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June 2023 Newswire

Written by Greenleaf on . Posted in newswire. No Comments on June 2023 Newswire

Message from the President

Linda C Headshot30

Dear SIO Members and Friends,

I usually begin these monthly updates with photos of my outdoor adventures over the past month, but this month has been a voyage of another kind. The SIO Executive Committee has been fully occupied since May 10, 2023, after learning that Graham Hauck, the principal at the Hauck & Associates nonprofit management company engaged by SIO since 2021, pleaded guilty to embezzlement from another nonprofit organization. 

As I mentioned in my message to members on May 22, 2023, we immediately terminated Hauck’s contract with cause. We engaged forensic accountants and outside counsel to assist the SIO in identifying the extent of any misappropriation of SIO funds and pursuing restitution, and that work continues. Through our outside counsel, we are cooperating with federal law enforcement in reviewing Hauck’s dealings with SIO. While the timing and result of any government investigation is unclear, our top priority remains the recovery of funds misappropriated by Hauck.

Since Hauck’s termination, members of the Executive Committee have devoted extraordinary efforts to stabilizing and maintaining the SIO’s operations. I want to recognize and thank each one of them – Santosh Rao (President-Elect), Ting Bao (Immediate Past President), Ana Maria Lopez (Treasurer), Jodi MacLeod (Corporate Secretary), Channing Paller (VP Advancement), and Eugene Ahn (VP Communications) – for their tireless service and unwavering commitment to SIO. We have grown much stronger as a team personally and professionally. 

A particular focus has been to ensure that preparations for our Banff 2023 Conference are not disrupted. We are happy to announce we have engaged with Funnel Communications, Inc. to undertake all conference planning duties moving forward. They have extensive experience in conference planning, even hosting a similar conference at the same venue in 2019.

Through it all, we have remained united as an EC and Board of Trustees, upholding core leadership values of Accountability, Transparency, Vision and Compassion as we forge a path forward which will protect SIO from future vulnerabilities.

I want to thank the Board of Trustees for their continued support of our efforts, the members and friends of SIO, and our generous benefactors, for your understanding and patience as we navigate this transition. 

We encourage all of you to join us at our Banff 2023 Conference to celebrate our 20th Anniversary as a community. We will have much to celebrate this September in Banff as SIO moves into its third decade as a stronger, more united society, focusing, as always, on our mission to advance evidence-based, comprehensive integrative healthcare to improve the lives of people affected by cancer.

Linda E. Carlson, PhD, SIO President

Conference Planning

Conference planning activities have resumed full force with the switch of conference planning companies. The call for late-breaking poster abstracts is open here until June 9th. Don’t miss your last chance to participate in the conference as a presenter!

All presentation acceptance notifications from our earlier call for abstracts went out in early May, but some abstract submitters seem not to have received them. Please check your junk and spam folders as the notification would have come from Oxford Abstracts, our abstract management system, not SIO directly. If you submitted an abstract and have not heard back from us, please send an email to: info@integrativeonc.org and we will check its status and email you the notification once again.

Scholarship and New Investigator forum applications have been received, and we will be reviewing these and sending outcome notifications within the next month. 

Earlybird registration rates are in effect until June 30th – make sure you register now here, and don’t forget to purchase your ticket for the conference gala atop the Sulphur Mountain gondola! It will most certainly be one to remember. 

We look forward to seeing you for an exceptional 20th Anniversary conference in Banff!

Message to the SIO Community

Written by Linda Carlson on . Posted in Latest News. No Comments on Message to the SIO Community

May 22, 2023

Dear SIO Community,

The Society for Integrative Oncology is an international nonprofit organization established 20 years ago to advance evidence-based, comprehensive integrative healthcare to improve the lives of people affected by cancer. We are staffed by a group of volunteer healthcare providers, researchers, and patient advocates. Due to our volunteerism business model, it is necessary to outsource full time management of our business which includes finance, accounting, human resources, event planning, legal and other needs. Since inception, SIO has frequently relied on third-party consultancy firms specializing in nonprofit management for these tasks. In 2020, the consultancy firm of Hauck & Associates (“H&A”) in Washington, DC was selected as its outside management company after completing background checks and reviewing references. H&A started in that role on January 1, 2021.  

