Integrating Traditional East Asian Medicine Dietary and Herbal Therapies for Supporting Cancer Treatment and Survivorship in the West
Article information
Abstract
Traditional East Asian Medicine (TEAM) dietary and herbal therapies emphasize balance, nourishment, and resilience, and have long supported cancer care in Asia. In Western integrative oncology, these therapies are increasingly being used to manage side effects, enhance quality of life, and support survivorship. This retrospective study included patients to illustrate the integration of TEAM therapies in Western academic settings. Case 1, was an 84-year-old woman with Stage 4 bladder and kidney cancer who discontinued immunotherapy due to the side effects of treatment (dietary and herbal). A TEAM-informed dietary and herbal formulas plan was implemented alongside integrative group visits. Case 2, was a 65-year-old woman with metastatic breast cancer experiencing endocrine therapy-related insomnia. She was treated with Suan Zao Ren Tang and a comprehensive sleep support plan (dietary, herbal, and cancer-related medications - i.e letrozole, abemaciclib, and zoledronic acid). In Case 1, the patient gained 3.2 kg, her foot ulcers healed, sleep and mobility improved, and she transitioned from using a wheelchair to using walker. In Case 2, the patient reported improved sleep within weeks of using Suan Zao Ren Tang, she discontinued use after 4 months, and 2 months later, she had maintained restful sleep without recurrence of insomnia. Both patients experienced enhanced quality of life, and treatment adherence without adverse effects. These cases highlight the potential of personalized, culturally sensitive TEAM dietary and herbal therapies to support symptom management and survivorship in cancer care. Integrative approaches combining traditional and modern modalities can improve patient outcomes and quality of life, even in advanced stages of disease.
Introduction
Traditional East Asian Medicine (TEAM) dietary therapy (DT) and herbal therapy (HT) have been used in cancer care in Asia for thousands of years. Typically, the current practice is for patients with cancer, treated in Asia, to receive both modern treatments (chemotherapy, radiation, immunotherapy, precision medicine) and traditional medicine; many hospitals have dedicated departments of TEAM that integrate TEAM with Western medicine. Whereas Western medicine excels at treating the disease though tumor eradication by surgery, radiation therapy, and other systemic antagonist or blocking therapies, TEAM focuses on supporting, strengthening, and nourishing the person, restoring balance, and enhancing the body’s defense system. Patients, especially those in the East, often receive both treatments [1]. In the West, Chinese medicine is increasingly being used [2]. It can reduce side-effects from chemotherapy or radiation therapy, aid recovery after surgery, palliate symptoms, and address survivorship challenges. Advanced scientific principles applied to ancient medicine suggest molecular mechanisms underlying the chemopreventive and therapeutic activity of TEAM on the host and their microbiome, as well as potential effects on modulating the tumor microenvironment [3,4]. Judicious synergistic combinations of biomedical treatments with TEAM in oncology trials are being explored by research committees to improve survival and symptom management [5,6].
The complementary role of TEAM in cancer management has been acknowledged, although its implementation continues to face numerous challenges [7]. As these challenges are being addressed and high-quality clinical trials are being developed, healthcare providers should be trained and supported with resources in the safe clinical application of TEAM DT and HT. Patients facing cancer are not waiting for randomized clinical trials to be developed and performed; some are self-prescribing herbal medicines and dietary supplements to ameliorate side effects of conventional drugs [8]. Providers and clinical pharmacologists must be familiar with the herb-drug interactions that may occur following the concomitant use of herbals and conventional drugs, as well as the adverse reactions associated with herbals [9]. Providers should also be trained in integrating TEAM DT and HT during cancer treatment and survivorship as benefits exist with synergistic care. Patients seek safety guidance from reputable and ideally, dual-trained providers.
Cancer treatment including chemotherapy, radiation, immunotherapy, endocrine therapy, and cold capping can adversely affect the constitution of patients. The use of TEAM foundational dietary principles such as the 5 flavors, seasonal eating, thermal properties of food, and the role of individual constitution can play a powerful role in treatment planning. Harnessing the role of flavors, food qi movements, and meridian affiliations in diet prescriptions (i.e., warm soups) can help patients adhere to their prescribed conventional treatment by restoring their form (nourishing yin) and function (tonifying qi). In addition, engaging with patients in shared decision making concerning their dietary choices give patients self-efficacy and a feeling of control during a time when many other areas of their life seem out of their control. Choosing nourishing foods based on seasonality, individual body constitution, and preference can support physical and psychoemotional resilience during a common time of depletion. Many cancer patients also prefer herbal prescriptions (over conventional pharmacological medications) for common treatment side effects including gastrointestinal symptoms (constipation, poor appetite, bloating, nausea, diarrhea), pain, fatigue, poor mood, insomnia, hot flashes, or dizziness [2].
