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Author Commentary: A systematic review of integrative oncology programs

OICCCommentary by Laura Weeks PhD and Dugald Seely ND, M.Sc., FABNO

In recent years, there are an increasing number of journal articles that describe examples of integrative oncology programs. This trend is encouraging, because it shows an increase in the interest and establishment of integrative oncology to support patients in their use of complementary therapies alongside standard conventional treatment. It also demonstrates willingness on the part of the people who are involved in these programs to share their experiences and lessons learned, and contribute to a broader understanding of the potential benefits and risks relevant to integrative oncology.

In an effort to explore the range of integrative oncology models in existence, as well as experiences implementing and evaluating those models, we conducted a systematic review of published descriptions of established programs and centres. We searched nine electronic databases, hand searched medical journals and conference abstracts and contacted experts looking for articles that described examples of integrative oncology care, defined as the provision of complementary care in addition to (and not in opposition to) conventional care.

We found 53 articles that describe 29 integrative oncology programs internationally; however, most of the programs operate within the United States or England. From each of the articles, we extracted data for 88 variables, which we categorized according to 6 main concepts: 1) description of the article (e.g., author, year of publication); 2) description of the program (e.g., name of clinic or program, setting of care); 3) components of care (e.g., conventional therapies offered, complementary therapies offered, means for practitioner collaboration); 4) administrative structure (e.g., charitable status, means of cost recovery); 5) process of care (e.g., process of initial assessment, process of referral between practitioners); and 6) measurable outcomes employed (e.g., active research and/or evaluation programs).

Most of the 53 articles were descriptive and outlined the structure and model of integrative care within certain programs. There were also articles describing evaluation, qualitative or observational studies to assess the model of care or patient experiences. We were disappointed that many data elements were not consistently reported across articles, in particular elements related to the administrative structure and process of care. More comprehensive reporting would have enabled us to better explore similarities and differences across models, and across countries. Further, comprehensive program descriptions are needed for others interested in establishing integrative oncology programs to understand what program elements can be transferred to their particular context.

Despite less than ideal reporting in many cases, the review highlighted the increasing number of integrative oncology programs, and allowed us to summarize some of the major elements of those programs. We learned that the majority of established programs operate in urban centres, and over half operate within a hospital. Most also seem to treat people with any type and any stage of cancer, although some programs focus solely on breast cancer.  A wide variety of complementary therapies are offered across programs, with mind-body medicine (including meditation, visualization and relaxation), massage, nutrition counseling and acupuncture being the most common. At least half of the programs include family members or caregivers by offering complementary therapies, support sessions or other psychological interventions. In addition to patient care, most integrative oncology programs also share a focus on education and research. Within their research programs, the focus is on clinical trials to explore the safety and effectiveness of therapies offered within the program, and/or evaluating of the program in terms of a range of outcomes.

Documenting the variety in established programs was perhaps the most useful result of this systematic review. It became clear that there is no gold standard model of care, and perhaps defining one should not be the goal. To us, the variety across programs signifies a need to develop and maintain a solid understanding of the local environment and local needs for the community in which the program will operate. Without this understanding, and inherent flexibility within the model, the relevance and sustainability of the program becomes questionable.

In our own community, we have observed a need for patients to have better access to integrative oncology care. This systematic review formed part of a feasibility study, in which we were interested to explore the readiness for an integrative oncology program in Ottawa and how such a program would ideally be structured. In November 2011, the Ottawa Integrative Cancer Centre (OICC) opened with the mission to provide evidence-informed integrative and preventative cancer care, research, and education across the spectrum of prevention to survivorship. Within our program there are three operational pillars—integrative care, research and education—each informed in part by our systematic review.

We are encouraged by the increasing number of integrative oncology programs that share a common vision to provide whole-person, patient-centred care. We strongly believe that the focus on evidence and caring for the whole-person within the integrative approach is the best guide to continue on the path to safe, effective and efficient cancer care programs. Our experiences at the Ottawa Integrative Cancer Centre only reinforce these beliefs.

We hope the results of our review are helpful for others who may be seeking to begin an integrative oncology program of their own. Finally, we encourage others involved in complementary or integrative care programs to publish descriptions and evaluations of their experiences, so the field of integrative oncology can continue to grow and demonstrate value for cancer patients who want to use complementary therapies alongside standard conventional treatments.

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