During the 1960s and 1970s, the concept of an expanded approach to oncologic treatment encompassing “body, mind, and spirit” grew in patient popularity and morphed into two basic categories: “alternative” and “complementary” therapies. Together, these later became known by the acronym CAM, for complementary and alternative medicine. However, because the term “alternative therapy” often refers to unproven or disproved treatments that have no place in legitimate care, the CAM terminology tends to be misleading and confusing.
“Integrative medicine”—or, in our case, “integrative oncology”—increasingly has replaced CAM as a preferred term, one that hopefully removes CAM’s negative connotations. Integrative oncology is a synthesis of mainstream treatment and complementary therapies in cancer care. These are noninvasive, nonpharmacologic adjuncts to mainstream treatment that improve patients’ strength and control the physical and emotional symptoms associated with cancer and cancer treatment. They also provide patients with a sense of control and self-empowerment at a time when many feel vulnerable and life seems out of control.1
The Integrative Approach
Although today’s successful oncology treatments cure increasing numbers of patients, they also result in adverse effects, some of which are lasting. Side effects from cancer surgery, hormonal blockade, chemotherapy, and radiation treatments are common, and they impact the quality of patients’ lives during treatment and after. Therefore, optimal care must include attention to more than the tumor. It requires a broadened attention to patients’ physical and emotional needs, both during the course of treatment and into the years of survivorship that, for many, lie ahead.
Mainstream medical treatments already include successful approaches to alleviating side effects, but many of these are marginally successful, costly, and have their own side effects. As a result, patients increasingly seek complementary therapies to assist them in coping with the rigors of care. They also look for ways to improve strength and mood, to decrease stress, pain, and anxiety and often to enhance their clinical status.2 Unfortunately, some patients gravitate to the use of widely promoted disproved or unproven “alternative” modalities to achieve these goals. No less than mainstream cancer therapies in common use, complementary therapies must be evidence-based or, lacking firm evidence, must at least have a rational basis.
Integrative Oncology in the United States
Most U.S. cancer centers and cancer programs have at least some component of integrative medicine. This may include music therapy for inpatients, occasional lectures, or perhaps massage therapy for outpatients. Some are engaged exclusively in research. Others focus on specific subsets, such as pediatric inpatients. Although the availability of integrative therapies varies widely, it would be difficult to find a major cancer program in the United States that does not include at least some attention to complementary modalities. Integrative cancer care in other countries is not far behind.
The Integrative Medicine Department at Memorial Sloan-Kettering Cancer Center provides inpatient and outpatient clinical care as well as education, training, and research, all in collaboration with clinicians, researchers, and others throughout the institution. A primary focus of our program is to study and provide appropriate complementary therapies to patients, survivors, their families, staff, and the community. These approaches may be perceived as extensions of the supportive care associated with oncology for decades past. We also have developed a website to provide physicians and the public with evidence-based information about herbal remedies, vitamins and other dietary supplements, and bogus cancer treatments, all at no cost (www.MSKCC.org/AboutHerbs). This information is continuously updated and accessed internationally, receiving more than 2 million hits in the past 10 months alone.
At the same time, we work diligently to stop the use of unproven ″alternative” therapies that are promoted in lieu of mainstream cancer treatment. These fake cancer cures constitute a multibillion dollar business in the United States and other developed countries. Such quackery has no place in proper cancer care.
Major Components of Integrative Oncology
This field is too new for perfect agreement about what constitutes complementary therapies, and variations in language exist. However, the following categories are commonly applied and are available in the Memorial Sloan-Kettering program: massage therapy; mind-body techniques including meditation, self-hypnosis, yoga, and tai chi; music therapy; acupuncture; exercise/physical fitness; and advice about nutrition, herbs, and other dietary supplements.
Each of these evidence-based approaches has an important role in enhancing well-being and contributing to overall patient and survivor care. A few are highlighted below.
- Mind-Body Therapies: Research demonstrates the clinical benefit as well as cost-effectiveness of mind-body treatments such as meditation and self-hypnosis. Patients can learn to use these techniques as needed, to decrease symptoms and improve quality of life. These therapies are widely used by patients with successful results.
- Fitness and Nutrition: Exercise and physical fitness improve clinical outcome and decrease negative side effects. Physical activity is an important recommendation of virtually every oncology organization internationally. Data increasingly show that physical activity directly increases survival. In recently diagnosed patients, adherence to a Mediterranean diet as part of comprehensive lifestyle intervention alters gene expression3 and improves clinical outcome.4,5
- Acupuncture: Among the most studied of complementary therapies, acupuncture research demonstrates safety, physiologic benefits, and symptom relief, as well as insight into its mechanisms of action. Ongoing research on acupuncture for conditions such as neuropathy, xerostomia, and lymphedema is especially important, as available mainstream treatments often fail to control or reduce these and other difficult problems.
Integrative oncology continues to grow in popularity. It is increasingly available clinically and appropriately subjected to study in a growing number of academic centers. These therapies are safe, inexpensive, and effective. Many are self-applied, thus providing patients some control over what they perceive as an uncontrollable circumstance. These therapies are a needed component of contemporary cancer care. ■
Disclosure: Dr. Cassileth reported no potential conflicts of interest.
References
1. Deng, G, Frenkel M, Cohen L, et al: Evidence-based clinical practice guidelines for integrative oncology: Complementary therapies and botanicals. J Soc Integr Oncol 7:85-120, 2009.
2. Barnes PM, Bloom B, Nahin R: Complementary and alternative medicine use among adults and children: United States, 2007. National Health Statistics Report No. 12, 2008. Available at nccam.nih.gov/news/camstats/. Accessed December 8, 2011.
3. Ornish D, Magbanua MJ, Weidner G, et al: Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci USA 105:8369-8374, 2008.
4. Meyerhardt JA: Beyond standard adjuvant therapy for colon cancer: Role of nonstandard interventions. Semin Oncol 38:533-541, 2011.
5. Zeng H, Irwin ML, Lu L, et al: Physical activity and breast cancer survival: An epigenetic link through reduced methylation of a tumor suppressor gene L3MBTL1. Breast Cancer Res Treat. August 12, 2011 (early release online).
Dr. Cassileth is Chief, Integrative Medicine Service, and Laurance S. Rockefeller Chair in Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York. She is the author of The Complete Guide to Complementary Therapies in Cancer Care (World Scientific, 2011).
