Integrative Oncology Programs
A growing number of leading cancer care centers have integrative medicine programs, including Memorial Sloan Kettering Cancer Center in NYC and MD Anderson Cancer Center in Houston, Texas. Of the 71 National Cancer Institute (NCI)-Designated Cancer Centers that exist, 51 are considered “Comprehensive Cancer Centers.”5 Although they address the same transdisciplinary approach, the specific practices employed under the umbrella of integrative oncology vary from center to center.
Oncologist Donald Abrams, MD, treats people living with cancer at the University of California San Francisco (UCSF) Osher Center for Integrative Medicine. Dr Abrams told Cancer Therapy Advisor that “cancer is like a weed and my job is to work with the garden and make the soil as inhospitable as possible to growth and spread of the weed.”
He considers nutrition to be medicine, and to him, it’s the most significant intervention. He promotes the adoption of an organic, plant-based, antioxidant-rich, anti-inflammatory, whole-foods diet before and during treatment. A cancer diagnosis may make an individual feeling helpless, but Dr Abrams said, “if you come to an integrative oncologist, you’re not [just] a non-small cell lung cancer or pancreatic adenocarcinoma — you’re a person living with cancer who wants to be empowered by having a menu of things” to try, such as a change in diet, to take supplements, to learn how to decrease stress, do exercise and yoga, or get acupuncture, “and connect with the things that bring [you] joy.”
The independent Block Center for Integrative Cancer in Skokie, Illinois — outside of Chicago — employs oncologists, researchers, and specialists that integrate conventional care with their patient-centered “Life Over Cancer” approach, which includes diet, exercise, biobehavioral therapies, supplements, and nutritional infusions.6 Two similarly aged patients with the same diagnosis will still have 2 different treatment plans, noted Keith Block, MD, who is the medical and scientific director at the Block Center. He said his individualized treatment plans are based on broad laboratory and metabolic assessments of cancer growth-promoting or cancer-inhibiting factors, which are all part of the “biochemical terrain.” Cancer growth-promoting factors include inflammation, oxidation, stress chemistry, glycemia, and others, noted Dr Block.
Chronomodulated chemotherapy regimens optimize the timing of drug delivery to improve effectiveness and reduce side effects. When appropriate, off-label and repurposed drugs — such as metformin or statins, according to Dr Block — are selected based on results of a patient’s clinical laboratory assessment. “Cancer is a chronic condition that needs constant vigilance,” he said — particularly after treatment and during remission — to delay or prevent its return.
Lorenzo Cohen, PhD, is a research psychologist and professor and director of the Integrative Medicine Center at The University of Texas MD Anderson Cancer Center. Dr Cohen said what distinguishes their program is that it is physician-led and is part of an academic hospital system, and it has an active research program of clinical trials featuring integrative medicine interventions. Clinical decisions are made by 1 of 3 integrative physicians, but physicians and other providers together guide patients in services including acupuncture, massage, music therapy, yoga, tai chi, qi gong, physical therapy, nutrition, and health psychology throughout and after cancer treatment.
Epidemiological vs Clinical Findings
Data from the Block Center suggest patients with stage IV breast cancer had better survival outcomes when they were treated at integrative centers compared with patients included in published literature with similar but “somewhat more favorable” prognostic factors who were treated at conventional clinics. Median survival was 38 months (95% CI, 27-48) for patients with metastatic breast cancer who were treated at integrative centers compared with median survival times of 20 months to 23 months across patient records culled from prior studies. Patient 5-year survival was 27% for integrative care compared with 17% for conventional care.7
However, Dr Abrams commented that these kinds of studies are retrospective chart review (RCRs), “and that’s quite different from prospective randomized placebo-controlled clinical trials (RCTs).” He added, “That is just one of the problems with evidence-informed practice.”
Similarly, Dr Cohen remarked, “Besides some lifestyle intervention research, when it comes to herbs and supplements, I am not aware of any good research (RCTs) to suggest that this approach leads to improved survival.”