In the early years of my career, I've mainly focused on two things: treating patients and doing research. But over the past year I've also developed an interest in helping to promote high-quality cancer care, a quest that led to the development of this website.
For cancer patients, getting top-notch cancer care is very important and can directly impact the chances of treatment success. But most patients are unaware of the importance of getting good-quality treatment, and don't know how to make sure that the treatment they are receiving is indeed the best available.
A website alone can't provide enough of the detailed information needed to help patients get top-notch care. Websites tend to be consumed in small, blog-sized bites. Longer, more-detailed posts are often skimmed or ignored. So last year, my wife Cheryl and I came up with the idea that patients really need a 'how-to' manual, a book to help them get good-quality cancer care.
So I put together a proposal for the book, which was picked up by a superstar literary agent in California. She found a home for the idea at New Harbinger publications.
The book is called Taking Charge of Cancer, and it will be published on July 1. It is already listed on Amazon. The book includes a foreword by Dr. Anthony Zietman. Dr. Zietman is a Harvard Professor and editor of one of the major journals in our field. Last month, he was the recipient of an ASTRO Gold Medal for his outstanding lifetime contributions to our field.
There are thousands of books about cancer treatment, but as far as I know, this is the only book specifically geared toward helping patients get high-quality treatment. Here are some of the topics covered in the book:
The book includes an online Patient Toolkit, with helpful videos that guide patients through many of the steps described above.
My other goal in writing this book is to improve the lives of future patients through cancer research. So I've signed off all the author royalties to the London Health Sciences Foundation, to be used for cancer research in London. The LHSF's fundraising efforts have made a major impact on cancer care and research, and this book will help them advance their goals a little bit further. The hundreds of hours spent writing this book has been a volunteer effort for me.
I've already shared early drafts of the book with some friends and colleagues, who have provided valuable input. I look forward to sharing the book with the rest of the world in July!
Surgery, radiation, or observation - which is best? Two big studies published this summer will change the way doctors and patients choose between treatment options.
Prostate cancer is one of the most common cancers in men, affecting more than one in seven males. Over the past two decades, there have been big debates over the optimal treatment approach. Treatment options include surgery, external radiation, internal radiation, and close observation (often called active surveillance or monitoring). Until now, doctors have not had good data to compare these options.
Making things more complicated, a new type of surgery, called robotic surgery, has taken off in popularity, About 80% of the prostate cancer surgeries done in the U.S. now use the robot, adding about $5,000 to the cost of each surgery. Although the robotic approach has been touted as a way of reducing side effects and perhaps improving cure rates, the science to support its use has lagged behind its popularity.
Two new studies published this summer have gone a long way toward tackling these questions. They are both randomized studies, which are viewed as the strongest study design in medicine. Randomized studies assign patients to different treatments groups at random (like flipping a coin), allowing for fair comparisons between treatment options. You can read more about the importance of randomized studies here.
Prostate Surgery: Robot or Not?
The first randomized trial compared two approaches in men having surgery for prostate cancer: robotic surgery vs. open surgery. Open surgery is the traditional approach, where the surgeon makes a standard incision, almost always in the lower abdomen. Researchers in Australia enrolled 326 men aged 35-70 with prostate cancers that had not spread outside the prostate, and all men had a PSA test measured at no higher than 20. Half of the men were assigned to receive robotic surgery and half were assigned to receive open surgery. The main outcomes that the researchers wanted to examine included urinary and sexual function after treatment.
When comparing these two groups of men after treatment, those who received the robotic surgery vs. those who received the open surgery, there was no difference in urinary or sexual function at 6-weeks or 12-weeks post-surgery. The authors also looked at the rates of "positive margins", meaning that the tumor came to the edge of the surgical specimen, a finding that raises concerns that some tumor is left behind. The positive margin rates were similar in the two groups - 15% in the robotic group and 10% in the open group. The robotic approach did have some minor advantages, including less blood loss (although no one in the open group needed a transfusion), but these are considered much less important than the main outcomes.
We are awaiting the long-term data from this trial, including the outcomes at two years post-surgery. But this early data suggests that there's not a big difference between the two approaches. In the words of the authors: "In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach."
