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Robin Daly
Hello welcome to the Yes to Life show. I’m Robin Daly, your regular show host and founder of Yes to Life, the UK’s integrative cancer care charity. Integrative medicine or integrative oncology when applied in cancer care has been a long time coming, particularly here in the UK. Part and parcel of the many strengths of our much-loved NHS is the strength to resist change, which in this field it has done resolutely for decades. Thankfully though, outside forces are pushing the NHS towards inevitable change that it won’t be able to stave off much longer. The science base of integrative medicine just goes on building and the development of integrative oncology moves on a pace in other countries. I’ve noticed that in recent years the glowing talk here in Britain of building oncology centres to rival the best in the US has somewhat fizzled out as the integrative model has gained an ever greater foothold there. A more broad-minded breed of young oncologists is beginning to emerge, many with a cultural heritage that embraces traditional and holistic approaches alongside conventional medicine. But I’d say the greatest pressure for change is coming from those with cancer, who through the internet are now empowered to inform each other of ways to support their own recovery, leading to an increasingly untenable gulf of knowledge between old-school oncologists and the patients they’re supposed to be helping. One oncologist who has gained the extra mile to accommodate and embrace additional strategies that patients are adopting in an effort to prolong or save their lives is Dr Jon Krell and I’m absolutely delighted to have the opportunity to speak to him today. I’m so pleased to finally met you and now to have you as my guest on the Yes Life show.

Dr Jon Krell
Thank you very much for having me.

Robin Daly
So I’ve heard a lot about you, all good from our beneficiaries at Yes Life. So of course I’m keen to find out more about you in the way that you were first of all I wanted to ask you well many people are drawn to medicine for a whole variety of reasons but oncology really is a tough column in amongst the rest of medicine as there’s all these tragic cases to deal with and compared to some other conditions we’re relatively ill-equipped to meet the challenges. So maybe you can tell us well what took you into medicine and why did you choose to focus on cancer.

Dr Jon Krell
Yeah, I think you’re right. I think oncology is a very difficult specialty in the work that we do. I think probably like a lot of people in oncology, there’s some personal motivation to to the job that we do. I was unfortunate to have lost both of my parents to cancer as a teenager. Oh, wow. I’ve had breast cancer when I was 12 years old, and she died a few years later. My dad passed away a year after that. Wow. So I think really that was my motivation for going off to medical school and ultimately becoming an apologist.

Robin Daly
Well, that’s plenty of motivation. What a rollercoaster at such a young age. Yeah, okay. So, as I mentioned, you’ve had lots of good press from many of our beneficiaries. So, what do you think they’re finding in you that’s kind of hitting the spot in a way that all too often other oncologists are spectacularly failing to do?

Dr Jon Krell
I don’t know. I think oncology is a very diverse and complex specialty. I think that there are many ways of treating cancer now, both sort of the conventional and less conventional or integrative approaches. And I think as oncologists and physicians, we are very much set down the roots of the conventional treatments. And we’re not very well set up, I don’t think, in our training or through the National Health Service and the facilities and services that we can provide to really offer very much of the other approaches to treatment. We’re not blessed with the resources really to have other sort of modalities of treatment within our clinic. So I try and utilize as many of our colleagues in other specialties in the integrated world, in the nutritional world, to really try and support patients in a holistic way. So I think by providing very up-to-date conventional therapy through the clinic, through the research that we do, but also being very understanding and accepting of the failings that we still have within the limitations of what we can provide and being able to access expertise of others that can provide those sort of services and support networks for patients.

Robin Daly
Well, I think you describe very well why our bear fishery’s like us services, that kind of willingness to embrace a broad approach and to say, okay, we got answers, but not all the answers and some other people can help in other ways. I feel that really typifies what people are wanting from an oncologist and that’s, and interested in, well, what is it about you that made you look in that direction? Obviously, you didn’t have to, you could have gone through medical school, just come out and done what it says on the tin, you know, so you’ve obviously had an interest to explore wider, something in particular brought that out.

