The Case for Integration of Health Coaching within Integrative Oncology - Needs, Outcomes, Models, and Standards

Abstract

Purpose of the Review

This review advocates for the integration of health coaching into oncology care to enhance outcomes for patients, caregivers, healthcare professionals, and oncology services. Health coaching is a person-centred, supportive process that facilitates navigation through trauma, loss, and change while promoting holistic health, physical, emotional, social, and spiritual. It also supports overcoming depression and anxiety by aiding patients in redefining life priorities for health and fulfilment post-treatment.

Recent Findings

Systematic reviews indicate that health coaching can reduce anxiety and depression in cancer patients, conditions linked with increased cancer recurrence and mortality. Consequently, health coaching holds potential not only to improve quality of life but also to influence cancer morbidity and mortality.

Summary

The authors’ view is that health coaching fills an important gap in oncology services, offering a scalable, cost-effective solution to improve patient outcomes across the cancer continuum. With established global standards and clear competencies, health coaching should be integrated as an essential component of oncology care services.

Introduction

Defining Health Coaching in Integrative Oncology

Health coaching, as defined by the Society for Integrative Oncology (SIO) and the British Society of Integrative Oncology (BSIO) Special Interest Group in 2025, is an evidence-based, non-clinical discipline that supports integrative oncology by empowering patients and their caregivers [1]. A health coach facilitates a person-centred, supportive process that helps patients/clients explore and develop their whole health, physical, emotional, and spiritual while successfully navigating change, loss and trauma. Health coaching is a skilled profession with robust, internationally recognized training standards and a clear scope of practice. The global standard setting lead bodies for health coaching are outlined in section"Training and Professional Standards in Health Coaching"and Table 1.

Table 1.

The global lead bodies in health coaching in 2025

Organisation	Abbreviation	Date Founded	Description and website
American Holistic Nurses Credentialing Corporation	AHNCC	1997	Ensures the validity, reliability, security, and integrity of the certification processes with AHNA to advance Holistic Nursing and Nurse Health Coaching www.ahncc.org
The National Society of Health Coaches	NSHC	2007	USA organisation dedicated to advancing the use of evidence-based health coaching by health professionals (doctors, nurses, physical therapists) in clinical practice www.nshcoa.com
Health Coach Alliance	HCA	2011	HCA empowers and supports registered health coaches, nutrition counsellors and advocates for their integral role in healthcare settings. www.healthcoachalliance.ca
National Board for Health and Wellness Coaching	NBHWC	2015	Established national standards for health and wellness coaching in the USA www.nbhwc.org
UK & International Health Coaching Association	UKIHCA	2018	Established professional body and education & training standards for health coaching in the UK and internationally www.ukihca.com
Health Coaches Australia and New Zealand Association	HCANZA	2019	Created a voice for the Health Coaching profession in Australia and New Zealand www.hcanza.org
Society of Behavioural Health, Singapore	SBHS	2023	To foster collaborative research and provide training and services to build on the field of behavioural health and medicine in Singapore. www.sgbehaviouralhealth.com

Health coaches can play a critical role in empowering patients by fostering self-awareness, supporting the development of health-promoting behaviours, and encouraging self-care practices that enhance emotional and physical well-being. Through a collaborative, person-centred approach, health coaches work with individuals to assess their current state across physical, emotional, mental, and spiritual domains, as well as their psychological response to diagnosis. This process helps to determine the patient’s ability to embrace change and informs the development of personalised health goals and onward referrals to therapeutic and self-help resources. Based on these individual needs, reactions and circumstances, health coaches support patients in identifying appropriate support and self-help strategies, guiding them throughout the cancer care continuum into short and long-term wellness programmes.

