Integrative Oncology: The Basics
Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: April 1, 2015
What is integrative oncology?
Integrative oncology, or integrative medicine, refers to the use of complementary, or integrative, therapies in collaboration with conventional medicine. These therapies work in concert with standard treatment methods (surgery, chemotherapy, radiation) to treat the patient's body, mind and spirit. Integrative therapies contribute to the overall goals of treatment, symptom management, distress relief, and may improve overall treatment efficacy and adherence.
Defining the Terms
Conventional cancer therapies: cancer treatments that are widely practiced and have been proven beneficial in clinical research trials. These are often called standard care and may include surgery, chemotherapy, radiation therapy, and/or hormonal therapy.
Complementary and alternative medicines and practices (CAM): not considered standard treatments, though many can be beneficial to cancer patients. Often, these therapies are not routinely taught in medical schools and your physician or nurse may not be familiar with them.
- CAM therapies fall into two categories: complementary and alternative.
- Complementary medicines: cancer therapies used in conjunction with conventional medical treatments. For example, acupuncture and guided imagery may be used to manage nausea caused by chemotherapy.
- Alternative medicine: therapies that are used instead of conventional medical therapies. For example, receiving vitamin infusions to treat cancer, instead of a standard therapy prescribed by an oncologist.
Integrative Oncology: is an approach to cancer care that incorporates promising complementary therapies to support the whole patient: mind, body and spirit. Many cancer centers have integrative medicine programs that offer complementary therapies on-site.
What modalities are considered integrative therapies?
- Mind-body methods - mindfulness, biofeedback, cognitive-behavioral therapy, mediation, relaxation, guided imagery, hypnosis, yoga, music therapy, creative/expressive therapies and spirituality.
- Biologically based practices - vitamins, herbs, foods, special diets.
- Body based practices - massage, chiropractic interventions, reflexology.
- Energy medicine - Reiki, Tai chi, Jin Shin Jyutsu, therapeutic touch.
- Other medical delivery systems - Chinese medicine including acupuncture, homeopathy, naturopathy.
Many integrative therapies are helpful in relieving side effects and supporting a patient's overall wellbeing. Unfortunately, for many of these therapies, we are not certain what risks, if any, they pose, and for others the risks are well known. Integrative therapies that are taken by mouth or given through an IV may interfere with standard cancer treatments (either negating or intensifying its action) or cause certain blood test results to be inaccurate, so it is important to discuss those with your providers. In addition, the treatments may have side effects of their own. For example, they may worsen other medical conditions a patient has, such as high blood pressure.
Vitamins, herbal therapies and supplements do not require FDA approval and they are not subject to the same manufacturing and purity standards as regulated pharmaceuticals. This has led to production batches containing impurities, or not containing what the label states they contain. One way to safeguard against this is to buy from reputable manufacturers or those that are verified by USP (United States Pharmacopeial Convention). USP is a non-profit organization that tests vitamins and supplements for purity and assures that the products contain what the label says they contain. Verified vitamins and supplements will have a "USP verified" seal on the packaging.
There can also be safety concerns for some mind-body and body-based practices, depending on your situation. For example, deep tissue massage is typically not recommended for areas affected by lymphedema and acupuncture could increase infection risk in patients with a low white blood cell count. This underscores the importance of discussing ALL integrative oncology therapies with your providers.
Talking to your health care team about integrative oncology therapies
The key to integrating these therapies into your cancer care is to talk about it with your healthcare team. Although many integrative therapies can be helpful, others have been proven ineffective or can interact with your standard cancer treatments or other medications. In recent years, oncology providers have become more aware of promising integrative therapies and are usually willing to support their patients in using these therapies safely. Your team can help guide you towards therapies that may be beneficial to your care needs based on your symptoms, coping and stress reduction needs. Your healthcare team can refer you to integrative practitioners at your treatment center, or in your area. It is important that all of your care providers know what therapies you are using and work together to provide you with optimal treatment. This includes your integrative medicine providers. An oncology social worker or navigator can also help you with coordinating care and facilitating communication amongst providers.
Are integrative treatments covered by my insurance?
These therapies are not typically covered by insurance, but some plans do cover therapeutic massage, acupuncture, some psychological treatment methods, and nutrition counseling. Contact your insurance company to inquire about these benefits. Many cancer centers include integrative medicine as part of their overall oncology service offerings, often at no additional charge. The local affiliate of the Cancer Support Community may also offer free integrative oncology services. The American Cancer Society maintains a database of supportive care services, including integrative oncology services. In addition, your social worker may be able to recommend a local resource for integrative therapies.
Resources & Further Reading
Talking About Complementary and Alternative Medicine With Health Care Providers: A workbook and tips from the OCCAM at the NCI.
USP (United States Pharmacopeial Convention)
Greenlee. H, et al. Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer as Supportive Care in Patients Treated for Breast Cancer. Journal of the National Cancer Institute Monographs, No. 50, 2014.