Pine Street Foundation

Lung Cancer Detection by Canine Scent: Will there be a lab in the lab?

Pine Street Foundation — Tue, 18 Dec 2012 21:05:10 +0000

A team of researchers led by R. Ehmann at Ambulante Pneumologie (Stuttgart, Germany) have published an article in the current issue of the European Respiratory Journal reporting on a study in which trained dogs detected lung cancer with sensitivity of 90% and specificity of 72% [1]. Their well-designed study involved 60 lung cancer patients and 110 healthy controls, and is novel for also including ‘‘disease controls’’; 50 patients with non-malignant lung disease. The findings of EHMANN et al. [1] corroborate the results of an earlier study of canine scent detection of lung cancer, which reported sensitivity and specificity of 99%. Together, these two papers, which achieved high accuracy while using different dogs, trainers and human subjects, beg the question of where this might all be leading. The purpose of this article is to review the evidence for canine scent detection of human cancers, and focus on how these papers may help advance knowledge in the field of lung cancer. There are very few published data on canine scent detection of cancers in general, or lung cancer in particular, and they vary widely in accuracy achieved and disease studied. However, the high accuracy of canine scent detection of lung cancer suggests dogs might, in the future, make some modest contribution to successes in lung cancer screening and detection.

CURRENT METHODS FOR LUNG CANCER DETECTION FACE MANY CHALLENGES
The goal of accurate, safe and noninvasive methods to detect lung cancer in its early and curable stages is shared by patients, researchers and clinicians worldwide. However, lung cancer is all too often diagnosed at late stages. Lung cancer is the leading cause of cancer deaths across the European Union, both in terms of standardised mortality rates and absolute numbers of people dying [2]. In 2010, an estimated 220,000 new cases of lung cancer were diagnosed, and over 150,000 deaths occurred, making it the leading cause of cancer death in both males and females in the USA [3]. Early detection of lung cancer remains a challenge, despite recent evidence from the ongoing National Lung Screening Trial in the USA showing that lung cancer mortality can be reduced by up to 20% with low-dose spiral computed tomography (CT) screening com- pared to chest radiography [4].

While patients diagnosed with advanced lung cancer have a 5-yr survival rate of ,5%, survival can increase to .70% for patients whose disease is identified early when the lesion is small and localised [4]. However, at first diagnosis, over 75% of patients have advanced stage disease. Identifying lung cancer early is crucial to improve treatment outcomes and patient survival. The low sensitivity of chest radiographs, combined with the low specificity and high radiation dose of CT scanning, limit the reliability and safety of these technologies as screening tools. Furthermore, cumulative radiation exposure resulting from the use of repeated CT scanning can increase the risk of developing cancer [5].

EXHALED BREATH ANALYSIS: DOGS ARE ONE OF MANY DIFFERENT TYPES OF SCENT DETECTORS
An alternative strategy to lung cancer detection is the improved accuracy that can be gained from combining several tests as screening tools; one possible candidate may be the use of exhaled breath analysis.

There is strong biological plausibility to the idea of dogs detecting lung cancer in exhaled breath. Both our paper [6] and that of EHMANN et al. [1], in the current issue of the European Respiratory Journal, used an independent validation phase in which dogs were able to distinguish lung cancer patient breath samples from controls, using samples from individuals not previously encountered in their training. Nevertheless, critics may turn up their nose at the mention of using sniffer dogs.

This may arise in part because there are very few published data on canine scent detection of cancers in general (n58) [1, 7–13], or lung cancer in particular (n52) [1, 9]. The findings of these studies vary widely in accuracy achieved and types of cancer studied, and papers on either replication of early findings or screening trials have not yet been published [14, 15]. It can be said, however, that the high-quality papers among those published, in which the investigators used rigorous patient selection, sample handling and dog training methods, have shown promising results.

