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The Evidence Base for Integrative Approaches to Cancer Care

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November 20, 2014
Josephine P. Briggs, M.D.
Josephine P. Briggs, M.D.

Director
National Center for Complementary and Alternative Medicine

View Dr. Briggs' biographical sketch

The most recent issue of the Journal of the National Cancer Institute Monographs features a series of articles on the role of integrative oncology in cancer survivorship. I was pleased to have been invited to write a perspectives piece for this issue on building the evidence base for integrative approaches to the care of cancer survivors.

Integrative oncology is a relatively new movement, and the research is in early stages. But due in part to patient demand for a more “holistic” approach to care as well as the desire of physicians to develop a style of practice that will facilitate changed relationships with patients, with more emphasis on healing and less on technical advice, the movement, along with the evidence base, is growing.

We at NCCAM continue to focus resources on building a rigorous evidence base, conducting research on complementary and integrative health approaches for symptom management, particularly pain management, but also fatigue, loss of sleep, and loss of appetite. These approaches should continue to be tested for potential benefits, risks, and continued improvement, to provide a solid scientific basis for guiding patient decisions and provider recommendations.

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This is request for NCCAM staff, if they are reading this, to help me locate any research or trials looking at diet and the immune system, particularly enhancing production of t-cells relating to blood cancers. I’d like to know if there is any scientific proof that ingested natural substances beyond those found in a healthy diet have any effect in retarding the growth of malignant white blood cells.Thanks for your time 

Thanks for the blog.  Hope equiped with scientific evidence, we can make integrative cancer care a standard of care.

Having survived metaplastic breast cancer and endometrial cancer surgeries, I was given very little hope and palliative care was it … I changed my diet to a more macrobitoic approach and turned to Traditional Chinese Medicine and five years later I am alive and well. But what I write about here is the very negative attitude of today’s doctors and the ridicule I received - which turned me off any treatment from them as I walked away from chemo and radiation. There needs to be more integration of eastern and western medicines for the benefit of the patient. Time is now to learn the bigger picture and not just one that is propelled by today’s money-making therapies.

Dear Dr. Briggs,I am a cancer survivor and yoga teacher of cancer patients and survivors. I also train yoga teachers to work with cancer patients.  While some of the research in complementary approaches has been less than rigorously scientifically studied, many approaches are well documented for their benefits:  1) diaphragmatic breathing, 2) mindfulness meditation, and 3) restorative yoga.  The related fields in which these scientific studies have been done are related to cancer patients.  For example, studies on mindfulness have shown marked decreased in anxiety, improvement of sleeping and better choices. These approaches have been used in heart patients, overweight patients, PTSD, and many other. I suggest a retrospective study of each approach;  including scientific studies done in India for over 100 years. The UCSD Integrative Medicine Department is conducting research and has montly community forums to discuss integrative approaches.  The have integrative clinics throughout San Diego offering complementary services, like Reiki, Yoga, Accupuncture and Mindfulness.Personally, I have experienced the benefits and witnessed the effects of an integrative approach through many cancer patients.  I would like to see the NIH work closely with Yoga Alliance, our certifying body, to create certification protocols that improve the quality of education being given to yoga teachers. Namaste and Thank you,Jean

Herbal Medicines prescribed by a fully qualified medical herbalist/ herbal practitioner are especially good at rebuilding blood count, in particular immune cells and an immune system damaged by chemo - and radiotherapy. Some herbs show promise alongside conventional medicines. Example: Curcumin Circumvents Chemoresistance in vitro and Potentiates the Effect of Thalidomide and Bortezomib against Human Multiple Myeloma in Nude Mice Model (research). It is a common fallacy to affirm all herbal medicines have negative interactions with cancer drugs, only a very few do. Some herbs actually can be used to enhance therapeutic effects of drugs concomitantly or to prevent nasty side effects, while others have to be timed apart from conventional drugs to rebuild the system - that is where nutrition comes in as well. These are areas that should be researched more. There are studies that show enhanced survival time with e.g. Chinese Medicine (herbs and treatments). I’d like to comment on David Gunter’s comment above as well - start by doing some research on turmeric, green tea polyphenols and ginseng as well as the host of other cancer-fighting herbs.  

