INTEGRATIVE CANCER THERAPIES 3(1); 2004 pp. 82-87

One Oncologist"s View of Integrative Care: Keynote Address, Comprehensive Cancer Care Conference, April 2003

Mitchell Gaynor, MD 

DOI: 10.1177/1534735403262316

MG is at Gaynor Integrative Oncology, New York, New York.

Correspondence: Mitchell Gaynor, MD, Gaynor Integrative Oncology, 331 East 65th Street, New York, NY 10021. E-mail:mgaynor@gaynoroncology.com.

This particular conference comes at a very appropriate time because, despite the fact that there is more information now about integrative and complementary care than there has ever been, people are probably more confused than ever about what to do with complementary and alternative modalities—especially if they have an illness like cancer. Patients say to me on a regular basis,

Dr. Gaynor, one day fiber is good for you, the next day they say it doesn"t matter. One day soy is a great nutrient to be consuming, the next day you read you shouldn"t have soy if you have had a history of breast cancer or pre-malignant breast disease, or even a family history.

People are confused about antioxidants. Every day I see people come in and they say, "My doctor says," "My radiation oncologist says," no fruits, no vegetable juices, no tea because they contain antioxidants. And I ask, "So what are you eating?" and they say, "Water and pretzels are all that"s left." It is wonderful to have a conference on integrative care so that people can really share information and science—in something more thorough than press releases.

I became interested in integrative oncology in 1987 when I was at Rockefeller University in the lab of Drjoseph Nevins looking at the immune system and at cancer-gene interactions. I began reading initially dozens, and later hundreds, of articles explaining nutrient-gene interactions critical in the development as well as prevention of cancer.¹1 was absolutely flabbergasted that in all of my medical training, my internship, serving as chief medical resident at Cornell, during my hematology and oncology fellowship, also at Cornell, nobody had ever taught me what I was now reading—that hundreds of scientific papers demonstrated how various nutrients could affect genes that contribute to promoting or preventing cancer. Nutrients, I learned, could turn on and off cancer cells, could affect the growth and proliferation of cancer cells, could profoundly affect the very parts of the immune system that are responsible for preventing a recurrence of cancer. I subsequently became associate medical director and director of medical oncology at the Strang Cancer Prevention Center. Throughout my career, I have focused on combining the very best that medical science had to offer in the fields of new chemotherapeutic advances, monoclonal antibody therapies, and advances in stem cell transplantation. I have incorporated these with mind-body practices and nutritional modalities, both of which affect the immune system, the endocrine system, and the body"s detoxification system.

For instance, there is a lot of research about antioxidants in terms of free radicals, but the molecules that we call antioxidants have a host of other effects besides being antioxidants. Antioxidants—vitamin A, vitamin C, vitamin E, and other antioxidants, even nutrients found in soy and turmeric—bind to the antioxidant response element in our DNA and can upregulate the transcription of detoxification enzymes.²³ These enzymes break down many of the carcinogens in our environment to which we are exposed. Awareness of our environment is also becoming more important in cancer care. There are many gene-environment interactions. For instance, we have various susceptibilities to toxins such as dioxin, furans, arsenic, cadmium, and lead. Because of current actions by the Bush administration to roll back several provisions of the Clean Air Act, we and our children will for decades to come be increasingly exposed to many more of these toxins. I think that that is a huge problem in a country where already 1 in 3 Americans are going to hear the words "You have cancer" at some point in their life. Integrative oncology really focuses on all of these facets of cancer.

It appears to me that the current paradigm for medicine in general and for oncology in particular really focuses on just treating the symptoms. And what is wrong with this paradigm? Well, in the early 1970s, Richard Nixon declared a War on Cancer. Since that time, tens of billions of dollars have been spent on cancer research, and much good has come out of it. Many new drugs have been developed, monoclonal antibodies are being developed, but the fact of the matter is that overall, cancer mortality has not improved since that time. Even more alarming, there has been an increase of many types of cancer since that time. I think that rather than only a war on cancer, we also need a war on carcinogenesis—a war on obesity, smoking, environmental degradation. Rolling back many of the provisions of the Clean Air Act is not the way to win this war. I recently wrote the foreword to Devra Lee Davis"s book, When Smoke Ran Like Water,⁴ which I would strongly recommend. It finished in the top 5 finalists for the National Book Awards, and it is a wonderful expose of environmental pollution and its far-reaching effects over the past 50 years in this country. I am currently completing a book detailing the role environmental toxins play in human illness."

