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Palliative and Integrative Care
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and Integrative Medicine
is an area of medicine focused on quality of life issues for patients and their families facing life-threatening illness. Integrative medicine is a combination of traditional medicine and complementary medicine to treat the whole person; mind, body and spirit.
specialists address a broad range of issues, including:
- support for family members and caregivers
- pain and symptom management
- nutritional support
- emotional distress
- financial issues
- end of life issues
Although may address end of life issues for patients with serious illness, it is different from hospice care. is available at any of a serious illness, including during active treatment. Hospice refers to a special type of to maintaining comfort in people towards the end of their lives. People with serious illness are often referred to hospice care if they have decided to discontinue active treatment, and they are expected to six months or less.
The National Comprehensive Cancer Network (NCCN) has guidelines for , which includes:
- All cancer patients should be screened for needs at their initial visit, at appropriate intervals, and as clinically indicated.
- Patients/families/caregivers should be informed that is an integral part of their comprehensive cancer care.
- specialists should be readily available to provide consultation or direct care to patients/families/caregivers and/or health care professionals who request or require their expertise.
The American Society of Clinical Oncologists (ASCO) recommends that all patients with advanced cancer receive a plan within eight weeks of their diagnosis. Other recommendations include:
- Patients with advanced cancer should receive dedicated services early in the disease course and while undergoing treatment.
- Providers may refer caregivers of patients with early or advanced cancer to services.
Integrative medicine
Integrative medicine is a combination of traditional medicine and complementary medicine to treat the whole person; mind, body and spirit. The National Center for Complementary and Integrative Health (NCCIH) is a branch of the National Institutes of Health. They advise that people learn about the benefits, risks and scientific evidence before pursuing any complementary or integrative product or practice. This is particularly important for people who are thinking about taking supplements that have not been prescribed by their doctor.
The NCCN has guidelines on the use of dietary supplements:
- Taking dietary supplements is not recommended for most cancer survivors unless a patient has a known nutritional deficit, an inadequate diet or other indication (for example, ).
- Little data exist to support the use of vitamins or other dietary supplements for the purposes of cancer control, recurrence or prevention.
- Taking vitamin supplements does not replace the need for a healthy diet. Patients should try to get nutrients from the foods they eat and the beverages they drink.
- People should tell their doctors about any supplements that they are taking.
The Society for Integrative Oncology (SIO) guidelines recommend the following evidence-based guidelines for integrative therapies:
- Music therapy, meditation, stress management, and yoga for anxiety/stress reduction.
- Meditation, relaxation, yoga, massage and music therapy for depression/mood disorders.
- Meditation and yoga to improve overall quality of life.
- Acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting.
Find Experts
The following resources can help you locate an expert near you.
Finding integrative care experts
- The National Certification Commission for Acupuncture and Oriental Medicine has a searchable directory of licensed acupuncturists.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the symptoms and side effects from cancer prevention or treatment.
Find Experts
The following resources can help you locate an expert near you.
Finding and hospice services
- The Center to Advance (CAPC) maintains a directory of programs by location
- The National Hospice and Organization maintains a database of hospice providers by location
Related experts
Some symptoms may be managed by other experts. People experiencing side effects from cancer or treatment may benefit from a consultation with the following experts.
Acupuncture experts
- The National Certification Commission for Acupuncture and Oriental Medicine has a searchable directory of licensed acupuncturists.
Mental health experts
- Association of Oncology Social Workers: Database for finding a social worker by location
- National Alliance on Mental Illness: Tips for finding a mental health professional
- The Anxiety and Depression Association of America: Database of licensed professionals who provide
telehealth services - Mental Health America: Tool for finding a mental health care professional based on people's current needs
Nutritionists
- Eatright.org, the website for the Academy of Nutrition and Dietetics, has an online tool to find a nutritionist in your area. Search by specialty, including "cancer," "weight management" and "heart health."
Physical therapists
- The American Physical Therapy Association's ChoosePT.com website allows you to search for a physical therapist in your area.
Sexual health experts
- The Sexual Medicine Society of North America (SMSNA) has a search tool to find experts in your area who sexual health care services.
- The American Association of Sexuality Educators, Counselors and Therapists (AASECT) maintains a tool to help people find a sexual health expert near them.
Sleep experts
- The American Academy of Sleep Medicine maintains the public-facing website SleepEducation.org that includes a section on finding a sleep center by location.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have specialists to manage the symptoms and side effects from cancer prevention or treatment.
Related Resources
The following organizations have resources related to integrative and complementary care.
- FORCE related resources:
- Information: and integrative medicine
- XRAY category: Alternative treatments
- FORCE video: How Can Help People at Any of Diagnosis (from 2022 conference)
- FORCE video: Complementary and Integrative Medicine (from 2021 conference)
- FORCE video: Complementary and Integrative Medicine for Symptom Management (from 2014)
- Unite for Her provides financial support for services that help improve the quality of life in people diagnosed with breast or ovarian cancer.
- The National Center for Complementary and Integrative Health (NCCIH) is part of the National Institutes of Health that researches practices and products that are not part of conventional medicine.
- How Safe is this Product or Practice? is a resource from NCCIH with results from research on complementary and integrative therapies.
- Be An Informed Consumer is a resource from NCCIH to help people become informed consumers of complementary medicine.
