Medical treatment is considered necessary as it aims to achieve a cure for any disease allowing the individual to live long. In cancer, if the medical treatment is ineffective in curing the disease, it shows efficacy in reducing the symptoms by reducing the tumor size and slowing down cancer growth. The medical treatment in cancer depends upon various factors such as type of cancer, stage of cancer, the patient’s health and preference as per the patient’s medical condition. The common approaches for medical treatment in cancer include:
Surgery: It aims to remove cancer. It is the most common type of treatment. The surgeon is responsible for removing the mass of cancerous cells and nearby tissues. It is mainly done to relieve the side effects caused due to tumors.
Chemotherapy: It utilizes drugs which are effective in killing the cancerous cells. The drugs are either given orally or intravenously. Combinations of drugs are given to the patient simultaneously or one after the other.
Radiation therapy: It uses x-rays, particles, or radioactive seeds to kill cancerous cells. Cancer cells have the capability of faster growth and proliferation when compared with normal cells in the body. Radiation therapy is capable of damaging cancer cells when compared with normal cells. It prevents the cancer cells from growing and dividing and leads to cell death. Different types of radiation therapy are available involving:
- External-beam radiation therapy
- Internal radiation therapy (Brachytherapy)
- Proton therapy
Targeted therapy: It utilizes the drugs to inhibit the growth and spread of cancer cells to other body parts. It causes less harm to normal cells when compared with other treatments. The different types of targeted therapy include:
- Monoclonal antibodies
- Small-molecule drugs
- Apoptosis inducers
Immunotherapy: It depends upon the body’s capability to fight infection while targeting the immune system. It uses substances made by the body or in a lab to help the immune system work harder or in a more targeted way to fight cancer. It enables the body to get rid of cancer cells.
Hormone therapy: It uses hormones to kill cancer cells. Surgery and drugs are used to block natural hormones. It helps slow the growth of cancer cells. The surgery involves the removal of organs that make hormones, such as ovaries or testes. The drugs are given by injection or as pills.
Cryoablation: It kills cancer cells with cold treatment. During cryoablation, a thin, wandlike needle (cryoprobe) is inserted through the skin and directly into the cancerous tumor. Gas is pumped into the cryoprobe to freeze the tissue. Then the tissue is allowed to thaw. The freezing and thawing process is repeated several times during the same treatment session to kill the cancer cells.
Hyperthermia: It uses heat to damage and kills cancer cells without harming normal cells. The heat is delivered from a machine outside the body or through a needle or probe placed in the tumor. It includes:
- Local or regional hyperthermia
- Hyperthermic intraperitoneal chemotherapy (HIPEC)
- Hyperthermic intrathoracic chemotherapy (HITHOC)
- Whole-body hyperthermia
Laser therapy: It uses an arrow, a focused beam of light, to destroy cancer cells. It is often given through a thin, lighted tube inside the body. Thin fibers at the end of the tube direct the light at the cancer cells. Lasers are also used on the skin.
Radiofrequency ablation: It utilizes electrical energy to heat cancer cells, resulting in cancer cells’ death. During radiofrequency ablation, a thin needle through the skin or an incision is passed into the cancer tissue. High-frequency energy passes through the needle and causes the surrounding tissue to heat up, killing the nearby cells.
Chromodulation therapy: It involves the integration of chemotherapy drugs at optimal times during the entire day at which cancer cells become more susceptible and less likely to be damaged by treatment.
Low-dose metronomic chemotherapy: The administration of metronomic chemotherapy is prolonged, repetitive and frequently by providing low doses of chemotherapy drugs. It involves several advantages involving the interference with the ability of cancer to create its essential blood supply and reducing the ability of cancer to become resistant.
- Clinical evidence:
The clinical evidence has shown efficacy in working against cancer growth or spread, improving survival, or working with other treatments or therapies to enhance their anticancer action. Some of them are discussed below:
- Surgery has shown efficacy at an early stage of cancer, followed by radiation therapy and chemotherapy (Arruebo et al., 2011).
- Targeted therapies have been effective in promoting cell survival and targeting cells that control whether cells live or die (Luo et al., 2003).
- Cryoablation shows efficacy in treating benign and malignant primary tumors (Gage et al., 1998).
- Improved survival rates have been observed in the case of glioblastoma while integrating multimodal immunotherapy (Van Gool et al., 2018).
- The hyperthermia therapy shows a good tolerance level with intensity-modulated radiotherapy in the case of esophageal cancer (Liming et al., 2017).
- Radiation therapy effectively reduces cancer cells’ ability to proliferate by damaging the DNA (Jackson & Bartek, 2009).
B) Other cancer types:
Lung cancer: Following are the medical treatment used in treating lung cancer:
- Radiation therapy
- Targeted therapy
- Laser therapy
- Photodynamic therapy (PDT)
- New combinations
- Endoscopic stent placement
Skin cancer: Following are the medical treatment used in treating skin cancer:
- Excisional surgery
- Mohs surgery
- Curettage and electrodesiccation or cryotherapy
- Radiation therapy
- Photodynamic therapy
Blood cancer: Following are the medical treatment used in treating blood cancer:
- Drug therapies
- Radiation therapy
- Vaccine therapy
- Stem cell transplantation
- Blood transfusion
- Clinical trials
Head & neck cancer: Following are the medical treatment used in treating skin cancer:
- Radiation therapy
Liver cancer: Following are the medical treatment used in treating liver cancer:
- Embolization therapy
- Radiation therapy
- Targeted therapy
Pancreatic cancer: Following are the medical treatment used in treating pancreatic cancer:
- Radiation therapy
- Targeted therapy
- Clinical trials
Brain cancer: Following are the medical treatment used in treating brain cancer:
- Radiation therapy
- Targeted drug therapy
- Clinical trials
Kidney cancer: Following are the medical treatment used in treating kidney cancer:
- Radiation therapy
- Targeted therapy
- Active surveillance
- Clinical trials
Breast cancer: The medical treatment for breast cancer involves the use of drugs with the traditional mode of treatment involving:
Surgery: Mastectomy (total mastectomy, modified radical mastectomy, radical mastectomy, skin-sparing mastectomy, lumpectomy), Lymph node surgery, Breast reconstruction
Chemotherapy: Use of drugs such as
- Anthracyclines involving doxorubicin (Adriamycin) and epirubicin (Ellence); Taxanes involving docetaxel (Taxotere) and paclitaxel (Taxol)
- Combination of above drugs used with carboplatin, cyclophosphamide (Cytoxan), and fluorouracil (5-FU).