Instead of a war just on the symptoms of cancer, then, we need to look at the underlying causes of cancer. We also need to look at how to support all of the body systems while we are treating a patient for cancer. That involves teaching people mind-body practices such as the use of sound, voice, and music in healing; a whole nutritional protocol based on solid science; and also the basics of environmental medicine, looking at toxin exposures that people may have in their homes and communities.

When we talk about supporting body systems, we really need to move away from the paradigm that in essence views cancer as being due to a deficiency in chemotherapy. It is not. Cancer is much more complicated. We need to treat the cancer with conventional modalities, but at the same time we need to support all the body"s systems simultaneously. This really points to the fact that many of the assumptions that doctors have made over the years have proved to be wrong. We know these assumptions are at work when patients come in literally avoiding fruits, vegetables, and tea because their doctors just dismissively say, "No antioxi-dants." That dictate is very similar to doctors" reflex-ively giving every postmenopausal woman estrogen supplements for the past several decades. Why were they told to take estrogen? Physicians were telling women, "It will prevent osteoporosis." We have since lea"rned that it has little if any effect. Doctors told them it was going to prevent them from having heart attacks and congestive heart failure. However, if anything, it increases the rate of those. A lot of the assumptions

about conventional medicine that we have made have turned out to be wrong. I think this has very significant consequences. There is a significant literature showing that the "no antioxidants during chemotherapy or radiation therapy" assumption may be off base as well. This is even more critical given that phytonutrients that are antioxidants are key to proper immune functioning.^24-27 

All of us are being exposed to a variety of environmental carcinogens every day—in our air, in our water, and in our soil. I have been particularly concerned about several legislative initiatives that involve the Clean Air Act, in which there are glaring loopholes even now. Most of the cement made in this country, for instance, is manufactured by foreign conglomerates, which are allowed to burn hazardous waste near populated areas. Strong regulations govern the incineration of industrial wastes, but the cement industry has found a way around that. When they burn wastes in their kilns, it is called "recycling." Substances such as used paint thinners, industrial solvents, and old tires are currently being burned near populated areas in the name of "recycling." Regardless ofwhat it is called, toxins are toxins.²⁸ I have looked into one particular cement company that wants to build one of the largest cement plants in North America 2 hours north of New York City. They also operate the largest cement plant in Canada, on the western shore of Lake Ontario where, in 1956, they began burning waste. In fact, the company"s own Web site claims that they pioneered that practice for their industry. Lake Ontario now has the highest levels of dioxin and furans of any of the Great Lakes, which all have significant amounts. The trout in Lake Ontario, a University of Wisconsin study showed, have died off since the 1950s.²⁹ Every 10 years or so, government agencies try to reintroduce lake trout into Lake Ontario. All the trout die because the half-life of these toxins is so long. Seagull eggs along Lake Ontario have the highest levels of dioxin and furans of any of the Great Lakes. Snapping turtle eggs have the same problem." So what do trout, snapping turtles, and seagulls have to do with humans? A study in upstate New York showed that when mothers decreased their consumption of PCB-contaminated fish, breast milk PCB levels declined." In addition, while you might think that the highest rates of lung cancer in New York State would be around New York City, with all the cars and factories in nearby New Jersey and Staten Island, they are not. Many of the counties in New York State with 100% or greater than predicted rates of lung cancer are along Lake Ontario. You see, the fish, turtles, and seagulls have DNA and immune systems just as we do. We need to see that a large part of the diseases that we are treating is
preventable—and I think that all of us need to be more concerned about the environment.

