Ask Dr. Block: Recurrence Prevention

This is perhaps the most overlooked aspect of conventional oncology. Once a patient is deemed “in remission,” they are typically disconnected from care – as well as any attending support – and told to come back in three to six months where diagnostic scans or blood tests will determine if the cancer has returned.  I suggest a far more proactive, empowered approach. For the past few decades I have developed a program for maintaining remission. Every patient that goes into remission deserves a remission maintenance plan that offers cancer survivors a personalized program to regain control of their health, restore vitality, and protect against the cancer returning. At the Block Center, once a patient has completed their treatment, we conduct an updated detailed integrative assessment, and then personally tailor a comprehensive Remission Maintenance program. This program includes a full detox plan, in order to restore and rehabilitate them from their prior treatment regimen. Following this, we update therapeutic nutrition, prescriptive exercise, bio-behavioral strategies, selective supplementation and anti-tumor therapies with the goal of sustaining long-term remission.

It is quite understandable that after a patient hears “you’re in remission,” their inclination is to psychologically retreat to a “cancer-free” zone and never think about cancer again. Not a good idea! And here’s why: Cancer is invisible, as much a microscopic and molecular disease as it is a visible one. Thus a patient in remission may still harbor malignant cells (ones that were resistant to chemotherapy or radiation, and therefore survived the “attack phase,” or treatment phase). Unfortunately, these cells have the ability to return and show up with a vengeance, even when one least suspects it.

Particularly in the first year or two of remission, we provide “aggressive monitoring,” which includes lab tests and imaging to detect early signs of a disrupted biochemistry, or a recurrence of disease. In the first years after remission, therefore, we recommend:

• Clinical visits with your oncologist, at least every three to four months in the first and second year and every six months for the next several years
• Scans and blood tests of tumor markers every three to four months.
• Complete blood count and chemistry test every three months.
• Every three months, update Integrative Assessments, and evaluate biobehavioral, physical and nutrition status, strength, flexibility, aerobic competence, weight changes, body composition, and albumin levels.
• Internal comprehensive terrain monitoring, every three to six months, for the terrain factors that are most potentially problematic.

While doing this monitoring, there is no reason to simply wait anxiously for the proverbial “other shoe” to drop. So we also immediately implement the Remission Maintenance program I referenced above. We know that people whose biochemical environments are disrupted have higher recurrence rates and greater mortality. Conversely, it’s possible to keep the biochemical environment in harmony. And the implementation of individualized, specific lifestyle interventions and dietary strategies can harness immune and biological defenses to help restore both physical and psychological vitality, as well as improve the odds of staying cancer-free. Where recurrence risks are high, we will also carefully select immune and off-label treatment regimens appropriate to the disease and a patient’s needs.