- Other drugs for advanced breast cancer includes Albumin-bound paclitaxel (nab-paclitaxel or Abraxane), Capecitabine (Xeloda), Eribulin (Halaven), Gemcitabine (Gemzar), Ixabepilone (Ixempra), Liposomal doxorubicin (Doxil), Mitoxantrone, Platinum (carboplatin, cisplatin), Vinorelbine (Navelbine)
- Combination of chemo drugs include Adriamycin and Cytoxan, Adriamycin and Taxotere, Cytoxan, methotrexate, and fluorouracil, Fluorouracil, Adriamycin, and Cytoxan, and Cytoxan, Adriamycin, and fluorouracil
Hormone therapy: Use of drugs such as
- Abemaciclib (Verzenio)
- Anastrozole (Arimidex)
- Exemestane (Aromasin)
- Fulvestrant (Faslodex)
- Goserelin (Zoladex)
- Letrozole (Femara)
- Leuprolide acetate (Eligard, Fensolvi, Lupron)
- Megestrol (Megace ES)
- Tamoxifen (Nolvadex, Soltamox)
- Toremifene (Fareston)
- External beam radiation
- Proton therapy
Targeted therapy: Use of drugs such as
- Fam-trastuzumab-deruxtecan-nxki (Enhertu)
- Lapatinib (Tykerb)
- Pertuzumab (Perjeta)
- Trastuzumab (Herceptin)
Colorectal cancer: Following are the medical treatment used in treating colorectal cancer:
- Radiofrequency ablation
- Chemotherapy: Using the drugs involving:
- Capecitabine (Xeloda)
- Irinotecan (Camptosar)
- Oxaliplatin (Eloxatin)
- Combination drug trifluridine and tipiracil (Lonsurf)
- Radiation therapy
Targeted therapy: Using drugs involving:
- Bevacizumab (Avastin)
- Cetuximab (Erbitux)
- Panitumumab (Vectibix)
- Regorafenib (Stivarga)
- Ziv-aflibercept (Zaltrap)
Immunotherapy: Using the following:
Immune checkpoint inhibitors: Nivolumab (Opdivo) and Pembrolizumab (Keytruda)
Ovarian cancer: Following are the medical treatment used in treating ovarian cancer:
- Targeted therapy
- Hormone therapy (in rare cases)
- Clinical trials
Prostate cancer: Following are the medical treatment used in treating prostate cancer:
- Radiation therapy: It involves:
- External beam radiation
- Proton therapy
- Hormone therapy
- Bisphosphonate therapy
- MRI-guided transurethral ultrasound ablation
- High intensity focused ultrasound ablation
- Pulsed low-dose-rate radiation therapy
C) Common side-effects and symptoms of medical treatment:
Surgery: Possible side-effects of surgery are caused due to the drugs used and the patient’s overall health. The more complex the surgery evolves, the more risk of side effects. Minor operations and taking tissue samples such as biopsies have less risk when compared to any more extensive surgery. Pain at the surgery site is the most common symptom among cancer patients. Infections at the site and reactions to the drugs used to numb the area (local anesthesia) are also possible. Some of the common side effects during surgery include:
- Blood clots
- Damage to nearby tissues
- Drug reactions
- Damage to other organs
- Slow recovery of other body functions
Chemotherapy: It causes side effects, mainly among those patients who are under medication or have a history of chronic diseases. The side effects of chemotherapy depend upon the drugs or combination of drugs prescribed to the patient. Some common side effects of chemotherapy include:
- Fatigue: It is the feeling tired or exhausted even after getting enough sleep.
- Hair loss: It starts after the first several weeks of chemotherapy and tends to increase 1 to 2 months into chemotherapy. The doctor can predict the risk of hair loss depending upon the drugs and doses received.
- Pain: chemotherapy causes pain, including headaches, muscle pain, stomach pain and pain from nerve damage such as burning, numbness, or shooting pains, usually in the fingers and toes.
- Mouth and throat sores: Chemotherapy damages mouth and throat cells, causing painful sores in these areas. Mouth sores usually happen 5 to 14 days after treatment. It is also important to watch for infection in these sores.
- Diarrhea: Chemotherapy causes loose or watery bowel movements.
- Constipation: Not having a bowel movement is caused due to chemotherapy. Other medicines, such as pain medication, can also cause constipation.
- Nausea and vomiting: These side effects depend on the specific drugs and dose given during the chemotherapy.
- Blood disorders: Chemotherapy affects the process of making new blood cells in the bone marrow causing side effects from having too few blood cells.
- Nervous system side-effects: Some drugs cause nerve damage. This can cause nerve or muscle symptoms such as tingling, burning, weakness or numbness, weakness, soreness, tiredness, or achy muscles, loss of balance, shaking or trembling, stiff neck or headache, problems seeing, hearing, or walking normally, and feeling clumsy.
- Changes in thinking and memory: Some people have trouble thinking clearly and concentrating after chemotherapy.
- Sexual and reproductive issues: Chemotherapy affects the fertility rate of individuals. Chemotherapy can also harm an unborn baby. This is especially true during the first 3 months of pregnancy when the organs are still developing.
- Appetite loss: It results in loss of weight and loss of nutrients that are required by the body.
- Heart issues: Some types of chemotherapy can affect heart functioning.
Radiation therapy: It causes the occurrence of early side effects and late side effects. Early side effects happen during or shortly after treatment and usually go away within a few weeks after treatment ends. The most common early side effects are fatigue (feeling tired) and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area. The late side effects can take months or even years to develop depending upon the area treated and the radiation dose used. Common side-effects of radiation therapy include:
- Fatigue: Fatigue felt during radiation treatment does not get better with rest. It can last a long time and affects the usual activities.
- Skin problems: The radiation treatment area is red, irritated, swollen, blistered, sunburned, or tanned. After a few weeks, the skin becomes dry, flaky, or itchy, or it may peel. This is sometimes called radiation dermatitis.
- Hair loss: Radiation therapy results in thinned hair or loss of hair in the region being treated.
