New practice guideline addresses integrative therapies for cancer patients

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The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) have published a new joint practice guideline to address gaps in how to treat common cancer symptoms and pain using integrative medicine approaches safely and effectively.

The guideline, published in the Journal of Clinical Oncology, builds off ASCO’s existing guideline focused on cancer pain and dives deeper into the use of integrative therapies for pain management. Researchers assessed 227 studies to inform the evidence base for the guideline.

“Pain is a clinical challenge for many oncology patients and clinicians, and there's a growing body of evidence showing that integrative therapies can be useful in pain management. But to date there has not been clear clinical guidance about when and when not to use these approaches,” said Heather Greenlee, ND, PhD, co-chair of the SIO Clinical Practice Guideline Committee in a statement.

According to SIO, 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.

The SIO-ASCO guideline was developed following a review of published literature, including research only from randomized clinical trials. A large panel of oncology experts was convened, and they reviewed existing evidence and assessed the quality of studies; once consensus was reached, recommendations were made based on the strength of the evidence available.

According to the guideline, recommendations included offering acupuncture as a modality to breast cancer patients experiencing joint pain related to the use of a medication common in breast oncology called aromatase inhibitors. Because there was moderately strong evidence supporting its effectiveness and its low risk of harm, the expert panel also recommended acupuncture for general cancer pain or musculoskeletal pain as well as for chemotherapy-induced peripheral neuropathy. The guideline also recommended the use of massage therapy for patients in palliative care or hospice who are experiencing pain.

“Clinician uptake of evidence-based treatments is always a concern, which is one of the reasons why we create practice guidelines,” said Eduardo Bruera, MD, of MD Anderson Cancer Center and a representative of ASCO in a statement. “We are hoping that by showing the growing evidence that is out there, healthcare systems will start hiring these kinds of practitioners and insurance systems will start covering these treatments, because more and more, these are being shown to be effective at managing pain for cancer populations.”

In addition, to help ensure patients play a role in the treatment decision-making process and to inform their discussions about integrative therapies with their oncologists, ASCO and SIO have posted a listing of integrative medicine patient resources on their respective websites.