Read more about picking a good surgeon.
Surgery, Radiation, or Observation?
The second trial, done in the UK, took a broader approach and compared three options for prostate cancer: surgery, external radiation, or active monitoring. Active monitoring means holding off on treatment until it becomes clear that the cancer is progressing. The trial enrolled 1643 men aged 50-69 who had prostate cancer detected by PSA testing and had not spread beyond the prostate.
The men were each assigned to one of the three groups (surgery, radiation, or active monitoring). The main purpose of the trial was to look at the rates of death from prostate cancer at 10 years, and there were no differences found. In each group, only about 1% of patients had died of prostate cancer by 10 years. And the chances of dying from anything within 10 years was also very similar in all three groups, around 10%.
The advantage of the active monitoring group is apparent: almost half of the patients in that group (45%) still didn't need any treatment 10 years later. Because they were able to delay or avoid treatment, the active monitoring group did better in many of the quality of life outcomes (such as sexual function and urinary continence). The disadvantage of the active monitoring group is that they had a higher chance of the cancer spreading elsewhere in the body, but that risk was very low, about 0.6% per year.
The Bottom Line
These two studies provide valuable information that will help patients diagnosed with prostate cancer. To me, the bottom line is this:
The crowd of almost 10,000 people at last night's Tragically Hip concert knew that it would be a special night. The concert was scheduled to start at 8:30 PM, but almost everyone was in their seat early. When the band stepped on stage in a blaze of lights and sound, the crowd roared its approval, the cheers louder than at any concert I'd been to before.
Gord Downie and the Tragically Hip perform in London, Ontario, August 8, 2016.
The Tragically Hip did not disappoint, performing for more than two hours in a high-energy concert capped with an emotional goodbye to their London fans, Singer Gord Downie was perfect. Although everyone in the room was aware of Downie's recent diagnosis of a brain cancer called glioblastoma, his performance was unaffected - he was his normal, musical-genius self.
For a generation of Canadians, the Tragically Hip is the band that wrote the soundtrack to our lives. With a career spanning more than 30 years, including 13 albums, they have been part of our culture since we were little kids. Their songs bring back golden memories of the major events in our lives: high-school dances, summer campfires, times with friends, and even weddings.
The news that a Canadian legend has been diagnosed with an incurable brain tumor has led to an outpouring of support online, including a petition for Downie to be awarded the Order of Canada. The petition currently has almost 70,000 signatures and hopefully will spur our government to act. Downie has also launched the Gord Downie Fund for Brain Cancer Research at Sunnybrook, a world-leading centre in the research and treatment of brain tumors.
The research is badly needed. Glioblastoma is a rare tumor - only occurring in 2-3 adults per 100,000 every year - but it is one of the most difficult cancers to treat. Even the most aggressive treatment, which is a combination of surgery, radiation and chemotherapy, doesn't achieve the results that we need. We've lost several important people to brain cancers, including U.S. politician Ted Kennedy, and O.J. Simpson lawyer Johnnie Cochrane.
Watching the concert yesterday, I was blown away by Downie's courage. Despite facing an extremely difficult diagnosis, he is giving Canadians the chance to say goodbye. He is using his stature as a way to raise money to help other patients diagnosed with cancer.
The band's last song was Fiddler's Green, a song written as a tribute to Downie's nephew who died as a child. In Irish legend, Fiddler's Green was a place where old sailors would go in the afterlife, a place of never-ending happiness and a fiddle that never stops playing. When the music ended, Downie waved one last goodbye to the adoring crowd and walked off down the tunnel.
Let's walk with him. Please sign the petition and donate to Gord's cause.
A guest article from former naturopathic doctor Britt Marie Hermes.
What is a licensed naturopath?
Licensed naturopaths attend four-year post-graduate naturopathic programs. There are seven programs in North America, two of which are in Canada. The Boucher Institute of Naturopathic Medicine is located in British Colombia and the Canadian College for Naturopathic Medicine is located in Toronto. All seven North American naturopathic programs are accredited by the Council on Naturopathic Medical Education (CNME).