Dr Jon Krell
I think that there are great things that we do within the oncology clinics and within conventional medicine, but I’ve seen the benefits in other patients who’ve explored integrative approaches and I think both in terms of the treatments that they have in terms of drug treatment in addition to what we’re giving the other benefits that they can provide in terms of symptom control, support, management of side effects and to some degree some of the actual anticancer effects of some of the treatments given can be really helpful, but I think also the additional care that’s provided by other specialists such as psychological support, physiotherapy, counselling and all of the other things that these clinics and specialists provide that are under provided and under serviced through the NHS. So it’s partly experienced through patients, experienced through talking to and working with integrative oncologists, but also reading the data. You know there are data out there now to support this approach and you look to other countries like the US where it’s very much being integrated into the MDTs and so really educating ourselves about these approaches rather than just saying well there’s no data, there are data out there now and we need to read them.

Robin Daly
musics by ears. Thank you. So look it’s a really interesting time in cancer in many ways. On the one hand there’s been this huge growth in interest and availability of data regarding the genetic components of cancer and how these relate to the success or otherwise the treatment approaches. So and there’s also been a growing appreciation of the instability and the variability of those genetic components between different patients, between different parts of their tumor, even the same sites at different times. And all that’s been going on but in parallel there’s this other model of cancer is primarily a metabolic disease in which genetic damage is seen as a kind of side effect, a symptom. It’s increasingly taking hold. So we’ve got a kind of chicken and egg here which is which out of these two is it really the genes that are causing the initial damage that’s then leading on to the cancer and the metabolic problems are a result of that or is the metabolism the initial cause that’s then leading on to the genetic damage. I’m interested to hear how you see it.

Dr Jon Krell
I’ll probably sit on the fence a little there, but I think both approaches are important, and I think no one cancer is the same, no one tumor is the same, and even within a tumor, no one cell is the same, although certainly there’s much heterogeneity between cells within a tumor. That means there’s different things going on within each cell or within each component of the tumor. What’s driving the growth, in part, can be genetic, it can be molecular on the level of gene expression, protein expression, mutations in genes, but equally cancer cells, like any other cell, require food and energy sources, and certainly metabolism and energy is equally as important in stimulating growth of cancer cells, and I think that’s borne out by the fact that targeted therapies and genetically driven treatments can be very effective and can be very beneficial. Likewise, drugs that target the immune system and activate the immune system can be as well, but not in all tumors, so I think there are all of these different components that can be important in driving the growth of the cancer and thereby in preventing and treating tumors as well.

Robin Daly
Mmm. Yeah, that’s the interesting thing in a way. You’re right is that I mean Nobody’s quite got to the bottom of which is the egg here but as you say both things are playing into the the recipe of what’s going on and There are merits to targeting either its energy supply the metabolic or its genetic base It’s a case of well, what’s going to work? And Do you find yourself in your own approach? Combining these two things

Dr Jon Krell
Yeah, absolutely. I mean, I won’t profess to be an expert on integrative medicine and therefore, you know, I will talk to patients, a lot of my patients about other approaches and diet and exercise and the importance of integrating that into their care and often point people in the right directions to those who are experts in that field. And, you know, my experience of integrative oncologists who I’ve worked with today is that they are exactly that very integrative, very understanding of the importance of the drugs that we’re giving and the importance of working together to combine both approaches, both in terms of achieving better response to treatment, but equally better symptom control and side effect management as well.

Robin Daly
So, on the genetic side, as I was saying, there’s lots of data now which can inform treatment choices. Is that something you’re very involved with?

Dr Jon Krell
Yeah, I mean, personalizing approaches to cancer treatment through genetics is something I’m involved in in terms of the research that I do and the clinical trials that we undertake. There are various drugs that we have in trial or commercial drugs that we have in commercial studies that look at targeting specific genetic changes with specific drugs. So I think that’s very important. I think other areas that are of interest and that are becoming more usable within the cancer clinic are in vivo or ex vivo models of response to treatment where we can actually take a sample of tumor, grow that outside of the body and treat it with drugs to determine which drugs will work. And importantly, which drugs won’t work as well to avoid giving patients drugs that are only going to give potential side effects but that from the outset, I’m not gonna have any benefits. So in ex vivo culture model that we’re using in collaboration with a company called Q response that we’re testing the validity of the test at the moment. So I think there are pitfalls to a purely molecular sort of profiling based approach to treatment and combining that with ex vivo cultures, we can go a lot further in selecting the right drugs for patients.

Robin Daly
Right. Okay. So you’re distinguishing there between things which on the face of the evidence would appear to be a good treatment choice with actually trying it out. Is that right? That’s right. Yes. That’s interesting. So those two things don’t necessarily correlate. Is that true?

