Principles to Guide Integrative Oncology and the Development of an Evidence Base

Abstract

BackgroundIntegrative oncology uses both conventional and complementary medicine to meet the needs of individual patients and to focus on the whole person. The core principles of integrative oncology include individualization, holism, dynamism, synergism, and collaboration, but the nature of the evidence to guide the development of integrative oncology has been given little attention. Objectives• To discuss the need for evidence to support the integration of complementary therapies for integrative oncology care.• To emphasize that the evidence base must be valid and respect the underlying principles of individual complementary therapies and integrative oncology practice.• To suggest ways to begin developing the evidence base. Review and DiscussionAlthough the evidence for safety and efficacy seems paramount for supporting the integration of an individual complementary therapy into mainstream cancer care, the need for evidence to support the overall practice of integrative oncology has to be considered as well. We argue that developing an evidence base for integrative oncology requires a contextual and comprehensive research approach that assesses a range of outcomes over a suitable period of time that the patient and the patient's family, in addition to the health care providers, deem important. Conclusion KEY WORDSIntegrative oncology, evidence-based medicine, randomized controlled trials, whole-systems research

The Peter Brojde Lung Cancer Centre: A Model of Integrative Practice

“…In the future, evidenced-based combinations may include healing therapies such as Chinese herbs that are given as adjuvant therapy to prevent chemoresistance or depressed immune functioning. Those therapies, like medical treatments, are subject to change over time 13 .…”

“…The main challenge of the scientific evidence to date is the paucity of research findings based on whole-systems research, which has been identified as the appropriate methodology for evidenced-based integrative practice 13 . Although a few studies have begun to investigate patterns of interrelationships among preselected symptoms experienced by cancer patients 58,96 , the findings are at a very preliminary stage-as indeed is the whole field of cluster analysis.…”

“…Although the philosophy of integrative oncology is well described [10][11][12][13] , conceptual models in the literature tend to be lacking 12,[14][15][16] . A conceptual model describes the values, relevant concepts, scientific evidence, clinical approach, and theoretical underpinnings that direct clinical and research practice [17][18][19][20] .…”

“…Pragmatic designs are considered more appropriate for studies calling for a tailored, individualized intervention 13 . In a pragmatic trial, the question of overall effectiveness is evaluated, not the contributions of the individual components.…”

Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care

“…107 This kind of research is indeed useful and very important in establishing an evidence base for the use of CAM. 108 However, in the context of the myriad, complex multidimensional issues and concerns encountered on the cancer journey, most integrative oncology research remains largely confined to the reductionist paradigm, continuing to focus on smaller and smaller pieces of the puzzle while often missing the larger reality of what patients and families are actually wanting, needing, and experiencing.…”