Integrative Oncology Services Research Articles

Assessing the understanding and utilization of integrative oncology among patients with a history of cancer.

e23231 Background: Integrative oncology (IO) is an evidence-informed field of cancer care the utilizes mind-body practices, natural products, lifestyle medicine from different traditions alongside conventional therapies. Many of these components have growing evidence of benefit and are part of guideline recommendations. The Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University has an integrative oncology program that sought to identify patients’ understanding of integrative health, assess their utilization of integrative medicine approaches, and define interest in IO consultations. Methods: Patients with a history of cancer or at high risk for cancer who presented for care at an SKCC clinical site received an electronic record invitation to complete a brief survey with binary and free-response questions regarding current knowledge, experiences, and interest in IO. At the end of the survey, patients also had the option to express interest in an IO consultations at SKCC. Results: Among 1327 responders, 900 (67.8%) were female, and 998 (75.2%) were between 45-75 years of age. Most were white (980, 73.9%), followed by Black or African American (279, 21.0%). Breast cancer (435, 32.8%) and hematologic cancers (277, 20.9%) were the most reported malignancies. Overall, 340 (26.4%) and 123 (9.27%) had previously utilized in-person IO services and virtual IO services, respectively. 887 (66.8%) patients reported that IO was never discussed during their care. 946 (71.3%) expressed interest in an IO consultation. Conclusions: Approximately a third of patients who completed the survey had previously used an IO modality. More than double that number expressed interest in and IO consultation. With the increasing evidence of benefit for IO care and the inclusion of these recommendations in clinical guidelines, expansion of IO services is indicated. IO consultations would address knowledge gaps, enhance implementation of guideline-based care, and, perhaps, improve clinical outcomes.

Assessing the landscape of integrative oncology at US comprehensive cancer centers (CCC).

e13565 Background: Interest in integrative oncology (IO) has grown among patients and its availability has expanded within CCCs. This study assesses the availability of IO programs in U.S. CCCs. Methods: In 2023, a cross-sectional survey was sent to CCCs including NCI-designated CCCs by email regarding IO programs. Participants were asked to describe the importance of IO within their cancer center, the programs and services offered, and how the programs are provided. Results: Of ninety-four survey invitations sent, fifty-eight completed surveys were returned (response rate 62%). Three-fourths of completed surveys (74%) came from NCI-designated CCCs. Over half of respondents (57%) rated IO services to be important (or very important) at their center with 53% stating that their center has a formal IO clinical program. Univariate analysis showed that non-NCI centers were more likely to perceive IO services as being important compared to NCI-designated centers (100% vs. 77%, p=0.04). Respondents stated that their IO program has been in existence for ≥10 years (40%), 5-9 years (26%), and 0-4 years (34%). Among the surveyed cancer centers, availability of IO program was 33% (adult and pediatric) vs. 49% (adult only). The IO programs are available to patients with active cancer (91%), patients in survivorship off-treatment (81%), and healthy patients without a history of cancer (22%). The IO services were offered in an outpatient clinic on the main campus (76%), community sites (29%), or inpatient settings (40%). The most common oncology specific services reported were nutrition (51%), exercise counseling (42%), mind-body medicine (38%), and acupuncture (33%). The clinicians who provided integrative medicine consultations were primarily in internal medicine (31%), family medicine (26%), and medical oncology (19%). In inpatient and outpatient settings, insurance was billed for physical therapy (50% vs. 67%) and diet/nutrition (36% vs. 50%) services, whereas acupuncture (47%) and massage (43%) services were charged by cash/card in an outpatient setting only. Music therapy (33% vs. 47%) and pet therapy (34% vs. 43%) services were offered for free most commonly in both inpatient and outpatient settings, respectively. The highest average out of pocket fee service was acupuncture ($42±27) followed by integrative medicine consultations ($34±29). Conclusions: Despite increasing patient interest and established benefits of integrative therapies as noted by recently published ASCO clinical guidelines, only half of CCCs reported having a formal IO program. More research is needed to understand the gap between patient interest, the growing evidence-base, and how to expand integrative oncology services within existing cancer centers.

Establishing an Integrative Oncology Service: Essential Aspects of Program Development.

Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors. Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.

Developing implementation strategies for promoting integrative oncology outpatient service delivery and utilisation: a qualitative study in Hong Kong.

