WHEN KAREN COCHRANE WAS DIAGNOSED with breast cancer during a routine mammogram in 2016, her reaction was typical: shock and fear.
But, what happened next was not.
Cochrane’s oncology team at UAB Hospital in Birmingham, Alabama, asked if she wanted to enroll in a study examining the effects of diet and exercise on outcomes among patients with her type of cancer. She said yes, and for several weeks leading up to the start of treatment, she worked with an assigned dietitian and physiologist to count her calories and steps. Researchers wanted to examine whether the interventions could lower estrogen levels in the body and thus cut down on fuel for the tumor, but Cochrane also found other benefits. She felt better and more ready for the treatment, and gained a sense of control.
“It took my focus away from the cancer,” Cochrane says. “It was very helpful to take my thinking away from, ‘Oh my gosh, this is a doomsday-type thing.’”
A nationwide survey from the Samueli Foundation, a nonprofit based in Corona del Mar, California, finds Cochrane is in good company. The survey asked more than 1,000 cancer patients and 150 oncologists about their beliefs and experiences with “integrative oncology,” a practice that combines conventional treatment with practices such as acupuncture, music therapy and support group attendance.
The survey found that more than 50% of patients and 60% of treating oncologists said they “strongly agree” on the ability of integrative practices to improve both treatment experiences and patients’ overall well-being. More than 40% of both doctors and patients also said they believe an integrative care approach can actually improve outcomes and survival.
Wayne Jonas, who led the study as former executive director of Samueli Foundation’s Integrative Health Programs, says the survey is the latest indication of growing acceptance of integrative care among doctors. Jonas, a physician who has held roles related to integrative care with the U.S. National Institutes of Health and the World Health Organization, says buy-in has grown as more research showing benefits has emerged, followed by new best practices.
“It definitely has increased in the past 10 to 20 years, as significantly more evidence has accumulated,” Jonas says. “A lot of things that used to be considered alternative are now pretty much mainstream … [and doctors] see it coming across in the guidelines.”
Key Questions: Which Therapies, and When?
The three most popular integrative therapies among patients, the survey found, largely target the body: nutrition (40%), massage therapy (37%) and exercise consultation (35%).
But while four in five doctors said their institutions offered nutritional services, less than half offered therapies like massage, exercise, acupuncture or yoga. Mental health services and patient support groups, reported by 60% of doctors to be offered at their institutions, were more commonly available than physical therapies.
Another significant gap the survey found between patients and health care providers was when to discuss integrative care. Among patients, 62% wanted the conversation to take place between diagnosis and treatment, and another 20% wanted it within two weeks after starting treatment. Among doctors, only one in three felt it best to discuss before treatment, with nearly 40% stretching it to a month or two after treatment. Overall, both patients and oncologists reported that conversations never took place in about 60% of cases.
Jonas says these statistics reveal a few problems. First, doctors are often more focused on starting treatment—putting in ports and coordinating surgery and chemotherapies—than they are on integrative care.
“That’s sort of logical. Except, as this survey shows, patients don’t want to wait,” Jonas says. “They know [standard] treatments produce a lot of side effects, which scares them. And so they want to know, ‘What can I do now to help mitigate these things?’”
A second challenge speaks to a larger problem in the health care system: a lack of time and resources.
Impediments to Integrative Care
Asked about the most significant barriers to integrative oncology, doctors first listed no insurance reimbursement (49%), lack of staff to implement (39%), patients not interested (32%), and no time (31%).
Jonas and other experts say health insurance coverage and more staff on hand would make integrative care more accessible. These are difficult systemic issues, but Jonas says he sees promise as more patients seek out health care systems that offer integrative care, and more hospitals respond in kind. In addition, some facilities ask patients about integrative care on intake forms, standardizing and expediting the process.
But there are also shortcuts doctors and patients can pursue. One is simple awareness of the popularity and benefits of integrative care, which Jonas says should help patients and doctors feel empowered and comfortable starting conversations. Another is knowledge: Many patients don’t know what options are available to them. Often, neither do their doctors.
Doris Piccinin, a registered dietitian at Penn Medicine’s Abramson Cancer Center in Philadelphia and a breast cancer survivor, knows these realities firsthand. In the busy world of health care, she says it can be challenging for dietitians to focus on anything more than top-priority patients who are losing too much weight. But she was excited to see in the survey that a majority of cancer patients would be willing to pay $11 to $25 a month for integrative care, which opens the door to provide more offerings.
During her own bout with cancer, a bit of detective work went a long way. She found a physical therapist to help restore her range of motion after surgery, took advantage of reiki and massage therapies that helped her deal with chemotherapy treatments, and learned about Unite for Her, a Philadelphia-based nonprofit that provides free reiki, health counselors, gym memberships and more.
She and her colleagues at Penn have since taken the initiative, offering a virtual exercise group to cancer patients and providing helpful take-home items like water bottles and exercise bras designed for mastectomy patients.
“It is important to get people back into physical activity,” Piccinin says. “It can help with their mental health, their attitude, and improving their quality of life.”
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