Dr Jon Krell
Well, that’s true. We see that in patients as well, you know, for example, you know, take a case of a lady with breast cancer and her two positive tumours, so it’s her two protein being expressed at high levels. Within the tumour there are, we know in theory that that will be stimulating the great cancer cells and there are drugs, her two targeting drugs that will target that particular pathway. But the effectiveness of drugs, even in the first-line setting, is not 100%. It’s probably not even 70% or 80% in the majority of cases. So, you know, that’s an example of selecting a treatment based upon a genetic biomarker, but it not being effective in everyone. It is interesting.

Robin Daly
Right, okay, but how about the reverse though? I think you mentioned already the idea that you can use this kind of information to avoid taking useless and damaging treatment that’s not going to do anything for you, has some horrible side effects. So which is the most effective method there? Is it again the same kind of situation?

Dr Jon Krell
I think that, yeah, I think they’re both important to use together and, you know, those importance both to patients in terms of not giving drugs that aren’t going to work, not given side effects that aren’t going to benefit, as well as making sure you’re selecting the most effective drugs. But there are also more general, more global benefits in terms of health economics in millions of pounds of spent drugs each year and it could save the National Health Service and other care providers lots of money by ensuring we’re not giving expensive or even cheaper drugs that may only create side effects and no benefits.

Robin Daly
Yeah, yeah, definitely very important. And how much effect is this having on kind of mainstream oncology, this type of information?

Dr Jon Krell
I think mainstream oncology, the use of targeted treatments and selecting treatments based on molecular markers within the tumor is becoming more and more commonplace. That’s probably still at a more selected level where we are selecting specific markers to test for because we have a specific drug that is licensed and proven for use. I would say that’s slightly different than a broader molecular profiling approach where we say, well, I’m not going to just look for specific marker X or Y or Z because we have a drug to target those, but to say, well, that’s broadened the net and profile the whole genetics of the tumor to see whether there may be targets that we wouldn’t normally expect to see for that cancer type and for which we may not normally use drugs within that tumor. So that sort of broad molecular profiling is less commonplace. Still, the main reason why it’s relatively expensive, but equally the drugs that you may be highlighted at the end of that are not yet funded or licensed for use in that particular tumor type. So one of the pitfalls of a broader approach is you may end up highlighting potential benefits of a drug that you have no access to.

Robin Daly
That is interesting. Yeah, because, I mean, you can end up with apparently kind of wisely off piece drug appearing to be the most pertinent one to a particular cancer, is that right?

Dr Jon Krell
That’s right, absolutely. And to me, one of the ways to navigate that difficult scenario is to have another test like an ex vivo test to say, okay, well, you’ve highlighted a marker for which we have a drug that isn’t licensed or proven in that tumor type. Let’s test it on a fresh tumor, and you know, an ex vivo tumor from a biopsy to provide further evidence for its potential use or not. Right. That’s right.

Robin Daly
it builds the case for actually using it. But those kind of tests are not being used in any case by the NHS.

Dr Jon Krell
Um, so certainly selected marker testing is being broadly used, uh, within different tumor types, you know, lung cancer, breast cancer, ovarian cancer, endometrial cancer, there are four of those tumor types. There are specific markers we look for to help guide specific use of drugs that are licensed for use for those markers, uh, but poor molecular profiling to perhaps select drugs that you use in different cancers, you might want to use in another cancer because you found the same biomarker, um, is not currently in approach used because, uh, we don’t have access broadly to that testing and getting hold of the drugs that may be highlighted or, uh, it isn’t, isn’t possible within the governance and funding structure.

Robin Daly
It’s tricky, isn’t it? On the one hand, you’ve got the direction of our understanding of cancer as I was saying, getting into more and more randomness, if you like, in as much as random markers and therefore random drugs that are actually useful. But on the other hand, we’re up against this system, which is very prescriptive about what you can and can’t use and was built in the days when we thought, well, we’re just developing a prostate cancer drug and that was that. So it’s a bit of a dichotomy trying to fit these two things together, isn’t it? The system is beginning not to serve the actual, the territory we’re in.

