This summary was written by Liz Hiles, Engagement Specialist for Gryt Health.
If you missed this program live, you missed a lot! We had a jam-packed Zoom room for this event on this extremely popular and growing topic and our first-ever 90-minute program. While this specific program was focused on using these methods for oncology diagnoses, many of the approaches and techniques can be utilized with other diagnoses.
For those who have never heard of this, Integrative Oncology, as defined by the American Society of Clinical Oncology’s Educational Book, is the diagnosis-specific field of integrative medicine, that addresses symptom control with nonpharmacologic therapies. Known commonly as “complementary therapies” these are evidence-based adjuncts to mainstream care that effectively control physical and emotional symptoms, enhance physical and emotional strength, and provide patients with skills enabling them to help themselves throughout and following mainstream cancer treatment. Integrative or complementary therapies are rational and noninvasive.
We were joined by Santosh Rao, MD, ABOIM, Medical Director of Integrative Medicine and Supportive Oncology at Banner MD Anderson Cancer Center and President-Elect for the Society of Integrative Oncology; Elizabeth “Liz” Bullock, MT-BC (Board Certified Music Therapist), Music Therapist at Seidman Cancer Center, University Hospitals Connor Whole Health; Sam Rodgers-Melnick, MT-BC (Board Certified Music Therapist), Integrative Health Research & Data Specialist, at University Hospitals Connor Whole Health; and Desirée A. H. Walker, Patient Research Advocate, Motivational Speaker and Health Equity Champion for the evening’s interactive session.
Dr. Rao started out the evening explaining what integrative oncology is and why it is useful. He also described the process of integrating it into Western medical practices. Even though many integrative practices are derived from traditional medicines of diverse populations and have their findings in ancient practices, many have only recently begun to have documented clinical studies attached to them and that is what gives way to being able to incorporate them into treatment practices with the supervision of a medical team and insurance coverage.
In his slides, Dr. Rao expanded on the definition of Integrative Oncology, stating “Integrative oncology is a patient-centered, evidence-informed, field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health quality of life and clinical outcomes across the cancer care continuum and to empower people to become active participants before, during, and beyond cancer treatment.” Dr. Rao also made it very clear that integrative medicine is not the same as alternative medicine. Integrative medicine is a practical look at the evidence as much as possible in order to optimize a patient’s health.
Next, Dr. Rao explained how the appointment process goes at his facility at Banner MD Anderson Cancer Center in Arizona where they schedule hour-long appointments. Their approach was modeled after the MD Anderson Cancer Center in Houston, Texas. They combine physical, social, and psycho-spiritual aspects of patient health and consider conventional modalities like chemotherapy, surgery, and radiation as well as integrative modalities like meditation, yoga, acupuncture, nutrition, and more to come up with a holistic plan of care for the patients. They do their best to coordinate all these efforts and keep the primary oncologist in the loop for all treatments, which is something that does not always happen at facilities that do not offer integrative techniques.
Our next guest speaker was Desirée Walker, a two-time breast cancer victor, patient advocate, and motivational speaker. One of her many roles in advocacy is serving on the Patient Advisory Committee for SIO. Desirée shared her diagnosis story and proceeded to tell how she “stumbled” onto integrative oncology. Before actively practicing integrative medicine, Desirée found that music helped her to prepare for her surgeries and radiation. It has always been something that soothed her and helped her center herself despite not knowing that music therapy was a thing.
Later, having found out that she had an estrogen-positive type of breast cancer, she was thrown into medically-induced menopause and found it necessary to find natural ways to deal with hot flashes and the other side effects that came from being in menopause. Desirée believes that it is important for a patient’s mental state to have space and support while they explore what options work for their circumstances. One of the integrative techniques that she has discovered is especially beneficial for her is acupressure, which is similar to acupuncture in terms of its analysis of the human body, but it uses pressure rather than needles to achieve its effects. There are benefits including the elimination of potential complications of bleeding and infection and expanding the range of patients who might benefit from this treatment to include individuals receiving anticoagulants, those with needle phobia, and those who are severely immunosuppressed. Acupressure can also be taught to the patient who can then apply this technique as self-treatment on a more frequent basis. Desirée even demonstrated an acupressure technique later on in the evening that she learned and has been really helpful for her in dealing with nausea. One of the biggest benefits of acupressure is that you do not have to be a professional to administer these types of treatments.
Then, Sam Rodgers-Melnick and Liz Bullock joined us live from their sound studios at Cleveland’s Seidman Cancer Center, University Hospitals Connor Whole Health to walk us through some music therapy examples, and then we wrote a group song. Due to some technical difficulties, they rerecorded their part of the presentation with high-quality sound and we have inserted it into our original video recording so that anyone watching the replay will be able to clearly hear the information and music.
They explained that the official definition of music therapy is clinical and evidence-based music interventions to assist in accomplishing individualized goals within a therapeutic relationship with a credentialed professional. This type of therapy has been proven to help address stress and anxiety as well as improvement of self-management skills.
