Jun J. Mao, MD, MSCE
In 2019, we will mark the 20th year of the establishment of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center (MSK), which helped lay the foundation for the emerging field of integrative oncology. Over the past 2 decades, academic cancer institutions, including The University of Texas MD Anderson Cancer Center, Dana-Farber Cancer Institute, and Fred Hutchinson Cancer Research Center, have established integrative medicine centers and programs to provide clinical care, conduct research, and educate health-care providers as well as the general public.1
Yesterday and Today
TWENTY YEARS AGO, there were many skeptics who predicted that integrative oncology would not survive in academic medicine. Today, passionate skeptics continue to question its existence and attempt to lump it in with alternative medicine. Rather than having others define integrative oncology, a group of international scholars from the Society for Integrative Oncology (SIO) used mixed-methods research to create the following definition: “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.”2
Today, the need for education about integrative oncology is even more pressing. According to ASCO’s 2018 National Cancer Opinion Survey, 4 out of 10 Americans believe that natural approaches alone can cure cancer.3 More often, younger people tend to hold such beliefs.
Our own research showed that family plays an important role in shaping the expectations of patients with cancer about complementary and alternative medicine, including unrealistic expectations of cure.4 The motivation for using complementary and alternative medicine may include a preference for natural approaches, a desire to take active control over one’s illness, a need to address unmet symptom and psychological requirements, and a distrust of the pharmaceutical industry and organized medicine.5,6 Sadly, when patients choose alternative medicine instead of conventional oncologic treatment, their survival is compromised.7 Therefore, we must find solutions to meet patients’ needs while helping them adhere to conventional treatments that may extend their lives.
Translating Evidence Into Clinical Practice
IN THE PAST 20 years, research has yielded a robust evidence base for yoga, meditation, massage, and acupuncture for symptom control.8-12 Now, we need to translate this evidence into clinical practice, ensuring that practicing oncology professionals are well informed. Given the high level of comorbidities experienced by patients, it is essential to train integrative health-care professionals to provide high-quality, safe, and effective care. To do this, we need to build scalable and sustainable integrative oncology practices in academic centers and community hospitals so patients can have adequate access to these services. Using a dissemination and implementation framework to guide future research may help to evaluate optimal strategies for the integration of complementary therapies across the cancer care continuum.
“Twenty years ago, there were many skeptics who predicted that integrative oncology would not survive in academic medicine.”— Jun J. Mao, MD, MSCE
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2019 SIO Conference
I WELCOME you to join me at the SIO’s 16th Annual International Conference, jointly sponsored by MSK, with the theme of “Advancing the Science & Art of Integrative Oncology.” The conference will be held October 19–21, 2019, at the New York Hilton Midtown in New York (https://integrativeonc.org).
Confirmed keynote speakers include Nobel Prize Laureate Michael W. Young, PhD, of Rockefeller University, who will discuss the biology of circadian rhythms for health; exercise scientist Lee Jones, PhD, of MSK, who will explore the mechanisms and effects of exercise on cancer survivors; health outcomes clinician-scientist Dawn Hershman, MD, MS, of Columbia University, who will discuss optimal clinical trial design and research to evaluate the effect and impact of integrative medicine in cancer survivorship; and Jamie H. Von Roenn, MD, FASCO, medical oncologist and Senior Director of ASCO’s Education, Science, and Professional Development Department, who will assess the art of practicing palliative and supportive care.
In closing, if we adhere to the rigors of scientific principles and humanistic qualities of art in our everyday pursuit of medicine, we will be better able to serve our patients’ physical, emotional, and spiritual needs. ■
DISCLOSURE: Dr. Mao reported no conflicts of interest.
1. Yun H, et al: Growth of integrative medicine at leading cancer centers between 2009 and 2016. J Natl Cancer Inst Monogr 2017(52), 2017.
2. Witt CM, et al: A comprehensive definition for integrative oncology. J Natl Cancer Inst Monogr 2017(52), 2017.
3. ASCO: National Cancer Opinion Survey, 2018. Available at www.asco.org. Accessed January 23, 2019.
4. Latte-Naor S, et al: Influence of family on expected benefits of complementary and alternative medicine in cancer patients. Support Care Cancer 26:2063-2069, 2018.
5. Mao JJ, et al: Cancer survivors with unmet needs were more likely to use complementary and alternative medicine. J Cancer Surviv 2:116-124, 2008.
6. Bauml JM, et al: Do attitudes and beliefs regarding complementary and alternative medicine impact its use among patients with cancer? Cancer 121:2431-2438, 2015.
7. Johnson SB, et al: Complementary medicine, refusal of conventional cancer therapy, and survival among patients with curable cancers. JAMA Oncol 4:1375-1381, 2018.
8. Lyman GH, et al: Integrative therapies during and after breast cancer treatment. J Clin Oncol 36:2647-2655, 2018.
9. Mustian KM, et al: Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol 31:3233-3241, 2013.
10. Deng GE, et al: Complementary therapies and integrative medicine in lung cancer. Chest 143:e420S-e436S, 2013.
11. Zia FZ, et al: The National Cancer Institute’s conference on acupuncture for symptom management in oncology. J Natl Cancer Inst Monogr 2017(52), 2017.
12. National Comprehensive Cancer Network®: NCCN Clincal Practice Guidelines in Oncology: Cancer-Related Fatigue, version 2.2018. Available at www.nccn.org. Accessed January 23, 2019.