- Low blood counts: Radiation therapy causes changes in the blood count levels by lowering the blood cells. .
Side effects of radiation therapy as per different cancer types:
- Brain cancer: Side effects include headaches, hair loss, nausea, vomiting, fatigue, hearing loss, skin and scalp changes, trouble with memory and speech, and seizures.
- Head & neck cancer: Side effects include soreness, dry mouth, trouble swallowing, change in test, nausea, earaches, tooth decay, swelling in gums, throat and neck, hair loss, changes in skin texture, jaw stiffness.
- Breast cancer: Side effects include skin irritation, breast soreness, breast swelling.
- Lung cancer: Side effects include sore throat, swallowing problems, loss of appetite, cough, and shortness of breath.
- Abdomen cancer: Side effects include nausea, vomiting, belly cramps, diarrhea and constipation.
- Bladder cancer: Side effects include pain or burning sensations, trouble passing urine, blood in the urine, and an urge to urinate often.
Targeted therapy: Side effects of targeted therapy depends on the type of targeted therapy received by the patients and how their body reacts to it. The most common side effects include:
- Problems with blood clotting and wound healing
- High blood pressure
- Mouth sores
- Nail changes
- The loss of hair color
- Skin problems such as rash or dry skin
Immunotherapy: Immunotherapy causes side effects, many of which happen when the immune system may act against healthy cells and tissues in the body. The common side effects of immunotherapy includes:
- Nausea and vomiting
- Muscle or joint aches
- Trouble breathing
- Low or high blood pressure
- Swelling and weight gain from retaining fluid
- Heart palpitations
- Sinus congestion
- Organ inflammation
Cryoablation: In the days after the procedure of cryoablation, mild symptoms such as an achy chest and discomfort or bruising in the area where the catheter was inserted are observed in the patients. Some of the common side effects of cryoablation include:
- Complications from anesthesia, such as trouble waking up or nausea.
- Damage to surrounding structures.
- Fluid collection in surrounding areas.
- Infection from any opening in the skin.
- Nerve damage leading to weakness or numbness.
Hyperthermia: It uses perfusion techniques such as heat to damage and kills cancer cells without harming normal cells. Its common side effects include:
- Blood clots
- Damage to the normal tissues
- Nausea and vomiting
Laser therapy: Laser therapy has some risks. The risks for skin therapy include:
- Changes in skin color
- Confusion after walking from the operation
- Heart attack
Radiofrequency ablation: It causes long term side effects while damaging the surrounding blood vessels and nerves during needle insertion resulting in excessive bleeding and/or irreversible neurologic damage causing long-term numbness and tingling. Heat damage to structures adjacent to the target nerve. The common side effects of radiofrequency ablation include:
- Shoulder pain
- Capsular hematoma
D) Management of the side effects of the medical treatment:
Surgery: The surgical team will take various steps to reduce your risk of side effects and surgery complications. It includes shaving and cleaning the area before cutting the skin to avoid infection, using unique leg pumps and low-dose blood thinners to avoid blood clots. Breathing treatments (respiratory therapy) to help prevent pneumonia. The information regarding the possible complications of surgery and what can and will be done to help prevent them needs to be asked from the surgeon.
Chemotherapy: The side effects of chemotherapy can be managed by communicating with the cancer care team regularly regarding the side effects. It may be helpful to track side effects over time and share that information with the care providers. Some of the ways of managing the side effects are discussed below:
- Pain can be managed by giving pain-relieving medications
- Blocking pain signals from the nerves to the brain with spinal treatments or nerve blocks
- Adjusting dose of specific drugs
- Eating a healthy diet and keeping the mouth and teeth clean can lower risk of mouth sores.
- Preventing diarrhea or treating it early helps prevent dehydration (losing too much body fluid).
- The risk of constipation is lowered by drinking enough fluids, eating balanced meals, and getting regular exercise.
- Medications are given before and after each dose of chemotherapy that can usually prevent nausea and vomiting.
- Routine checkups for blood counts using two types of tests involving complete blood count (CBC) and platelet count.
- The doses of chemotherapy are adjusted to prevent low blood counts.
- Drugs are available to treat blood disorders.
- The drugs help the bone marrow make more blood cells.
- They can help prevent leukopenia in people with a high risk.
- A Lower dose of chemotherapy is given to lower the adverse impact of nerve damage.
- Follow-up care is provided to cancer patients involving regular physical examinations, medical tests, or both.
Radiation therapy: The side effects of radiation therapy are managed by using radioprotective drugs. These drugs are given before radiation treatment to protect specific normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy. Some other methods of managing the side effects of radiation therapy include:
- Do not wear tight, rough-textured, or stiff clothes over the treatment area.
- Do not rub, scrub, scratch, or use adhesive tape on the treated skin.
- Do not put heat or cold (such as a heating pad, heat lamp, or ice pack) on the treatment area.
- Protect the treated area from the sun.
- Use lukewarm water and mild soap only.
- If the side effects are severe, the radiation oncologist may change the treatment schedule or arrange a break
Targeted therapy: The treatment team can help manage any side effects of targeted therapy, which often need a different approach to side effects from other cancer treatments. Some other methods of coping with the side effects of target therapy include:
- Applying topical minoxidil to treat the hair loss
- Educating patients to avoid friction, wearing gloves or socks to protect the nails, and limiting pressure on the nails.
- Antihistamine or steroid cream is prescribed to help with itching and dry skin.
- The dose of the targeted therapy drug is reduced to see if that helps ease the side effects.
Immunotherapy: Because immunotherapy works differently from other cancer treatments, it is essential to work closely with the treatment team to monitor any side effects and how cancer responds. The following points should be considered for managing the side effects of immunotherapy:
- The potential side effects should be discussed with the cancer specialist before immunotherapy.
- Some tests are conducted to check that the patient is well enough to have immunotherapy.
- Throughout treatment, the team will regularly test the blood and ask the patient questions to check for early signs of side effects.
- Do not start any new medicines, including anti-inflammatory steroids, herbal therapies or over-the-counter medicines, without consulting the oncologists.
- If side effects become too severe, the immunotherapy must be stopped permanently.
