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TCM and Integrative Oncology Practice in China During COVID-19
Yufei Yang MD*, Yun Xu MD, Lingyun Sun MD | Authors’ affiliation: Clinical Cancer Center, Xiyuan Hospital of China Academy of Chinese Medical Sciences | *corresponding author
March, 2020
Listen to Traditional Chinese Medicine and COVID-19 from Integrative Oncology Talk on Apple Podcasts.
- How are Chinese healthcare practitioners providing integrative oncology care while limiting risk of transmission?
Introduction:
Given the rapidly progressing global COVID-19 crisis, SIO leadership has decided to launch a COVID-19 column to specifically address our members’ needs. Our first interview is with Yufei Yang, MD, who is the director of integrative oncology at Beijing Xiyuan Hospital. We would like to learn from our Chinese colleagues’ recent advances in combating COVID-19. This is in keeping with SIO’s practice of facilitating opportunities to share our members’ experiences and perspectives. The following column represents Dr. Yang and her team’s views only.
- How are Chinese healthcare practitioners providing integrative oncology care while limiting risk of transmission?
COVID-19 has a higher rate of transmission compared to other infectious diseases such as SARS or MERS[1]. Because cancer patients often have suppressed immune systems, they may have higher risks of being infected. As such, it is imperative that cancer patients protect themselves by practicing social distancing. However, patients still need treatments for both cancer control and symptom management during this time. In China, about 80% of cancer patients receive Traditional Chinese Medicine (TCM) treatments, including herbal medicine, patent Chinese medicine, and acupuncture. To address these needs, we have certain procedures that provide TCM services to cancer patients while limiting the risk of transmission during the COVID-19 outbreak.
During COVID-19 outbreak, most TCM hospitals and their oncology departments outside Hubei province continuously accepted patients. At that time, admission was limited to local patients only. To be treated, patients first needed to undergo COVID-19 screening, which included history taking and relevant symptom screening. The patients who needed hospitalization underwent chest CT scans as well. Meanwhile, it was critical that every corner of the hospital be sterilized. Both doctors and patients wore masks and recorded their body temperature at least twice daily. For TCM services, even though we could not offer acupuncture or massage treatment that requires direct patient contact, we recommended TCM herbal medicine and patent Chinese medicine (patent Chinese medicine is commercialized TCM products of certain dosage approved by the National Medical Products Administration).
In China, many cancer patients receive TCM treatments in big cities such as Beijing, Shanghai and Guangzhou. Since the COVID-19 outbreak, many patients could not visit their doctors because of transportation and hospitalization restrictions. For these patients, online remote TCM consultations, services and educational programs were used. To the best of our knowledge, there are more than ten online apps that offer such services in China. Patients could also contact their TCM doctors through hospitals’ official websites. To help more cancer patients get through this crisis, some TCM doctors waived fees for online consultations. In Xiyuan Hospital of China Academy of Chinese Medical Sciences, staff helped patients by home delivering prescribed TCM herbs and other medicine.
- What have been the challenges and facilitators of integrative oncology care during the COVID-19 pandemic?
As mentioned above, transportation limitations and other restrictive policies presented the biggest challenge for us to provide TCM services to cancer patients, both outpatients and inpatients, during the COVID-19 outbreak. Nonetheless, there were still opportunities for TCM and other integrative oncology interventions such as mind-body therapies like Taichi/Qigong, to play an even more important role in helping cancer patients weather this outbreak[2]. Patients whose cancer treatments were delayed or changed because of the COVID-19 outbreak had greater need for TCM interventions to control cancer-related or treatment-induced symptoms. Some TCM herbs or patent Chinese medicines with anti-tumor effects could be used for advanced cancer patients who needed timely chemo or radiotherapy to reduce their cancer burden. This echoed some western medicine oncologists’ recommendations in China on the management of cancer treatments during this period. This was also met with a high receptivity of cancer patients in China towards using TCM to protect themselves from COVID-19.
Since TCM plays an important role in the treatment of COVID-19, more Chinese cancer patients were confident and willing to utilize TCM for their treatments. TCM methods such as Taichi/Qigong could be practiced inside the home and were welcomed by many cancer patients to help strengthen their essential Qi, or vital life energy. From one of our ongoing multi-center clinical trials in China, we found that stage II/III colon cancer patients from TCM hospitals or integrative oncology departments were less likely to have adjuvant chemotherapy delays related to COVID-19.
- What practices have been found helpful in supporting cancer patients affected by COVID-19 in China?