Work toward the development of an ‘‘electronic nose’’ for cancer detection has been underway for several decades; how-
ever, dogs still appear to be ahead in the race and seem to have sniffed their way to the front of the line. We recently published a systematic review of all known data on the evidence for cancer biomarkers in exhaled breath [16], and a limited number of other research teams have published pilot data on exhaled breath analysis in lung cancer. There are no agreed standards for of these methods has limitations hampering their use for highly accurate lung cancer screening, and none have achieved the high sensitivity and specificity seen with dogs.

DETECTING HUMAN DISEASE BY ODOUR HAS A LONG HISTORY
The first published report of detecting human disease in a specific organ system by odour appeared in a 3rd century BC Chinese medical text, the Nan Jing Classic of Difficulties.

‘‘[Every disease of the five solid organs is reflected in (externally observable) colour and smell. For diseases of the liver, it is a greenish colour and rank odour].’’

An earlier writing by Hippocrates (ca. 460 BC to ca. 370 BC) included a more general mention of odour changing in febrile patients in the medical text Prorrhetics II.

“[The (doctors) nostrils indicate much and well in (the case of) fever patients; the odours, however, differ a lot].”

Cancer detection by dogs
The first publication of a dog detecting cancer the case of a young female from the UK who remarked to a dermatologist examining a suspicious mole on her leg that her dog had been licking, nipping and barking energetically and persistently at the lesion [12]. The subject of this paper was then interviewed for a television documentary broadcast in 2006 in the UK [17]. Following the publication of our group’s lung and breast cancer paper [9], several dozen people have written letters reporting a similar story (data not shown).

A vision for the role of dogs in detecting cancer
Since we began our work in canine scent detection of lung cancer 10 yrs ago, we have frequently heard patients, clinicians and researchers lament about several critical issues at conferences, presentations and during scent trials: 1) the frustrations related to the slow progress in the forward movement of science, specifically with early detection; and 2) the anxieties caused by false positives and regrets resulting from false negatives, with current cancer screening and diagnostic methods. These com- ments from patients are understandable, given the frequent reports in the media about problems with lung cancer detection methods, whether it be the poor ability to detect lung cancer with chest radiographs, the hazards of cumulative radiation from CT scans, or the poor resolving power with small modules of the positron emission tomography (PET) scan.

However, imagine a future in which the term PET takes on a new meaning. Dogs could serve as an inspirational role, with the story of dogs detecting cancer in rigorous trials used as a friendly message to the public, perhaps encouraging patients who may be reluctant to seek medical help to do so.

Dogs could also serve a more pragmatic role. If enough funding were allocated to allow other research groups to replicate and refine the encouraging results of the two existing papers on canine scent extension of lung cancer [1, 9], dogs could be used as a noninvasive preliminary diagnostic screening tool or be used to help reduce false positives and false negatives of

existing imaging technologies. This would maximise the power of joint probabilities, similar to the combination of PSA and digital examination being more accurate than either method alone for detecting prostate cancer, or CA-125 and transvaginal ultrasound for detecting ovarian cancer.

In both the literal and the metaphorical sense, with the pub- lication of these papers on canine scent detection of lung cancer, dogs are once again demonstrating their ability to serve as protectors and guides. People worldwide feel a close affinity with the dog as a friend and protector. Whether or not sniffer dogs actually make it into the continuum of diagnostic evaluation has yet to be seen; their image could be employed in public health outreach for cancer screening, and may encourage people with worrisome symptoms to take earlier action. This would be a case of the dog acting as a shepherd; Lassie and Rin Tin Tin are still out there, looking out for our health.

STATEMENT OF INTEREST
None declared.

REFERENCES
1 Ehmann R, Boedeker E, Friedrich U, et al. Canine scent detection in the diagnosis of lung cancer: revisiting a puzzling phenomenon. Eur Respir J 2012; 39: 669–676.

2 Malvezzi M, Arfe A, Bertuccio P, et al. European cancer mortality predictions for the year 2011. Ann Oncol 2011; 22: 947–956.

3 Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277–300.

4 Aberle DR, Berg CD, Black WC, et al. The National Lung Screening Trial: overview and study design. Radiology 2011; 258: 243–253.