I am also very concerned about children. Childhood lymphoma has increased 30% since 1973. Childhood acute lymphoblastic leukemia has increased 21% in the past 30 years, and childhood brain tumors have increased more than 20% since the mid-1970s.^32-34 You cannot say that this is because of better screening or lifestyle choices. Children do not smoke, they do not drink, and they do not work in chemical factories. I think, again, we need to look at the environment. How are children being exposed? Ten percent of American women have enough mercury in their blood to cause real harm to the developing fetus if they become pregnant, and this, I think, is just one of the clues to the childhood cancers. Industrial polluters have argued for years that "dilution is the solution of pollution." If you send something up in a smokestack, it will diffuse in the local atmosphere, thus falling within the Environmental Protection Agency"s guidelines for air pollution levels. That, I think, is absolutely meaningless. This argument prevails for the same reason that we wasted 50 years arguing whether smoking causes lung cancer: because the cigarette industry knew how to manipulate statistics, in the same way they are still being manipulated by other industries. We eat from the top of the food chain. Seventy percent of dioxin exposure, for instance, comes from our consumption of beef and dairy products. Dioxin, a potent carcinogen, gets into the air, in the soil, in the grass, and eventually into the cows. This process is called bioaccumulation. During breastfeeding, toxins are mobilized and enter the mother"s milk supply. So, in 6 months of breastfeeding, 20% of a mother"s fat-stored dioxin is transferred to the infant. Many times, a nursing infant, by 6 months, ingests the maximum lifetime allowable dose of dioxin. It is no wonder that while the breast cancer risk in the 1940s was 1 in 22 women, it is now 1 in 8. It is the second leading cause of death for American women in general, and it is the leading cause of death for women 35 to 54 years old. I strongly suspect that a similar dynamic is at work in the case of childhood tumors. With all of these things, why are we allowing regulations of the Clean Air Act to be rolled back? All of us need to become environmental advocates. We must also refuse to allow industrial polluters to ignore evidence that we are all endangered by low, steady, cumulative exposures to toxicants. Industrial polluters still argue that until we can find the smoking gun—the bullet that is fired and the body into which it was discharged—there is no proof. We must demand that regulations are made based on the sum total of scientific evidence to predict and prevent harm.

I saw a 23-year-old patient last year who developed bladder cancer, amazingly, at age 18, with absolutely no family history of any cancer. She related to me that when she was 11 years old, millions of gallons of toxic chemicals were dumped into a landfill in the town adjacent to hers. Activities such as these usually result just in fines because they are considered victimless crimes. But I suspect that my patient was, indeed, a victim. In New York State, there are more than 1000 Superfund sites waiting to be cleaned up, which may not happen for quite some time because the New York State Superfund is bankrupt. It is important to realize that we do have a detoxification system and that there are many nutrients that can enhance our detoxification system, such as garlic, green tea, and antioxidant vitamins. Scientists are doing research on this at Cornell and Johns Hopkins by looking at what we can do to improve detoxification systems, but part of the response to ever-increasing pollution loads must certainly be taking care of our environment.

As far as what cancer patients can do for themselves, I think that it is very important to look at patients who have really defied the odds—who have overcome cancers that nobody thought they could. A patient of mine who was discussed in the pages of Newsweek, Marisa Harris, first came to see me about 5 years ago.35 At that time, she had a stage IV, very poorly differentiated adenocarcinoma of unknown primary, very enlarged portahepatic nodes, peripancreatic nodes, inguinal nodes. She had been seen at some of the major cancer centers in New York and was given a 6- to 9-month prognosis and told she was medically incurable. She asked her doctors whether she should get chemotherapy. They said it might let her live another month or two, but they were all dogmatic that she was going to be dead in 6 to 9 months. When she now talks to the medical students at Cornell, she always relates the fact that she asked one of the doctors, "What about a support group?" He looked at her very puzzled and asked, "Why do you need a support group?" So, she came to see me (I was at the Strang Center at the time), and she received chemotherapy, she received my nutritional protocol, she also became very interested in all of the work we were doing with sound and music. She has been in remission now for 5 years and has been off chemotherapy for most of that time. She reported in Newsweek that she ran a marathon right after finishing the chemotherapy, before her hair even grew back. I have seen a number of patients like that, and I think that when we study why a patient like that recovers, we will only then begin to understand some of the things that happen with them. When a patient first goes to see a medical oncologist, there is literally a tidal wave of fear that is going through them. There is fear of losing their hair,
there are fears of dying, there are fears about who is going to be taking care of their family when they have to go into the hospital—and we know the role of stress and anxiety depressing every aspect of our immune system. When a patient comes into my office, we do everything that we would normally do at an academic medical center but also create a detailed nutritional program and a mind-body program. I also discuss current life stresses as well as old anguish and how patients hold on to these in their bodies and their psyches and then look at ways of beginning to release them. I have never found anything more powerful than sound, voice, and music in allowing people to move to what I call "their own inner harmony"—their own core, their own soul.

