Integrative oncology
Integrative oncology is a holistic approach that merges traditional cancer treatments with complementary and alternative medicine (CAM) to enhance patient care. This multidisciplinary strategy aims to alleviate symptoms, improve quality of life, and boost treatment effectiveness by addressing the mind-body-spirit connection. Many cancer patients experience significant side effects from conventional therapies, leading a substantial proportion—between 25 to 80 percent—to seek additional support through CAM. These techniques include a variety of therapies such as acupuncture, yoga, massage, meditation, and nutritional counseling, which have shown potential in managing symptoms like pain, anxiety, and fatigue. While some CAM methods originate from Eastern practices, others have Western roots, and their scientific validation varies. Importantly, integrative oncology emphasizes the need for open communication between patients and healthcare providers about the use of these therapies to ensure safety and efficacy. As integrative oncology continues to gain recognition, it fosters a patient-centered care approach that empowers individuals to actively engage in their treatment journey.
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Subject Terms
Integrative oncology
ALSO KNOWN AS: Complementary medicine
DEFINITION: Integrative oncology combines mainstream or traditional cancer care with other approaches to manage symptoms, improve quality of life, enhance wellness, and improve the efficacy of treatment. It integrates the best of traditional cancer care with care that emphasizes the mind-body-spirit connection to provide a multidisciplinary approach to managing disease. Alternative medicine, by definition, is used to replace traditional treatment and should not be confused with complementary medicine.
The patient population: Patients receiving cancer therapy encounter a challenging treatment period that lasts for an extended period of time, often years. Side effects of treatment are significant and can include nausea, vomiting, pain, limits to mobility, fatigue, and other symptoms often difficult to manage with traditional medicine. A 2023 review of studies showed between 25 and 80 percent of cancer patients use some type of complementary and alternative medicine (CAM), with or without their physicians’ knowledge, in an attempt to manage the side effects of their treatment and symptoms of their disease.
Perceived benefits: Multiple studies report that complementary and alternative medicine can provide benefits to the well-being of the patient. Some scientific reports that document the benefits of complementary and alternative medicine, but anecdotal reports of benefits are often accepted when complementary medicine is used in conjunction with traditional medicine. The barrier of proof with alternative therapies is higher, although some have been used for many years in non-Western societies. Psychosocial interventions are an integral part of any cancer patient’s care. Mind-body-spirit therapies enhance mood, reduce anxiety, decrease depression, and improve coping skills, as reported in multiple studies. Pain reduction, managing conditioned nausea and vomiting, and control of other physical symptoms are also attributed to mind-body-spirit techniques practiced by the patient on a routine basis.
Types of CAM therapies: The Office of Cancer Complementary and Alternative Medicine of the National Cancer Institute spends time and resources exploring the scientific validity and impact of complementary and alternative medicine in cancer care. Alternative medicine techniques are often based on theories generated apart from and earlier than conventional Western medicine. Some methods have eastern origins, coming from Asian cultures, including acupuncture, ayurveda, and traditional Chinese and Tibetan medicines; others are of Western origin, including homeopathy and naturopathy. Energy therapies are based on the use of energy fields purported to surround and penetrate the human body, but there is no scientific evidence that these fields exist. Reiki therapy, therapeutic touch, and qi gong are energy therapies. Electromagnetic therapies include pulsed electromagnetic fields and magnet therapy. Exercise therapies such as tai chi, yoga, walking, and gentle workouts all contribute to the feeling of well-being in cancer patients and are often recommended. Massage therapy, reflexology, osteopathy, and chiropractic medicine are based on manipulating body parts. All manipulation must be appropriate to the physical condition of the patient, but gentle massage and reflexology often create a feeling similar to that created by exercise if the patient’s condition limits that option.
The most common mind-body-spirit interventions are related to learned techniques that are practiced by the patient. This active participation empowers the patient to provide benefits related to the control of side effects of care. Meditation, relaxation therapy, guided imagery, mindful breathing, self-hypnosis, and biofeedback, when routinely practiced, may control pain, nausea, vomiting, anxiety, and other symptoms. Participation in support groups, art therapy classes, music therapy, dance therapy, journaling, and aromatherapy programs provides, both potential symptom management and social interaction that contribute to a feeling of well-being. Spiritual therapies involve spiritual healing and intercessory prayer as central components.
Nutritional, pharmacological, and biologic treatments have varying levels of scientific support but are frequently used by patients. Nutritional counseling, macrobiotic and vegetarian diets, dietary supplements, vitamins, and minerals are routinely accepted in complementary medicine. Off-label drug use and natural products, such as shark cartilage and Laetrile (an amygdalin compound), have had varying levels of success in symptom management and are scientifically unproven as primary treatments.
Future of integrative oncology: Integrative oncology has become an essential part of cancer therapy, but complementary and alternative medicine therapies, like other therapies, must be scientifically evaluated for safety and efficacy. Patient communication is key in this process, as many complementary therapies do not interfere with traditional therapies, but there is still the threat of an inappropriate interaction with prescribed therapies. An increasing number of physicians and facilities are offering complementary and alternative medicine therapies as a part of their patients’ care, but patients should still inform their healthcare practitioners of any complementary and alternative medicine therapies used at the same time that they are undergoing therapy. This active communication ensures that the patient is fully involved in their own care.
Bibliography
Blevins, Andrea S. “Survey: Most Cancer Patients Use Complementary or Alternative Medicine.” Cancer Therapy Advisor, 28 Sept. 2023, www.cancertherapyadvisor.com/news/survey-most-cancer-patients-use-complementary-or-alternative-medicine. Accessed 7 July 2024.
Cassileth, B., et al. PDQ Integrative Oncology. Hamilton, Ont.: BC Decker, 2005.
“Complementary and Alternative Medicine (CAM).” National Cancer Institute, 22 May 2024, www.cancer.gov/about-cancer/treatment/cam. Accessed 7 July 2024.
Davies, A. A., et al. “Nutritional Interventions and Outcome in Patients with Cancer or Preinvasive Lesions: Systematic Review.” Journal of the National Cancer Institute, vol. 98, 2006, pp. 961-963.
Horneber, Markus, et al. "How Many Cancer Patients Use Complementary and Alternative Medicine." Integrative Cancer Therapies, 2011, doi.org/10.1177/1534735411423920. Accessed 7 July 2024.
Källman, Maria, et al. "Use of CAM among Cancer Patients." BMC Complementary Medicine and Therapies, vol. 23, no. 51, 14 Feb. 2023, doi.org/10.1186/s12906-023-03876-2. Accesed 7 July 2024.
Vickers, A. J., et al. “Acupuncture for Dyspnea in Advanced Cancer: A Randomized, Placebo-Controlled Pilot Trial.” BMC Palliative Care, vol. 4, 2005, p. 5.