Health coaching has also been shown to improve patient engagement with clinical care teams by facilitating improved communication with healthcare professionals and strengthening a sense of personal agency throughout the cancer journey. It promotes resilience, self-efficacy, and proactive health management, enabling individuals to live well during and after treatment. Additionally, by guiding patients through a structured review of their health and life priorities, health coaching can alleviate psychological distress such as anxiety and depression by initiating and sustaining engagement in personalised health programmes and revised life priorities. This reflective process often supports the emergence of renewed meaning and purpose, potentially reframing the cancer experience as an opportunity for personal growth and a more fulfilling, health-oriented life.

The Need for Health Coaching in Cancer Care

Early focus group research at the UK’s Bristol Cancer Help Centre [2] highlighted that cancer patients and carers face complex emotional, physical, spiritual, and self-management needs that busy oncology professionals cannot fully address. Participants emphasized the critical importance of emotional support, citing experiences of shock, fear, isolation, and overwhelm, and the need for link workers or patient navigators to facilitate their understanding, coping strategies, and access to resources. Complementary therapies for symptom management and encouragement of self-help were also deemed essential as were advanced communication skills in oncology professionals.

In response to the growing need for psychosocial and behavioural support in cancer care, health coaching programmes, such as those pioneered by Margaret Moore in the United States [3] and Dr. Rosy Daniel in the United Kingdom [4], have been developed over the past 25 years to address this critical gap. Since then, health coaching has evolved into a globally recognised and regulated profession, underpinned by rigorous training and professional standards. With cancer incidence now estimated at a lifetime risk of 1 in 2 in the UK [5] and 1 in 5 globally [6], there is an urgent imperative to empower patients to take an active role in their care and survivorship programmes. Doing so not only has the potential to improve individual outcomes but also to alleviate pressure on overstretched healthcare systems and professionals. Within oncology, health coaching provides essential motivational support that enhances patient engagement and self-management throughout the cancer journey.

The Relationship Between Depression, Anxiety, and Cancer Outcomes

Depression and anxiety are prevalent among individuals with cancer and are associated with poorer clinical outcomes, including reduced survival. A meta-analysis conducted by Wang et al. [7], involving over 282,000 patients with breast cancer across 17 studies, revealed that depression was associated with a 24% increased risk of cancer recurrence and a 29% increase in cancer-specific mortality. Extending these findings across multiple cancer types, Walker et al. [8] reported that major depression was linked to an increased mortality risk of up to 76%. Similarly, Getie et al. [9] found that cancer patients experience significantly higher rates of depression and anxiety compared to the general population. Notably, a study by Berzins et al. [10] demonstrated that health coaching interventions can effectively reduce symptoms of anxiety and depression while simultaneously improving health behaviours such as physical activity, sleep, and nutrition.

These findings underscore the critical need to integrate mental health support into cancer care. They demonstrate that health coaching, through the use of motivational interviewing and goal-setting strategies, can decrease anxiety and depression, supporting patients in restoring a sense of purpose and in achieving psychological well-being. By enhancing mental resilience and healthy lifestyle behaviours, such interventions may ultimately contribute to improved survival outcomes.

Evidence and Outcomes

Lifestyle and Behaviour Change: Impact on Cancer Outcomes

Leading international oncology organisations including the American Cancer Society (ACS), National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), Cancer Research UK (CRUK), and European Society for Medical Oncology (ESMO), advocate for the integration of lifestyle interventions targeting physical activity, nutrition, and stress management throughout cancer care. Demark-Wahnefried et al. [11], observed that early-stage cancer patients demonstrate motivation to adopt healthier behaviours during treatment. Therefore, guidance and motivational support in using those with the greatest benefits is desirable. Liu et al. [12], reported that cancer survivors engaging in multiple healthy behaviours experienced reduced mortality, especially when mental health improved concurrently. Comander et al. [13], confirmed that lifestyle interventions enhance disease-free survival among breast cancer survivors. Furthermore, Bettariga et al. [14], found that higher fitness levels correspond with up to a 46% reduction in all-cause mortality.

These findings emphasize the beneficial use of sustained health behaviour modifications in improving cancer outcomes, underscoring the potential importance of routine health coaching to initiate, motivate, signpost resources and maintain such changes in health-defining behaviour.

