Holistic Oncology & Integrative Cancer Care

A cancer diagnosis can change everything very quickly. Within a short period of time you may be dealing with scans, pathology, surgery, oncology appointments and treatment decisions that you never expected to face.

Many people then ask the same question:  What else can I do?

My approach starts with that question and comes back to three things:

Treat the tumour. Strengthen the host. Make life as difficult as reasonably possible for the cancer cell.

I do not believe patients should have to choose between conventional oncology and holistic medicine. Surgery, radiotherapy, chemotherapy, immunotherapy, hormonal treatment and targeted therapy can all be extremely important. At the same time, there is often more we can do to support the person going through treatment, improve resilience, correct deficiencies, maintain muscle and nutrition, and consider additional treatments where they make sense.

The first step is to understand exactly what we are dealing with.

I want to see the diagnosis, stage, pathology, scan results, treatment history and, where relevant, molecular or genetic findings. I also want to understand what your oncology team is recommending and what they are hoping to achieve.

The aim may be cure. It may be to reduce the risk of recurrence. In advanced disease, it may be to slow progression, control symptoms, maintain function and preserve quality of life.

Good integrative cancer care starts with good conventional information.

• What type of cancer is this?
• What stage is it?
• What does the pathology show?
• Has molecular testing added anything useful?
• What treatment has been recommended?
• What is the likely benefit?
• What are the likely side effects?
• Are there areas where we can improve treatment tolerance or recovery?
• Are there additional approaches worth considering?

I prefer to review oncology letters, pathology reports and imaging wherever possible. It is much easier to make sensible decisions when we are working from the actual information rather than summaries or assumptions.

Cancer cells are not passive. They adapt.

They change the way they use energy, alter signalling pathways, influence the tissue around them and find ways to survive under pressure. Some avoid immune recognition. Some become resistant to apoptosis. Some rely heavily on particular metabolic pathways. Others switch fuel sources or develop resistance after treatment.

That is what I mean by thinking like a cancer cell. We look at what the cancer is trying to do, what it needs in order to survive, and where it may be vulnerable. The strategy then has to fit the cancer. A person with newly diagnosed breast cancer needs a different approach from someone with metastatic prostate cancer, lymphoma, pancreatic cancer or a bladder tumour that has just been removed.

The health of the person carrying the cancer matters.

Cancer itself can reduce appetite, weight and muscle. Treatment may add fatigue, nausea, bowel problems, poor sleep, reduced fitness and nutritional deficiencies. A patient who maintains muscle, eats adequately and remains active is in a better position than somebody who becomes progressively weaker through treatment. This part of care is often straightforward and very practical.

Depending on the individual, we may focus on:

• adequate protein and calorie intake
• maintaining or rebuilding muscle
• resistance exercise
• cardiovascular fitness
• hydration
• vitamin and mineral deficiencies
• glucose and insulin control
• bowel and gut function
• sleep
• fatigue
• mobility
• cardiovascular health
• psychological resilience

These basics often have more practical value than adding another supplement. If somebody is losing weight, eating poorly and becoming sarcopenic, that usually deserves attention first.

Cancer cells survive because they acquire advantages.

Depending on the cancer, these may involve:

• altered glucose metabolism
• insulin and growth signalling
• abnormal mitochondrial function
• angiogenesis
• inflammatory signalling
• immune escape
• resistance to apoptosis
• altered redox balance
• cancer stem-cell biology
• changes within the tumour microenvironment

These are areas that may become relevant when we consider additional treatment options. Starting with a list of supplements or repurposed drugs and then trying to fit them to the patient gets things backwards. I start with the cancer and work out what may be relevant.

The practical questions are simple:

• What are we trying to target?
• Is there a reasonable biological basis?
• Is there human evidence?
• What are the risks?
• Could it interfere with current treatment?
• Is it worth the cost and effort?

That usually removes a lot of unnecessary treatment very quickly.

One of the problems with cancer is its ability to adapt.

A treatment may initially work well and then become less effective. Resistant cells survive, alternative pathways become more important, or the tumour finds another way to maintain its growth. For that reason, I am interested in using more than one line of attack where it is sensible to do so.

I try to identify the main problems rather than add treatments indiscriminately, then address those problems in a way that is safe and manageable.

For one person, the priority may be surgery and good preparation for it. For another, it may be maintaining weight and muscle during chemotherapy. In somebody else, metabolic dysfunction may deserve more attention. Additional treatments only make sense if they fit into that wider picture.

Some medicines used for conditions such as diabetes, cardiovascular disease, infection or inflammation also affect pathways that may be relevant to cancer. This is the basis of drug repurposing.

