According to surveys in the United States, Canada and Europe an average of 35% of cancer patients use Chinese Herbal Medicine during their cancer treatments.  Among Asian patients the use of Chinese Herbs is even higher.  There are always the questions of both safety as well as drug-herb interactions when patients use herbal medicines concurrently with cytotoxic chemotherapy treatments.

Two of the most widely studied Chinese medicinal mushrooms are Reishi or LingZhi (Ganoderma lucidum, Ganoderma chinense) and YunZhi or Turkey Tail Mushroom (Trametes versicolor, Coriolus versicolor).  These are widely used as adjunctive medicinal foods by cancer patients and as therapeutic agents in both traditional and Modern Chinese Medicine.  These mushrooms are considered Immune Modulators having an epigenetic impact on the expression of tumor promoter and tumor suppressor genes.  Additionally, they act as Immune System Activators influencing both innate and adaptive functions of the immune system, influencing the activity of T cells, natural killer cells and neutrophils and have antiviral and antioxidant properties. Chinese Mushrooms positively impact glycemic control as well as supporting the health and balance of the intestinal microbiome.  Traditionally and historically Chinese Mushrooms have been considered to Enhance Overall Health and Vitality, Promote Longevity and Support Cognitive Clarity and Meditation.

In a systematic review by Lam, et al, of 213 studies, including 77 human studies both Reishi Mushroom and Turkey Tail Mushroom were found to be safe when used concurrently with chemotherapy.  In some studies, a synergistic effect and enhancement of tumor cell cytotoxicity and clinical efficacy of the chemotherapy drugs was observed.  There was a general decrease in common adverse effects such as fatigue, gastrointestinal discomfort, nausea, vomiting, diarrhea, constipation. Peripheral neuropathy and hand-foot syndrome were also reduced.

It was noted that PSP, a derivative of YunZhi, did show interactions with cyclophosphamide, potentially increasing the cytotoxic effects.   Overall undesirable drug-herb interactions were not reported.  Further studies to expand knowledge of pharmacokinetics of medicinal mushrooms is required to understand their mechanisms of action more deeply.

Patients who used these mushrooms while undergoing chemotherapy treatment with a wide range of cytotoxic chemotherapy drugs showed improved quality of life, improved survival, and improved response to treatment.  Patients also experienced less side effects and support for maintenance of normal immune function.

I generally do include Chinese Medicinal Mushrooms, including Reishi and Turkey Tail as therapeutic concentrated foods.   Hot water extracts of both fruiting body and mycelia are recommended.   Companies that product mushrooms on a natural medium yield the most active therapeutic constituents.  I do not recommend mushroom products grown on grain or products that contain only mycelia.  While these are cheaper, they are of poor quality and do not have the extraordinary life-giving properties of traditionally produced mushrooms.

I recommend 3-6 grams daily of properly prepared high quality mushroom powders as a therapeutic dose and 2-3 grams daily for healthy individuals as a nutritional dose.

Powerful immune enhancing agents are contraindicated in patients with auto-immune inflammatory syndromes, patients receiving immunotherapy with PD1, PDL1 and Checkpoint inhibitors and transplant patients on immunosuppressive therapies.  Additionally use caution with patients diagnosed with leukemias and lymphomas.

Selected References

1. Lam CS, Cheng LP, Zhou LM, Cheung YT, Zuo Z. Herb-drug interactions between the medicinal mushrooms Lingzhi and Yunzhi and cytotoxic anticancer drugs: a systematic review. Chin Med. 2020 Jul 25;15:75. doi: 10.1186/s13020-020-00356-4. PMID: 32724333; PMCID: PMC7382813.

2. Carmady B, Smith CA. Use of Chinese medicine by cancer patients: a review of surveys. Chin Med. 2011;6:22.

3. Lam Y, Cheng C, Peng H, Law C, Huang X, Bian Z. Cancer patients’ attitudes towards Chinese medicine: a Hong Kong survey. Chin Med. 2009;4:25.

4. Yeh Y, Chou Y, Huang N, Pu C, Chou P. The trends of utilization in traditional Chinese medicine in Taiwan from 2000 to 2010: a population based study. Medicine (Baltimore). 2016;95(27):e4115.