E) Integrative methods for managing the side effects of cancer:
Integrative medicines: use of herbs and natural products shows efficacy in managing side effects of the medical treatment among cancer patients. Some of them are mentioned below:
- Breast cancer: Some of the integrative medicine for breast cancer are illustrated below:
- Cancer treatment: Grape seed extract, Flaxseed lignans, Mistletoe extract, Melatonin (with caution during surgery), Reishi mushroom, Vitamin D, Curcumin, Silymarin, Medical cannabis and cannabinoids, Turkey tail mushroom
- Management of side-effects and promoting wellness: Ginger, Medical cannabis and cannabinoids, Grape seed extract, Vitamin D, Curcumin, Melatonin, Astragalus, Bromelain, Coenzyme (CoQ10), Guarana, Mistletoe extract
- Optimizing body function: Curcumin, reishi mushrooms, astragalus, omega‐3 fatty acids, ginseng, medicinal mushrooms such as agaricales, maitake, reishi and shiitake
Colorectal cancer: The integrative medicines effective for colorectal cancer care are illustrated below:
- Cancer treatment: Grape seed extract, reishi mushroom, Vitamin D, curcumin, medical cannabis and cannabinoids, medicinal mushrooms such as turkey tail mushrooms or extracts, shiitake mushroom extracts
- Management of side-effects and promoting wellness: Ginger, Medical cannabis and cannabinoids, grape seedeExtract, Vitamin D, curcumin, melatonin, omega‐3 fatty acids, beta-glucans, milk thistle, astragalus, L‐glutamine (glutamine), probiotics
- Risk reduction: Curcumin, medical cannabis, melatonin, beta-glucan, calcium supplements, magnesium supplements, Vitamin B2 supplements, medicinal mushrooms such as reishi mushrooms, turkey tail mushrooms or extracts
- Optimizing body function: Curcumin, Reishi mushrooms, omega‐3 fatty acids, beta-glucans, grape seed extract, green tea extract, aged garlic extract, astragalus and other saponins, EGCG supplements, L‐glutamine, probiotics, Vitamin E supplements
- Ovarian cancer: Following are the natural products effective for ovarian cancer care:
- Cancer treatment: Combination therapy of Indole 3‐carbinol (I3C) and EGCG, grape seed extract, melatonin (with caution during surgery), reishi mushroom, Vitamin D, curcumin, silymarin, medical cannabis and cannabinoids
- Management of side-effects and promoting wellness: Ginger, medical cannabis and cannabinoids, curcumin, melatonin, panax ginseng, Vitamin E
- Optimizing body function: Isoflavones including genistein from soy, Selenium, Milk thistle, Silymarin
Prostate cancer: Following are the natural products effective for prostate cancer care:
- Management of side-effects and promoting wellness: Cranberry juice or extract, medical cannabis and cannabinoids, grape seed extract, curcumin, melatonin
- Risk reduction: Grape seed extract, lycopene, quercetin
Kidney cancer: Following are the natural products used as integrative medicine for patients with kidney cancer:
- Cancer treatment: Integrative medicines used in kidney cancer treatment includes:
- Grape seed extract: It shows antioxidative activity and anti-inflammatory effects that improve renal injury in case of surgery for kidney cancer.
- Melatonin: It induces apoptosis in renal cancer cells through up-regulating the expression of E2F1 and Sp1, leading to the enhancement of the expression of Bcl-2-interacting mediator of cell death.
- Curcumin: It promotes cell cycle arrest and inhibits survival of human renal cancer cells by negative modulation of the PI3K/AKT signaling pathway.
- Amygdalin: It reduces the growth of renal cancer cells and proliferation.
- Thymoquinone: It induces autophagy in renal cell cancer cells.
- Englerin: It kills kidney cancer cells.
- Vitamin E: It reduces renal cortex superoxide production and preserves nNOS abundance, which helps restore the kidney’s local balance between NO and superoxide.
- Genistein: It induces cell apoptosis and inhibits the proliferation of kidney cancer cells via regulating CDKN2a methylation.
- Coumarin: It shows efficacy in counteracting the side effects caused by radiotherapy in renal cell carcinoma.
- Sulforaphane: It inhibits proliferation and invasive activity of everolimus-resistant kidney cancer cells.
- Honokiol: It shows efficacy in inhibiting the growth of renal cancer cells by releasing in the form of therapeutic agents-loaded electrospun scaffolds in the treatment of kidney cancer.
- Kahweol: It inhibits renal cancer proliferation and migration by inducing apoptosis in kidney cancer.
- Alpinumisoflavone: It shows anti tumor effects in treating renal cell carcinoma.
Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhances the health outcome of kidney cancer patients:
- Reishi mushroom: It makes the kidney less permeable, helps with proteinuria and helps stop the erosion of the outer membrane of the nephron by reducing kidney inflammation.
- Medical cannabis and cannabinoids: It provides relief from pain and other symptoms of kidney cancer during and after chemotherapy.
- Curcumin: It reduces inflammation in patients with kidney cancer.
- Quercetin: It protects the kidney by lowering glucose, reducing oxidative stress while increasing the antioxidant capacity of cells, and delaying fibrosis by inhibiting the conversion of renal tubular epithelial cells in kidney cancer.
- Grape seed extract: It reduces kidney damage and improves function by reducing oxidative stress and inflammatory damage.
- Silymarin: It helps reduce chemotherapeutic drugs’ side effects and toxicity in renal cancer.
- Milk thistle: It supports detoxification while enhancing kidney functions.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in kidney cancer patients:
- EGCG supplements: It improves renal function and attenuates renal fibrosis, which indicates that it may lower blood pressure via exerting renal protective effects.
- Brain cancer: Following are the natural products used as integrative medicine for patients with brain cancer:
- Cancer treatment: Integrative medicines used in brain cancer treatment includes:
- Reishi mushroom: It stimulates nerve growth, promotes communication among the neurons in the brain, and helps protect the brain against seizures.
- Curcumin: It is used as a therapeutic agent in case of brain tumors, including glioblastoma multiforme.
- Procyanidin: It is the inhibitor of P-glycoprotein in the blood-brain barrier and shows chemo-sensitizing effects in the human cerebrum in brain cancer.
- Scillarenin: It improves the efficacy of therapy regimens in treating brain cancer.
- Latex: It causes cell death in case of brain cancer while showing synergistic response among patients.
