What is Integrative Oncology and How Can it Help Your Cancer Journey?

A cancer diagnosis can reveal a new spectrum of emotions– overwhelm, hopelessness, fear, heartbreak, and isolation. It can also lend itself to many new tasks: navigate insurance, check benefits, find in-network doctors, coordinate child care during treatment, file FMLA paperwork, and find a ride to radiation treatments, to name a few. In the midst of this, patients find themselves asking:  

"What else can I do for my cancer?"

"What should I eat?"

"Can I exercise?"

"How can I manage these side effects better?"

Fortunately, the paradigm in cancer treatment is shifting for the better. There is a demand from patients for more comprehensive care, better symptom management, and a focus on the quality of life. There is a rising specialty that can help fill the gap in cancer care: Integrative Oncology. Let's take a closer look at this specialty and how it can complement cancer treatment.

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What is Integrative Oncology?

The definition of Integrative Oncology is ever-expanding. However, simply put: integrative oncology is the marriage of conventional oncology treatments (chemotherapy, immunotherapy, surgery, radiation) with evidenced-based integrative medicine (lifestyle, diet, botanical medicine, IV therapy). Integrative oncology aims to increase the quality of life, decrease the treatment side effects, and support the patient after treatment is over to get their health back on track.

The three main groups of patients that benefit from integrative oncology are:

• high-risk patients in order to decrease their risk of developing cancer
• those in active treatment to help improve quality of life and reduce side effects
• cancer survivors to help decrease the risk of relapse as well as restore health

Those trained in integrative oncology have knowledge of both conventional and non-conventional cancer treatments. Most importantly, they have knowledge of how to safely implement non-conventional treatments alongside chemotherapy, immunotherapy, surgery, and radiation.

A benefit of incorporating integrative oncology into your cancer team is the time that the provider can spend with you. An average medical oncology visit is 23 minutes. However, an integrative oncology visit can be anywhere from 45 to 60 minutes. This allows the patient to ask questions about the risks, benefits, and potential alternatives to their treatment plan. It also allows for a longer conversation about the patient's quality of life– how is their energy? Is their employer understanding of their diagnosis and the time they may have to take off? Are they sleeping okay? How is their anxiety? All of these conversations can significantly impact a patient’s overall outcome.

How Can Integrative Oncology Help Someone Who Was Recently Diagnosed?

There are many evidence based resources showing that Integrative oncology can benefit patients in numerous ways, including:  

• Improve post-operative surgical recovery
• Addressing and managing pre-existing comorbidities (diabetes, anxiety, autoimmune conditions, etc)  
• Manage chemotherapy-related side effects with safe, botanical medicines
• Improve sleep and treat insomnia
• Monitor and encourage adequate nutrition
• Reduction of cancer-related fatigue
• Supplement recommendations and education to avoid drug-herb interactions
• Incorporate acupuncture and other traditional medicines (Ayurveda, etc.)
• Decrease toxicity of anti-cancer therapies to the liver and kidneys
• Address the spiritual and emotional needs of a patient
• Recommendations and referrals to treat the existential distress that accompanies a diagnosis

What Are Some Of The Most Common Integrative Oncology Treatments?

The spectrum of integrative oncology treatments is vast and can range from IV therapy to yoga therapy. Most integrative oncology treatments aim to improve the quality of life of the cancer patient. However, some integrative oncology treatments have the potential to be targeted anti-cancer therapies.

Phytomedicines (or botanical medicine)

"Phyto" means "of a plant or relating to plants." Therefore phytomedicines is another way to say plant-derived medicine or botanical medicine. Many phytomedicines have anti-cancer properties. Some of the most commonly used phytomedicines are:

• Epigallocatechin Gallate (EGCG) - this plant compound is found in green tea and is known to have anti-proliferative effects.
• Resveratrol - a polyphenol found in wine can. Resveratrol has been shown to counteract metastasis and suppress cancer cell survival.
• Curcumin - the medicinal part of the turmeric root, is known to reduce the side effects of both chemotherapy and radiotherapy.
• Quercetin - this antioxidant primarily found in onions can be particularly helpful in a type of brain cancer known as glioblastoma multiforme (GBM).

IV Therapy

Many botanical medicines, as well as vitamins and minerals, can be administered intravenously. These IV infusions, alongside chemotherapy, can significantly improve quality of life and decrease side effects. For example, high-dose IV ascorbic acid (also known as vitamin C) can reduce chemotherapy-associated toxicity in patients with ovarian cancer and improve the quality of life in terminal cancer patients. IV therapy recommendations are personalized and almost always require lab work to be run in order to make sure that the liver and kidneys are properly functioning.

Acupuncture

In the last 20 years, the research on acupuncture has skyrocketed. Acupuncture is a form of Traditional Chinese Medicine (TCM) that involves the use of very thin needles on specific points in the body. Acupuncture has been shown to be helpful for chronic pain, migraines, reproductive issues, and stress management. However, in the world of oncology, it can be used for:

• Cancer-related insomnia
• Perioperative pain and anxiety
• Chemotherapy-induced peripheral neuropathy (CIPN)
• Aromatase inhibitor-related joint pain
• Reduction of treatment-related nausea

Diet

“What should I eat?" is a question that is top of mind for many cancer patients. Unfortunately, there is a lot of information online about diet and cancer, and much of it is not evidence-based. During an integrative oncology visit, a practitioner can review your current diet and make individualized recommendations on improving your diet from a nutritional standpoint. It's important to remember that loss of appetite, nausea, and vomiting are common chemotherapy-related side effects. If not well managed, these side effects can make a patient nutritionally depleted and dehydrated. If you are undergoing active treatment, the dietary suggestions recommended will be very different for a patient who has finished treatment and is in active surveillance.

Lifestyle

Movement, meditation, and mindfulness have all been shown to improve the quality of life in cancer patients. Exercise is helpful both preventatively and during active treatment. Research now highlights the positive effect of exercise on the immune system, such as elevation in T-cell proliferative capacity, increased neutrophil function, and natural killer (NK) cell cytotoxic activity.

Exercises like resistance training and or aerobic activities have been found to be helpful in reducing the fatigue associated with cancer.

How to Find an Integrative Oncology Clinic?

If you or someone you know are interested in integrative oncology services, the best place to start is by asking your care team if your hospital has integrative oncology providers. Many major cancer centers have departments dedicated to integrative oncology and integrative oncology research. There are also over 100 board-certified naturopathic oncologists (FABNO) in North America who have specialized training in working with cancer patients.

• Integrative Oncology Centers

Summary

The field of integrative oncology is meant to work in consort with medical oncologists, radiation oncologists, and surgical oncologists. Integrative oncology aims not to replace any members of your primary care team, but instead to complement your team. Those with training in integrative oncology are there to support the patient and help them navigate their cancer diagnosis, as it can be overwhelming. The spectrum of integrative oncology therapies is vast. However, the recommendations should be personalized to a patient's individual diagnosis in order to provide them with the best overall outcome.