Integrative gynaecological oncology in prehabilitation: scoping review of patient-centred care models.

Complementary and Integrative Oncology in the Cross-Cultural Region of the Middle East and South Asia

Integrative oncology (IO) services provide a wide range of complementary medicine therapies, many of which can augment the beneficial effects of conventional supportive and palliative care for patients with ovarian cancer. This study aims to assess the current state of integrative oncology research in ovarian cancer care. We review the clinical research both supporting the effectiveness of leading IO modalities in ovarian cancer care as well as addressing potential safety-related concerns. There is growing amount of clinical research supporting the use of IO and implementation of integrative gynecological oncology models of care within the conventional supportive cancer care setting. Additional research is still needed in order to create clinical guidelines for IO interventions for the treatment of female patients with ovarian cancer. These guidelines need to address both effectiveness and safety-related issues, providing oncology healthcare professionals with indications for which these patients can be referred to the IO treatment program.

Feasibility of an Online Integrative Oncology Treatment Program During COVID-19

The Middle East is a promising arena in which researchers can explore the interchange between cross-cultural traditional medicine and supportive cancer care, as provided within an integrative oncology setting. Integrative oncology research and clinical practice in this part of the world have been focusing, for the most part, on the use of herbal medicine and mind-body-spiritual modalities, both of which are deeply rooted in traditional medical care. A regional, multinational, and interdisciplinary collaboration is currently being undertaken as part of the academic activities of the Middle-East Research Group in Integrative Oncology (MERGIO). This group is part of the Middle-East Cancer Consortium, a body supported by the National Cancer Institute. MERGIO currently facilitates a number of innovative educational, basic science, and clinical research projects that are investigating the effectiveness and safety of traditional herbal remedies. In order to create a structured, pragmatic "bedside-to-bench" and subsequent "back-to-bedside" approach, MERGIO has designed a patient-tailored integrative oncology model of supportive-palliative care. This approach addresses both patients' individual health belief models and the larger social-cultural-religious context, as defined by the health-related values of the patient's community.

What is Integrative Oncology and Can It Help My Patients?

1631 Background: Integrative approaches are used in Oncology care, often as an auxiliary measure to the Standard of Care (SoC). There is paucity of data regarding Integrated oncology model approach combining alternate systems of medicines like Ayurveda & Siddha, Yoga and Dietary modification recommendations along with SoC . In this study, we present an audit of this novel Integrated oncology model of care provided by online and in-patient consultations at Isha Integrative Oncology Clinic (IIOC), Isha Health Solutions (IH), Coimbatore, India. Methods: A clinical audit was conducted for 514 patients who have received care through Integrated oncology consultations ( in-person or online) at IIOC from January 2016 to July 2024. This abstract focuses on the statistical analysis of data of the initial 196 consecutive patients based on descriptive data from clinical proformas and follow-up visits for symptomatic response outcomes. Updated data will be presented at the conference. Results: Among 196 patients analysed, 99% of patients had online consultations. The median age was 52yrs (7-81yrs) and Male: Female ratio was 1: 1.3. 50% belonged to age group 40-60 yrs whereas 29% were between 60-85 yrs. Most common cancers in males were hematological cancers (20%), prostate cancers (11%), GI cancers (11%) and in females were breast (26%), ovary (10%) and colon (5%). The most common stage was Stage 4 (58%) followed by Stage 3 (40%). Most common symptoms were pain (49%), anorexia (43%), fatigue (42%), lack of sleep and anxiety (39%). Most common side effects of chemotherapy were fatigue (32%), constipation (25%), anorexia/weight loss (25%), pain (16%) etc. Most common expectations were cure/avoid relapse (32%), symptomatic relief (15%), reduction from chemotherapy side effects (11%), integration of Yoga (10%) etc. Only 6% of patients wished to avoid chemotherapy. Integrated oncology model based on complementary systems of medicine (Ayurveda & Siddha), dietary changes and yoga was provided to all patients (100%). After using this model of care, improvement in cancer-related symptoms was reported by 90% of patients and compliance seen in 73% of patients. Conclusions: Our study is one of the largest clinical audits in Integrative oncology in published literature. Younger patients and advanced cancer patients more often seek integrative oncology care and main expectation is to achieve better cure rates and symptomatic relief. In this study, all patients were provided a novel integrated oncology model with alternative medicines (Ayurveda & Siddha), yoga, and dietary modifications in addition to their ongoing SoC resulting in good symptomatic relief and high compliance rates. Integrative oncology model incorporating alternative medicine, yoga, and dietary changes can be effectively offered to cancer patients alongside standard treatment. Further prospective studies are warranted.

