As the new editor of the Integrative Oncology section of the Cancer Knowledge Network, I will discuss my opinion on the current status of integrative oncology in Canada.
Integrative Oncology is a term initially used by Barrie Cassileth PhD, who leads the Integrative Oncology Program at Sloan Kettering Cancer Center, New York. The term emphasizes evidence based interventions that improve coping, symptom control, self-regulation, and quality of life during cancer treatment. Interventions are not alternatives to conventional cancer care but are a person-centered approach to enhance the patient’s sense of control and enhance quality of life, using interventions that are either additional to pharmaceutical drugs or (in some cases) used instead of. Unfortunately, the term has sometimes been hi-jacked to include non-proven interventions and alternatives to good evidence based medicine. It is not alternative medicine, but evidence-based therapies that are complementary to the medical cancer treatments. It is part of a supportive care program that enhances coping and well-being. In Canada, we have advanced psychosocial programs that incorporate many of the features of integrative oncology. This is in contrast to the United States, which has pursued complementary therapies as a separate component of supportive care. One reason is their individual specialties are kept in separate silos. Another reason is business-related. Since oncology centers compete for insured patients, a program of complementary therapies became an attractive addition to their anti-cancer therapeutic programs. In Canada, an expansion of our current psychosocial programs will incorporate additional evidence-based complementary interventions, and there is really no need for alternative programs. A good example is the Integrative Oncology Program led by Linda Carlson PhD, a clinical psychologist, at the Tom Baker Cancer Centre, Calgary, Alberta
The concept of integrative oncology has allowed the combination and integration of psychosocial, nutritional, and mind-body interventions that enhance the patient’s resilience and coping. In some cases an increase in cancer cure, in addition to improved well-being, is possible through increased patient engagement, reduced symptoms, enhanced nutritional status, and better adherence to medical interventions. After a decade of clinical trials, some previously considered fringe therapies have become main stream. These include some obvious lifestyle factors, such as nutrition and exercise, as well as psychological therapies, acupuncture, massage, and some natural supplement derivatives. It is important to emphasize that the interventions are contextual and specific for treating particular indications as defined by positive studies. For example, acupuncture may help certain types of pain, dry mouth, neuropathy, hot flashes and fatigue, but is not a blanket intervention for all symptoms
One argument for the general utility of complementary therapies is that most of these interventions are relatively harmless and therefore can be tried in all circumstances. However, there is always some risk (albeit small when delivered by trained professionals) but, in addition, fiscal responsibility and the patient’s opportunity time must be taken into account. There is a cornucopia of health systems available, including Chinese medicine, homeopathy, and naturopathy. Although these have recently come under the Regulated Health Professions Act in Ontario, there is controversy over equivalent standards established by the more traditional regulated bodies, such as medical doctors, dentists, nurses, and pharmacists. This schism is mainly based on perceived quality of the science that underwrites these older and more primitive health care systems. On the other hand, we have learned that specific aspects of these alternative systems are very important. For example, homeopathy emphasizes the individual therapeutic relationship. German naturopathy has emphasized the importance of exercise and nutrition. Chinese medicine has brought us acupuncture and specific herbs that have been refined into drugs. It is important to emphasize that the relationship of these disciplines with each other continues to evolve, but should develop on a foundation of scientific evidence, the same professional standards, and mutual cooperation that is directed to the patient’s best outcome.
The future of integrative oncology is to integrate the best of patient care along with strategies to cure cancer. We have learned that health care is not just an acute mechanistic intervention that targets the disease alone. Future Oncology considers the whole patient, enables the patient to be part of the decision-making process, and educates her to make wise decisions in pursuing treatment programs that meet her individual needs.1
- Garchinski CM, Dibiase A-M, Wong RK, Sagar SM. Patient-Centered Care in Cancer Treatment Programs: The Future of Integrative Oncology through Psycho-Education. Future Oncol. (2014) 10(16), 2603–2614.
Stephen Sagar BSc (Hons), MB BS, MRCP, FRCR, FRCPC, CKN Integrative Oncology Section Co-Editor
Stephen Sagar, Professor Oncology, McMaster University, Canada
Dr. Sagar’s research interests are supportive care, patient-centered care, the reciprocal relationship between the mind and body, epigenetic phenomena, and reducing the adverse effects of anti-cancer therapies. He has published widely on radiation oncology and supportive care (including complementary therapies), and presented at numerous international meetings. He is past-president of the Society for Integrative Oncology, member of the International Psycho-Oncology Society, and member of the American Society for Therapeutic Radiation Oncology.