Dr Jon Krell
No, that’s right. I think keeping clinical practice up to date with the science and technology is difficult. And of course, all of these approaches need validation in some way because as oncologists and as doctors, we wouldn’t be comfortable using a test that hasn’t been well validated. And there are lots of tests out there that are not well validated, but there are some that are going through rigorous clinical trial and validation. And ultimately, that’s what’s needed for us as oncologists to really have faith in using them and for them to make their way through the licensing and governance structures within hospitals and clinics to allow us to use

Robin Daly
Yeah, okay. Well, we have to, I just sort of wonder, actually, do you think that the direction to it’s going, basically was that under threat at the moment, just the sort of one size fits all computer driven model of like, oh, you’ve got this type of a breast cancer, therefore, here’s the treatment, boom, print it out, you know. And it seems like, well, nobody liked that very much, except for the system somehow liked it. I don’t think the treat patients as we now increasingly realize everybody’s an individual. And that approach is great for a few and not great for the rest. So, do you think that this new information that’s as it increases, is going to finally sort of break the model of, you know, this prescriptive way of treating in en masse like that?

Dr Jon Krell
I think it will and it’s already is, you know, before we had as much knowledge about all of these different markers before we had the drugs to target them. Our treatment was very much based on large clinical trials, testing drug A or a combination of drugs versus drug B or a combination of drugs and seeing overall which was the most effective treatment and that’s ultimately how the standard guidelines for use of chemotherapy has come about by first line, second line, third line algorithms that we use, but we are branching out already with targeted treatments, immunotherapies and others and that will continue to evolve as we learn more and as tests and technology and diagnostic markers improve and become better validated.

Robin Daly
I hope so, so just want to look a little bit at the other side of things we’re talking about metabolism. You acknowledge it’s not your primary field, but nonetheless, obviously you’re certainly coming across this, you’re working with people who are taking this kind of approach. So cancer has been known for 100 years now to have a fundamentally different kind of metabolism, and that makes it a target. You can target it based on the fact that it’s got a different way of generating energy. Ketogenic diet is a great example of something that is the first sort of dietary approach you like that seems to have made an impression on the mainstream. It’s now being researched in the mainstream and it’s spoken about openly as a potentially useful tool for some cancers at least. Is it something you’ve worked alongside very much to have much interaction with people who are on the ketogenic diet? Is it something you would talk to somebody about?

Dr Jon Krell
So it’s not something we talk to everyone about, it’s something that a number of patients will talk to us about and we do our best to have those discussions with the knowledge that we have around the ketogenic diet. So I think a lot of patients will talk about fasting around chemotherapy, fasting for a day or two around chemotherapy, not necessarily following a ketogenic diet throughout their treatment. And there’s certainly some evidence of benefits of that in terms of side effects of treatment. I think there’s more work to be done on studies to demonstrate an improvement in efficacy as well, but there’s certainly studies that are showing signals for that. And so that’s one area I think where there’s fasting around chemotherapy and there are patients that follow a ketogenic diet and I think it’s the most people I know who patients I know who’ve done that really feel it’s been beneficial.

Robin Daly
And with something like the fasting, what’s your observation? Do you feel as it’s helping people? Do you notice any, as you said, the thing it’s sort of best known for is for making the whole journey through chemotherapy better? Is that your experience?

Dr Jon Krell
I mean, anecdotally, absolutely, there are patients I look after and I’ve looked after who seem to have benefited a lot from confessing around chemotherapy.

Robin Daly
Interesting. Another thing you mentioned earlier on was that there is a sort of contribution in the drugs area coming from integrated medicine these days. It’s a relatively recent development. Maybe six or seven years it’s been beginning to come into the sort of mainstream of integrated medicine if you like. These things were always around in odd little pockets here and there for years but nobody took serious notice of them until maybe the last five years. Again, do you have a lot of experience of people coming to you who are adding in repurposed drugs on a kind of metabolic basis? These are going to help metabolically.

Dr Jon Krell
Yeah, I think I see lots of patients. I think patients don’t always tell us everything they’re doing, but I think, so there’s probably more than we even necessarily know about in the clinics, but lots of patients who ask about repurposed drugs, who are taking repurposed drugs, who are, you know, you’ll get the odd patient who’ll come in with bags full of stuff from saying, John, you know, is it all right if I take these with my chemotherapy? You know, I think it’s very difficult for patients in that there’s a whole wealth of information for them to try and work their way through, absorb, understand, be guided through. It’s complex. It’s very complex, and there will always be another drug, another over-the-counter treatment alternative, integrative, whatever you want to call the drug for a patient to hear about, to be told about by well-meaning friends, relatives, and that’s why I feel that the integrative specialists are so vital to us, not only because of the work that they do, but to help guide patients more and more through this complex area that many of them are involved in because it’s becoming more and more popular and more and more spoken about.