5 Sodickson A, Baeyens PF, Andriole KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009; 251: 175–184.

6 McCulloch M, Jezierski T, Broffman M, et al. Diagnostic accuracy of canine scent detection in early- and late-stage lung and breast cancers. Integr Cancer Ther 2006; 5: 1–10.

7 Gordon RT, Schatz CB, Myers LJ, et al. The use of canines in the detection of human cancers. J Altern Complement Med 2008; 14: 61–67. 8 Horvath G, Jarverud GA, Jarverud S, et al. Human ovarian carcinomas detected by specific odor. Integr Cancer Ther 2008; 7: 76–80.

9 McCulloch M, Jezierski T, Broffman M, et al. Diagnostic accuracy of canine scent detection in early- and late-stage lung and breast cancers. Integr Cancer Ther 2006; 5: 30–39.

10 Pickel D, Manucy GP, Walker DB, et al. Evidence for canine olfactory detection of melanoma. Appl Anim Behav Sci 2004; 89: 107–116.

11 Sonoda H, Kohnoe S, Yamazato T, et al. Colorectal cancer screening with odour material by canine scent detection. Gut 2011; 60: 814–819.

12 Williams H, Pembroke A. Sniffer dogs in the melanoma clinic? Lancet 1989; 1: 734.

13 Willis CM, Church SM, Guest CM, et al. Olfactory detection of human bladder cancer by dogs: proof of principle study. BMJ 2004; 329: 712.

14 Moser E, McCulloch M. Canine scent detection of human cancers: a review of methods and accuracy. J Vet Behav 2010; 5: 145–152.

15 Lippi G, Cervellin G. Canine olfactory detection of cancer versus laboratory testing: myth or opportunity? Clin Chem Lab Med 2011 [Epub ahead of print DOI: 10.1515/cclm.2011.672].

16 Szulejko JE, McCulloch M, Jackson J, et al. Evidence for cancer biomarkers in exhaled breath. IEEE Sensors J 2010; 10: 185–210. 17 Can Dogs Smell Cancer? Storyville. BBC television documentary 2006. Available from: www.passionateproductions.co.uk/film_can_dogs.htm

Our 2012 Accomplishments

Pine Street Foundation — Tue, 11 Dec 2012 19:00:48 +0000

It’s been another fantastic year at the Pine Street Foundation…we’ve published peer-reviewed research, presented papers at conferences, received lots of media coverage in the national press, hosted community events, and made huge strides with all our other ongoing research projects. Here are some of the highlights:

Colon Cancer and Chemotherapy
We have been awarded a $70,243 one-year research grant from the prestigious Institute of East-West Medicine of New York to conduct a meta-analysis in which we will systematically identify all published randomized trials that provided patients who have colon cancer with Chinese herbs in combination with their chemotherapy. We will be looking for the impact of Chinese herbal medicine on both immediate results (do people using herbal medicine experience less damage to white blood cells or less drug toxicity?) and long-term results (do people using herbal medicine live longer after treatment and is their quality of life better?), as compared to treatment with chemotherapy alone. Click here to learn more.

Canine Scent Detection of Cancer
We have been awarded a $100,000 two-year research grant from the prestigious Robmar Foundation to provide mentorship for other researchers and dog trainers working to train dogs in scent detection. We will expand our work in developing the Human-Dog bond, building on our prior work with ovarian cancer, to also include lung cancer, breast cancer, and prevention of bladder cancer caused by chonically acute bladder infections in paraplegics. This establishes an important scientific requirement facing the field of canine scent detection in human health: replication of prior work by different groups working with different populations of patients. Click here to learn more.

Publication and Follow-up Presentations: Our Lung and Colon Cancer Survival Studies
Following official publication in December 2011, we spent 2012 presenting our work to clinicians and researchers across the country. These studies represented the results of ten years of treatment and follow-up for patients with lung and colon cancers and were the first to apply modern statistical analysis techniques to the analysis of data from patients treated with Chinese medicine for lung or colon cancer. We believe these papers will help set a new standard for rigorous analysis of data from non-randomized trials. Click here for more.

