Integrating Conventional and Chinese Medicine in Cancer Care

This new clinical resource clearly explains how to approach integrated care in a way that combines Chinese herbal medicine with Western medicine to enhance and improve medical care for patients with cancer – without undermining or negatively impacting patients' medical treatment. Each chapter covers a different type of cancer, first introducing the conventional medical understanding of that cancer including its etiology, diagnosis, and treatment according to staging and type. The chapter then covers that cancer from the perspective of Oriental medicine. Case studies illustrate the integration of treatment for each cancer type, raising important issues and considerations associated with specific cancers and treatments.

Key Features

• Formulas are presented within the context of conventional treatment, intended to enhance the effectiveness of treatment and/or treat side effects without undermining the treatment's function.
• Each formula is followed by a discussion of how and why the herbs are used, including classical Chinese theory and relevant pharmaceutical studies.
• Staging and the age and performance status of various patients is used as a means by which to explain how formulas are changed.
• Case studies explore issues related to the integration of treatment for each type of cancer.

I felt a sense of familiarity reading the introduction to this book, realising that Tai Lahans’ own map of this subject was so closely matched to my own. Having studied, practised and taught Chinese Medicine (CM) oncology for decades, virtually everything in this book rings true with the authentic voice of hard won expertise. At last, a commendable book on cancer.
In her introduction Lahans mentions the shared East‑West medical ethic of “first do no harm” and the difficulty of sustaining this ideal using current biomedical care. This is an important paragraph to bear in mind when reading the text as a whole, where the presupposition is that Chinese medicine is primarily a support act for standard chemo- and radio- therapy regimes. She implicitly acknowledges the awkward ethical and medico‑political difficulties inherent in the subject. In doing so she rightly expresses respect for our biomedical colleagues, reminding us that CM is not in a position to claim superiority in offering a reliable cure for cancer. Lahans walks comfortably on both sides of the bamboo curtain.

Structurally the book consists of an opening chapter titled ‘General Pathology and Treatment’, then chapters 2 to 11 summarise the biomedical and Chinese medicine understanding and treatment of the commonest cancers. The final three chapters are titled ‘Concurrent Issues’, ‘Death and Dying’ and ‘Prevention’.

The opening chapter addresses numerous issues: the scientific understanding of cancer and its causes, diagnosis and treatment. Covered too is cancer in the Chinese medicine tradition and its development in modern times, including an overview of common herb treatment strategies for differing clinical situations (note that there is very little on acupuncture in this book ‑ which does not of course mean there is nothing for acupuncturists). The information is accurate and, to my mind, reasonably complete but it is densely written and offers few diagrams or illustrations that might have made it easier to assimilate. To give one example, Lahans outlines the appearance of abnormal tissues under the microscope when a graphic or photograph would have been more memorable. Indeed, there are no graphics in the entire book, just words and tables.

There is enough subject matter in this first 32 pages to occupy a whole book. Pretty much all the main bio‑ and Chinese‑ medicine issues in relation to cancer are discussed although they could have been laid out in a more leisurely and user‑friendly way. Lahans’ discussions on really fascinating issues, such as the recent developments in the molecular biology of cancer, are so densely presented I fear they could seem garbled to readers approaching this material for the first time. Again, diagrams would have helped. Gripes aside, this is still the most approachable text on this subject yet published in English.

Lahans offers wisdom as well as knowledge. Later in the chapter she advises,
“Do not do anything to undermine the treatments chosen by patients themselves. It is not our task to make choices for patients in cancer treatment … we can teach ... and provide information ... to help patients make choices” .

My sentiments almost exactly and surely another issue worthy of fuller discussion. How do we explain to patients what CM has to offer in cancer care, what should we say to patients desperately consuming dozens of different “supplements”, what do we say to the patient who asks “if I was your mother would you recommend I have chemotherapy?” What if a patient is spending so much on shark’s fin extract they cannot afford Chinese herbs? What of the UK company that markets ling zhi mushroom to cancer patients for £3000 a month?
The subsequent chapters on individual cancers are excellent, offering well‑balanced discussions on aetiology, biomedical pathology, classification, clinical and lab diagnosis, CM treatment and case histories. These are just the ideal length and depth to read through the night before you see a new cancer case.

The ‘Concurrent Issues’ chapter includes discussions of all the main types of damage associated with chemotherapy and their CHM support; this material will be familiar to those who have already studied the Chinese literature on the subject. Other common issues such as pain, nausea, anxiety and depression are presented. There is a missed opportunity to discuss acupuncture and the evidence for its value in cancer care; strangely it only receives a brief mention and a bullet point list of its applications. There is a useful discussion of pleural effusion and ascites. Suggested treatments include formulas using harsh cathartics. I felt that some cautions would be appropriate here given that these work, probably palliatively, to eliminate water by allowing alarming quantities to be passed per anus.
The concluding chapters, ‘Death and Dying’ and ‘Prevention’ are pretty much what you would expect, sensible and to the point.

A brief hypercritical moment; the text has quite a few small errors. On page 25 for example, mu dan pi is wrongly listed as a qi‑moving herb; also some of the references on this page do not seem correct. Listed here too are herbs used in cancer care according to their basic functions but, surprisingly, prime oncology blood stasis herbs such as e zhu and jiang huang have been omitted. Later, we are incorrectly told that “Huang qi, bai zhu and fu ling are the primary elements of si jun zi tang.” (p122). Minor author slips are inevitable with such complex subject matter which highlights a need for improved pre‑publication proof reading and peer review.

When teaching this subject I say that to become a Chinese medicine oncology specialist is challenging on many levels. It is not sufficient simply to be well skilled in the tradition; it is essential to have a good understanding of biomedical oncology plus an awareness of the modern Chinese research into herbs and formulas in the context of cancer care. On top of this we need clinical guidance to become experienced enough as practitioners to be able to see through the maze of clinical possibilities so that we can prioritise treatment in the most appropriate way and to work around conventional care. And, of course, we need to be mature and wise enough to cope effectively and compassionately with patients facing the sadness, fear and loneliness of their own mortality. This special combination of skills and attributes is all well acknowledged in Lahans’ text. She is to be admired for being amongst the first in the West to gain such skill in this field and thanked for passing on her knowledge by contributing a benchmark text on Chinese medicine oncology.

Charles Buck

Preface
Introduction
Disclaimer
1.General pathophysiology and treatment: conventional and Chinese medicine
2. Lung cancer
3. Colorectal cancer
4. Breast cancer
5. Prostate cancer
6. Cervical and uterine cancers
7. Ovarian cancer
8. Bladder and renal cancer
9. Pancreatic and hepatic cancers
10. Lymphomas
11. Leukemia
12. Concurrent issues
13. Death and dying
14. Prevention