Robin Daly
Yeah, well, I agree. It’s enormously complex and there’s plenty of pitfalls in there as well, and you know, it’s definitely an area which I feel expertise is required. You know, a few people, okay, they have the inclination to really get into it in depth and to understand it well, but I think for most people it’s far too complex for that, and they need some answers basically, and they may be a bit desperate and so it’ll probably drive them to do things which are a bit foolhardy. So, yeah, I think expertise is super important in many areas, in fact. But how do you respond generally to these people? Are you basically telling them, well, look, who advised you to do this and why? Or are you encouraging them to to desist in any way or what?

Dr Jon Krell
No, I tend to speak to patients about what they’re taking, why they want to take it, what information they have, try and express any knowledge I may have on it, or go and research it myself, and when it comes to patients who are integrating their own medicines and what we’re doing. You know, pharmacy are a very useful resource, pharmacy information, and I would always send information off to pharmacy and find out exactly what we know about these drugs and interactions, what we’re doing, of course the answer is we don’t always know, and if someone’s taking 10 or 20 or 30 medications in addition to what we’re giving, the interactions is even more difficult to necessarily determine because there can be interactions on interactions, but I’m certainly not someone who would say, no, you mustn’t take that if I’m giving you this, it’s the case of trying to find out as much as we can, and as I say, utilize the expertise of exquisite physicians who will know a lot more about that. You know, I saw very early on, as a junior doctor, some of the difficulties with this lady who was taking a medication from the lady from Poland, and I was working with a friend at the clinic, what she was taking, and he translated what it said on the bottle and it was arsenic and it said, take two drops until you feel intoxicated and then double the dose or something along those lines, and it wasn’t making her feel well, and you know, she stopped it. So I think that sort of epitomized to me the importance of this being done in the right hands and patients exploring all of these approaches within specialist clinics.

Robin Daly
Yeah, I completely agree. I mean, to be fair, of course, it always starts off from the place as, well, I can’t get anybody to do it, so I’m going to have to do it myself. That’s where it starts from. And so that is fair enough. People are trying to save their lives. I would make room for that. But beyond that, it does get quite quickly. If it turns out to be something useful, like repurposed drugs, you know, they’ve now, they’ve got everywhere, basically. I mean, you know, everybody in the field of integrative cancer care understands they’re in use. And so they’re definitely places who can give you a very expert’s opinion on what to use with what.

Dr Jon Krell
Absolutely and that’s you know that’s where I will always signpost patients who express a wish or an interest in you know in honoring that approach and it’s something I promote to patients as well because I’ve seen the benefits that it can have.

Robin Daly
Right. That’s interesting. So what kind of benefits are you particularly referring to there? Are you talking about in longevity or in quality of life?

Dr Jon Krell
But all of those things, really, I think, certainly quality of life. So there are lots of tests that we do as doctors. You know, we focus on certain blood tests when we’re looking at the cancer patients, for example, and it’s mainly things like kidney function, liver function, full blood count. With respect to the chemo, we’re giving the side effects of the chemo. The doses that we’re able to give, whether we’re able to go ahead or not with treatment, but there are other more subtle nuances to some of the bloods that we take. And I think that we don’t have necessary the time or the training to necessarily understand all of those nuances and all of the things that could be done to perhaps improve some of these results. And the benefits that that may bring to patients. So certainly, there’ll be patients who I’ve sent to refer to an integrative oncologist who’ll say, have you seen their LDH levels really high? Have you seen their B12 levels really high? Well, you know, their inflammatory markers are high and they’ve given treatment focus specifically on that. And that’s led to an improvement of certain symptoms. So I think that, you know, a very good example is one of the drugs we used to treat breast cancer that can affect blood glucose levels, very commonly affect blood glucose levels through a pathway called PR3 kinase. And again, within the oncology clinic, if someone has a high blood glucose level on this drug, we give them a drug like, you know, diabetes drug like like metformin and that sort of limitations to what we do. But, you know, in the integrative clinics, they focus on exercise, diet, other medications they can be taking, other than metformin, and the papers published in the case reports now on this type of approach that the side effects of what can be a very effective drug can be negated through, you know, some measures other than just taking another drug to counteract that. So that’s an area I’ve seen a huge benefit.

