Desire for integrative therapies requires oncologists to go ‘beyond killing the tumor’
Click Here to Manage Email Alerts
Despite both patients and oncologists approving of complementary and integrative therapies as part of cancer management, a survey identified a disconnect between oncologists’ perception of patient interest and actual attitudes.
“There is a knowledge and communication gap,” Wayne Jonas, MD, president of Healing Works, a nonprofit devoted to integrating healing and curing in routine health care, told Healio. “Patients will go onto the internet or speak with their families and friends, but they don’t talk to their doctor about these approaches. What these surveys show is that the preferred timing of discussions around complementary therapies was quite different between oncologists and patients.”
In a survey conducted on behalf of the Healing Works Foundation, researchers asked more than 1,000 patients and 150 oncologists about complementary and supportive therapies such as nutrition counseling, exercise, massage and meditation. Jonas spoke with Healio about the disconnect that emerged from this research, the potential causes for this misunderstanding and how oncologists can work to close these gaps.
Healio: What inspired you to commission this study?
Jonas: We started this series of surveys because we’ve known that patients with cancer are interested in these approaches and because many of them are beneficial. Other surveys have looked at the use of these approaches by patients, and it’s substantial — anywhere from 50% to 80% of patients use some sort of complementary therapy. There has been growing interest among oncologists as well.
I teach medical students and residents, and I have seen that younger physicians are especially interested in these areas and in learning more about them. They see there is a growing science behind many of these therapies, especially when you broaden the discussion beyond individual modalities to whole-person care. There is accumulating body of evidence showing that whole-person care can influence the tumor microenvironment. Research shows that these therapies can influence both quality and quantity of life. We were involved in a study that was published last year in the Journal of Clinical Oncology showing that patients with breast cancer treated at cancer centers that did the minimum in terms of nutrition, stress management and exercise lived longer versus those treated in centers that did nothing. Evidence has emerged suggesting that these are not only good for how your patients feel, but it also increases their survival. For all those reasons, there is growing interest in paying attention to whole-person and complementary care.
Healio: What disconnect did your study identify between oncologists’ perceptions and patient attitudes?
Jonas: This is one of the first surveys that simultaneously tracked oncologists and patients with the same kind of questions. This allowed us to compare different interests and attitudes with parallel data. The results showed that patients were interested in having conversations about whole-person cancer care and wellness issues right from the beginning of their diagnosis. Two-thirds of patients expressed this interest, whereas two-thirds of oncologists felt they should talk about cancer treatment first, and then later discuss complementary or wellness therapies to mitigate side effects. So, there was a disconnect in terms of the timing as to when to offer such approaches. Oncologists were thinking patients wanted this later, but patients wanted it right away.
A second disconnect is that about one-third of oncologists continue to think patients are not interested in these approaches. In fact, only 13% of patients expressed a lack of interest. The bottom-line message here is that oncologists should ask patients about complementary therapies and discuss them early. They should make this part of their intake and planning from the beginning. Patients are looking for this sort of openness and interest from their oncologists.
Healio: Why would oncologists think patients are not interested in complementary therapies? Is it because they are hardwired to focus on treating the tumor?
Jonas: I think so, yes. The framework around cancer and cancer care is, once you make a diagnosis, you work to kill the tumor. That’s complicated enough. Oncologists often feel like their time is fully occupied by efforts to kill the tumor, and then if there’s something else patients would like to discuss later, the patient will bring it up. The reality is patients won’t bring these topics up unless they are asked about and given an opportunity to do so.
In addition, we now know more about the biology of cancer, and whole-person care influences that biology. Cancer development is a long process and evolves over time. Cancer biology involves the immune system, genetics, the environment, behavior and areas like the gut microbiome, which is influenced by the food we eat. Scientific research is filling in knowledge in many of these areas, and clinical practice has not caught up. Oncologists are starting to see this and wondering how to put this science into practice. That means going out and looking at the evidence beyond killing the tumor and integrating whole-person care into daily practice.
Healio: Why do patients hesitate to bring up complementary therapies with their clinicians?
Jonas: It’s a combination of factors. First, there is a major power differential between doctor and patient. The patient is dependent on the oncologist and their teams to deliver the cancer treatment. They don’t want to upset the apple cart, so to speak. They also know they have a limited time to speak with their oncologist during visits, and there might not be time to address these areas. As a result, the patient might decide to not ask about these approaches and stick with the basics of treating the cancer.
Another obstacle is that oncologists don’t know a lot about integrative and supportive therapies. We need more continuing medical education in these areas. Oncologists say they want to have this education, so we need to supply it.
The final thing is that the cost for many of these approaches is still out of pocket. Even services like nutrition and exercise are not covered as part of the usual package of care.
Healio: What can oncologist readers do to improve communication about integrative therapies?
Jonas: There are three things oncologists can do to make an immediate difference. Number one is to make sure there is time during a visit and permission to discuss these topics. We know patients are interested and they want to have this discussion. Creating some time to do that, and having your team back you up with support, is the first step. Oncologists can’t and don’t need to do it all, but teams and resources are usually available in many oncology centers. They can coordinate these services and make them available. Oncologists can have their nurses, nurse practitioners and medical assistants help patients access these services.
A second thing oncologists can do is educate themselves more about whole-person care. There are several ways to do this. I’ve written a comprehensive guidebook on whole-person cancer care with an oncologist from the VA. The book is called Healing and Cancer and will come out in April 2024. It discusses what we currently know and what the challenges and some solutions are for whole-person care. We’re also working with Tufts University to create a free CME program that oncologists can take to learn more about these approaches.
A third thing oncologists can do is review current guidelines for integrative and whole-person care and implement improvement processes to embed them into practice. ASCO and the Society of Integrative Oncology have come out with two new guidelines in the past year, and they have three more guidelines planned. Go to your clinic or hospital administrators and ask how these guidelines can be made routine at your institution.
Healio: Is there anything else you’d like to mention?
Jonas: We found in our survey that 55% of patients said that when they were considering a cancer center or hospital for their care, they would look to see if complementary therapies were offered as part of their decision-making process. Therefore, for hospitals trying to attract patients, it might be helpful for administrators to know that patients are basing their decisions on this. I would advise hospital administrators and oncologists to look at what they have available and make that known to the public. Many facilities have these offerings available and just need to coordinate their services to help them become routine. At our foundation, we are trying to make tools available so this can happen more easily.
References:
- Crudup T, et al. J Clin Oncol. 2021;doi:10.1200/JCO.2021.39.15_suppl.e18588.
- Jonas W. Support for integrative oncology grows. Available at: https://healingworksfoundation.org/cancersurvey2023/. Posted Oct. 12, 2023. Accessed Dec. 1, 2023.
For more information:
Wayne Jonas, MD, can be reached at Healing Works Foundation, 1800 Diagonal Road, Suite 642, Alexandria, VA 22314; email: wjonas@healingworksfoundation.org.
Visit Healio CME for Oncology activities
Collapse
Healio Interviews
Click Here to Manage Email Alerts