Introduction to integrative oncology

Written By Nina Fuller-Shavel

BSIO (British Society for Integrative Oncology) 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 

Integrative oncology seeks to support a sense of agency and empowerment and fosters resilience for people affected by cancer and their loved ones. It is about having an expanded toolkit to choose from to support your overall wellbeing. It is important to remember that the approach is collaborative and does not in any way replace conventional medical care, instead aiming for enhanced support and synergy with the oncology plan. 

Integrative oncology may help support you throughout the cancer care pathway through:

  • supporting prehabilitation (pre-treatment support) for better treatment tolerance and recovery

  • offering additional options to manage side effects of treatment (including those poorly managed with current pharmaceutical options) and in some cases, potentially synergise with treatment for improving clinical outcomes or manage complications resulting from treatment, e.g. new onset diabetes

  • supporting faster recovery following active treatment and offering expanded options for reducing recurrence risk and associated anxiety and tackling long-term effects of treatment in survivors

  • offering options for compassionate supportive care of patients with metastatic disease

The practice of integrative oncology in the UK has sadly lagged behind a number of other countries, including the US, where such care models are incorporated in leading cancer centres, e.g. Banner MD Anderson and MSKCC (Memorial Sloan Kettering Cancer Center). There are many examples in other countries, such as Israel, Italy and Australia where hospital centres offer integrative oncology interventions and conduct research in this field. 

Misconceptions about integrative oncology (IO)

We hear many misconceptions about integrative oncology from patients, carers and healthcare professionals, and we 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 – think of it as having the best buffet of options to choose from alongside your oncology plan

  • 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 (integrative is very different to alternative)

  • 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

    • It is really important to know that getting long supplement or off-label medication lists off the Internet or Facebook groups from people who know nothing about your personal medical situation or current treatment can be dangerous and is not in line with the principles of integrative oncology. Please never listen to anyone who tells you to discontinue treatment or follow-up with your oncology team.

  • 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, depending on the study, and 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. It is understandable why people don’t want to disclose complementary therapy use – one might feel misunderstood or worry about how it is perceived by their team while wishing to have more information or options that are on offer within their current care model. In this gap may lie hidden risk and often internal conflict for the person. However, this is also an opportunity to change medical practice and for conversations to become more collaborative and open because ultimately what we all want is safe and effective care that does not leave the person feeling helpless, ignored or disempowered. 

Safe integrative oncology relies on mutual openness, honesty and respect. It allows us to ensure that your treatment is well supported by appropriately qualified and experienced practitioners (not Dr Google or social media) and encourages regular inter-professional communication and mutual learning. 

Integrative cancer care in practice

If you are new to integrative oncology/integrative cancer care, it’s important to understand the key components of an integrative oncology approach 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 (therapies) used in integrative oncology for symptom control. The scientific evidence for different approaches is always evolving. We have new guidelines and evidence for specific symptoms since the publication in 2019, which you will find further information on in the symptom relief hub of the Oncio app as we build content over time. 

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

The integrative oncology 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 therapies and approaches have their own benefit-risk ratios and appropriate conditions for their use that need to be assessed with the person on an individualised basis, always taking ongoing medical treatment into account. This helps support synergy instead of working at cross-purposes, particularly where there are interactions between herbs or supplements and medications to consider.

In the general information hub of the Oncio app, you will find some initial information on integrative oncology modalities/therapies/approaches, covering a wider range of areas from health coaching to acupuncture and yoga and more. The range of content will grow over time, so please bear with us, as we grow in resources and funding for our non-profit Community Interest Company. 

Additional resources

  • US Coalition for Cancer Survivorship – valuable information on integrative oncology and survivorship/in-treatment checklists:

    • https://canceradvocacy.org/resources/survivorship-checklist/integrative-oncology/ 

References

  • Aust A, Walton-Sonda D, Paterson C. How does Integrative Oncology Influence Patients' Physical and Psychosocial Outcomes, and What are Patients, Carers and Healthcare Professionals' Experiences? An Integrative Review. Semin Oncol Nurs. 2022;38(4):151258. 

  • BSIO website – https://www.bsio.org.uk/. Accessed May 2023.

  • Grant SJ, Hunter J, Seely D, Balneaves LG, Rossi E, Bao T. Integrative Oncology: International Perspectives. Integr Cancer Ther. 2019;18:1534735418823266. 

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

  • Mao JJ, Pillai GG, Andrade CJ, et al. Integrative oncology: Addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin. 2022;72(2):144-164. 

  • Witt CM, Balneaves LG, Cardoso MJ, et al. A Comprehensive Definition for Integrative Oncology. J Natl Cancer Inst Monogr. 2017;2017(52):10.

Content contributed/reviewed by:

  • Dr Nina Fuller-Shavel, Integrative Medicine Physician, Co-Founder of Oncio CIC (author)

  • Mr Kelvin Francis Gomez, Consultant Oncoplastic Surgeon, Expert Panel Member for Oncio CIC (reviewer)

  • Dr Penny Kechagioglou, Consultant Clinical Oncologist, Co-Founder of Oncio CIC (reviewer)

Nina Fuller-Shavel
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