Treatment varies with patient, cancer form

When a doctor finally diagnosed Karen Frejlach's persistent stomach cramps as pancreatic cancer, the Coeur d'Alene woman instantly inferred the meaning.

She would be dead within a year.

Frejlach knew all the stats of the disease that had killed her husband's previous wife. That the 5-year survival rate is 4 percent. That 74 percent die within one year of diagnosis.

"They told me my chances of survival were very slim," said Frejlach, 61. "I spent a few months waking up and crying, shaking, going through that rigmarole. Knowing I would die soon."

But she hasn't died. Four years after her diagnosis in October 2008, Frejlach is still enjoying her regular jaunts outdoors and doting on her four grandchildren.

When other cancer patients call her for advice, she credits her treatment - including the kind she sought outside the hospital.

"I say, 'I can't help you. I can just tell you what I'm doing,'" Frejlach said.

She started with conventional methods. Surgery to remove a tumor, followed by a year and a half of chemotherapy rounds at Kootenai Cancer Center.

"It got to where it was destroying my joints, my feet, my hands," she said."Finally, I got with my husband and girls and said, 'I can't do it anymore.'"

Frejlach adopted a gentler, complementary treatment; a cancer-geared nutrition plan she found online, based on oxygenated water and abstention from grain, dairy, meat. She exercises outdoors and takes a probiotic for liver support.

She believes her own regimen, as much as the chemo and surgery, aided in her survival.

"I will continue what I'm doing for the rest of my life," Frejlach said, "because I do not want this cancer to come back."

With so much randomness in cancer progression, it's hard to blame patients for taking some of the treatment into their own hands.

While traditional cancer treatments still reign, about 40 percent of adults in the U.S. are using some form of alternative and complementary medicines, according to 2007 data from the National Health Interview Survey.

Oncologist Karie-Lynn Kelly with the Kootenai Cancer Center estimates that today, it's closer to 70 percent.

"By far the majority (of KCC cancer patients) come in with some type of complementary medicine," Kelly said, citing treatments like herbs, diets, yoga.

But with so many options available, results depend on the case and the individual, she noted.

"Sometimes they do have an effect, but they're not a cure," she said of complementary approaches. "When used together with conventional medicine, it works well most of the time."

Growing Need

The Kootenai Cancer Center started as a modest enterprise in 1986, just an out-patient department at Kootenai Medical Center, with a couple medical oncologists and one radiation oncologist.

Over the years, the effort has evolved into two comprehensive cancer centers in Coeur d'Alene and Post Falls, offering medical oncology, or chemotherapy, and radiation oncology. The Coeur d'Alene center is currently installing a state-of-the-art, $6 million linear accelerator for radiation therapy, to match the same technology at the Post Falls center.

A satellite Sandpoint center offers medical oncology three days a week.

The three centers employ roughly 100. The number of new cases diagnosed and/or treated grew from 715 in 2000 to 878 in 2010.

"As we've grown over the years, we've been able to add additional services so people don't have to travel to Spokane," said Jeanne Atha, director of the centers.

The number of cancer cases does look to be increasing, she said.

"I think as our population ages, we're seeing the aging baby boomers," Atha said, noting that risk of cancer grows with age. "We're seeing an increased incidence in cancer, based on generation."

The Usual Way

Conventional care comes down to a trinity of treatment: Surgery, chemotherapy and radiation. Cancer cases can involve any combination of the three, Kelly said.

"Recommended treatment depends on the type of cancer, its stage, where it's localized, the age and health of the person and other health factors," the oncologist said.

The method to battle cancer isn't chosen lightly. Multi-disciplinary teams at KCC determine treatment for individuals cases, Kelly said.

A thoracic tumor board, for instance, comprised of surgeons, pulmonologists, pathologists and other experts, meets regularly to discuss lung or esophageal cancer patients.

There's a similar breast cancer board, Kelly said. Medical experts conduct general tumor rounds to discuss other cancer cases.

"Multiple studies have shown if patient care is involved with a multi-disciplinary team, physicians from all disciplines, the outcomes are better," Kelly said. "Cure rates are better."

Duration of treatment varies. Radiation therapy, administered daily, uses high-energy radiation to shrink tumors and kill cancer cells by damaging their DNA. Typical courses of radiation last one to eight weeks, Kelly said, between 1 and 40 treatments.

Chemotherapy, delivered in cycles, uses drugs to destroy quickly dividing cancer cells. It can be applied to reduce a tumor before surgery or radiation, to abolish recurring cancer cells, and to destroy cancer cells that remain after other treatments.

Some older chemo agents do damage healthy cells, resulting in side effects like hair loss, said Cindy Johnson, KCC pharmacy supervisor. But many newer drugs target a specific class of cells, she said, so the usual side effects aren't seen.

"(The new agents) are more specific and generally less toxic," Johnson said.

Chemotherapy is sometimes scheduled daily, weekly or monthly. Some agents are administered in pill form, or intravenously. The extent of chemotherapy depends on a tumor's response, Kelly said.

"If the chemo is working, it will continue. If not, the chemo drugs will be changed," she said. "That can go on for years."

Surgery is usually applied to physically remove all or part of a tumor, to evaluate the advancement of cancer, or to help with diagnosis or symptom relief.

