Book Review

Integrative Oncology: Incorporating Complementary Medicine into Conventional Cancer Care

N Engl J Med 2008; 359:542-543July 31, 2008

Article

Integrative Oncology: Incorporating Complementary Medicine into Conventional Cancer Care
(Current Clinical Oncology.) Edited by Lorenzo Cohen and Maurie Markman. 216 pp., illustrated. Totowa, NJ, Humana Press, 2008. $79.95. ISBN: 978-1-58829-869-0

This comprehensive and practical book describes the experiences of the pioneers who established integrative oncology programs at five of the leading National Cancer Institute Comprehensive Cancer Centers in the United States: the University of Texas M.D. Anderson Cancer Center in Houston, the Memorial Sloan-Kettering Cancer Center in New York, the Dana–Farber Cancer Institute in Boston, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, and the Mayo Clinic Cancer Center in Rochester, Minnesota. It discusses the challenges of providing therapies that “exist at the interface of science and healing” at institutions with reputations for “providing world class conventional, evidence-based medicine.” The book also includes strategies for meeting these challenges, leaving readers with a feeling of confidence that they now have some of the basic tools for establishing a program at their own medical centers.

Many patients with cancer want to improve their chances for successful outcomes and decrease the chances of treatment-related side effects by incorporating complementary therapeutic approaches into their overall treatment plans. But many of these patients never divulge information about these complementary treatments to their oncologists, which can have a negative effect on the response to conventional treatment. Integrative oncology is not about the use of specific unconventional approaches to treatment; it is about an overall approach to treatment of the whole patient. One of the book's highlights is an outstanding chapter in the introductory section that provides insights into and a rational strategy for communicating with patients about the use of complementary therapies.

The second section of the book addresses some of the nuts-and-bolts questions about establishing integrative oncology programs: How does one go about credentialing acupuncturists at a major academic cancer center? What is the best approach for educating medical staff about the potential benefits of various complementary interventions? Is Reiki within the scope of practice of registered nurses in your state? The Dana–Farber team has contributed a particularly helpful chapter that includes valuable tables as well as copies of policies, procedures, and competency evaluation forms, a template for an acupuncture referral letter, and an outline of how acupuncturists document their interventions in electronic medical records. The chapter contributed by the team from Johns Hopkins includes practical tables on indications and contraindications for acupuncture and massage for the oncology patient, clearly outlining who may benefit and how best to administer these treatments safely.

Each of the major contributors to this book is a recognized clinical investigator, committed to increasing the knowledge base in this emerging field. The M.D. Anderson team is at the forefront of mind–body interventions, the Memorial Sloan-Kettering group conducts extensive botanicals research, and the teams at Dana–Farber and Johns Hopkins have strong acupuncture investigators. The Mayo Clinic group, focusing on symptom management, has used “various research venues to try to compensate for the paucity of evidence by developing and completing studies with popular complementary interventions that had minimal to no published evidence base.”

The closing section of the book provides more details on the integrative oncology research being conducted at the five cancer centers. These leaders in the field all recognize that the way to ensure that these methods become fully integrated into cancer care is to provide the data that will allow even the most conventional oncologists to appreciate their value. In addition to research, the contributors to this book are all deeply involved and committed to educating their colleagues about the advances in the field; three of them have served as presidents of the Society for Integrative Oncology.

This book is an invaluable resource for all involved in the care of patients with cancer. Those interested in developing an integrative oncology program, or any integrative medicine services, at their institutions will find the book especially useful. Although the book has a few shortcomings — there is some redundancy in the five chapters on establishing the individual clinical program and in the subsequent section on the research programs at each site, and the detailed information on entry criteria and recruitment plans is better suited for protocol documents — they are minor relative to the wealth of extremely valuable information that is packed into this slim book. It may well inspire others to follow the lead of these courageous pioneer clinician–scientists in their attempts to maximize healing for people living with and beyond cancer.

Donald I. Abrams, M.D.
University of California, San Francisco, San Francisco, CA 94143
dabrams@hemeonc.ucsf.edu