Depending on the medicine, these effects may involve metabolism, insulin signalling, angiogenesis, inflammation, mitochondrial function, tumour growth, immune activity or cancer stem-cell biology.

I am prepared to consider selected medicines off-label when there is a reasonable rationale and the balance between possible benefit and risk is acceptable. The decision also depends on liver and kidney function, other medications, current cancer treatment and possible interactions.

Repurposed does not mean interaction-free.

 High-dose intravenous vitamin C is one of the treatments I am frequently asked about. Intravenous vitamin C behaves very differently from oral vitamin C. The gut limits how much vitamin C can be absorbed by mouth, whereas intravenous administration can produce much higher blood concentrations. At those concentrations, vitamin C has effects that are not seen with ordinary supplementation and has been studied in a number of cancer settings.

I see intravenous vitamin C as an adjunct rather than a replacement for oncology treatment. Whether it is worth using depends on the cancer, stage, treatment plan, kidney function, G6PD status, other medical conditions and the aim of treatment.

For some patients it is a reasonable option, while in others the likely benefit may not justify the cost and complexity. I prefer to make that decision before treatment starts.

Many patients arrive taking a long list of supplements. Some are useful, some overlap, some have very little evidence behind them, and a few may interfere with treatment. My first job is often to simplify rather than add more.

I review what you are taking, the dose, why you are taking it, and whether it is appropriate alongside your current treatment. Correcting a deficiency is quite different from using a supplement because it may have an anticancer effect. Treating low vitamin D, for example, is not the same as taking a botanical compound because it has shown activity in laboratory studies. Both may be worth discussing, but they should not be treated as though the evidence is the same.

Chemotherapy can be hard on the body, and supportive care needs to be specific to the drugs being used. Common priorities include maintaining weight and muscle, getting enough protein, keeping well hydrated, managing nausea and bowel changes, staying active where possible, and improving recovery between cycles.

I also pay attention to neuropathy risk, blood results, nutritional deficiencies and treatment-related fatigue. Supplements, intravenous therapies and repurposed medicines need to be checked against the actual chemotherapy regimen because some may be reasonable between cycles but inappropriate close to treatment. Timing can matter just as much as the intervention itself.

Radiotherapy works by damaging cancer cells, so supportive treatment needs to be planned around it rather than added without thought. Depending on the treatment area, we may focus on nutrition, protein intake, hydration, exercise, bowel function, skin and tissue support, fatigue and sleep.

Some patients develop delayed radiation injury months or years later. In selected cases, treatments such as hyperbaric oxygen can be useful for established late radiation damage, particularly where healing has become impaired.

Cancer surgery is a major physiological stress, and where time allows, the period before surgery is a good opportunity to improve strength and recovery. Preparation may include:

• protein intake
• resistance exercise
• aerobic fitness
• glucose control
• correction of deficiencies
• smoking cessation
• reducing excess alcohol
• sleep
• bowel function

My background in anaesthesia and perioperative medicine is particularly relevant here. I want patients going into surgery as well prepared as they reasonably can be, because physical reserve, nutrition and metabolic health all influence how well someone tolerates an operation and recovers afterwards.

Cancer metabolism is complex and is often oversimplified. It is not correct to say that sugar directly causes cancer or that removing carbohydrates will cure it, but poor metabolic health can still matter.

Insulin resistance, hyperinsulinaemia, obesity, visceral fat, reduced muscle mass and poor glucose control are relevant in some cancers and worth addressing. Depending on the situation, I may assess:

• fasting glucose
• HbA1c
• fasting insulin
• lipids
• body composition
• muscle mass
• cardiovascular fitness

The aim is not to force everybody onto the same diet. It is to improve metabolic health without weakening the patient or compromising nutrition.

Ketogenic diets and fasting may have a place in selected patients, but they can also be used badly. A restrictive diet may be reasonable in someone who is overweight, insulin resistant and maintaining muscle, yet the same approach may be completely inappropriate in a patient who is losing weight and struggling to eat.

The same applies to fasting. I do not recommend metabolic interventions simply because they are fashionable in cancer circles; they need to fit the clinical situation and the patient’s nutritional reserve. The cancer cell needs fuel. So does the patient. The balance between those two matters.

I am a hyperbaric physician and have a strong clinical interest in photobiomodulation, so I am very comfortable discussing where these treatments may be useful and where the evidence is still limited. I am equally happy to advise when I do not think they add enough value to justify the cost, time or complexity.

