Santosh Rao, Channing J. Paller, Ana Maria Lopez, Eugene Ahn, Jodi MacLeod, Ting Bao, and Linda E. Carlson of the Society for Integrative Oncology show how integrative oncology is transforming cancer care.
Cancer remains one of the leading causes of death and suffering worldwide, with nearly 20 million new cases and 10 million deaths reported in 2020 [1]. Modifiable lifestyle factors, such as unhealthy diet, lack of physical activity, excess weight, metabolic disorders, smoking, and alcohol consumption, have a significant impact on the development of the disease and mortality [2].
Advances in diagnosis and treatment have led to improved survival rates, but cancer survival is often accompanied by comorbidities and treatment-related symptoms. Fatigue, pain, anxiety, depression, neuropathy, sleep disturbances, and cognitive impairment are common and require clinical intervention. Integrative oncology has demonstrated effectiveness in alleviating these challenges and has the potential to revolutionize cancer care.
Definition of integrative oncology
The Society for Integrative Oncology (SIO) defines integrative oncology as:
"...a patient-centered, evidence-based field of oncology care that combines mind-body techniques, natural products, and/or lifestyle modifications from various traditions with conventional cancer treatment. The goal of integrative oncology is to optimize health, quality of life, and clinical outcomes at every stage of cancer treatment, and to support patients' active participation in prevention, therapy, and recovery." [3]
Integrative oncology is not an alternative to conventional treatment, but supports and complements it. Replacing proven cancer therapy methods with so-called alternative treatments is associated with worse prognosis and higher mortality [4]. This is why the US National Institutes of Health changed the name of its research center from "alternative" to "integrative" [5], and other institutions and scientific journals followed suit.
In the United States, a growing number of cancer centers are offering integrative therapies, such as acupuncture, massage, meditation, yoga, dietary counseling, physical activity recommendations, supplementation, and the use of natural products [6]. This approach is often associated with fewer side effects than pharmacological treatments and may contribute to improving patients' overall health [7].
Traditional medical practices
Integrative oncology also encompasses traditional medical practices, provided they have credible scientific data to support their effectiveness. In many regions of the world, these methods exist alongside conventional allopathic medicine and are readily available to cancer patients.
Recognizing the need for in-depth research on indigenous and traditional forms of healing, the US National Cancer Institute organized a virtual expert meeting in 2020 on International Perspectives on Integrative Medicine for Cancer Prevention and Cancer Patient Management [8].
The need for guidelines for integrative oncology care
Many cancer patients seek integrative therapies, but they do not always share this information with their healthcare team. Conversely, many healthcare professionals do not feel adequately prepared to provide reliable, evidence-based advice in this area [9].
Meanwhile, informed and competent support from medical personnel allows for the creation of a coherent, personalized, and coordinated treatment strategy that integrates conventional approaches with supportive therapies. This approach can effectively alleviate symptoms, improve the patient's quality of life, and strengthen their sense of control over the treatment process.
Currently, research is also being conducted on the biological mechanisms of action of integrative therapies and their potential impact on the risk of disease relapse.
Integrative Oncology Guidelines
The Society of Integrative Oncology (SIO) has published a series of evidence-based clinical guidelines developed according to a standard methodology. While non-binding, these guidelines have a real impact on clinical practice and the shared decision-making process between patients and physicians, informed by the best available evidence.
In 2014, a shortened version of the document, “Clinical Practice Guidelines for the Use of Integrative Therapies as Supportive Care for Patients with Breast Cancer,” was published [10]. This document was updated and expanded in 2017 [11] and endorsed by the American Society of Clinical Oncology (ASCO) in 2018 [12]. To date, these guidelines have been downloaded more than 67,000 times.
In 2022, SIO and ASCO co-organized a conference and published joint guidelines entitled "Integrative Medicine for Pain Management in Oncology: ASCO Integrative Oncology Guidelines" [13]. This was the first in a series of documents developed jointly by these two prestigious organizations. Their goal is to implement evidence-based integrative pain management methods in clinical practice worldwide.