Robin Daly
Yeah, it’s interesting that sort of cascade of drugs to treat the side effects of drugs is you’re on to sort of losing wicket there in a way and to have another approach is so valuable because of course the main treatment can be very effective and can do a lot often but the side effects always make this balancing act well, which you know, is it more benefit than it is harm? So yeah, ways of mitigating those extraordinarily important. I’m kind of imagining, despite the fact that you claim no expertise at all, over time you must be becoming a bit of an expert in something like re-purpose drugs simply by interacting with patients and finding out what they’re doing and whether it’s safe and why they’re doing it. I mean, you must be getting to know a lot of the ones that are commonly used anyway.

Dr Jon Krell
Yeah, I mean, there are commonly used repurposed drugs that focus on various aspects of metabolism, glucose, fats, angiogenesis, vascularity, all of these drugs. And I think, again, the importance to me is that there isn’t a one size fits all approach to this, that, you know, it’s not a case that every patient should take six or seven repurposed drugs. Some they need, some they don’t need, some will help them, some won’t. And that’s why it needs to be done in a scientific, in an expert way. And absolutely, there are drugs that people I look after take that if they stop them, they notice the change, if they’ve had to stop them for any reason. So yeah, we are learning more and more about all of these different

Robin Daly
are you a little frustrated to see that in mainstream oncology we’re talking about very cheap products of the pharmaceutical industry here being set against unbelievably expensive new products that in terms of the actual benefit that it gives to the patient maybe some of these cheapest chips repurposed drugs rival or outperform the latest new you know blockbuster drugs in terms of quality of life or life extension but they’re not being used is that somewhat frustrating to you

Dr Jon Krell
And it is frustrating and it also provides us with difficulties in the clinic because there are some, you know, you look at some repurposed drugs like statins, like aspirin. They have been studied to some degree in some context. So there’s good evidence for aspirin in prevention or treatment, co-directile cancer. In addition to standard of care conventional treatments, statins has been some studies looking at their use in the adjuvant setting after treatment in ladies who had breast cancer. But the frustration in those studies are, if some of those studies haven’t yet been taken forward into bigger, you know, phase three randomized trials that can really prove those results. A lot of the data that is retrospective looking back are cohorts and like you I think can do to some of that comes down to cost. These are cheap drugs that are generic and, you know, who’s going to pay for the studies and all of these things.

Robin Daly
Yeah it’s interesting because we’re into similar territory to natural products because they suffer from the same thing. Actually there’s not enough money in them basically and they’re not paintable. But this seems to me is where our government stroke health service should step in. This is what they should be doing because of course aspirin is not a dangerous drug. So we don’t need safety tests of aspirin do we? We know what’s safe and what’s not about aspirin and so therefore the only thing we’re testing for is for effectiveness and to add aspirin into a protocol you’re already doing is well it’s no big deal all you’ve got to do is collect the data. So you know who else should be doing it other than our health service the people who are actually administering the treatments. It doesn’t make any sense that they wouldn’t do something like this if they’re genuinely interested in improving care.

Dr Jon Krell
No, that’s right. And I think it often comes down to only there have been add aspirin studies, as I’m sure you know, there have been studies where you’ve added aspirin. But they that’s been within the context of a dedicated clinical trial. And that’s still what’s really going to be ideally needed to some, to some degree, to prove the benefits of whatever intervention it is in the setting that you’re doing that in. And yeah, that’s, that’s to me often the difficulty is getting the funding to do that study because it can’t simply be a case of we’ll add x, y and z into the treatment of this patient, we need to understand who is going to necessarily benefit on the most and, and why and some of that we can get from research that’s already been done. I think in some settings, it will require some sort of prospective study as well.

Robin Daly
Okay, so traditionally, oncologists, they focused exclusively on tumors and eradicating them by a variety of physical means. So, interlude of oncology is looking to broaden the whole thing out, both its objectives and the approaches, and to aim for something much more rounded in terms of well-being, so it was a holistic that includes mind and spirit alongside the physical. So, I’ve noticed, delights to say, that you’re a council member of the British Society for Integrative Oncology. So, I wondered if you could say what integrative oncology means to you, and why you feel it’s important that oncology moves in this kind of direction.