An Integrative Pediatric Oncology Program Addressing Parents’ Quality of Life-Related Concerns

Integrative oncology has emerged as a recognized medical subspecialty because of growing interest in the use of integrative medicine in modern cancer care on behalf of both patients and providers. Acutherapy and mind-body techniques, such as meditation and yoga, have been shown to aid in symptom control and improve quality of life in oncologic patient populations, and the Society of Integrative Oncology and American Society of Clinical Oncology have recently endorsed a set of guidelines for the implementation of these techniques specifically in patients with breast cancer. Although the current guidelines focus largely on the management of chronic symptoms, there exists evidence to support the use of these techniques in acute symptom management as well. With surgical resection representing the backbone of many cancer treatment regimens, symptoms that arise during the perioperative period are prime examples of the acute symptomatology common among patients with cancer. Here, the authors provide a detailed literature review of the current evidence supporting the use of integrative techniques during the perioperative period and demonstrate their applicability for acute symptom management within oncologic and surgical populations. In doing so, the authors introduce a new paradigm of surgical practice they call integrative surgical oncology and integrative surgery.

Integrative oncology in the Middle East: Researching traditional remedies to address supportive cancer care

Nearly half of cancer patients use complementary therapies alongside the conventional cancer treatment. This clinical reality is a challenge for the medical team mainly to guarantee patient's safety. The evolution from Supportive Care to Integrative oncology is taking shape. Integrative oncology, a new field in cancer care, combines conventional supportive care and validated complementary approaches. The first part of this review is to highlight the process of validation of one of the most popular complementary medicines among European cancer patients: homeopathy. It seems to be a well tolerated and useful complementary approach in integrative cancer care. The second part shows through the example of stage IV lung cancer the transition from conventional supportive care to integrative oncology with a benefit for their quality of life and survival. The future of supportive cancer care seems to lead towards a move from coexistence of conventional care and complementary approaches to a combination of both in integrative oncology. This would require new skills among caregivers, specific academic training and adapted studies. Further research is needed to highlight the benefits in the specific field of integrative cancer care.

Integrative oncology (IO) has been shown to improve quality-of-life (QoL) and increase adherence to planned chemotherapy regimens. This study examined the impact of a patient-tailored IO program on adherence to chemotherapy among patients with advanced gynecological cancer. This prospective non-randomized, pragmatic, preference study examined patients with stage III/IV gynecological cancers undergoing 6weeks of weekly IO treatments. Adherence to the planned chemotherapy regimen was assessed using the relative dose intensity (RDI) calculation. Patients consistently attending IO treatments (consistent-IO group) were compared to those who were not (non-consistent IO group). RDI was calculated for 73 patients in the consistent-IO group (99 chemotherapy cycles) and 61 in the non-consistent-IO group (96 cycles with IO care, 126 cycles without). Both groups had similar baseline demographic characteristics, with endometrial cancer more prevalent in the consistent-IO group. RDI was significantly less reduced in the consistent-IO chemotherapy group (p = 0.005). During taxane-based regimens, RDI was better maintained in the consistent-IO group (0.93 vs. 0.87, p = 0.012), though not with platinum-based cycles. Linear regression model found a correlation between preserved RDI and consistent attendance at weekly IO treatments, and lower rates of chemotherapy-induced peripheral neuropathy and pain. Patient-tailored IO programs for patients with advanced gynecological cancer may help preserve adherence to chemotherapy at 6weeks, especially with taxane-based regimens. Further research needs to explore whether this correlation is chemotherapy agent-specific.

Objective: Nurses are increasingly becoming involved in integrative oncology (IO) programs. This study examined the additive effect of nurse-provided guidance for self-administered IO therapies on cancer-related fatigue and quality of life (QoL). Methods: The study was randomized and controlled, enrolling patients undergoing active oncology treatment with IO interventions for fatigue and other QoL-related outcomes. IO practitioner guidance on self-treatment with manual, relaxation, and/or traditional herbal therapies was provided to patients in both the intervention and control arms. However, patients in the intervention arms also received additional guidance on self-treatment by IO-trained palliative care nurses. All participants were assessed for fatigue and QoL at baseline and at 24-h follow-up, using the Edmonton Symptom Assessment Scale (ESAS) and the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire tools. Results: Of 353 patients recruited, 187 were randomized to the intervention and 166 to the control group. Both groups had similar demographic and oncology-related characteristics. Patients in the intervention arm reported significantly greater improvement in ESAS scores for fatigue (p = 0.026) and appetite (p = 0.003) when compared to controls. Conclusion: The addition of nurse-provided guidance on self-administration of IO treatments to that provided by IO practitioners further reduced short-term scores for fatigue and improved appetite. The relationship between palliative and IO supportive cancer care requires further study.