Some cancers are easier to eliminate than others, Kelly said. She estimated that 60 to 65 percent of radiation treatment at KCC is provided with the intent of obliterating the cancer completely.

Otherwise, 35 to 40 percent of treatments are applied for only palliative purposes, Kelly said, to abate symptoms like pain or coughing up blood.

"We're not treating to lengthen their life," Kelly said of those instances. "With palliative treatment, the goal is to treat the symptoms and make them more comfortable."

When standard treatments aren't the best option, KCC also offers patients access to clinical trials testing new procedures, medications and treatments.

The number of drugs applied to cancer treatment seems to grow every day, Johnson noted.

Sometimes anti-estrogen drugs are now used to treat specific types of breast cancer, she said. And as new drugs are developed for chemotherapy, different uses are found for traditional agents.

"They're constantly looking; is there a new use for an old drug?" Johnson said. "They're finding them. Some older drugs did things they didn't know."

Drugs Running Out

Some treatments have become more challenging to provide, Johnson said.

That's due to an issue KCC sees increasingly: Shortages of drugs used for cancer treatment.

"It generally occurs with generic drugs," Johnson said. "There have been occasions when we have had to pay 10 times what we usually pay to get the drugs. Sometimes that's why you end up paying so much."

Shortages occur two or three times a month, Johnson said.

Affected medications have included an agent that helps intensify the effect of chemotherapy, and is standard for rectal/colon cancer treatment.

The issue stems from some manufacturers not making enough profit on some agents, Johnson said. They tend to cut down or even halt production as a result.

When pharmaceutical technicians at KCC realize that the supply isn't going to hold out, she said, that triggers a frenzy of calls to wholesalers, other hospitals, even to the manufacturers themselves, to track down more.

"A tech comes and says 'I can't find this anywhere,' and we go to the shelf and count how many we have, and how many patients we have," she said. "It's made it a lot more challenging in health care."

The FDA has been prompted to crack down on the shortages, she said, by monitoring availability, but sometimes federal penalties for manufacturers just lead to more shortages.

"We try to stay ahead of the curve," Johnson said.

The Less Usual Way

But drugs aren't the only answer.

Several cancer patients a year seek out Coeur d'Alene acupuncturist Rho Zaragoza to thistle their flesh with healing needles.

??Most of the people who come to me with cancer as their history are complaining of nausea and fatigue," Zaragoza said, adding that muscle spasms and pain are other symptoms.

His goal isn't to eradicate their cancer in his office, he said. He aims to enhance the effects of conventional treatment and minimize any side effects, he said, by reorienting individuals' energy flows.

"They generally see results immediately," Zaragoza said, adding that some patients return after their latest rounds of conventional therapies.

That approach to treatment isn't unusual these days, Kelly said. Most patients want conventional treatment, "but they want to complement it with alternative medicine," the oncologist said of KCC patients.

She breaks unconventional therapies into three categories. There are natural products like herbs and supplements, mind and body practices like acupuncture and yoga, and manipulated body practices like chiropractic and massage.

A survey completed by 70 KCC patients revealed the preferred complementary therapies as: Vitamins and minerals, used by 31 percent of patients; chiropractics, used by 30 percent; and exercise programs, practiced by 27 percent.

Sometimes complementary therapies do prove helpful, Kelly said. The herbal remedy primrose, for instance, helps with hot flashes, a side effect of anti-hormone therapy. Even KCC offers massage therapy for cancer patients with lymphedema, or blockage of lymphatic fluid.

But she said some nontraditional treatments get in the way - like remedies full of anti-oxidants that rebuild DNA. Those will undo the work of some chemotherapies that break down cancer cells, Kelly said.

"What's important is patients need to tell all their health care professionals about any complementary practices they're using," she said, adding that clinical trials have yet to prove the safety and effectiveness of most complementary therapies.

Only occasionally do patients opt for the alternative therapy route, Kelly said, where they invoke holistic therapies only, completely foregoing conventional treatment.

She has never seen it work.

"Usually we see those patients come back, with a very advanced disease," she said.

It Might Work

The appeal of non-traditional treatments is that patients feel more in control of their cancer, said Jeremiah Stevens, naturopathic physician in Liberty Lake.

"It's giving people empowerment," Stevens said. "They're taking charge of their treatment."

When working with cancer patients, he focuses on building their nutrition, he said, providing them supplements and anti-cancer agents like mushroom extract.

"For a lot of people going through chemo and radiation, we've found that adding these things improved their quality of life," Stevens said. "They felt better while they're doing it."

He has met cancer patients who cured themselves with only alternative healthcare, he added.

"But those are somewhat few and far between," he said.

That doesn't mean he refutes it entirely. He pointed to one cancer patient he worked with, who had been given three months to live.

Forgoing additional conventional therapy, Stevens said, the man sustained himself with a strict diet, feeding himself handfuls of supplements and vitamins every day.

He lasted another three years, Stevens added.

"He made it his full time job to get well, and it was encouraging and inspiring to see that," Stevens said. "He did end up succumbing, but he had that extra time."

That's why Stevens encourages patients to educate themselves thoroughly on all methods of survival, he said.

In the end, it's their decision what to pursue.

"People want to do as much as possible when they have cancer, to give themselves the highest likelihood of success," he said.