Integrative oncology for breast cancer patients: introduction of an expert-based model

Background. Naturopathic oncology in conjunction with conventional treatment is commonly referred to as integrative oncology (IO). Clinics directed by oncology board certified NDs (Fellows of the American Board of Naturopathic Oncology or FABNOs) provide high-quality data for describing IO therapies, their costs and measuring clinical outcomes. Purpose. To describe the types of IO therapies prescribed to breast cancer patients by ND FABNO physicians. Study participants (n = 324). Women who sought care at 1 of 6 naturopathic oncology clinics in Washington State were asked to enroll in a prospective 5 year observational outcomes study. Methods. Medical records were abstracted to collect treatment recommendations and cost data. Results. More than 72 oral or topical, nutritional, botanical, fungal and bacterial-based medicines were prescribed to the cohort during their first year of IO care. Trametes versicolor was prescribed to 63% of the women. Mind-body therapy was recommended to 45% of patients, and 49% received acupuncture. Also, 26% were prescribed injectable therapy, including mistletoe, vitamin B complex (12%), IV ascorbate (12%), IV artesunate (7%), and IV nutrition and hydration (4%). Costs ranged from $1594/year for early-stage breast cancer to $6200/year for stage 4 breast cancer patients. Of the total amount billed for IO care for 1 year for breast cancer patients, 21% was out-of-pocket. Conclusions. IO care for women with breast cancer consists of botanical and mushroom oral therapies, parenteral botanical and nutrient therapy, mind-body medicine and acupuncture. IO clinic visits and acupuncture are partially paid for by medical insurance companies.

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Breast cancer survivorship and level of institutional involvement utilizing integrative oncology.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18588 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18588-e18588

Author(s):

Terri Crudup ◽

Linna Li ◽

Jennifer Wright Dorr ◽

Elizabeth Lawson ◽

Rachel Stout ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Metastatic Disease ◽

Multivariate Modeling ◽

Breast Cancer Patients ◽

Integrative Oncology ◽

Academic Setting ◽

Significant Difference ◽

The Relationship

e18588 Background: A growing body of evidence has shown that a Whole Person Integrative Oncology approach, adding the use of complementary and lifestyle therapies to cancer treatments, benefits patients by improving patient-reported outcomes and potentially extending overall survival. This study aims to investigate the relationship between the survival outcomes of breast cancer patients and the level of involvement in Integrative Oncology at the institutions treating those patients. Methods: Between January 2013 and December 2014, 4,815 breast cancer patients were available for survival analysis using an established claims-based method. These patients were filtered to include those with clear mapping to treating oncologists and treating institutions. To measure each institution’s level of Integrative involvement, a scoring system was developed with the Samueli Foundation and oncologists from each institution were surveyed on the education, availability, and financing of 12 complementary and lifestyle approaches during the treatment timeframe. Statistical analysis using multivariate modeling with logistic regression and a lasso approach were employed. 19 variables across region, patient demographics, and institutional profile were included. Model coefficients are exponentiated and presented as odds-ratios, with less than one having a negative impact on survival and greater than one improved survival. Results: We identified 173 patients mapping to 103 institutions and 103 oncologists who responded to our survey. Median age of breast cancer patients was 51 (range: 32-76). 14 of the patients (8%) were identified as metastatic. The 5-year overall survival among the Low scoring institutions was 89%, Low-Mid 96%, Mid-High 96%, High 95%. Chi square testing across these cohorts showed no statistically significant difference between them. On multivariate modeling, age, geography, metastatic status, academic setting, and Integrative score were predictors of 5-year survival. The most significant 9 variables are shown in Table. Having metastatic disease, treatment at a non NCCN designated facility, treatment at Midwest or Western Region predicts for lower 5-year survival. Older age, treatment at an academic setting, and having a High or Low-Mid Integrative score are predictors of improved survival. Conclusions: This study suggests that in addition to traditional predictors of survival such as metastatic disease and younger age, patients receiving treatment at an institution that supports Integrative Oncology programs may be associated with improved survival. More work is needed to evaluate the relationship between Integrative Oncology and cancer treatment outcomes.[Table: see text]

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Evaluation of breast cancer patients' and oncologists' expectations for integrative oncology in an ethnically diverse population.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e12028 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e12028-e12028

Author(s):

Catherine Lee ◽

Monica Lieberman ◽

Farooq Faheem ◽

Jeremy Ramdial ◽

Eugene Ahn ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Ethnically Diverse ◽

Diverse Population ◽

Breast Cancer Patients ◽

Integrative Oncology

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Breast Cancer Survivorship and Level of Institutional Involvement Utilizing Integrative Oncology

Journal of Oncology ◽

10.1155/2021/4746712 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Terri Crudup ◽

Linna Li ◽

Jennifer Wright Dorr ◽

Elizabeth Lawson ◽

Rachel Stout ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Support Groups ◽

