Roxanne Nelson

November 15, 2011

November 15, 2011 (Cleveland, Ohio) — Is integrative oncology a concept that exists only on paper — out of reach to most cancer patients?

According to the results of a qualitative study, integrative oncology remains an elusive goal for many cancer patients. Conventional and alternative/complementary therapies often function as parallel, rather than integrated, systems, and patients frequently find substantial barriers in the conventional healthcare system.

It is unclear where integrative oncology occurs, said lead author Lynda Balneaves, PhD, RN, associate professor of nursing at the University of British Columbia, Vancouver, Canada, who presented the results of the study here at the 8th International Conference of the Society for Integrative Oncology.

"Do we assume that its occurring in a conventional care setting, or is it happening out in the community in an independent integrative care clinic, or is it happening in a complementary provider's office, or is it happening at home, where patients and families sit together and make up their own care plan?" she asked.

The most recent data review of prevalence rates around the world show that up to 40% of people living with cancer in North American and Europe report using some form of complementary medicine after their diagnosis, Dr. Balneaves explained.

Only about 3% to 5% have completely removed themselves from conventional care are using complementary/alternative medicine exclusively.

"These data suggest that a large number of people living with cancer are using both complementary and conventional treatment together, in what we hope would be an integrative manner," she explained. But is it?

The team set out to find out whether conventional and complementary medicine are being used in a way that is really integrative, and whether "all the different players are working together to come up with a comprehensive plan."

The study was a secondary data analysis from a larger trial, the PATH study, which is an international study with partners in Canada, Norway, and the United States. The aim of the PATH study was to look at how people are approaching their cancer care, not only from a conventional perspective, but also from complementary and self-care perspectives.

The researchers hoped to generate a hypothesis about what care pathways are the most promising in terms of outcome.

In their study, Dr. Balneaves and her team evaluated the processes that patients underwent to integrate complementary medicine into conventional cancer care.

Interviews were conducted (face to face or by telephone) with 35 individuals who were diagnosed with cancer in the previous 6 years. Follow-ups were conducted every 2 to 3 months for more than a year in Canada and the United States.

In all patients, it seemed apparent that integration was a process, rather than a state that unfolded across the cancer trajectory as patients moved from diagnosis, to active treatment, to survivorship. "In terms of what they were telling us," said Dr. Balneaves, "there was a clear preference to have their complementary care and their conventional care combined." One participant said that it should all be a "package."

Limited Information From Providers

Dr. Balneaves pointed out that the patients in the study were not just drawing from a naïve sense of complementary medicine. "They had used it for overall health and other conditions, and most of them had been working toward changes in their lifestyle before they were diagnosed," she said.

There were some clear recommendations from conventional health professionals about the use of specific supplements — the majority from doctors in the United States, Dr. Balneaves continued. "We didn't see the same recommendations coming from Norway or Canada."

For the majority of patients, social support was very strong and there was some suggestion from family networks that they should be using complementary and alternative approaches. They "were creating a treatment plan from their fellow cancer patients. They were going to support groups and creating a treatment plan around that."

The majority of patients were incorporating complementary therapies into conventional treatment; it was only prostate cancer patients who were using an alternative route, she noted. They were doing active surveillance and incorporating complementary medicine into their treatment plan.

Dr. Balneaves noted that some patients reported feeling "let down" when their active treatment ended, that they were not being appropriately monitored, and that there was a "gap." For them, integrative oncology was one way of filling that gap.

"But when people tried to negotiate integration of their care, they were really blocked by conventional healthcare providers," she said. One patient summed it up by saying that her provider "just fluffed it off."

Patients also felt that it was their own decision to chose whether or not to use complementary medicine; they were happy to take an active role in their treatment and didn't want to be told what to do. But the problem, said Dr. Balneaves, was that they weren't getting any information or advice from their providers.

Parallel Systems

"This integration is not occurring on a wide scale," she explained. "Conventional care and complementary care are being provided in parallel systems by health professionals who are not consulting with each other. For many, integrative oncology is only a reality if you are in the upper echelons of the economic trajectory."

She pointed out that this isn't just an issue with integrative oncology. "I think it is reflective of cancer care in general around the world," she said. "There is poor communication for patients and among healthcare professionals, and there's a lack of continuity in the acute care we provide and as we move from acute to primary care."

Gary Deng, MD, president of the Society for Integrative Oncology, who was approached by Medscape Medical News for independent comment, pointed out that this study highlights the problem in integrative medicine. "It involves more than science," said Dr. Deng. "It's about public policies, economics, politics — ...there are multiple factors at play."

But bridging the gap between the 2 types of therapies is a gradual process, he added. "We have made a lot of progress in this area" in the past 5 or 10 years.

8th International Conference of the Society for Integrative Oncology. Abstract 2. Presented November 12, 2011.

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