Roxanne Nelson

November 14, 2011

November 14, 2011 (Cleveland, Ohio) — The future has never been more exciting than it is right now in the treatment of cancer, and the integrative approach is a critical part of that future.

This message was delivered by Francis S. Collins, MD, PhD, director of the National Institutes of Health (NIH) and a physician and geneticist who previously served as director of the National Human Genome Research Institute, during the keynote address here at the 8th International Conference of the Society for Integrative Oncology.

The NIH has a whole center to study this integrative approach — the National Center for Complementary and Alternative Medicine, Dr. Collins explained.

Dr. Francis Collins

"We believe that these approaches have great appeal to the public, but they need to be subjected to the same kind of rigorous evaluation to understand what works and what doesn't," he said. "That will help people make the right choices on how to improve their outcomes, how to do prevention, and how to improve treatment in a way that embraces all kinds of options."

"As we are the major supporter of biomedical research in the world," he added, "this is part of our enterprise — to try to provide the evidence that allows people to make good choices."

Integrative oncology strategically combines complementary therapeutic approaches with conventional medical care. These approaches include natural and botanical products, nutrition, and acupuncture, traditional Chinese medicine, and mind–body therapies.

"Integrative cancer treatment combines the best of conventional therapies with a broad set of sound complementary interventions," said Keith Block, MD, chair of the conference, in a statement. "Today, what is being called 'personalized care' simply means targeting tumor genomics. But an integrative approach to personalized care in cancer treatment requires identifying and addressing the unique comprehensive needs of each patient in careful combination with targeting the tumor."

Widely Used Among Cancer Survivors

The evidence is overwhelming that these approaches are being widely used, including by individuals with cancer, Dr. Collins noted. He cited a 2008 report that found that complementary medicine was being used by 40% of adults and 12% of children in the United States, and that out-of-pocket spending on these approaches is $34 billion.

A study published this year, he continued, found that cancer survivors are more likely to use these therapies than the general population — 43% reported using them in the previous year and 65% reported using them over the course of their lifetime. Individuals reported using these therapies to improve their sense of wellness, immune function, energy, pain, psychological distress, and insomnia.

"Cancer survivors were likely to be using these therapies because they were unhappy that the medical treatments have not helped them, or it was recommended by their provider," Dr. Collins said.

The idea that providers feel negatively about these therapies is not supported in the case of cancer, he added, "at least in the case of this study."

Not Informing Providers

There has always been concern about the possible interaction between complementary therapies and conventional approaches, and that is still the case. In addition, quite a few cancer patients are not telling their providers about their use of these therapies, he pointed out.

A recent study focusing on phase 1 trials found that 52% of cancer patients are using some type of complementary therapy, but less than half mentioned it. "This is something that trial managers are very interested in having information about," Dr. Collins said.

Well-Designed Trials Needed

Although there is no question that integrative therapies are widely used, their effectiveness needs to be tested in well-designed clinical trials. "That way we have evidence that can be shared with the public about whether or not this particular approach is going to help them," he said.

One approach is doing comparative-effectiveness research to provide evidence on the effectiveness, benefits, and harms of different treatment options. "NIH has been doing this for many decades, although we didn't necessarily call it this," said Dr. Collins. "Comparative-effectiveness research can be applied to prevention, to diagnosis, to treatment, to behavior changes in all systems, to special populations, and certainly to complementary and alternative medicine."

Natural Remedies Revisited

There is great excitement in the current era about identifying the cause of disease, including cancer, at the molecular level and about therapeutics that target these new discoveries, Dr. Collins noted. "But where are we going to find these exciting molecules that have the right properties?"

Natural remedies have been the source of great success stories over the decades, and "many of us are hopeful that we will see the next generation of breakthroughs," said Dr. Collins.

One example of this, he pointed out, is the antimalarial drug artemisinin, which is now used in combination with other treatments and is recommended by the World Health Organization as a first-line treatment for the disease. He explained how the drug was found after an extensive search through ancient Chinese remedies.

Chinese scientist Tu Youyou and her team began their research in the 1960s, with the hope of developing a malaria drug to replace chloroquine, which was losing its effectiveness because malaria parasites were developing resistance to it. They conducted extensive research into ancient Chinese remedies, and one of the plants they studied was sweet wormwood, or Artemisia annua. From this, they developed the drug artemisinin, which proved to be an effective antimalaria agent in humans. For her role in the discovery and development of artemisinin, Dr. Tu received the 2011 Lasker~DeBakey Clinical Medical Research Award.

Some Words of Wisdom

Dr. Collins offered a few words of advice for young physicians and scientists interested in pursuing research in complementary and alternative medicines. One should not to be discouraged by prevailing attitudes toward these therapies, he said. "Some look sideways at alternative medicine as not being as solid and rigorous, but they may not be as solid and rigorous either if you look closely," he said with a chuckle.

"I think it helps enormously to have your own set of colleagues to follow the same path, because no investigators in the current climate can do these things all by themselves," Dr. Collins added on a more serious note. "So figure out ways to develop collaborative ideas and bring them forward, and talk to the people at the National Cancer Institute Office of Cancer Complementary and Alternative Medicine if you really have some groundbreaking ideas."

"If you're going to spend your time doing research, spend it on important ideas, not just incremental advances," he emphasized. "That was the advice I was given as a postdoctoral fellow. This is an exciting time. This is the moment; don't be shy."

8th International Conference of the Society for Integrative Oncology. Presented November 10, 2011.

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