What if we also talked about the connection that intergrative,more holistic care brings to the table.  Touch, movement etc… often times benefits from care on this level is almost impossible to measure and control in terms of a cure.  I beleive we have to step out of the box of just eviedence based.  What about connection based.   Connection to self and others that comes from consciousness. Eating for our consciousness the energy that whole food brings.   Raising the consciousness that healing takes many forms tha can not be mesured and may not mean serviving cancer but living while dying

Research on Traditional Chinese Medicine herbal supplements such as Yun Zhi (Coriolus versicolor or Turkey Tail mushroom) has demonstrated statistical significance in helping certain cancer patients to be strong enough to receive radiation and chemotherapy. An extract has been shown to stimulate white blood cells, bone marrow cells and macrophages to boost immunity. The study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/22185453Much work is yet to be done to standardize dosage, and assess the impact on potency based on harvest region, season, or differences in manufacturing processes. This leaves a market wide-open where patients can choose to buy a bottle of Yun Zhi capsules for as little as $19 all the way up to $500 retail… but herbal supplements aren’t covered by medical insurance, and there is no way for consumers to substantiate differences in product efficacy. Unfortunately, the trial timeframe is also a time of critical decision-making.Consumers can look for “USP Verified Dietary Ingredient” certification as evidence of product purity. Without that certification, it’s reasonable to question if the advertised ingredient is even in the product, or if contaminents such as pesticides or heavy metals are present.

Hello Dr Briggs,  I am a Clinical Acupuncturist Kaiser Permanente in Maryland that studied TCM in China and here in Amercia and treat alot of with Oncology patients as well a pain management  issues and I also teach Qi Gong classes to assist with balancing and harmonizing these patients. The patients report they all do so much better with the added alternative medicine benefits they received(diet, excerise, Qi Gong, and acupuncture treatments) . I hope that this will someday be common practice like it is in other countries outside the US, and that it will be viewed as option for everyone not just if you have special covered benefits for it (ie: medicare and medicaid).  thanks

include vigorous  exercise in anything you do and you’ll be better off.(this does not mean a brisk walk and a few rounds on a universal machine lifing easy weights, it mean hard, hard, hard work. Get the heart rate jacked and feel the muscles burn to fatigue.)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885882/

Dear Dr. Briggs,  I’m delighted to see this new focus on “Evidence-Base for Integrative Approaches to Cancer Care.”When your health is deteriorating, things become very basic, and all options to change that down-ward trajectory become open.Five major health conditions developed post-operatively after undergoing a prophylactic bilateral oophrectomy were reversed.Understanding the concept of evidence-based medicine, in all its implications was required.”Alternative Medicine,” (2007) introduced the concept of EBM to the U.S. consumer public with a look at the science beneath both alternative and conventional medicine, with issues to consider in its absence.You can access medical reviews and endorsements on that publication, at the website. Again, thanks for focusing on the evidence-base for integrative oncology care. As someone once said, “there are no atheists in fox-holes,” i.e., when your health is deteriorating, you explore all options available, be they conventional or alternative.Christine A. Larson, Ph.D.  P.S. I have an allegiance toward oncology patients, as an oncology protocol was used in my case-bilateral oophrectomy.     

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Integrative Oncology, like all of Integrative Medicine, has the potential to join together the Best of Peer-Reviewed and re-reviewed, Evidence-Based Science with “researched & safe historically time proven & reviewed practices” that help allow us to join together Eastern & Western Medicine, & begin to enhance our ability to: take a Step Back, to treat the entire Patients mind/body/spirit; and not simply view the patient as a body part alone, that needs fixing. We can all remember that childhood rhyme that mentions in part something along the lines of; (sing it)……..”The head bone is connected to the mind & brain, and the mind & brain are connected to the heart (universe) feeling, and the heart is connected to the breast bone and the breast bone is connected to the lung, and the lung is connected to the oxygen we breath, & the oxygen we breath is connected to our muscle tissue, blood, heart, and, etc., etc. etc…..or it goes something like that….. :-)

  •   — The point is, with Integrative Oncology, we have come to understand our entire mind-body-spirit(energy) is all interconnected.  We are not only an isolated body part.  We are not just a statistic in a Cancer research paper. We are each unique human beings, thus allowing us to see the importance of taking a “step back” & really seeing the entire uniqueness of the patients life force, where there may be blocks & parts not working together & find the personalized combination of procedures/treatments that can help a patient feel whole & at Peace from moment to moment.  

In doing so, at times, we redefine our definition of what HOPE is, and introduce Integrative Oncology with the goal of enhancing the persons quality of life at every stage of our life experiences.  And to maybe find the happiness & inner smile too, in a scientific, caring, compassionate setting.I have heard it said that we want to help the patient feel at EASE, not dis-EASE. Stopping disease by taking the “DIS” out of disease to find “Ease,” thus allowing Peace, Calm, Balance & Love to flow through our Body, Mind, Spirit.  We can help do this with every breath we bring in & let go of… Toward our unique & interconnected universal Peace & Love.In sickness & health, both the patient & “Trusted Board-Certified Qualified Clinician” and the clinicians team, can step-back, let go of those usual thoughts that percolate up to our consciousness, connect to our breath & feel all of our sensations.  Including our own spirituality & our awareness, as we do Deep Listening within, to work-out, with an acknowledgement of detachment & loving acceptance of what we may be facing.Let us know that by incorporating Integrative Oncology (medicine), we are treating our entire SELF with state-of-the-art universal Quality care for our entire SELF & Total WellBeing!  Alan Kaye

