Elevating Integrative Oncology: Supporting Patients with Whole Person Care

Robert Rountree, MD: You’ve had a long and illustrious career in mainstream oncology and immunology. What inspired you to transition into integrative medicine?

Gary Deng, MD, PhD: I have been doing integrative oncology for about 20 years. I was the founding Medical Director of integrative medicine at Memorial Sloan Kettering Cancer Center (MSK) in New York City. I moved to UC Irvine to keep growing its integrative oncology program.

My interest in integrative health started when I was very young, when I was 7 or 8 years old, when my mom gave me a medical textbook on Traditional Chinese Medicine (TCM). I was in Beijing at that time. When I read it, I was very intrigued by its approach to health and the human body. As you know, in TCM, there are a lot of interconnections between organ systems, the balance between Yin and Yang, the balance between human and nature, and the outside environment and the importance of emotion. I went to medical school in Beijing, but it was a Western medical school, but even in that school, we learned TCM. There’s always a TCM course in Western medicine tracks there.

Dr. Rountree: What was the focus of the program?

Dr. Deng: They teach you mostly the TCM approach to health—the TCM understanding of the human body and the human mind, and how disease comes about as the interaction between the outside world and the inside world. I think Western medicine focuses too much on the outside world, and not enough on what the human body can do itself. Then there were the fundamentals of diagnostic techniques and how to group the findings into symptom patterns.

For example, they never just say, insomnia—they think insomnia is a manifestation of some imbalance, and there are several subtypes of imbalance that manifest as insomnia. Instead of looking at the human body vertically, like a system pathway, you look at it more horizontally, holistically, based on the interactions among what else is happening in the body as a whole. That’s where I learned this approach to health. It gave me a different outlook on the human body, the human mind, health, disease, and how to manage disease.

Dr. Rountree: How did they incorporate those concepts into your training? Did they call it integrative medicine?

Dr. Deng: They didn’t call it integrative medicine because that was a much later invention in terminology. At that time in China, they called it combination medicine. They combined Eastern and Western medicine. The exact Chinese word for it if translated is literally combining Eastern and Western medicine.

I think that’s where the seed was planted in me. Then, later, I came to the US to study immunology. There are two systems in the human body that I think are very interesting—the immune system and the nervous system. The immune system is vastly complex and interesting. A lot of what we are currently doing, such as mind-body therapy and stress reduction, is really about having a balanced and robust immune system, and we know the immune system interacts with the nervous system a lot.

Dr. Rountree: Was there a particular area you were focused on, or was it the whole field of immunology?

Dr. Deng: We focused specifically on immunotherapy for cancer. That was my PhD work, and then I went to residency where I trained with physicians who asked questions to make us think about the root cause of the problem rather than mere textbook answers—asking us to think about what actually created that problem, what happened in the patient’s life. We were provoked to think deeper and not just be satisfied with what the medical textbook or other people told you—you have to look at the patient and see what really is causing the problem.

You look at the patient’s medical problem in the context of their life. In 2026, this is called a whole person health approach, but back in the 1990s, people didn’t think so. It made me think a lot about medicine and human health more than what the textbook told us, and then also think about the TCM training I had before.

Dr. Rountree: Did you go straight from immunology research into integrative care?

Dr. Deng: I did internal medicine for a few years at MD Anderson Cancer Center. That is regular Internal Medicine, but I think that’s also a good experience because we saw real-world scenarios. Sometimes the approach to cancer care is too simple. It’s rather linear and one dimensional, and patients may have other issues that are under-addressed. I see some deficiencies in the standard Western medicine practice and some room for improvement. Integrative oncology is aligned with my philosophy in medicine and health, and that’s how I started working formally in this field.

Dr. Rountree: What kind of feedback did you get from the other oncologists? Were they excited about what you were doing?

Dr. Deng: I started in 2002, and at that time, integrative oncology was a new thing. Most people never heard about it. They didn’t know what it entails.