A national study of 1,590 COVID-19 patients in China showed a higher incidence of COVID-19 infections among cancer patients (1%), compared to the general population (0.29%). If they were infected by the virus, cancer patients usually had worse medical conditions and worse adverse events (death or ventilator requirement) than those without[3]. This emphasized the importance of self-protection for cancer patients during COVID-19 outbreak. Staying at home is a relatively safer and better choice for them.
However, it is a dilemma that cancer treatments are usually time dependent, and just waiting at home could make many cancer patients feel anxious and helpless. As mentioned above, our multi-center RCT showed that over 50% of stage II/III colon cancer patients experienced delayed or changed treatment regimens, mainly due to hospitalization policies and transportation restrictions during this period. The real number of cancer patients who have been affected by the epidemic may exceed current estimations. For cancer patients who were waiting for scheduled surgery and adjuvant chemotherapy, as well as for cancer survivors, our recommendation was to hold off treatment for now and stay at home to reduce the risk of becoming infected. Emotional support from their families and caregivers, as well as online patient education and remote consultation were very important in reducing cancer patients’ concerns and worries. For patients with advanced diseases who need timely chemo or radiotherapy, we suggested they receive treatments locally instead of traveling to the larger cities, and that their disease progression be evaluated as scheduled locally. For patients needing palliative and supportive care, we suggested that healthcare providers offer them psychological support and emergency room referrals if needed.
- What integrative medicine practices are being used in China to address the effects of COVID-19?
First of all, integrative medicine practices and TCM play a role in disease prevention, especially in vulnerable populations. From the perspective of TCM theory, the principle of ‘preventive treatment of diseases’ takes priority. Since the outbreak of COVID-19, TCM experts have collected and analyzed data on TCM characteristics of COVID-19 patients in WuHan. According to this data and experience, TCM experts in China quickly reached a consensus that the disease was highly correlated with TCM syndrome and the pathogenic factor of dampness. Thus, during COVID-outbreak, prevention methods such as herbal teas were widely used around China to prevent the infection by strengthening the body’s essential Qi of the Lung and Spleen, as well as eliminating pathogenic factors such as dampness, wind, cold or heat. However, such preventative methods need to be adjusted based on season, location and climate. In addition, mind-body therapies such as yoga and Taichi/Qigong are also useful as practical disease preventions, especially for those who stay at home.
TCM played a very important role in the treatment of COVID-19 patients in China during this pandemic [4]. Since January 2020, over 4,900 TCM doctors or nurses have rushed to support the Hubei province, taking charge of several hospitals, wards and temporary mobile hospitals in WuHan. According to data released from the Information Office of the State Council press conference on March 23rd 2020, 91.5% of all COVID-19 patients in China have utilized TCM herbal medicine or patent Chinese medicine for treatment of mild disease, assistance in the treatment of severe cases, and the rehabilitation of the patients who have recovered. The overall effectiveness rate of TCM treatments for COVID-19 was 90%[5]. None of the patients with mild diseases in temporary mobile hospitals developed severe disease after TCM intervention. For severe cases, the concurrent use of TCM reduced the use of hormone and antibiotic drugs as well as the death rate of the disease. Recently, Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7) has been published in both Chinese and English. It introduced TCM regimens for different types and phases of the disease and highlighted three patent Chinese medicines ‘Jinhua-Qinggan Granule’ (金花清感颗粒), ‘Lianhua-Qingwen Capsule’ (连花清瘟胶囊), ‘Xuebijing injection’（血必净注射液）, and three prescriptions ‘Qingfei-Paidu Formula’（清肺排毒方), ‘Xuangfei-Baidu Formula’(宣肺败毒方),‘Huashi-Baidu Formula’(化湿败毒方)[6]. There are several ongoing registered randomized clinical trials on these TCM herbal medicine decoctions’ efficacy in treating COVID-19 and related symptoms in China. Acupuncture, Taichhi/Qigong (such as Baduanjin), and even dancing were also used by infected patient populations to relieve symptoms such as anxiety and dyspnea, and to promote quality of life during hospitalization.
- Is there any data yet on the use of TCM to prevent COVID-19 infection (or reduce its severity) in cancer survivors?
So far, to the best of our knowledge, there is no existing evidence on TCM’s ability to prevent COVID-19 infection in cancer patients[7]. However, in our clinical practices, we have been providing TCM preventative herbal medicine for cancer patients since they are immune-suppressed and vulnerable to infection. The herbal medicine is manufactured into granules, which are easily administered. Many cancer patients have reported that the medicine is useful in relieving symptoms of the common cold and fever. Experts from Hubei province published a consensus on prevention of COVID-19 for cancer patients by utilizing integrative Chinese medicine and western medicine, including daily prevention methods, TCM herbs and other TCM intervention such as moxibustion, massage, and auricular acupressure[8].