Case reports can be beneficial for practitioners who need guidance on how to integrate TEAM DT and HT into conventional care models. Questions such as “How do we address food and herb questions from patients?” “How do we communicate the safe use of herbal products during cancer treatment?” “Which TEAM herbs have existing evidence-based information for common symptoms experienced by oncology patients, and what are their clinical effects and mechanisms of action?” “How should clinicians evaluate cancer patients and manage the treatment response or lack thereof?” This study aimed to address this gap by reviewing the foundational principles, highlight the current clinical practice in 2 cases, and provide practical clinical resources for implementing the integration of TEAM DT and HT into conventional cancer care models.
Case 1
1. Patient information
An 84-year-old Chinese woman with Stage 4 bladder and right kidney cancer was referred for integrative care after discontinuing pembrolizumab due to severe side effects. Presenting symptoms included fatigue, weight loss, foot ulcers, and poor sleep. Her daughter, the primary caregiver, sought dietary guidance after transitioning her mother from a ketogenic to a plant-based diet. The patient expressed a desire to return to warm, traditional Chinese foods.
2. Timeline
TEAM treatment began in early November where herbal foods were introduced gradually over 2 weeks. The patient also joined integrative group visits focused on diet and movement. Assessments occurred at baseline, 1 month, and 3 months.
3. Diagnostic assessment
TEAM pattern differentiation revealed qi and yin deficiency with Spleen and Lung qi weakness. Outcomes were measured based on clinical observation and patient/family reports; validated quality-of-life instruments were not used due to hospice status.
4. Therapeutic intervention
4.1. DT
Initial dietary recommendations focused on transitioning from a raw plant-based diet (which the patient found difficult to tolerate) to a warm, cooked, anti-inflammatory diet aligned with TEAM principles. The patient resumed eating traditional Chinese foods that she had craved, including congee, millet, red and black rice, legumes, and cooked vegetables such as pumpkin and burdock. Organic chicken soup was prepared with TEAM herbs including Ren Shen (Radix et Rhizoma Ginseng), Huang Qi (Radix Astragali), Ling Zhi (Ganoderma), Gou Qi Zi (Fructus Lycii) and Da Zao (Fructus Jujubae). These foods were selected to tonify qi, support immune function, and improve energy. The patient was encouraged to eat small, frequent, warm meals and to avoid cold or raw foods, which she reported worsened her symptoms. Her daughter was educated on preparing nutrient-dense, easily digestible meals that balanced protein needs with the patient’s plant-based preferences. The inclusion of wild-caught salmon, and eggs from free range hens was supported because it was based on the patient’s tolerance and nutritional needs. Probiotic-rich foods were encouraged to support gut health, and the use of supplements such as probiotics were discussed, all with the emphasis on food-based sources due to concerns about kidney function.
4.2. HT
Sheng Mai San (Generate the Pulse Powder) was selected to tonify qi, nourish yin, and support Heart-Lung function. Yu Ping Feng San (Jade Windscreen Powder) was given to strengthen wei (defensive) qi and reduce infection risk. Adherence was high, due to the support given by the daughter’s active involvement. No adverse effects were reported.
4.3. Follow-up and outcomes
By 1 month, the patient’s weight increased from 45 kg to 48 kg and her foot ulcers had healed. She reported improved energy, sleep, and mobility whereby she had progressed from wheelchair-bound to using a walker. The patient’s glucose and blood pressure remained stable without medication. Despite a minor cervical fracture from a fall in December, she continued to improve with conservative management.
4.4. Patient/family perspective
Throughout the course of integrative care, the patient and her daughter expressed deep appreciation for the personalized, culturally sensitive approach that honored both their values and traditions. The patient, though initially frail and discouraged by the side effects of immunotherapy, found comfort and strength in returning to familiar foods that reminded her of home and family. She often remarked that the warm, nourishing meals “felt right” in her body and helped her feel more like herself again.
