Pulse
The Best of Both Worlds
Integrative oncology blends conventional and complementary therapies with the goal of relieving symptoms for cancer patients.
Susan Sencer, M.D., was determined to learn as much as she could about complementary and alternative medicine after hearing some of the desperate ideas the parents of her young cancer patients were considering. “People were being approached by neighbors, friends, strangers, saying things like, I heard about someone who used an electric coil under the bed to cure cancer,” she recalls, “No one wants to leave any stone unturned.” As a pediatric oncologist, she was worried that patients might abandon conventional therapy—surgery, radiation, and chemotherapy—for alternatives that were not effective.
So in 1998, Sencer took a break from her practice at Children’s Hospitals and Clinics of Minnesota to do a Bush Foundation fellowship. Her idea was to study complementary therapies and look for ways those with scientific backing might fit in to her practice. Although she found nothing to be as effective as conventional therapies for treating cancer, she did find evidence that showed aromatherapy, acupuncture, acupressure, massage therapy, guided imagery, and music therapy help control the pain, nausea, anxiety, and other symptoms that accompany cancer and its treatments.
Using her newfound knowledge, Sencer started integrating those therapies into her practice the following year. Today, integrative medicine is offered throughout the Children’s Minneapolis and St. Paul campuses, and every patient has the opportunity to meet with a member of the integrative medicine team to discuss options for relieving symptoms. “Quality of life is really what integrative oncology is all about,” Sencer says.
Although Children’s was one of the first pediatric hospitals in the United States to offer integrative oncology, complementary therapies are finding a place in a number of Minnesota cancer programs. SMDC Medical Center in Duluth, St. John’s Hospital in Maplewood, Woodwinds Hospital in Woodbury, Mayo Clinic, Hennepin County Medical Center, and Abbott Northwestern Hospital in Minneapolis are among the hospitals that now offer complementary therapies alongside more traditional cancer treatments.
In addition, a number of Minnesota providers have joined the Society for Integrative Oncology, which was formed in 2003 to help practitioners exchange information about the latest research into complementary therapies. The society currently has approximately 350 members. A third of those are physicians; one is Sencer.
As Good as it Gets?
The fact that patients want more from cancer care than a diagnosis and treatment is driving interest in integrative oncology. “Patients are asking, What else can I do?” says Greg Plotnikoff, M.D., M.T.S., who sees patients at the Penny George Institute for Health and Healing at Abbott Northwestern Hospital and is a member of the Society for Integrative Oncology. Often, they’re using alternative therapies, whether or not their doctors know about it—and whether or not those modalities might interfere with conventional treatments. A study out of Kaiser Permanente published in Breast Cancer Research and Treatment last year found more than 86 percent of 1,000 women with breast cancer used some form of complementary medicine immediately after diagnosis. Of those, 47.5 percent were using botanical supplements, 64 percent mind-body healing techniques such as hypnosis or yoga, 29 percent special diets, and 27 percent energy medicine.
“Oncology has traditionally been focused on the three big things: surgery, chemotherapy, and radiation. We’ve been quite successful with these, but now people are saying we need to take this to another level and address quality of life and the physical, nutritional, and spiritual fitness that go along with it,” Plotnikoff says.
In 2008, he co-chaired a task force at Abbott Northwestern that explored issues related to cancer survivorship. In addition to the four components of survivor care identified as essential in a 2006 Institute of Medicine report—prevention, surveillance, intervention for the consequences of cancer and its treatment, and coordination of care—the task force affirmed the importance of promoting wellness and well-being through nutrition, exercise, and the mind-body-spirit connection. “There are so many unmet needs and efficacy gaps. For example, we’ve reached a limit on acceptable toxicity of therapies, so now we need to look at other things that will contribute to prolonged survival and recovery,” Plotnikoff says.
The task force’s work has raised awareness throughout Allina Health System, Abbott Northwestern’s parent organization, of the need to improve cancer patients’ quality of life and the potential to reduce the risk of recurrence through nutritional fitness, development of mind-body skills for reducing stress and anxiety, and physical fitness.
Plotnikoff says the ultimate goal is to create a cancer program that combines conventional care with rehabilitation and integrative health. He explains that at Abbott Northwestern, staff from the Virginia Piper Cancer Institute often refer patients to the George Institute for acupuncture, exercise therapy, nutrition consultations, yoga classes, massage therapy, biofeedback, ayurvedic assessments, and educational programs on resilience training and Qigong. In addition, the institute provides inpatient massage, reflexology, acupuncture, guided imagery, and guided meditation services to cancer patients.
He says the plan is to bring such inpatient services to all Allina hospitals. “What I’d like to see happen is that there would be physicians, nurse practitioners, and naturopaths who would work in partnership with acupuncture, massage, and biofeedback specialists to address issues on cancer survivorship,” he explains.
Gathering Evidence
Before more hospitals fully adopt integrative oncology, more research is needed on the efficacy of various therapies.
According to Donald Abrams, M.D., chief of hematology-oncology at San Francisco General Hospital and president of the Society for Integrative Oncology, one of the problems with research into complementary therapies for cancer patients is the degree of evidence needed to ensure safety. “Oncologists are often demanding the same degree of evidence from integrative interventions that they are from conventional interventions, and I’m not sure that’s absolutely fair,” he says. “It makes more sense to me that the degree of evidence should be proportionate to the potential for the intervention to do harm. With chemotherapy, yes, I’d like a lot of evidence. But getting a massage twice a month or eating more blueberries or broccoli, I don’t know how to study those effectively in a randomized, double-blind placebo- controlled situation. How many resources should we expend when the potential for harm is so low?”
Through the North Central Cancer Treatment Group, a network of cancer specialists at hospitals, cancer centers, and community clinics involved in clinical trials, Mayo Clinic investigators have been proving that it is possible to evaluate complementary and alternative therapies in a scientifically sound way since the late 1970s.
According to Charles Loprinzi, M.D., a medical oncologist at Mayo, Mayo has conducted more than 30 clinical trials of various complementary therapies for treating cancer and controlling symptoms. These have included pilot studies and prospective, randomized, placebo-controlled trials. Among their findings: using oral cryotherapy (having patients suck on ice chips for 30 minutes) before and during administration of the chemotherapy agent 5-FU decreases the incidence of mouth sores by 50 percent; a cream containing capsaicin, the substance that makes chili peppers hot, decreases postsurgical neuropathic pain. They also have evaluated the efficacy of various complementary agents and even hypnosis for treating hot flashes, a common complaint among women who’ve experienced early menopause because of chemotherapy or who receive tamoxifen or an aromatase inhibitor as treatment for breast cancer and experience menopausal symptoms.
“In the recent past, studies looking at individual complementary therapies have been very small and weren’t broadly applicable. But more people are now doing larger, more sophisticated studies of various modalities,” says Debra Barton, R.N., Ph.D., an associate professor of oncology at Mayo and member of the Society for Integrative Oncology’s board. Barton has given a number of talks about the growing evidence base for some complementary therapies. Loprinzi says they try to get the word out about whether or not data support the use of particular modalities by publishing their findings in respected medical journals and reporting on them at conferences. “Our goal is to try to figure out which things do work and provide some direction on that. We also want to let people know which things that sound promising on the Internet and in other places do not have a scientific basis and/or have been shown not to be of benefit,” he says. “These are the kinds of things that can influence clinical practice.”—Kim Kiser