Are there specific TCM botanical combinations or practices that can address the buildup of pulmonary fibrosis due to COVID-19 infection in any patient population?
What advice would you have for providers in countries now facing an increase in cases, based on your experience in China?
References
1. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, Zhang LJ: Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology 2020:200490.
2. Yang G, Zhang H, Yang Y: Challenges and Countermeasures of Integrative Cancer Therapy in the Epidemic of COVID-19. Integr Cancer Ther 2020, 19:1534735420912811.
3. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, Li C, Ai Q, Lu W, Liang H et al: Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. The Lancet Oncology 2020.
4. Chan KW, Wong VT, Tang SCW: COVID-19: An Update on the Epidemiological, Clinical, Preventive and Therapeutic Evidence and Guidelines of Integrative Chinese-Western Medicine for the Management of 2019 Novel Coronavirus Disease. Am J Chin Med 2020:1-26.
5. Council IOotS: Press Conference on Traditional Chinese Medicine’s Important Role on Prevention and Treatment of COVID-19 andis effective drug In.: Information Office of the State Council; 2020.
6. Medicine SAoTC: Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7). In.; 2020.
7. Luo H, Tang QL, Shang YX, Liang SB, Yang M, Robinson N, Liu JP: Can Chinese Medicine Be Used for Prevention of Corona Virus Disease 2019 (COVID-19)? A Review of Historical Classics, Research Evidence and Current Prevention Programs. Chinese journal of integrative medicine 2020.
8. Z. H: Expert consensus on novel coronavirus pneumonia during the epidemic period in Hubei area: Integrated Traditional Chinese and Western medicine prevention and rehabilitation (First Edition). Herald of Medicine 2020:1-8.
9. Wang T HL, Wang Y, et al.: Research progress of Chinese patent medicine in the treatment of viral pneumonia. Chinese Journal of traditional Chinese Medicine 2020:1-7.
10. Li C ZX, Liu S, Shang H: Novel coronavirus pneumonia (COVID-19) evidence and research prospect of Xuebijing Injection. World science and technology modernization of traditional Chinese Medicine 2020:1-6.
11. Bian Y MJ, Ren Y, et al.: Based on VEGFR and FGFR, to explore the intervention effect of traditional Chinese medicine on pulmonary fibrosis in the sequelae of covid-19. Chinese Journal of traditional Chinese Medicine 2020:1-8.
Reflections on COVID-19 Rotation, by Ting Bao, MD, DABMA
May, 2020
Dear SIO Friends:
As I write to you, I am happy to report I have just completed a seven-day rotation at the COVID-19 inpatient service at my hospital in New York City! Overall, it was a positive experience, despite the occasional sad and scary moments. I left the service feeling uplifted and fulfilled. I am glad to have been on the front line of the war against this life-changing virus, making my contribution.
The most important lesson I have learned through this unique experience is things are not as bad as I thought they would be. I started the service with eleven patients; all were COVID-19 positive with cancer. Most of them had received chemotherapy within the previous two weeks, and some had low white cell counts and other co-morbidities. I thought most of them might deteriorate rapidly, and found with amazement that nine patients remained stable and got better over the next seven days. Among them, seven went home and two remained in the hospital with minimal COVID-19 symptoms, but waiting for placement. Two elderly end stage cancer patients ultimately passed away peacefully, with their family members able to visit the bedside one by one. I am glad our hospital was able to make the exception for our dying COVID-19 positive patients by allowing their family members to pay tribute as the end approached. As such, it makes this process much more humane and tolerable.
We admitted eight new patients over the week. Six were quite stable on the floor and would be going home soon. One patient quickly went to the ICU the same day of admission, but miraculously did not require intubation, improved significantly over two days, came back to the regular floor, and was discharged home three days later. Another patient with metastatic cancer, who had received chemotherapy about ten days prior, came in with COVID-19-induced respiratory failure. Initially he was classified “Do Not Resuscitate/Do Not Intubate” after extensive discussion with the family about his poor prognosis and essentially zero chance of coming off the ventilator. The family members then reversed his code status back to full code (requiring chest compression and intubation) when he was actively dying.
The whole process was very painful for everyone, especially the family members. My observation is that COVID-19 significantly shortened the time remaining for some of our end stage cancer patients, and often the family members were not ready for the inevitable end, not having had time to fully process their impending loss. We must be supportive in these cases, and should call in psychosocial support for the family when available.