Clinical Advocacy for Patients with Cancer:
In collaboration with the Commonweal Retreat Center, we participated in a workshop and public presentation on the ways in which clinical advocates help people with cancer. Included in our presentations was a discussion of the past, present, and future of clinical advocacy, Pine Street’s approach to Chinese Medicine-based integrative care, and how to work with patients who are reluctant or are refusing conventional care. Click here for more.

How You Can Help
Whether you’ve known us since 1989 or have only recently discovered our work, it is important to note that the Pine Street Foundation is one of the most efficient and cost-effective research organizations of its kind in the country. And since the vast majority of all our funding comes from individual donors like you, your financial support truly helps us advance the field of integrative medicine and beenfits those in need of better treatments.

As you consider your year-end charitable giving, please keep the Pine Street Foundation in mind. Click here to make a donation now.

New Training Consortium: Leveraging Our Experience to Expand Our Reach

Pine Street Foundation — Tue, 11 Dec 2012 17:05:25 +0000

We have been awarded a $100,000 two-year research grant from the prestigious Robmar Foundation to provide mentorship for other researchers and dog trainers working to train dogs in scent detection. We will expand our work in developing the Human-Dog bond, building on our prior work with ovarian cancer to also include lung cancer and breast cancer. This establishes an important scientific requirement facing the field of canine scent detection in human health: replication of prior work by different groups working with different populations of patients.

We will provide educational and mentorship support to other researchers and trainers involved in training dogs to use their sense of smell in evaluating human health. We will leverage our more than twelve years of experience with canine scent detection, expanding our reach beyond what has already been achieved within our own group. As we move forward with our own research projects, we wish to provide significant mentorship to other teams doing the same type of work. In our mentorship of other teams, we will provide:

Mentorship (helping other teams turn their visions into reality with concrete project design)
Scientific support (helping other teams write proposals, analyze data, and publish results)
Training support (helping other dog trainers become better scent detection trainers), and
Collaborative support (helping other organizations with project management and data auditing support).

Our goal is to expand our reach through this mentorship and research and to help other groups spread the word through publication in scholarly journals and through media exposure.

HOW YOU CAN HELP
Click here to make a gift (of any amount) to help support this project.

Chinese Herbal Medicine and Chemotherapy in the Treatment of Colon Cancer: A Meta-Analysis of Randomized Controlled Trials

Pine Street Foundation — Tue, 11 Dec 2012 17:00:45 +0000

We have been awarded a $70,243 one-year research grant from the prestigious Institute of East-West Medicine of New York to conduct a meta-analysis in which we will systematically identify all published randomized trials that provided patients who have colon cancer with Chinese herbs in combination with their chemotherapy.

Following our successful analysis of clinical trials testing combinations of herbal medicine and chemotherapy for lung cancer, we’re now turning our attention to colon cancer. In medical centers across Asia, patients being treated for colon cancer frequently use herbal medicine in combination with their chemotherapy. The Pine Street Foundation is now critically examining published studies to see whether Chinese herbal medicine, when added to chemotherapy, could measurably improve treatment outcomes for people with colon cancer, as compared to using the same chemotherapy alone.

WHAT WE PLAN TO DO
We will be looking for the impact of Chinese herbal medicine on both immediate results (do people using herbal medicine experience less damage to white blood cells or less drug toxicity?) and long-term results (do people using herbal medicine live longer after treatment and is their quality of life better?), as compared to treatment with chemotherapy alone.

We will also be looking carefully at the quality of the published studies. Most of the studies we have located in our systematic search of the medical literature were published in China and one of our goals with this meta-analysis is to better understand the level of scientific quality of these studies; many researchers in the Western scientific community have criticized Chinese studies for their low quality of design and reporting.

