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"Buku yang berjudul "Alternatives in cancer therapy : the complete guide to non-traditional treatments" ini ditulis oleh Ross Pelton dan Lee Overholser. Buku ini membahas tentang cara-cara alternatif terapi kanker."

"Meningkatnya prevalensi kanker terutama yang sudah dalam kondisi terminal membutuhkan penatalaksanaan komprehensif melalui perawatan paliatif yang mana pasien sangat didorong untuk dapat terlibat mengambil keputusaan mandiri. Penelitian ini bertujuan untuk mengeksplorasi esensi atau makna dari pengalaman pasien dalam pengambilan keputusan perawatan paliatif di rumah. Penelitian ini menggunakan metode kualitatif dengan pendekatan fenomenologi dengan metode pemilihan partisipan menggunakan teknik puposive sampling. Sampel dalam penelitian ini sebanyak 10 partisipan pasien kanker stadium lanjut advanced cancer. Pengambilan data dengan teknik indepth interview dengan analisa data menggunakan metode Collaizi. Hasil penelitian menunjukkan enam tema yang signifikan mengambarkan dimanika pasien kanker selama proses pengobatan hingga pengambilan keputusan tempat perawatan paliatif. Tema ndash; tema tersebut yaitu : nyeri dan sedih yang berkepanjangan, dampak nyeri terhadap perubahan aspek kehidupan, alasan pemilihan tempat perawatan paliatif, pengambilan keputusan dengan melibatkan keluarga, kebutuhan pasien akan perawat paliatif dalam menjalani perawatan di rumah serta menjalani akhir kehidupan end of life di rumah dengan tenang. Diharapkan penelitian ini menjadi acuan bagi perawat dalam melakukan pendekatan terapeutik dengan memperhatikan karakteristik partisipan, meningkatkan pengetahuan serta kemampuan berkomunikasi untuk mengadvokasi dan menginformasikan program perawatan paliatif di rumah secara jelas sehingga tidak menimbulkan keraguan pada pasien untuk menerima pemulangan dari rumah sakit dan menerima perawatan paliatif di rumah. Selain itu, perlu adanya strategi dari pemerintah untuk mengoptimalkan program paliatif melalui perawatan paliatif berbasis home care diberbagai daerah di wilayah Indonesia.

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Increased cancer prevalence especially in terminal condition needs a comprehensive management approach through a palliative care in which patient is very encouraged to be involved in an independent decision making of, especially, palliative care facility. The study intends to explore in depth the essence of patient's experience in decision making of palliative care at home.

It uses qualitative method with phenomenological approach. The participants were selected by using purposive sampling technique. They are 10 patients with terminal cancer. The data were collected by using in depth interview technique and analyzed by using Collaizi method.

The result shows six themes which significantly describe the dynamic of patients with cancer from medication process to decision making of palliative care facility. The teams are prolonged pain and sadness, painful effects on life changing aspects, palliative care selection reasons, family involvement decisions, palliative care needs in home care and end of life at home quietly.

The study is expected to be a reference for nurses in conducting therapeutic approach by considering participant's characteristics. It is also expected to improve nurse's knowledge and communication skill in advocating and clearly informing palliative care purposes and program at home. Thus, patients do not have doubt to receive discharge from hospital and palliative care at home. In addition, there needs to be a strategy from the government to optimize palliative programs through palliative care based on home care in various regions in Indonesia.Keywords patient with terminal cancer, decision making, palliative care at home"

