Integrative Oncology in Cancer Care: Bridge Research Findings and Clinical Practices

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, 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 H. Buben­zer, 22. Sep­tem­ber 2018, Berlin.
Rai­ner H. Buben­zer from 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.

Bitte Ihre Frage, Anmerkung, Kommentar im folgenden Feld eingeben