Cancer: Supportive and Integrative Care

Overview

Cancer remains the second leading cause of death globally, responsible for approximately 10 million deaths annually. While conventional oncology — surgery, chemotherapy, radiation, immunotherapy, and targeted therapies — has achieved remarkable advances in certain cancer types, the overall war on cancer declared in 1971 has not delivered the decisive victory that was promised. Five-year survival rates for metastatic pancreatic, liver, lung, and brain cancers remain dismally low. Meanwhile, cancer incidence in adults under 50 has risen sharply, with early-onset colorectal cancer increasing by 51% since 1994, suggesting that environmental and metabolic factors are contributing to cancer beyond the traditional risk factors of aging and genetics.

Integrative oncology — the evidence-based combination of conventional cancer treatment with complementary therapies that address the whole person — has emerged as a critical discipline that aims not to replace standard care but to optimize treatment outcomes, reduce side effects, enhance quality of life, and potentially improve survival. The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) have jointly published clinical guidelines endorsing specific integrative therapies for cancer-related symptoms. This is not “alternative” medicine — it is comprehensive medicine that recognizes cancer as a systemic disease affecting every dimension of a person’s being.

This article explores the tumor microenvironment and metabolic approaches to cancer, the evidence for medicinal mushroom immunotherapy, mind-body oncology, and practical strategies for quality of life optimization during and after cancer treatment. The emphasis is on what is evidence-based, clinically applicable, and potentially transformative for the lived experience of cancer patients.

The Tumor Microenvironment

Beyond the Tumor Cell

Traditional oncology focused on the tumor cell itself — its mutations, growth signals, and resistance mechanisms. The past two decades have revealed that the tumor microenvironment (TME) — the complex ecosystem surrounding the tumor including immune cells, fibroblasts, blood vessels, extracellular matrix, and signaling molecules — is equally important in determining cancer progression and treatment response.

Key components of the TME include:

Tumor-associated macrophages (TAMs): Macrophages recruited to the tumor often adopt an M2 (pro-tumorigenic) phenotype, suppressing anti-tumor immunity, promoting angiogenesis, and facilitating metastasis. High TAM infiltration is associated with poor prognosis in many cancer types. Repolarizing TAMs from M2 to M1 (anti-tumor) phenotype is an active area of immunotherapy research.

Regulatory T-cells (Tregs): While Tregs prevent autoimmunity (as discussed in the autoimmune article), their accumulation in the TME suppresses anti-tumor immune responses. The balance between cytotoxic T-cells (CD8+) and Tregs within the tumor determines immune surveillance capability.

Cancer-associated fibroblasts (CAFs): These activated fibroblasts produce a dense extracellular matrix that physically barriers immune cell infiltration and creates hypoxic conditions that promote tumor aggression and treatment resistance.

Tumor angiogenesis: Tumors stimulate new blood vessel formation through VEGF (vascular endothelial growth factor) signaling. These new vessels are structurally abnormal, creating areas of hypoxia that drive genetic instability, immune evasion, and metastatic potential.

Immune checkpoint molecules: PD-L1 on tumor cells binds PD-1 on T-cells, effectively putting the brakes on anti-tumor immunity. The revolution of immune checkpoint inhibitors (pembrolizumab, nivolumab) works by releasing these brakes.

Inflammation and Cancer

Rudolf Virchow observed the connection between inflammation and cancer in 1863, and modern research has validated his insight. Chronic inflammation creates the soil in which cancer grows through multiple mechanisms: NF-kB-driven production of survival signals (anti-apoptotic proteins), COX-2-mediated prostaglandin synthesis that promotes proliferation and angiogenesis, reactive oxygen species that damage DNA, and immunosuppressive cytokines (IL-10, TGF-beta) that impair immune surveillance. An estimated 20% of cancers are directly attributable to chronic infection-driven inflammation (H. pylori — gastric cancer; HPV — cervical cancer; HBV/HCV — hepatocellular carcinoma).