"Penyakit kanker disebabkan oleh peristiwa karsinogenesis dan ditandai dengan adanya kerusakan oksidatif DNA. Senyawa tert-butilhidroquinon TBHQ diduga sebagai pemicu terjadinya peristiwa karsinogenesis. Tujuan penelitian ini adalah untuk mengetahui dan mengidentifikasi adanya pembentukan DNA adduct 8-hidroksi-2 rsquo;-deoksiguanosin 8-OHdG akibat adanya paparan senyawa TBHQ pada 2 rsquo;-deoksiguanosin dan calf thymus DNA secara in vitro dengan variasi pH, waktu, dan suhu. Penelitian ini dilakukan menggunakan 2 39;-deoksiguanosin-5 39;-monophosphat dan TBHQ melalui reaksi fenton dengan variasi pH yaitu 7,4 dan 8,4, variasi waktu inkubasi yaitu 1 jam dan 3 jam, dan variasi suhu yaitu 37oC dan 60oC. Kemudian sampel dari 2 rsquo;-deoksiguanosin dianalisis menggunakan HPLC, sedangkan sampel dari calf thymus DNA dianalisis menggunakan UV-Vis. Dilakukan juga uji kestabilan 8-OHdG dengan variasi pH menggunakan HPLC. Hasil yang diperoleh menunjukkan bahwa konsentrasi pembentukan 8-OHdG lebih banyak terjadi berturut-turut pada pH 8,4 daripada pH 7,4, dengan waktu inkubasi 3 jam daripada dengan waktu inkubasi 1 jam, dan pada suhu 60oC daripada suhu 37oC, serta menunjukkan adanya reaksi fenton. Rasio kemurnian calf thymus DNA pada ?260/?280 yang digunakan dalam penelitian ini adalah 1,83. Terjadi pergeseran puncak panjang gelombang maksimum dari hasil inkubasi calf thymus DNA dan senyawa TBHQ serta Fe2 yang menandakan terjadinya perubahan struktur DNA. Hasil uji kestabilan 8-OHdG pada kondisi asam dan basa menunjukkan 8-OHdG mengalami kerusakan.

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Cancer is caused by a carcinogenesis and is characterized by DNA oxidative damage. The tert butylhydroquinone TBHQ compound is thought to be the trigger for the carcinogenesis. The aim of this study was to investigate and identify the formation of 8 hydroxy 2 39 deoxyguanosine 8 OHdG adduct DNA due to exposure of TBHQ compounds to 2 39 deoxyguanosine and calf thymus DNA in vitro by pH, time, and temperature variations.

This study was carried out using 2 39 deoxyguanosine 5 39 monophosphate and TBHQ by fenton reaction with pH variation of 7.4 and 8.4, variation of incubation time ie 1 hour and 3 hours, and temperature variation ie 37oC and 60oC. Then a sample of 2 39 deoxyguanosine was analyzed using HPLC, while samples from the calf thymus DNA were analyzed using UV Vis. It also performed a stability test of 8 OHdG with pH variation using HPLC.

The results show that the concentration of 8 OHdG formation occurs more successively at pH 8.4 than pH 7.4, with an incubation time of 3 hours than with an incubation time of 1 hour, and at a temperature of 60 C rather than 37 C, fenton reaction. The purity ratio of calf thymus DNA in 260 280 used in this study was 1,83. There is a maximum wavelength peak shift from the incubation of the calf thymus DNA and the TBHQ and Fe2 compounds indicating the change in DNA structure. Stability test results of 8 OHdG on acid and base conditions showed 8 OHdG damage."

"Siklofosfamid merupakan senyawa pengalkilasi golongan oksazafosforin, berkhasiat sebagai antineoplastik yang mengalkilasi DNA sehingga sel kanker gagal bereplikasi. Siklofosfamid dapat memberikan efek terapi apabila sudah termetabolisme menjadi 4-hidroksisiklofosfamid (4-OHCP). Analisis 4-OHCP dilakukan pada 26 orang pasien kanker Rumah Sakit Kanker ?Dharmais? yang mendapatkan regimen siklofosfamid. Darah yang digunakan sebagai sampel diambil pada 0,5 dan 1 jam setelah pemberian kemoterapi masing-masing sebanyak 3 ml. Analisis 4-OHCP dilakukan setelah plasma diderivatisasi dengan semikarbazid HCl menggunakan kromatografi cair kinerja ultra tinggi ? tandem spektrometer massa. Metode ini telah divalidasi pada penelitian sebelumnya, Hasil validasi metode secara parsial menghasilkan akurasi dan presisi intra hari dengan % diff dan koefisien variasi (KV) tidak lebih dari 15% dan tidak lebih dari 20% pada konsentrasi LLOQ. Kurva kalibrasi yang linear didapat pada rentang 50 ? 15.000 ng/ml untuk siklofosfamid dan 5 ? 1.000 ng/ml untuk 4-OHCP. Metode ini telah memenuhi syarat akurasi dan presisi intra hari sesuai EMEA Guidelines. Hasil analisis kadar 4-OHCP pada 26 pasien kanker menunjukkan kadar 4-OHCP yang terukur berada pada rentang 5,25 ng/ml hingga 832,44 ng/ml. Hal ini menunjukkan bahwa pengobatan dengan siklofosfamid pada 26 pasien kanker tersebut sudah tepat dan diharapkan dapat menyembuhkan kanker.

