Integrative Oncology
"Integrative oncology is the evidence-informed combination of conventional therapy with complementary interventions into an individualized therapeutic regimen that addresses the whole person living with or beyond cancer." - Dr. Ayer
Dr. Ayer, has been a practicing oncologist for over 20 years, specializing in cancer diagnosis, treatment, and prevention. Since studying integrative medicine with the Andrew Weil School of Integrative medicine, she has turned her focus to integrative oncology. Integrative oncology is a comprehensive approach to cancer care that combines conventional treatments with complementary therapies and lifestyle modifications to optimize health, quality of life, and clinical outcomes. It aims to address the whole person, including their physical, emotional, and spiritual well-being. While no longer accepting patients as a primary oncologist, she collaborates with other oncologist to provide integrative care including nutrition, exercise, stress management, and mind-body practices .
Living With Cancer and through Cancer Treatment
Recent advances in cancer care have resulted in an increasing emphasis on targeted treatments, such as small molecule kinase inhibitors, vascular endothelial growth factor inhibitors, and immunotherapy. These newer treatments, which often are combined with each other or chemotherapy, show promise in improving cancer outcomes. However, common issues that patients and families experience include chronic fatigue from cancer and therapies, sleep disturbances, as well as a fear of recurrence of their cancer. Furthermore, some treatments can last for years, presenting challenges for how we deal with persistent side effects requiring ongoing support. Despite scientific advances in conventional cancer treatment, approach to supportive care remains hit or miss. Many cancer patients have turned to complementary and integrative medicine approaches to address these supportive care needs
Collaborative Approach
Few oncologists or primary care providers are adequately trained to address patients' needs and interests in complementary and integrative options, leaving patients to make uninformed or unguided decisions. Given the complexity of modern cancer treatment, it is important that the entire treatment plan is integrated and coordinated to avoid harmful interactions or other potentially negative side effects, and that the safest and most effective integrative approaches are recommended to best serve the patient's needs. All providers, oncologists, and primary care providers need to be knowledgeable about the range and scope of integrative oncology so they may provide their patients with a full spectrum of options and outstanding care for the whole person.
Challenges of Utilizing Integrative Oncology during Cancer Care
Challenges include accounting for potential adverse consequences, such as drug-herb interactions. Evidence-based therapy should be the goal. However, patients often inquire about therapies that have not yet been fully evaluated for their potential efficacy or their possible interaction with conventional chemotherapy or radiation. As new targeted and immunotherapies are being released at an ever-increasing rate, the potential interactions of many interventions are not yet known. Studies to define safety and efficacy may never be done because of financial constraints and the complexity of studying potential interactions. Rather than not answering patient queries due to a lack of hard data, we attempt to use best available evidence to make informed recommendations. This involves taking a risk-stratification approach in which the best available evidence is combined with clinical experience and judgment.
Antioxidant Debate
Patient often would like to take antioxidants while receiving treatment for cancer. While antioxidants from food are generally considered safe, those in supplement form, like vitamins A, C, E, or carotenoids, may counteract some cancer treatments.
Radiation therapy works through the generation of free radicals causing deliberate DNA damage in cancer cells. This mechanism of action presents a clinical dilemma for patients taking antioxidant supplements, because they may inhibit the effectiveness of the radiation therapy. Additionally, some radiation oncologists may discourage diets high in antioxidants.
Some chemotherapies (e.g., platinum agents, alkylating agents, and antitumor antibiotics) work by generating free radicals, raising a similar concern. For this reason, medical oncologists may fear that if the patient uses antioxidant supplements during radiation or chemotherapy, they may be inadvertently protecting the tumor against maximal benefit from therapies.
For patients in whom the goal of treatment is a cure, or who are receiving adjuvant therapy, the use of supplemental antioxidants should probably be postponed until active therapy has been completed. For patients recieving palliative care, risks and benefits should be weighed individually.
Effects of Supplements on Metabolism of Chemotherapy Agents
Another major concern is the potential for complementary therapy to alter the concentration of the therapies they prescribe by interaction with cytochrome P450 (CYP450) enzyme. St. John's wort, for example, used as a botanical therapy for depression, induces CYP450 leading to more rapid metabolism of pharmaceuticals that are handled by the same enzymes. Numerous pharmacokinetic interaction studies of St. John's wort and cancer treatments, including conventional chemotherapy as well as small molecule kinase inhibitors, demonstrate reduced doses of the cancer therapies, possibly making them less effective and leading to more rapid resistance. On the other hand, grapefruit juice inhibits CYP450, potentially leading to a higher concentration of prescribed cancer therapies, which may increase their toxicity. It is impossible to conduct pharmacokinetic interaction studies on all the potential pharmaceutical-supplement combinations. Hence, much of the information presented on informative websites is actually more theoretical than based on human studies data.
Alternative Cancer Therapies
Integrative oncology emphasizes the uses of evidenced based complementary alternative therapy in addition to conventional cancer treatments. This is in contrast to alternative cancer treatments which replace conventional therapy despite possible lack of evidence of efficacy. Based on observational studies, patients who choose alternative cancer treatments rather then traditional therapies are 2.5 times more likely to die from cancer than those who availed themselves of recommended chemotherapy, radiotherapy, surgery, and/or hormone therapy. However, patients choosing alternative treatments may seek collaboration with integrative oncology practices requesting support for alternative therapies in which case it is the usually the goal of the integrative oncologist to support patient autonomy while making sure patients fully understand the risk and benefits associated with conventional treatments and the potential risk of choosing another path.
Management of Cancer Survivors
Patients in remission often are not sure how to return to their “normal” life. Despite being given promising and reassuring news, many patients do not feel well emotionally, mentally, or physically. They may have residual long-term side effects from treatment or as a primary result of the cancer. They may have a persistent fear of cancer recurrence that adversely impacts their quality of life. The introduction of complementary and integrative therapies can play a vital role here. Guidance on optimal diet and exercise can help the patient regain strength and energy. Thoughtful consideration of the pros and cons of various dietary supplements can address a variety of symptoms such as fatigue or disordered sleep. Mind-body therapies can address stress and increase a sense of self-efficacy.
Key Points About Integrative Oncology
Holistic approach: It considers the physical, emotional, and spiritual well-being of the patient, not just the cancer itself.
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Evidence-based: It incorporates therapies that have been studied and shown to be safe and potentially beneficial for cancer patients.
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Collaboration with conventional care: Integrative oncology practitioners work closely with oncologists to ensure treatments are coordinated and do not interfere with standard cancer therapies.
Common Integrative Therapies Used in Oncology
Nutrition counseling: Tailored dietary plans to address specific needs during cancer treatment
Physical activity: Exercise programs designed to manage fatigue and improve overall fitness
Stress management techniques: Mindfulness meditation, yoga, deep breathing exercises
Acupuncture: Needle therapy to manage pain and side effects
Massage therapy: To alleviate muscle tension and promote relaxation
Art therapy: Creative expression to manage emotional distress
Benefits of Integrative Oncology
Improved quality of life by managing symptoms like fatigue, pain, anxiety, and nausea
Enhanced coping mechanisms for dealing with cancer diagnosis and treatment
Potential to improve treatment adherence and overall well-being
Important Considerations
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Patient-centered care: Integrative oncology prioritizes individual needs and preferences
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Communication with healthcare team: Open discussion with oncologists about incorporating integrative therapies is crucial
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Research-based practices: Choosing therapies with evidence supporting their efficacy and safety