Integrative Cancer Care: How Far We’ve Come!

November 9, 2018

SIO’s clinical practice guidelines are now available as a resource to ASCO’s members “to assist providers in clinical decision making.” Now these guidelines have earned a place on ASCO’s guidelines for Supportive Care and Treatment Related Issues.

We urge you to review ASCO’s discussion points regarding the integrative therapies listed in the SIO guidelines. Some very important considerations and cautions are highlighted. Find these discussion points at Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline.

It was a very significant event when the American Society for Clinical Oncology (ASCO) endorsed the Society for Integrative Oncology (SIO) clinical practice guidelines for breast cancer. ASCO is the leading organization of its kind. SIO is the leading organization of its kind. Historically, these two organizations, both committed to quality oncology care, did not share the same view or value of weaving the best conventional cancer care with the best complementary approaches. Now, many factors including the growing evidence base for complementary therapies and patient interest and demand, seem to be bringing ASCO and SIO closer to working on a common goal of providing person-centered care in a more integrative way. Is this endorsement of the SIO guidelines a game-changer? We have reason to hope so.

The June 2018 Journal of Clinical Oncology headline reads: “Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline.” Leading conventional and integrative oncology clinicians and researchers, such as Gary Lyman, MD; Gary Deng, MD; Heather Greenlee, ND, PhD; Lorenzo Cohen, PhD, summarize: “The ASCO Expert Panel determined that the recommendations in the SIO guideline—published in 2017—are clear, thorough, and based on the most relevant scientific evidence [italics added]. ASCO endorsed the guideline with a few added discussion points.”

This is a big deal for several reasons:

It’s vital that seminal professional associations for clinical oncologists, such as ASCO, recognize and acknowledge the value and credibility of evidence-based integrative cancer therapies.

First, if the field of truly integrative oncology care is to advance, it’s vital that seminal professional associations for clinical oncologists, such as ASCO, recognize and acknowledge the value and credibility of evidence-based integrative cancer therapies. ASCO’s endorsement of the SIO guidelines do just that. This should encourage patients and integrative care clinicians to open dialogue with conventional oncologists about integrating complementary approaches.

Second, it is a remarkable accomplishment for integrative oncology to demonstrate to ASCO’s satisfaction that there is quality evidence to support integrating certain complementary therapies into conventional care. This shows that the field of integrative oncology is reaching a stage in its evolution where it has a compelling evidence base for some complementary therapies.

Third, respected integrative oncology clinicians and researchers, like Wayne Jonas, MD, and Donald Abrams, MD, are able to articulate the usefulness of evidence-informed complementary therapies. These are therapies that may realistically never be tested in rigorous randomized controlled clinical trials, either because pharmaceutical companies have no financial incentive to test them or because their complexity does not allow for a controlled study design. But they should not be overlooked--they may bring great benefits to many with cancer.

The field of integrative oncology is reaching a stage in its evolution where it has a compelling evidence base for some complementary therapies.

ASCO’s endorsement shows how far integrative oncology has come. To think, for example, the first legal acupuncture center in the US was established in 1972. It took 25 years of clinical trials evidence to prompt the NIH to formally acknowledge that acupuncture is valuable in relieving symptoms such as pain and nausea after surgery or chemotherapy. NIH also recommended teaching acupuncture in medical schools.1 Now, acupuncture in cancer care has become one of the most robustly studied complementary therapies.

We must continue to realistically consider the limitations of evidence and look for the promising and the overlooked complementary therapies and approaches that may reduce suffering, improve quality of life, and potentially extend life for people with cancer.

In 1984, when I was studying to be an advanced practice oncology nurse, we were just beginning to look at the role of stress in cancer. Pioneers advocating meditation, progressive muscle relaxation and imagery were being booed from the scientific podium. Yet it is clear today that stress and anxiety influence cancer development, growth and spread, as well as quality of life. It is also clear from the 2017 SIO guidelines that mindfulness-based stress reduction and relaxation techniques get a Grade A rating for reducing anxiety, mood disturbance, stress and depression in women with breast cancer. What a long leap that has been!

So, while we are grateful for this significant evidence of progress for integrative oncology, we at BCCT are leaving our sleeves rolled up—for we must continue to realistically consider the limitations of evidence and look for the promising and the overlooked complementary therapies and approaches that may reduce suffering, improve quality of life, and potentially extend life for people with cancer.

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