Much of this work is done with Tibetan bowls and quartz crystal bowls, and I also have a machine that I have been using at our center for a number of years that literally allows the vibrations of instrumental music and chants to be felt throughout the head, chest, and abdomen. Patients are then able to listen to headphones while the specially designed transducer allows these sounds to be felt by the body. This device is called a biosonic machine and is currently sold commercially only in Japan. When using all of these in conjunction with chanting and specially composed music, on the most stressful day of a person"s life, the day they come to see a medical oncologist for the first time, patients invariably experience the greatest relaxation and peace-fulness they have ever felt. That seems like an impossibility, but I see it every day. We do the same things while patients are getting outpatient chemotherapy— sound, voice, music, aromatherapy, massage—and I think this affects not only the quality of life but also the outcome of treatment. It should not be any surprise that it does. There are a number of studies discussed in the classic textbook Psychoneuroimmunology edited by Dr David Felten that discuss the link between stress and the immune system. Not surprisingly, Dr Felten discusses animal models in which stressed animals respond far less well to chemotherapy than do nonstressed animals. Again, we need to find how best to support all of the body systems while treating the symptoms of the cancer.

Another aspect of this work comes from my time in the southeastern part of India, where I do medical charity work and have also studied a number of other modalities for healing. Many of the sound and breathing techniques are taken from anayama yoga techniques taught to me by Sri Aryani Amma. It is also really understood in traditional Chinese medicine, that chi, or life energy, comes in through the breath; in Ayurvedic medicine, prana, a similar concept, also comes in through the breath.

I first became aware of the role of sound back in the early 1990s when I was asked to do a hematology consultation at New York Hospital. In the intensive care unit, I was asked to see a young Tibetan monk who had a very rare disease called fibrosing mediastinitis. It causes tremendous thickening and scarring of all the great blood vessels in the chest and the esophagus, and it affects the heart. I was asked to see him for anemia, and we did all of the conventional things and talked with him about a bone marrow biopsy and what he would need. I then asked him about things going on in his life, and he related a story that he remembered from when he was 3 years old. He was a Tibetan refugee in India. His parents could no longer afford to feed either him or his 6-year-old brother, so they had to leave him at an orphanage run by Tibetan Buddhist monks. He remembered his parents walking away; he was looking at them through the fence, crying and asking them to come back. You could only imagine how that would be for a 3-year-old, wondering if he was ever going to see his parents again. I did not feel that it was any coincidence that on an emotional level, he had been carrying around a broken heart for all of those years and on a physical level, he was literally dying of a broken heart. He was able to recover enough to leave the hospital, and when he came into my office he brought me, as a gift, a metal Tibetan bowl. The metal bowls are made of between 7 and 9 different metals and they have a wonderful sound.

The sound from the bowls is full of overtones when they are played because all of the metals vibrate at different frequencies. I was really struck by the fact that I could feel that sound going through my entire body the first time I heard it. The young monk confirmed that it actually was doing just that. I started working with the bowls in conjunction with the meditation and imagery work I had already been doing with patients receiving chemotherapy and was amazed at the growth and the amount of inner peace they were all achieving in such a short time.

I also have been working with quartz crystal bowls. A wonderful museum exhibit several years ago featured Egyptian quartz and alabaster carillons, which were crystal bowls that had been found in the pyramids. Tibetan and quartz crystal bowls are amazing musical instruments for promoting inner peace and relaxation.