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Cyclophosphamide is an alkylating agent from oxazaphosphorine compound, used as antineoplastic which alkylate the DNA cause the cancer cell fail to replicate. Cyclophosphamide is able to give therapeutic effect if it has been metabolized into 4-hydroxycyclophosphamide (4-OHCP). 4-OHCP analysis performed on 26 cancer patients in ?Dharmais? Cancer Hospital who get cyclophosphamide. Blood used as samples taken at 0,5 and 1 hour after administration of chemotherapy respectively 3 ml. Analysis of 4-OHCP done after plasma was derivatized with semicarbazide HCl by Ultra High Performance Liquid Chromatography ? Tandem Mass Spectrometry. This method has been validated in the previous research. Results of partial method validation produced intra-day accuracy and precision which % diff and coefficient of variation (CV) not more than 15% and not more than 20% at LLOQ concentration. A linear calibration curve produced in the range of 50 ? 15.000 ng/ml for cyclophosphamide and 5 ? 1.000 ng/ml for 4-OHCP. This method has been qualified for intra-day accuracy in accordance to EMEA Guidelines. Results of the analysis of 4-OHCP in 26 cancer patients showed the measured value of 4-OHCP are in the range of 5,25 ng/ml to 832,44 ng/ml. This suggests that treatment with cyclophosphamide in 26 cancer patients were appropriate and is expected to cure the cancer."

"Terapi Paliatif bertujuan untuk meningkatkan kualitas hidup dan mengurangi gejala, namun menambah kompleksitas terapi pasien. Penelitian ini bertujuan untuk menganalisis profil pengobatan dan prevalensi DRPs yang terjadi pada pasien yang menjalani terapi paliatif di RSK 'Dharmais'. Penelitian ini adalah penelitian cross sectional. Data pada penelitian diambil secara prospektif dari data medis pasien bulan maret sampai juni 2011. Karakteristik pasien, 33 orang (68,8%) perempuan, 15 orang (31,3%) laki-laki, dan kasus kanker padat terbesar adalah kasus kanker payudara sebanyak 15 orang (33,3%). Berdasarkan profil pengobatan, 64,6% hanya menjalani satu kali terapi paliatif. Reaksi obat yang tidak diinginkan (ROTD) manifestasi dialami olah 70,1% subyek uji dan 66,2% mengalami ROTD potensial. Lima koma tujuh persen (5,7%) mengalami interaksi dengan signifikansi moderate dan 15,0% terjadi karena pemakaian morphine, dan amitriptyline. Peningkatan risiko kejadian ROTD dipengaruhi oleh (1) usia, bertambahnya usia tidak selalu menyebabkan peningkatan ROTD manifestasi; (2) jenis kelamin, laki-laki akan lebih berisiko mengalami peningkatan ROTD manifestasi; (3) riwayat rejimen kemoterapi kuratif, meningkatkan risiko ROTD manifestasi; (4) penyakit penyerta, meningkatkan risiko ROTD manifestasi dan potensial; (5) jumlah obat; penggunaan > 5 jenis obat dapat meningkatkan risiko ROTD manifestasi dan ROTD potensial. Risiko kejadian interaksi obat dipengaruhi oleh faktor adanya penyakit penyerta dan penggunaan > 5 jenis obat.

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The goal of palliative care is to increase the quality of life and to reduce the symptomps, but its often increace the complexity of patient's therapy. The aim of these research is to analyst the patient's therapy profile and the prevalence of DRPs of patient undergoing the palliative care at 'Dharmais' Hospital National Cancer Center. This reasearch is a cross sectional study. The data of the research is prospectively taken from the patients' medical records start from march to june 2011. The patient characteristic who followed the reasearch are 33 patients (68.8%) women, 15 patient (31.3%) men, and the most solid cancer case are breast cancer, 15 patients (31.3%). Based on therapy profile, 64.6% only had once palliative care. Manifest adverse reaction happen in 70.1% patient of subject and 66.2% subjects get potential adverse reaction. Five point seven percent (5.7%) of drug interaction had moderate signification, 15.0% caused by the morphine, and amitriptyline use. The risk of incident adverse reactions influenced by (1) age, increasing the age not always increase the risk of having the manifest adverse reaction, (2) sex, men will have higher risk of manifest adverse reaction, (3) history of curative chemotherapy regimen, increase the risk of manifest adverse reaction, (4) comorbidities will increase the risk of manifest and potential adverse reaction, (5) the number of drug use, using more than 5 drugs ( > 5 drugs) will increase the risk of manifest and potential adverse reaction. The risk of drug interaction will increase because of the comorbidities and the number of drugs using ( > 5 drugs)."