We incorporated music therapy first, because, who’s going to say no to music, and massage therapy, because again, everyone wants to get a massage. Then with acupuncture, there was some skepticism, but there was alreadysome research evidence, both neuroscience research and clinical research, and then we enlisted the oncologists to serve as co-principal investigators in acupuncture clinical trials. Through that process, they got familiarized with acupuncture and they saw the clinical effects. So initially acupuncture may have been seen as a novelty, something strange, but has actually become a standard of care.

With ER positive breast cancer patients or survivors experiencing hot flashes, there’s no good treatment for that. You cannot give them estrogen, when normally estrogen replacement is used to treat menopausal hot flashes. So what do you do? I did one of the first clinical trials using acupuncture to treat hot flashes, and we saw good results. So the oncologists started to refer patients to us for hot flashes and the patients went back and said this really helps. You can show the oncologists all the clinical trial data, but when their own patients improve and do better, I think that speaks to the oncologist very powerfully.

Dr. Rountree: They believe it when they see it! Was the main objective to mitigate side effects and improve quality of life, or was the goal to actually increase progression-free survival?

Dr. Deng: At that time, we focused mostly on reducing side effects and supporting treatment. There are people who are going to have so many health issues, like joint pain, that they’ll come off the aromatase inhibitor, and then recurrence will be higher. So if you can reduce the side effects and thus keep them on it for longer, indirectly you will improve progression-free survival because you make people tolerate treatment better. It’s the same with chemotherapy. Sometimes patients have too much neuropathy or too much nausea, and then they stop the chemotherapy. If you can suppress those side effects, and they can finish the full six courses of chemo, rather than two, you actually help the treatment efficacy indirectly. So instead of using drugs we use this complementary therapy which tends to have much fewer side effects That’s a good example of helping the oncologist become more familiarized with this complementary therapy and the integrative approach and eventually they turn from skeptic to neutral or indifferent, then to support, then to friend and then to champions and partners. At the end, most oncologists are actually our friends, champions, and partners in both research and clinical care. It takes two things to get there—one is rigorous scientific research, and the other is real-world effects.

When we have patients with refractory problems that have not been responding to the standard of care who respond to, for instance, dietary changes or lifestyle changes or TCM herbal formulations, the oncologist is going to send you more of these patients. So you can see we’re moving from just treating some symptoms to tackling some unique problems that have not been responding to the standard of care.

Now 20 years later, there is more evidence showing that if you use this integrative approach to cancer care, you may actually improve response to treatment, especially immunotherapy and improve survival and delay recurrence because you change the whole body’s environment. You can actually change the ecosystem for cancer cells and that will make the body more hostile and less friendly to cancer cells. You are actually not only improving symptoms, but you are also contributing to the efficacy of the cancer treatment. In the talk I’m giving next week at the Nutrition and Supplementation in Clinical Care conference in Carlsbad, California, I’ll show some of the data on that.

Dr. Rountree: Has Memorial Sloan Kettering Cancer Center been leading the way in this area or are there other centers that are also conducting research into what works or doesn’t work?

Dr. Deng: Memorial Sloan Kettering Cancer Center and MD Anderson and Dana Farber are the three of the earliest cancer centers that established integrative oncology programs and of course it’s a collective effort in this country and around the world. It’s an evolving field. Clinical trial design has become more and more rigorous. In recent years, there’s some very large randomized multi-center trials done with solid data.

Dr. Rountree: Do you believe there are still a lot of things to be discovered in the botanical realm—that TCM formulas or compounds derived from them might prove to be therapeutically useful?

Dr. Deng: During the 1980s, the National Cancer Institute did a systematic screening of anti-cancer agents from natural sources. Some of the most popular chemotherapy drugs now being used came from those screenings. One example is paclitaxel that comes from the Pacific Yew tree.

While I was at Memorial Sloan Kettering Cancer Center, we also did that. We focused on anti-cancer and immunomodulator botanical agents. We found some, for example astragalus, which has a component and polysaccharides from mushroom extracts, that improves the efficacy of vaccines. We found that echinacea has both immune enhancing and immune suppressive components. So it should not be used all the time. It should only be used during the first phase of upper respiratory tract infections. We also did screenings of natural products for suppression of tumors and we found several. The challenge there was the potency. It may work great in the labs and tests, but when we did clinical trials and we did the dose escalation, we found that you would need like 40 capsules to have activity in the blood that would inhibit tumor growth. By that time, people were having adverse events like vomiting similar to what is experienced during chemotherapy.