Additional Evidence Supporting Health Coaching for Cancer Patients

National Comprehensive Cancer Network and Society for Integrative Oncology guidelines indicate that health coaching impacts cancer care through both direct and indirect pathways [15, 16], Directly, coaching influences physical and psychological outcomes by promoting behavior change and emotional resilience. Indirectly, coaches support health gain by introducing and helping people to sustain engagement with self-help techniques, lifestyle approaches, and complementary therapies such as relaxation, meditation and introduction to therapeutic modalities including acupuncture, shiatsu, massage, mindfulness-based stress reduction (MBSR), herbal medicine, hypnotherapy, emotional freedom technique, counselling, spiritual healing, and Reiki.

Emerging research in psychoneuroimmunology, epigenetics, immune regulation, and nutrition further elucidates mechanisms by which these self-help and therapeutic approaches mediate health improvements. Chang et al [17], outline how stress-related biobehavioral pathways including neuroendocrine and immune mechanisms can influence cancer progression and highlights the importance of psychosocial interventions to improve both patient well-being and cancer outcomes. Ornish et al. [18] found in the Geminal Study that comprehensive lifestyle changes including plant-based diet, exercise, stress reduction, and social support were associated with reduced prostate cancer progression in men with early-stage disease, with measurable impact on oncogene regulation. Walker et al. [19], showed in a randomised trial that relaxation training and guided imagery during chemotherapy improved psychological wellbeing with up-regulation of immune parameters in breast cancer patients. The Pomi-T study of Thomas et al. [20] found that a polyphenol-rich supplement significantly slowed PSA progression in men with prostate cancer, suggesting benefits from dietary phytonutrients. Blackburn et al [21] found that lifestyle, stress, and psychosocial factors influence telomere biology, thereby impacting aging and the development and progression of chronic disease. Ornish and Blackburn et al [22] further showed in their Telomere Follow up Study, that intensive lifestyle interventions could significantly increase telomere length over five years, suggesting a potential slowing of cellular aging and disease progression through stabilisation of gene integrity.

This body of evidence strongly supports the pivotal role of health coaches in guiding patients to access and sustain these interventions to improve cancer outcomes.

Direct Evidence of Health Coaching in Oncology

Several studies demonstrate the efficacy of health coaching in cancer populations. Bantum et al. [23] investigated a combined health coaching and web-based intervention for cancer survivors, reporting significant improvements in psychological distress management, physical activity, and weight control. The Brain Tumour Charity [24] found coaching reduced fatigue and enhanced mental health among brain tumour patients. Siwik et al. [25] reported that group health coaching was associated with reductions in anxiety and depression, improved physical and emotional functioning, and overall quality of life. Importantly, no significant difference was observed between in-person and telehealth delivery modalities, although participants expressed a preference for personal contact.

More broadly within the health coaching field, the Compendium of Health and Wellness Coaching [26] catalogues over 480 articles, including 140 randomized controlled trials, illustrating the expanding evidence base for health coaching in healthcare.

Economic Benefits of Health Coaching in Healthcare Systems

Wolever et al [27] have demonstrated economic benefits through decreased healthcare utilisation, improved chronic disease management, and enhanced patient outcomes in diabetic patients. While specific economic analyses in oncology remain to be quantified, existing data from other healthcare domains suggest comparable cost savings are likely achievable by integrating health coaching into cancer care.

Models of Health Coaching in Oncology

Settings and Operational Models for Health Coaching Delivery

Health coaching for individuals affected by cancer, including patients, caregivers, and healthcare professionals, is currently delivered across a range of clinical and community settings. In some healthcare institutions, the health coach is integrated into the multidisciplinary teams (MDT). For example, at the Department of Supportive Care at Chris O’Brien Lifehouse in New South Wales, Australia, health coaches contribute to multidisciplinary case discussions, and document in patients’ digital health records [28]. In other contexts, coaching is offered through affiliated charitable organizations or community-based cancer support centres. At the Fountain Centre at the Royal Surrey Hospital, UK, for instance, patients can access confidential, free health coaching as part of a suite of supportive services, independent of the formal clinical care team [29].

