Dr. Gary Deng
© Helixor, Rosenfeld, 2018.
Dr. Gary Deng (MSKCC, New York, USA) is one of the renowned driving forces behind the Integrative Oncology (IM) in the USA. Deng told Heilpflanzen-Welt.de, that - after 20 years of ideals-driven work combining conventional oncology with evidence-based modalities of complementary medicine - the first ever guideline for integrative oncology (breast cancer) is now published and even adopted by the American Society of Clinical Oncology (ASCO). And he gave some personal impressions about the preconditions of Integrative Oncology in daily practice (Interviewer: Rainer H. Bubenzer, Berlin).
Question: Integrative medicine (IM) - 20 years after first use of the concept: Now we have definitions like in ‘J Natl Cancer Inst Monogr. 2017 Nov 1;2017(52)’ which are even recognized at ASCO (e.g. SIO guideline breast cancer). Could you describe, what changed/developed in the basic understanding of IM during the last years? Will IM become an integral part of oncology more and more? Or is it a “fig leaf“-complement for “school medicine“-oncology, with the purpose to hide some of the biggest problems of conventional oncology (side effects, efficacy, 'body orientation', costs)?
Deng: What has changed is a critical mass of research data, health care professionals working in this field and academic medical centers that have established integrative medicine programs. This critical mass carries a momentum to move the field forward. I am confident that integrative medicine will increasingly become a part of standard cancer care. When patients experience benefits, and when our colleagues who initially might have been skeptical then observed how patients benefit and become more aware of the increasing body of evidence, it is just natural for oncology professionals to welcome and even embrace it. It is what is happening in our institution. I don’t think it a “fig leaf” at all.
Question: All cancer patients in Germany ideally should have access to psycho-oncologic or - later - to palliative care, at least our government and our oncologists associations claims. Nevertheless, in reality, the majority of all cancer patients are excluded from this (no access, no covering, and no service/offers by hospitals except in bigger cities). The same is true for IM/IO. What are your experience in USA to share IO to everybody? Which ways would be practical to realize “health for all“ - even underprivileged patients? Or, in terms of social medicine: Would realizing the concepts of IO "make the world a better place“ (former marketing claim of Phillips)?
Deng: For a mode of care to be widely adopted in clinical practice, there are many factors in play, other than scientific factors. These factors may be societal, cultural, political, economical or behavioral (it is hard to change habits). Our ideas of solution are education, building bridges, and continue to demonstrate benefits to patient and the society at large through our clinical care and research activities. “Health for all“ and “make the world a better place“ are lofty and noble causes, but would take a lot of achieve. We can all just do our small part one step at a step – achieving greatness by doing small things with great love.
Question: If IM (at least in parts) was originally an element of hospital marketing concepts, it arrived nowadays in the daily routine of many hospitals, as you reported from the US. But can IO also be implemented in the outpatient treatment, in the ambulant setting? And if yes, how? How about “medical networking“ to bridge the gap between hospitals and private practice? Are there already working tools?
Deng: Some hospitals may see it as a marketing concept, but there are also many people truly believe it is the right thing to do to improve patient care. It is their passion. Otherwise they would not have sustained themselves. IO is both inpatient and outpatient as it is currently practiced in the US. Big medical centers can establish their own outpatient IO practices or partner with providers practicing independently in the community.
Question: Your mentioned that the “digitization“ of medicine could reach also IO. Do you already have experience, how to bring IO via Internet to patients who do not have access to expensive therapies, hospitals or doctors (relaxation therapies, online-Yoga ..). What about the “human touch“, the lively connection between patients and doctors in internet-based IM?
Deng: We use online platform to deliver multimedia contents. You can find them here. We also teach online mind-body practice classes. Of course some of the human touch is lost, but it is a compromise for increasing the reach so more people can have access.
Question: Can you give some rough figures about funding of IM/IO for SKMCC (compared to the US)? In addition: How many patients per year use IM/IO in Sloan Kettering?
Deng: We have more than 30,000 patients encounters a year in our service.
Question: Which role plays CAM-immunostimulation with herbs, hyperthermia, Viscum album or other concepts in the MSKCC?
Deng: Hyperthermia is used in clinical trial settings. We guide patients in the proper use of herbs – use those that are safe and beneficial and avoid those with unfavorable risk/benefit ratio. Viscum is currently not formal available in the US.
Question: Science: In the definition of evidence based medicine (EBM) Sackett never excluded the personal approach to our medical experience, the case studies. Do you think, in IO we should come back to this age-old method of knowledge transfer- and communication-method in medicine?
Deng: As I discussed in my workshop, we need to look at the totality of the evidence. Not only that, we need to consider all three factors in making clinical decisions: strength of evidence, risk and burden to patients, and the alternatives. It is not just the strength of evidence that dictate care, because there are infinite numbers of clinical scenarios and only limited resource to generate evidence.
Question: Many years ago, the IOM-report “Lost in transition“ showed a most critical point of cancer care. Today with targeted therapies and other therapeutic advancements in oncology, we have even more long-term survivors without a suitable care. Are there already specific ideas in IM for this growing group of patients?
Deng: Cancer survivors is a group who are most interested in IM and for whom IM has the most to offer. The essence of IM is to nurture and strengthen the body’s intrinsic ability to recover and to thrive. That is actually what cancer survivors want and can achieve.
Question: “See your patient as friend, as part of your family“ is your suggestion for the basic attitude, which could drives IM. Is this really realistic in the modern world regarding the education, training, income, social status of medical doctors? What about religion /religious beliefs as personal precondition for the practice of IM?
Deng: We practice that philosophy and try to instill that in our trainees. It is an attitude and an awareness. We all have family members with difference education, income, social status as us, but we treat them with the best intent and their best interest in mind. This is what I meant by “as friend and a member of your family.“ Personal religious beliefs do not come in play in our practice. It is about humanity and relief of human suffering.
! Dr. Deng, many thanks for your time and your answers!
Rainer from Heilpflanzen-Welt.de met Gary Deng at:
Integrative Medicine Meeting 2018: “Innovation & Experience in Oncology“ in Rosenfeld, 17.-20.9.2018. Veranstalter: Integrative Medizin Veranstaltungs-GmbH. Chairmen: Prof. Dr. Gary Deng, Medical Director, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA and Prof. Dr. Roman Huber, Centre for Complementary Medicine, University Hospital Freiburg, Germany.
Autor/In: Rainer H. Bubenzer, September 2018, Berlin.,