So there may be an active compound, but it’s not potent enough to be clinically practical. This is a common problem among natural products. Sometimes you see reports in the headlines saying that an herbal product kills cancer cells, but as a scientist and physician, when I look at the paper and actually read the method section, I want to see what the dose range is to be clinical relevant and the challenge is that many of these active compounds are just not potent enough to be used practically, and so they are not currently capable of becoming standard treatment for cancer. You have to take a massive dose that is not practical. A lot of things may work on paper, but not in real life. The synthetic compounds are like 100 times more potent than we found from the natural world. So the clinical potency remains a challenge, but there are still things to be discovered.

Dr. Rountree: There is also the issue of bioavailability.

Dr. Deng: Yes, it’s bioavailability and it’s metabolizing in the blood, in the target tissue, the tissue concentration—all of that. Having said that, there’s another area of natural product research, which is the interactions and synergy. If you look at all the TCM herbal formulations, there are always multiple components and when you analyze it they actually work together. They tend to attack multiple pathways at the same time and there are also components that will enhance absorption. When you study botanicals with a reductionist approach, you analyze a single isolated herbal compound and then often lose the efficacy. That’s a challenge and also an opportunity to investigate.

Dr. Rountree: I recently heard a presentation by Howard Hang, PhD, who is Chair of the Immunology Department at Scripps. His team had been looking at cancer patients who were resistant to PD-1 inhibitors. He found that many of them were lacking a particular microbe in their gut that expressed a certain gene. The gene is involved in production of a molecule that has immunomodulating properties. They were trying to figure out how to reintroduce that microbe or engineer a probiotic to include the gene. The idea is that if you upregulate certain pattern recognition receptors then it actually makes PD1-1 inhibitors work more effectively at activating exhausted T lymphocytes. Do you think that’s a worthwhile avenue to pursue?

Dr. Deng: Yes. It’s actually a very hot area for research. The gut microbiome and immune system is linked to the efficacy of immunotherapy. There is even evidence showing that the circadian rhythm is linked to immunotherapy. And a high fiber diet is associated with higher immunotherapy efficacy.

There’s also chronotherapy. If you give immunotherapy or even chemotherapy during the early part of the day, it appears to work better than during the later part of the day. So all these reinforce integrative health—what’s happening to the rest of your body and your life actually can influence cancer treatment. So lifestyle, diet, exercise, stress reduction, sleep, and social environment are important. Stress is a known immunosuppressant and promotes angiogenesis to promote cancer cell growth.

If you look deeper at integrative medicine practice, there is a lot of focus on the host, the patient’s body, rather than the outside only. It is trying to look at what can be mobilized inside the human body to integrate the inside and outside—whether that is chemotherapy, radiation or drugs—for better health.

What I’m currently focusing on at UCI is to broaden to not just integrating these complementary therapies—acupuncture, massage, meditation, etc.—but also to actually do a multi-modal care package including every holistic intervention possible to promote physical and mental resilience. We are not only fixing what went wrong—we also want to promote what can go right, which means you make your body such a hostile environment for cancer cells, you don’t give them the nurturing nutrients and environment for their growth, and you take care of your immune system so that you have a robust immune surveillance. We are integrating both pathogenesis and salutogenesis.

We’re not only improving quality of life and managing symptoms—we are also improving the outcome of cancer treatment because we now have enough evidence to say that you can mobilize the patient’s own force to fight cancer. That’s my main focus now.

Dr. Rountree: That’s amazing. I wish every oncologist could hear what you are saying.

Dr. Deng: The mission is to generate the information, the data so that people will be on board, and fortunately we have many emerging projects that are working towards that direction.

