Despite the significant rise over the past 50 years in the use of evidence-based integrative medicine in conjunction with conventional cancer treatments—up from just 20% in the 1970s to about 80% in 20171—training opportunities in the fundamentals of this emerging field within the specialty of palliative medicine are not meeting patient demand. To help fill this gap, in 2022, ASCO and the Society for Integrative Oncology (SIO) developed the Integrative Medicine for Pain Management in Oncology Guideline2; that was followed, in 2023, with the Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer3 and, in 2024, with the Management of Fatigue in Adult Survivors of Cancer.4
The practice of integrative oncology, defined by SIO as “a patient-centered, evidence-informed field of comprehensive cancer care that utilizes mind-body practices, natural products, and lifestyle modifications from different traditions alongside conventional cancer treatments,” is meant to provide a continuum of care throughout cancer survivorship.
“Patients with a high-symptom burden from cancer and its treatments, including pain, fatigue, insomnia, anxiety, and depression, will benefit the most from integrative oncology approaches, because research shows they help to reduce cancer-related symptoms with minimum side effects,” said Ting Bao, MD, MS, FSIO, Co-Director of the Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute; Co-Chair of the SIO Education Committee; and Past President of SIO. “But patients with early-stage disease and those who have completed active treatment and have moved into long-term survivorship can benefit as well.”
“There is increasing interest among patients with cancer and their families in pursuing complementary medicine, and we have to meet that need.”— TING BAO, MD, MS, FSIO
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To facilitate the implementation of the ASCO/SIO integrative medicine guidelines into clinical practice, SIO has developed training modules in the management of cancer-related pain, anxiety, and depression that include continuing medical education (CME) credits (https://integrativeonc.org/training-modules/). To build upon these efforts and provide additional educational opportunities in this field, this year, SIO is holding its annual international conference, co-hosted by Dana-Farber Cancer Institute Zakim Center, on October 27–29, 2025, in Boston (https://integrativeonc.org/sio-2025-conference/). The theme of this year’s conference is “The Future of Integrative Oncology: Bridging Cultures, Embracing Innovation, and Fostering Unity.”
“Right now, there is limited formal training in integrative oncology approaches for patients with cancer, especially training for oncologists,” said Dr. Bao. “With this year’s conference, we hope to bring together health-care professionals, researchers, and patient advocates dedicated to advancing integrative oncology care.”
In this interview with The ASCO Post, Dr. Bao discusses the role of integrative oncology in providing high-quality, patient-centered care; the need to increase training opportunities for oncology providers on the fundamentals of evidence-based integrative oncology; and the barriers to accessing this care.
Propelling the Field of Integrative Oncology and Palliative Care Forward
Please talk about the significant rise in research in integrative oncology to improve patient outcomes. What are you learning about the role of integrative oncology in informing high-quality, personalized cancer care and improving palliative care for patients?
Over the past 30 years, there has been a remarkable increase in the number of high-quality, randomized controlled trials examining integrative medicine approaches in improving care for patients with cancer. The research is primarily focused on cancer-related symptom management of physical issues, such as fatigue and pain, as well as psychological concerns, including anxiety and depression, which are associated with poorer quality of life and higher mortality among patients.
Now, we have the results from a number of studies showing how acupuncture helps to reduce cancer-related pain and how mindfulness-based interventions, including tai chi and qigong, improve the severity of fatigue. We also know from research that mindfulness-based modalities, such as yoga, hypnosis, relaxation therapies, music therapy, reflexology, and lavender essential oils, may relieve symptoms of anxiety and depression and also improve treatment adherence, reduce treatment costs, and decrease both mortality and morbidity.5 The data from these studies have informed the recommendations in the ASCO/SIO integrative oncology guidelines2-4 and have helped propel the field of integrative oncology and palliative care forward.
Expanding Physicians’ Knowledge of Complementary Medicine
How knowledgeable are oncologists about integrative oncology in the practice of palliative medicine?
It varies depending on the clinical setting. Right now, there is limited formal training for oncologists and palliative care physicians in evidence-based integrative medicine for patients with cancer. This is why we hope our guidelines and educational training modules in the management of cancer-related pain, fatigue, anxiety, and depression will expand physicians’ knowledge of these complementary modalities and provide patients with a more holistic approach to their care.
Incorporating Integrative Oncology Training in Medical Schools
Are medical schools starting to include training in integrative oncology? How do providers attain training and credentialing in this field?
My understanding is that medical schools, so far, are not offering formal training in integrative oncology, and I certainly would like to see a course in this field incorporated into the medical school curriculum. There are some training opportunities for oncology professionals, including online training programs and fellowships, but they are scarce.
The University of Arizona offers an Integrative Medicine in Hematology Oncology fellowship program in collaboration with Mayo Clinic Arizona, to prepare fellows for board eligibility in integrative medicine upon completion of the fellowship (https://cancercenter.arizona.edu/integrative-medicine-hematology-oncology-fellowship-program). And the University of Michigan has developed an outstanding Integrative Oncology Scholars Program to train oncology specialists across the health-care field in evidence-informed complementary therapies for cancer care. So, the field is getting increasing attention.
Currently, the Integrative Medicine Boards through the American Board of Integrative Medicine (ABOIM) is the only multispecialty certifying board in the United States to offer integrative medicine board certification.
Overcoming Barriers to Accessing Integrative Palliative Care
What are some of the barriers for patients to access integrative palliative care? Are complementary health approaches, such as acupuncture and massage therapy, covered by insurance?
The financial cost of these therapies is the number-one barrier to accessing integrative care. Acupuncture, chiropractic care, therapeutic massage, and nutrition counseling are sometimes covered by health insurance, but even then, the number of sessions allowed is limited. Some academic cancer centers provide acupuncture, acupressure, aromatherapy, and mind-body practices free of charge, but again, these integrative therapy resources are limited and usually don’t exist in the community cancer setting.
The second huge barrier is the lack of qualified practitioners, especially in rural areas of the country, and lack of knowledge about these practices among oncologists. We need to educate oncology health-care providers on the basics of evidence-based integrative oncology practices to meet the needs of patients.
The bottom line is there is increasing interest among patients with cancer and their families in pursuing complementary medicine, and we have to meet that need.
DISCLOSURE: Dr. Bao reported no conflicts of interest.
REFERENCES
1. Witt CM, Balneaves LG, Cardoso MJ, et al: A comprehensive definition for integrative oncology. J Natl Cancer Inst Monogr 2017(52), 2017.
2. Mao JJ, Ismaila N, Bao T, et al: Integrative medicine for main management in oncology: Society for Integrative Oncology–ASCO guideline. J Clin Oncol 40:3998-4024, 2022.
3. Carlson LE, Ismalia N, Addington EL, et al: Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol 41:4562-4591, 2023.
4. Bower JE, Lacchetti C, Alici Y, et al: Management of fatigue in adult survivors of cancer: ASCO–Society for Integrative Oncology guideline update. J Clin Oncol 42:2456-2487, 2024.
5. Gowin K, Muminovic M, Zick SM, et al: Integrative therapies in cancer care: An update on guidelines. Am Soc Clin Oncol Educ Book 44:e431554, 2024.