- Alerts, Advisories and Recalls from the and the FTC
Paying For Care
Insurance coverage
- Insurance coverage of integrative and complementary therapies varies based on the insurance plan and the type of care or product being used. Some cancer centers may offer free classes (e.g., yoga or mindfulness) or services (e.g., consultation with a nutritionist) as part of their care. In general, insurance companies will only cover therapies shown by research to be safe, effective and medically necessary.
- Private insurance, Medicare and Medicaid will often pay for some services. Coverage varies depending on the insurance plan and the type of service being provided.
Financial assistance for integrative therapies
- The nonprofit organization, Unite for Her offers a Wellness Passport Program that provides people diagnosed with breast and ovarian cancer with $2000 in coupons that can be used for integrative medicine services.
Open Clinical Trials
The following studies are looking at for people diagnosed with cancer.:
- NCT04733469: EMPOWER 3: Improving Health Literacy and Utilization (EMPOWER 3). This study is designed to test an educational intervention to help patients understand , use it and feel better emotionally and physically.
- NCT04989556: Technology-Enhanced for Advanced Cancer Patients. The goal of this study is to learn if the technology-enhanced palliative care symptom-monitoring program, when combined with in-person clinic visits and standard remote care visits (by phone or video call), helps increase the quality of life and care for patients with advanced cancer who are participating in phase 1 trials.
- NCT03767517: A Culturally-Based Tele-consult Program for Rural Southern Elders. This study will compare a culturally-based Tele-consult program with usual hospital care to determine whether a culturally-based PC Tele-consult program leads to lower symptom burden in hospitalized African American and white older adults with a life-limiting illness
Open Clinical Trials
The following studies are looking at integrative medical care for people diagnosed with cancer.
Multiple cancer types
- NCT03449511: Aromatherapy for Integrated Cancer Care. The purpose of this clinical trial is to determine the feasibility and effectiveness of aromatherapy in relief of commonly reported symptoms in cancer patients undergoing chemotherapy.
- NCT04917796: The Effect of Electroacupuncture on Nerve Pain Caused by Chemotherapy (Chemotherapy-Induced Peripheral Neuropathy. The purpose of this study is to learn if Electroacupuncture can improve peripheral neuropathy pain caused by chemotherapy in cancer survivors.
- NCT03581357: Mobile Mindfulness Meditation to Improve Neuropathy in Cancer Survivors. The studies a mobile app for cancer-related neuropathy in people with breast, colorectal, endometrial, pancreatic, and other cancers, who have finished treatment and are experiencing neuropathy.
- NCT03897556: Effect of High-Dose Guarana And Cancer-Related Fatigue. This research will examine the effectiveness of a guaraná nutrition energy bar supplement on cancer-related fatigue based on scores from fatigue questionnaires.
- EnergyPoints: A Mobile App Guiding Use of Acupressure for Cancer-related Fatigue and Sleep Disturbances: This study is looking at an app that uses acupressure to manage cancer-related fatigue and sleep disturbances.
Breast cancer
- NCT02754752: Electroacupuncture Therapy in Reducing Chronic Pain in Patients After Breast Cancer Treatment. This will look at how well electroacupuncture therapy works in reducing chronic pain in patients following surgery for I-III breast cancer. Electroacupuncture therapy is a type of complementary integrative medicine in which pulses of weak electrical current are sent into certain points in the skin.
- NCT04837820: Effect of Acupuncture on Memory and Thinking Difficulties after Breast Cancer. The purpose of this study is to test whether acupuncture can improve difficulties and insomnia in survivors of breast cancer.
- NCT02831582: Omega-3 Supplementation to Prevent Aromatase Inhibitor-Induced in Patients With I-III Breast Cancer. This study looks at omega-3 fatty acid supplementation to prevent aromatase inhibitor-induced side effects in patients with I-III breast cancer.
- NCT01802346: Controlled Low Calorie Diet in Reducing Side Effects and Increasing Response to Chemotherapy in Patients With Breast or Cancer. This trial studies how well a low calorie diet works to lower side effects and increase chemotherapy response in people with breast or cancer.
Gynecologic cancer
- NCT05053230: A Study Evaluating the Integrative Medicine at Home (IM@HOME) Program in People With Gynecologic Cancer. This study will look at whether the Integrative Medicine at Home (IM@Home) program can help reduce patients' symptoms (such as tiredness, pain, or insomnia). The IM@Home program offers virtual (online rather than in-person) group classes focusing on mind-body practice.
cancer
- NCT02871752: Reducing the Effects of Cancer Active Surveillance Stress, Uncertainty and Rumination Thru Engagement in Mindfulness Education. We will examine the efficacy of couples-based mindfulness-based stress reduction on positive and negative psychological responses to active surveillance with a sample of men on Active Surveillance and their spouses.
- NCT04519879: White Button Mushroom Sup for the Reduction of in Pts With Biochemically Rec or Therapy Naive Fav Risk Cancer. This phase II trial studies how well white button mushroom supplement works in reducing prostate-specific antigen () levels in patients with cancer that has come back (recurrent) or has favorable risk and has not undergone any therapy (therapy naive).
- NCT01802346: Controlled Low Calorie Diet in Reducing Side Effects and Increasing Response to Chemotherapy in Patients With Breast or Cancer. This trial studies how well a low calorie diet works to lower side effects and increase chemotherapy response in people with breast or cancer.
Last updated March 11, 2020