Metabolic Approaches: The Warburg Effect and Beyond

Cancer Metabolism

In 1924, Otto Warburg observed that cancer cells preferentially ferment glucose to lactate even in the presence of oxygen — a phenomenon now called the Warburg effect or aerobic glycolysis. While normal cells generate 36 ATP per glucose molecule through oxidative phosphorylation, cancer cells generate only 2 ATP through glycolysis but do so at a much faster rate. This metabolic reprogramming provides cancer cells with biosynthetic precursors for rapid proliferation, generates lactate that acidifies the TME and suppresses immune function, and creates a dependency on glucose that may be therapeutically exploitable.

The Ketogenic Diet as Adjunctive Therapy

The ketogenic diet — very low carbohydrate, high fat, adequate protein — reduces circulating glucose and insulin while providing ketone bodies as an alternative fuel. The hypothesis is that cancer cells, with their impaired mitochondria and dependence on glycolysis, cannot efficiently utilize ketones, while normal cells can. Preclinical evidence is substantial: ketogenic diets slow tumor growth, enhance radiation sensitivity, reduce angiogenesis, and improve survival in multiple animal cancer models.

Clinical evidence is more limited but growing. A 2018 systematic review by Klement identified 24 clinical studies (mostly case reports and small prospective studies) showing the ketogenic diet was feasible and safe during cancer treatment, with preliminary signals of benefit in glioblastoma, advanced cancer cachexia, and quality of life measures. The ERGO2 trial and several ongoing RCTs are evaluating ketogenic diets as adjuncts to standard glioblastoma treatment. Important caveats: the ketogenic diet is not appropriate for all cancer types or patients, and should only be implemented under medical supervision, particularly during active treatment. Cachexic patients require adequate caloric and protein intake, not further restriction.

Fasting and Fasting-Mimicking Diets

Valter Longo’s research on fasting and the fasting-mimicking diet (FMD) in oncology has generated significant interest. Short-term fasting (24-72 hours) before chemotherapy creates “differential stress resistance” — normal cells enter a protective, quiescent state in response to nutrient deprivation, while cancer cells (which cannot downregulate growth signals) remain vulnerable. This potentially enhances chemotherapy’s selectivity for cancer cells while protecting normal tissues. The NCT01954836 trial showed that fasting-mimicking diets during chemotherapy reduced hematological toxicity and potentially enhanced treatment efficacy. Longo’s ProLon FMD (5 days of caloric restriction mimicking the metabolic effects of water fasting) is being studied as a periodic adjunct to cancer treatment.

Insulin and IGF-1

Insulin and insulin-like growth factor 1 (IGF-1) are potent mitogenic signals that activate the PI3K/Akt/mTOR pathway — the central growth signaling cascade in many cancers. Hyperinsulinemia (from insulin resistance) is associated with increased risk and worse prognosis in breast, colorectal, prostate, and pancreatic cancers. Metformin, which reduces insulin and activates AMPK (opposing mTOR), has shown anti-cancer effects in multiple epidemiological studies and is being evaluated in clinical trials as an adjunctive cancer therapy. Lifestyle strategies that reduce insulin and IGF-1 — time-restricted eating, plant-predominant diet, regular exercise, adequate sleep — represent low-risk, potentially high-impact metabolic interventions.

Mushroom Immunotherapy

Beta-Glucans and Immune Activation

Medicinal mushrooms have been used in East Asian medicine for millennia and are now the subject of rigorous immunological research. The primary bioactive compounds are beta-glucans — polysaccharides with beta-1,3 and beta-1,6 glycosidic linkages that are recognized by pattern recognition receptors on innate immune cells (Dectin-1, complement receptor 3, TLR2). Beta-glucan binding activates dendritic cells, macrophages, and NK cells, enhancing anti-tumor immune surveillance without the toxicity of conventional immunotherapy.

Key Medicinal Mushrooms in Oncology

Turkey Tail (Trametes versicolor): Contains polysaccharide-K (PSK, Krestin) and polysaccharopeptide (PSP). PSK has been approved as an adjunctive cancer therapy in Japan since 1977 and is one of the most extensively studied natural compounds in oncology. A 2012 meta-analysis of 13 RCTs (over 8,000 patients) found that PSK significantly improved survival in gastric and colorectal cancer when added to standard chemotherapy. A 2012 NIH-funded phase I trial at Bastyr University demonstrated dose-dependent immune enhancement in breast cancer patients taking turkey tail extract.

