What Really Is Integrative Cancer Care?
Sharon, a 46-year old high school teacher recently diagnosed with stage 3 colon cancer is discussing treatment options with her new oncologist and feeling overwhelmed.
Sharon knows she will need to be fully empowered to heal from this diagnosis and questions her doctor about investigating “alternative” treatments.
The oncologist nods her head and then suggests an “integrative” medical approach as the strongest overall strategy for healing on all levels.
Sharon has heard the terms alternative, complementary, traditional and integrative medicine, but wants to know more. Before moving forward, Sharon wants to understand the differences between these types of care and how they will impact her course of treatment.
What’s in a Name?
Various group define these terms differently and even the National Cancer Institute (NCI) and the National Center for Complementary and Integrative Health (NCCIH), both divisions of the National Institutes of Health (NIH), differ slightly in their definitions.
These agencies and many other groups and individuals call the dominant medical system we know in the United States, “mainstream, Western, orthodox, standard or conventional” medicine. It is also sometimes called allopathic medicine.
The NCI defines this type of medicine for cancer care as:
“A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery.”
Note: “Traditional” medicine typically does not refer to this type of standard Western medicine, but rather to knowledge systems developed over generations within various cultures, such as Traditional Chinese Medicine.
Complementary and Alternative Treatments
Both the NCI and the NCCIH basically define “Complementary” and “Alternative” treatments as:
“Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard or conventional treatments.”
The term “alternative” has largely fallen out of favor and often carries connotation of being “unproven.” As a reflection of this trend, the National Center for Complementary and Alternative Medicine changed their name to the National Center for Complementary and Integrative Health in December of 2014.
Mind-Body Practices
The NCI narrowly defines a “mind-body practice” as:
“A health practice that combines mental focus, controlled breathing, and body movements to help relax the body and mind.”
The NCCIH quite differently defines “Mind and Body Practices” as:
“A large and diverse group of techniques that are administered or taught to others by a trained practitioner or teacher [italics added]. Examples include acupuncture, massage therapy, meditation, relaxation techniques, spinal manipulation, and yoga.”
Note: It seems that the NCCIH definition is not actually a definition at all, other than “a large and diverse group of techniques” followed by examples that one can only surmise are somehow related. It is interesting that the caveat that agency added regarding this “group of techniques” includes the “that are administered or taught to others by a trained practitioner or teacher,” as though the method of delivery and its perceived quality, in fact define the technique itself.
Integrative Health Care Defined
Perhaps the most accurate and simplest single definition on this topic is the one the NCCIH uses for Integrative health care:
“There are many definitions of “integrative” health care, but all involve bringing conventional and complementary approaches together in a coordinated way [italics added].”
The emphasis on the coordination of the practice in the definition above suggests an intentionality or a discernment to the appropriate use of the various medical approaches. As shown in the example below, a key element in the integrative medicine framework is that no type of treatment is accepted nor rejected without a critical eye to the risks and benefits.
Integrative Medicine at the University of Arizona
This NCCIH definition fits well with the much longer definition of Integrative Medicine shown below, used at the Integrative Medicine Program at the University of Arizona, founded by the Harvard-trained, Andrew Weil, MD in 1994:
Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.
The principles of integrative medicine:
- A partnership between patient and practitioner in the healing process
- Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response
- Consideration of all factors that influence health, wellness and disease, including mind, spirit and community as well as body
- A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
- Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms
- Use of natural, effective, less-invasive interventions whenever possible
- Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
- Training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development
Integrative Cancer Care therapies can include a wide variety of techniques and modalities that focus on addressing the effects of the illness itself, underlying imbalances and conditions, as well as the many side effects that cancer treatments potentially cause.
The Bravewell Collaborative
The Bravewell Collaborative is a “community of leading philanthropists who work together to transform our health care system and improve the health of the American public through the advancement of integrative medicine.” Their definition of integrative medicine shares many points of the University of Arizona definition above, along with the following commentary:
A practical strategy, integrative medicine puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. By treating the whole person, both the patient’s immediate needs as well as the effects of the long-term and complex interplay between a range of biological, behavioral, psychosocial and environmental influences are addressed. This process enhances the ability of individuals to not only get well, but most importantly, to stay well.
Types of Integrative Cancer Care Therapies
Integrative Cancer Care therapies may include the following modalities:
- Therapeutic Yoga
- Mindfulness and Meditation
- Exercise, Rehabilitation and Mindful Movement, including Tai Chi, Qigong
- Psychosocial Support and Counseling – group and individual
- Acupuncture, Reiki and other Energy-Based Modalities
- Hypnotherapy
- Oncology Massage and Reflexology
- Oncology Skin Care
- Nutrition Education
- Pain Management
- Stress Reduction Strategies
- Spiritual Support
- Therapeutic Art and Writing
- Laughter and Community Activities
- Chiropractic, Ayurvedic, osteopathic and naturopathic care
- Other Cancer Treatment Modalities
Many integrative cancer therapies make the client feel better, but can they help with the cancer and cancer treatment side effects?
Studies showing the objective medical benefits of these therapies are increasingly geometrically. Well-designed studies are being published in mainstream medical journals such as Journal of Clinical Oncology (which deems itself as “the single most credible, authoritative resource for disseminating significant clinical oncology research”).
Industry-specific journals also provide research updates, including the peer-reviewed Integrative Cancer Therapies, which reports that it is:
“…focused on the scientific understanding of alternative medicine and traditional medicine therapies, and their responsible integration with conventional health care. Integrative care includes therapeutic interventions in diet, lifestyle, exercise, stress care, and nutritional supplements, as well as experimental vaccines, chrono-chemotherapy, and other advanced treatments.”
For a journey as difficult and as stressful as cancer and its treatment can be, integrative therapies, selected with wisdom and care, can provide hope, healing and a sense of wholeness, no matter what the diagnosis may be.
In the years that I worked managing the wellness programs for a large cancer resource center, I saw the effects of integrative and complementary care every day. I saw the smiles on the faces of our participants and in the zest for life that returned when they supported their lives through an array of complementary modalities… whether or not the conventional treatments were “working.”
I saw that despite a tough situation, integrative care gives each person a deck that is more stacked in their favor.
