Dr. Niraj Mehta, a radiation oncologist at GenesisCare, is a strong proponent of integrating holistic care for cancer patients. In this Q&A, he discusses the confusion over terminology in this area, where to look for outcomes, information about holistic practices, and the importance of patient empowerment in healing.
What is holistic care, and how does it compare to integrative care?
Holistic care simply refers to treating the whole person. That’s very important because sometimes people confuse holistic medicine with alternative medicine, and they’re not the same. Holistic medicine includes five dimensions:
- The first is physical, including diet and nutrition.
- The second is mental, including the effect of limiting mental beliefs.
- The third is the emotional landscape, including our triggers for a range of emotions.
- The fourth is spiritual — you cannot talk about cancer without talking about confronting mortality and our connection with something bigger than ourselves.
- The fifth is relationships, including family stories, spouse stories, a child’s story, and so on.
It’s important to define holistic care because otherwise, it may seem like something outside the box, and the truth is it’s very much in the box.
For example, not every radiation oncologist fully understands the compassionate use of medical marijuana, even though it began in the 1970s. The truth is, it’s a lot of work for the radiologist, and it may not be in their wheelhouse. Still, it may help tremendously with nausea from cancer treatments, increasing appetite and energy, and — most importantly — giving patients the ability to think past their illness to a time when they go back to their regular lives. At the end of the day, that’s what everyone wants: not just to survive, but also to get back to living their best possible lives.
What is integrated medicine?
Integrative medicine is slightly different. It combines standard practices, research, and evidence-based approaches with practices and treatments from alternative medicine. Often, alternative treatments here in the US are considered conventional treatments in their country of origin. For example, the Ayurvedic system from India involves affecting inflammation through food, and traditional Chinese medicine includes acupuncture, tai chi, and herbal products.
A related field is functional medicine, which focuses on addressing the root cause of disease, taking an individualized approach based on evolving research on nutritional science, genomics, and epigenetics. For example, the Institute for Functional Medicine has done extensive research on the physiological effects of meditation.
Both integrative and functional medicine dovetail with holistic medicine, which can provide physicians with non-pharmaceutical tools that help patients with stress, anxiety, inflammation, and more as they undergo surgery, radiation, and chemotherapy.
Can you provide evidence-based examples of how this approach can positively affect patients?
The Society for Integrative Oncology is one of the best places for outcomes information. They have been publishing guidelines on the use of integrative therapies since 2007, including supportive care for breast cancer patients and the diagnosis and management of lung cancer.
We can also look at the services major cancer centers provide to patients. Insurers can sometimes be slow to pay for alternative therapies, so it’s important to note when a major cancer center offers these therapies. They’re providing these services regardless of whether or not an insurance company will reimburse them because they realize they work and that patients want them.
What are the reasons some physicians are resistant to this approach?
Some physicians worry that integrative treatments will interfere with surgery, radiation, or chemotherapy. The timing of holistic or integrative treatments can indeed be complex, especially if someone is undergoing a challenging course of treatment, but that doesn’t mean it can’t be done. For example, there’s new research on how intermittent fasting can aid patients being treated for gynecological cancers, and it’s a simple regime that may help with chemotherapy-related toxicity.
Physicians may also worry that suggesting integrative treatments will undermine a patient’s trust in the healthcare system. The truth is, cancer patients deserve access to all types of treatments, traditional and otherwise. From an institutional standpoint, there remains a severe lack of support (i.e. lack of social workers, coordinators and educational opportunities) from organizations in educating their employees on the values of these practices. Physicians cannot do this alone as the process can lead to burnout. Incorporating both forms of care is the pathway for institutions to show their value. Those of us advocating for a more holistic approach feel it’s time to move beyond arguing about traditional versus alternative care methods. Holistic practices don’t adversely affect survival rates, and they can help patients have a better quality of life during and after treatment.
The American Cancer Society recognizes acupuncture’s role in potentially decreasing – mild pain and nausea and also other forms of holistic practices such as:
- Using art and music therapy to promote healing and enhance quality of life
- Biofeedback for gaining conscious control over physical processes (i.e., heart rate, blood pressure, temperature, sweating, and muscle tension)
- Massage therapy to decrease stress and alleviate anxiety
- Prayer to help with emotional side effects
- Incorporating Tai chi and yoga to improve strength and balance.
CA: A Cancer Journal for Clinicians, peer-reviewed by the American Cancer Society, acknowledges that integrative oncology care has the potential to benefit cancer patients.
How can oncologists incorporate holistic practices during patient sessions before and after treatment?
It begins with assessing a patient’s physical, mental, and emotional status. I’ve created a holistic health questionnaire that helps patients rate things like their stress level, their current sleep patterns, the amount of regular exercise they get, and their dietary habits.
Then it’s a question of which treatments could benefit the patient. For example, medical marijuana may ease nausea and pain. The benefits of acupuncture to alleviate cancer symptoms and treatment side effects are well documented. But it’s important to note that oncologists shouldn’t feel they have to learn a whole new language and practice. There are experts available with information about holistic treatments and social workers who also possess knowledge that’s helpful for patients, so oncologists can support these ideas without creating and delivering these programs themselves.
Dr. Brian Lawenda, a colleague here at GenesisCare, developed an online course in integrative oncology. It’s available as a standalone course or consultation with Dr. Lawenda. Another resource is Dr. Roy Vongtama’s Healing Before You’re Cured, which discusses the effects of thoughts, suppressed emotions, and spiritual life on health and the immune system.
My experience is that once oncologists begin learning about holistic practices and their benefits, they are excited to discuss them with patients. I have never met a physician who didn’t want their patients to be happier; they know it makes their experience with cancer much more manageable.
A New Conversation
The term “patient empowerment” has been used in various ways, but it’s vital in the context of holistic care. Here are a few key factors:
- It’s critical to ensure patients have access to, and an understanding of, the external resources you’re recommending.
- Oncologists need to convey that holistic medicine involves harnessing their inner resources, whether through deep breathing, meditation, developing one’s spirituality, or something else.
Patient empowerment also means turning the conversation around. Cancer care should not simply be about what the oncologist thinks is best for the patient. Instead, patient empowerment must include educating the patient on what’s best for them, based on accurate information, and the oncologist facilitating the conversation. In that way, patients can use this health crisis to understand their health in terms of stressors, personal growth, clarity of thought and expression, and perhaps even finding their true calling. I think it’s time to start having those kinds of conversations, and it’s been time for quite a while.
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