Roxanne Nelson

October 30, 2013

VANCOUVER, British Columbia — Integrative oncology is a rapidly growing field, and there is a need for clear, evidence-based clinical guidelines that practitioners can follow. The Society of Integrative Oncology (SIO) recently published guidelines for integrative medicine in lung cancer, which were developed in accordance with American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines (Chest. 2013;143[5 Suppl]:e420S-e436S).

The SIO guidelines recommend, for example, mind–body therapies as part of a multidisciplinary approach to reduce anxiety, mood disturbance, sleep disturbance, and acute or chronic pain, and to improve quality of life.

Another suggestion is that acupuncture or related techniques can be used as an adjunct treatment option for nausea and vomiting related to chemotherapy or radiation therapy, and for cancer-related pain and peripheral neuropathy.

Clinical guidelines provide evidence-based recommendations for clinicians, explained Gary Deng, MD, PhD, from the integrative medicine service at Memorial Sloan-Kettering Cancer Center in New York City. This is even more important for integrative medicine because clinicians might not be as familiar with it, he added.

"When patients ask them about therapies, they may not know what to say," said Dr. Deng, who spoke about the guidelines during a plenary session here at the 10th International Conference of the SIO, and is first author on the guidelines. "This gives them something to fall back on, and makes them more comfortable making a recommendation."

"These are geared toward the medical community at large, and gives them a tool," he told attendees.

The preparation of guidelines gives the community an ideal opportunity to review the available data. "By doing that, we become clearer as to where we are," he said.

Producing evidence-based guidelines is also good for the organization, Dr. Deng continued. "We are a new organization, and having guidelines gives us a venue to increase our visibility, credibility, and impact on the professional community at large."

In 2005, the ACCP asked the SIO for information on integrative medicine that could help physicians address questions from patients. Guidelines were published in 2007, and then updated with more current data. To date, the SIO has published 4 separate evidence-based clinical guidelines; the latest are for the diagnosis and management of lung cancer.

The first 3 guidelines are more of a narrative review, and did not undergo as rigorous a process as the latest set. "The most recent guidelines have gone through the full rigorous process," said Dr. Deng.

Current Guidelines

There were 2 main goals for these guidelines, said coauthor Heather Greenlee, ND, PhD, assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, and SIO president-elect.

"The first was to assess current evidence on the benefits and risks of complementary modalities as adjuncts to mainstream medicine to control symptoms associated with cancer and cancer treatment," she said. "The second was to form the evidence base from which specific recommendations can be made to guide clinical practice."

Dr. Greenlee noted that the goal was to be conservative, to look at where the evidence is right now, and to ask, "What can we say given the evidence to date?"

A systematic literature review was conducted, and a large number of randomized controlled trials, systematic reviews, and meta-analyses met the predetermined inclusion criteria, as did a number of prospective cohort studies. The included trials addressed many issues faced by lung cancer patients, such as symptoms of anxiety, mood disturbance, pain, quality of life, and treatment-related events. Available data covered a wide variety of complementary interventions, including acupuncture, nutrition, mind–body therapies, exercise, and massage.

The authors conclude that the "the body of evidence supports a series of recommendations. An evidenced-based approach to modern cancer care should integrate complementary therapies with standard cancer therapies such as surgery, radiation, chemotherapy, and best supportive care measures."

In the summary of recommendations, they note that "it is suggested that all lung cancer patients should be asked about their interest in and usage of complementary therapies. Counseling on the benefits and risks of those therapies should be provided."

The next set of guidelines from SIO will be on breast cancer, specifically integrative therapies for related adverse effects and quality of life.

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