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结直肠癌的综合治疗:一种全面的方法。

Integrative Treatment for Colorectal Cancer: A Comprehensive Approach.

作者信息

Block Keith I, Block Penny B, Gyllenhaal Charlotte

机构信息

Block Center for Integrative Cancer Treatment , Skokie, IL.

出版信息

J Altern Complement Med. 2018 Sep/Oct;24(9-10):890-901. doi: 10.1089/acm.2018.0125.

Abstract

A comprehensive approach to integrative treatment of colorectal cancer (CRC) patients involves three spheres of intervention: lifestyle, biology, and conventional treatment. Individualization of treatment is emphasized. The lifestyle sphere includes nutritional therapies, biobehavioral strategies with circadian interventions, and physical care modalities. The biology sphere comprises six host factors in the patient's internal biochemical environment or "terrain": inflammation, glycemia, oxidative stress, immune dysregulation, coagulopathy, and stress chemistries. Laboratory testing of these factors guides integrative lifestyle and supplement recommendations. The conventional treatment sphere includes individualized lifestyle recommendations, and supplements or drugs used to enhance tolerability or effectiveness of conventional treatments. Innovative strategies are implemented, including chronomodulated chemotherapy, chemosensitivity testing, and using results of molecular genomic testing to guide nutritional infusions and supplement recommendations. In the lifestyle sphere, substantial evidence from cohort studies supports recommendations for a diet that emphasizes plant and fish proteins, healthful fats in amounts that are tailored to the clinical circumstance of the patient, and carbohydrates based on unrefined whole grains, vegetables and whole fruits. High glycemic diets and refined carbohydrates, especially sugar-sweetened beverages, should be avoided. Biobehavioral strategies include practice of the relaxation response and related approaches. In addition, specific strategies to promote robust circadian organization (CO) are used to combat quality of life concerns and worsened survival that accompany disrupted CO. Physical activity, including aerobic activity and muscle strengthening, is recommended at all disease stages. In the biology sphere, supplements and lifestyle recommendations for inflammation and glycemia are discussed. In the conventional treatment sphere, supplements and innovative and complementary therapies that may remedy treatment toxicities are reviewed. Approaching CRC treatment with a comprehensive, individualized intervention enables safe and beneficial outcomes in this patient population, which can vary widely in individual biology, treatment toxicities, and disease complications. Further research in integrative therapies for CRC patients is needed.

摘要

结直肠癌(CRC)患者综合治疗的全面方法涉及三个干预领域:生活方式、生物学和传统治疗。强调治疗的个体化。生活方式领域包括营养疗法、采用昼夜节律干预的生物行为策略以及身体护理方式。生物学领域包括患者体内生化环境或“内环境”中的六个宿主因素:炎症、血糖、氧化应激、免疫失调、凝血障碍和应激化学物质。对这些因素进行实验室检测可指导综合生活方式及补充剂建议。传统治疗领域包括个性化生活方式建议,以及用于提高传统治疗耐受性或有效性的补充剂或药物。实施创新策略,包括时辰化疗、化疗敏感性检测,以及利用分子基因组检测结果指导营养输注和补充剂建议。在生活方式领域,队列研究的大量证据支持以下饮食建议:强调植物蛋白和鱼类蛋白、根据患者临床情况调整适量的健康脂肪,以及以未精制全谷物、蔬菜和完整水果为基础的碳水化合物。应避免高糖饮食和精制碳水化合物,尤其是含糖饮料。生物行为策略包括放松反应及相关方法的实践。此外,采用促进稳健昼夜节律组织(CO)的特定策略来应对因CO紊乱而导致的生活质量问题和生存恶化。建议在所有疾病阶段都进行体育活动,包括有氧运动和肌肉强化运动。在生物学领域,讨论了针对炎症和血糖的补充剂及生活方式建议。在传统治疗领域,对可能改善治疗毒性的补充剂、创新疗法和补充疗法进行了综述。采用全面、个体化的干预方法治疗CRC,可使该患者群体获得安全有益的结果,因为该群体在个体生物学、治疗毒性和疾病并发症方面差异很大。还需要对CRC患者的综合治疗进行进一步研究。

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