Naturopathic programmatic accreditation means that procedural and operational standards related to organizing and running an academic program have been approved by the CNME. The CNME is not affiliated with the North American organization that sets the standards for conventional medical schools. The naturopathic curriculum is not evaluated by government organizations.
As of 2016, 18 U.S. states and five Canadian provinces have regulated naturopathic practitioners. The registered provinces include British Colombia, Alberta, Saskatchewan, Manitoba, and Ontario. In a licensed jurisdiction, naturopaths may call themselves naturopathic doctors (N.D). In unlicensed jurisdictions, naturopaths are not permitted to practice medicine or call themselves doctors or physicians.
There are considerable legal risks for naturopaths practicing without a license.
The naturopathic belief system
Naturopaths believe that the forces of nature can cure disease. Naturopaths refer to this power as the “vis,” which they claim resides inside the human body. Other systems of pre-modern medicine have similar ideas about healing energies. In traditional Chinese medicine, it is called qi. In Ayurvedic medicine, it is called prana.
In naturopathy, the vis is manipulated using treatments that are based on food, water, plants, minerals, and physical contact. The mainstay naturopathic therapies are nutrition, hydrotherapy, herbal medicine, spinal manipulation, homeopathy, and traditional Chinese medicine. Some naturopaths utilize methods and substances that are more familiar to modern medicine, including intravenous injections and pharmaceutical drugs.
Naturopathic training is commonly described as being “similar to medical doctors.” This phrasing can be misleading to patients who are not familiar with modern medical training.
Naturopathic students complete a minimum of 850 hours in a naturopathic clinic and see at least 450 patients. This training primarily takes place in a clinic affiliated with a naturopathic program. Naturopathic clinics are out-patient clinics, which means patients are not hospitalized. Emergency medicine and urgent care are not offered in naturopathic clinics.
A residency is not required for naturopaths to practice. After a naturopathic student graduates, he or she may move directly into practice after passing two licensing exams that primarily focus on testing knowledge about naturopathic therapies and philosophy, such as homeopathy and herbs.
In comparison, medical doctors (MDs) complete the majority of their clinical training in a university hospital. Medical students are exposed to thousands of patients across specialty areas. This exposure ensures a comprehensive medical education. Medical students are required to pass three sets of licensing exams, depending on their country of training, including a clinical skills part that tests the clinician’s physical exam and diagnostic skills, in order to become licensed. A medical residency is usually compulsory in order to practice in any field of medicine.
After completing a medical residency, the MD can then choose to become board certified in a specialty, which requires demonstrating clinical expertise and another comprehensive specialty exam. The average physician has completed about 20,000 hours of clinical training and has seen tens of thousands of patients during his or her medical education.
Naturopathic training in cancer care
Naturopathic students take one lecture course (about 20 classroom hours) in cancer care. In my course at Bastyr University, I was taught that no natural substance has been proven to cure cancer.
Most naturopaths start practicing directly after passing their licensing exams and can immediately go on to consider themselves cancer specialists. Some naturopaths choose to complete a voluntary residency program in naturopathic oncology. These residency positions are typically two years long, and are sponsored by clinics that provide alternative cancer therapies to patients in an out-patient setting.
Residents in naturopathic cancer care learn practices that are delivered independent of, or alongside, modern medical care. They do not learn how to prescribe or use radiation, surgery, or chemotherapy.
After completing a residency in cancer care, a naturopath can take a certification exam administered by the American Board of Naturopathic Oncology to become a fellow and place “FABNO” after his or her name. Those who have not completed a residency may also sit for the exam if they have many years of experience practicing naturopathic cancer care. Thus, not all naturopaths with the FABNO title have completed naturopathic residency training, and not all naturopathic “oncologists” have the FABNO credential.
What is naturopathic cancer care?
Naturopathic cancer therapies are not a part of standardized medical protocols that are set by evidence-based guidelines, common medical practice, or scientific consensus.
Naturopathic cancer care comes in a variety of packages and flavors. There is no such thing as a typical naturopathic treatment plan. Since naturopathic protocols are not standardized, plans are fluid, usually picking up and eliminating various therapies as treatment is underway.
