Increasing Knowledge About Integrative Oncology May Serve to Reduce Cancer Burden

Jun J. Mao, MD, MSCE, lead author if this study and an Integrative Medicine Specialist at Memorial Sloan Kettering Cancer Center in New York City, NY

As patients with cancer have different levels of access to care and treatments all around the world, factors such as how quickly they are diagnosed and what intervention methods are used are largely tied to their location.

The Society of Integrative Oncology (SIO) is leading an initiative to bring equal access to oncological care, no matter where a patient is in the world. A recently published review article explores global challenges of cancer treatment and how cancer could be prevented.

Jun J. Mao, MD, MSCE, lead author if this study and an Integrative Medicine Specialist at Memorial Sloan Kettering Cancer Center in New York City, spoke about why integrative oncology is important for patients with cancer.

“We don’t have enough health care providers, like the traditional and complementary health providers such as healers, massage therapists, or yoga instructors. They could potentially help patients engage in cancer prevention activities, quit smoking, or get cancer screening. Cancer can be diagnosed at an earlier stage or prevented all together,” said Mao.

In an interview with CancerNetwork®, Mao talks about what the authors aimed to accomplish, what recommendations were made, and how clinicians can adapt to integrative oncology.

What is integrative care and how does it apply to the treatment of patients with cancer?

Integrative oncology is a field that seeks to bring together therapies and practice from other cultures and traditions into conventional cancer care to help patients manage the physical and psychological [adverse effect] of cancer and empower them during cancer treatments, and [throughout] survivorship. It utilizes lifestyle modifications, appropriate mind and body therapies, as well as natural products.

What were some of the goals of this study?

What motivated us for this paper is that the National Cancer Institute [NCI] has an office of Complementary and Alternative Medicine and [I was asked] to lead the writing of this paper based on the conference that NCI and the NIH [National Institute of Health] organized. The goal is to highlight some of the potential challenges in global cancer controls from prevention, treatment, survivorship and palliative care, and [ease] tensions between traditional and integrative medicine and conventional modern oncology as they become available in those settings. Then, [we outlined] some of the solutions for the field to move forward to address some of the global inequity in cancer care.

What were some approaches outlined in the study?

After almost a year-long process, a group of international scholars with folks from all parts of the world as well as NIH and WHO, or the World Health Organization, came up with 3 recommendations. The first one is to train the traditional complementary and integrative health providers about evidence-based cancer control and management principles and practices. In many regions, say Africa or South America or in parts of Asia, conventional oncology or cancer control are just not [enough].

[These integrative care providers] don’t necessarily have the knowledge about what is evidence-based cancer prevention. Training that workforce can increase the capacity to provide effective care, cancer prevention, and detection strategies.

The second [recommendation] is to develop, test, and conduct rigorous research interventions in traditional, complementary, and integrative approaches to addressing cancer symptoms, quality of life issues [associated with] cancer treatments, as well as palliative care and survivorship. Many of those traditional healing practices are culturally more congruent with a population and has been used to support the more holistic nature of mind, body, and spirit of the person with cancer. Modern oncological treatments such as radiation oncology, surgery, or chemotherapy are more widely available to the low- and middle-income countries around the world. The suffering of cancer is immense and relying simply on drugs to address pain, fatigue, nausea, and vomiting may not be adequate or aligned with people’s cultural beliefs. Especially in the setting of survivorship, we want people to return to their normal life and to be independent. Many pharmaceutical interventions may not be the best way for people to regain a sense of self and be integrated in our culture and settings. [Clinicians should] learn what we can from those culture and social settings and distill the interventions and go through rigorous research [to determine] ultimately if can we allow those therapies to play an integral role in cancer care and survivorship.

The third recommendation is to implement therapies and practice [management] that have already been established with evidence for intervention to improve cancer pain symptom controls in a culturally appropriate way, [both] in the local environments and around the world. For example, through 20 years of research and through the work of many researchers, many of them part of the SIO, we have been able to demonstrate practices like meditation, yoga, or acupuncture massage that can help with addressing psychological distress of cancer treatment. In survivorship settings, [these practices can help manage] fatigue, hot flashes, sleep, and pain. Many of those practices are much cheaper than drugs in many countries and cultures and are more readily available. We need to figure out how to train those health care providers to become familiar working with [patients with cancer] and influence the local health system to adapt those interventions into the care for their [patients with cancer] and ultimately, evidence interventions can be transformed into real clinical practice to improve people’s lives.

How do you believe clinicians can begin to implement these recommendations into their practice?

The SIO is working on several [endeavors]. First is education. We need to develop education for oncologists, oncology nurses, and integrative health providers. We need to create the cross-talks of oncologists and oncology nurses and know what some of the safe and effective strategies of integrative health interventions are to address symptoms for [patients with cancer]. Then the integrative health care providers need to know the common cancer treatments, common symptoms, and potential [adverse] effects and interactions of the drugs and the therapies they use. We need to make sure we incorporate these therapies with conventional oncological treatment in a safe and effective way for the patient.

Finally, we also need to equip [patients with cancer] and survivors of cancer or the advocate with the knowledge and skill so the patient or the family become aware of those therapies. That’s the first step. That’s a knowledge dissemination. Implementation wise, I do think there are going to be many challenges as well as opportunities. There are financial and logistical policy barriers that need to be overcome for some of the therapies to be implemented. Any challenges could represent opportunity. There’s a brand-new type of science called implementation science, using specific scientific framework and models with the implementation of evidence-based interventions or strategies on a population level. I think a scientist should also begin to apply in those rigorous methods of implementation science, to study how best to implement those practices in the clinical settings to truly improve people’s lives.

Reference

Mao JJ, Pillai GG, Andrade CJ, et al. Integrative oncology: Addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin. 2022;72(2):144-164. doi:10.3322/caac.21706