On May 10, 2023, we learned that Graham Hauck, the principal manager at H&A, pleaded guilty in federal court to misappropriation of funds of another nonprofit organization managed by H&A. SIO quickly terminated H&A, and initiated a series of risk management measures, including securing its assets to prevent further losses; retrieving paper and electronic files and financial books and records; revoking Hauck’s access to bank accounts, internet sites, keys, credit cards and the like; arranging for new management, accounting and operations solutions to replace H&A; hiring a forensic accountant, Chess Consulting LLC, to detect any misappropriation of SIO funds and determine the amount involved; and retaining as outside counsel white collar criminal attorney, Zach Hafer at Cooley LLP (formerly with the US Attorney’s Office), Michael Sanders, a tax exempt tax attorney and professor at Georgetown Law Center and his partner, Malcolm Sandilands, a corporate attorney, both at Blank Rome LLP. We are working with conference specialists in Canada to ensure that our Banff 2023 conference is not disrupted by these developments, and with other specialists to ensure that the SIO’s other activities continue with the minimum possible adverse impact.  

Internally, SIO has appointed its first general counsel, Nelson Lin, to coordinate our legal response, which includes crisis management and supervision of recovery, while the Executive Committee of the Board of Trustees has worked continuously since learning of Hauck’s guilty plea to transfer every single management function out of his firm’s hands. That process continues, and we will make every effort to secure the return of any funds that were misappropriated from SIO; our criminal counsel has reached out to Hauck to pursue prompt restitution of any misappropriated funds.

The Board of Trustees will report progress biweekly to SIO members as it continues to investigate this matter.

We thank you for your understanding and patience and we will continue to do everything we can to resolve this in an expeditious and efficient manner. 

 Sincerely

Linda Ellen Carlson, PhD, RPsych 

President, Society for Integrative Oncology, Inc.

TCM and Integrative Oncology Practice in China During COVID-19

Written by Greenleaf on . Posted in Research Blog.

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.

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Reflections on COVID-19 Rotation, by Ting Bao, MD, DABMA

Written by Greenleaf on . Posted in Research Blog.

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

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COVID Announcements & Calls to Action

Written by Greenleaf on . Posted in Announcements.

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

Written by Greenleaf on . Posted in Announcements.

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

Written by Greenleaf on . Posted in Announcements.

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/ASCO New Recommendations for use of Integrative Therapies for Pain Management

Written by Greenleaf on . Posted in Announcements.

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.

Does Sugar Feed Cancer?

Written by Eugene Ahn on . Posted in Research Blog.

Does Sugar Feed Cancer?

The SIO Research Committee is pleased to offer this first installment in a new blog series known as “Myths of Cancer”. In this series we will address some of the most common myths and misperceptions that arise around cancer risk and treatment related to diet and natural health products, as well as other complementary therapies such as yoga, acupuncture and meditation. If you have a question you’d like us to address or comments about this post, please send your suggestions to: info@integrtiveonc.org

We hope you enjoy the series!
Linda Carlson and Eugene Ahn, Research Co-Chairs.

Co-written by Eugene Ahn, MD and Kristen Trukova, MS, RD, LDN, CNSC, CSO
© 2016 Rising Tide

Eugene Ahn, MD is the medical director of clinical research and medical oncologist at Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center (Midwestern), and Kristen Trukova, MS, RD, LDN, CNSC, CSO is a clinical oncology dietitian at CTCA® at Midwestern. They are both SIO members and have a passion for education and keeping their communities up to speed on the latest in scientific research. Disclaimer: The opinions expressed here are the authors’ own, and not necessarily those of the Society of Integrative Oncology or Cancer Treatment Centers of America. The SIO and CTCA supports open dialogue between health care practitioners and patients to make sure patients can make informed decisions. As always, your comments and feedback are welcome.

There are so many questions we get from patients in our clinics that are provocative but lack simple answers, and today we tackle one of the most common questions: “Does sugar feed cancer?” To condense the topic into a blog entry, we will not address specifically a ketogenic diet (low carbohydrate and protein, high fat, caloric restriction and fasting diet), but will save that for another blog, so stay tuned!