Operational models vary widely. In clinical settings, coaching is often provided free at the point of delivery, typically funded through salaried positions, to date mainly funded by charitable organizations, or research grants within pilot or exploratory programmes. Group coaching has also emerged as a viable solution where individual coaching is not feasible due to funding constraints. Berzins et al. [30] demonstrated the effectiveness and acceptability of virtual group health coaching for people with cancer, offering a scalable alternative to one-to-one support.

Beyond traditional clinical environments, health coaching is also delivered on a paid basis through holistic health clinics, independent private practitioners, or as part of corporate wellness programmes in businesses and educational institutions. Community-based and workplace health coaching service delivery enables broader reach and engagement outside of the medical environment, which is beneficial for those with high anxiety in medical settings.

Importantly, health coaching is increasingly being extended to oncology healthcare professionals themselves, as a strategy to promote self-care and mitigate emotional burnout and physical exhaustion, challenges that are prevalent in cancer care delivery settings.

Continuity of Support Across the Cancer Continuum

Health coaching offers longitudinal, client-centred support spanning the entire cancer journey from diagnosis and uncertainty, through treatment and survivorship, to end-of-life care and bereavement. This adaptable approach addresses evolving emotional, informational, and behavioural needs, aligning with core supportive care domains recognized in oncology guidelines of the National Comprehensive Cancer Network (NCCN) [15]. Seven key supportive care categories provided by health coaches include: psychological and emotional support; communication facilitation and patient advocacy within medical settings; empowerment of patients to transition from passive recipients to active health partners; comprehensive needs assessment and resource navigation; promotion of mind-body integration; development and teaching of self-help and wellness strategies; and enhancement of health literacy through education and information provision.

Health coaches discern varying levels of patient resilience and self-efficacy, providing tailored emotional and motivational support and if needed onward referral for those experiencing anxiety, depression, or difficulty navigating their diagnosis and treatment. Functioning as a neutral and non-judgmental sounding board, health coaches facilitate clients’ self-exploration and decision-making, fostering self-awareness and empowering patients to voice their values and preferences as described in the NCCN and SIO Guidelines [15, 16].

Addressing Moments of Peak Vulnerability

The “Meeting the Needs” focus group study¹ identified critical moments of heightened vulnerability during the cancer continuum when health coaching can be particularly helpful. These include times of awaiting test results, initial diagnosis or recurrence, periods of isolation, managing caregiving responsibilities amid bad news, apprehension about medical interventions, complex treatment decision-making, treatment and the end of treatment, symptom and side effect management, reintegration post-treatment socially and at work, confronting bodily changes or losses, and facing mortality. At these junctures, health coaching facilitates the expression of fears and supports the development of creative, adaptive self-management strategies.

Training and Professional Standards in Health Coaching

Global Leadership and Medical Recognition

Health coaching has emerged as a distinct professional discipline within healthcare, supported by several global organizations that set educational and competency standards.

Notably, in 2019, the American Medical Association (AMA) formally recognized Certified Health & Wellness Coaches (NWB-HWCs) and Certified Nurse Coaches through approval of new Category III CPT billing codes, enabling integration of health coaching into mainstream medical practice in the USA. The AMA has also developed a comprehensive toolkit to guide physicians in implementing health coaching programs [31], encompassing coach recruitment, training, and program evaluation.