Her daughter, who served as the primary caregiver, was highly engaged and proactive in implementing dietary and herbal recommendations. She expressed initial confusion and concern about balancing plant-based ideals with her mother’s nutritional needs, especially regarding protein intake. However, through ongoing dialogue and support, she gained confidence in preparing meals that were both healing and aligned with her mother’s preferences. She noted that her mother’s mood, energy, and strength improved significantly after resuming traditional Chinese soups and congee, and that these changes brought a sense of hope and relief to their household.
The daughter also shared that the integrative care visits provided emotional support and a sense of partnership in care. She felt heard and empowered, especially when navigating complex decisions about diet, supplements, and symptom management for her mother. Despite the challenges of caregiving and the emotional toll of her mother’s illness, she found meaning in being able to provide comfort and dignity during her mother’s final months. After the patient’s peaceful passing, the daughter personally reached out to express her gratitude. Her mother had been able to live her last months with grace, strength, and connection.
5. Summary
This case has illustrated the potential of TEAM dietary and herbal therapies to support quality of life and symptom management in a patient with advanced cancer receiving hospice care. Despite her frailty, comorbidities, and discontinuation of immunotherapy due to adverse effects, the patient experienced meaningful improvements in energy, appetite, wound healing, sleep, and emotional well-being through a personalized integrative approach.
One of the most significant outcomes was the resolution of painful foot ulcers and a reversal of weight loss, which occurred within 1 month of initiating TEAM-informed dietary changes. These improvements coincided with the reintroduction of warm, cooked foods, and the inclusion of immune-supportive herbs such as Ren Shen (Radix et Rhizoma Ginseng), Huang Qi (Radix Astragali), and Ling Zhi (Ganoderma).
The case highlights the importance of cultural relevance and patient preference in dietary planning. The patient’s desire to return to traditional Chinese foods was not only nutritionally beneficial but also emotionally comforting, reinforcing the therapeutic value of food as both nourishment and connection to identity. The daughter’s active involvement in meal preparation and caregiving was instrumental in the patient’s adherence and outcomes, underscoring the role of family-centered care in integrative oncology.
Limitations of this case include the absence of objective tumor response data, as the patient was under hospice care, and not undergoing active cancer treatment. Laboratory and imaging assessments were limited, and improvements were primarily based on clinical observation and patient/caregiver reports. In addition, while the patient’s quality of life improved, her disease remained terminal, and she passed away nine months after diagnosis. However, the peaceful nature of her passing and the family’s expression of gratitude suggest that integrative care played a meaningful role in her end-of-life experience.
Case 2
1. Patient information
The patient is a 65-year-old Ashkenazi Jewish woman with a history of iron deficiency anemia, hypothyroidism, small intestinal bacterial overgrowth, and chronic insomnia.
2. Timeline
She was initially diagnosed with ER+/PR+ right breast invasive ductal carcinoma in 2014 and underwent lumpectomy, chemotherapy, radiation, and multiple endocrine therapies (anastrozole, letrozole, exemestane, and tamoxifen). In 2024, she was diagnosed with recurrent metastatic disease and was treated with surgical biopsy, chemotherapy, right axillary node dissection, and radiation. She was started on letrozole, abemaciclib, and zoledronic acid.
3. Diagnostic assessment
The patient was referred to integrative medicine due to persistent insomnia, worsened by her ongoing endocrine therapy. Suan Zao Ren Tang (SZRT; Sour Jujube Decoction), is a traditional formula known for its calming and sleep-promoting properties. SZRT was recommended to manage sleep disturbances in a patient with recurrent metastatic breast cancer undergoing endocrine therapy. A review of literature confirmed no contraindications (e.g., anticoagulant use).
4. Therapeutic intervention
The patient was prescribed a 7:1 water extract of SZRT (500 mg/tablet) to be taken twice daily (a classical TEAM formula traditionally used for insomnia and irritability). She was directed to a commercial product from a well-known vetted TEAM pharmaceutical herb company. The formula included: Suan Zao Ren (Semen Ziziphi Spinosae) - 46%; Fu Ling (Poria) - 18%; Chuan Xiong (Rhizoma Chuanxiong) - 18%; Zhi Mu (Rhizoma Anemarrhenae) - 9%; and Gan Cao (Radix et Rhizoma Glycyrrhizae) - 9%.