Quick Answer Box

It’s complicated. But one should feel comfortable taking in sugars through fruits and vegetables due to their higher nutritional value and content that goes with the sugars. Some cancers might become more resistant to treatment with high sugar intake, but the science of predicting which cancers would benefit from a low sugar diet is too early in its infancy to make any general recommendations.

Let’s take a closer look at the science behind this question with the goal of determining a reasonable dietary change to impact both cancer risk and potentially cancer outcomes. One of the best principles in discerning the truth of information available on the internet is being mindful of our desire to over-simplify the complex. Answers given on the internet on this topic tend to make two erroneous assumptions 1) all cancers have the same biology and sensitivity to manipulation of sugar intake, and 2) because diet or excessive sugar consumption may increase risk of cancer, sugar cessation is an adequate treatment for cancer alone.

First, the answer to the question “does sugar feed cancer?” is yes, but it’s important to recognize that all of the cells in our bodies use glucose (blood sugar) for energy. In fact, the brain can only use glucose for energy. Even in a diet that contains absolutely no sugars or carbohydrates, our bodies have processes to convert some of the calories we consume from protein and fat into blood sugar so your brain and other tissues can function (thank goodness).

However, there is scientific evidence that high sugar intake is at least indirectly responsible for increased cancer risk. For example, research has shown that diets excessive in sugary beverages increase the risk of many cancer types (www.aicr.org). These studies point to excessive caloric intake from sugar that promotes weight gain and obesity (a known risk factor for several cancers) and secondarily increases insulin and other growth hormones in the body (which as we will learn later, is one of the proposed mechanisms by which high sugar intake could worsen cancer outcomes). What we know sugar does not do is directly damage DNA or cause cancer, but the secondary effects of excessive sugar intake – obesity and increased insulin and insulin-like growth factors – might create an environment where cancer evolution is more likely to occur.

Given that several cancers express the insulin growth factor family of receptors on its surface, it is biochemically plausible that reducing sugar intake and thereby reducing insulin and insulin growth factor levels could help improve cancer outcomes in cancers that gain survival/growth benefits through that signaling pathway. However, this has not been proven yet in rigorous, well-designed randomized clinical trials. The best evidence we have to support this concept comes from animal models. To highlight one study among several, mice implanted with prostate cancer cells that became palpable were randomized to high carbohydrate, high fat meals or low carbohydrate, high fat meals. The investigators found that the mice fed high carbohydrate meals had statistically significant higher insulin and IGF-1 (Insulin Growth Factor-1) levels and body weight as well as nearly two times greater prostate cancer cell growth (Venkateswaran V, 2007).

Evidence is less strong for human studies, but in a retrospective study, investigators found that consumption of sugary beverages correlated to shorter survival with cancers of the upper aero

-digestive tract (Miles FL, 2016). Also, individuals with Laron syndrome (mutations in the growth hormone receptor that lead to severe congenital IGF-1 deficiency, with decreased insulin/IGF-1 signaling) have reduced cancer risk.

The next question you might be asking is, why are these studies focusing on insulin levels and IGF-1 levels and not blood glucose? First, the blood glucose of these mice would likely have been normal. Our bodies have an intricate biochemical system to make sure blood glucose levels stay within a tight range (when out of balance, diabetes ensues) and insulin is a key regulator of this. But the current paradigm of understanding the harmful effects of high glucose intake is rooted in the concept of secondary hyper-insulinemia required to cope with such a lifestyle and the effects insulin, IGF-1 can have on both cancer growth and resistance to conventional treatment such as chemotherapy or hormone therapy.

For the most current understanding of how insulin, IGF1 affect cellular function, see Figure 1.

Sugar figure 1

Djiogue et al 2013 “Insulin resistance and cancer: the role of insulin and IGFs” Endocr Relat Cancer Feb 1 2013 R1-R17

The main point of showing this figure is to demonstrate the futility of making general statements like “sugar feeds cancer”, “insulin feeds cancer” or even “IGF1 feeds cancer”. The figure shows that there are several receptors that can bind insulin or IGF1. How a cancer cell reacts to insulin or IGF1 depends on the context of which, if any, of those receptors lies on its surface. For example, insulin could just simply mediate sugar metabolism (through Insulin Receptor B), or it could deliver proliferation signals through an Insulin Receptor A, IGFR-1 or a hybrid of these two receptors, and speed up cancer growth or make the cancer cells more resistant to conventional cancer treatment. Lastly, if the cell does not have Insulin Receptor A or IGFR-1 on its surface, no effects might be seen.

