Remission should not mean the end of treatment

“We got it all.”

Words every cancer
patient loves to hear. And it is indeed news worth celebrating. However, you
shouldn’t be fooled into thinking this favorable pronouncement means treatment
is over and you can go back to life as it was before cancer. Consider this:
What is the “it” that they got all of? “It” is the tumor and any detectable
cancer cells. What they didn’t “get” is the biochemical and molecular
environment within your body that made the cancer possible and helped fuel its
growth. A tumor is merely the most visible manifestation of an underlying,
systemic disruption of the body’s processes. In other words, the macroscopic
evidence – the tumor – is the most obvious indication of the illness. As
important as it is to address the tumor, it is not by any means enough.

The confident announcement that “we got it
all” is also somewhat misleading in another way. When all detectable cancer
cells have been eradicated, there is still the possibility that some
undetectable cancer cells lurk in places far from the original tumor. According
to some estimates, up to half of all cancer patients in remission have some
micrometastases – that is, cancer cells that have migrated to other parts of
the body – where they are in the process of creating another tumor. With all
good intentions, surgeons are simply unable to know whether there are any
residual cells in circulation looking for a site where they can dock, harbor
and replicate in order to rear their heads at a future day. This is why you
should think of remission not as the end of treatment, but as the start of the
next phase in your treatment, what I call a “remission maintenance
program.”  .

While conventional cancer treatment
generally ignores this phase, it is actually the time for a very aggressive
approach to treatment. Why? Simply put, a patient in remission may still harbor
malignant cells (ones that were resistant to chemotherapy or radiation), that –
though we are getting diagnostically better with new testing techniques
discovering CTCs, “circulating tumor cells” – not even the best diagnostic
technologies can detect these with certainty. Worse yet, cancer patients face
what I call, “the valley of death.” This is the chasm between what we know and what actually gets implemented
in clinical care.  In other words, though we can measure CTCs, only some
clinical centers routinely provide this as part of their – our – care of
patients.

But it is the unfortunate existence of
CTCs that are often why some patients, even those who have achieved a complete
remission, sometimes suffer a recurrence months or even years later. And why,
at the Block Center, we recommend all of our patients participate in a
remission maintenance program, an ongoing, comprehensive, individualized
program that includes diet, fitness, supplementation, stress care strategies
and anti-tumor therapies.

Of course this requires a reassessment of laboratory
biomarkers that can provide a heads up if a patient’s situation is shifting and
showing signs toward a greater risk of a recurrence. Rather than waiting
passively, I encourage my patients to be aggressive and pursue a full
treatment plan before a recurring problem can take hold.  Instead
of pursuing a plan of “watchful waiting” as was coined years back for observing
prostate cancer patients before moving to invasive therapy, I am far more
interested in my patients pursuing a plan of what I call “active
participating.” As opposed to only going back to your doctor for the next scan,
and waiting anxiously to see if the disease has come back, I want my patients
being proactive and engaged in strategies for preventing a recurrence. 
And in addition to recurrence prevention, this remission treatment plan will
help rebuild your strength as well as bolster your energy. It is during
this time that many of my patients describe feeling that life as a cancer
survivor is more vibrant, even more enriched, than it was before their
diagnosis.

While it is optimal that a “remission
maintenance program” be individually tailored, based on objective evaluation
and assessment of each patient, there are some strategies I will generally
recommend to all of my patients:

• Eat a mostly
  plant-based diet that includes lots of fruits and vegetables.
• Reduce or,
  better still, eliminate meat and dairy.
• Eat more
  cold-water fish (such as salmon, sardines, tuna, and cod). Try to have
  cold-water fish a couple of nights a week.
• Stay
  well-hydrated by drinking plenty of healthful fluids (including water, white or
  green tea, herb teas, purple grape, and apple juices)
• Get plenty of
  sleep.
• Exercise
  regularly and stay fit.
• Learn to
  effectively manage stress. Practice meditation, yoga, or your preferred
  stress-reducing technique every day.
• Develop (or
  maintain) a close network of supportive friends and family.

If your response to hearing “we got it
all,” is to move confidently and resolutely into the next phase of treatment,
you won’t be going back to life as it was before cancer. You will be
purposefully engaged in optimizing your health and well-being, and focused on
strategies to maintain your remission. What I understand and know with
certainty, is that after all you’ve gone through since your diagnosis, you
deserve to be done with cancer and never see this troublesome beast
again.