Literature supporting efficacy for SZRT in improving sleep quality was reviewed with the patient and included studies showing its benefit in patients with chronic insomnia, and its favorable safety profile. In addition to HT, a comprehensive sleep support plan was implemented, including stress management techniques (yoga nidra, meditation), circadian rhythm regulation, cooling strategies for night sweats, acupuncture, digital tools such as sleep apps, and cognitive behavioral therapy for insomnia. Magnesium glycinate was also recommended to support sleep and counteract potential gastrointestinal side effects from abemaciclib. Dietary guidance included emphasis on cooked vegetables, whole grains, and hydration with herbal teas.
5. Follow-up and outcomes
After implementing the recommendations including SZRT, the patient reported improved sleep quality, fewer nighttime awakenings, and feeling more rested. After a few months, her hot flashes had significantly decreased, and she was able to discontinue SZRT while maintaining restful sleep. Six months later, she remained on letrozole and abemaciclib with no recurrence of insomnia. Her most recent scans (March 2025) showed no evidence of disease.
6. Patient perspective
Patient expressed she is doing well in June 2025. She is facing some medication related fatigue and seeks further integrative support (which may include TEAM HT). She remained physically active, continued practicing yoga and meditation, and reported improved overall well-being.
7. Summary
This case demonstrates the potential of TEAM HT, specifically SZRT, to address endocrine therapy-related insomnia in breast cancer patients. The integrative approach of conventional medicine with TEAM, combining evidence-based herbal support, with lifestyle and mind-body interventions was well tolerated and contributed to improved quality of life and conventional treatment adherence. The patient’s positive response to SZRT, combined with her ability to taper off the formula after symptom resolution, suggested that TEAM HT can be both effective and sustainable. Importantly, the intervention was well tolerated and did not interfere with her ongoing cancer treatment. The integrative approach also empowered the patient to take an active role in her care, enhancing adherence and quality of life.
Limitations of this case include the lack of objective sleep measurements and the single-patient design. However, the patient’s subjective improvements and sustained outcomes support the value of individualized, integrative care in oncology.
SZRT may be a safe and effective adjunct for managing sleep disturbances in patients undergoing endocrine therapy for breast cancer. When integrated into a comprehensive care plan, TEAM herbal therapies can support symptom relief and enhance survivorship outcomes.
A literature review indicated a relative paucity in literature particularly on TEAM DT and HT in oncology patients [2,10–13]. Original case studies provide real-world clinical practice examples of how TEAM DT and HT can be applied to oncology patients even in the West.
Discussion
There is a small, but growing body of literature advocating for the integration of TEAM dietary therapies into Western oncology care and Case 1 provides evidence to advocate for this type of integrative medicine, particularly for enhancing quality of life. Personalized, culturally sensitive nutrition plans, when combined with caregiver engagement and integrative support, can lead to improvements in strength, symptom control, and emotional well-being, even in the context of hospice care. The limitations of the observations include low patient number, lack of controls, reliance on subjective outcome measures, and objective tumor response data were unavailable (due to hospice status). In Case 2, the potential role of TEAM HT in managing endocrine therapy related insomnia in breast cancer patients was highlighted. The use of SZRT was assessed as part of a broader integrative strategy that included mind body therapies, lifestyle modifications, and nutritional support. The results showed that TEAM HT can be well tolerated, effective, sustainable, and does not appear to interfere with cancer treatment.
When considering TEAM DT vs. TEAM HT Case 1 focused on TEAM DT, while Case 2 focused on TEAM HT. While there is significant overlap between TEAM DT and HT, there are important distinctions. TEAM DT centers on long-term, diet-based approach while HT focuses on potent herbal decoctions. From a western perspective, it may be easiest to think of TEAM DT and herbalism as a continuum, with food therapy as “superfoods” and herbal decoctions more like “pharmaceutical drugs.” There are at least 111 food-medicine herbs that are used both as food and medicine, and share principles of combination and preparation methods. Examples include Gou Qi Zi (Fructus Lycii), Da Zao (Fructus Jujubae), Ju Hua (Flos Chrysanthemi), and Sheng Jiang (Rhizoma Zingiberis Recens). In addition to the herbs and formulas discussed in these 2 cases, there are many other herbs and formulas commonly used in TEAM DT and HT that support the patient as they go through their conventional oncology treatments. Listed below are highlights of several commonly used herbal formulas. Bao He Wan (Preserve Harmony Pill) is an example of an herbal treatment composed mostly of food herbs, that has been shown to help with the side effects of chemotherapy treatments [14]. BZT contains Shan Zha (Fructus Crataegi), Shen Qu (Massa Medicata Fermentata), Lai Fu Zi (Semen Raphani), Ban Xia (Rhizoma Pinelliae), Fu Ling (Poria), Chen Pi (Pericarpium Citri Reticulatae), and Lian Qiao (Fructus Forsythiae). The active ingredients alleviate inflammatory responses, reduce visceral hypersensitivity, improve anxiety and depression, and promote gastrointestinal health (functional dyspepsia) [15], gastro-esophageal reflux disease [16], motility [17], diarrhea [18], and intestinal mucositis [19]. Regarding potential herb-drug interaction, there is no clinical trial data; however, theoretical interactions exist for Shan Zha (Fructus Crataegi) with antiarrhythmics, antihypertensives, digoxin, and antihyperlipidemic agents [20].
