The Long and Winding Road to Modern Integrative Oncology

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Barrie R. Cassileth, MS, PhD

Surely more progress will occur in the future, but thanks to those who developed this new set of SIO Clinical Practice Guidelines, the well-being of breast cancer patients will be improved.

—Barrie R. Cassileth, MS, PhD

It has been a long road from the blind acceptance of unproven “alternative” remedies for the treatment of cancer to the development of rigorous guidelines for integrative care, which address symptom control. The recently released Society for Integrative Oncology (SIO) guidelines applicable to breast cancer patients—reviewed in this issue of The ASCO Post—are a vivid example of that progress.1

Historic Context

“Alternative therapies,” including many that are clearly bogus, have been around for centuries. But, they found new life in 1992, when the Office of Alternative Medicine was created at the National Institutes of Health (NIH). The motivation for this was not scientific; it was political. The new office was initiated by members of Congress who strongly believed in actual alternatives to mainstream cancer care.

One of these congressmen claimed that, although he had been successfully treated with mainstream cancer care, it was the bogus “alternative therapy” he received thereafter that cured him—although the U.S. Food and Drug Administration found that it was simply a solution of 5% nitrate, 1.4% ammonium, and traces of 22 additional chemicals. But politics trumps science, and “alternative medicine” was planted at the highest levels, an action that, tragically, legitimized unproven methods of care, including bogus therapies for cancer such as laetrile, krebiozen, and numerous others.

Having studied the use of unproven cancer treatments for more than a decade, I was invited to join the board of the then-new NIH Office of Alternative Medicine. At the first meeting, each participant sat down to find a large newsletter headed “Which side is she on?” I turned out to be the token scientist.

Most in the room felt that science was neither necessary nor applicable to “alternative” cancer therapies. Belief in scientific research was the “other side.” Their side was a multibillion-dollar industry that was beyond scientific inquiry. The SIO guidelines are a potent answer.

‘Alternative’ vs ‘Complementary’ Therapies

It turned out that not all interventions in the catch-all “alternative therapies” category were bogus. Although none was curative, many nonpharmacologic approaches were potentially helpful for symptom control.

In 1995, I attempted to sort through these interventions in what became the Alternative Medicine Handbook, a taxonomy that distinguished between useless “alternative cancer treatments,” many of which were downright quackery, and useful adjunctive or complementary therapies. These were not primary treatment options, but rather valuable nonpharmacologic adjuncts aimed to reduce symptoms associated with cancer and with legitimate cancer treatment. The “About Herbs” website that my colleagues and I developed shortly after I joined Memorial Sloan Kettering Cancer Center in 1999 supplemented this with data on hundreds of natural substances—some useful, many not.

To reduce the physical and emotional sequelae associated with cancer and cancer treatment, safe and useful adjunctive complementary therapies were identified. They would be safely integrated with conventional treatments for a better overall patient experience. They were “integrative therapies,” and the field that studied and applied them became known as “Integrative Medicine.”

Society for Integrative Oncology Is Born

In 2002, a small group of us gathered to form the SIO. We were confronted with the fact that many approaches outside of mainstream care were useful—but how should they be evaluated and applied? Within 3 years, the first set of SIO Clinical Practice Guidelines were published. Updates followed, including “Complementary Therapies and Integrative Oncology in Lung Cancer,” developed with the American College of Chest Physicians in 2007 and updated in 2013.

SIO’s latest achievement is a new set of guidelines addressing the use of integrative/complementary therapies in breast cancer. As described in the accompanying article in The ASCO Post, these guidelines set forth the appropriate use of a broad range of nonpharmacologic treatments, including meditation, yoga, music therapy, acupuncture, relaxation therapy, and more. They outline their use to control symptoms such as stress, sleep disorders, pain, neuropathy, chemotherapy-induced side effects, and others that plague cancer patients. But just as with mainstream treatments, each has its place, its potentials and limitations, and guidelines are just as necessary.

From the “alternatives” dangerously touted as viable cancer treatments, a compendium of useful, symptom-control adjuncts has been documented in the field of integrative oncology. Surely more progress will occur in the future, but thanks to those who developed this new set of SIO Clinical Practice Guidelines, the well-being of breast cancer patients will be improved. ■

Disclosure: Dr. Cassileth reported no potential conflicts of interest.


1. Greenlee H, Balneaves LG, Carlson LE, et al, for the Society for Integrative Oncology Guidelines Working Group: Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 50:346-358, 2014.

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


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