Even though my service is over, there are a few moments that keep resurfacing in my mind.
Heartwarming moment: One of the infectious disease (ID) attendings not only saw patients and gave advice on COVID-19 management, but also helped us with code status discussion (Discussing Resuscitation Preferences), which is completely above and beyond her duty. One of our patients was not a native English speaker, but this ID attending happened to speak the patient’s language. She helped us clarify the patient’s code status while spending lots of time in the room with the patient, not worrying about her own risk of being infected at all. When I thanked her for doing this, she responded, “No problem. He reminded me of my dad.”
Nerve wracking moment: On my second day in the COVID-19 service, during our afternoon call, the resident told me the new intern was sent home early because of shortness of breath. The intern had just come off the ICU rotation in a busy COVID-19 hospital two days before. While listening, my mind was racing, recalling every moment I was standing close to her, touching her phone while talking to our patients. Over the next few hours while her COVID-19 test was pending, I tried to recall what I did after my close contact with her over the previous two days, almost reliving every moment, preparing for the worst, and considering what to do if she tested positive. Finally, her COVID-19 test result was negative. I was so relieved.
Heartbreaking moment: “Why don’t you monitor his heart rate? His oxygen level?” the patient’s daughter came out of the room, asking us with teary eyes.
My reply: “Because he is actively dying. He has too many underlying conditions and now severe respiratory distress.”
“But he is a fighter. It just takes a few days, then he will get better. He will overcome this.”
Again: “He is actively dying. We are trying to make him comfortable. Look, he is very comfortable.”
“He will get better, he will get better.” She started crying, I got teary too, for her, and for the helpless situation.
Before I knew it, the rotation was over and I am back to normal life. No more wearing scrubs, rushing to the hospital; no more wearing double-layered face masks that would leave a mark on my nose and face; no more FaceTiming with the patient right outside the room; no more going back and forth to the laundry room four times per day; no more wondering every time anyone around me sneezed, coughed, or complained of sore throat, D’id I catch it? Did I spread it to my family?’ I am glad I worked on the front line and helped some COVID-19 patients. I am no longer living in fear that most of my cancer patients will die if they catch COVID-19, as I have seen that truly, most of them got better with time and treatment. I will continue to be cautious, though, as some of them could get very sick and die quickly.
The best moments usually came at 7pm everyday, when my daughter would join her friends on our building’s terrace, cheering for the health care providers. She would always add a sentence at the end, “I am cheering for my mom! She took care of COVID-19 patients!”
Stay safe and well. Let us stay connected during this isolating pandemic.
Ting Bao, MD, DABMA, MS
President
COVID Announcements & Calls to Action
SIO Fundraising Initiative for the Navajo Nation
The current COVID-19 pandemic has acutely affected the Navajo Nation, which lives in a region spanning parts of Arizona, Utah and New Mexico. Historically, the Navajo People have suffered high rates of diabetes, cardiovascular disease and cancer, all of which contribute to increased risk for poorer COVID-19 outcomes.
For decades, tribal land has been left without basic infrastructures such as running water, electricity and paved roads.
The Indian Health Service has been chronically underfunded, and the Tuba City Regional Healthcare Corporation is the only cancer treatment location on any Native American soil. The SIO is honored to present this support initiative. Donations will go directly to Tuba City Regional Healthcare through the Cancer Support Community donation page, and will be used for essential healthcare needs such as PPE for staff and hand sanitizer. Please join us in this opportunity to improve the lives of those who suffer such health disparities. Read the complete article.
For more information, please see links below, or visit SIO’s Donation Page to contribute.
“COVID-19 Ravaging the Navajo Nation”
by Mary Hasbah Roessel, MD; June 09, 2020 https://www.medscape.com/viewarticle/932019
“Native Americans Need More Funding to Battle COVID-19, Lawmakers Told” MedPage Today, June 12, 2020
https://www.medpagetoday.com/infectiousdisease/covid19/87032
Tuba City Regional Healthcare Corporation COVID-19 Supplies Needed
ASCO Endorses 2017 SIO Breast Cancer Guideline
The American Society of Clinical Oncology (ASCO) has endorsed, with a few added discussion points, the Society for Integrative Oncology (SIO) evidence-based clinical practice guidelines on integrative therapies during and after breast cancer treatment.