Cohort Analysis ◽

Multivariate Model ◽

Lasso Regression ◽

Breast Cancer Patients ◽

Integrative Oncology ◽

Chi Square ◽

Education Access

Objective. Integrative oncology is widely used by patients with breast cancer. This study aims to investigate the relationship between the survival outcomes of breast cancer patients and the level of involvement in integrative oncology at the institutions treating them. Methods. Claims-based data were used to find 4,815 newly diagnosed breast cancer patients treated between January 2013 and December 2014 for survival analysis. A scoring system was developed by asking oncologists about their institutions’ efforts to educate, support, and provide funding for 12 complementary and lifestyle approaches. Cohort analysis using two-tailed chi-square and a separate multivariate model using SMOTE and lasso regression were used. Nine variables across patient and institutional profiles were included. The model coefficients were exponentiated and presented as odds ratios. Results. 173 patients mapped to 103 institutions and 103 oncologists. The median patient age was 51, and 8% were metastatic. Institutions were scored for integrative oncology involvement and placed into four cohorts. Low-scoring institutions showed less effort to educate, support, and provide integrative therapies compared to others. The 5-year survival of patients in the low cohort was directionally but not significantly lower than others. In the multivariate model, a composite integrative oncology score was shown to increase 5-year survival odds three times for institutions in the low-mid cohort and 48% in the mid-high, compared to the low. Conclusion. Crossing the threshold beyond ‘low’ involvement in integrative oncology represents a new path to incremental survival benefit for many cancer patients. Entities invested in the survival of breast cancer patients should increase education, access, and funding for a core set of six therapies: nutrition counselling, exercise counselling, patient support groups, spiritual services, meditation, and psycho-oncology support.

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Efficacy of screening and treatment of breast cancer patients reporting high level of distress.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.101 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 101-101

Author(s):

Ryan West ◽

John W Thomas ◽

Elaine Smith ◽

Navneet Dhillon ◽

Haritha Pabbathi ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Health Care Providers ◽

Assessment Instrument ◽

Initial Assessment ◽

Free Text ◽

Care Providers ◽

Breast Cancer Patients ◽

Integrative Oncology ◽

Symptom Inventory

101 Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and specifically symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014].At Cancer Treatment Centers of America (CTCA) we perform screening assessments using a Symptom Inventory Tool (SIT) composed of 27 questions. Pts with moderate and severe levels of anxiety are evaluated by the Integrative Resource Assessment Program (IRAP) and subsequently referred to integrative oncology consultation. Methods: The SIT is an assessment tool that captures pts’ perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) and validated assessment instrument with 8 questions and a free text box added by CTCA. Symptoms were rated “at the worst” on an 11-point numeric scale ranging from 0 (“no present”) to 10 (“as bad as you can imagine”) in the previous 24 hours. Results: Between 9/1/2014 and 2/27/2015, 842 pts with multiple types of cancer were screened for distress and 435 (51.6%) scored 5 or greater, of which 212 completed a second screening assessment.58 breast cancer pts provided SIT distress scores at baseline and then again at least 23 days after the initial assessment. The average reduction in the distress scores for breast cancer patients was 2 (1st SIT mean = 6.2, 2ndSIT mean = 4.2) with 40 pts (69%) reporting a decrease, 7 pts (12%) having no change, and 11 pts (19%) reporting an increase in distress. The 4 interventions most frequently referred and completed by the pts were mind body therapy (100%), rehabilitation (66%), acupuncture (50%), and massage therapy (45%). Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in breast cancer pts using integrative oncology approaches will reduce the distress in 69% of cases.

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Awareness, perceptions, and usage of whole person integrative oncology practices: Similarities and differences between breast cancer patients and oncologists.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24123 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24123-e24123

Author(s):

Terri Crudup ◽

Linna Li ◽

Elizabeth Lawson ◽

Jennifer Wright Dorr ◽

Rachel Stout ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Well Being ◽

Integrative Approach ◽

Breast Cancer Patients ◽

Integrative Oncology ◽

The Us ◽

Academic Practices ◽

Education Gaps ◽

To Come

e24123 Background: The use of Complementary and Lifestyle (C&L) approaches in conjunction with medical treatments is known as Integrative Oncology. While Integrative Oncology practices have been steadily rising in the past few decades, there are still awareness and education gaps that medical professionals can help address for their patients. Methods: Survey-based data collection and analysis was used to assess awareness, perceptions, and usage of Integrative Oncology. Patients were randomly sampled among breast cancer patients diagnosed within 2 years and included all stages (0-IV) and all US regions (NE, South, Midwest, West). Physicians were sampled from a panel of community and academic practices across the US, with the requirement they treat at least 10 breast cancer patients in a typical 3-month period and have been in practice for at least 6 years since residency or fellowship. Results: Survey invitations were sent to 1,901 patients and 2,758 Oncologists; 164 breast cancer patients and 115 Oncologists completed the surveys. Approximately two-thirds of Oncologists and patients agree that C&L approaches contribute to improved quality of life and well-being for patients (table row 1, 2). However, significantly more patients than Oncologists believe that Integrative Oncology also leads to better treatment outcome and survival (row 3). In addition, Oncologists are significantly more aware of C&L practices than are patients (row 4). When asked what percent of breast cancer patients they discuss C&L methods with, Oncologists report 55% average (CI: 50-60%). However, when asked how they became aware of C&L, only 28% of patients (CI: 21-35%) mention their Oncologist/cancer care team or the institution where they were treated (not in table). Ideally, patients desire information about C&L to come directly from Oncologists, but that is not the predominant model (row 5). Conclusions: Many breast cancer patients believe an Integrative approach will improve their treatment outcomes and prefer their providers to discuss this with them.[Table: see text]

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