Use of SIO Clinical Guidelines
The guidelines are not intended to remove the freedom of individual decision making, and the authors emphasize the importance of having degrees of freedom. It is useful, however, for clinicians to refer to these guidelines when making clinical choices with their patients. They will also be useful for quality assurance, clinical governance, and medical legislation and will provide indications for reimbursement that add value to clinical programs. They clearly illustrate the importance of multidisciplinary health care teams that jointly use their skills based on the expanding evidence base for integrative medicine. We hope that the guidelines will prevent inappropriate variation in clinical practice and underline the professional basis for integrative medicine. As such, this will provide a useful resource for all clinicians as well as administrators. So, why publish guidelines? These are tools, not rules. We need to formulate clinical decision making that is based on the best research evidence available, based on knowledge of relative safety and possible adverse effects, and that is economical compared with other interventions. One of the tenets of integrative oncology is to involve patients in the decision-making process, so we place emphasis on the clinical encounter and the safe integration of combined modalities that suit the patient’s culture and belief system. However, economics includes not only financial costs but also the cost of missed opportunities and adverse events. It is imperative that all practitioners concerned for cancer patients have the knowledge and skills to design personalized programs that wisely support patients through their anticancer therapies. The consultation is an opportunity for education and must include clear guidance as to what is complementary and what is deemed alternative and, therefore, by definition, should be avoided. The guidelines clearly advocate evidence-based complementary therapies that support patients through their standard anticancer treatment, help reduce adverse effects, and improve their quality of life.
We are hopeful that the research will eventually show that using these evidence-based guidelines for integrative oncology will have economic advantages by supporting patients through their anticancer treatment, by teaching improved coping skills, by encouraging more rapid rehabilitation, and by teaching tertiary prevention strategies. By standardizing these approaches, we will be able to collect high-quality data that can be used to compare programs in various institutions and implement quality assurance.
History and Role of SIO in Developing Guidelines
The Society for Integrative Oncology (SIO) published its first edition of Integrative Oncology Practice Guidelines in 2007.1 Experts who specialize in defined categories of integrative or complementary therapies were asked to review the scientific literature and categorize the interventions into specific levels of utility that take into account the methodological strength of supportive evidence, benefits versus risks, practicality, and value. Members of the SIO Executive Committee, who are responsible for the final recommendations, peer reviewed and critiqued the submissions, with the final product a consensus. The 2009 edition2 updates and expands on the previous version and provides practical recommendations for the use of complementary therapies in the supportive care of cancer patients.
In 2014, SIO published the Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer in the Journal of the National Cancer Institute Monograph Special Issue on Integrative Oncology.5
Deng GE, Cassileth BR, Cohen L, Gubili J, Johnstone PA, Kumar N, Vickers A. Integrative oncology practice guidelines. J Soc Integr Oncol 2007; 5: 65 – 84.
Deng GE, Frenkel M, Cohen L, Cassileth BR, Abrams DI, Capodice JL, Courneya KS, Dryden T, Hanser S, Kumar N, Labriola D, Wardell DW, Sagar S. Evidence-Based Clinical Practice Guidelines for Integrative Oncology: Complementary Therapies and Botanicals. Journal of the Society for Integrative Oncology, Vol 7, No 3 (Summer), 2009: pp 85–120.
Cassileth BR, Deng GE, Gomez JE, Johnstone PA, Kumar N, Vickers AJ. Complementary therapies and integrative oncology in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl):340s-354s.
Deng GE, Rausch SM, Jones LW, Gulati A, Kumar NB, Greenlee H, Pietanza MC, Cassileth BR. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e420S-36S.
Greenlee H, Balneaves L, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monograph. 2014;50:346-358.