The use of BHW could be part of a comprehensive health management plan including TEAM DT based on the patient’s constitution, treatment, climate, and other factors. Dietary lifestyle changes can help sustain symptom remittance so that long-term use of BHW may not be necessary. Recommendations could include: (1) avoidance of cold, heavy, or greasy foods, which impede digestive function and are hard to break down; (2) consumption of foods that are easy to digest, e.g., slow-cooked foods (stews, soups, porridge, steamed foods, pressure-cooked foods); and (3) taking a slow walk for 5 minutes after each meal.
BHW is generally well tolerated. It should be avoided in patients with allergies to its ingredients including wheat or gluten intolerance. If no benefits are evident after a few days, it is prudent to stop and reassess. Like most herbals, long-term use (e.g., more than 2–3 months) should be minimized.
Huang Qin Tang (HQT; Scutellaria Decoction) is another TEAM decoction with a long history. Its use is supported by research at an academic center, and currently being investigated as an new drug in clinical trials.
HQT, a 4-herb decoction used for approximately 1,800 years in Asia, has been shown to be effective in reducing the side effects of chemotherapy (including nausea, vomiting, and diarrhea). Animal trials showed herbs used with chemotherapy restored intestinal cells faster than when chemotherapy was used alone [21]. A Phase 1 National Cancer Institute funded clinical trial using HQT (also designated as PHY906 or YIV906) led by researchers at Yale was conducted in patients with advanced colorectal cancer on irinotecan-based chemotherapy. The trial demonstrated safety and tolerability of the herbal medication with no alteration in the pharmacokinetics of 5Fu, irinotecan, and irinotecan metabolite Sn-30 [22].
Subsequently, a Phase 2 clinical trial on the combination of PHY906 with chemotherapy (capecitabine) in patients with advanced hepatocellular carcinoma showed PHY906 increased the therapeutic index of capecitabine by enhancing its antitumor activity and reducing its toxicity profile [23].
Currently there is a clinical trial using YIV906 in patients with hepatocellular cancer being treated with sorafenib [24]. Researchers have hypothesized that the herbal medication could enhance the body’s immune response to fight cancer and increase the antitumor activity of sorafenib while protecting the gastrointestinal tract by reducing inflammation and promoting tissue regeneration [23].
From a western pharmacological perspective, chemical components of the HQT exhibit anti-inflammatory effects by decreasing neutrophil and macrophage infiltration, tumor necrosis factor-α expression in the intestine, and proinflammatory cytokine concentrations in the plasma [21]. Chemical constituents of HQT also inhibit nuclear factor κB, cyclooxygenase2, and inducible nitric oxide synthase [21]. The herbal formula promotes the regeneration of intestinal stem cells while also acting as an antibiotic, anti-inflammatory, and anticancer agent [21]. Research suggests it may promote immune checkpoint blockade antibody action and chimeric antigen receptor T-cell activity [25].
From a TEAM perspective, HQT contains 4 ingredients with synergistic and complementary effects. Huang Qin (Radix Scutellariae) clears damp heat, Bai Shao (Radix Paeoniae Alba) nourishes yin, and Gan Cao (Radix et Rhizoma Glycyrrhizae) and Da Zao (Fructus Jujubae) tonify qi. The combination of the disease attacking effect of Huang Qin (Radix Scutellariae) and the restorative support from the other herbs, help to nourish, strengthen and tonify the body (digestive tract) allowing the patient to better tolerate the treatment [25,26]. Besides the aforementioned formulas, there are many other herbal formulas that have been used for cancer care symptoms (mood, fatigue insomnia, gastrointestinal, myelosuppression, hot flashes, idiopathic sweating; Table 1 [4,27–46]).