Lead bodies setting training and practice standards include the American Holistic Nurses Credentialing Corporation (AHNCC) certifies nurse health coaches within holistic nursing frameworks, the National Society of Health Coaches (NSHC, USA), the Health Coach Alliance (HCA, Canada), National Board for Health and Wellness Coaching (NBHWC, USA), UK & International Health Coaching Association (UKIHCA), Health Coaches Australia and New Zealand Association (HCANZA), and the Society of Behavioural Health Singapore (SBHS). (Table 1)

Scope of Practice

Professional health coaches adhere to clearly defined scopes of practice established by the global health coaching lead credentialing bodies in Table 1. Health coaches engage clients in collaborative, client-centred processes to facilitate achievement of self-determined health and wellness goals, utilizing motivational strategies, behaviour change techniques, and resource navigation. Crucially, health coaches do not perform clinical assessments, diagnose or treat medical conditions, interpret laboratory data, prescribe treatments, or provide individualized medical or nutritional advice unless separately qualified within another professional domain.

Educational Frameworks in Health Coaching and Specialist Cancer Coaching

Training frameworks developed by global health coaching bodies emphasise core competencies for all health coaches. These include communication skills, health sciences, behaviour change theories, positive psychology, mind-body integration, and professional ethics.

Specialist cancer health coaches receive additional training to support clients in processing emotional distress, managing fear and uncertainty, learning established guidelines for the integrative healthcare of people with cancer [15, 16] and fostering wellbeing across physical, psychological, and social domains [32–34].

These cancer coach specialists facilitate values-based conversations around identity and purpose, crucial in survivorship, and guide navigation of integrative oncology guidelines issued by organizations such as the Society for Integrative Oncology (SIO), American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN). They support implementation of evidence-informed complementary therapies including acupuncture, exercise, mindfulness-based stress reduction, and nutritional counselling, addressing symptoms like pain, fatigue, cognitive dysfunction, anxiety, and sleep disturbances.

Moreover, well documented by Gerain et al [35] cancer health coaches enhance health literacy by helping clients interpret complex medical information and access trusted resources, promoting self-management support that fosters active patient engagement and improved doctor-patient relationships throughout the cancer continuum.

Cancer-specific health coaching education encompasses comprehensive knowledge of oncology fundamentals - cancer biology, treatments, and side effects; psychological frameworks for managing illness-related distress; unmet needs, self-advocacy, behavioural change strategies for lifestyle factors (diet, exercise, stress, sleep); identity reconstruction post-treatment; healthcare system navigation; and practical symptom self-management techniques as defined by SIO [16]. These educational themes empower coaches to assist clients in reframing their cancer experience, restoring agency, and aligning future goals with personal values that bring new life.

The Ethos of Health Coaching

The effectiveness of health coaching is influenced not only by formal training but also by the coach’s underlying philosophy and the ethos of their practice setting. Some operate within a medical model emphasising treatment adherence, complementary symptom management and adjustment to change. Others adopt holistic perspectives that honour people’s potential for healing and wellbeing beyond conventional medicine. This can engender a sense of hope and empowerment. Finkelstein et al [36] found that higher levels of hope in people with advanced cancer were associated with increased healthcare engagement and a clear survival advantage, suggesting that hope may positively influence survival outcomes. Penny Brohn, diagnosed with breast cancer in 1979 and co-founder of the UK’s first holistic cancer centre famously asserted at the centre’s ‘Question of Hope’ conference[37], “Hope is not a promise; it is a vital psychological state that enables people living with life-threatening illness to engage meaningfully with life, day by day.”

Historic research by Hirschberg and Barasch reported in their book Remarkable Recovery [38] mapped common belief systems among long term cancer survivors, including belief in their healthcare providers and treatments, belief in their self-healing capacities, belief in the possibility of healing from higher powers, and use of belief-based techniques and therapies such as visualisation and hypnosis. Supporting people’s positive mindset and fostering empowerment remain key tasks of the health coach which must be supported and reinforced across the entire oncology team. The communications of authority figures in healthcare hold great power to uplift or bring down the fragile mental states of people with cancer, and training in communication skills is vital as a key training element for all oncology healthcare professionals.