WHY THIS WORK IS IMPORTANT
By analyzing these studies, we’ll determine what study quality problems are most significant and where improvement is needed. Pine Street has three primary aims in conducting this meta-analysis. First, we are using the results of this study as a basis for designing a double-blinded, randomized trial for patients with colon cancer. Second, by pointing out where improvements in study methodology are needed, we hope to contribute to the improvement in quality of clinical studies in China. Third, we want to educate readers outside of China on the vast quantity of research being conducted there, research that highlights the potential clinical benefits of integrative medical care.

HOW YOU CAN HELP
Click here to make a gift (of any amount) to help support this important project.

List of Publications

Pine Street Foundation — Mon, 10 Dec 2012 16:31:36 +0000

Central to our mission is to distribute our research as widely as possible. Here’s a list of our various publications, book chapters, and poster sessions.

INVITED REVIEW PAPERS
McCulloch MF, Turner K, Broffman M. Lung Cancer Detection by Canine Scent: Will there be a Lab in the Lab? Euro Respiratory J 2012;XX(XX):XX. (In press)

PUBLICATIONS (PEER REVIEWED)
1.     McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Kramer A, Gao J, Colford JM: Lung Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models and Propensity Score Methods. 2011. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.
2.     McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Abrams DI, Gao J, Colford JM: Colon Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models And Propensity Score Methods. 2011. Sep 30. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.
3.     See, CJ, McCulloch MF, Smikle C, & Gao J. (2011). “Chinese herbal medicine and clomiphene citrate for anovulation: a meta-analysis of randomized controlled trials.” Journal of Alternative and Complementary Medicine 17(5): 397-405.
4.     Szulejko JE, McCulloch MF, Jackson J, McKee DL, Walker JC, Solouki T. Evidence for Cancer Biomarkers in Exhaled Breath. Sensors Journal, IEEE. Jan. 2010;10(1):185-210.
5.     Moser E, McCulloch MF (2010). “Canine Scent Detection of Human Cancers: a Review of Methods and Accuracy.” Journal of Veterinary Behavior. May. 2010; 5(3):145-152
6.     Ensminger JJ, Jezierski T, McCulloch MF: Scent Identification in Criminal Investigations and Prosecutions: New Protocol Designs Improve Forensic Reliability. (Listed on SSRN’s Top Ten download list for Animal Law eJournal).
7.     McCulloch MF, See C, Shu XJ, Broffman M, Kramer A, Fan WY, Gao J, Lieb W, Shieh K, Colford J. Astragalus-based Chinese herbs and platin-based chemotherapy for advanced non-small cell lung cancer: meta-analysis of randomized trials. Journal of Clinical Oncology. 2006 Jan 20;24(3):419-30.
8.     McCulloch MF, Jezierski T, Broffman M, Hubbard A, Turner K, Janecki T. Diagnostic accuracy of canine scent detection in early- and late-stage lung and breast cancers. Integr Cancer Ther. Mar 2006;5(1):30-39.
9.     Shu X, McCulloch MF, Xiao H, Broffman M, Gao J. Chinese herbal medicine and chemotherapy in the treatment of hepatocellular carcinoma: a meta-analysis of randomized controlled trials. Integr Cancer Ther. 2005 Sep;4(3):219-29.
10.   Pai M, McCulloch MF, Gorman JD, Pai N, Enanoria W, Kennedy G, Tharyan P, Colford JM Jr. Systematic reviews and meta-analyses: an illustrated, step-by-step guide. Natl Med J India. 2004 Mar-Apr;17(2):86-95.
11.   Pai M, McCulloch MF, Enanoria W, Colford Jr JM. Systematic reviews of diagnostic test evaluations: What’s behind the scenes? (Editorial). ACP J Club. Jul-Aug 2004;141(1):A11.
12.   McCulloch MF, Broffman M, Gao J, Colford JM. Chinese herbal medicine and interferon in the treatment of chronic hepatitis b: a meta-analysis of randomized, controlled trials. Am J Public Health. 2002 Oct;92(10):1619-28.
13.   Pai M, McCulloch MF, Colford JM Jr. Meta-analysis of the impact of HIV on the infectiousness of tuberculosis: methodological concerns. Clin Infect Dis. 2002 May 1;34(9):1285-7.
14.   Pai M, McCulloch MF. Computer Programs for Epidemiologists: PEPI v4.0. Am J Epidemiol. 2002;155(8):776-777.
15.   Broffman M, McCulloch MF. Instrument-assisted pulse evaluation in the acupuncture practice. American Journal of Acupuncture 1986; 14.

