are true, but why the bias to antihormonal therapy if exercise has a lot fewer side effects and a lot of benefits outside of just breast cancer risk? Answer is again reimbursement-based medicine.
So integrative oncology - the true goal of this field - is to reshape our current systems of care so that they truly reflect the current science of what defines truly comprehensive cancer care. The moment we do this, we will see a much more trustworthy relationship between patients and medical providers.
How has the Covid Pandemic Affected Oncology?
myDoqter: Thank you for that informative reply. We are seeing that patients are more interested in treatments that look at the whole person! As far as the pandemic goes, how has the Covid crisis affected your practice and the approach to patient care? Are there specific considerations and precautions that need to be taken prior to administering chemotherapy and/or other immune modulating treatments?
Dr. Ahn: Obviously we have all seen the changes that are pretty standard at medical clinics - 6-foot distancing, mandatory masks, and screening for symptoms and temperature before entering the main building/elevators. I am not nearly as fearful as I was in March of 2020 about giving chemotherapy or immunosuppressive therapy because our experience has been actually quite positive. I have not lost anyone getting curative intent chemotherapy to COVID19 despite three testing positive.
Interestingly, it is our standard of care for breast cancer to check a vitamin D25 level and if low, immediately replace it as epidemiological data is very compelling that there is a linear relationship to breast cancer with vitamin D25 level, and that fixing it lowers future cancer risk. The three patients of mine that got COVID during curative intent chemo had very limited illness (3 days of muscle aches with mild fever, no shortness of breath or lung manifestations) and were confirmed with nasal swab PCR.
It turns out though, and this is why it's so important to be scientific, because a lot of what we assumed to be the case with COVID19 risk for cancer patients turned out to be untrue, that patients who got immunotherapy (to boost their immune response against cancer) were actually more likely to die of COVID-19 infection.
Practical Tips for Oncology Patients and Covid
myDoqter: Are there any special precautions that oncology patients should be taking regarding Covid in addition to following the recommended guidelines for the general public?
Dr. Ahn: I recommend everyone to get a vitamin D25 level checked with their primary care physician and if low, take 5000iu/d D3 on a full stomach preferably since it is a fat-soluble vitamin, and have it rechecked in 3mo or so to make sure it is responding (and not overshooting as too high a level can have a higher risk of kidney stones). The research papers that have come out since the COVID pandemic started are too compelling (the association of low vitamin D and serious illness with COVID19) to ignore, and if you are low on vitamin D you likely will only feel more energy and alert and be less likely to get those "winter doldrums".
I will be reviewing evidence supporting vitamin D supplementation to reduce serious illness with COVID19 in late January as a webinar. Stay tuned and follow @integrativeonc or myself on Twitter for announcements!
myDoqter: What would you say are the most important points that oncology patients should know in navigating their conditions and their care in this time?
Dr. Ahn: If you are under age 70, the cancer is likely a much greater threat to your longevity and wellness than COVID19. Social distancing, mask wearing works, and reduces risk of transmission from someone who is positive from as high as 90% to 2%. The greatest risk of transmission is indoors, so do not let the fear of COVID19 stop you from going for a walk outside, enjoying nature, etc. The greatest risk of transmission is not in hospitals since they tend to be very rigorous with screening, but in restaurants, bars, large indoor social gatherings. But do take advantage of telemedicine when appropriate! One of the silver linings is that telemedicine is now mandatory for coverage by insurance, and this has been a big boon for CTCA since a lot of our patients travel long distances to see us and fly.
Mind-Body Medicine in Cancer Patients
myDoqter: You have a special interest in Mind Body medicine. Could you give us some very practical tips on what this means and what actions we can take to promote wellness?
Dr. Ahn: Going through training to be a physician is a school of hard knocks, and a trial by fire, and I was not immune to the common mental and physical health issues that trainees go through. I have suffered severe clinical depression but also found my way out of it through mind-body practices such as mindfulness and journaling. From that whole journey I can share a few tips:
One simple rule - you are what you put your attention upon. So, if you dwell on the future possible development of recurrent cancer (or any negative event) than you physiologically are experiencing that event in the present moment (feeling stress of having that news given).
Second rule - have a curiosity about why your mind is focusing on whatever it is focusing on. This will lead to insights that "I am thinking about this...because I believe X". For cancer survivors, sometimes that belief will be something like "My mother died of cancer, so I believe I am going to die of it too". So, the solution is to remove this core belief, that a mother's fate determines the daughter's fate. That is only possible though when you recognize that you have the belief.
By realizing you chose the belief (consciously or not) you have acquired the ticket to healing because now you have the choice to give up or release that belief as no longer being for your benefit. And so, begins a process of include and transcend as a healing process (owning up to the belief, then choosing consciously to transcend that belief as no longer defining you)
Unfortunately, this cannot be done without doing the real conscious work. It means confronting emotions that we tend to prefer to push away. So, it feels counterintuitive to the way we normally operate in a given day. Our society celebrates avoiding emotions through alcohol, cigarettes, pharma, and comfort food versus the inner practices. But the more we are present with our emotions the more we will start to see the language behind them. They no longer become something to fear, but a tool to help be as fully authentic to ourselves as possible.
And in a very deceptively simple way, you have a gameplan of what holistic practitioners call "peeling the onion". Making sure we live life more beautifully and pure to who we are, and not living a life that was prescribed to us by society or any other authority besides ourselves. My experience as a physician and healer has shown me that miracles happen. But the number one reason it is so "rare" is that we have been programmed by a sick society to believe we are not worthy of miracles. We need to achieve success to be bestowed with gifts and benefits. We just need to establish to ourselves, that humanity is inherently worthy, and nothing is more important for our society than to support the wellness and healthy growth of every human being on this planet.
The current scientific research says if we modify our society in a way to reflect this, we will well be on the way to curing (preventing) cancer.
featured article what now navigating cancer treatment during Covid Interview with Dr. Eugene Ahn, board certified oncologist, with My Doqter.
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