"Pendahuluan: Prevalensi penyakit kanker payudara di Indonesia terus meningkat. Keberhasilan terapi kanker saat ini tidak lepas dari efek samping serta biaya yang tinggi, sehingga mendorong eksplorasi bahan alam yang berpotensi antikanker. β-glukan dari jamur tiram (Pleurotus ostreatus) berpotensi sebagai anti kanker melalui sifatnya sebagai imunostimulator. Tujuan penelitian ini yaitu menganalisis aktivitas imunostimulasi dan anti proliferasi β-glukan pada tikus Sprague-Dawley yang diinduksi kanker payudara dengan DMBA.Metode: Tikus dibagi dalam 7 kelompok yang terdiri atas kelompok normal (5 ekor) dan 6 kelompok perlakuan yang diinduksi DMBA (8 ekor per kelompok). Kelompok perlakuan terdiri atas kelompok DMBA, kelompok DMBA dengan β-glukan yang diberikan secara preventif dosis 0,25 g/kg BB (P 0,25) dan 1 g/kg BB (P 1,00) selama 28 minggu dan sebagai adjuvan bersama dengan Doxorubicin (10 μg/kg BB) dengan 2 dosis yang sama (A 0,25 dan A 1,00), β-glukan diberikan selama 30 hari. Induksi tumor dilakukan dengan pemberian DMBA per oral dengan dosis 20 mg/kg BB, selama 3 minggu (2x/minggu, total 5x).Hasil: Pemberian β-glukan secara preventif cenderung menurunkan insidensi tumor sebesar 37,5% (P 0,25) dan 50 % (P 1,00) dibandingkan kontrol karsinogen DMBA (87,5 %). Volume total tumor terendah didapatkan pada kelompok P 0,25 (5,3 cm3), sedangkan jumlah total tumor terendah pada kelompok P 1,00 (5 nodul). Penurunan volume total dan jumlah total tumor juga tampak pada kelompok adjuvan. Kelompok A 0,25 memiliki volume total tumor (6,5 cm3) dan jumlah total tumor (8 nodul) terendah. Pemberian β-glukan secara preventif tampaknya memicu pelepasan TNF-α yang diikuti oleh NO dan memberikan hambatan karsinogenesis sehingga menurunkan volume dan jumlah total tumor. Terdapat gambaran Ductal Carcinoma Invasive (DCIV) pada semua kelompok perlakuan dengan rerata skor dan gradasi yang bervariasi, dimana kelompok P 0,25 memiliki rerata skor terendah (2,4). Pemberian β-glukan menghambat proliferasi sel tumor secara bermakna, dengan indeks AgNOR yang terendah pada P 0,25 (1,4 ; p < 0,05), dan A 0,25 (1,6; p <0,05). Ekspresi CD8+ pada kelompok β-glukan lebih rendah daripada kelompok DMBA.Simpulan: β-glukan yang diberikan secara preventif memediasi respon imun antitumor yang diperantarai oleh TNF-α dan NO.