BOOK CHAPTERS
1. Broffman, M, McCulloch MF, See C, Burns B. (2008). Magic Fusion: the Meaning of Integration in Medicine. Botanical Medicine in Clinical Practice. R. R. Watson and V. R. Preedy (eds). Wallingford, UK, CABI.

PUBLICATIONS (NON-PEER REVIEWED)
1.     McCulloch, MF, M Broffman, and J Cannell. (2010). “Vitamin D3: A Review of the Evidence for its Role in Human Health.” Avenues 29/30(Spring/Summer): 3-12.
2.     McCulloch, MF and C See (2009). “When the Answer Isn’t So Clear: Interpreting the Results of Medical Research.” Avenues 26(Summer): 3-8.
3.     McCulloch, MF and M Broffman (2009). “Swine Flu Vaccination, Treatment, and Prevention: A Common Sense Discussion and Review of the Evidence.” Avenues 27/28(Autumn/Winter): 3-10.
4.     Altgelt, J. and MF McCulloch (2009). “Lymphoma, Chemotherapy and Antioxidants.” Avenues 25(Spring): 3-8.
5.     Altgelt, J., H. Ly, and MF McCulloch. (2008). “Colon Cancer, Chemotherapy And Antioxidants.” Avenues 22(Summer): 3-12.
6.     Altgelt, J., H. Ly, and MF McCulloch. (2008). “Ovarian Cancer, Chemotherapy And Antioxidants.” Avenues 23-24(Autumn/Winter): 3-12.
7.     Altgelt, J. and MF McCulloch (2008). “Lung Cancer, Chemotherapy And Antioxidants.” Avenues 21(Spring): 3-12.
8.     McCulloch, MF (2005). “Your Mind and Cancer Treatment Understanding and Addressing Cognitive Decline.” Avenues 12(Winter): 3-6.
9.     Altgelt, J. and MF McCulloch (2007). “Breast Cancer, Chemotherapy and Antioxidants.” Avenues 19-20(Autumn/Winter): 9-14.
10.   Paster, J. and MF McCulloch (2007). “Antioxidants and Chemotherapy For Advanced Prostate Cancer The Latest Research On Specific Interactions.” Avenues 18(Summer): 7-10.
11.   Broffman M and McCulloch MF. Integrative Traditional Chinese Medicine and CMF/CAF chemotherapy in node-positive and metastatic breast cancer: 5- and 10-year survival data. San Francisco Medicine 2001; 74(10): 29-30.

POSTER SESSIONS (PEER REVIEWED/INVITED)
1.     McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Kramer A, Gao J, Colford JM. (2010). Lung cancer survival with herbal medicine & vitamins in a whole-systems approach: 10-year follow-up data analyzed with marginal structural models and propensity score methods. 2010 Annual Meeting of the American Society of Clinical Oncology; June 4- 8, 2010; Chicago, Illinois. (publication only)
2.     Solouki, T., MF McCulloch, J Szuleko, JC Walker. (2009). Early detection of ovarian cancer biomarkers at the highest level of confidence using exhaled breath: Fourier Transform Ion Cyclotron Resonance Mass Spectrometry and biosensors designed by nature. Canary Foundation Early Detection Symposium; May 4th – 6th 2009; Stanford University, Palo Alto California.
3.     McCulloch MF, Broffman M, Abrams DI, Kramer A, Gao J,Colford JM. Survival In Non-Small Cell Lung Cancer Patients Following Treatment With An Adjunctive Chinese Herbal/Vitamin Protocol. Traditional Chinese Medicine and Cancer Research: Fostering Collaborations, Advancing the Science; April 10-12, 2006; National Institutes of Health, Bethesda, Maryland.
4.     Solouki, T., MF McCulloch, et al. (2006). Early detection of cancer biomarkers at the highest level of confidence using exhaled breath: Fourier Transform Ion Cyclotron Resonance Mass Spectrometry and biosensors designed by nature. The Emerging Role Of Screening & Prevention In Women’s Cancers; May 4th & 5th 2006; New York University School of Medicine.
5. McCulloch MF, Broffman M, Gao J, Colford JM. Chinese herbal medicine and interferon in the treatment of chronic hepatitis B: a meta-analysis of randomized, controlled trials. International Scientific Conference on Complementary, Alternative and Integrative Medicine Research. April 12-14, 2002. Harvard Medical School.