- Ethanolic extract of Propolis: It inhibits proliferation in glioblastoma and fibroblast cell lines.
- Propolisis: It increases the sensitivity of human brain cancer cells when combined with TMZ, showing efficacy glioma therapy.
- Tetrandrine: It inhibits cell migration and invasion in human brain glioblastoma multiforme GBM 8401 cells.
- Quercetin: It inhibits the tumor cell proliferation in case of glioblastoma,
Management of side effects and promoting wellness: Following integrative medicines are used for reducing the side-effects and enhancing the health outcome of the brain cancer patients:
- Grape seed extract: It is used as a dietary supplement and possesses water-soluble properties that are capable of crossing the blood-brain barrier more easily than other natural antioxidants.
- Melatonin: It reduces the side effects associated with chemotherapy and radiation therapy by exerting synergistic effects in brain cancer.
- Silymarin: It is effective in reducing brain metastasis by eliminating metastasis by traversing the blood-brain barrier.
- Medical cannabis and cannabinoids: It provides relief from pain and other symptoms of brain cancer during and after chemotherapy.
- Ginger: It possesses anti-inflammatory properties that increase serotonin and dopamine levels and reduce inflammation in the brain.
- Ginseng: It is effective in memory improvement and the direct prevention of brain cancer.
- Vitamin E supplements: It helps in prolonged survival in the patients of malignant glioma.
- Probiotics: It is used as a replacement or a complementary therapy in case of glioblastoma cancer.
- Omega-3 fatty acids: It is effective in brain development and reduces the risk of brain cancer development.
- Essential oils: It is effective in improving cognitive function and brain function in case of surgery or brain injury in brain cancer patients.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in brain cancer patients:
- EGCG supplements: It protects the brain from oxidative stress and helps in reducing brain damage.
Pancreatic cancer: Following are the natural products used as integrative medicine for patients with pancreatic cancer:
- Cancer treatment: Integrative medicines used in pancreatic cancer treatment includes:
- Melatonin: It shows the therapeutic approach of antioxidants and tissue protector against inflammation and oxidative stress in pancreatic cancer.
- Reishi mushroom: It shows anti-cancer potential when used in pancreatic cancer when the patient undergoes specific chemotherapy.
- Curcumin: It suppresses tumor growth in pancreatic cancer cell lines in a time- and dose-dependent manner by inhibiting nuclear transcription factor-kappa B (NF-κB).
- Polydatin (Polidal-Ghimas): It possesses antimutagenic and antitumor action, involving pathways related to the cell cycle, apoptosis, angiogenesis, and metastatic progression in pancreatic cancer.
- Kampo: It is used as medicine in advanced pancreatic cancer cases for prolonged survival.
- Shiitake extract: It is used as an oral formulation showing an extended survival rate among pancreatic cancer patients.
- Lactoferrin: Its oral administration controls the tumor proliferation, survival, migration, invasion, and metastasization in patients of pancreatic cancer.
- Active Hexose Correlated Compound (AHCC): It shows efficacy in downregulating the HSP27 of pancreatic cancer cells and helps in the cytotoxic effect of gemcitabine.
- Artemisinin: It shows growth inhibitory effects on pancreatic cancer cells as a single agent or in combination with gemcitabine.
- Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhance the health outcome of the pancreatic cancer patients:
- Mistletoe: It improves the quality of life among patients suffering from locally advanced or metastatic pancreatic carcinoma.
- Silymarin: It inhibits pancreatic cancer growth and reduces pancreatic cancer-induced cachexia or weakness.
- Medical cannabis and cannabinoids: It relieves pain and other symptoms of pancreatic cancer during and after chemotherapy.
- Curcumin: It is effective in reducing the inflammation of the pancreas.
- Milk thistle: It protects the pancreas from causing any side effects during the chemotherapy sessions for pancreatic cancer.
- Vitamin D: It acts as a protective factor in reducing the risk of pancreatic cancer by regulating the cell cycle differentiation.
- Vitamin E supplements: It acts as antioxidants and reduces the incidence of pancreatic cancer by inhibiting the pancreatic cancer cell line growth.
- Selenium: Its intake reduces the risk of pancreatic cancer development, lessens pain, and prevents pancreatitis recurrences.
- Probiotics: It suppresses the growth of pancreatic cancer cells by showing anti-proliferative properties and regulating intestinal immunity.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in pancreatic cancer patients:
- Green tea extract: It inhibits growth, induces apoptosis in human pancreatic cancer cells, and suppresses the process of pancreatic carcinogenesis.
- Probiotics: It releases cytokines that act against pathogens in the case of pancreatic cancer and helps in boosting the immune response.
Liver cancer: The integrative medicines effective for the liver are illustrated below:
Cancer treatment: Integrative medicines used in liver cancer treatment includes:
- Berberine: It is capable of suppressing the proliferation of liver cancer cells showing a clinical approach in the form of anti-tumor drug.
- Flavonoids: It shows reaction while arresting the cell cycle, inducing apoptosis and suppressing the cancer cell proliferation.
- Brucein D: It shows anti-cancer activity in the case of hepatocellular carcinoma.
- Matrine: It shows efficacy in cancer cell proliferation by strengthening anti-cancer capacity of chemotherapeutic drugs.
- Longikaurin A: It induces arresting of cell cycle and apoptosis in case of hepatocellular carcinoma.
- Isoquercitrin: It is capable of inhibiting the progression of liver cancer through the molecular mechanism of the MAPK signaling pathway.
- Gigantol: It shows inhibition of proliferation and induction of apoptosis by liver cancer HepG2 cells.
- Curcumin: It shows efficacy as an anti-cancer agent in treating liver cancer and decreases the chances of recurrence.
Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhance the health outcome of liver cancer patients:
- Astragalus: It possesses antibacterial and anti-inflammatory properties that protect the liver from infection and inhibit tumor growth by inducing apoptosis.
- Reishi mushroom: It reduces the chances of hepatitis B infection in liver cells and improves liver function.
- Planch root extract: It inhibits the cancerous biological behavior of hepatocellular carcinoma cells by regulating epithelial-mesenchymal transition.
- Ganoderma lucidum polysaccharide (GLP): It enhances radiosensitivity while showing the therapeutic effect on hepatocellular carcinoma cells.