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Introduction: The prevalence of breast cancer in Indonesia continues to increase. Since current therapy of cancer is accompanied by the presesnce of side effects and high costs, exploration of potentially natural anticancer material needs to be encouraged. β-glucan from oyster mushroom (Pleurotus ostreatus) have potency as anti-cancer through its nature as an immunostimulatory. The purpose of this study is to analyze the activity of immunostimulation and anti-proliferation of β- glucan in Sprague-Dawley rats induced breast cancer with DMBA.Methods: Rats were divided into 7 groups: i.e. 1 group of normal/control (5 rats) and 6 groups of DMBA-induced treatment (8 rats each). The treatment group consisted of DMBA and DMBA groups with β-glucan fed, which were given as preventive at dose of 0.25 g/kg-body weight (P 0.25) and 1 g/kg-body weight (P 1.00) everyday for 28 weeks and as adjuvant with doxorubicin (10 μg/kgbody weight) at the same dose (A 0.25 and A 1.00) everyday for 30 days. Cancer induction was conducted by giving DMBA orally at a dose of 20 mg/kgbody weight, for 3 weeks (twice a week, totally 5 times).Results: The result showed decreasing tendency in the incidence of tumors in group P, i.e. 37.5% (P 0.25) and 50% (P 1.00), in comparison with DMBA (87.5%). The lowest total tumor volume was found in group P 0.25 (5.3 cm3), while the lowest total number of tumors were in group P 1.00 (5 nodules). A decrease in the total volume and the total number of tumors was also seen in the adjuvant group. Group A 0.25 has total tumor volume (6.5 cm3) and the total number of tumors (8 nodules) the lowest. Administration of β-glucan preventively seem to trigger the release of TNF-α followed by NO and inhibit carcinogenesis resulting in lower volume and the total number of tumors. Invasive Ductal Carcinoma (DCIV) were found in all treatment groups with varied mean score and gradation, where in group P 0.25 had the lowest mean score (2.4). Administration of β-glucan inhibits tumor cell proliferation significantly, with a low AgNOR index at P 0.25 (1.4; p <0.05), and A 0.25 (1.6; p <0.05). Expression of CD8+ in the group of β-glucans were lower than DMBA group.Conclusion: β-glucan given preventively could favorably modify antitumor immune response mediated by TNF-α and NO."

"Kanker payudara menempati urutan kedua penyebab kematian akibat kanker tertinggi di Indonesia. Keterbatasan tatalaksana kanker payudara yang tersedia saat ini mendorong potensi tanaman herbal sebagai pengobatan alternatif, salah satunya daun suruhan (Peperomia pellucida) yang studinya masih terbatas di Indonesia. Serbuk daun suruhan dimaserasi menggunakan tiga jenis pelarut sehingga diperoleh ekstrak etanol, etil asetat, dan n-heksana. Uji fitokimia dan KLT dilakukan untuk mengetahui jenis dan jumlah komponen fitokimia. Aktivitas antioksidan diketahui melalui uji DPPH, sedangkan sitotoksisitas terhadap sel kanker payudara MCF-7 diketahui melalui uji MTT. Adapun korelasi antara aktivitas antioksidan dan sitotoksisitas ekstrak daun suruhan ditentukan melalui uji korelasi Pearson. Komponen fitokimia yang terkandung dalam ekstrak daun suruhan mencakup alkaloid, flavonoid, tannin, steroid, dan triterpenoid. Uji KLT menunjukkan bahwa ekstrak daun suruhan mengandung 20 komponen fitokimia. Ekstrak etanol dan etil asetat daun suruhan menunjukkan aktivitas antioksidan yang sangat kuat (IC₅₀ = 14,45 µg/ml dan 22,12 µg/ml), sedangkan ekstrak n-heksana memiliki aktivitas antioksidan yang sedang (IC₅₀ = 102,71 μg/mL). Ketiga jenis ekstrak memiliki efek sitotoksisitas yang kuat terhadap sel kanker payudara MCF-7 dengan kisaran nilai IC₅₀ = 10,68 - 62,73 µg/ml. Adapun aktivitas antioksidan dan sitotoksisitas ekstrak daun suruhan menunjukkan korelasi yang sangat tinggi dan bernilai positif (r = 0,99). Ekstrak daun suruhan memiliki kandungan senyawa fitokimia, aktivitas antioksidan, dan efek sitotoksisitas terhadap sel kanker payudara MCF-7. Semakin kuat aktivitas antioksidan ekstrak daun suruhan, semakin kuat juga efek sitotoksisitasnya. Oleh karena itu, ekstrak daun suruhan berpotensi untuk dikembangkan menjadi agen terapeutik dalam tatalaksana kanker payudara.

