Guideline addresses use of integrative therapies for cancer-related pain management
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A new clinical practice guideline jointly published by ASCO and Society for Integrative Oncology addresses the potential role of integrative pain management techniques in management of cancer-related pain in adults.
“Patients with cancer, as well as cancer survivors, often experience various types of pain that can linger and negatively impact their quality of life and ability to function,” guideline co-chair Jun J. Mao, MD, MSCE, chief of the integrative medicine service at Memorial Sloan Kettering Cancer Center, said in an interview with Healio. “With the opioid epidemic widespread in the United States, both patients and physicians are hesitant to use opiates for pain management. That leaves many patients with pain that is not well-controlled.”
Integrative oncology is a patient-centered, evidence-based field of cancer care that uses mind/body practices, natural products and lifestyle changes from different health care traditions alongside traditional oncology.
Mao spoke with Healio about how the panel of experts arrived at these recommendations, which build upon ASCO’s existing guideline on cancer-related pain, and discussed how they may fill gaps in care in the current climate of pain management.
Healio: What prompted the development of this guideline?
Mao: Patients are very interested in trying alternative or complementary ways of managing pain, but there is very little in terms of clear guidelines on how to help doctors and patients make informed decisions. So, the Society for Integrative Oncology and ASCO joined forces to systematically evaluate published randomized clinical trials and systematic reviews with the goal of developing a set of very clear guidelines to help patients and clinicians make these informed decisions.
Healio: Who collaborated on this guideline?
Mao: We have panel members representing the diverse fields of medical oncology, surgical oncology, radiation oncology, palliative care, psychosocial oncology and integrative medicine. We also have patient advocates on the panel. We formed this diverse panel to provide a balanced and comprehensive view of this issue.
Healio: What were the key recommendations?
Mao: One key recommendation is that acupuncture should be offered to patients with breast cancer experiencing joint pain related to the use of aromatase inhibitors. This pain can be very debilitating and may cause women to stop their hormone therapy. So, this pain can not only impact quality of life, but can potentially also decrease overall survival. There was clear evidence that acupuncture has benefit in managing aromatase inhibitor-related pain.
The second recommendation is based on a very large trial published in JAMA Oncology, as well as other, smaller trials, advising that acupuncture may be offered to patients with cancer who experience musculoskeletal or general cancer pain.
The third recommendation is based on a large study conducted in patients with advanced cancer. From this, we concluded that massage therapy may be recommended for patients in a palliative care or hospice setting.
Healio: Do you recommend these interventions be given alone or in combination with other therapies?
Mao: The recommendations are meant to help patients and doctors make personalized decisions based on the evidence. In some settings, such as aromatase inhibitor-induced pain, acupuncture could potentially be used as first-line treatment, so patients wouldn’t necessarily need to take additional medications. In other settings, such as a palliative care or hospice, patients with cancer might already be on opioid therapy to manage very debilitating cancer-related pain. So, I would say in this setting massage should be added on rather than serve as a replacement.
Healio: What additional progress would you like to see in incorporating integrative medicine into oncology pain management?
Mao: This guideline very clearly summarizes the evidence, and our goal is to offer more options to patients, both pharmacologic and nonpharmacologic. I think this guideline truly serves that need. Also, in the process of reviewing the evidence, we identified many research gaps in terms of mind/body therapies like meditation or herbs and natural products. There were also research gaps in the pediatric population and in racial and ethnic minorities. So, I think this will require us to do more rigorous research that is inclusive and diverse, so we can incorporate more evidence-based treatments to help our patients.
I also would note that given the evidence we accumulated, I would also hope there will be more systemic insurance coverage from Medicare, Medicaid and commercial insurers, so patients can have access to these therapies regardless of socioeconomic background. Cancer is a very expensive disease, and we need to figure out how to help patients not only have a better chance of survival, but also have a good quality of life.
For more information:
Jun J. Mao, MD, MSCE, can be reached at: Memorial Sloan Kettering Cancer Center, 321 E. 61st St., Room 456, New York, NY 10065.
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