Integrative Oncology: Translating Principles into Practice. Introduction

According to the International Agency for Research on Cancer, 17 million individuals were diagnosed with cancer worldwide in 2018, with 27.5 million new cases predicted by 2040.¹ The global burden due to cancer is also expected to rise greatly due to population expansion and aging as well as an increase in risk factors that include smoking, physical inactivity, unhealthy diet, and cancer-causing infections. It is well known that cancer diagnosis and treatment have profound and long lasting effects on the physical, emotional, and spiritual wellbeing of both patients and caregivers. Surveys also indicate widespread use of complementary and alternative medicine (CAM) among cancer patients. Reasons cited for such use include cultural beliefs, influence of family and friends, or simply the desire to do everything possible to cure the cancer.^2–4

Recognizing the importance of addressing diverse patient needs and preferences while advancing the science and practice of oncology, Memorial Sloan Kettering Cancer Center founded the first integrative medicine service in 1999. Over the last 20 years, leading academic centers such as the MD Anderson Cancer Center and the Dana-Farber Cancer Institute have established similar programs to conduct rigorous research, innovate clinical care, and educate. Today, the majority of U.S. National Cancer Institute-designated Comprehensive Cancer Centers provide integrative oncology services.⁵ According to the recent official definition developed by the Society for Integrative Oncology (SIO), integrative oncology is an evidence-informed and patient-centered field of cancer care that utilizes lifestyle modifications, mind-body practices, and natural products in conjunction with conventional cancer treatments.⁶ In this special issue, consistent with this definition, we have invited leaders in the field of integrative oncology to offer their expertise on how to apply the principles of integrative medicine to clinical practice, and to provide recommendations for future research.

The issue begins by addressing the importance of patient-clinician communication to manage patient expectations of CAM therapies so that these approaches can be effectively integrated into cancer care (Latte-Naor). In addition, Lopez et al. discuss practical approaches for incorporating patient-reported outcomes (PROs) into integrative oncology to better inform patient-centered care and clinical research.

Lifestyle modifications, including diet and physical activity, are essential foundations of good health for cancer patients and survivors. Greenlee et al. provide an overview of recommendations and guidelines for managing malnutrition and obesity, as well as adopting a healthy diet to improve cancer outcomes, and discuss how to implement behavioral changes and interventions. Brown et al. review the current evidence and guidelines for physical activity in cancer survivors, and examine ways to disseminate and implement methods to improve patient outcomes and transform clinical oncology practice.

Another important component of integrative oncology focuses on the use of mind-body therapies. There is a growing evidence base for the effectiveness of mind-body practices to manage many common symptoms and side effects of cancer and its treatments. Carlson et al. review interventions for alleviating stress that include yoga, massage, cognitive-behavioral stress management, and mindfulness, and suggest ways to improve the quality of research in this emerging area. Garland et al. summarize findings from research on cognitive-behavioral, meditative, and body-based treatments, and provide future research directions. Zick et al. present their systematic review of complementary therapies for cancer-related fatigue by discussing the current evidence base, research limitations, and future opportunities. Given the current opioid crisis, there is an urgent need to identify appropriate tools for pain management in cancer survivors. Deng reviews the current evidence that supports integrative approaches for pain management and considers methods for patient-centered integration.

Cancer patients and survivors also demonstrate a strong interest in using natural products as part of their treatment and recovery. Given the lack of rigorous clinical research, safe and appropriate use of herbs and dietary supplements in the oncology setting presents a challenge for clinicians. Hou et al. review the ten herbs most frequently searched for on Memorial Sloan Kettering Cancer Center’s About Herbs website and discuss their potential use, scientific evidence, and herb-drug interactions. This information can help enable meaningful clinician-patient discussions about herbal use. Finally, Liu et al. summarize the proceedings of a recent multi-disciplinary meeting and provide recommendations for rigorous clinical trial design and conduct to evaluate Traditional Chinese Medicine herbs in the oncology setting.

In closing, we hope this special issue will provide oncologists and clinicians with practical information to incorporate integrative oncology principles into their practices. As we highlight 20 years of progress in integrative oncology, we anticipate that the expert-identified limitations of current research and future recommendations will stimulate greater collaboration between researchers and clinicians to advance this important field.