Multidisciplinary Therapy: Integrated Medicine in Cancer Care

Originally printed in the American Journal of Hematology/Oncology, Oct. 2007

Currently, studies show that as many as 80% of patients undergoing conventional treatment for cancer also use other approaches, often termed “complementary” or less appropriately, “alternative” care.1 The popularity of these approaches has increased over the past decade, yet the communication between patients and their practitioners regarding their use continues to be limited. Regardless of why a patient elects not to share that information with his/her oncologist, the result is the same – no one has a complete picture of the patient’s treatment. For clarity’s sake, it may be useful to define some of the terms commonly used when referring to categories of health care.

According to the National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health (NIH), CAM refers to a diverse group of medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is that medicine practiced by holders of MD and DO degrees and by their allied health professionals.2 Complementary medicine is the use of nonconventional or “other” systems/practices/products along with conventional medicine, while alternative medicine is the use of one or more of the other systems/practices/products in place of conventional medicine. Interdisciplinary care refers to the use of at least one form of conventional medicine simultaneously with the use of another. Finally, integrative medicine is the combined use, a synergy, of the various treatments – conventional and any number of other systems/practices/products.

Patients attempting to integrate their own care often do so with minimal information about the various practices and products they utilize. Accurate information about the efficacy, mechanism of action, interactions with drugs and other dietary supplements, or side effects is often not known or communicated by the well-wishing family members or friends, or by health food store clerks. The Internet is another common source of information, or misinformation. Some of the most commonly employed practices or products in the complementary category include dietary supplements such as vitamins, minerals, and herbs, special diets, and spiritual practices. These are used by patients for numerous and varied reasons, including their perceptions of the limitations of conventional cancer care, a desire to use a natural approach, and in response to manufacturers’ marketing strategies.

Often, anxiety and fear drive their decisions – anxiety about losing the battle with cancer, and about having limited control in treating the disease. As part of these anxieties and fears, patients often do not share information about their use of these practices and products with all their healthcare providers, and most specifically their conventional medicine practitioners. Patients fear rejection by the provider and fear they may be told to discontinue those practices of Integrative Medicine in Cancer Care.
 
As many as 80% of patients undergoing conventional treatment for cancer also use “complementary” or “alternative” care.
Some patients simply assume that their additional treatment approaches have no impact on their conventional care, and consequently don’t share that information.

From a healthcare perspective, there is an ever increasing understanding of the mechanisms and effects (beneficial and adverse) of many of these not so conventional approaches. As these practices and products become more clearly understood through research, many of them move along the category continuum from alternative and complementary to conventional medicine. The lines between them become blurred, and categorizing them becomes more difficult. Focusing on the category in which each system/practice/product belongs does not advance the practice of medical care. Our purpose as healthcare providers is to treat patients with the most effective methods that will achieve the greatest survival benefit, with the minimum of adverse effects, while maintaining or enhancing the quality of life in the process. To achieve this, we must examine the various practices and products that have the potential for benefit and consider their applications, interactions, and safety. Approaching cancer care with an interdisciplinary team brings together specialists who do just that: bring to the table the treatment options for each individual patient, knowing the safety, efficacy, and potential for adverse effects of those treatments, as well as an awareness of any potential for interactions with the other modalities discussed. Specialists from the various categories of medicine share information, thus forming an integrative team.

This approach to medicine maximizes the effectiveness of the various modalities, much like commonly used radiosensitizing chemotherapy, while simultaneously minimizing the adverse effects of those modalities. Communication is enhanced, each patient remains the central focus, and at the same time are encouraged to share information and participate in their own care. To develop a multidisciplinary, integrative treatment plan, communication among the healthcare providers regarding goals, practices, and interactions of the various treatments is necessary. Information from patients regarding their other healthcare practices and product use is critical. Patients are often more willing to share this information when they understand that their care is designed by a multidisciplinary team that considers a variety of treatment modalities and does not dismiss any strategy because it has traditionally fallen into a nonconventional category.

An effective team includes specialists from a variety of fields to address patient needs, such as a spiritual care counselor, mind-body medicine counselor, dietitian, naturopathic doctor, and acupuncturist. While the spiritual care counselor and the dietitian may be the more familiar components in a cancer care center, the roles of the mind-body medicine counselor, the naturopathic doctor, and the acupuncturist are less common. Mind-body medicine plays a role in all aspects of healthcare, no matter what the condition, the age or gender of the patient, or even the level of awareness of the concept. Soothing a crying infant with a calm voice, distracting a toddler from his most recent tumble, or speaking with a patient diagnosed with cancer about goals, fears, and the relationship between the two is to practice mind-body medicine.

The impact of emotions on health first became evident through the study of the effects of stress on the cardiovascular system. We now know a good bit more about stress and the relationship of emotional responses with health. Mind-body therapy focuses on the interaction of the mental, emotional, social, spiritual, and physical aspects of the individual. Mind-body counselors use strategies that promote health by helping patients reduce pain levels, improve mood, develop coping skills, and reduce symptoms of treatment side effects. There is some evidence that mind-body medicine can affect immune health. Interventions may include meditation training, cognitive restructuring, journaling, guided imagery, and support groups. Naturopathic medicine combines the latest research in modern medicine with centuries-old natural, nontoxic therapies. Naturopathic doctors who are trained in accredited naturopathic medical colleges and universities and who specialize in oncology evaluate and treat cancer patients using a variety of strategies. Treatment most commonly includes therapeutic nutrition, dietary supplements, and Information from patients regarding their other healthcare practices and product use is critical.

Integrative medicine in cancer care botanical medicine. Treatment goals in an integrative  setting include supporting the patient’s immune system, inhibiting metastases through apoptosis and antiangiogenic mechanisms, and encouraging normal  cell reproduction. Other aspects of naturopathic  oncologic practice include supporting other treatment modalities, such as enhancing recovery from  surgery, and reducing adverse effects of other treatment  approaches, such as minimizing bowel disturbances  or skin reactions from radiotherapy. In addition,  naturopathic physicians are trained to sort  through the myriad of supplements that patients have self-prescribed to augment their care.

Reviewing these practices and products with a specialist  in this field often reassures the patient and provides  expert advice to the integrative team as well.

Acupuncture is one element of the practice of  Chinese medicine. The use of solid needles by  trained acupuncturists to stimulate traditionally  identified points along meridian lines can eliminate neuropathies caused by other cancer treatments and  can reduce nausea and/or vomiting experienced by  patients receiving chemotherapy. Pain can also be  reduced with acupuncture used either independently  or in conjunction with other treatment approaches designed to minimize physical discomfort. Like  other treatment approaches mentioned, integrating  this strategy into a whole treatment plan optimizes  the benefits and experience for the patient.

In summary, the treatment of cancer patients can  take many forms and be provided by a variety of  practitioners. However, putting together integrative  treatment-planning teams of well-trained specialists promotes a more streamlined and effective medical  practice. Integrative medicine calls upon our creative  resources and attributes of respect as we come to learn from one another and develop the optimal treatment  care plans for patients diagnosed with cancer.

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