Abstract
A cancer diagnosis often means having to navigate and interact with a complex medical world. It can also significantly change the physical, emotional, and personal life of the person suffering from cancer. Acutely aware of these complexities, the Society for Integrative Oncology (SIO) is transforming oncology care by engaging clinicians to learn about evidence-based integrative therapies in order to reduce suffering in their patients. Specifically, the SIO is setting industry standards through clinical guidelines and competencies in order to help clinicians better practice and implement an integrative approach in cancer care.
Lynda Balneaves, PhD, RN, president-elect of the SIO, associate professor at the College of Nursing, University of Manitoba, Winnipeg, Canada, and former director of the Center of Integrative Medicine at the University of Toronto, Toronto, Canada, commented, “Many cancer survivors desire non-pharmacological solutions to their problems. Within the SIO, we are interested in the evidence around complementary therapies for conditions and symptoms that are common to people living with cancer, such as pain, fatigue, nausea, anxiety, and many others. The SIO also looks at evidence-based therapies and interventions in the areas of diet, exercise and stress reduction, which help people with cancer live healthier lives.” Balneaves added, “When people develop cancer, it is a teachable moment to help survivors look at how they can improve their life and fulfill their roles that are important to them and to society. Utilizing evidence-based, cost-effective and non-invasive approaches to help people achieve greater relief from suffering and improve their health is a win-win situation and is the emphasis of the mission of the SIO.”
For the last 20 years, Balneaves has devoted her research to developing educational tools and decision support interventions around complementary therapies for both cancer patients and oncology health practitioners so that they recognize the risks and benefits. “When I became involved with the SIO, I connected with colleagues who were interested in oncology, evidence-based research and in further developing the field of integrative oncology. It felt like coming home. There is an acceptance of the possibility of these therapies balanced with an informed approach.” Balneaves has attended almost every SIO meeting since its inception, has co-chaired the SIO conference in Vancouver, Canada, has served as a board member, and, in the fall of 2017, will become the SIO's president.
Jun J. Mao, MD, MSCE, current president of the SIO and the Laurance S. Rockefeller Chair in Integrative Medicine, Chief, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, New York City, New York, commented that he has observed interesting findings in integrative oncology during his term: “The field is growing. Through our own research, for example, we recently found that, compared with medications, acupuncture therapy can help with symptoms common to cancer survivors including long-term reduction of hot flashes with less side effects and improvement in sleep quality. 1,2 Other studies have shown that yoga and mindfulness have important therapeutic potential to reduce distress and improve quality of life. Many of these findings are further synthesized in SIO clinical guidelines for women with breast cancer, recently published in CA: A Cancer Journal for Clinicians.” 3
Leading the Way with Multi-Faceted Endeavors
Founded in 2003, the SIO today seeks to provide a range of venues from which clinicians can gain knowledge and skills in order to offer an integrative approach in cancer care. Among those activities includes an annual conference with growing global attendance. The SIO's 14th International Conference will be held in Chicago, Illinois, November 12–14, 2017, on the theme “Person-Centered Care in Integrative Oncology: Innovations, Impact, and Implementation.” Balneaves stated, “Survivorship and morbidity are important outcomes in research and clinical practice; however, person-centered outcomes are important as well in order to tailor care to patients' preferences. Empowerment and a sense of hope are significant to the patient.”
Another major endeavor of the SIO is developing integrative oncology guidelines, which summarize integrative therapies and cancer care research, informing clinicians about how to recommend such therapies to patients. These peer-reviewed consensus guidelines (
“These guidelines along with other SIO endeavors shift people's understanding of this field and their openness to sharing these therapies with patients,” Balneaves said. Balneaves commented that, years ago, when she was working as a graduate nurse and research assistant on a bone-marrow transplant unit, she frequently received questions from patients about the specifics of complementary therapy use. “I couldn't answer many of their questions at the time, and this piqued my interest,” Balneaves said. She added, “There was a knowledge gap, and my colleagues didn't have a lot of information either and, therefore, dismissed patients' questions around this topic. A pivotal moment occurred for me when a patient with recurrent breast cancer, including bony metastases in her neck, came into the clinic. She had been in a car accident and mentioned to someone at the reception desk that she was going to see her chiropractor. I became alarmed about her going to the chiropractor and wanted them to know about this patient's condition. It turns out the patient didn't feel well after her chemotherapy and went home and didn't see the chiropractor. However, this was a wake-up call, as I realized that patients often do not understand the risks of integrative therapies, and as clinicians, we often do not communicate well about the risks or the benefits. The guidelines help address such issues.”
