Like hospice and palliative care, the integrative medicine movement began as edgy outsiders. But in the last 10–15 years, integrative oncology practices, often tied with integrative medicine programs, are being established in major medical institutions across the country. Many are embedded in medical centers that are leaders in the development and provision of the most advanced modern technologies for cancer care. This issue of JNCI Monographs focuses on the role of integrative oncology in care of cancer survivors; the editors have brought together commentaries on the “state of the science.” We at the National Center for Complementary and Alternative Medicine together with our partners in the Office of Cancer Complementary and Alternative Medicine at the National Cancer Institute are the main National Institutes of Health supporters of that science. Our shared goal is a rigorous evidence base to guide patient decisions and to help providers make sensible recommendations: a solid scientific basis, assessing both risks and benefits.
Not surprisingly, since integrative oncology is a relatively new movement, the science is just beginning. It is already very clear that approaches that fall under the general rubric “integrative oncology” are meeting important and often neglected needs. Two things are driving change. In part, the integrative oncology movement is a response to patient demand. Patients are asking for change—for access to an approach to care that is seen as more “holistic,” perhaps gentler, perhaps more optimistic. Change is also being driven by providers. Some physicians, including a number of oncologists, see in the integrative medicine movement an opportunity to develop a style of practice that will facilitate changed relationships with patients: less emphasis on technical advice, more emphasis on healing, defined broadly, on provision of emotional and spiritual supports, on creation of positive expectations, on encouragement to healthy living. By and large, when integrative practitioners offer “alternative” practices, it is as a complement to modern “mainstream medicine.” And by and large, patients interested in integrated approaches, do not want (and are not well-served by) care that does not integrate effective mainstream techniques for cure, prolongation of life, or substantive palliation.
National Center for Complementary and Alternative Medicine has decided, through a year-long strategic planning process (1), to focus our resources on research on benefits and risk of complementary health practices for symptom management, particularly pain management, but also fatigue, loss of sleep, loss of appetite. A variety of complementary approaches and a number of practitioners from disciplines outside mainstream medicine are increasingly part of the integrative approach to symptom management. This monograph will, we hope, stimulate continued interest in testing these approaches and in their continued improvement. Our patients deserve nothing less.