Conclusion

Health coaching is an emerging intervention with demonstrated benefits for individuals affected by cancer, healthcare professionals, and the wider health system. By fostering patient empowerment, emotional resilience, and proactive self-management, health coaching can transform the cancer journey from one marked by fear and passivity to one of agency and partnership. Evidence highlights its effectiveness in reducing anxiety and depression, factors linked to poorer outcomes, while also improving fatigue, nutrition, physical activity, and psychological well-being.

As oncology increasingly embraces patient-centred care [39], integrating health coaching into cancer services offers a timely, low-cost and compassionate means of addressing the emotional, spiritual, and self-management needs of patients alongside medical treatment. It can also support healthcare professionals in managing their own wellbeing. The limitations of this work are the relative paucity of studies of the direct impact of health coaching on cancer outcomes and cost effectiveness studies within oncology settings. To realise its full potential, the global health coaching community must prioritise awareness-raising amongst oncology professionals, establishment of pilot projects, standardisation of practice, rigorous research, agreed competencies for specialist cancer coach training, and establishment of sustainable funding sources. Meanwhile, the authors’ view is that there is sufficient evidence now for the benefits of health coaching for it to become recognised and integrated as a core component of compassionate, high-quality cancer care.

Key References

• Wang, Y. et al., 2020. Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Molecular Psychiatry, 25(7), pp.1487–1499. 10.1038/s41380-019-0595-x

  • ○ This study demonstrates that depression is linked to increased cancer recurrence and mortality.

• Chang, A., Sloan, E.K. and Lutgendorf, S.K., 2022. Bio-behavioral pathways and cancer progression: Insights for improving well-being and cancer outcomes. Integrative Cancer Therapies, Published 17 May. 10.1177/15347354221096081

  • ○ This study highlights how psychological and social factors can influence cancer progression through biobehavioral pathways such as inflammation, immune function, and stress hormones, suggesting that targeting these pathways may improve both well-being and cancer outcomes.

• Berzins, N. J., Orsega-Smith, E., Mackenzie, M., Galantino, M. L., Culos-Reed, N. S., Leonard, T., & Narducci, E. (2025). Assessing the feasibility, acceptability, and preliminary health behaviour outcomes of a community-based virtual group health coaching for cancer survivors’ program. Supportive Care in Cancer, 33, Article 269. https://doi.org/10.1007/s00520-025-09295-y

  • ○ This study found that virtual group health coaching for cancer survivors improves mental health, reducing depression and anxiety which are related to higher recurrence and mortality rates.

• Gérain, P., Tanious, R., Jacquet, W., Meziani, A. and Van Hoof, E., 2025. What is “Coaching” in interventions for patients in cancer care research? A systematic scoping review. European Journal of Cancer Care, 34(1). 10.1155/ecc/2858931. Available at: https://onlinelibrary.wiley.com/doi/full/10.1155/ecc/2858931.

  • ○ This scoping review outlines a structured framework of competencies and practices defining effective cancer care coaching interventions.

Author Contribution

RD created the article framework and did the main writing incorporated contributions from JB and IZ along with other elements from the Special Interest Group to which we all belong.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

Dr Rosy Daniel trains Health Coaches Julie Bach trains Health Coaches Izabella Natrins is Director of the UK and International Health Coaching Association setting professional training standards and a professional register for Health Coaches

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Authors’ Positions

The authors serve together on the SIO/BSIO SIG looking at the place of Health Coaching in Oncology.

• Dr Rosy Daniel BSc MBBCh is lead author and an Integrative Medicine Consultant in her own medical practice. She is also Medical and Training Director of the Health Creation Coaching and Mentorship Academy, training Cancer Health Coaches since 2000

• Julie Bach MBA, NBC-HWC is Chair of the SIO Health Coaching Special Interest Group and a Health Coach and Director of Training of Wellness for Cancer’s NBHWC continuing education Cancer Health and Wellness Coaching Course.

• Izabella Natrins BSc PSYCH, is a UKIHCA Registered Health Coach, a BSIO Council Member and Chief Executive Officer of the UK & and International Health Coaching Association