All About Integrative Oncology

What is integrative oncology?

Integrative oncology, or integrative medicine, is the use of complementary therapies along with conventional (standard) medicine. Complementary therapies work together with conventional treatment methods (surgery, chemotherapy, radiation) to treat the whole patient (body, mind, and spirit). Integrative therapies can help with your treatment goals, side effects, and distress. Integrative therapies can help you stick to your treatment plan, which may lead to better outcomes.

Defining the Terms

Conventional medicine: Treatments that are widely used and have been proven useful in clinical research trials. These are often called the standard of care. Conventional medicine for cancer may be things like surgery, chemotherapy, radiation therapy, immunotherapy, and/or hormonal therapy.

Complementary and alternative medicines and practices (CAM): These treatments are not part of the standard of care for cancer in Western countries, but may help cancer patients. These techniques are not usually taught in medical schools and your healthcare team may not know much about them.

CAM therapies fall into two categories: complementary and alternative.

• Complementary medicines: Treatments or practices used along with conventional or “standard” medical treatments. For example, acupuncture and guided imagery may be used to help with nausea caused by chemotherapy.
• Alternative medicine: Treatments or practices that are used instead of conventional medical therapies. For example, getting vitamin infusions to treat cancer, instead of a standard therapy prescribed by an oncologist, like chemotherapy.

Integrative Oncology: This is an approach to cancer care that uses complementary therapies along with conventional therapies to support the whole patient: mind, body, and spirit. Many cancer centers have integrative medicine programs that offer complementary therapies on-site.

What is considered integrative therapy?

• Mind-body methods:  These may include mindfulness, biofeedback, cognitive-behavioral therapy, meditation, relaxation, guided imagery, hypnosis, yoga, music therapy, creative/expressive therapies, spirituality, and more.
• Biologically based practices: Vitamins, herbs, foods, and special diets are used.
• Body-based practices: Massage, chiropractic interventions, and reflexology may be used.
• Energy medicine: This includes Reiki, Tai chi, Jin Shin Jyutsu, and therapeutic touch.
• Other medical delivery systems: Chinese medicine such as acupuncture, homeopathy, and naturopathy.

Safety Considerations

Many integrative therapies can help with side effects and can help your well-being. Unfortunately, we are not sure what risks there are with some of these options. You should talk about any therapies you are using or thinking about using with your cancer care team. Integrative therapies that are taken by mouth or given through an IV may negatively impact standard cancer treatments or cause certain blood test results to be wrong. Also, the treatments may have side effects of their own. For example, they may worsen other medical issues you have, such as high blood pressure.

Vitamins, herbal therapies, and supplements do not need FDA approval. They do not have the same manufacturing and purity standards as pharmaceuticals. This has led to batches having impurities, or not containing what the label says they contain. One way to protect yourself is by buying from companies 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 package.

There can also be safety concerns for some mind-body and body-based practices, depending on your situation. For example, deep tissue massage is often not recommended for areas affected by lymphedema, and acupuncture could increase the risk of infection in patients with a low white blood cell count. This is why it is so important to talk about ALL integrative oncology therapies with your providers before you start them.

Talking to Your Healthcare Team about Integrative Oncology Therapies

If you are interested in integrative therapies, the most important thing to do is to talk about them with your healthcare team. Healthcare providers are becoming more aware of integrative therapies and are often willing to support their patients in using them safely. Your team can help you figure out which therapies might work for you based on your treatment and 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 different providers know what therapies you are using so they can work together to provide you with the best possible care. An oncology social worker or navigator can help you coordinate care and help with communication between providers.

Are integrative treatments covered by my insurance?

These therapies are not often covered by insurance, but some plans do cover therapeutic massage, acupuncture, psychological treatment methods, and nutrition counseling. Call your insurance company to find out about these benefits. Many cancer centers offer integrative medicine, often at no extra charge. Your local Cancer Support Community may also offer free integrative oncology services. The American Cancer Society has a list of supportive care services, including integrative oncology services. In addition, your social worker may be able to help you with local resources for integrative therapies.

Resources & Further Reading

Society of Integrative Oncology

Guidelines from the Society of Integrative Oncology

Office of Cancer Complementary and Alternative Medicine

Talking About Complementary and Alternative Medicine With Health Care Providers: A workbook and tips from the OCCAM at the NCI.

National Center for Complementary and Integrative Health

USP (United States Pharmacopeial Convention)