Most patients with cancer want to discuss integrative therapies before starting treatment
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Patients who have been diagnosed with cancer value interventions that address their mental and emotional well-being, according to results of a survey study.
“Patients don’t just want to have a longer life, they want to have a good quality of life,” Wayne Jonas, MD, executive director of Samueli Foundation’s Integrative Health Programs, told Healio. “Mental health is extremely important for patients, because cancer produces fear and distress.”
Oncologists, however, tend to remain more focused on curative treatment strategies during their initial time with patients.
The survey study, led by Jonas on behalf of Samueli Foundation, showed 62% of people with cancer wanted to know about complementary therapies such as exercise, nutritional counseling, massage and meditation when initiating conventional treatment However, only 33% of oncologists supported this timeline.
The survey included more than 1,000 patients diagnosed with cancer within the past 2 years, as well as 150 oncologists. It revealed that patients strongly prefer cancer care that integrates whole-person approaches. Moreover, 40% of patients with cancer stated that if they had the chance to do it again, they would have chosen a hospital that offered integrative therapies. Among oncologists, 76% indicated that they would like to learn more about complementary therapies.
Jonas spoke with Healio about the benefits of complementary and integrative therapies, the discrepancies between patient and oncologist attitudes, and the need to educate oncologists about the value of integrative care.
Healio: Why do you think there is such a gap between patient and oncologist attitudes toward complementary treatments?
Jonas: Physicians are busy treating the cancer, and that is their top priority — as it should be — but they often lose sight of the person in the process. Paying attention to the whole person is a challenge. That’s asking them to do more than they were trained and might have time for. In addition, they usually aren’t familiar with integrative medicine. Samueli Foundation has been running the Integrative Oncology Leadership Collaborative, which includes mainstream centers like Hopkins, Mayo Clinic and University of California, Irvine. We looked at current guidelines for oncologists from the National Comprehensive Cancer Network, ASCO and others. Many integrative approaches are already embedded in these guidelines. For example, a new guideline from the Society of Integrative Oncology and ASCO on pain management recommends many of these treatments.
It is a challenge to have a dialogue with patients about integrative services when you’re only focused on killing cancer cells. There are centers doing it, but they have to make a specific effort and that can be difficult, especially when you are ill. Among patients, there might be concern that if they ask their oncologist about these treatments, they might be told to avoid them or be dismissed or scolded. So, on both sides, there are reasons the conversation isn’t happening.
Healio: What are some of the barriers to patients accessing integrative care?
Jonas: One major barrier is a lack of clear, reliable information. If a patient goes on the internet and consults “Dr. Google,” they get a barrage of confusing and conflicting information. There are people claiming you can cure cancer through diet or some herb or other “magic bullet” treatment. Unfortunately, a number of people are anti-conventional care. It’s difficult for patients to sort out credible information from less reliable information. Many of the good, reliable resources are often technically not easy to understand.
Another factor is that patients don’t necessarily know where to get integrative care. Some hospitals have free supportive and integrative services for patients with cancer, but nobody at the oncology center is talking about these services, so patients might not be sure where to access them.
Payment is another issue. A patient might find that acupuncture, yoga or some kind of mind/body approach will be helpful, but these are often not covered by insurance. Financial toxicity is already a problem for patients in cancer care, and adding further expenses can exacerbate it.
Finally, I find that many patients don’t want to spend more time than necessary thinking about how to deal with their cancer, and spending time on more therapies causes that. Patients with cancer want to live a normal life and not be professional patients. They might be willing to participate in approaches like yoga and mind/body practices for general well-being but they don’t want to do them because of their cancer.
Healio: Why do patients with cancer have so much appreciation for complementary interventions that are not curative treatments?
Jonas: The general population has come to understand that caring for the whole person, not just treating the disease, is essential. For example, they may find mind/body practices are helpful to mental health. People hear the word “cancer” and may think, “I’m going to die.” A heart attack is also a threat, but you don’t generally have time to think about it. With cancer, you have a long time to think about it, and that fear is perpetuated through treatment and afterward. People worry about their labs and scans. So, the mitigation of fear becomes extremely important. That’s why mind/body practices and spiritual support are so important. We, as physicians and clinicians, need to give them skills for dealing with that fear and make sure we communicate about the cancer in a reassuring manner. We need to empower the patient to be their own advocate. If they feel like there is something they can do for themselves, they will feel less afraid.
Healio: Your study showed 76% of oncologists want to learn more about complementary therapies combined with traditional medicine. Do you think oncologists need further education in this area?
Jonas: I was happy to see that statistic and it surprised me the most. Not only did 76% of oncologists say they wanted to learn more about integrative medicine, over 60% said they thought complementary therapies were beneficial. The fact that two-thirds of oncologists want to learn more shows we need to provide ways for them to learn about it. They want to learn, but they face the same dilemmas as patients needing to know where to get good, reliable information. Oncologists get this information from organizations like ASCO and NCCN, and so I think those organizations should develop more educational tools in integrative oncology and provide CME credit for this education.
For more information:
Wayne Jonas, MD, can be reached at: Samueli Foundation, 6009 Beech Tree Drive, Alexandria, VA 22310; email: wjonas@samueli.org.
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US patient and oncologist awareness, usage & attitudes toward whole person Integrative oncology. Final report: Sept. 30, 2022 (update Oct. 7). Prepared for Samueli Foundation by Iqvia. Available at: healingworksfoundation.org/wp-content/uploads/2022/10/Samueli_Integrative-Oncology-Tracking-W1_Final-Report_7-Oct-2022.pdf. Accessed Jan. 9, 2023.
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