I recently saw a patient who had been diagnosed with a vulvar melanoma. She was looking at anticipating very debilitating surgery. She had already had positive margins on 2 surgeries. She came in to see me, and we did a lot of work with sound, voice, music, and nutrition before she went back for a final biopsy to determine whether she was going to need this debilitating surgery. She was also dealing with a disabled son at home. After 1 session with the crystal bowl and the metal bowl, she had an amazing sense of peacefulness. All of her tension left, and she was able to start doing this for herself at home. She went in for her biopsy, which was negative. Her case is consistent with a recurring pattern I have seen with patients, which is the fact that regardless of what is going on in their life, people have access to an inner harmony, an inner peace, that can be approached through the use of the bowls and also through other mind-body techniques.

Nine years ago, I saw a 29-year-old young man in the bone marrow transplant service at Cornell Medical Center who had been treated with conventional therapy for lymphoma. It had recurred twice. His only chance for a cure was a stem cell transplant. When I went in to talk to him, I asked him what was bothering him the most. He said, "Actually, the thing that"s bothering me the most is that I haven"t slept in 3 months." His mother was there, and I said, "You must have slept some in 3 months," and his mother said he actually had not. I asked, "Didn"t your doctors in the community hospital give you anything?" He said yes, they had given him valium and sleeping pills but they did not help. I asked him what he thought about before he tried to fall asleep at night. He said, "I"m afraid I won"t wake up." I then worked with him to teach him some simple breathing techniques and chanting, and he was able to fall asleep in about 10 minutes. He was able to sleep every night thereafter, throughout his bone marrow transplant. He was able to get out of the hospital in under a month, and he is still in remission today. This example shows how practices that are literally thousands of years old can interact well with the best that modern medicine has to offer.

When I was doing the research for The Healing Power of Sound,³⁶ I was fascinated to find that there is a tremendous scientific literature on sound. Sound affects, literally, every aspect of our body. It affects our endocrine system, it affects melatonin levels, and it affects stress hormone levels. In fact, there can be approximately a 50% drop in cortisol levels and ACTH levels during painful medical procedures just from listening to classical music. Certainly, part of the effect of sound on the body comes from a decrease in stress, which has profound implications for cancer. For instance, Ohio State researchers investigated women recovering from breast cancer surgery.¹" Women with the most stress and the most depression had the deepest suppression of the very parts of the immune system that were responsible for preventing a recurrence of the cancer.

Using the Tibetan bowls and crystal bowls, as well as the biosonic machine, patients are able to move to a tremendously deep and lasting state of inner peace. This gives people not only a refuge from the fear that they experience with cancer, but it also has given people a completely different perspective, which I call a "healing perspective." So many of my patients have told me that in retrospect, having had cancer was one of their greatest blessings because they were able to start looking from a state of inner harmony at all the other things in their life—all the anguish, all the trauma—and everything looked so different when viewed from the healing perspective.

I think that this perspective points to the fundamental distinction between healing and curing. To me, fundamentally healing is about wholeness. Healing is about discovering who you are and why you are here, on the most fundamental levels. Curing is about treating a physical problem on a physical level. Both are very important and both we can do, but I think things become very out of balance when you try to do one without the other.

Over and over, I hear from patients, when they first come in, that their whole world is in chaos. They feel like everything is completely out of control. So many people ask, "Why me?" or "Why is this happening to my son?" or "my daughter?" I think it is important to realize that you can teach people what is really important in life. If you look at the wealthiest man in the world, I tell people, at the end of his life, he cannot go back and say, "If I just had that 1 year back that I spent worrying, or in panic, or depressed, or angry—if I could just have that 1 year back, I would give you all of my money, God." He could not even get 20 more minutes of that time. It shows you that the most important thing is each day and each moment. When patients are able to approach their lives while they are undergoing chemotherapy from that perspective, they begin to achieve more inner peace.

We are also discovering that patients can do so much for themselves with nutrition. Outstanding research has been done on things such as green tea, vitamins, various herbs, natural COX-2 inhibitors such as rosemary and resveratrol, and curcumin. There is so much science that we need to be able to translate into actual patient care. Only then can people start using these tools. There are many mind-body practices that can be used effectively to help people through the journey of cancer. There is an epidemic of environmental pollution that people also need to know about so that they can begin to control it.