A closer look at the clinical relevance of the IGF signaling pathways

To avoid confusion, sugar does not specifically drive increased IGF-1 production, but the secondarily increased insulin does suppress production of insulin growth factor binding proteins, which makes IGF-1 more available to both normal and cancer cells (M, 2012). Also, drugs that have been studied in human clinical trials that target and block the IGF1R receptor have been disappointing and benefit has mainly been seen in the subset of patients who have high circulating IGF1 levels. One of the common explanations given for the disappointing results is the degree of “cross-talk” and “redundancy” between the different receptors and signaling pathways, where blocking IGF1R only inhibits one route of several by which cells are given growth stimuli. Additionally, the recent published preclinical study has demonstrated that sucrose and fructose overconsumption in mice greatly accelerates the onset and progression of breast tumors in three different mouse or human breast tumor models through modulation of inflammatory pathways, independent of weight change or blood sugar (Jiang Y, Cancer Research, 2016).

So what should I do about sugars?

Although not reviewed here, there are many long-term benefits of reducing sugar intake such as weight control. Several studies have shown women who gain weight after breast cancer diagnosis trend towards worse cancer specific outcomes and clear improvement in all-cause mortality (Playdon MC, 2015). The best anyone can say with the current science is that limiting sugar intake for someone dealing with cancer diagnosis will improve overall health and weight, and reduce side effects of cancer treatment (sugar intake can worsen hot flashes from anti-hormonal treatment). It might also enhance the benefits of conventional treatment (surgery, chemotherapy and radiation) and reduce risk of future cancer diagnoses. And for a subset of the cancers diagnosed, there might be a benefit in reducing sugar intake and secondary insulin and IGF1 availability as well as reducing inflammation on actual cancer outcomes, but the data is limited to animal studies and specific cancer cell lines.

So if one were inclined, the 2015 Dietary Guidelines for Americans encourage a limit of only 10 percent of calories per day from added sugars. For the average person, this means only 200 calories (50gm) from added sugars out of 2000 calories total should be consumed. This is a tough order. For example, a 12oz. can of soda or a single serving size of your favorite sweetened yogurt likely contains up to 40 gm of added sugars. One teaspoon of sugar is equal to four grams of sugar. Thus, sugary beverages which include soda, fruit juices, sports drinks, energy drinks and specialty sweetened coffees should be consumed only occasionally. Are these guidelines effective enough to harness a potential anti-cancer effect? We do not know. But, if your baseline sugar intake is greater than 50gm/day currently, chances are your overall health will eventually be compromised.

But thinking further, what does this mean for brown sugar, raw sugar, honey, molasses, maple syrup and jam? Beyond sweeteners, what about foods that contain natural sugars, as in fruits and plain yogurt, as well as added sugars, which include just about everything you can think of from ketchup to bread? What about carbohydrates, like starches, fruits and milks, which are broken down into sugars? What is left to eat?

Keep in mind that a plant-based diet has been found to be cancer protective. Choosing whole grains, vegetables, beans and fruits in the right portion provides important phytochemicals, antioxidants, electrolytes and fiber in addition to the carbohydrates. One key to success is to avoid “empty calories” such as soda, refined grains and highly processed foods, where very little nutritional value is being provided outside of the calories. And take the time to read the sugar content on the food labels. Find the cereals and yogurts with the least sugar possible. Eat your fruit to get more fiber/pulp in lieu of juices. And be aware that too much portions of a healthy food can still make it unhealthy from a caloric standpoint.

Finally, malnutrition and severe weight loss, especially muscle weight, is very common during cancer treatment. Adequate nutrition is critical. It has been shown that weight loss and malnutrition during cancer treatment decreases tolerability of cancer therapy and is associated with worse outcomes (Barret M, 2011). Any dietary change that results in a lower caloric intake should be reviewed by your health care provider, and other foods might be required to meet nutritional needs. Making weight loss the only end point for your dietary and lifestyle choices could lead to harmful outcomes, so please seek guidance from an available dietitian.v