The ASCO endorsement was announced on June 11 and published in the Journal of Clinical Oncology, “Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline.” The ASCO Expert Panel determined that the recommendations in the SIO guideline are clear, thorough, and based on the most relevant scientific evidence. In the SIO guideline, the researchers evaluated more than 80 different integrative therapies and developed grades of evidence based on the latest research.
“We are delighted to receive the ASCO endorsement if this important resource,” said SIO President Lynda Balneaves, PhD, RN. “This furthers our goal to provide clinicians and patients with practical information and tools to make informed decisions on whether and how to use a specific integrative therapy for a specific clinical application during and after breast cancer treatment,” On behalf of SIO, she expressed appreciation to the many members involved in developing the guidelines, from multiple health disciplines and international institutions.
Published in 2017 in CA: A Cancer Journal for Clinicians, the SIO guidelines were based on an analysis of peer-reviewed randomized controlled trials conducted from 1990 through 2013. Studies had to include more than 50 percent breast cancer patients or separately report results for breast cancer patients; use an integrative therapy as an intervention during standard treatment or address symptoms and side effects resulting from diagnosis and/or treatment of cancer; and address an endpoint of clinical relevance for breast cancer patients and survivors.
Heather Greenlee, ND, PhD, a past president of SIO and co-chair of the SIO guideline task force, called the ASCO endorsement a “very important step for the field of integrative oncology.” She pointed to the rigor with which the guidelines were written and reviewed. The ASCO panel further critically reviewed and updated the evidence supporting the recommendations presented in the current guideline endorsement. “We looked at all of this with a critical eye,” she said. “We have a very high bar and followed a very rigorous process with both the SIO and ASCO to evaluate these therapies. There were many different disciplinary eyes vetting them.”
SIO/ASCO collaboration on series of evidence-based guidelines in 2021-22
SIO announces collaboration with the American Society of Clinical Oncology (ASCO) to develop two new evidence based guidelines in 2021 and 2022
WASHINGTON (October 27, 2020) – The Society for Integrative Oncology announced today that it is collaborating with the American Society of Clinical Oncology, Inc. (ASCO®), the world’s leading professional organization of its kind representing oncology professionals who care for people living with cancer, to develop a series of evidence-based clinical practice guidelines for integrative therapies in oncology care. The guidelines, planned for publication in 2021 and 2022, will provide clinicians and patients much-needed guidance on safely and effectively treating common cancer symptoms and side effects using integrative approaches.
“It is critical to separate evidence-based, integrative health approaches from those without evidence,” said Ting Bao, MD, DAMBA, MS, president of SIO. “These guidelines will help the cancer community ensure safe, effective use of integrative approaches for managing patients’ cancer-related symptoms.”
The majority of people with cancer seek out integrative therapies sometime after receiving their diagnosis. Integrative health approaches during cancer care are patient-centered treatments that utilize evidence-informed mind and body practices, natural products, and/or lifestyle modifications from various traditions, alongside conventional cancer treatments.
“We are delighted to collaborate with SIO on the development of evidence-based guidelines that will help optimize the care of patients with cancer using therapies complementary to cancer treatment,” said Chair of the ASCO® Clinical Practice Guidelines Committee, Douglas E. Peterson, DMD, PhD. “The guidelines will focus on important concerns in patient care that greatly impact quality of life, and will help equip the oncology community with the essential knowledge needed to manage integrative therapy approaches.”
SIO and ASCO® will convene independent panels of experts representing members of both societies to produce a series of three evidence-based guidelines for adults focusing on cancer-related pain management, fatigue in cancer survivors, and care of anxiety and depressive symptoms experienced by those with cancer. The topics were selected based on expert consensus and surveys of SIO’s membership. Each expert panel will review published literature, including systematic reviews and existing guidelines. The expert panels will outline and recommend evidence-based integrative therapies to use, as well as caution against ineffective or harmful approaches, for specific clinical indications during and after cancer treatment.
“Many patients already use integrative approaches during and after their cancer treatment, but medical decisions need to be made based on firm science,” said Heather Greenlee, ND, PhD, co-chair of SIO’s Clinical Practice Guidelines Committee. “By co-developing these clinical guidelines, SIO and ASCO® will help bring this evidence-based treatment information to patients and oncologists worldwide, so they can wisely allocate resources to the most effective complementary approaches.”
SIO received an unrestricted grant to fund guideline development from the Samueli Foundation.
ASCO® is a registered trademark of the American Society of Clinical Oncology, Inc. and is used with permission. ASCO is not a partner or affiliate of SIO and does not recommend or endorse any organization, product, or service.
