Page 56 - IDF Journal 2023

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IDF – Webinar Series IDF News – Spring 2023
Integrative Oncology
Whole Person Care for Optimising Patient Resilience and Clinical Outcomes
Dr Nina Fuller-Shavel
Integrative oncology (IO)
is a patient-centred field
of cancer care based on
a rational integration of conventional medicine with evidence-informed nutrition, lifestyle, psycho-emotional wellbeing and complementary approaches. The goal of integrative oncology is to support better quality of life, improve resilience, minimise the side effects of treatment and improve outcomes.
Integrative oncology
As we know, 1 in 2 people in the UK will be diagnosed with cancer during their lifespan. Beyond the need to improve outcomes, particularly in the face of dismal UK statistics compared to the rest of Europe, there is also a growing population of millions of cancer survivors with unique needs and consequent morbidity whom we need to support.
Integrative oncology (IO) offers us a broad toolkit for the complexity of cancer with
a rational synthesis of the best evidence- informed approaches in conventional, nutrition, lifestyle, psychological and complementary medicine1. It is whole- person oriented and addresses the physical, emotional, mental and spiritual needs of the individual. IO offers a sense of agency and empowerment to both patients and healthcare practitioners (HCPs), supporting self-efficacy and resilience instead of learned helplessness. Through a combination of approaches
in the IO toolkit we can support patients
throughout the cancer care continuum, starting with minimising cancer risk
and prehabilitation for better treatment tolerance and faster recovery, through to managing side effects of treatment and supporting better clinical outcomes, as well as caring for survivors and patients with metastatic disease.
The key foundations of support in IO start with nutrition, physical activity, sleep, psycho-emotional support and stress management2. Assessing and addressing these aspects has been shown to improve quality of life and may also affect survival and recurrence risk, depending on the cancer context3-8. Alongside
this, we would also look at both cancer and treatment impact to specifically alleviate symptoms and manage complications, choosing a combination of personalised interventions from an expanded toolkit that may include yoga or yoga therapy, acupuncture, and other complementary modalities2, 5, 9. We have a well-established and burgeoning body of evidence that integrative oncology approaches may improve symptom control and quality of life10-12. Going beyond that, several studies have now also demonstrated improvements in breast and gynaecological cancer survival with integrative oncology input13, 14 as a promising start to building the evidence base.
While IO would ideally be delivered in
a personalised, multidisciplinary team setting, where resources are limited, commissioning may consider group interventions, e.g. health coaching to support lifestyle changes (guided by qualified nutrition professionals who use up-to-date evidence), cancer exercise therapy, yoga and mindfulness-based interventions to support patients during treatment.
Safety is often seen as a stumbling block in adopting integrative oncology approaches, yet when IO is delivered under proper guidance from medical professionals through an expert multidisciplinary team, safety is placed
front and centre with a personalised assessment of risk-benefit2. However,
not offering integrative oncology input,
or not being open to discussions about
it in conventional oncology care, places more patients at risk, as they may find unregulated poor-quality information without any evidence base online and may then conceal what they do, exposing them to unnecessary risks.
IO in UK practice – an example
Integrative oncology is well-established in the US with many leading cancer centres providing integrative medicine input, e.g. Memorial Sloan Kettering Cancer Center, Banner MD Anderson and many others. However, it is relatively new to the UK due to the lack of resources in the NHS and lack of familiarity with this care model and IO evidence base.
At Synthesis Clinic, I run a medically led multidisciplinary, personalised medicine practice specialising in integrative
cancer care. We have established cross-referral pathways with several private oncology providers, seen as expert partners providing integrated
input from our team which includes medical, nutrition, physiotherapy, cancer exercise therapy and psycho-emotional wellbeing professionals. With our weekly MDT meetings to ensure alignment and effective secondary care collaboration, we deliver dynamic whole person support that is greatly valued by both our patients and our oncology partners.
Our recent breast cancer patient survey presented at the SIO Annual Conference in 2021 showed that only 25% of women attending our clinic felt that conventional care alone met their health needs.
100% of women rated their care at the clinic as very high/high quality, and all women surveyed felt that integrative cancer support has been extremely/very important in their overall care. The most common aspects identified as lacking in conventional care and better met through