- Grape seed extract: It shows efficacy in improving the grade of fatty liver changes showing anti-cancer effects.
- Selenium: It suppresses liver cancer carcinogenesis and improves liver function by reducing the serum aspartate transaminase and alanine transaminase.
- Medical cannabis and Cannabinoids: It provides relief from pain and other symptoms of liver cancer during and after chemotherapy.
- Curcumin: It helps in reducing inflammation in the case of liver cancer.
- Probiotics: It influences the gut microbiota and modulates pathogenesis in liver cancer.
- Aloe vera: It acts as an antioxidant by cutting down the free radicals from the body and boosting the immune response.
- Reishi mushroom: It stimulates compounds responsible for tumor suppression and decreases inflammatory compounds in the liver.
- Fucoidan: It shows anti-metastatic effects showing biological mechanisms in human liver cancer cells.
- Lactone: It shows efficacy in lowering portal hypertension by improving liver fibrosis in liver cancer.
- Vitamin C: It shows antioxidant effects, helps defend against liver damage and prevents cirrhosis.
- Garlic: It cleanses the liver and triggers the liver enzymes by flushing out the toxins naturally.
- Ginger: It inhibits liver carcinogenesis through the downregulation of elevated NF-κB and TNF-α.
- Silymarin: It acts as a free radical scavenger and modulates the enzymes concerned with the liver.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in liver cancer patients:
- Green tea extract: It regulates lipid metabolism, which reduces the accumulation of lipids in the liver.
- EGCG supplements: It inhibits the growth and induces apoptosis of other liver cancer cells by activating different molecular mechanisms.
- Milk thistle: It helps treat liver inflammation in cancer patients who receive chemotherapy.
Head & neck cancer: The integrative medicines effective for head & neck cancer are illustrated below:
Cancer treatment: Integrative medicines used in head and neck cancer treatment includes:
- Mistletoe extract: It promotes tumor defense by eliminating minimal residual cancer cells in patients with head and neck cancer.
- Gossypol: It inhibits growth and promotes apoptosis of human head and neck squamous cell carcinoma.
- Curcumin: It inhibits proliferation, migration, invasion and metastasis and induces apoptosis via modulating multiple signaling pathways in head and neck cancer.
- Vitamin A: It shows strong differentiation induction effects with anti-tumor effect on head and neck squamous cell carcinoma.
- Black raspberry extracts: It induces apoptosis, terminal differentiation, and suppresses the translation of VEGF (vascular endothelial growth factor).
- Bowman Birk inhibitor (BBI): It acts as chemopreventive agent in treating head and neck cancer
- Cucurbitacins: It is a highly potent inhibitor of cell proliferation and viability.It inhibits the proliferation of both SCC-40 cells and UM-SCC-47.
Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhance the health outcome of head and neck cancer patients:
- Green tea extract: It protects against diverse steps in cancer progression and invasion through multiple and complex signal transduction pathways.
- Reishi mushroom: It exerts anti-cancer properties and improves survival rates among head and neck cancer patients.
- Selenium: It results in cell-mediated immune response when taken during therapy.
- Medical cannabis and cannabinoids: It provides relief from pain and other symptoms of head and neck cancer during and after chemotherapy.
- Vitamin A: It shows anti-tumor effect on head and neck squamous cell carcinoma patients.
- Curcumin: It suppresses the growth of xenograft derived from head and neck cancer.
- L‐glutamine (glutamine): It maintains the patients’ nutritional status and reduces the patients’ diet-related or other side effects caused by radiotherapy.
- Probiotics: It is effective in reducing oral Candida spp, which can be recommended alone or in combination with traditional antifungal agents for effective reduction of oral Candida in the head- and neck-radiotherapy patients.
- Aloe vera: It reduces the severity of radiation-induced mucositis without side effects.
- Sandalwood oil: It prevents radiodermatitis in head and neck cancer patients undergoing radiation therapy.
- Indigowood root extract: It enhances immune response while patients with head and neck cancer undergo radiation therapy.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in head and neck cancer patients:
- Green tea extract: It protects against diverse steps in cancer progression and invasion through multiple and complex signal transduction pathways in patients with head and neck cancer.
- EGCG supplements: It protects against diverse steps in cancer progression and invasion through multiple and complex signal transduction pathways in head and neck cancer patients.
- Milk thistle: It prevents radiotherapy induced mucositis in patients with head and neck cancer.
Blood cancer: Following are the natural products used as integrative medicine showing efficacy among leukemia patients:
Cancer treatment: Integrative medicines used in blood cancer (leukemia) cancer treatment includes:
- Vitamin C: It suppresses the development of leukemia from blood forming stem cells.
- Curcumin: It helps to stabilize the condition of chronic lymphocytic leukemia.
- Reishi mushroom: It has potency and ability to selectively target leukemia cells makes it a promising candidate for cancer treatment.
- Melatonin: It suppresses the growth of the human myeloid leukemia HL‐60 cells by blocking the progression from G1 to the S phase.
- Vitamin E: It reduces tumor growth rate, improves host survival and increases serum vitamin E level.
- Omega‐3 fatty acids: It can selectively kill the leukemia-causing stem cells.
- Probiotics: It induces tumor cell apoptosis and inhibits tumor cell proliferation and metastasis.
- Aspirin: It induces apoptosis of chronic lymphocytic leukemia (CLL) cells.
Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhance the health outcome of blood cancer (leukemia) patients:
- Grape seed extract: It has the potential to curb leukemia.
- Medical cannabis and Cannabinoids: It provides relief from pain and other symptoms of blood cancer during and after chemotherapy.
- Garlic: It inhibits proliferation and induces apoptosis of human leukemia cells and induces apoptosis in myeloblasts.
- Ginseng: It induces the inhibition of proliferation and differentiation of leukemia.
- Curcumin: It inhibits the growth and invasion of human monocytic leukemia.
- Vitamin C: It reduces the risk of leukemia, and may also be helpful as chemotherapy for blood cancer.
- Kenaf: It inhibits the proliferation of WEHI-3B leukemia cells.
- Gongura: It enhances cell death in leukemia cells.
- Moringa powder: It shows anti-cancer effects on leukemia cells.
- Green seed extract: It appears to keep cancer in check in most chronic lymphocytic leukemia (CLL) patients.