About The Society for Integrative Oncology:
Founded in 2003, SIO is the premier multi-disciplinary international professional organization for integrative oncology. The mission of the SIO is to advance evidence-based, comprehensive, integrative healthcare to improve the lives of people affected by cancer. SIO enables communication, education, and research to occur by bringing together practitioners and researchers across professions focused on the care of cancer patients and survivors. Members share the common goals of excellent comprehensive patient care, enhancement of anti-cancer therapy, supportive care, and prevention of cancer. SIO members are part of a unique multidisciplinary community of oncologists, nurses, psychologists, social workers, nutritionists, complementary therapy practitioners, naturopathic doctors, acupuncturists, massage therapists, epidemiologists, researchers, and many other health care practitioners. Learn more at https://integrativeonc.org/, and follow us on Facebook, Twitter, LinkedIn, and YouTube.
CONTACT: Tamara Moore, 202-868-4008
October 27, 2020 tmoore@thereisgroup.com
SIO Announces Guidelines in Progress as of December 2022
Fatigue
Anxiety/Depression
Sleep Management
SIO/ASCO New Recommendations for use of Integrative Therapies for Pain Management
FOR IMMEDIATE RELEASE:
CONTACT: Hanna Hayden
September 19, 2022 hhayden@thereisgroup.com
New recommendations address the use of integrative therapies for pain management in cancer populations
The joint practice guideline results from a partnership between the Society for Integrative Oncology and the American Society of Clinical Oncology
WASHINGTON, D.C. (September 19, 2022)—A new joint practice guideline from the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology, Inc. (ASCO®) has been published to address gaps in healthcare providers’ knowledge of how to safely and effectively treat common cancer symptoms and side effects using integrative medicine approaches.
“Pain is a clinical challenge for many oncology patients and clinicians, and there’s a growing body of evidence showing that integrative therapies can be useful in pain management. But to date there has not been clear clinical guidance about when and when not to use these approaches,” said Heather Greenlee, ND, PhD, co-chair of the SIO Clinical Practice Guideline Committee.
SIO joined forces with ASCO to develop a clinical practice guideline on the use of integrative therapies and pain management, building off of ASCO’s existing guideline focused on cancer pain. “This new guideline takes a deeper dive on the use of integrative therapies, which is important because clinicians and patients need to have access to the latest evidence-based information to make clinical decisions,” said Jun J. Mao, MD, MSCE, co-chair of the SIO-ASCO guideline on use of integrative therapies for pain management.
Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.
“Practice guidelines are a critical way to ensure healthcare providers use treatments that are based on quality evidence from scientific studies that have shown the treatment to be effective and safe,” said Immediate Past Chair of the ASCO® Evidence-Based Medicine Committee, Scott T. Tagawa, MD, MS, FACP. “The guidelines focus on important concerns in patient care that greatly impact quality of life and will help equip the oncology community with the essential knowledge needed to manage integrative therapy approaches.”
The SIO-ASCO guideline was developed following a rigorous review of published literature, including literature only from randomized clinical trials—the gold standard in healthcare research. A large panel of oncology experts was convened, co-chaired by Jun J. Mao, MD, MSCE, of Memorial Sloan Kettering Cancer Center representing SIO, and Eduardo Bruera, MD, of MD Anderson Cancer Center representing ASCO. The panel reviewed existing evidence and assessed the quality of studies; once consensus was reached, recommendations were made based on the strength of the evidence available.
Among the guideline’s strongest recommendations are that acupuncture be offered to breast cancer patients experiencing joint pain related to the use of a medication common in breast oncology called aromatase inhibitors. Because there was moderately strong evidence supporting its effectiveness and its low risk of harm, the expert panel also recommended acupuncture for general cancer pain or musculoskeletal pain as well as for chemotherapy-induced peripheral neuropathy.
The guideline also recommends the use of massage therapy for patients in palliative care or hospice who are experiencing pain.
“Clinician uptake of evidence-based treatments is always a concern, which is one of the reasons why we create practice guidelines,” said Dr. Bruera. “We are hoping that by showing the growing evidence that is out there, healthcare systems will start hiring these kinds of practitioners and insurance systems will start covering these treatments, because more and more, these are being shown to be effective at managing pain for cancer populations.”
Because the expert panel was conservative in making their recommendations, the guideline also includes areas identified as potentially relevant to cancer care but needing more research. This distinction is important because the lack of endorsement for a given therapy is not an indication that the therapy is necessarily ineffective or unsafe. Rather, it indicates that the expert panel felt the evidence was insufficient to support its recommendation. For instance, said Dr. Greenlee, more studies are needed to assess the safety and effectiveness of natural products.
