Dr. Mark Kelley — Metabolic Oncology
You have probably not heard the term Metabolic Oncology. That’s because it is a clinical medical subspecialty that does not yet exist. My goal is to change that.
In the simplest terms, Metabolic Oncology refers to the study of the relationship between metabolism and cancer. Scientists have studied this relationship for many years and have found many links between metabolism, cancer risk, and outcome. Unfortunately, none of these observations has led to an effective metabolic-based treatment of cancer thus far. For this reason, the clinical management of patients with or at risk of developing cancer has been organized into the traditional clinical oncology subspecialties: Medical Oncology, Surgical Oncology, and Radiation Oncology.
There has been increasing awareness of the benefits of interventions to improve metabolic health and fitness for cancer patients in these traditional subspecialties. However, the current medical practice paradigm does not support the type of practice and tools that will be required to make meaningful changes in the metabolic health and fitness of cancer patients. That is why I believe that we need a new clinical medical subspecialty called Metabolic Oncology focused on this goal.
What would the new subspecialty actually do?
The existing oncology subspecialties are focused primarily on the treatment of cancer rather than prevention. Their strategy is to try to eradicate an established cancer using one of the following tactics: surgery, chemotherapy, immunotherapy, or radiation. These tactics can be very effective in some cancers, especially when diagnosed early, but have limited potential to cure most advanced cancers.
Metabolic Oncology is focused primarily on prevention rather than treatment. The strategy is to improve metabolic health and fitness to reduce the risk of developing cancer, improve the effectiveness of standard treatments, and reduce the risk of recurrence in patients with a history of cancer. The tactics of Metabolic Oncology involve changes in “lifestyle” factors such as Exercise, Nutrition, Sleep, Stress, and targeted use of drugs and supplements. Helping patients understand the link between “lifestyle” factors, metabolic health, and cancer and developing an individualized plan to improve metabolic health is the long-term goal of this new specialty.
How can that goal be achieved?
The major barrier to developing a Clinical Metabolic Oncology Practice has been the current paradigm of medical care, which focuses primarily on treating established cancer rather than prevention. A new approach is needed, and I believe that Medicine 3.0 is the way forward in health care, including Clinical Oncology.
What is Medicine 3.0?
This term was described and popularized by Dr. Peter Attia, an innovative and influential Longevity Medicine Physician. For years, I have felt a disconnect between my current Surgical Oncology practice and my desire to broadly impact health by reducing the burden of cancer. I sensed the limitations of the current system and the need for a different approach, and Dr. Attia’s description of “Medicine 3.0” put a framework around this. You can find a more detailed description of the topic in Dr. Attia’s book, Outlive, on his website peterattiamd.com, or on his podcast The Drive.
He contrasts the current medical paradigm, called Medicine 2.0, with a potential future state, called Medicine 3.0. There are many contrasts between these paradigms, but the key distinctions are the goal, strategy, tactics, effectiveness measures, and patient involvement.
Medicine 2.0 vs. Medicine 3.0
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Aspect Medicine 2.0 Medicine 3.0 Goal Extend lifespan by treating diseases when they develop Keep diseases from developing by preventing or managing the causes of disease Approach ”Reactive medicine" "Proactive medicine” Primary Tactics Procedures and drugs, with limited counseling on “lifestyle factors” Focus on “lifestyle factors” such as exercise, nutrition, sleep, and stress management, with limited use of drugs, hormones, and supplements Time Horizon Measured in months or years Extends for decades or a lifetime Effectiveness Measures Evidence-based medicine and randomized controlled clinical trials Broader approach to determining the benefit of interventions, integrating all available evidence balanced against the risk of no action Patient Involvement Patient is a passive participant Patient takes a much more active role (captain of their “health ship”)
How is Medicine 3.0 related to Metabolic Oncology?
Metabolic Oncology is the application of the principles of Medicine 3.0 to cancer care. Its strategy is to prevent or manage cancer by improving metabolic health using the tactics of Medicine 3.0: exercise, nutrition, sleep, and stress / emotional health. This includes a comprehensive analysis of the risk of cancer developing or recurring and an individualized plan to improve metabolic health and minimize that risk.
How does Metabolic Oncology fit in a Medicine 2.0 world?
Medicine 2.0 oncology care has achieved many significant achievements and should not be discarded. Metabolic oncology should be viewed as a complementary approach to traditional oncology care that adds more detailed risk evaluation and management as well as metabolic interventions to increase the effectiveness of proven treatments, improve quality of life, and reduce the risk of recurrence.
Metabolic oncology should not be considered an “alternative” to standard cancer care. Although we are interested in the potential for metabolic interventions to treat cancer directly, this has not been proven. Metabolic interventions should not be considered as a substitute for clinically validated treatments, but as tools to build upon and augment their benefits.
Traditional vs. Metabolic Oncology
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Aspect Traditional Oncology Metabolic Oncology Strategy - Eradicate established cancer
- Focus on treatment rather than prevention- Improve metabolic health and fitness
- Reduce risk of developing cancer
- Improve effectiveness of standard treatments
- Reduce risk of recurrence in cancer survivorsTactics - Surgery
- Chemotherapy
- Immunotherapy
- Radiation therapy- Exercise optimization
- Nutrition improvement
- Sleep enhancement
- Stress management
- Emotional health support
- Targeted use of drugs and supplementsFocus - Treatment of established cancer
- Limited potential to cure most advanced cancers- Prevention and risk reduction
- Long-term metabolic health improvementApproach - Reactive: responds to diagnosed cancer
- Standardized protocols based on cancer type/stage- Proactive: aims to prevent cancer development
- Individualized plans based on patient’s metabolismOutcome - Can be very effective for early-stage cancers
- Limited success with advanced cancers- Potential to reduce overall cancer incidence
- May enhance effectiveness of traditional treatments
- Improves overall health and quality of life