Hedging the Bet Against Cancer

An increasing number of patients are combining alternative therapies with conventional ones to improve their chances of survival.
by Michael Lerner

In 1981, my father, the writer Max Lerner, developed two life-threatening cancers: a non-Hodgkins lymphoma and prostate cancer that had spread to his lungs. He was a vibrantly alive 78-year-old man, but he was not given long to live.

I had been exploring mind-body health and complementary, or alternative, therapies professionally for 10 years. So I started to study whether any might be of benefit to him, and have now spent another decade studying complementary cancer therapies. I have traveled the world to do so, have served as a special consultant to the Office of Technology Assessment for a Congressional study of such therapies and have conducted more than 60 week-long retreats for people with cancer.

But my father never took advantage of the therapies I investigated. Having been treated with strictly conventional therapies, his two cancers went into complete remission, surprising his doctors. He died of a third and unrelated cancer 11 years later at the age of 89.

I actually delight in the fact that he achieved a remarkable remission without using any of the complementary therapies I explored. The reason is that my father's experience captures the essence of what my studies have led me to believe. In short, there is no single right way to fight cancer. The best general approach in my judgment is to learn what you can about the conventional therapy options, to get the best conventional treatment you can that makes sense to you, to explore complementary therapies only if they interest you and to recognize that this is uniquely your life struggle and that you are the best authority on how you want to go through it.

What are complementary cancer therapies? They are spiritual approaches like prayer; psychological approaches like support groups; nutritional approaches like macrobiotic diets or doses of vitamin C; physical approaches like massage or yoga, and many others. Some clearly are offered by charlatans, others by highly principled and credentialed practitioners. I have found among these therapies no scientific evidence -- or even strong anecdotal evidence -- of any systematic cure for any kind of cancer. But I have found many possible benefits, as well as some dangers.

I have seen hundreds of people whose quality of life has been greatly improved by complementary approaches, though the course of their cancer has not dramatically changed. Thousands of women and men have told me that prayer groups, support groups, diet, yoga, traditional Chinese medicine and other resources in various combinations have transformed their lives in the face of a life-threatening disease.

On rare occasions, I have seen spontaneous remissions in some of the most life-threatening cases. One young woman with metastatic breast cancer did what thousands of other women with breast cancer who explore complementary therapies have done. She changed her diet, took herbs and vitamins, joined a support group and developed a strong spiritual life. She has been in complete remission for several years. Her oncologist has no explanation.

More often, I have seen what seem to be examples of life extension, though without cures. An older woman with an advanced cancer had been on hospice care when her son gathered her friends from around the country for a party to celebrate her life, with her favorite food and favorite people. After the party, her cancer unexpectedly subsided. She went off hospice care, rediscovered her passionate interest in poetry and lived another year. She wrote a book of beautiful poems, and then, when the cancer returned, acknowledged that she was ready to die.

There does seem to be a correlation between an apparent prolonging of life, or at least a profound improvement in quality of life, and a patient's development of a unique and personal reason to live.

One doctor came to the Commonweal Cancer Help Program, our week-long residential support group, after nursing his wife through a painful, and fatal, neurological disease. Now he himself had advanced cancer and said he had no reason to live: he hoped when he died to rejoin his wife. This was his truth. I did not try to dissuade him, but asked him what might give his remaining time some real flavor. He said he did wish he had a cat, but was afraid to get one because he might become unable to care for it.

"Look, William," I said, "if you get sick, I have friends who will care for your cat. And if you die, my wife and I would be happy to take the cat. But if we are going to do that, let's get a Siamese cat, which my wife would love." William said no. He had devoted his life to helping poor children, and the only cat that would do for him was an abandoned kitten. Still, he was not sure it was responsible to adopt a cat when he was so sick. Weeks after he left Commonweal, William adopted an abandoned and sick kitten. He nursed it back to health and loved it deeply. William lived for several more years -- well beyond many expectations. Perhaps it was because he had given himself permission to love again.

There are at least three areas that anyone with cancer should consider exploring. One is choices in healing. This means finding ways of strengthening the physical, mental and emotional resources within us for recovery or simply for quality of life.

A second is choices in mainstream medicine, weighing the often difficult treatment options and recognizing the techniques needed to manoeuver through the complexities of high-technology medicine. A third is complementary therapies -- if they interest you.

Understanding choices in healing begins with understanding the difference between healing and curing. A curative medical treatment is something your doctor ardently hopes to provide. Healing, by contrast, starts within your own mind and body. The capacity to heal is what you bring to an encounter with illness. The body is designed to heal. When you break a bone, the doctor sets it, but the inner healing forces knit the bone back together. Curative medicine can work only when the inner healing forces of the organism are strong enough to respond. Otherwise, the bone does not knit, the wound does not close. To stay healthy or repair itself, the body and its immune system, its basic mechanism for fighting disease, depend in large part on some fundamental physical factors: proper diet, sleep, exercise and lack of extreme stress. There are psychological factors as well. Do you believe that your inner healing resources could make a difference? Do you want to fight the battle? Above all, are you committing yourself to the approaches that make sense to you?