- Probiotics: It helps in reducing the symptoms of gastrointestinal side effects due to chemotherapy, mainly among children with acute leukemia.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in blood cancer (leukemia) patients:
- EGCG supplements: It shows a greater drop in their leukemia cell count.
- Omega‐3 fatty acids: It improves red blood cell flexibility.
Skin cancer: Following are the natural products used as integrative medicine showing efficacy among skin cancer patients:
- Cancer treatment: Integrative medicines used in skin cancer treatment includes:
- Vitamin B: It helps in reducing non-melanoma skin cancers.
- Vitamin C: It is used as an adjunct to chemotherapy for tumors in melanoma cells and causes a decrease in tumor-cell invasiveness and growth.
- Curcumin: It protects the skin by quenching free radicals and reducing inflammation through nuclear factor-KB inhibition.
- Silymarin: It is a chemopreventive and pharmacologically safe agent which can be exploited or tested against skin cancer in the human system.
- Medical mushrooms: It is effective in healing wounds after surgery in skin cancer patients.
- Reishi mushroom: It hydrates the skin.
- Melatonin: It is used to control melanoma growth and support basic and clinical studies on melatonin as a promising immunometabolic adjuvant for melanoma therapy.
- Vitamin E: It inhibits the growth and survival of melanoma cells.
Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhance the health outcome of the skin cancer patients:
- Grape seed extract: Chemicals found in grape seeds help ward off skin cancer due to regular exposure to the sun.
- Mistletoe: It helps in tumor progression and improves psychosomatic self-regulation in patients with malignant melanoma.
- Ginger: It can reduce side effects of chemotherapy such as vomiting and nausea.
- Medical cannabis and Cannabinoids: It relieves pain and other skin cancer symptoms during and after chemotherapy.
- Curcumin: It inhibits skin cancer formation and prolongs the time to tumor onset.
- Melatonin: It suppresses ultraviolet (UV)-induced damage to skin cells and exerts strong antioxidant effects on UV-exposed cells.
- Vitamin C: It shows protective effects against the development of skin cancer.
- Apigenin: It reduces the incidence and size of tumors in both chemical and UVB-induced skin carcinogenesis.
- Optimizing body function: Following integrative medicines are used for optimizing body functions in skin cancer patients:
- Green tea extract: It reverses, inhibits or slows down the process of skin carcinogenesis at one or at all stages of carcinogenesis.
- Milk thistle: It protects against UV-induced skin cancer.
- Silymarin: It supplements sunscreen protection and provides additional anti-photocarcinogenic protection.
- EGCG supplements: It has anti-inflammatory and anticancer properties that may help prevent the development and growth of skin tumors.
- Bilberry: It acts as a protective strategy against ROS-induced skin cell damage.
- Ginkgo: It has potent antioxidant protection, skin-soothing effects, increased skin hydration, and effective anti-ageing defense.
- Hawthorn: It effectively inhibits the growth of melanoma cells.
Lung cancer: The integrative medication effective for lung cancer are discussed below:
Cancer treatment: Integrative medicines used in lung cancer treatment includes:
Reishi mushroom: It aids in improving oxygen utilization among lung cancer patients having asthma, bronchitis, pneumonia, chronic obstructive pulmonary disease (COPD) and similar conditions.
Curcumin: It activates the p38 pathway in lung cancer that induces cellular apoptosis.
Turkey tail mushroom: It is used as adjuvant therapy to strengthen lung cancer patients’ immune systems.
Polydatin: It suppresses proliferation and metastasis of non-small cell lung cancer cells.
Boswellia serrata (BSE): It improves lung function by enhancing the effectiveness of conventional leukotriene modifier medications.
Management of side effects and promoting wellness: Following integrative medicines are used to reduce the side effects and enhances the health outcome of the lung cancer patients:
- Ginger: It helps in reducing the severity of nausea.
- Medical cannabis and cannabinoids: It relieves pain and other symptoms of lung cancer during and after chemotherapy.
- Curcumin: It helps to prevent lung nodules from growing larger in former and current smokers.
- Melatonin: It is taken after complete resection to reduce lung cancer recurrence and mortality.
- Omega‐3 fatty acids: It improves nutritional status and inflammatory response in lung cancer patients.
- Beta-glucans: It exhibits direct anticancer effects and can suppress cancer proliferation in lung cancer patients.
- Astragalus: It improves lung functions, promotes healing, and reduces fatigue.
- Inositol: It reduces the tumor burden and prevents bronchial epithelial dysplasia in lung cancer patients.
- Apigenin: It promotes TRAIL-mediated apoptosis in human lung cancer cells.
- Acetyl L-carnitine: It helps to improve appetite and increase energy levels after conventional treatment.
- Ginseng: It activates the processes of proliferation and death of lung cancer cells.
- Epigallocatechin-gallate: It inhibits lung cancer cell proliferation.
- Aloe vera: It reduces the severity of side effects among cancer patients.
- Fucosterol: It is used as phytomedicine showing antiproliferative effects on human lung cancer cells.
- Lapacho: It induces apoptosis and inhibits telomerase activity in lung cancer patients.
- Risk reduction: Following integrative medicines are used to reduce risk among lung cancer patients:
- Vitamin A: It helps in preventing development of squamous and small cell carcinoma of the lung in smokers.
- Vitamin C: It evolves 7% decrease in the risk of developing lung cancer.
- Vitamin E: It acts as antioxidant and helps to prevent chronic lung condition.
- Selenium supplements: It is effective for current smokers in preventing chronic lung conditions.
- Green seed extract: It remodels a certain protein in the lung cancer cells, more likely to stick together and less likely to move.
- Tamarix Gallica: It inhibits invasion of human lung adenocarcinoma cells.
Optimizing body function: Following integrative medicines are used for optimizing body functions in lung cancer patients:
- Curcumin: It modulates the activity of several transcription factors and their signaling pathways and enhances immune response in cancer patients.
- Reishi mushrooms: It is adjuvant therapy that may help strengthen the immune system in patients with lung cancer.
- Omega‐3 fatty acids: It helps the body to combat lung infections.
- Beta-glucans: It is a potent immune-system enhancers in lung cancer patients.
- Probiotics: It reduces respiratory infections and duration of infection with the common cold in lung cancer patients.
