Team-Based Approach Improves Integrative Care in Kidney Cancer

Santosh Rao, MD

University Hospitals Connor Whole Health and Society for Integrative Oncology

A team-based approach involving good communication among multidisciplinary team members can help reduce stress and improve a patient’s diet and lifestyle when it comes to integrative care for those with kidney cancer, according to Santosh Rao, MD.

In tandem with Kidney Cancer Awareness Month, recognized in March, Rao spoke with CancerNetwork^® about broad developments in integrative and palliative care for kidney cancer. He discussed current research efforts aiming to elucidate the effect of certain factors on immunotherapy outcomes in patients with kidney cancer including the gut microbiome and the administration of antibiotics and probiotics.

“My sense is that if you have a team approach, you involve the right people at the right time, there’s good communication, and it’s patient-centered, you could potentially help somebody when they need it the most,” Rao said. “And I feel like that’s the direction we want to head [for integrative oncology].”

Rao, medical director of integrative oncology for University Hospitals Connor Whole Health and president-elect for the Society for Integrative Oncology, also described potential future initiatives including further research of inflammation and epigenetics that may help patients derive more benefit from integrative treatments.

CancerNetwork^®: Has there been any recent clinical research on integrative care in patients with kidney cancer that you have found intriguing?

Rao: There’s a lot going on right now when it comes to research. There are now guidelines around physical activity, which is important for us to know about obesity and diet. I find that some of the other areas of research are potentially impactful with renal cell carcinoma [RCC]. … One of the backbones of treatment for kidney cancer is immunotherapy. And while immunotherapy is new, we’re starting to learn more and more about the impacts of lifestyle and other factors that may modify somebody’s outcomes or response to immunotherapy.

I’ve seen certain studies where if you’re on antibiotics, for example, it can affect your response to immunotherapy. If you’re on probiotics, believe it or not, there were some studies suggesting that it might negatively impact your response to immunotherapy because you don’t have as much diversity. And while [the data are] early, these things are interesting and important.

As a physician, many times what we’re looking for is if we can maximize somebody’s benefit from a therapy. It’s not good enough to just say, “Hey, we’re going to give you this treatment, and you’re going to do well.” What we know is that there are some people who do really well, and some people who don’t get as much benefit. Sometimes, that’s a tumor-specific thing. But as we learn more, we want to get a better sense if there were things that we could have done differently that would have improved somebody’s outcome.

Where must future efforts be focused to improve integrative and palliative care for this patient population?

First of all, we need to keep doing studies in different types of cancers. While a lot of studies tend to focus on certain types of cancers, we need to broaden it out and have more studies that involve our patients with renal cell carcinoma, bladder cancer, and ovarian cancer. That helps because you don’t want to get the sense that it’s the same for everyone. The more you can engage in studies in different populations or different cancer types, that’s helpful.

The key thing is to have high quality research. If we find that there are things that are beneficial, we need to keep working, in my opinion, on mechanism. There’s this great feeling that a lot of the integrative modalities are partly beneficial just from the placebo effect and getting the sense that we’re just making somebody feel better, which is important in and of itself. But it would be helpful as we learn more to get a better understanding of what’s really happening from a mechanisms standpoint.

Many times, we know that some of the mechanisms are through certain pathways like reducing inflammation and improvements in epigenetics and the microbiome. But getting a better understanding of the interplay between these different systems will give us a better sense of how modifiable [the] different aspects of response to therapy and toxicity [are]. We’re learning more all the time, so I think the science is actually really interesting to me.

What do you hope your colleagues take away from this conversation?

I would hope that my colleagues think about integrative oncology and specifically [how] we can use it in different scenarios. What I tell my colleagues is if you have somebody who has pain, neuropathy, and fatigue, look up the NCCN guidelines and think about if you have certain [options] available in your own institution and your clinical practice. Acupuncture and yoga are very well represented in the NCCN guidelines, as well as some of the guidelines that I’ve already spoken about. [We should] think about that because if it’s available and [they are] low risk, you might really help your patients.

[We should also] think of opportunities to reduce stress and improve our patients’] diet and exercise. That may look different in different places, but developing a team approach has been really helpful. [Think of] ways to involve the right people at the right time in multidisciplinary care.

How does integrative oncology fit in with other parts of multidisciplinary care for kidney cancer?

We have to think creatively. When I think of multidisciplinary care, it’s obviously [disciplines such as] surgical, radiation, and medical oncology which includes chemotherapy and immunotherapy. And you look for the issues that can come up throughout that whole journey. I don’t think of it as just integrative oncology. Integrative oncology is a broad term that involves a lot of different things.

But it has a certain place which can be alongside palliative care, psycho-oncology, and physical therapy. All these different things that we employ such as social work affect all patients with cancer in some ways or another at different times. Kidney cancer is no different. If you [have] depression, for example, what are the resources that can really help someone? That’s really the way I think about it.

The other thing we didn’t talk about is that many people have a lot of questions. One of the things that I do is integrative oncology consults. We will look at someone’s lifestyle and how they manage their stress, and we’ll also talk about questions that they have and what supplements and natural products they’re using.

That, as we’ve seen, is a huge business. Many people have all sorts of important questions, but if you don’t have any guidance, people are just going online and reading stuff. And we know that they don’t always bring it up with their physician. Also, many people don’t understand what to tell patients [about] what [products are] safe, not safe, et cetera. That’s important too. Whether you’re treating kidney cancer or another cancer, it comes up. Getting good guidance, communicating and collaborating, and doing it in an evidence-based way is also important.

Reference

Mao JJ, Ismaila N, Bao T, et al. Integrative medicine for pain management in oncology: Society for Integrative Oncology-ASCO guideline. J Clin Oncol. 2022;40(34):3998-4024. doi:10.1200/JCO.22.01357