Chinese Medicine for People with Lung Cancer: Treatment Results

Pine Street Foundation — Sun, 14 Oct 2012 20:00:23 +0000

In collaboration with the Commonweal Retreat Center of Bolinas, Calif., we participated in a workshop and public presentation on the ways in which clinical advocates can help people with cancer. Included in our presentation was a discussion of the past, present, and future of clinical advocacy, our approach to Chinese Medicine-based integrative care, and how to work with patients who are reluctant or are refusing conventional care.

Download (PDF, 2.37MB)

Wellness Times

Pine Street Foundation — Thu, 09 Aug 2012 20:00:05 +0000

Service Dogs: A New Breed of Heroes

By Karolyn A. Gazella

Our canine companions continually remind us of their desire to serve and protect. Some do that as pets, but others make it their profession. Because of their keen sense of smell—which is up to 1,000 times more sensitive than human’s—dogs can be invaluable in searching for things undetectable to the human nose. “They toil daily on our behalf, snuffling out contraband, explosives and human bodies buried beneath tons of collapsed cement,” says Bill Benda, MD, who has written extensively about the healing power of animals.

But science is showing us that these beloved animals have abilities that go beyond airport security and into the field of medicine: “They can also detect covert cancer cells, or predict a hypoglycemic event or epileptic convulsion,” Benda says. Which begs the question: Is it time to put a Lab in the lab?

Click here to read the entire article.

Chinese Medical Debate

Pine Street Foundation — Wed, 08 Feb 2012 04:02:40 +0000

Study Abstracts: Pine Street 10 Year Survival Studies

Pine Street Foundation — Wed, 07 Dec 2011 23:13:15 +0000

If you would like to receive a complete copy of these studies, please contact us and we will send you a copy via email.

Lung Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models and Propensity Score Methods

McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Kramer A, Gao J, Colford JM: Lung Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models and Propensity Score Methods. 2011. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.

PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/21824893

Abstract: Complementary and alternative medicines are used by up to 48% of lung cancer patients but have seen little formal assessment of survival efficacy. In this 10-year retrospective survival study, the authors investigated Pan-Asian medicine + vitamins (PAM+V) therapy in a consecutive case series of all non-small-cell lung cancer patients (n = 239) presenting at a San Francisco Bay Area Chinese medicine center (Pine Street Clinic). They compared short-term treatment lasting the duration of chemotherapy/radiotherapy with long-term therapy continuing beyond conventional therapy. They also compared PAM+V plus conventional therapy with conventional therapy alone, using concurrent controls from the Kaiser Permanente Northern California and California Cancer Registries. They adjusted for confounding with Kaplan-Meier, Cox regression, and newer methods – propensity score and marginal structural models (MSMs), which when analyzing data from observational studies or clinical practice records can provide results comparable with randomized trials. Long-term use of PAM+V beyond completion of chemotherapy reduced stage IIIB deaths by 83% and stage IV by 72% compared with short-term use only for the duration of chemotherapy. Long-term PAM+V combined with conventional therapy reduced stage IIIA deaths by 46%, stage IIIB by 62%, and stage IV by 69% compared with conventional therapy alone. Survival rates for stage IV patients treated with PAM+V were 82% at 1 year, 68% at 2 years, and 14% at 5 years. PAM+V combined with conventional therapy improved survival in stages IIIA, IIIB, and IV, compared with conventional therapy alone. Prospective trials using PAM+V with conventional therapy for lung cancer patients are justified.