The National Comprehensive Cancer Network (NCCN)—an organization whose guidelines are often used by policymakers to set standards of care—has also included integrative interventions in its recommendations for symptom relief and care for cancer survivors. This further strengthens the position of integrative oncology as a recognized part of standard oncology care.
Barriers to implementing the guidelines
One of the main obstacles to the widespread adoption of integrative oncology is the lack of reimbursement for recommended therapies by health insurance systems [14]. As a result, access to these treatments is uneven and strongly dependent on the country of residence. Patients who wish to use guideline-based therapies often have to pay for them out of pocket, exacerbating inequalities in access to healthcare.
While clinical guidelines are often a necessary condition for reimbursement, they are not sufficient in themselves for widespread implementation of coverage – advocacy efforts are also needed.
Further research on the clinical effectiveness and cost-effectiveness of integrative oncology could play an important role in shaping health policy. Designing care models that address the challenges of global health equity could facilitate the implementation of integrative approaches in diverse communities.
Importantly, integrative oncology places the patient at the center, which naturally favors culturally sensitive healthcare. Current research aims to increase access to equitable, comprehensive cancer care globally.
Integrating integrative oncology into cancer care worldwide
Ongoing, rigorous scientific research aims to determine the most effective applications and implementation models for complementary therapies in the context of cancer treatment. Sharing research findings and practical knowledge not only with medical personnel but also with patients and their caregivers will be crucial to their widespread use.
Ensuring equal access to evidence-based cancer care, including integrative therapies – regardless of income, geographic location, or social status – can have a transformative impact on the cancer care system.
Source: https://www.openaccessgovernment.org/integrative-oncology-transforming-cancer-care-patients/150645/
1. World Health Organization. International Agency for Research on Cancer. The Global Cancer Observatory. December 2020. https://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf
2. The Global Burden of Cancer Attributable to Risk Factors, 2010-19; A Systematic Analysis for the Global Burden of Disease Study 2019. Lance. 400 (10352, p563-91, Aug 20, 2022).
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4. Johnson SB, et al. Complementary medicine, refusal of conventional cancer therapy, and survival among patients with curable cancers. JAMA Oncol. 2018;4:1375–1381. doi: 10.1001/jamaoncol.2018.2487.
5. National Institutes of Health Press Release. NIH complementary and integrative health agency gets new name: The National Center for Complementary and Alternative Medicine is now the National Center for Complementary and Integrative Health. December 17, 2014. https://www.nih.gov/news-events/news-releases/nih-complementary-integrative-health-agency-gets-new-name
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8. National Cancer Institute. Virtual Meeting: International Perspectives on Integrative Medicine for Cancer Prevention and Cancer Patient Management. October 27-30, 2020. https://www.cancer.gov/about-nci/organization/cgh/events/integrative-medicine-cancer-prevention-cancer-patient-management
9.R Lee et al. National Survey of US Oncologists' Knowledge, Attitudes, and Practice Patterns Regarding Herb and Supplement Use by Patients with Cancer. JCO Vol 32(36), Dec 20, 2014.
10. Greenlee H, Balneaves LG, Carlson LE, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014;2014(50):346– 358; doi: 10.1093/jncimonographs/lgu041.
11. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017;67(3):194–232; doi:10.3322/caac.21397.
12. Lyman GH, Greenlee H, Bohlke K, et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol 2018;36(25):2647–2655; doi: 10.1200/JCO.2018.79.2721.
13. Mao J et al. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. JCO, DOI: 10.1200/OP.22.00622 JCO Oncology Practice, Oct 19, 2022.
14. National Institutes of Health. National Center for Complementary and Integrative Care. Paying for Complementary and Integrative Health Approaches. 2016. https://www.nccih.nih.gov/health/paying-for-complementary-and-integrative-health-approaches