- Shiitake: It inhibits lung cancer cells.
- Maitake mushrooms: It helps in improving the symptoms in advanced lung cancer patients.
Anti-cancer diet: Common anti-cancer foods and nutrients involve flaxseeds, soy, garlic, berries, tomatoes, cruciferous vegetables, green tea, whole grains, turmeric, leafy green vegetables, grapes, and beans, etc. These common anti-cancer foods and nutrients are discussed below:
- Flaxseeds: It is a sesame-like seed that contains soluble fiber, alpha-linolenic acid (a form of healthy omega-3 fatty acid), and is the richest source of lignans involving phytoestrogens that function as antioxidants. The use of flaxseed has reduced the number and growth of breast tumors.
- Soy: Exposure to soy in the adolescent phase of life helps women to protect themselves from the risk of developing breast cancer. It is effective in lowering cholesterol.
- Garlic: It is considered a cancer-fighting food. Several studies have confirmed that intake of more garlic results in reducing the risk of cancer development such as esophagus, stomach, and colon cancer.
- Berries: It consists of powerful antioxidants that hinder the naturally occurring process in the body generating free radicals responsible for cell damage. Therefore, berries are considered the healing food for cancer.
- Tomatoes: It is effective in protecting against prostate cancer in men. It covers the DNA in cells from any damage that leads to cancer risk. It consists of a high concentration of an effective antioxidant called lycopene absorbed by the body, evolving into a cancer-fighting food.
- Cruciferous vegetables: It consists of broccoli, cabbage, and cauliflower, considered cancer-fighting foods. The components in the veggies help protect from the free radicals that damage the DNA of the cells. It also protects from cancer-causing chemicals helping to reduce tumor growth and enhancing cell death.
- Green tea: the leaves of the tea plant Camellia sinensis consist of antioxidants known as catechins which show efficacy in preventing cancer in several ways involving the protection of free radicals from cell damage. C catechins in tea effectively reduce the tumor size and the growth of tumor cells. Hence, drinking green tea has lowered the risk of cancer development.
- Whole grains: It contains many components that lower cancer risk, mainly fiber and antioxidants. Intake of more whole grains lowers the risk of colorectal cancer, making them a top item in the category of foods to fight cancer. Oatmeal, barley, brown rice, whole-wheat bread and pasta are all the components of food used as whole grains.
- Turmeric: It consists of an ingredient called curcumin that helps reduce cancer risk. Curcumin can inhibit several types of cancer and helps slow the spread of cancer (metastasis).
- Leafy green vegetables: It involves spinach and lettuce, considered good sources of the antioxidants beta-carotene and lutein. Collard greens, mustard greens, and kale are other food components of leafy green vegetables that contain chemicals that limit the growth of some types of cancer cells.
- Grapes: It is considered a rich source of an antioxidant called resveratrol that inhibits the growth of cancer cells from growing and spreading.
- Beans: It contains fiber that helps in reducing the risk of cancer. It also consists of antioxidant properties.
Physical fitness: Exercises have been considered safe and feasible in terms of oncology, and many studies have revealed that it has improved the patients’ quality of life during and after cancer treatment. The positive aspects of physical fitness include enhancing cardiorespiratory fitness and muscular strength while improving body composition. Also, maintaining physical fitness by doing regular exercises helps regulate various side-effects of cancer treatment involving fatigue, nausea and improved psychological condition, and decreasing anxiety and depression levels. Some of the activities that contribute to physical fitness include:
- Energy therapies
Emotional wellness: The after-effects of the treatment, such as chemotherapy, surgery, and radiation in cancer treatment, have been a significant reason for deteriorating the mental health of cancer patients. Emotional distress entirely depends upon the patient’s clinical condition, health, and prognosis. Therefore, there is a need to mitigate the emotional distress among the patients to improve their quality of life and increase their survival rate. Emotional wellness is known as an essential clinical task. The healthcare team has established supportive relationships with the patient and their families during the complete cancer journey, which has helped in normalizing the patient’s behavior towards any treatment, calming them in any situation and maintaining continuity towards cancer care. Also, nurses have considered the delivery of emotional care and support to patients and their families, which have helped them develop a fighting spirit against cancer. Some of the emotional wellness support include:
- Emotional and Spiritual Wellness
- Guided imagery
- Mind-body approaches
Healing environment: The natural healing environment offers positive energy for human psychology that further provides comfort and relaxation for the patient’s mind. Also, the aspect of the healing environment enhances the five human senses in the form of natural elements involving hearing, sight, touch, smell, and taste. The hearing senses affect the peaceful sound that helps lower the blood pressure and heart rate while developing a comfortable zone that positively impacts the immune system. Sense of light helps the patients provide relaxation to the eyes through scenery, natural light, artwork, and the use of specific colors. Sense of touch evolves the feeling of being able to see, smell, taste and hear. It brings a comfort zone to the patient by reducing the effects of stress. Sense of smell provides a pleasant aroma that effectively lowers the blood pressure and heart rate, making the patient feel relaxed and comfortable. Sense of taste is not so effective as it deteriorates the patient’s mental and physical well-being when the patient cannot receive any medication.
Community support: The community supports peace, calm, comfort and problem-solving during the post-diagnosis period, which further helps the cancer patients to determine the positive impact on their cancer journey. The support from family members, friends, neighbors, and health professionals is considered the most important factor. Community support is most effective during the treatment process as it traumatizes the patient completely due to the emergence of many side effects, and community support, in this case, provides a positive attitude to the patient to deal with the adverse events. Many healthcare centers integrate community classes that involve cancer patient survivors to share their experiences of their entire cancer journey. It helps in motivating the other cancer patients who are undergoing cancer treatment.
Second opinion: Choosing second opinions facilitates the treatment options for decision-making among the patients who are motivated in conditions when the patients are very uncertain regarding their options or lack confidence in the treatment decision process. The increasing complexities of treatment decision-making have made the second opinion options very important, allowing the patients to gain confidence in their physician’s decision regarding their proposed management plan. There is a need to integrate a second opinion to make patients aware of the option of seeking a second opinion in case of any significant discrepancies. When patients delay or avoid deciding on a treatment course, second opinions help reassure and expedite the treatment. Hence, this makes the patients emotionally strong while motivating them to deal with any situation during their cancer journey.
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