Patients often visit their naturopath for treatment two to three times per week, for stretches as long as twelve months, or even several years. When conventional cancer treatments have ended, naturopaths often recommend that patients still receive naturopathic therapies a few times per month, indefinitely. Most naturopaths believe these treatments are necessary to prevent cancer recurrence.
Common language used to describe naturopathic cancer treatments
Naturopaths tend to use an attractive set of phrases to describe natural cancer care. When looking at naturopathic clinic websites, you will likely read statements like these:
It is important to remember that no natural treatment has been scientifically proven to effectively treat cancer [1,2].
What does science say about some of the most common naturopathic treatments?
The cancerous process is very complex, and involves the breakdown and dysregulation of many molecular processes simultaneously . Sometimes cancer is related to a heritable genetic defect . Other times, it is just bad luck .
Common naturopathic therapies include strict diet changes, intravenous injections with high-dose vitamin C, injections with the herbal substance Mistletoe, and treating your blood with ozone gas.
Strict Diet Changes
The most ubiquitous naturopathic recommendation for cancer is a strict diet to reduce or eliminate foods that are believed to promote cancer growth or weaken the body’s immune system. Example diet recommendations include:
The most common diet recommendation is to avoid sugar. This recommendation is based on a belief that sugar “feeds” cancer cells . This is based on laboratory experiments that showed cancer cells “take-up” more sugar compared to healthy cells, as cancer cells have a higher metabolic rate than the average healthy cell .
Excessive sugar intake does have negative health consequences, namely, obesity . There is an increased risk of cancer due to obesity, which is a complex process that is caused by multiple behavioral, environmental, and genetic risk factors . There have been no conclusive studies directly linking sugar intake to increased cancer risk, and no studies have shown that sugar-free diets are associated with increased survival rates in cancer patients [10,11].
Following a strict diet can have negative consequences. Chemotherapy often results in significant weight loss. A diet that makes it difficult to eat typical meals may exacerbate muscle loss and wasting. Patients adhering to restrictive diets sometimes report a decrease in their quality of life from stress related to adhering to the diet [12,13]. There may be an increased cost of food associated with special diets . Patients may also feel unable to participate in social gatherings, due to their diet restrictions, which can translate to feelings of depression, isolation, and loneliness .
It is generally recommended to eat a well balanced diet, rich in fruits and vegetables, and to follow specific instructions from your medical doctor.
Intravenous High-Dose Vitamin C (IVC)
Vitamin C, also called L-ascorbate or L-ascorbic acid, is used by naturopaths for all types of cancers. It is injected intravenously in order achieve very high doses in the blood that are not attainable through oral supplementation .
Naturopaths believe high-dose vitamin C has many therapeutic actions, including:
These claims are based on the understanding of how vitamin C normally functions in the body. At low or moderate levels, vitamin C is an anti-oxidant and is essential for the production of collagen .
At high doses, vitamin C no longer works like an anti-oxidant. Instead, it makes reactive oxygen species, including hydrogen peroxide . In laboratory experiments and studies on rodents, this hydrogen peroxide has been shown to kill cancer cells, but safety and effectiveness has not been demonstrated in human trials [19-23]
Justification for using high-dose vitamin C in cancer patients is based predominately on case studies and trials that have not been controlled . These types of studies are considered weak forms of evidence and their findings should be taken with a grain of salt.
The evidence for improving a patient’s quality of life is limited; further studies are needed to know for certain what the effect of high-dose vitamin C has on a patient’s well-being 
High-dose vitamin C has also been shown to decrease the effectiveness of certain chemotherapy agents [25-28]. It is essential to inform your medical oncologist if you are receiving high-dose vitamin C while undergoing chemotherapy or radiation.
High-dose vitamin C is generally well-tolerated by patients . From my experience, common side effects include dehydration and increased thirst, pain and redness at the injection site, and feeling tired.
