ASCO HAS ENDORSED the recommendations in the Society for Integrative Oncology (SIO) clinical practice guidelines for integrative therapies during and after breast cancer.1,2 The guidelines “are clear, thorough, and based on the most relevant scientific evidence,” wrote the ASCO expert panel that reviewed the guidelines recommending therapies such as meditation, yoga, massage, and music therapy for managing symptoms and adverse effects of breast cancer treatment. The recommendations, along with a few “discussion points” where the ASCO panel’s recommendations diverge from those of the SIO, were reported in the Journal of Clinical Oncology.2
The report makes it clear that integrative therapy “coordinates the delivery of evidence-based complementary therapies with conventional cancer care,” but do patients understand that complementary therapies are truly complementary and are intended for managing symptoms and adverse events and not intended to replace conventional care? “I think some do, but I am concerned that many do not. They may feel the complementary treatment is treating the cancer,” Gary H. Lyman, MD, MPH, the panel chair and lead author of the article, said in an interview with The ASCO Post. Sometimes complementary therapies “are promoted that way inappropriately without evidence,” he added, rather than as a way to reduce the side effects of cancer or its treatment. Dr. Lyman is Co-Director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center and Professor of Medicine/Medical Oncology, University of Washington School of Medicine, Seattle.
Dr. Lyman advocates an “open dialogue” about integrative therapies, so “patients will be more likely to tell their doctors if they are having any side effects that might be from those types of therapies; and the doctors can tell the patients if they have concerns that some integrative medicine might interfere or complicate treatment. Transparency, open dialogue, and better education of oncologists and other cancer care providers, all this can only work to provide better care for the patients we treat.”
Generational Issue
“THERE MAY BE a generational issue,” Dr. Lyman said. Among physicians who have been practicing oncology for many years, “maybe we are a little more fixed in our ways,” he noted. “Probably some of the younger generation of oncologists are more aware of integrative therapies” and perhaps gained an understanding of these therapies during their medical training.
“Some oncologists, and I have heard this from patients, just don’t want to have anything to do with these things and discourage their patient from taking anything. But I think increasingly, particularly as more science is brought to bear on this, there is a more open attitude that some of these things may actually do some good and we shouldn’t just dismiss them out of hand,” Dr. Lyman said.
Cost Considerations
ANOTHER ISSUE to consider is cost. “Supplements certainly, and I presume other types of integrative therapy, are a multibillion-dollar business,” Dr. Lyman acknowledged. “Some of these costs in some states are reimbursed. For instance, in Washington State, acupuncture is reimbursed. But in many states and for many of these interventions, it is an out-of-pocket expense for patients.”
With the cost of cancer treatment already unacceptably high, “whatever is added to that may just be an additional burden on patients,” Dr. Lyman said. Patients and their families are often willing “to do anything and everything they can that is going to be helpful. But they do need to be able to share what they are doing and have a discussion with their oncologist, which should lead to the best outcome.” ■
DISCLOSURE: Dr. Lyman reported no conflicts of interest.
REFERENCES
1. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al: Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 67:194-232, 2017.
2. Lyman GH, Greenlee H, Bohlke K, et al: Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol. June 11, 2018 (early release online).
