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The State of Integrative Oncology: A New Era


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Now that we have entered 2018, let’s take a moment to reflect on how far we have come and what lies ahead in integrative oncology care.

Overview

To cope with the physical, emotional, and spiritual effects of cancer, and in search of relief from symptoms that their conventional treatments have not addressed,1-3 people with cancer often use complementary therapies such as acupuncture, yoga, massage, and meditation. Approximately 30% to 50% of patients with cancer use these modalities, popularly known as complementary and alternative medicine, and more recently, as complementary and integrative medicine.4,5 A number of complementary and alternative medicine approaches have been shown to improve symptom control and quality of life for patients and cancer survivors.6 In fact, cancer survivors are more likely than the general population to use complementary and alternative medicine for general wellness, immune enhancement, and pain relief.7,8

The field of integrative oncology has emerged in recent years, as interest in and use of these therapies have grown. The goal of this scientific discipline is to combine evidence-based complementary medicine and conventional cancer treatment to address the diverse needs of patients with cancer and their families.

Growth of Integrative Medicine in Cancer Care

In 1999, the Memorial Sloan Kettering Cancer Center established the first Integrative Medicine Service to provide evidence-based complementary therapies that improve patients’ quality of life by alleviating physical and emotional symptoms associated with cancer and its treatments. A number of other leading centers in cancer care, including The University of Texas MD Anderson Cancer Center and the Dana-Farber Cancer Institute, also formed integrative medicine programs. As evidence of the significant growth of this new field, in 2003, integrative oncology researchers and clinicians at major cancer centers in the United States established the Society for Integrative Oncology to advance evidence-based, comprehensive, integrative health care to improve the lives of people affected by cancer (www.integrativeonc.org). The Society for Integrative Oncology now has more than 500 members representing 32 countries and regions.

Integrative medicine in oncology care has continued to grow.5 We recently conducted a systematic analysis of the websites of all 45 U.S. National Cancer Institute–designated cancer centers and found a substantial increase in the information on integrative medicine since our original evaluation in 2009.9 Websites referencing dietary supplements grew the most (51.8%, P < .001), followed closely by exercise (51.5%, P = .001) and herbal supplements (45.0%, P < .002). We also found notable increases of more than 30% in each of the four representative integrative medicine therapies: acupuncture (30.3%, P = .005), massage (30.7%, P = .002), meditation (32.8%, P = .001), and yoga (30.6%, P = .002).


We must advance health policy that leads to reimbursement for evidence-based integrative therapies.
— Jun J. Mao, MD, MSCE

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The integrative medicine therapies most commonly offered by these cancer centers for their patients were acupuncture/massage (73.3% each); meditation/yoga (68.9% each); and consultations about nutrition (91.1%), dietary supplements (84.4%), and herbs (66.7%). The majority of these centers provide integrative medicine services in the same academic health systems in which they are located.9 Such growth suggests these cancer centers are incorporating these modalities into their cancer care.

The recent Journal of the National Cancer Institute monograph, “Advancing the Global Impact of Integrative Oncology,” presents a collection of original research and perspective manuscripts to highlight both the challenges and opportunities for advancing this growing field. The monograph includes a long-needed definition of “integrative oncology” in recognition of the steadily increasing growth and impact of integrative medicine in cancer care worldwide.10 The researchers developed the definition by using a mixed-methods approach, including a literature analysis and consensus procedure with an interdisciplinary expert panel and surveys.

The final definition appears here: “Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.”

Concluding Thoughts

With the publication of this definition, integrative oncology enters a new era, filled with significant opportunities for growth as well as for educating patients and their families, researchers, clinicians, funders, patient advocates, and key societal stakeholders. It also makes even more pressing the current challenges facing the field. Despite the increasing evidence of their efficacy, many integrative therapies are not covered by insurance, leaving many patients with the often-infeasible option of paying out of pocket for these services.

To improve patient experiences and outcomes, it is essential to increase the rigor of research and educational programs. It is also essential to determine appropriate regulations and credentialing procedures for integrative medicine providers and to improve collaboration among these therapists and other members of patients’ oncology care teams. Furthermore, we must advance health policy that leads to reimbursement for evidence-based integrative therapies. With each step we take to address these challenges, we move closer to alleviating the physical, psychological, and spiritual suffering experienced by those affected by cancer. ■

Dr. Mao is Laurance S. Rockefeller Chair in Integrative Medicine and Chief, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.

DISCLOSURE: Dr. Mao reported no conflicts of interest.

REFERENCES

1. Mao JJ, Cohen L: Advancing the science of integrative oncology to inform patient-centered care for cancer survivors. J Natl Cancer Inst Monogr 2014:283-284, 2014.

2. Boon HS, Olatunde F, Zick SM: Trends in complementary/alternative medicine use by breast cancer survivors: Comparing survey data from 1998 and 2005. BMC Womens Health 7:4, 2007.

3. Cutshall SM, Cha SS, Ness SM, et al: Symptom burden and integrative medicine in cancer survivorship. Support Care Cancer 23:2989-2994, 2015.

4. Gansler T, Kaw C, Crammer C, et al: A population-based study of prevalence of complementary methods use by cancer survivors: A report from the American Cancer Society’s studies of cancer survivors. Cancer 113:1048-1057, 2008.

5. Horneber M, Bueschel G, Dennert G, et al: How many cancer patients use complementary and alternative medicine: A systematic review and metaanalysis. Integr Cancer Ther 11:187-203, 2012.

6. 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 2014:346-358, 2014.

7. Anderson JG, Taylor AG: Use of complementary therapies for cancer symptom management: Results of the 2007 National Health Interview Survey. J Altern Complement Med 18:235-241, 2012.

8. Mao JJ, Palmer CS, Healy KE, et al: Complementary and alternative medicine use among cancer survivors: A population-based study. J Cancer Surviv 5:8-17, 2011.

9. Yun H, Sun L, Mao JJ: Growth of integrative medicine at leading cancer centers between 2009 and 2016: A systematic analysis of NCI-designated comprehensive cancer center websites. J Natl Cancer Inst Monogr 2017(52), 2017.

10. Witt CM, Balneaves LG, Cardoso MJ, et al: A comprehensive definition for integrative oncology. J Natl Cancer Inst Monogr 2017(52), 2017.


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