The SIO is also developing educational competencies, which, along with the cutting-edge clinical guidelines, will raise the bar for clinicians and researchers engaging in the field, according to Balneaves. Claudia Witt, MD, MBA, director of the Institute for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland, and a SIO board member in charge of creating the educational competencies, commented: “There are still many opportunities to clarify aspects of the field of integrative oncology. Recently, the SIO developed a formal definition of integrative oncology, which will be published in the winter of 2017. Our current project focuses on the development of core educational competencies for health professionals working in the field of integrative oncology. These competencies will define the knowledge and applied skills that enable people in the field to successfully perform in professional and educational contexts in regards to integrative cancer care.” Witt added, “We are very lucky that the SIO has a multi-professional board, which is well connected internationally and during this process of development, allows us to receive feedback from different professions from three continents, namely North America, Europe, and Asia. Both the definition and the educational competencies help to clarify the field.”
Balneaves stated that, in fact, SIO members from around the world are involved in groundbreaking research at the bench level and in clinical trials, for example, studying the effects of yoga and natural health products in cancer care and the role of sugar and how it reacts with cancer cells, and so on. “We are beginning to answer questions that have troubled people for years,” Balneaves said.
Linda Carlson, PhD, RPsych, co-chair of the SIO research committee, a world leader in the application of mindfulness-based stress reduction (MBSR) in cancer care, and the Enbridge Research Chair in Psychosocial Oncology and Professor, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada, commented on her research in integrative oncology: “I have been conducting research on mindfulness-based interventions in cancer care for almost 20 years now. Initially, our center was one of the only cancer centers offering such programs, but now these types of programs are offered all over the world. I consult with researchers and clinicians in Australia, Europe, the United States, and Canada who have adapted such programs for their patients. Today, many research studies on mindfulness-based interventions in cancer care have been published, and there are several reviews and meta-analyses supporting their benefit.” 4 –6
Carlson stated that the SIO research committee regularly reviews new studies published in integrative oncology and reports on the findings. “We choose the most well-designed, largest studies and highlight these on our website (
Carlson concluded, “The SIO has been an important venue for me to meet professionals from different backgrounds, and learn more about areas of integrative oncology that I am less familiar with such as the use of acupuncture and natural health products in cancer care. The organization has a great mix of clinician and researcher membership working all over the world to improve whole-person integrative care, so everyone brings their own perspective, but we all share this one over-arching goal, which is to improve cancer care using a whole-person integrative approach combining both conventional and complementary therapies. It is a very friendly and supportive community.”
Conclusion
The SIO has been flourishing as a respected and stable organization that is expanding its reach, according to Balneaves, who reported, “Dr. Mao, our current president, has been very active in creating global linkages in America and internationally. The SIO had a plenary at the World Congress on Integrative Medicine and Health in Berlin this past May, and the response was overwhelming. We now have an engaged group of members pushing forward some great initiatives. We are also a very welcoming group and respectful of people coming from various traditions whether that is conventional medicine, massage therapy, Traditional Chinese Medicine (TCM) or naturopathic medicine, etc.”
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Mao commented: “At the SIO, we are actively working to engage our colleagues and partners from around the world. Last year, we had individuals from 32 different countries/regions that attended our annual conference. In the fall of 2017, we are planning to release a special Journal of the National Cancer Institute Monograph: Advancing the Global Impact of Integrative Oncology.” Mao concluded, “The SIO will continue to push rigorous science, competency-based education, and novel clinical transformation with the hope of ultimately making integrative oncology a standard part of cancer care.” ■