Reishi (Ganoderma lucidum): Contains ganoderic acids (triterpenes) and beta-glucans. Reishi has demonstrated anti-proliferative effects against multiple cancer cell lines, enhances NK cell cytotoxicity, and modulates cytokine production. A Cochrane review found that reishi supplementation alongside conventional treatment improved quality of life and enhanced immune parameters in cancer patients, though evidence for survival benefit was insufficient.

Maitake (Grifola frondosa): Contains the beta-glucan fraction MD-fraction (maitake D-fraction). Clinical research has shown enhanced NK cell activity and immune recovery in cancer patients receiving MD-fraction alongside chemotherapy. A phase I/II trial at Memorial Sloan Kettering demonstrated immunostimulatory effects in breast cancer patients.

Chaga (Inonotus obliquus): Contains betulinic acid, which induces apoptosis in cancer cells through mitochondrial pathway activation. In vitro studies show activity against liver, lung, colon, and cervical cancer cell lines. Clinical evidence is limited to case reports but preclinical data is compelling.

Clinical Integration

Medicinal mushrooms are best understood as immune modulators rather than direct anti-cancer agents. They enhance the body’s immune surveillance capacity, potentially improving response to both conventional treatment and immunotherapy. Typical dosing: 2-6g daily of a combination hot-water-extracted mushroom powder (turkey tail, reishi, maitake) or 1-3g of concentrated beta-glucan extract. Mushroom supplementation should be discussed with the oncology team, as immune enhancement could theoretically interfere with certain immunosuppressive protocols.

Mind-Body Oncology

The Psychoneuroimmunology of Cancer

The field of psychoneuroimmunology (PNI) has established bidirectional communication between the nervous, endocrine, and immune systems — with direct implications for cancer biology. Chronic psychological stress impairs NK cell function (the immune system’s primary anti-tumor surveillance mechanism), increases inflammatory cytokine production, activates the sympathetic nervous system (which promotes angiogenesis and metastasis through beta-adrenergic signaling), and suppresses cellular immunity through cortisol-mediated effects.

David Spiegel’s landmark 1989 study in The Lancet showed that women with metastatic breast cancer who participated in supportive-expressive group therapy lived an average of 18 months longer than controls — a finding that generated both excitement and controversy. While subsequent replication attempts have produced mixed results for survival, the evidence for quality of life improvement through psychosocial intervention is consistent and robust.

Evidence-Based Mind-Body Interventions

Mindfulness-Based Stress Reduction (MBSR): Originally developed by Jon Kabat-Zinn, MBSR has been extensively studied in oncology. A 2019 meta-analysis found that MBSR significantly reduced anxiety, depression, fatigue, and sleep disturbance in cancer patients, with effect sizes comparable to pharmacological interventions. Telomere length — a biomarker of cellular aging — was maintained in breast cancer patients who completed MBSR, compared to shortening in controls (Carlson et al., 2015).

Yoga: The SIO/ASCO clinical guidelines recommend yoga for anxiety, depressive symptoms, and quality of life during and after cancer treatment (Grade A evidence). A 2017 meta-analysis of 29 RCTs found moderate-to-large effects of yoga on fatigue, sleep quality, and quality of life in cancer patients.

Tai Chi/Qigong: Multiple RCTs demonstrate benefits for cancer-related fatigue, immune function (NK cell activity), inflammatory markers, and quality of life. A 2018 meta-analysis found qigong/tai chi significantly improved fatigue, sleep quality, and depression in cancer survivors.

Hypnosis: SIO/ASCO guidelines recommend hypnosis for procedural pain and anticipatory nausea related to chemotherapy (Grade A evidence). Meta-analyses demonstrate large effect sizes for pain reduction during cancer-related procedures.