Dr Jon Krell
I mean integrative oncology to me means a very broad area of intervention for patients having cancer treatment. To me it’s not just about additional therapeutic interventions, it’s about lifestyle and healthy living and psychological support and all the other things that integrative specialists and integrative clinics provide for patients that certainly here in the clinics, my NHS clinics, we have over 100 patients each week in one clinic and we’re very time pressured and to be able to provide all of those other things for patients is impossible and even if I wanted to we don’t necessarily have all of those services in the hospital or in the community to do so. To me integrative medicine and integrative oncology is providing patients with other means of treatment other than what we can provide within the cancer clinic both to treat the cancer and to support patients through their treatment but also to better support them in terms of nutrition, health, living, exercise, psychological support, all of those things that are needed for you know for patients people to go through what is a very difficult challenging

Robin Daly
great I love it completely agree with you okay last question love talking to you I love your attitude to oncology feels perfect you’re exactly the kind of oncologist I want to speak to if I had cancer because you you offer your expertise and you’re broad-minded over-minded to whatever else I might be looking to do in order to help myself in this very desperate terrible situation that’s very supportive it’s brilliant and I would love it if many more of your colleagues saw it in the same way what do you think is needed in order to win over your colleagues

Dr Jon Krell
I think lots of things are, you know, I was thinking about this just the other weekend and, you know, I think it has to start in, in, in medical school, really, you know, there’s a lot of talk about teaching children in schools about all of these things. But, you know, and that’s important, but, you know, when you’re talking about teaching the public, members of the public and, you know, the whole country, really, about other approaches to health, I think that needs to come through healthcare professionals. And to me, it’s about integrating modules, lectures within the courses, within, within medical school courses. We run a B.S.C. course here for integrating, integrating medical school students in cancer. It’s called Cancer Frontiers, but it’s a cancer B.S.C. And we now have lectures, symposium on integrating oncology. On Thursday. Which has taken time, and it’s taken time to get that into the syllabus. But to me, it’s about educating doctors at medical school and during their training about these areas, because by the time they get to senior registrants consultants, they’re very specialized. We’re very time-deplete, and we don’t have the time necessarily to educate ourselves, and certainly not having even less time to implement these approaches. And, you know, the second thing really is, is liking the U.S. to start funding, trying to start funding these types of specialists within, you know, the conventional NHS hospital environment. Because eventually they will form part of our multidisciplinary teams, just like the surgeons and the clinical oncologists, the radiologists and the pathologists. You know, that’s what’s happening in the state. So I think it’s educating people and doing that as early as possible in training.

Robin Daly
Okay, well thank you very much indeed for talking John. It’s been very uplifting to hear everything you’ve got to say and to meet you. And yeah, as I say, I just love your attitude and hope that you are the oncologist of the future for the UK.

Dr Jon Krell
Thank you, it’s been a pleasure speaking to you.

Robin Daly
Thank you very much. Take care. I can imagine how many of you listening were thinking how much you would love your oncologist to look at things the way that Dr Krell does. Well at least the direction of travels now set oncologists like Dr Krell exist and there are others like him and as we’ve heard there will be more as training and attitudes progress. It’s all much much slower than we’d like of course but I’m confident it’ll pick up momentum along the way. It was lovely to meet many of you listening at our annual conference in London recently and to hear directly how much you appreciate hearing from my expert guests on The Yes to Life Show. We shared a marvelous day together and were treated to brilliant keynote talks and a host of expertly led workshops. Most importantly the sense of community generated by the day, the feeling of mutual support for fellow travellers on this very unwelcome and difficult journey was utterly tangible. This is the community that ultimately will change the way that cancer is prevented and treated and is the most precious resource available to anyone unfortunate enough to be diagnosed. If you weren’t able to attend the conference in person recordings the main talks will be available shortly so contact Yes to Life if you’d like a copy. We’re already busy making plans for next year’s public events and have some exciting plans on the table so keep an eye on developments at the Yes to Life website that’s org and be sure to sign up for the newsletter which you can do by clicking the sign up button in the footer of every single page of the Yes to Life website or by contacting the office details via the connect page for which there’s a link right at the very top of every page of the Yes to Life website. Thanks so much for listening today I hope you’ll be able to join me again next week for another Yes to Life show.