Focus Area: Integrative Approaches to Care
An integrative model of care remains uncommonly utilized in oncology practice. We present the integrative Patient Empowered Care model practiced at our institution in two cases of pancreatic cancer.
These cases demonstrate how a multidisciplinary model was utilized during treatment. The role of registered dietitians and naturopathic oncology providers are highlighted.
Each patient received standard treatment per NCCN guidelines combined with interventions from the integrative team.
Case 1: A 61-year-old female was diagnosed with stage IV pancreatic adenocarcinoma and diabetes in May 2010. She became malnourished and required counseling to broaden carbohydrate consumption for weight maintenance. Naturopathic input deducted self-prescribed supplements that were contraindicated with anticoagulant therapy. She was treated with pyridoxine to reduce palmar plantar erythrodysesthesia and vitamin D to correct insufficiency. Patient survived for 29 months after diagnosis.
Case 2: A 56-year-old female diagnosed with pancreatic adenocarcinoma in February 2011 became cachectic after Whipple procedure, feeding jejunostomy tube placement, and subsequent gastroparesis. She received a percutaneous endoscopic gastrostomy tube for drainage. During adjuvant chemotherapy, she received melatonin for cytokine modulation, curcumin to support apoptosis and antioxidant status, and acupressure to point pericardium 6 to reduce nausea. She gained weight on a peptide-based high-nitrogen formula, improved oral intake, and was able to discontinue tube feeding while receiving FOLFIRINOX. She continues treatment, teaches full-time, and remains active.
These cases demonstrate clinically relevant contributions made through our integrative model of care.