Mistletoe (Viscum album) is a naturopathic treatment commonly used as a supportive cancer therapy. Naturopaths claim that mistletoe may increase patient survival and improve one’s quality of life [29,30] In petri dish experiments, mistletoe has shown anti-cancer effects [31-36]. In human experiments, mistletoe has been suggested to increase the activity of the immune system through increasing the number of white blood cells and special immune chemicals called cytokine . Mistletoe is usually delivered in a small injection under the skin .
Mistletoe is popular in European countries, especially Germany and Switzerland. As a result, mistletoe is frequently marketed as a “European” cancer drug . The U.S. FDA does not approve mistletoe for use, even in homeopathic forms. This means it is not legal for medical providers to import mistletoe into the U.S.A. It is possible to receive mistletoe treatments in some Canadian provinces.
Common side effects from mistletoe injections include pain and irritation at the injection site  Flu-like symptoms, fevers, headaches, and chills are often reported .
Since mistletoe is not available for use in the United States, I have limited experience with this therapy. I am aware that American naturopaths import mistletoe from overseas and teach patients how to administer injections themselves at home. If an American naturopath offering this therapy, please be aware that in doing so, the naturopath may be breaking U.S. laws.
Ozone therapy is marketed for just about everything, including all types of cancer. It is most commonly associated with claims related to boosting the activity of the immune system .
Ozone (O3) is a gas made up of three oxygen molecules . Ozone is a very strong oxidizing molecule that can form products known to be damaging to the respiratory system . Ozone is categorized as a toxic gas and environmental hazard .
Ozone is delivered to patients in a variety of ways, including through the nose, ear, mouth, rectum, vagina, and skin, but for cancer treatment, ozone is most often delivered via autohaemotherapy . In this method, blood is taken out of a patient. This blood is then treated with ozone gas. The treated blood is then injected back into the patient [37,41]. Autohaemotherapy carries significant risks; some patients have died from this application, and as a result, autohaemotherapy with ozone has been illegal in Germany since 1984 [37,42].
The rationale for ozone use in cancer is based on a theory from the 1930s that demonstrated cancer cells can live and grow easily in low-oxygen environments inside the body  It is suggested that applying ozone gas to the blood will bring more oxygen to the cancerous tumor, thus causing cancer cells to die. However, tumors are very heterogeneous . While some cancer cells within a tumor potentially prefer a low oxygen environment, others readily thrive in the presence of oxygen .
The U.S. FDA and Health Canada do not allow manufacturers to advertise or sell ozone generators for medical use [45,46].
Editor's note: You can read more about these specific naturopathic compounds, and others, at the U.S. National Cancer Institute Website.
If you are considering naturopathic treatments
Patients should bear in mind that complementary and alternative therapies are not risk-free. There is preliminary evidence showing cancer patients who used complementary and alternative therapies in addition to conventional care experienced a decrease in the quality of their life .
Additionally, patients undergoing complementary and alternative treatments in conjunction with conventional treatments did not live longer compared to cancer patients receiving conventional treatment alone . A 2003 study from Norway reported patients undergoing complementary and alternative treatments died sooner than patients who did not integrate complementary and alternative methods into their cancer care .
In order to help you make an informed decision about naturopathic cancer care, I have compiled a short list of questions to ask your naturopathic provider:
Ask for the above answers to be provided to you in writing.
It is also essential to document your treatment plan. Naturopathic patients are often uncertain about which substances they are receiving. To assist with keeping track of your care, you can do the following:
If your naturopath asks you to keep your care secret, or asks you to stop seeing your oncologist, consider this a red flag for inappropriate treatment and medical misconduct.
Finally, and perhaps most importantly, take your time in deciding to pursue naturopathic cancer care. There should be no rush to implement naturopathic therapies, as no natural therapy has ever been proven to cure cancer.
Today, I no longer consider myself a naturopathic doctor. I left my practice after I discovered my former boss was importing a non-FDA approved substance called Ukrain, and delivering it to terminally ill cancer patients. I retired after I learned more about the lack of evidence and risks associated with naturopathic treatments.
In my former practice, patients would often ask me hypothetically whether I would recommend naturopathic treatment to my family members.
My answer is still “No.”
Read more articles by Britt Marie Hermes on naturopathic medicine at naturopathicdiaries.com
Susan McPeak-Sirois, a former cancer patient who co-chairs the Quebec Breast Cancer Foundation’s 20th anniversary fundraising campaign, said in a Montreal Gazette article:
"It's well known that patients in clinical research trials do better than those who aren't."
It made me wonder: What in her experience led to this belief? Do cancer patients who enroll in clinical trials do better than those who don't?
I have read a lot of marketing material for clinical trials and cancer research, but I'd never seen 'better care' listed as one of the benefits of joining a trial. Of course any health care team would provide the same level of care for all their patients, regardless of whether they join a trial, would they not? I am sure that Research Ethics Boards would not approve any patient information that would suggest that by participating in a clinical trial a patient would get better care.
So what would make someone think they would ‘do better’ in a clinical trial?
I had my a-ha moment during a patient's presentation at the Cancer Quality Council of Ontario meeting. The patient spoke about how frustrating it is to wait by the phone to receive calls for test appointments. In his experience, the biggest challenge in getting cancer treatment was time management. His idea of an ideal patient-centered care approach would be to have a ‘specific time frame for treatment…so we could actually plan our lives’. In other words, if you are going to have a cancer journey, why not start out with a good map? I believe that a clinical trial provides that map.
The benefits of a clinical trial
A surveyof patients who completed clinical trials reported that the large majority - 89% - would consider participating in another clinical trial. Why was this percentage so high? Having to stick around after chemotherapy to provide multiple blood samples can't be enjoyable. Additional tumor biopsies are not fun. Going to the center for more visits and to fill out multiple questionnaires does not fit well into a good work/life balance. What positive experiences of a clinical trial would make a patient want to participate again?
If you do a literature search asking 'Do you get better care on a clinical trial?’ there are several academic articles that pop up. Some might suggest that clinical trial patients have better survival outcomes, but there is no definitive answer in any of these articles, However there is one common theme. No study that I've seen says that clinical trial patients do worse. One study’s conclusion even recommended patients to insist on treatment as part of a protocol.
When putting all these ideas together, I started to connect the dots. The difference is two things: structure, and personal touch.
As referenced in the Quality Council presentation, patients want structure in their treatment. Where do clinical trial patients find this structure? In the consent document. The document may be a long read, but it spells out the expected length of time for participation, a description of all the procedures that will be completed, possible side effects, and more.
The clinical trial also follows a protocol, which is like a recipe for the health-care team. The protocol describes, in detail, the plan for conducting the clinical study and how to carry it out. Any deviations from treatments, tests, scans, visits, or timing in the protocol must be well-documented and in some cases reported to an Ethics Board or other oversight groups. No one likes to do extra paperwork, so someone must be making sure all the treatment, tests, and scans are being done, and done on time.
The personal touch comes from the clinical research coordinator (CRC). It has been said that the CRC is the heart and soul of the research study and plays a significant role in the success. This is the person who makes sure all the tests, and scans are being done on time. In most clinical trials, patients spend more time with their CRC than their doctor. Even after patients complete their participation in treatment part of the clinical trial, the CRC will continue to follow up with the patient to monitor their progress.
As for all the extra tests, scans, and questionnaires that a clinical trial participant has to complete, is there a benefit to the patient? I think so. Who would not welcome all the extra requirements if it meant being more closely monitored, and knowing as soon as possible if there is a change in their disease or how their treatment is working?
How to find a clinical trial
Is a clinical trial perceived as better care? Maybe, but sometimes perception is reality. If 89% of clinical trial patients want to participate in another clinical trial, I think it's more than just for altruistic purposes.
Am I biased because I am part of a clinical research team? Yes! However, I have seen the difference and I believe clinical trials provide what many patients are looking for in their treatment. For some people, the structure and additional personal touch of a clinical trial is considered better care.
Ultimately, it is up to each patient to decide whether participating in a clinical trial is right for them. If the ‘better care’ is perceived or real, it is worth considering a clinical trial.
There are many ways to find clinical trial information, but I recommend http://itstartswithme.ca in Canada and the National Cancer Institute website in the U.S. You can also talk to your doctors: ask them if any clinical trials would be appropriate for you.