Jun J. Mao, MD, MSCE
Luis Alejandro Salicrup, PhD
Nearly 20 million people around the world were diagnosed with cancer in 2020, with 10 million losing their lives to this devastating disease. We highlight here the salient points from our article published in CA: A Cancer Journal for Clinicians,1 which describes the major themes and recommendations that emerged from the Trans–National Cancer Institute (NCI)—National Institutes of Health (NIH) conference “International Perspectives on Integrative Medicine for Cancer Prevention and Cancer Patient Management,” held in October 2020.
Global Impact of Cancer
Even as low- and middle-income countries (LMICs) account for 80% of the cancer burden worldwide, a mere 5% of global spending is allocated to fight the disease. Consequently, people from LMICs will be most vulnerable because of unaffordability of quality cancer care. Additional exacerbating factors include the following:
- Inadequate implementation of interventions such as tobacco control and vaccinations for preventable, infection-related cancers such as those caused by hepatitis B virus (HBV) and human papillomavirus (HPV);
- Adopting a Western lifestyle characterized by consumption of highly processed fast foods and physical inactivity leading to obesity-linked diseases;
- Limited access to cancer treatments;
- Lack of survivorship and palliative care.
Prevalence of Traditional, Complementary, and Integrative Medicine in LMICs
Many patients in LMICs avail themselves of traditional, complementary, and integrative medicine (TCIM) practices—including acupuncture, meditation, yoga, tai chi, massage, music therapy, dance therapy, and natural products—because they are easily accessible and less expensive than conventional options. Although these practices are being widely used as an adjunct to standard care in high-income countries, combining the two for providing effective evidence-based care is challenging in LMICs because of the discord between mainstream medicine and TCIM perspectives.
The Role of Integrative Oncology
A patient-centered and evidence-informed field, integrative oncology uses lifestyle modifications, mind-body therapies, and natural products in concert with standard care. It is well positioned to provide a basis for determining safe and effective utilization of TCIM. Thus, it has enormous potential for minimizing the gaps in oncologic care to allow delivery of evidence-based approaches.
Based on more than 2 decades of clinical research, including data from high-quality randomized controlled trials, the Society for Integrative Oncology (SIO), the American Society of Clinical Oncology (ASCO), and, notably, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend integrative oncology modalities including acupuncture, meditation, massage, yoga, exercise, and music therapy for relief of common oncologic symptoms including pain, fatigue, nausea and vomiting, hot flashes, and sleep disorders.
“Integrative oncology provides a framework for bringing together [traditional, complementary, and integrative medicine] and standard oncologic care.”— Jun J. Mao, MD, MSCE, and Luis Alejandro Salicrup, PhD
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Additionally, many patients with cancer around the globe use herbs and natural products because of cultural familiarity and recommendations from their families. Such use in the context of cancer treatment is extensive despite limited clinical data; concerns over quality control; and the potential for herbal interactions with chemotherapy, anticoagulants, immunosuppressive agents, and hormonal therapies. Rigorous research and stricter regulation are therefore needed to allow for the safe use of natural products in cancer settings.
Recommendations for Incorporating TCIM Into Mainstream Care
At the conclusion of the 4-day conference, participants identified the following priorities:
Educate and integrate TCIM providers into the cancer control work force for promoting reductions in disease risk by increasing access to tobacco cessation programs; decreasing initiation of tobacco use; preventing/treating HBV and HPV infections; and encouraging a healthy lifestyle encompassing diet, physical activity, as well as overweight/obesity prevention;
Develop and test TCIM interventions to address symptoms associated with cancer and its treatment-induced side effects such as pain, fatigue, insomnia, and psychological burden with a particular emphasis on research and research training in LMICs;
Disseminate and implement evidence-based TCIM interventions by incorporating them into palliative and survivorship care, taking into consideration local cultural, economic, and social perspectives.
Key players for advancing this priority include the NCI-NIH, NCI-designated comprehensive cancer centers, the World Health Organization (WHO), the International Agency for Research on Cancer (IARC), professional organizations such as the SIO and ASCO, as well as cancer centers and research institutions in LMICs.
Concluding Remarks
Meeting these priorities will help to ensure equitable cancer care globally, particularly to citizens of LMICs, who are disproportionately affected with rising rates of cancer and limited access to preventive measures, treatments, and supportive care. Integrative oncology plays an important role in achieving this goal, as it provides a framework for bringing together TCIM and standard oncologic care.
DISCLOSURE: Dr. Mao has received research funding provided to Memorial Sloan Kettering Cancer Center from Tibet Cheezheng Tibetan Medicine Company Ltd. Dr. Salicrup reported no conflicts of interest.
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