Quality of Life Optimization

Managing Treatment Side Effects

Chemotherapy-induced nausea: Acupuncture and acupressure at PC6 (Neiguan point) have Grade A evidence for reducing chemotherapy-induced nausea. Ginger (1-2g daily) has demonstrated efficacy in multiple RCTs. Medical marijuana/CBD is increasingly used where legal, with growing evidence for nausea, pain, and appetite stimulation.

Cancer-related fatigue: Exercise is the single most effective intervention for cancer-related fatigue, with effect sizes consistently exceeding those of pharmacological treatments. The American College of Sports Medicine recommends 150 minutes of moderate aerobic exercise and 2-3 resistance training sessions weekly for cancer patients, modified for individual capacity.

Neuropathy: Alpha-lipoic acid (600mg daily), acetyl-L-carnitine (3g daily), and acupuncture have all shown benefit in chemotherapy-induced peripheral neuropathy. Cryotherapy (icing hands and feet during taxane infusion) has demonstrated significant prevention of neuropathy.

Cognitive dysfunction (“chemo brain”): Lion’s mane mushroom, omega-3 fatty acids, exercise, meditation, and cognitive rehabilitation programs address the multifactorial nature of cancer-related cognitive impairment.

Survivorship and Recurrence Prevention

Long-term cancer survivorship involves managing late effects of treatment and reducing recurrence risk. Key strategies include: regular physical activity (the LACE and WHEL studies demonstrated 40-50% reduction in breast cancer recurrence with regular exercise), maintaining a healthy body weight (obesity increases recurrence risk for many cancers through insulin and inflammatory pathways), an anti-inflammatory, plant-rich diet (cruciferous vegetables contain sulforaphane, which activates Nrf2-mediated detoxification and has anti-cancer properties), stress management and social support (sustained high distress is associated with faster progression), and ongoing immune optimization through sleep, exercise, mushroom supplementation, and vitamin D.

Clinical Applications

Integrative Oncology Protocol Framework

During active treatment:

• Coordinate all complementary therapies with the oncology team
• Exercise as tolerated (even walking 15 minutes daily provides benefit)
• MBSR or yoga for symptom management
• Acupuncture for nausea, pain, and fatigue
• Medicinal mushroom complex for immune support (verify no contraindications with treatment protocol)
• Nutritional support: adequate protein (1.2-1.5g/kg/day to prevent muscle wasting), anti-inflammatory foods, hydration
• Ginger for nausea, melatonin (3-20mg at bedtime) for sleep and potential chemoprotective effects

During recovery/survivorship:

• Progressive exercise program building to 150+ minutes weekly
• Metabolic optimization: maintain insulin sensitivity, reduce visceral adiposity
• Continued mind-body practice
• Mushroom and supplement protocol for immune maintenance
• Regular screening per guidelines
• Psychosocial support: support groups, therapy for adjustment, fear of recurrence management

Four Directions Integration

• Serpent (Physical/Body): Cancer is ultimately a physical disease — cells growing without the normal controls, invading tissues, commandeering blood supply, and disrupting organ function. The serpent’s medicine addresses the physical terrain in which cancer arises and thrives: metabolic health, inflammation, immune function, toxin burden, and the integrity of the cellular repair systems (DNA repair, apoptosis, immune surveillance) that normally prevent cancer. Nutrition, exercise, sleep, and detoxification create a physical environment that is inhospitable to cancer growth.

• Jaguar (Emotional/Heart): A cancer diagnosis unleashes a cascade of emotions that are themselves physiologically significant: fear, anger, grief, helplessness, and existential dread. These emotions are not obstacles to healing — they are the emotional material that must be processed for healing to occur. Suppressed emotions activate the sympathetic nervous system and HPA axis, impairing immune function. Expressing emotions — through therapy, support groups, journaling, art, or simply being heard by another person — activates the parasympathetic nervous system and enhances NK cell function. The jaguar’s courage is the courage to fully face what cancer means: mortality, loss, love, and the fierce desire to live.