5. Yuen JW, Gohel MD Anticancer effects of Ganoderma lucidum: a review of scientific evidence. Nutr Cancer. 2005;53(1):11-7. DOI 10.1207/s15327914nc5301_2.PMID: 16351502 

Exercise is Medicine

In order to be a Survivor-Thriver and significantly reduce risk of recurrence, cancer patients must be encouraged to develop a life-long habit of regular exercise with clear guidelines, measurable goals and behaviors and coaching support if necessary to successfully integrate a new habit. Exercise has the potential to reduce all cause mortality in cancer survivors by 25%.

According to investigator, Lee W. Jones, PhD, of Memorial Sloan Kettering Cancer Center in New York City, in a study involving 11,480 survivors, with 16 year median follow up, patients who followed exercise guidelines enjoyed a 25% reduced risk of all-cause mortality compared with patients who did no exercise (HR 0.75, 95% CI 0.70-0.80).   [1]

Additionally, patients who followed exercise guidelines also showed a significant reduction in cancer mortality (HR 0.79, 95% CI 0.72-0.88), as well as mortality from other causes (HR 0.72, 95% CI 0.66-0.78).[1]

Exercise was associated with a reduction in all cause mortality (for breast, endometrial, head and neck, hematopoietic, prostate, and renal cancers), cancer-specific mortality (for head and neck, and renal cancers), and other cause mortality (for breast, colon, endometrial, hematopoietic, and prostate cancers).

In patients who adopt an active lifestyle and follow exercise guidelines, the benefits may last for two decades after diagnosis.  [2]  Meeting versus not meeting the exercise guidelines was associated with a 25% reduced risk of all-cause mortality, a 21% reduced risk of cancer mortality, and a 28% reduced risk of death from other causes. [2]  

“Compared with no exercise, there were statistically significant reductions in cancer-specific mortality among those exercising below the exercise guidelines and larger reductions for those meeting and exceeding the guidelines, 19%, 25%, and 33% reductions, respectively, which demonstrates that all levels of exercise are beneficial.” [2]

“The American Cancer Society guidelines recommend that physical activity assessment and counseling begin as soon as possible after diagnosis, to help patients prepare, tolerate, and respond to treatments, and manage symptoms and treatment side effects.” [3]

Exercise Guidelines in the study included moderate-intensity exercise 4 or more days per week, with each session, on average, 30 or more minutes in duration and/or strenuous-intensity exercise 2 or more days per week, with each session, on average, 20 or more minutes in duration.

On the very first patient visit I talk about the value and importance of exercise and include an exercise prescription in every patient’s care plan from day one.   I ask patients to accumulate 60 minutes of movement activity daily.  They can start with 10 or 15 minute sessions until they build up more fitness, strength and stamina.  

Unfortunately, only 38% of cancer patients in the study were classified as “exercisers”.    Some cancer patients think, mistakenly, that they should rest and convalesce and that exercise may do harm.  On the contrary, patients undergoing all types of treatments and those in remission and in recovery benefit from some type of appropriate movement.  Of course, each patient should be assessed individually and given appropriate guidelines, training and supervision.   Using apps that track activity can increase interest and compliance.

The reality is that the awareness of the positive impact of exercise is very low among cancer patients and cancer survivors.  Exercise is truly one of the “big levers”, a source of significant impact upon the health, well-being, mood, sleep, bone density, muscle mass, prognosis, quality of life and SURVIVAL of cancer patients.  

I envision all cancer treatment centers having an exercise room at their facility!!!

I propose a new specialty “Exercise Oncology”!  

The OutSmart Cancer System is a HEALTH MODEL.  Every patient receives exercise guidelines, support and coaching to develop and sustain lifestyle and self care habits that create a body where cancer cannot thrive.

Selected References

1. Jessica Lavery, Lee Jones et al
   Pan-Cancer Analysis of Postdiagnosis Exercise and Mortality
   DOI: 10.1200/JCO.23.00058 Journal of Clinical Oncology  PMID: 37651670
   
   
2.  Stacey Kentfield, June Chan
   Meeting Exercise Recommendations Is Beneficial for Cancer Survivors
   DOI: 10.1200/JCO.23.01528 Journal of Clinical Oncology
   Published online September 20, 2023. PMID: 37729601
   
   
3. Rock CL, Thomson CA, Sullivan KR, et al:
   American Cancer Society nutrition and physical activity guideline for cancer survivors.
   CA Cancer  J Clin 72:230-262, 2022