Hyperbaric oxygen can have a well-established role in areas such as delayed radiation tissue injury and wound healing, while its use as a direct anticancer treatment remains much less certain. Photobiomodulation is also an area of growing interest, particularly for treatment-related symptoms, tissue recovery and neurological applications, but the strength of evidence varies considerably depending on the indication.

The same balanced approach applies to mistletoe, intravenous therapies, metabolic treatments and other adjuncts. I do not add them simply because they are available or biologically interesting. I look at the clinical problem, the evidence, the likely benefit, the risks and the practical burden, and then help you decide whether they genuinely deserve a place in your treatment plan.

The priorities change throughout the cancer journey. Soon after diagnosis, the main need may be understanding the situation and making sense of the treatment options. Before surgery, we may focus on physical and nutritional preparation, while during chemotherapy or radiotherapy the aim is often to maintain strength, reduce avoidable side effects and improve recovery between treatments.

After treatment, the focus may shift towards rebuilding fitness, improving metabolic health, restoring sleep and dealing with persistent problems such as fatigue, neuropathy or cognitive changes. Recurrence is also a common concern, and while there are no guarantees, there are often things we can improve, monitor and act upon.

Advanced cancer requires a different conversation. The aim may be disease control rather than cure, with treatment directed towards slowing progression, maintaining function, reducing symptoms and preserving quality of life.

The balance between uncertainty and acceptable risk also changes. An intervention with incomplete evidence may be hard to justify in somebody with a highly curable early-stage cancer, yet in advanced disease, where treatment options may be more limited, it can be reasonable to consider therapies with promising but less complete evidence if the potential downside is low. That judgement needs to be individual and grounded in the patient’s actual situation.

I believe strongly in evidence-based medicine, but it has limitations in holistic oncology.

Large clinical trials are expensive and are most likely to be funded when there is a commercial return. Many integrative treatments are inexpensive, off patent, or cannot be owned, so there is often little incentive to fund large studies. Lack of a randomised trial may therefore reflect lack of funding as much as lack of potential benefit.

There is also a practical mismatch between conventional research and holistic care. Clinical trials usually isolate one variable. In integrative oncology, a patient may leave the first consultation having changed nutrition, exercise, sleep, metabolic health, supplements, medication, treatment timing and other factors at the same time.

That makes it harder to know which intervention made the difference. In practice, however, cancer is complex and adaptive, and it often makes more sense to address several relevant problems together.

I use evidence as a guide rather than a gatekeeper. I look at human data, biological rationale, safety, interactions, cost and likely benefit, and I am prepared to consider interventions with incomplete evidence when the downside is low and the clinical circumstances justify it.

The threshold also changes with the situation. I will be more conservative in a highly curable early-stage cancer than in advanced disease with limited options.

There is no standard protocol that I use for everybody. At the first consultation, I want to understand:

• diagnosis
• stage
• pathology
• scans
• molecular testing where relevant
• previous and planned treatment
• medical history
• medications
• blood results
• nutrition
• weight and muscle
• metabolic health
• symptoms
• current supplements
• complementary treatments already being used

I also want to know what matters most to you. Some patients mainly want help getting through chemotherapy, some want to reduce their risk of recurrence, some have advanced disease and want to explore every reasonable option, and others simply need help sorting useful information from noise. The plan follows from that clinical picture and from the patient’s priorities.

A cancer diagnosis creates a strong urge to act, and that can quickly become exhausting. Patients may end up following restrictive diets, taking twenty or thirty supplements, arranging multiple treatments and still worrying that they are not doing enough.

A good plan should reduce that burden rather than add to it. Sometimes the right decision is to add a treatment, sometimes to stop one, and sometimes to concentrate on eating properly, rebuilding muscle, improving sleep and preparing well for the next stage of treatment. You do not need to do everything; you need to know what matters.

I provide physician-led integrative oncology care throughout New Zealand, mainly by telehealth. My background is in conventional medicine, anaesthesia, hyperbaric medicine and perioperative care, and I now work in functional and integrative medicine. That combination has given me a very practical way of looking at cancer care.

I routinely review oncology letters, pathology, scans and treatment protocols, while also looking at nutrition, metabolic health, supplements, intravenous therapies, hyperbaric oxygen, photobiomodulation and selected repurposed medicines. I am comfortable moving between conventional and integrative approaches because both can be relevant to the same patient.

Before we meet, it is helpful to provide oncology correspondence, pathology and imaging reports, recent blood tests, a medication list and details of any supplements or complementary treatments already being used. This allows us to spend the consultation discussing what matters and building a sensible plan rather than reconstructing the medical history.