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Breast cancer is the second most common cancer to cause mortality in Indonesia. Suruhan leaf (Peperomia pellucida), whose research is still limited in Indonesia, has the potential to be used as an alternative treatment for breast cancer due to the limitations of currently existing therapies for the disease. Suruhan leaf powder was macerated in three solvents to produce ethanol, ethyl acetate, and n-hexane extract. The type and amount of phytochemical were determined using phytochemical and TLC assays. Antioxidant activity was assessed using the DPPH method, and cytotoxicity effect on MCF-7 cells was determined with the MTT method. The correlation between antioxidant activity and cytotoxicity was determined using the Pearson correlation test. The suruhan leaf extract comprises alkaloids, flavonoids, tannins, steroids, and triterpenoids. TLC assay identified 20 phytochemical components within the suruhan leaf extract. The ethanol and ethyl acetate extracts displayed very strong antioxidant properties (IC₅₀ = 14.45 µg/ml and 22.12 µg/ml), while the n-hexane extract exhibited moderate antioxidant activity (IC₅₀ = 102.71 µg/ml). All three extract types demonstrated strong cytotoxicity effect against MCF-7 breast cancer cells, with IC₅₀ values ranging from 10.68 - 62.73 µg/ml. The antioxidant activity and cytotoxicity effect showed a very high correlation and had a positive value (r = 0.99). Suruhan leaf extract possesses phytochemicals, antioxidant activity, and cytotoxicity against MCF-7 breast cancer cells. The stronger the antioxidant activity of suruhan leaf extract, the stronger the cytotoxic effect. Therefore, suruhan leaf extract has the potential to be developed as a breast cancer therapeutic."

"This comprehensive guide delivers informed hope along with effective tools for reclaiming your vitality in the midst of cancer treatment, healing, and recovery.When you or a loved one is faced with a cancer diagnosis, the need for accurate and trusted medical information becomes urgent. Naturopathic physician Lise N. Alschuler and medical journalist Karolyn A. Gazella present an overview of what cancer is, its causes and preventative strategies, an in-depth approach to integrative treatment options, descriptions of key body functions, and discussions of more than twenty specific cancers. The Definitive Guide to Cancer, now in its third edition, encourages you to take an integrative approach that embraces both alternative and conventional therapies across the spectrum of cancer prevention, treatment, and healing."

"Few events in life are more traumatic than being diagnosed with cancer. But there's good news! Modern medical science has made tremendous strides in developing effective treatments for many cancers. In addition, remarkable studies now indicate that alternative therapies can complement and even enhance traditional cancer treatments. In this empowering book, Dr. Dan Labriola, a nationally renowned cancer-therapy expert, presents a revolutionary program for combining conventional oncology and natural medicine to create formidable cancer treatments that are second to none. Inside, you'll discover how to:·Create a treatment strategy tailored to your individual needs·Use drug-nutrient combinations that will work best for you·Minimize the side effects resulting from conventional treatments·Select the best health-care provider for you by asking the right questions·Develop the healing power of the body-mind connection·And moreAnd you don't have to choose between conventional or natural medicine. You can get the best of both worlds. This book shows you how."Ultimately, the best health care is provided by a collaboration of conventional and natural medicine. Nowhere is this more critical than for those with cancer. This unique, insightful, and extremely valuable resource is absolutely necessary for patients and oncologists who are intent on optimizing care."—Joseph E. Pizzorno, N.D., founding president of Bastyr University, coauthor of the bestselling Encyclopedia of Natural Medicine and author of Total Wellness"Dan Labriola, one of the first naturopathic physicians to be published in a mainstream medical journal, has done a great service to individuals with cancer. His step-by-step advice will show you the right way to combine standard and alternative therapies for the best possible outcome."

"In Knockout, Suzanne Somers interviews doctors who are successfully using the most innovative cancer treatments—treatments that build up the body rather than tear it down. Somers herself has stared cancer in the face, and a decade later she has conquered her fear and has emerged confident with the path she's chosen.Now she shares her personal choices and outlines an array of options from doctors across the country:Effective alternate treatments•without chemotherapy•without radiation•sometimes, even without surgeryIntegrative Protocols•combining standard treatments with therapies that build up the immune systemMethods for managing cancer•outlining ways to truly live with the dieaseSince prevention is the best course, Somers' experts provide nutrition, lifestyle, and dietary supplementation options to help protect you from getting the disease in the first place. Whichever path you choose, Knockout is a must-have resource to navigate the life-and-death world of cancer and increase your odds of survival. After reading stunning testimonials from inspirational survivors using alternative treatments, you'll be left with a feeling of empowerment and something every person who is touched by this disease needs…hope."