Colon Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models And Propensity Score Methods

McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Abrams DI, Gao J, Colford JM: Colon Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models And Propensity Score Methods. 2011. Sep 30. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.

PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/21964510

Abstract: Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference-namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified.

Our 2011 Accomplishments

Pine Street Foundation — Wed, 07 Dec 2011 16:23:26 +0000

It’s been another fantastic year at the Pine Street Foundation…we’ve published peer-reviewed research, presented papers at conferences, received lots of media coverage in the national press, hosted community health screenings, and made huge strides with all our other ongoing research projects.

Published Research: Complementary & Alternative Medicine For Lung & Colon Cancer
For patients with lung and colon cancer, does adding complementary and alternative medical (CAM) therapy to standard treatment extend survival? We analyzed more than 10 years of follow-up data from the Pine Street Clinic for patients who used CAM therapy and compared their outcomes to a control group. In two papers published this autumn in Integrative Cancer Therapies, one of the most important peer-reviewed journals in this field, we found that patients who took an integrative approach had significantly better longevity than those patients who only had standard treatment. Click here for more.

Continuing Research: Can Dogs Detect Ovarian Cancer?
Is there meaningful information contained within the breath that could lead to the early detection of ovarian cancer? In collaboration with Baylor University and the University of California at San Francisco, we are using dogs to find biomarkers in the exhaled breath of women with ovarian cancer that could lead to earlier detection – and better treatment outcomes – for women diagnosed with this disease.

We’ve made great progress on this study this past year and, in preliminary analysis of our data, have seen that training dogs to detect ovarian cancer is highly feasible and efficient, similar to what was seen in our 2006 paper on patients with lung and breast cancers.

To complete this study, we just need to recruit eight more women who are either newly diagnosed with ovarian cancer but have not yet begun treatment, or have been previously treated and now have a rising CA-125 but have not yet resumed treatment. Click here to see if you or someone you know is eligible to participate.

As The Year Draws To A Close…
Whether you’ve known us since 1989 or have only recently discovered our work, it is important to note that the Pine Street Foundation is one of the most efficient and cost-ef- fective research organizations of its kind in the country. And since the vast majority of all our funding comes from individual donors like you, your financial support truly helps us advance the field of integrative medicine and benefits those in need of better treatments. Click here to make a secure donation now.

As you consider your year-end charitable giving, please keep the Pine Street Foundation in mind. We really appreciate it!

Best wishes,

Pine Street Foundation

2011 PUBLICATIONS (PEER REVIEWED)
1.      McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Kramer A, Gao J, Colford JM: Lung Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models and Propensity Score Methods. 2011. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.
2.      McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Abrams DI, Gao J, Colford JM: Colon Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models And Propensity Score Methods. 2011. Sep 30. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.
3.      See, CJ, McCulloch MF, Smikle C, & Gao J. (2011). “Chinese herbal medicine and clomiphene citrate for anovulation: a meta-analysis of randomized controlled trials.” Journal of Alternative and Complementary Medicine 17(5): 397-405.

LECTURES/TEACHING
2011 Novel Statistical Approaches to Evaluating Whole Systems Therapies: The Case of Lung and Colon Cancer Survival
2011 Project-Based Learning: Research in Chinese Medicine, A Course for 3rd year students on how to read, and conduct research. American College of Traditional Chinese Medicine. San Francisco, CA. (Presented in two consecutive semesters)

REVIEWER FOR THE FOLLOWING JOURNALS & COMPETITIONS
European Respiratory Journal: 2011
Integrative Cancer Therapies: 2011

EDUCATION
We held two free health screenings for members of our community in Marin County, California. Click here to learn more about these events.