Context and objectivesThe present study examined the perspectives of healthcare providers (HCPs) in designing a multi-disciplinary model of supportive cancer care for the relief of dermatology-related symptoms caused by monoclonal antibody therapies.MethodsThe study employed a mixed research methodology, with qualitative research embedded within a pragmatic prospective study of a registry protocol study. Patients undergoing oncology therapy with MoAB, anti-HER2, and anti-PD-L1 monoclonal antibodies were identified among a cohort of patients referred to an integrative oncology (IO) consultation for symptom relief and improved quality of life (QoL). Case studies with significant dermatology-related concerns were selected and presented to a panel of 6 HCPs trained in medical oncology, oncology nursing, family medicine, supportive cancer care, and IO. HCP narratives were qualitatively analyzed and assessed using ATLAS.Ti software for systematic coding.ResultsOf the 924 patients referred to the IO consultation, 208 were treated with monoclonal antibodies, from which 50 were selected for further evaluation. Of these, 7 cases were presented to the HCP team who were asked to identify treatment gaps requiring a multi-disciplinary approach. Qualitative analysis identified 3 major themes: a biophysical perspective; a psycho-social-spiritual perspective; and the implementation of integrated care.DiscussionThere is a need for a multi-disciplinary approach when treating patients suffering from monoclonal antibody treatment-related skin toxicities. HCP-reported themes highlight the need to identify patients for whom such an approach is warranted; conditions in which a psycho-social-spiritual perspective should be considered, in addition to a bio-physical approach; and considerations of who should be designated as the patient’s primary case manager.

215 Background: Integrative Oncology (IO) has become a specialized area of cancer care because of patient desire for holistic approach to care and in response to unmet symptom burden. Until now most IO programs have been limited to large academic medical centers. At Tennessee Oncology (TO), a large community oncology program spanning over 30 clinical sites of care throughout Tennessee and Georgia, an IO program was developed and implemented to bring IO to patients in the community. Methods: In June 2021, the IO program was launched with a physician and a nurse practitioner, both trained in Integrative Oncology. The program started at 8 clinics with visits primarily performed through telemedicine to allow access to each clinic. Providers were educated via email communication and a short video describing the program. Patient education was provided through our website and flyers placed in clinics. A referral order was created within the electronic health record. Results: Within one year, the IO program grew from seeing less than 20 patients per month to seeing over 100 patients per month. To date we have provided approximately 1,050 IO visits for 432 unique patients. Of these patients, 362 (83%) were female and 70 were male. The average age was 59 years old. The top three associated malignancies for patients were breast (n = 182), colorectal (n = 30), and gynecologic oncology (n = 29). Our IO program has expanded from eight to 16 clinics during this time frame. 75% of visits were provided through telemedicine. The most common reasons for IO referral were nutrition and symptom management (fatigue, neuropathy, etc). Conclusions: Implementation of an IO program is possible and scalable in a large community oncology setting. Future directions include studying the impact of our program on patient experience and overall health and wellness.

e23173 Background: Persons with a diagnosis of cancer are seeking innovations in cancer care. Integrative oncology (IO) utilized along with conventional cancer therapy can enhance quality of life, improve symptom management, and potentially result in better outcomes by addressing various dimensions of health. IO care has generally focused on the outpatient setting. The Integrative Oncology Program at the Sidney Kimmel Comprehensive Cancer Center initiated inpatient IO consultative services focused on the care of persons undergoing stem cell therapy in July 2023. We present a summary of patient characteristics and IO interventions from both inpatient and outpatient settings. Methods: Through a chart review, demographic data, cancer diagnosis, and IO assessment and recommendations were collated. Descriptive statistics were generated using SAS. Results: 108 unique charts were reviewed. Of these, 41 (43.62%) were female. 45 (41.67%) were ≥ 65 with a mean age of 60.26 years (SD: 11.48). 33 (30.55%) were diagnosed with multiple myeloma, 22 (20.37%) leukemia, and 15 (13.89%) non-Hodgkins lymphoma. Assessments included 74 (68.52%) diet, 82 (75.93%) spiritual, 83 (76.85%) sleep, and 84 (77.78%) stress reduction and physical activity. Personalized IO recommendations were provided based on the assessment (Table). Conclusions: This retrospective clinical assessment underscores the feasibility of IO as part of the comprehensive care of people with cancer. A multifaceted IO assessment in the OP or IP setting results in personalized treatment recommendations that are beneficial to patients of varying cancer diagnoses and demographics. Future assessments will include longitudinal health outcomes and quality of life. Summary of personalized IO recommendations based on assessment. Physical Activity Recommendations Stress Recommendations Sleep Recommendations Diet Recommendations Spiritual & Mindfulness Recommendations Additional Recommendations Encourage and advance exercise as tolerated Meditation practice Sleep hygiene Diet rich in fruits, vegetables, whole grains Prayer practice Aromatherapy for nausea Ambulation and increased activity Engagement w/ social support Melatonin supplementation Adequate water intake Pastoral consult Acupressure for nausea Yoga Aromatherapy Avoid caffeine/soda after 12pm Increase vitamin D supplement intake Creative arts for mindfulness Diabetes nurse educator consult Encouraged walking Gratitude practice Compliance w/ CPAP Avoid processed sugars Mindfulness apps and resources Obtain exercise equipment Physical therapy consult Breathwork Tea before bedtime Easier to digest foods Spiritual community engagement Recommendations for massage therapy Acupuncture Lavender aromatherapy Mindfulness-based stress reduction Guidance for managing cancer-related symptoms Family connections Meditation and prayer practices