Herbal Formulas Used for Cancer Care Symptoms
Responding to patient demand for information and clinical care, TEAM DT and HT have been integrated into 1:1 consultations and oncology shared medical appointments at academic medical centers. One such virtual integrative oncology shared medical appointment was implemented in a pilot study in New York (N = 72) where food, herbs, and supplements were discussed over a series of 7, 1-hour sessions, and it was determined that these appointments are feasible [47]. Another academic oncology institution, Memorial Sloan Kettering, offers TEAM educational seminars as part of a monthly fitness, mind-body membership program for their patients [48]. No-cost “Shop with the Doc” grocery tours led by a dual-trained East-West physician provide guidance to oncology patients and community members by highlighting the health benefits of various TEAM foods [49,50].
Herbal formulas (such as those listed in Table 1) are commonly used in in various academic centers in the West (such as the Memorial Sloan-Kettering Cancer Center [51], University of California, Los Angeles [52], University of California San Francisco [53], Cleveland Clinic [54], and Cornell University [55]). As the challenges for implementation are being addressed and high-quality clinical trials are being developed, healthcare providers can be trained and supported with TEAM utilization and risk management resources for safe clinical applications of TEAM DT and HT within evidence-based multidisciplinary collaborative care (Table 2 [56,57]).
Primer for Clinicians
Due to cultural and healthcare system differences, studies in Western countries focus more on non-pharmacological TEAM therapies such as acupuncture, qigong, and massage, while research in Asian countries significantly emphasize HT (particularly multi-herb combinations) [7]. In addition, current evidence gaps exist due to lack of research stan-dardization in examining symptom clusters, incomplete research on herbal toxicity and safety, insufficient evidence for direct antitumor activity of herbs (relying mostly on pre-clinical data), few high-quality RCTs to validate their clinical efficacy, and studies in homogeneous populations (Asian) lacking generalizability [58]. The lack of dual training may cause the rift to become wider between Western trained healthcare providers who have concerns about the quality of evidence, while TEAM practitioners may lack expertise in oncology and herbal pharmacology.
There is the need for more high-quality TEAM clinical trials to supplement existing evidence for clinical practice [37,59], of which HQT is an excellent decoction study [60]. Improved regulations for herbal supplements as well as transparency of production are needed. Development of TEAM utilization and risk management tools [61,62] will also help guide evidence based multidisciplinary collaborative care. Conventional medical training should include integrative medicine education and cultural sensitivity [63–65], enhancing the understanding and acceptance of TEAM [66]. Cultural sensitivity is a competency requirement of the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education. Patients also need improved access to dual trained western and TEAM specialists. While the research world is reconciling the Eastern and Western world, training programs and resources exist for interested providers seeking to better support patients (Table 3 [67–69]).
Training and Resources
The integration of TEAM dietary and herbal therapies into conventional oncology care highlights the need for a structured, evidence-informed framework. By examining foundational principles and illustrative case reports, this case report underscores both the opportunities and challenges in bridging traditional and biomedical paradigms. Continued clinical research, systematic evaluation, and knowledge translation are essential to ensure safe, effective, and patient-centered applications of TEAM-based interventions in cancer care.
Notes
Author Contributions
Conceptualization, Writing-Original Draft, Writing-Reviewing and Editing: ML, Writing-Reviewing: JKC.
Conflicts of Interest
The authors have no conflicts of interest to declare.
Author Use of AI Tools Statement
During the preparation of this manuscript, the authors used Microsoft Co-Pilot for the purpose of improving clarity and grammar. All content was subsequently reviewed and revised by the authors who accept full responsibility for the final version of the work.
Funding
None.
Ethical Statement
Informed consent included deidentified patient specific information for this case report. This case report was based on the patient’s medical records and was exempt from review by the Institutional Review Board of Weill Cornell Medicine/New York Presbyterian.
Deidentified information was presented in accordance with ethical standards. Effort was made to contact the patients’ relatives. Effort was made to contact the daughter but could not reach her in Case 1. The last contact was when she reached out to thank us after her mother passed. But given that she initiated that, consent may be implied. Consent was, retained in Case 2, and the deidentified information was presented in accordance with ethical standards
Data Availability
The data will be made available upon request.