The duo described how the therapy typically has been administered to their patients as well as the various ways they have adapted their delivery techniques due to the COVID-19 pandemic. They also shared that there have been studies at MD Anderson that have shown clinically and statistically significant reductions in pain reduction to 1.5 units across 727 sessions, reduction in anxiety to 2.9 units across 508 sessions as well as a reduction in symptoms of fatigue.
Sam and Liz demonstrated some drumming techniques and utilized basic blues music in a group songwriting demonstration where the group created a song about self-care. All in attendance really enjoyed the demonstrations.
Dr. Rao also discussed the benefits of Ayurveda practices within Integrative Oncology. Ayurveda is the traditional medicine of India has played an important role in disease management and health for many centuries, their present frequent use is challenged by the necessity to determine its complex composition and its multitarget mode of action. It is a plant-based practice. According to Dr. Rao, it is “basically an element system” and is a directive on how to manifest the strengths of your own internal nature. Dr. Rao is optimistic that Ayurveda will become more integrated into American medicine as he is currently sitting on an international committee through the National Institute of Health (NIH) with India and they are evaluating these techniques in precise terms for research.
Yoga is another ancient practice that has been proven to be effective in improving the quality of life of cancer patients. It helps create physical routines and regulates a person’s circadian rhythm, which also helps control their sleep patterns.
At the beginning of the Q-and-A, Gryt Health team member, Lauren Lastauskas, reminded everyone that no decisions should be made without your healthcare team. If they are not already familiar with integrative oncology practices and techniques, it is within your right to ask for a discussion about it or to seek a second opinion. Dr. Rao agreed and stressed that if you are disconnected from your oncologist and/or surgeon, your care really isn’t going to be complete and some of the techniques can cause fragmentation within your treatment plan and actually work against each other. Everyone must be on the same page and keep the same goals in mind.
In terms of insurance coverage, access to integrative medicine can be a challenge. You really have to work with your doctor’s office and your insurance policies to see what is available to you. Some places provide services on a sliding scale if they are not covered by your insurance plan, but it is a very real possibility that pursuing these techniques could contribute to the financial toxicity of cancer diagnoses, especially if you have to pay 100% of the costs for these treatments as an out-of-pocket expense. It is also likely that you may not be able to participate in every treatment option that you want to try. Desirée stressed that it is really important to ask a lot of questions and to do your own homework on the options available to you. Bringing research-based evidence to the insurance companies and policymakers are what is needed to bring these issues to the forefront and initiate changes.
Desirée also stated that if you have to get a new insurance plan at any point in your healthcare journey, you need to research the plans, the company and ask lots of questions before making the commitment to the insurance plan, especially if you would like to consider integrative medicine in your care plan.
Sam shared that sometimes it depends on what state you reside in and how the hospital that you receive treatments from is structured. There is a new era in healthcare and healthcare is slowly moving towards value-based care. In Ohio, for example, Medicaid access has been expanded to include acupuncture for lower back pain and migraines in order to begin to address the opioid epidemic.
The panel reiterated that Integrative Medicine is not a one-size-fits-all approach to medicine and that any plan should be individualized as well as independently researched so that you can make informed decisions with your healthcare team that all involved are comfortable with.
Many of the attendees wondered how they could find an integrative oncologist in their area. Fortunately, SIO is set up with a search engine specifically for that. You can find an integrative oncology professional in your area here. It is important to keep in mind that these services are fairly new in the US and are not yet available at every cancer center. If you really want to incorporate some of these practices, you may need to travel outside of your area and/or pay out-of-pocket for some of the services you desire.
If you would like to view this program in its entirety, please check out the video below. Let us know you’ve watched it in the comments and if you have any questions, drop those in the comments as well. If we don’t know the answer, we’ll reach out to the panelists or SIO for more information.
Other resources on the topic that were provided by our panelists follow.
Finding an integrative oncology practitioner:
SIO does not provide individual patient referrals or treatment recommendations. Patients should always consult with their healthcare team about adding any evidence-informed integrative or complementary therapies to their care plan.
Nancy’s List was created by Nancy Novack, PhD.
Research for Wellness was created by SIO member and cancer survivor, Cheryl Leving, this website contains evidence-based information for a healthy “new normal” after cancer diagnosis and treatment, along with a list of integrative cancer programs in the US and much more.
Information on integrative oncology:
A comprehensive definition of integrative oncology
Music Therapy Resources:
To find a music therapist or learn more about music therapy, visit the American Music Therapy Association’s website at https://www.musictherapy.org/
Bradt et al. (2021) Music interventions for improving psychological and physical outcomes in people with cancer
MSK Integrative Medicine at Home Membership Program offers virtually-delivered fitness for everyone, music therapy, yoga, tai chi, kung fu, mindfulness meditation, dance therapy, and much more for a low membership fee.
Project Life MBC offers virtual integrative programs, including art therapy, for people living with metastatic breast cancer.
Maple Tree Cancer Alliance offers free exercise oncology programs online.
Healthy Lifestyle Resources:
Natural Products, Herbs, Dietary Supplements:
KNOW Integrative Oncology Database is also available for free as an SIO membership benefit.