Choices in conventional cancer therapies represent the best hope by far for curing cancer today. Surgery, radiation therapy and chemotherapy are curative for many cancers. In advanced cancers, they may offer palliative assistance, but not cures. Perhaps the most difficult choices in conventional cancer therapies are between aggressive and conservative treatments. There is scientific debate about which is preferable. Localized prostate cancer, for example, can often be treated with anything from radical prostate surgery or radiation therapy to "expectant treatment" -- essentially, waiting and watching. You have to decide whether you want to be an "informed" cancer patient -- and learn about such choices -- or leave your choices to a trusted doctor. If, for example, you want to make your own choices and you have metastatic cancer for which there is no known cure, you'll have to weigh whether a palliative conventional therapy has a risk-benefit ratio that makes sense to you: is debilitating chemotherapy that may prolong life for two months worth theagony?

A poignant example of such a dilemma was the case of a mother of two in her 40's who had metastatic breast cancer. She and her husband studied the medical literature on bone marrow transplants, which are highly controversial because they are arduous, expensive and experimental. She decided to undergo the therapy, survived it remarkably well, enjoyed a wonderful period during which she thought she might be cured, then had a recurrence. But neither she nor her husband regretted the measures they had taken, and she died a peaceful death, which her family and friends experienced as sacred.

The phone at Commonweal rings with calls from people across the country who want objective information.

"What about shark's cartilage?"
"Someone told me about a tea called pau d'arco."
"What about macrobiotic diet?"
"What about traditional Chinese medicine?"
"Can imagery really help?"

I wish to re-emphasize that in the course of my research, I have not found any complementary therapy that offers any systematic cure. On the other hand, very few scientific studies exist to evaluate some interesting questions: for one, short of a clear-cut cure, do any alternative therapies effectively complement standard ones?

There is scientific evidence that some of these therapies, notably psychological ones, improve quality of life for some patients. The critical question of the efficacy of complementary therapies in delaying or preventing recurrence or extending life is unanswered. Yet an increasing number of knowledgeable cancer patients are betting that integrating complementary therapies with the best of the conventional may improve their odds.

Among the numerous complementary methods used by cancer patients, I believe four "lifestyle" approaches -- spiritual, psychological, nutritional and physical -- provide a variety of open, ethical approaches to cancer that, carefully explored in consultation with a doctor, can be of potential benefit.

By contrast, some of the alternative pharmacological therapies should be approaches much more skeptically. Some offer opportunities for unscrupulous marketing of expensive and unproven remedies that have none of the obvious benefits of the life-style approaches and can be harmful.

A regimen of regular exercise, yoga or tai chi is among the complementary physical approaches that inspire confidence and are plausible. These practices may help improve what doctors call "functional status." That is, basically how much physical stamina a patient will have in encounters with cancer and its treatment. Functional status is a modest but significant predictor of improved survival rate with many cancers. Similarly, scientific studies show that relaxation techniques somewhat improve immune function. Studies also show that intense stress can enhance the growth of some cancer tumors in animals, and probably in humans as well. So relaxation and other stress-reduction techniques, like meditation, hypnosis or visual imagery (in which patients imagine their tumors shrinking, for example), are now widely used.

The most famous psychological study is by Dr. David Spiegel, a Stanford professor, who found that women with metastatic breast cancer who joined a psychological support group had twice the average survival rate of women who underwent the same medical treatment but did not participate in a support group. Dr. Fawzy Fawzy, a professor at the University of California in Los Angeles, has found support groups to have similar benefits for patients with malignant melanoma. Both studies were small and preliminary, but the research certainly was interesting.

Nutritional approaches may also be beneficial. The question is whether a low-fat high-fiber diet associated in epidemiological studies with fewer cases of many common cancers -- colon, prostate and breast cancer among them -- might also contribute to lowering the risk of recurrence for some of these cancers. The patients who adopt vegetarian diets are in effect betting on it.

Spiritual approaches like prayer and meditation bring enormous solace -- and possible physical benefits as well. Though the effect of meditation on the recurrence of cancer or on its ability to prolong the life of cancer patients has yet to be systematically studied, its stress-reducing qualities offer hope that such benefits are plausible. And the scientific literature on prayer suggests that this most ancient of human responses to illness may help also.

It is important for anyone battling cancer, as it is for those with many other serious diseases, to know that in 90 percent of cancer cases, pain can be controlled by doctors and other health practitioners skilled in this science and art. Most doctors, however, are still not well trained in pain control -- a national scandal. Cancer is usually less painful, studies show, than people expect, but the pain can still be severe. In addition to medication, pain can be reduced through psychological therapy, acupuncture and neurological devices that block the perception of pain with an imperceptible electrical current. Hospice doctors and nurses are normally expert in pain control and provide help even to people who are not dying.

Finally, we all must face death. But the way we face it can make an extraordinary difference. Some of the most poignant times of my own life have been spent with dying people. Wheeling my father through the halls of a hospital as he talked about theories of civilization touched me beyond words, his telling me what he most wanted me to know before he died. Sitting up through the night with a dying friend in Bolinas, California, singing to her as she labored to breathe, touching her hand and talking to her the last night of her life.

Our culture has made dying a toxic subject. But many cultures accept death as an integral part of life. We can detoxify it by facing it, by studying the great religious and philosophical literature on death and talking about it with people we care about. Anyone who has worked with patients who are facing death knows that the extraordinary spiritual and psychological healing that sometimes emerges is a gift. Learning to cope with grief in life's final moments, and helping to lessen the grief of others, makes a profound difference.


Michael Lerner, president of Commonweal, a health and environmental research institute in Bolinas, California, received a MacArthur Prize Fellowship in 1983 for work in public health. This article is adapted from his new book, "Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer."