Overall, the goal is to help people understand what is helpful or not helpful, and to empower people to do things for themselves before, during, or after cancer treatment.
If you’re here, you may be looking for ways to support your wellness — both body and mind — during cancer treatment or after it has ended. You may also have questions about holistic approaches and complementary therapies, such as their effectiveness and how (or if) to include them along with your cancer care program or survivorship care plan.
If you’re thinking about trying evidence-based approaches to enhance your cancer care or quality of life in survivorship, keep reading. Santosh Rao, M.D., medical director of Integrative Oncology for University Hospitals Connor Whole Health.
Dr. Rao: Integrative oncology brings together complementary approaches and lifestyle strategies to help people affected by cancer with prevention and managing symptoms, using available scientific evidence. Utilizing a holistic approach that often minimizes side effects, integrative oncology incorporates many culturally developed medical practices like acupuncture in a coordinated way that complements and is used alongside conventional care.
Overall, the goal is to help people understand what is helpful or not helpful, and to empower people to do things for themselves before, during, or after cancer treatment.
How can integrative oncology empower patients? Dr. Rao explains in this video produced by the National Coalition for Survivorship in partnership with the Society for Integrative Oncology.
Dr. Rao: Complementary approaches often involve stress management (e.g. mindfulness), lifestyle strategies (e.g. dietitian guidance, yoga), and then integrative modalities. These integrative modalities may include acupuncture, massage, expressive arts, yoga, mind-body therapy, and others. Evidence is building for how we can utilize these approaches to help with symptoms.*
Dr. Rao: We take time to understand what symptoms someone is dealing with, how they are feeling emotionally and spiritually, and what may be modified in terms of lifestyle and their living situation or environment. I think all healthcare providers focus on the “whole person,” but integrative oncology tends to put things together in ways we can support the whole-person approach.
Helpful Terms At a Glance
Complementary approaches refer to nonconventional approaches that are used along with conventional medical care. They can include nutritional, psychological, or physical approaches, or any combination of these.1
Alternative approaches refer to nonconventional approaches that are used instead of conventional medical care.1 Integrative oncology is not alternative medicine.2
Holistic healthcare involves caring for the whole person — mental, physical, spiritual, and social aspects — and plays a key role in integrative healthcare.3,4
Integrative healthcare brings conventional and complementary approaches together to treat the whole person. It can involve coordinated care among multiple providers and institutions.1
Dr. Rao: Some examples may be acupuncture, mindfulness, and massage for pain, or mindfulness, expressive arts, and massage for anxiety and depression. These integrative approaches are already considered standard approaches to try for many cancer-related symptoms or treatment side effects. Therefore, providers and patients should be knowledgeable about them.
For fatigue, stress management techniques like mindfulness are a strongly recommended approach (among others).
A common integrative oncology consultation is for patients who have side effects from hormonal therapy (for breast cancer or prostate cancer, as examples) such as joint aches and hot flashes. Acupuncture can be very helpful and worth trying, in addition to other approaches like yoga.
Personalizing an approach based on a patient’s range of symptoms, preferences, and what is available to them is important as we partner with them on how to best manage their symptoms.
Dr. Rao: The overall research is building, but there is strong research that is well agreed upon of the importance of physical activity and stress management. We know that for most types of cancer, regular physical activity reduces fatigue, improves outcomes, and reduces the chance for a recurrence of cancer. For other complementary approaches, the evidence is building.
Although there are some studies that look at an overall “integrative” approach, more studies examining the impact of integrative oncology on outpatient and hospitalized cancer patients are still needed to demonstrate that integrative oncology has a strong impact on cancer outcomes.
Dr. Rao: The SIO-ASCO and NCCN guidelines help us determine which complementary therapies have the highest level of evidence for various symptoms or needs. In that sense, we can start to understand which therapies are more effective. But part of it is also based on patient preference and what works for them. It is patient specific.
For some people, acupuncture may be better for managing their pain; for others, massage may be better. Studies suggest both are good options. Part of determining an integrative oncology plan is to give options and discuss with patients where they may start, and then re-evaluate based on the effects before considering other options or staying the course.
Dr. Rao: Most integrative approaches are safe, but specifically, guidelines are followed regarding interventions like acupuncture and massage to avoid areas of infection and other concerns. People may need some instruction with yoga, especially if they have physical limitations after treatments or at baseline.
The approach we advocate for is to complement conventional cancer care, coordinating care and making sure we adhere to scientific evidence as best as we can. It has been shown that pursuing alternative treatment — eschewing conventional cancer care in the process — has led to worse outcomes in cancer patients. It’s important to understand the whole approach to care — a team-based comprehensive approach that gives patients helpful options but avoids mixed messages and confusion.
Finally, we take a very measured approach to using natural products, looking at drug-herb interactions and a risk/benefit approach, because many of these products are not well studied compared to prescribed medications.
Dr. Rao: Self-care is so important, whether we are engaged in an “integrative” program or not. Part of the integrative approach is to help people with self-care, including lifestyle and stress management. It is accounting for the fact that what someone eats, how they move, and how they manage stress and their daily routine (including sleep) has an impact on cancer and quality of life measures.
We try to work with people to personalize their approach while also encouraging them to consider how to help themselves through whatever they are facing, using our own support as needed.
Dr. Rao: It really starts with where you are and what’s available. You can discuss it with your healthcare provider and see what is available and what they know about in your region. If you are in a part of the country where there is an integrative program, that makes it easy. You can visit them and decide if that works.
Otherwise, there are people who can help you with various aspects of an integrative approach, such as psychologists, dietitians, and acupuncturists. That may not always be intertwined in a program, but you can make your own team. There are also a growing number of online resources that can help with education on lifestyle and stress management.
Dr. Rao: It really is variable, depending on the insurance carrier and the state you live in. That is partly why integrative programs can look different in various parts of the country.
Acupuncture is variably covered for cancer-related care, but not uniformly. Massage is not as often covered. Depending on the program you engage with, or the cancer center you visit, dietitians, physical therapists, and psychologists are usually covered as visits.
Many integrative therapies can be offered for free in some programs, for example yoga and music therapy. But it all depends on how a program is set up and their financial support.
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