To ensure patients can play a role in the treatment decision-making process and to inform their discussions about integrative therapies with their oncologists, ASCO and SIO have also posted a listing of integrative medicine patient resources on their respective websites.
“This is the first of three evidence-based guidelines for adults that SIO and ASCO are developing together, which combines the strengths of these two organizations,” added Linda E. Carlson, PhD, President of SIO. “The goal of this important collaboration is to inform as many clinicians and patients as possible about where the evidence for integrative therapies lies to support the best clinical outcomes possible for all cancer patients. And we believe this new guideline accomplishes that.”
SIO received an unrestricted grant to fund guideline development from the Samueli Foundation.
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ASCO® is a registered trademark of the American Society of Clinical Oncology, Inc. and is used with permission. ASCO is not a partner or affiliate of SIO and does not recommend or endorse any organization, product, or service.
About The Society for Integrative Oncology:
Founded in 2003, SIO is the premier multi-disciplinary international professional organization for integrative oncology. The mission of the SIO is to advance evidence-based, comprehensive, integrative healthcare to improve the lives of people affected by cancer. SIO enables communication, education, and research to occur by bringing together practitioners and researchers across professions focused on the care of cancer patients and survivors. Members share the common goals of excellent comprehensive patient care, enhancement of anti-cancer therapy, supportive care, and prevention of cancer. SIO members are part of a unique multidisciplinary community of oncologists, nurses, psychologists, social workers, nutritionists, complementary therapy practitioners, naturopathic doctors, acupuncturists, massage therapists, epidemiologists, researchers, and many other health care practitioners. Learn more at https://integrativeonc.org/, and follow us on Facebook, Twitter, LinkedIn, Instagram, and YouTube.
You can find the PDF version of the press release here.
MD Anderson Cancer Center’s Integrative Medicine Program Virtual Workshop: May 18 & 19
Date: May 18 & 19, 2023
Time: 8 a.m.-1 p.m. CT
Registration: Click here to register
The Integrative Medicine Program Virtual Workshop is designed for healthcare professionals interested in learning more about integrative medicine in a comprehensive cancer center. The primary goal of the program is to expose the participant to key aspects of Integrative Oncology at The University of Texas MD Anderson Cancer Center. The Workshop will be conducted via Zoom.
– Learn tools to help you establish an integrative oncology program
– Gain key insights into our clinical programs and operations, research, and education programs
– Learn effective strategies for hybrid clinical delivery models combining in-person and telehealth
– Meet and interact with program leaders and faculty
– Virtual tour of our Integrative Medicine Center facilities
Hosted by
Lorenzo Cohen, PhD | Professor and Director | Integrative Medicine Program
and
Gabriel Lopez, MD | Associate Professor and Center Medical Director | Integrative Medicine Center
Registration: Click here to register
Registration Fee: $250.00 US dollars
Contact Person: Tameka Sneed at
IntegrativeMed@mdanderson.org
Tribute to Founding President of the Society for Integrative Oncology
Tribute to Barrie Cassileth, PhD
Founding President of the Society for Integrative Oncology
Founding Chief of the Memorial Sloan Kettering Cancer Center (MSK) Integrative Medicine Service (IMS) First Laurance S. Rockefeller Chair in Integrative Medicine.
Founding Member of the Advisory Council to the National Institute of Health’s Office of Alternative Medicine, now the National Center for Complementary and Integrative Health
Member, National and the NY–NJ Regional Boards of the American Cancer Society
It is with great sadness that we announce the passing of Dr. Barrie Cassileth, founding president of the Society for Integrative Oncology (SIO). “Dr. Cassileth was one of the most elegant, hardworking, and caring women I have ever met,” Ting Bao, MD, DABMA, MS, the director of Integrative Breast Oncology at MSK and Immediate Past-President of SIO, said of her mentor. “It is amazing how much the field of integrative medicine has developed over the past twenty years; this progress would have not been possible without her. We will all miss her greatly.”
From the beginning days of the Society in 2003, Dr. Cassileth sowed the seeds of research, education, international outreach, and the value of the patient voice, which grew into the thriving SIO of 2022. The Society is still prioritizing these goals as it leads the way towards comprehensive, evidence-informed, integrative oncology care to improve the lives of people with cancer worldwide.
