Integrative oncology – key principles and future directions in the UK

BSIO defines integrative oncology (IO) as a patient-centred, evidence-informed field of cancer care that utilises psychological, nutritional, lifestyle and complementary interventions alongside conventional cancer treatments to support better quality of life, improve resilience, minimise the side effects of treatment and improve outcomes. As my Co-Chair, Dr Penny Kechagioglou, has highlighted in her blog, IO seeks to support a sense of agency and empowerment and fosters resilience for patients with a cancer diagnosis and their loved ones.

With the right education and support, IO can also empower healthcare practitioners with an expanded toolkit to:

• tackle cancer prevention

• support prehabilitation for better treatment tolerance and recovery

• effectively manage side effects of treatment (including those poorly managed with current pharmaceutical options) and potentially synergise with treatment for improving clinical outcomes

• support faster recovery following active treatment and offer multimodal management of recurrence risk and associated anxiety, as well as tackling long-term effects of treatment in survivors

• offer options for compassionate supportive care of patients with metastatic disease – both in living well with cancer and at the end of life

The practice of IO in the UK has sadly lagged behind a number of other countries, including the US. As the leading professional organisation for integrative oncology in the UK, it is BSIO’s mission to change this through our core work streams of supporting evidence-informed clinical practice, providing high quality up-to-date education to our multidisciplinary audience and supporting best practice in IO research.

Misconceptions about integrative oncology (IO)

As an integrative medicine doctor who supports patients with a cancer diagnosis, I hear many misconceptions about IO from patients, carers and healthcare professionals, and I would like to offer some guiding principles to clarify this approach.

Integrative oncology is or should be:

• a personalised and rational integration of the best in conventional, psychological, lifestyle and complementary medicine

• whole-person oriented and addresses physical, emotional, mental and spiritual needs

• supportive of targeted, personalised medication use where necessary without over-medicalising and aims to ameliorate medication side effects whenever possible

• about caring for people, not mindless protocols

• evidence-based healthcare - combining the best available research evidence, clinical expertise and patient values

Integrative oncology is not:

• disregarding the benefits of conventional oncological treatment or ignoring the science or medical advances

• green pharmacy – using long lists of supplements (often without any professional input) instead of medications with a lack of personalised assessment, unifying strategy and evidence-informed consideration of risk and benefit

• disregarding safety and not checking drug-supplement-herb interactions

• doing random therapies on the ‘off chance’ that it might help

We know that 40-90% of patients are using complementary therapies, and the recent US research in breast cancer presented at ASCO 2021 has highlighted a significant gap of 30% between oncologist awareness of complementary medicine use in their patients and actual patient engagement. In this gap lies hidden risk and often internal conflict for the patient but this is also an opportunity to change our practice. The standard approach of saying ‘no’ to everything outside conventional treatment does not mean compliance, as we often see with other interventions in medicine. Safe integrative oncology relies on mutual openness, honesty and respect. It allows us to ensure that the patient’s treatment is well supported by appropriately qualified and experienced practitioners (not Dr Google) and encourages regular inter-professional communication and mutual learning.

IO in practice

If you are new to IO, it’s important to understand the key components of an IO consultation and the range of modalities and professionals involved.

The graphic below comes from a 2019 overview paper by Dr Shelly Latte-Naor and Dr Jun Mao and shows some key components of an integrative oncology consultation, as well as introducing a selection of modalities used in integrative oncology for symptom control.

Latte-Naor S, Mao JJ. Putting Integrative Oncology Into Practice: Concepts and Approaches. J Oncol Pract. 2019 Jan;15(1):7-14.

The IO field is, of course, much broader than the above, and incorporates a wide variety of therapeutic modalities alongside being able to offer more than symptom control. All therapeutic modalities and approaches have their own benefit-risk ratios and appropriate indications for use that need to be assessed with the patient on a personalised basis within a multiprofessional team that has the required knowledge and competency to deliver such care.

Future perspectives for IO in the UK

What does the future hold for IO in the UK? We hope that BSIO will drive change through:

• Developing and maintaining a network of professionals and organisations interested in the field of integrative oncology in the UK, including establishment of multidisciplinary working groups engaged in developing clinical practice, education and research

• Providing education to promote dialogue between professions, enhance understanding of integrative oncology, share best practice nationally and internationally and seek clarity about safety, effectiveness and cost-effectiveness of IO interventions

• Linking to reliable evidence-based resources that offer high quality information on integrative oncology and supporting further research projects in IO to build a more robust evidence base

• Maintaining international links, including a planned joint SIO-BSIO membership and close collaborative working with SIO on clinical guidelines and research

As demonstrated by the success of the Fellowship in Integrative Medicine at the University of Arizona and the establishment of the National Cancer Institute-funded Integrative Oncology (IO) Scholars training program in the US, there is a significant demand for high quality structured education on IO, which is an unmet need in the UK.

BSIO is looking forward to exploring options for structured postgraduate education in integrative oncology to truly establish working knowledge of this approach in both NHS and private healthcare professionals and foster respectful and effective inter-professional collaboration for the benefit of patients with a cancer diagnosis. Alongside CPD initiatives and the annual Integrative Oncology UK conference, this will form a linchpin for our education workstream, as well as supporting IO research and implementation in clinical practice across the UK to transform patient care.

Author

Dr Nina Fuller-Shavel, integrative medicine doctor, scientist and educator; Director of Synthesis Clinic; Fellow of the College of Medicine; Co-Chair of the British Society for Integrative Oncology