I will end by reminding you that, in 1954, Roger Bannister broke the 4-minute mile. In the entire recorded human history, nobody had ever done that. Within several months, 3 other people had broken the 4-minute mile, and within 5 years after that, it was becoming routine—many other people had done it. What changed between the time of entire recorded human history and after Roger Bannister broke that record? What changed was human consciousness.

People became conscious that that was possible. I think that when we see people recovering from cancer, people living with cancer far longer than anyone thought they could have, people being able to have complete peace in their life while they are undergoing chemotherapy—once people see that that is possible, I think that will become part and parcel of cancer care. This is what integrative oncology is bringing to the world.

References

1.  Gaynor ML, Hickey J, Fryer W. Dr. Gaynor"s Cancer Prevention Program. New York, NY: Kensington; 2000.

2.  Maurya AK, Singh SV. Differential induction of glutathione transferase isoenzymes of mice stomach by diallyl sulfide, a natural occurring anticarcinogen. Cancer Lett. 1991;57:121-129.

3.  Elegbede JA, Maltzman TH,  Elson CE,  et al.  Effects of anticarcinogenic monoterpenes on phase 11 hepatic metabolizing enzymes. Carcinogenesis. 1993;14:1221-1223.

4.  Davis DL.  When Smoke Ran Like Water. New York, NY: Basic Books; 2002.

5.  Gaynor, ML. Nurture Nature, Nurture Health—A Doctor"s Guide to Environmental Pollution and Human Health. New York: Nature Press. In press.

6.  Block, G. Vitamin C and cancer prevention: the epidemiologic evidence. Am J Clin Nutr. 1991;53:270S-282S.

7.  O"Connor HJ, Habibzedah N, Schorah CJ, Axon AT, Riley SE, Garner RC. Effect of increased intake of vitamin C on the mutagenic activity of gastric juice and intragastric concentrations of ascorbic acid. Carcinogenesis. 1985;6:1675-1676.

8.  Knekt P. Serum vitamin E level and risk of female cancers. Int J Epidemiol. 1988;17:281-286.

9.  Schacter E, Williams JA, Hinson RM. Oxidative stress interferes with cancer chemotherapy: inhibition of lymphoma cell apoptosis and phagocytosis. Blood. 2000;96:307-313.

10.  Lu HZ, Geng BQ, Zhu YL, Yong DG. Effects of beta-carotene on doxorubicin-induced cardiotoxicity in rats. Chung Kuo Yao Li HsuehPao. 1996;17:317-320.

11.  Morishima I, Matsui H, Mukawa H, et al. Melatonin, a pineal hormone  with  antioxidant property,  protects against adriamycin cardiomyopathy in rats. LifeSci. 1998;63:511-521.

12.  Shimpo K, Nagatsu T, Yamada K, et al. Ascorbic acid and adriamycin toxicity. Am J Clin Nutr. 1991;54(6 suppl):1298S-1301S.

13.  Oglive GK, Feltman MJ, Mallinckrodt CH, et al. Effect of fish oil arginine, and doxorubicin chemotherapy on remission and survival time for dogs with lymphoma. A double-blind, randomized placebo-controlled study. Cancer. 2000;88:1916-1928.

14.  Unnikrishnan MC, Soudamini KK, Kuttan R. Chemoprotec-tion of garlic extract toward cyclophosphamide toxicity in mice. Nutr Cancer. 1990;13:201-207.

15.  Kioka N,  Hosokawa N,  Komano T,  et al.  Quercetin, a bioflavonoid, inhibits the increase of human multi-drug resistance gene (MDRI) expression caused by arsenite.FEBS Letters. 1992;301:307-309.

16.  Mimoto J, Kiura K, Matsuo K, et al. Epigallocatechin gallate can prevent cisplatin-induced lung tumorigenesis in A/J mice. Carcinogenesis. 2000;21:915-919.

17.  Ciaccio M, Tesoriere L, Pintauadi AM, et al. Vitamin A preserves the cytotoxic activity of adriamycin while counteracting its peroxidative effects in human leukemic cells in vitro. Biochem Mol Biol Lnt. 1994;34:329-335.

