"The value of Integrative Oncology in medicine:
The German model - a best practice example?“
Peter Zimmermann MD, PhDThomas Breitkreuz, MD
Lunch Meeting with Dr.Thomas Ulmer, MEP
10th May 2011
European Parliament Strasbourg, Salon LOW
IVAA, European Parliament, Strasbourg, 10.5.11
University of ArizonaStanford
University University of California , Los Angeles University of California, San
FranciscoUniversity of Colorado at
Denver School of Medicine University of
Connecticut
Yale University University of Hawaii-
Manoa
John A. Burns School of Medicine
Northwestern University Feinberg
School of MedicineUniversity of Illinois at Chicago School of
MedicineUniversity of Kansas Johns
Hopkins University
University of Maryland
Boston University School of Medicine
Harvard Medical School
Massachusetts Medical
SchoolUniversity of Michigan Mayo
Clinic
University of Minnesota University of
Medicine and Dentistry of New Jersey
University of New MexicoAlbert
Einstein College of Medicine of Yeshiva
UniversityCarolina Duke University
Forest University School of Medicine
The Ohio State UniversityGeorge
Washington University
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Oregon Health and Science University
Thomas Jefferson University of
PittsburghVanderbilt
UniversityUniversity of Texas Medical
Branch University of Vermont College
of Medicine University of Washington
George Washington University
University of Wisconsin-Madison
PATHOGENETIC CONCEPT
focusses on pathogenesis
physical / biochemical intervention
biochemic blockade
analytic / quantitatively orientated
substance and space
ideal: precise intervention
addition von single factors
“as much as necessary”
IVAA, European Parliament, Strasbourg, 10.5.11
SALUTOGENETIC CONCEPT
focusses on healing process
constitution / life style
stimulation of processes
holistic / qualitatively orientated
process and time
ideal: global dynamic
combination / composition of effects
„as much as possible“
Case historyMrs A. J., 54 years, breast cancer
History:Suffered breast cancer 4 years ago pT1b pN1 M0, PR+, ER+
Operation Chemotherapy Radiotherapy Hormone therapy (Tamoxifen) – stopped due to side effects
Presentation:Weakness / FatigueShortness of breathWeight loss: 7,5 kg / 5 months
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
www.medizin-individuell.de
IVAA, European Parliament, Strasbourg, 10.5.11
http://www.anthromed.de/
IVAA, European Parliament, Strasbourg, 10.5.11
Case historyMrs A. J., 54 years, relapse of breast cancer
Findings in outpatient setting: Liver metastasis Elevated tumour markers
Hospital admission:
Examinations (radiographs, computer tomography, endoscopy...)
Start constitutional (salutogenic) anthroposophic treatment(fatigue, appetite, anxiety / depression)
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
Multimodal approach I: Medical intervention / Diagnostic tools
Intensive Care
Endoscopy, catheterization, diagnosticinterventions (i.e. biopsy techniques..)
Oncology: Surgery provided, chemotherapy provided
No difference to other hospitals
Staff is well-trained with „double competences“
AM as an integrative, not „alternative“ medicine
Case historyMrs A. J., 54 years, relapse of breast cancer
Findings in physical examinations: Liver metastases Pleural effusion causing shortness of breath Lymph node metastases (chest, abdomen)
Other findings: Vitality: weakness / fatigue; disturbed sleep; difficulty to
stand up and move; loss of appetite; disturbed circulationand heart rate
Psychological: anxienty / depression Biographical: excessive demands at work / job strain;
family conflicts; deep questions on meaning of life
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
Case historyMrs A. J., 54 years, relapse of breast cancer
Medical Treatment: Start with mistletoe therapy (first intravenously, continue
with injections) Strengthen vitality with AM medicines (Levico comp.
injections, Stibium met praep D6 intravenously, Hepatodoron Tablets
Puncture of pleural effusion / mistletoe pleurodesis Start with hormone treatment (Femara)
Nursing and physical therapies: Liver compresses with milfoil (common yarrow) extract Rhythmic massage
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
www.mistel-therapie.de
Study data: overview of prospective studies (10/2010)
Prospective comparative studies
30 RCT´s, Σ = 3396 patients
18 N-RCT´s, Σ = 4068 patients
Results: ✔ survival (OS) : 16 studies: significantly positive 16 studies: positive trend
2 studies without significant results
✔ QoL : 13 studies: significantly positive 2 studies: positive trend
IVAA, European Parliament, Strasbourg, 10.5.11
Study data: overview of retrospective studies (10/2010)
Retrospective comparative studies
42 studies, Σ = 7571 patients
parameter examinded:survival, QoL, remission / PFS, reduction of adverse effects of
Cx / Rx
Results: ✔ advantage mistletoe „overall“: 39/42
studies
✔ advantage mistletoe in high quality studies: 12/13 studies
IVAA, European Parliament, Strasbourg, 10.5.11
Multimodal approach II: AM Medication
Wide range of AMP´s (>2000)
Parenteral application of particular impor-tance (about 25% of total prescriptions)
AM pharmaceuticals used in intensive care as well as for chronic disease
Indication / selection:
medical condition
affected organs
individual constitution
process-related
„individualized therapy“
IVAA, European Parliament, Strasbourg, 10.5.11
www.bfarm.de
IVAA, European Parliament, Strasbourg, 10.5.11
www.escamp.org
Multimodal approach III: Nursing and physical therapies
Compresses
Medical washings / medicinal baths
(whole body, foot bath)
Rhythmic massage (oil, ointment)
Inhalation
specific AM techniques
AM pharmaceuticals for external use
very effective in acute medical conditions
differentiated therapy, not wellness!
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
Case historyMrs A. J., 54 years, relapse of breast cancer
Active therapies: Eurythmy: movement therapy. Helps to activate healing
forces, helps to overcome fatigue, find new active relationto own own physical vitality
Art therapy (painting): express inner psychologicaldynamics, helps to find individual ways of coping with thedisease
IVAA, European Parliament, Strasbourg, 10.5.11
Multimodal approach IV:
Art therapy / Eurythmy therapy
Art therapy: Painting / design
Speech therapy
Sculpture
Music therapy
Eurythmy therapy: movement therapy
Patient is active in the healing process
based on psycho-somatic interaction:
creativity impression and expression physiological functions
available in bedside setting
Case historyMrs A. J., 54 years, relapse of breast cancer
Hospital discharge after 12 days: Strengthened vitality, good appetite, regained 2 kg No shortness of breath, effective pleurodesis New ideas for every day life Learned mistletoe injection technique
Course after 2 months: Rapidly growing lymph node metastasis Liver / lungs: stable Decision to start short course of chemotherapy in
combination with whole-body-hyperthermia
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
Case
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
Case historyMrs A. J., 54 years, relapse of breast cancer
Chemotherapy / hyperthermia / mistletoe therapy: 3 months of treatment with 4 courses of epirubicin (3 week
interval) Reduction of metastases (complete: liver; partial: lymph
nodes) No side effects during therapy
Continues AM therapy (mistletoe, constitutional, eurythmy therapy: Completely regained weight and vitality Active at work, changed every day life, positive attitude
towards life Clinically stable since 3 years
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
IVAA, European Parliament, Strasbourg, 10.5.11
www.uni-wh.de/gesundheit/anthroposophische-medizin-ibam/