• Hummingbird (Soul/Mind): Cancer frequently catalyzes a profound transformation of identity, priorities, and meaning. Many cancer survivors describe a “post-traumatic growth” — a deepening of relationships, clarification of values, enhanced appreciation for life, and a new sense of purpose that emerges from the crucible of diagnosis and treatment. The hummingbird’s journey through cancer involves making meaning from suffering, finding purpose in the experience, and allowing the encounter with mortality to clarify what truly matters. This is not toxic positivity (“everything happens for a reason”) but genuine soul work that transforms the experience of cancer from purely destructive to potentially generative.

• Eagle (Spirit): Cancer confronts every patient with the ultimate spiritual question: mortality. The eagle’s medicine is the capacity to hold the paradox of being both mortal and infinite, both a body that can be destroyed and a consciousness that transcends the body. Spiritual practice — whatever form it takes — provides a container for the existential dimension of cancer that medicine alone cannot address. Studies consistently show that cancer patients with strong spiritual coping have better quality of life, less depression, and in some studies, better survival outcomes (Jim et al., 2015). The eagle’s perspective does not deny the reality of cancer but holds it within a larger context of meaning, connection, and transcendence.

Cross-Disciplinary Connections

Integrative oncology draws from multiple disciplines. Metabolic medicine provides the framework for understanding cancer as a metabolic disease and applying dietary and metabolic interventions. Immunology underpins both conventional immunotherapy and natural immune enhancement through mushrooms and lifestyle medicine. Psychoneuroimmunology connects emotional health to immune function and cancer outcomes. Traditional Chinese Medicine has a rich tradition of cancer-supportive herbal formulas (including Huang Qi/Astragalus for immune support and Fu Zheng therapy for treatment side effects). Exercise oncology is an emerging discipline demonstrating that exercise is a potent anti-cancer intervention through immune, metabolic, and hormonal mechanisms. Palliative care — which should begin at diagnosis, not end-of-life — addresses symptom management, quality of life, and the existential dimensions of living with cancer.

Key Takeaways

• The tumor microenvironment — immune cells, fibroblasts, blood vessels, and inflammatory signaling — determines cancer progression as much as the tumor cell itself.
• Cancer cells rely on altered metabolism (Warburg effect); metabolic interventions (ketogenic diet, fasting, insulin reduction) may enhance treatment efficacy.
• Medicinal mushrooms, particularly turkey tail (PSK), have robust clinical evidence for immune enhancement in cancer patients.
• Mind-body interventions (MBSR, yoga, tai chi) have Grade A evidence for cancer-related symptom management and quality of life.
• Exercise is the single most effective intervention for cancer-related fatigue and may reduce recurrence risk by 40-50%.
• Emotional expression and psychosocial support improve quality of life and may influence immune function and survival.
• Integrative oncology complements conventional treatment — it does not replace it.
• Cancer survivorship requires long-term attention to metabolic health, immune function, stress management, and meaning-making.

References and Further Reading

• Warburg, O. (1956). “On the origin of cancer cells.” Science, 123(3191), 309-314.
• Longo, V.D. & Fontana, L. (2010). “Calorie restriction and cancer prevention: metabolic and molecular mechanisms.” Trends in Pharmacological Sciences, 31(2), 89-98.
• Eliza, W.L., et al. (2012). “Efficacy of mushroom-derived compounds in cancer treatment.” Integrative Cancer Therapies, 11(1), 16-28.
• Standish, L.J., et al. (2008). “Immune defects in breast cancer patients after radiotherapy.” Journal of the Society for Integrative Oncology, 6(3), 110-119.
• Carlson, L.E., et al. (2015). “Mindfulness-Based Cancer Recovery and Supportive-Expressive Therapy Maintain Telomere Length.” Cancer, 121(3), 476-484.
• Seyfried, T.N. (2012). Cancer as a Metabolic Disease. John Wiley & Sons.
• Bredesen, D.E. (2017). The End of Alzheimer’s. Avery.
• Greenlee, H., et al. (2017). “Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.” CA: A Cancer Journal for Clinicians, 67(3), 194-232.
• Li, X., et al. (2012). “Polysaccharide Krestin (PSK) and survival in gastric and colorectal cancer.” Cancer Epidemiology, Biomarkers & Prevention, 21(9), 1531-1540.