18.  Nakagawa M,Yamaguchi T, Ueda H, et al. Potentiation by vitamin A of the action of anticancer agents against murine tumors.  Jpn J Cancer Res. 1985;76:887-894.

19.  Tanigawa N, Katoh H, Kan N, et al. Effect of vitamin E on toxicity and antitumor activity of adriamycin in mice. Jpn J Cancer Res. 1986;77:1249-1255.

20.  Legha SS, Wang YM, Mackay B, et al. Clinical and pharmaco-logic investigation of the effects of alph-tocopherol on adriamycin cardiotoxicity. AnnNYAcadSci. 1982;393:411-418.

21.  Blumenthal RD, Lew W, Reising A, et al. Anti-oxidant vitamins reduce   normal   tissue   toxicity   induced   by   radio-immunotherapy. lnt J Cancer. 2000;86:276-280.

22.  Kagerud A, Lund N, Peterson HI. Tocopherol in irradiation of temporary hypoxic tumors. Acta Radiol Oncol. 1981;20:l-4.

23.  Lissoni P, Meregalli S, Nosetto L, et al. Increased survival time in brain glioblastomas by radioneuroendocrine strategy with radiotherapy plus melatonin compared to radiotherapy alone. Oncology. 1996;53:43-46.

24.  Prasad JS. Effect of vitamin E supplementation on leukocyte function. Am J Clin Nutr. 1980;33:606-608.

25.  Tanaka J, Fujiwara H, Torisu M. Vitamin E and immune response. Immunology. 1979;38:727.

26.  Prasad KN, Kumar A, Kochupillai V, Cole WC. High doses of multiple antioxidant vitamins: essential ingredients in improving the efficacy of standard cancer therapy. J Am Coll Nutr. 1999;18:13-25.

27.  Zhou Y, Lee AS.  Mechanism for the suppression of the mamalian stress  response by genisten, an anticancer phytoestrogen from soy. J Natl Cancer Inst. 1998;90:381-388.

28.  Floret N, Mauny F, Challier B, Arveux P, Cahn JY. Viel JF. Dioxin emissions from a solid waste incineration and risk of non-Hodgkin lymphoma. Epidemiology. 2003;14:392-398.

29.  Peterson R. Cause found for Great Lake trout reproduction failure. Sea Grant, University of Michigan, February 13, 1997.

30.  Environment Canada and United States Environmental Protection Agency. State of the Great Lakes—2001. US EPA Publication 905-R-01-003. Washington, DC: Environment Canada and United States Environmental Protection Agency.

31.  Fitzgerald EF, Hwang SA, Bush B, Cook K, Worswick P. Fish consumption and breast milk PCB concentrations among Mohawk women at Akwesane. Am J Epidemiol. 1998;148:164-172.

32.  National Cancer Institute Research on Childhood Cancers. National Cancer Institute, Factsheet 2002. Available at: http://cis.nci.nih.gov/fact/6_40.htm http://cis.nci.nih.gov/fact/6_40.htm. Accessed December 10, 2003.

33.  Reynolds P, Von Behren J, Gunier RB, Goldberg DE, Hertz A, Smith DF. Childhood cancer incidence rates and hazardous air pollutants in California: an exploratory analysis. Environ Health Perspect. 2003; 111:663-668.

34.  Ries LAG, Eisner MP, Kosary CL, et al., eds. SEER Cancer Statistics Review, 1975-2000. Bethesda, Md: National Cancer Institute. Available at:  http://seer.cancer.gov/csr/1975_2000, 2003. Accessed December 12, 2003.

35.  Cowley G. Now, "integrative care." Newsweek, December 2, 2002. Available at http//www.gordonresearch.com/correlating articles/8383182.htm. Accessed November 3, 2003.

36.  Gaynor, M.  The Healing Power of Sound: Recovery From Life-Threatening Illnesses UsingSound, Voice and Music. New York, NY: Shambala; 2002.

37.  Anderson, BL, Farrar WB, Golden-Kreutz D, et al. Stress and immune responses after surgical treatment for regional breast cancer. J Natl Cancer Inst. 1998;90:30-36.