Patients, as the primary stakeholders in their own well-being, are increasingly showing a profound interest in holistic approaches to cancer care that extend beyond traditional medical treatments. Growing evidence supports this interest, showing that some whole-person and integrative approaches can improve quality of life and survival outcomes. Oncologists’ attitudes are shifting in the same direction, though with less urgency than our patients’.
We recently conducted parallel surveys of oncologists and cancer patients and found that patients want complementary therapies, such as nutrition and exercise counseling, mindfulness, meditation, and yoga, and they want options presented to them early in their cancer journey. Patients are looking for oncologists and care centers to proactively support their quest for integrative care with conversations, guidance, and access to therapies.
Two-thirds of patients said they want to discuss complementary therapies — such as nutrition counseling, exercise, massage, or meditation support — before traditional cancer treatments begin, while a similar proportion of oncologists say they delay conversations about these services until later in the treatment process, likely when they are needed to mitigate side effects. About a third of oncologists still think patients are not interested in complementary therapies, yet only 13 percent of patients told us that they were. Patients desire a care team that proactively supports complementary therapies from the start of their cancer treatment journey.
We now know a lot more about the biology of cancer, and we know it’s more complex than we once thought. Cancer development and progression involve the immune system, genetics, the environment, and the gut microbiome, which is influenced by the food we eat. Science is showing the benefits of whole-person approaches, such as exercise and stress management, yet clinical practice has not caught up. Oncologists are starting to see this, and they’re wondering how to put this science into practice. That means going out and looking at the evidence for what works beyond treatments that seek to kill the cancer cell alone.
Putting it into practice
Physicians are increasingly pressed to squeeze more into less time. A discussion of whole-person care feels like one more thing to incorporate into frustratingly limited time with patients. Cancer care teams are trained to focus on treating the tumor, and they want to get to this important job, which is a complicated process on its own. However, there are ways to build support for integrative approaches into practice while respecting the other demands of the team’s role in caregiving. First, make sure there is space and permission for patients to discuss integrative care. We know patients are interested and they want to be able to talk about it with their doctor, if possible. So, creating time to do that, starting at intake, is important. Get support from your team to back you up. Once you start the conversation, team members such as nurse practitioners and medical assistants can take a strong hand in providing information and connecting patients to services; resources are available in many oncology centers to coordinate this care.
Patients need to know what services that might benefit them are available and that you support them. Complementary care was more widely available at care centers than patients in our survey seemed to understand. Nearly 96 percent of oncologists said some kind of complementary therapy was offered by their institution, with nutrition consultations and patient support groups being the most common. Yet patients were often unaware of these resources. Despite the awareness gap, patients also say they are increasingly considering their options when choosing a cancer center. A full 55 percent of patients said they would have chosen a health system with more complementary therapies if they could choose again, up substantially from 40 percent a year ago. Administrators and providers alike should recognize the significance of making these services routine and readily available. Hospitals and cancer centers can leverage this information to align their offerings with patient preferences, ultimately enhancing their appeal to individuals seeking holistic care.
The cost and coverage of complementary therapies present additional barriers, necessitating a systemic approach to addressing these concerns. By advocating for the inclusion of these services in comprehensive cancer care packages and collaborating with administrators to navigate reimbursement options, oncologists can help overcome financial barriers that hinder access to such therapies and ultimately aid our patients.
Physician education
More resources than ever before are now available to provide physicians with information about integrative therapies. The Society for Integrative Oncology recently teamed up with the American Society of Clinical Oncology to develop clinical practice guidelines assessing the evidence for interventions like massage, hypnosis, music therapy, acupuncture, and therapeutic yoga in specific circumstances such as cancer pain. Oncologists can look at what’s recommended in these guidelines, and then work with hospital administrators to make these offerings routine at your institution.
The tides of support for whole-person oncology are turning. While the integration of complementary therapies into cancer care demands a shift in mindset and a commitment to early and open communication, we have an opportunity to change care delivery. By embracing a holistic approach, we can transform cancer care into a more comprehensive, person-centric experience that addresses not only the tumor but the whole person from the very beginning of their journey.
Wayne B. Jonas is a family physician. Alyssa McManamon is a hematology-oncology physician.