Dr. Rountree: You wrote a book called The Wellness Principles: Cooking for a Healthy Life. ¹

Dr. Deng: Yes. When we see patients, we always talk about the foundation of health, which is diet, exercise, stress management, sleep, circadian rhythm, social environment and positive things, meaning and joy in life. We’ve been doing whole person health for like 20 years and I think it’s catching on. When we talk about diet, we talk about all the principles and the data, how it helps cancer prevention and cancer treatment and reduces recurrence and the patient says yeah, that’s all great, but how do I do it, what do I do?

None of the cookbooks I have seen were exactly what I had in mind—some are very healthy, maybe too healthy for people to sustain, or maybe it tastes good but it’s not that healthy, or it’s too elaborate or too sophisticated and not approachable. I wrote a cookbook because I’m a home cook myself. I just love cooking. I cook for my family, three meals a day. This book, The Wellness Principles: Cooking for a Healthy Life, ¹ has 100 recipes for patients to give them specific tools to improve their diet—recipes that are healthy, tasty, and quick, since most of us do not have the time to cook.

Dr. Rountree: Do you have a favorite meal that you recommend?

Dr. Deng: Well, the main theme of that book is a healthy diet is not about a particular super food, it’s about balance and diversity. So, you want a very diverse diet. We need hundreds, if not thousands, of micronutrients, and the only way you get them is from a very diverse diet. For each meal, you should have at least 10 ingredients. One of my favorite recipes in the book is the full-spectrum salad—I also call it the “everything salad.” It’s a combination of vegetables of various colors, high-quality protein, and a little bit of carbohydrates. The beauty of it is that you can mix and match. In the recipe, it shows different renditions, and you can keep changing it every day.

I’m also making a cooking show here at UCI with the chair of Urology, Dr. Jaime Landman. The Susan Samueli Integrative Health Institute has a very elaborate teaching kitchen, and we filmed 12 episodes last month, which should come out in the coming months. The recipes came from that book.

Starting with high-quality ingredients is very important. I was fortunate; right downstairs from our home in New York, one block away, there was a farmer’s market every Wednesday, and I always got my vegetables from them. They had like five different kinds of carrots in different colors, and when I got lettuce, the leaves were still crispy rather than withered, and sometimes there was a worm inside, so I knew it had not been exposed to pesticides. And across the street from where I live now in Irvine, like 5 minutes away, there’s one of the largest Farmers Markets in Orange County every Saturday morning.

Our overall goal is to develop an integrated whole-person cancer care model and then we’re going to research it, generate data demonstrating the benefit and safety, and then disseminate the model. Hopefully, this will elevate the field of integrative oncology to the next level, which is integrated whole person care instead of just, for example, having neuropathy that’s not responding to drugs and just trying acupuncture for that only. I think that’s very last-decade. In the next decade, we want to go to the next step.

Dr. Rountree: To make whole person care a universal model?

Dr. Deng: We want every cancer patient to be engaged with integrative health and integrative oncology at the beginning of their cancer journey, which means upon diagnosis, to make their bodies and minds stronger going into cancer treatment, to make them happy with the tools to eat well and to reduce stress so they do better during and after surgery, they recover better during chemotherapy, they have less side effects, they can complete the course, and then after treatment, they have less long-term side effects and lower recurrence risk.

Dr. Rountree: You are transforming the standard of care in oncology.

Dr. Deng: We haven’t gotten there yet, but that’s our mission. It’s a transformative paradigm shift, not only treating the cancer, but treating the whole person as well—not only giving people therapy from the outside but also harnessing and mobilizing their internal force to contribute to their treatment.

Dr. Rountree: What’s the best way for people to follow your work?

Dr. Deng: The Susan Samueli Integrative Health Institute has a website—https://ssihi.uci.edu/. There’s a lot of information there and I encourage people to explore that. For example, we have an extensive library of videos, for instance, on cooking classes, meditation practices, etc. I think that’s a good place to start. It’s not limited to oncology, but I think it’s universally important.

Dr. Rountree: Wonderful. This has been a very inspiring conversation. Your work has huge potential and I’m looking forward to seeing how it evolves. Thank you so much for your time today.

Dr. Deng: Thank you. I look forward to seeing you next week.▪