Dr. Cassileth was also the founding Chief of the Memorial Sloan Kettering Cancer Center (MSK) Integrative Medicine Service (IMS) and the first Laurance S. Rockefeller Chair in Integrative Medicine. “Dr. Cassileth had great courage and vision,” said Jun J. Mao, MD, MSCE, the current Chief of Integrative Medicine at MSK and SIO Past President, who also described how Dr. Cassileth’s seminal work in clinical programming and research opened doors for the field of evidence-informed integrative oncology.
Importantly, Dr. Cassileth oversaw the development of the first of a series of integrative oncology clinical practice guidelines, which continue to be developed today by SIO in collaboration with mainstream organizations such as the American Society for Clinical Oncology (ASCO). As Dr. Cassileth explained in a 2017 ASCO Post interview, “My strong belief in the necessity of helping patients and family members, as well as physicians and staff, participate in cancer research spurred me on. It was always clear that patients and family members need more than excellent surgery, chemotherapy, radiation, and all the new treatments.”
Born in Philadelphia, Dr. Cassileth attended Bennington College in Vermont, which she described as “a cauldron of intellectual freedom.” She earned a PhD in medical sociology at the University of Pennsylvania while working in the UPenn Comprehensive Cancer Center’s inpatient unit for people with leukemia, where she was deeply affected by her interaction with patients who were in the end-stages of the disease. It was at UPenn that she also initiated the first palliative care program that included psychosocial therapies in an academic setting in the US.
After a period of years in North Carolina, where she was appointed Consulting Professor of Community and Family Medicine at Duke, she was recruited in 1999 by Memorial Sloan Kettering Cancer Center (MSK) in New York City to develop an integrative medicine program. This program, the Integrative Medicine Service at MSK, still offers complementary therapies to inpatients at the main MSK hospital as well as outpatient services and is still conducting practice-changing research in integrative oncology.
It was partly the need for scientifically robust clinical research supporting the use of complementary therapies to manage symptoms and side effects of cancer and its treatment that inspired Dr. Cassileth to found the Society for Integrative Oncology in 2003. She invited like-minded pioneers in research who were also committed to improving the lives of people with cancer. These fellow integrative medicine research pioneers became the founding members of SIO and its first presidents, David Rosenthal, MD; Debu Tripathy, MD; Peter Johnstone, MD; and Lorenzo Cohen, PhD.
During her long career, Dr. Cassileth published several books, from The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies in 1998 to The Complete Guide to Complementary Therapies in Cancer Care in 2011, and, in 2014, Survivorship: Living Well During and After Cancer.
Next year, SIO will celebrate its Twentieth Anniversary at the 20th International Conference in Banff, Alberta. Today, as we carry forward the mission of SIO, we gratefully offer this tribute to Dr. Barrie Cassileth, the kind, brilliant, and visionary founding president of the Society for Integrative Oncology.
Open Access: The Society for Integrative Oncology: Two Decades of Global Leadership in Evidence-Based Integrative Health Care
The Society for Integrative Oncology: Two Decades of Global Leadership in Evidence-Based Integrative Health Care
The first column by SIO Leadership in the Journal of Integrative and Complementary Medicine (JICM), features the latest expert column, “The Society for Integrative Oncology: Two Decades of Global Leadership in Evidence-Based Integrative Health Care”. The paper is available Open Access from November 3rd through the 17th, 2022 online here.
Open Access: Integrative oncology: Addressing the global challenges of cancer prevention and treatment
SIO leaders have co-authored a defining international publication alongside key stakeholders from NIH, WHO, Europe, and countries such as Brazil, Argentina, and India. Titled “Integrative oncology: Addressing the global challenges of cancer prevention and treatment”, the open-access article was published in CA: A Cancer Journal for Clinicians. Corresponding author and SIO Past-President, Jun J. Mao, MD, MSCE, Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center writes, “We advocate for using SIO’s integrative oncology framework to further develop this field to meet the global challenges of cancer control.” This publication builds on the momentum of global collaboration demonstrated at the September 2021 SIO 18th International Conference, during which oncology leaders from countries around the world discussed priorities for improving oncology outcomes worldwide.
Find the link to the article here.
Dr. Jun Mao on Good Morning America
August 6, 2021
Dr. Jun Mao, SIO Past President and current SIO Trustee, comments on cancer patients who have struggled with addiction in the past and how it affects their pain management.
Listen to Dr. Jun Mao on Good Morning America here, and where Kathy Griffin opens up about her treatment after lung cancer surgery.
SIO Offers Membership Scholarship
SIO Membership Scholarship is an opportunity to provide assistance to individuals whose financial circumstances are such that full payment of membership dues would pose a financial hardship. Please download and complete the SIO Membership Scholarship Application and email to: info@integrativeonc.org.