Integrative oncology: integrating hope

contributed by Eric Olsen

Suzanna M. Zick, co-director of Integrative Family Medicine at U-M, on the benefits of integrative oncology in cancer care.

Suzanna M. Zick, N.D., M.P.H

Photo: Erica Reist Bass

Integrative oncology is a holistic approach to medicine that has steadily gained prominence among the medical community in their approach to cancer treatment. This methodology uses complementary healing therapies and treatments such as yoga, meditation and acupressure, alongside conventional therapies like surgery, radiation and chemotherapy. Practitioners of integrative oncology bring a holistic, evidence-informed approach that centers people with cancer in the treatment process.

To gain a fuller understanding of the approach at University of Michigan Health, Rogel spoke with Suzanna M. Zick, N.D., M.P.H., co-director of Integrative Family Medicine and research professor in family medicine and nutritional sciences in the U-M School of Public Health.

What is integrative oncology?

Simply put, integrative oncology combines evidence-based approaches that include both what we would consider conventional treatments, along with things that have traditionally been thought of as complementary, like acupuncture and acupressure, yoga, mindfulness space practices, Tai Chi and Chi Gong. Diet and physical activity also fall under those rubrics and, where appropriate, certain dietary supplements.

When you have a care provider who understands the evidence base for both approaches, they can help in shared decision-making throughout the cancer continuum of care. Integrative oncology really emphasizes patient-centered care and helping a person with cancer, and their family and loved ones, make the best decisions possible.

How is mindfulness used in treatment?

Mindfulness-based practices encompass therapies such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). These therapies are often used to help patients with anxiety, stress, depression, fatigue and pain management.

Mindfulness practices help patients take an integral role in their own treatment path, and we’ve seen some of the strongest evidence for efficacy of mindfulness practices among cancer populations.

How about dietary supplements?

Dietary supplements get talked about a lot, but so far there isn't much evidence around them. However, some supplements have high quality evidence supporting their use in people diagnosed with cancer and a few dietary supplements have enough evidence to be included in clinical guidelines for cancer care.

For example, lavender essential oil has been tested in several clinical trials and is being used in general patient populations to help with sleep and anxiety. It’s also been helpful for cancer patients in treating anxiety surrounding procedures. Another supplement is injectable mistletoe, which has risen to be included in guidelines for its effects on improving quality-of-life in people with cancer.

As we see the results of more research in this area, we’ll likely see an increase in the potential use of supplements and when not to use them.

There has been a lot of discussion in recent years that certain types of diets can be treatment strategies, that food can be medicine. What is the role of diet in integrative oncology?

There are several clinical guidelines for people with cancer about the evidence for diet and its effect on cancer. These guidelines are what most of us in integrative oncology recommend, specifically the focus on a plant-based diet emphasizing a variety of fruits and vegetables, nuts/seeds, whole grains and healthy proteins. They’re not explicitly advocating for a vegetarian or vegan diet, but they are saying most of a person’s diet should be plant-based. There’s also guidance for the amount of sugar and red meat people with cancer should eat. An integrative oncology provider and oncology nutritionist can help to individualize these recommendations based on personal preferences.

We have a very negative diet culture here in the U.S., and there are stigmas, hopes and fears that can really push people to try more extreme diets. Diet is a way for patients to feel empowered and sometimes people with cancer or their loved ones can go a little overboard for a lot of very well-intentioned reasons. But most of my integrative oncology colleagues say, “Let’s see how we can make this diet work, no matter what it is, as varied and healthy as possible.” Balance is important.

What are some of the other benefits you see in integrative oncology?

Integrative oncology is extremely strong in symptom control. That's where the bulk of our science is, both during active treatment, in the survivorship stage, and during end-of-life care. If we can work with a person to minimize symptoms such as fatigue or pain, their cancer journey has a greater likelihood of having a higher quality of life and lower symptom burden.

Many of our integrative oncology approaches including high quality diets, increased physical activity, stress reduction, and improving sleep quality help to decrease the risk of cancer recurrences as well as other diseases such as diabetes and heart disease that are often more common in people with cancer.

Integrative oncology also gives patients a feeling of being more involved, more in control of their treatment. We've been taught in integrative oncology that we will do our utmost best to educate and educate in a way that is appropriate for where that person's at.

All of this really ties back to the philosophical model for integrative oncology, and its emphasis on teams of care, shared decision-making and patient-centered care.

Patients want to be heard, and we listen.