Should hem/oncs recommend integrative therapies to their patients?
The term used to be complementary and alternative medicine, but now the NIH uses the term “integrative” medicine, because these approaches are meant to combine the best of traditional cancer therapy and other approaches — without having one be an alternative to the other. There is a recent study showing that some patients who use nonmedical therapy as an alternative to standard medical care indeed have shorter survival.
Integrative medicine often is used to address pain and stress, which are common among patients with cancer. Studies have shown that integrative treatments like hypnosis, acupuncture, yoga and other mindfulness strategies are highly effective for symptom control, are far less toxic, have far fewer side effects, and are a lot safer than opioids for chronic pain. They can improve mood without risk for addiction. Despite this, we are in the middle of an opioid epidemic. By recommending integrative therapies for patients with pain and stress, we can improve coping while reducing the number of patients on chronic opioids.
By extending life, making cancer more a chronic than a terminal illness, we have created an even larger population of people with pain, fear of recurrence and other cancer-related stressors. More people than ever are in need of treatments that address the side effects of cancer treatments and enhance coping. Integrative treatments often help and seldom hurt.
Johnson SB, et al. JAMA Oncol. 2018;doi:10.1001/jamaoncol.2018.2487.
David Spiegel, MD, is medical director at Stanford Center for Integrative Medicine. He can be reached at 211 Quarry Road, Stanford, CA 94304; email: email@example.com. Disclosure: Spiegel reports no relevant financial disclosures.
We should focus our attention on patients’ fears and nutrition.
Everybody has their own mental model of what complementary/alternative medicine means. Many view this as a derogatory term because it implies that whatever tools are being used are just that — add-ons or suspicious to the “good” medicine. I avoid it.
The brand of integrative medicine I practice is called “functional medicine” — another confusing term — but it essentially looks at the seven or so systems the body uses to function optimally: energy production, digestion, immunity and repair, to name a few. This includes looking at the internal, spiritual self and what’s going on there.
Whether I am seeing children or adults with cancer, I spend the vast majority of time going over the timeline of what is going on, addressing their fears, and walking them through options for treatment. For adults, they are autonomous and capable of calling the shots, even if they refuse conventional treatment. But, in the end, I help them understand why it is important to go with the oncologist recommendations as the best treatment we know; why it is important to avoid many supplements, herbals and other such therapies, largely because of the unknown interactions; and then talking about how to maximize body function while going through the trials of chemotherapy and radiation. We discuss nutrition and maintaining a healthy gut — the No. 1 place where serious infections come from. The intention is to partner with the oncologist to make the journey as tolerable as possible and to help pick up the pieces afterward.
John E. Neely, MD, is pediatric hematologist-oncologist at Penn State Health Milton S. Hershey Medical Center. He can be reached at 500 University Drive, Hershey, PA 17033. Disclosure: Neely reports no relevant financial disclosures.