All you need to know and do is within you.  I am a spiritual healer, nutritionist and presently attending the Cayce/Reilly School of Massotherapy in Virginia Beach. The time is now upon us to make the integration of all sciences and beliefs. To bring them together for the greater good of all. Cancer is not the problem. It is your soul that need healing in a spitiual way. The body, mind, spirit trinity is the answer to all ills and dis-ease. Begin your journey to enlightment and truth. You will be cured if tht is waht you truly wish with all your being. The future of medicine is in sound (vibratory-frequences) and color, (color vibratory frequences). The knife will be discarded and used only for making things (food), not for destroying thiings.   I am legally blind and a survivor of 3 near death experiences. I know what I am talking about.Please feel free to contact me and I will steer you to the research and proof you are looking for. All the coments are on the right track but you must incorporate all three of the  universal governing laws. Body, Mind and Spirit for anything to be fully accomplished.Light/Love - Love/Light - Go now in the knowledge that we are ONE with the Father God Creator.To your health and longevity through your Body, Mind and Spirit.  Larry Fisher

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I am a Chiropractor using four NonForce techniques = no cracking. The results I get using these techniques are unheard of in Chiropractic. I am looking for a team of Intergrative professionals that I can work together with here in Los Angeles County, Ca. We are looking for answers for every condition, the more tools you have to use the faster we can get there. I would like to be with a group who strive to results, who strive to change old ways of thinking and to strive to find the answers everyone is asking. Dr. Wayne

I am looking for an traditional Chinese medicine practicioner in the New York area.  The problem is advanced esophageal cancer. 

I have developed a meditation protocol (Integrative Restoration – iRest), which has been studied as an integrative and adjunctive/supportive program for patients going through cancer treatment. The protocol also has research on its use with various forms of trauma, anxiety, depression, and sleep issues. The iRest protocol is being used in VA centers, DoD sites, hospice, homeless shelters, hospitals and priviate settings. My non-profit, Integrative Restoration Institute, trains and certifies teachers in this approach. Research studies are available at… 

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@MichaelT, I'm sorry to hear about your diagnosis. Although we don't refer people to practitioners, we have resources that may provide recommendations or lists of complementary health practitioners at nccam.nih.gov/health/howtofind.htm

You may  want to view our information about complementary health approaches and cancer at http://nccam.nih.gov/health/cancer. You might also want to read our fact sheet about traditional Chinese medicine (http://nccam.nih.gov/health/whatiscam/chinesemed.htm). 

Please keep in mind that unproven products or practices should not be used to replace or delay conventional medical treatment for cancer. Also, some complementary approaches can interfere with standard cancer treatments or have special risks for people who have been diagnosed with cancer. We encourage you to talk with your health care provider before using any complementary health approach. (See nccam.nih.gov/timetotalk for tips on talking with your health care provider about complementary health.)

The National Cancer Institute, the lead U.S. Federal agency for cancer research, has information about treatments for advanced esophageal cancer. You can view their Web site at www.cancer.gov, call their Cancer Information Service toll-free at 1-800-4-CANCER, or e-mail to cancergovstaff@mail.nih.gov.

@David Gunter, You can search the CAM on PubMed database (http://nccam.nih.gov/research/camonpubmed) and NIH RePORTER (http://projectreporter.nih.gov/reporter.cfm) to locate studies on this topic that might be of interest to you.  

CAM on PubMed, part of a larger database run by the U.S. National Library of Medicine, contains medical journal articles related to complementary health. 

NIH RePORTER is a database of current and past federally funded research projects.

MichealIT, nccaom- the national certification commission for Acupuncture and Oriental Medicine has a listing by state.I hope this helps. 

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The integrated treatment approach for cancer patient or many auto immune diseases is a need of the day. It is a fact that modern pathy has definite limitations for various reasons. The disease ecome medically resistant accompanied by many side effects leading to loss of appetite , allergies , vomitting , loose motion, pathological disorder, loss of sleep, loss of weight , arthrities, cardia and brain complications. Specially this is experience in secound or subsequent phases of cancer.The integrated treatment finds supportive answer and relef  to cancer patients. Whether the system is clinically proved or not should not be given high weightage and should be practised on merits by health carer .In my practise of lasr 51 years in naturopathy I have taken into account many problems mentioned as aboce and happy to say I am successfull to manage or cure cancer y alternative remedies along with allopathic treatmet or when it is discarded as a primary treatment.Cancer patients has a danger to his life due to water retentation, plural effusion , pericardial effusion, asipis , and acute pains. There are many factors also which endanger the life of cancer patient such as failure of vital organs. In my prcatise by using many modelities in topical, oral , and rectal applications of herbs . natural juices„ oils, creams, cold and hot foamention , ozone blanching hyperaric oxygen therepy and many more .What is more important is to save the life of patient 

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