Current evidence supports the use of integrative oncology (IO) interventions in cancer supportive care. The demand for outpatient IO services in Hong Kong is expected to soar following the surge in cancer incidence due to population ageing. This study identified the factors influencing the delivery and utilisation of outpatient IO from local stakeholders' perspectives and developed corresponding implementation strategies. This study involved two sequential stages. First, with individual semi-structured interviews guided by the Theoretical Domains Framework (TDF), we explored stakeholders' views on the barriers to and facilitators for implementing IO. Second, guided by a TDF-based qualitative data analysis of interview transcripts, we performed intervention mapping to develop Behaviour Change Wheel-based implementation strategies that may overcome the barriers and strengthen the facilitators. We interviewed 31 stakeholders, including traditional Chinese medicine (TCM) practitioners (n = 8), biomedically-trained doctors (n = 7), nurses (n = 6), administrators (n = 4), caregivers (n = 4), and pharmacists (n = 2). The key local factors influencing outpatient IO are (1) lacking nursing and administrative workforce supporting IO service delivery, (2) lacking awareness of IO services among healthcare professionals, administrators, patients, and caregivers, and (3) lacking knowledge among healthcare professionals of herb-drug interaction and herbal toxicities. We recommended a multi-faceted implementation strategies package that included arranging funding to train, recruit, and retain nursing and administrative staff, devolving resources into promoting interprofessional collaborations and evidence on IO effectiveness and safety, integrating evidence on herb-drug interactions and herbal toxicities into automated electronic health record systems monitored by pharmacists with dual qualifications in TCM and conventional pharmacy.

Challenges in Implementing Guideline on Integrative Oncology and Pain: The Israeli Perspective

Context and objectivesTo explore the feasibility of implementing the joint guideline on integrative medicine for pain management in oncology, published by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), for integrative oncology (IO) services in supportive and palliative care. MethodsA qualitative research methodology was co-designed by the SIO-ASCO guideline committee, with the Society for Complementary Medicine, Israel Medical Association (IMA). A questionnaire with five open-ended questions exploring barriers and enablers to implementing the guideline was distributed to chairs and board members of nine IMA-affiliated medical societies; four deans of Israeli medical schools; and nurses from the Israeli Society for Oncology Nursing. Respondent narratives were qualitatively analyzed using ATLAS.Ti software for systematic coding. ResultsQuestionnaires were completed by 52 physicians and nurses from medical oncology, hematology, gynecological oncology, pediatric oncology, palliative medicine, pain, family medicine, internal medicine, and integrative medicine. The SIO-ASCO guidelines were endorsed by nine IMA-affiliated societies. The domains identified included the importance of guideline implementation in clinical practice; barriers and facilitators to implementation; practical aspects required for this implementation (e.g., IO training); clinical indications for referral; budget-related issues; and clinical and administrative models enabling practical implementation of the guideline. ConclusionWe found across-the-board consensus among the nine IMA-affiliated societies supporting the current guideline. This, while identifying potential facilitators and barriers in order to address the implementation of the SIO-ASCO guideline recommendations.

Integrative Medicine for Ovarian Cancer

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.

Integrative Oncology in Young Women With Breast Cancer.

Small studies have demonstrated the benefit of integrative oncology (IO) therapies in patients with breast cancer; however, referral patterns and timing of therapies are unknown. This study describes the referral pattern and utilization of IO services by young women with breast cancer. A retrospective review identified female patients, 40 years or younger, with a breast cancer diagnosis between 2014 and 2019, and a documented IO consultation. Patient demographics, cancer characteristics, treatments, reasons for seeking and timing of IO consultation, and IO treatment modalities were analyzed. The IO program treated 64 young women with a median age of 38.6 years. Clinical staging was primarily IA (27%), IIA (34%), or IIB (27%), and 64% of patients were clinically node negative with no evidence of metastasis. Women utilized the IO program for recurrence risk reduction and for treatment-related adverse effects (TRAEs), most commonly vasomotor complaints (44%). Therapies utilized were acupuncture (36%), healing touch (28%), oncology massage (30%), and other (75%; music therapy, therapeutic art, spiritual care, meditation, t'ai chi, yoga, and nutrition), which were commonly initiated during treatment (69%). Our data suggest that young women utilize IO services to reduce their future cancer risk and TRAEs, but they are often referred after standard cancer care treatments have begun. Future studies could examine the optimal timing for IO intervention.

How does Integrative Oncology Influence Patients' Physical and Psychosocial Outcomes, and What are Patients, Carers and Healthcare Professionals' Experiences? An Integrative Review.

To identify the relationship between integrative oncology (IO) services on patients' physical and psychosocial outcomes and to explore the experiences of IO among patients, carers and healthcare professionals. This integrative review was reported according to PRISMA guidelines. A search architecture was developed using key words and the following databases were searched: Medline (OVID), EmCare for Nurses (OVID), PsycINFO (OVID); AMED (OVID), CINAHL (EBSCO), Pubmed, the Cochrane Library (CCRT and CDSR) controlled trials databases and ANZ CTR. All articles were assessed according to a pre-determined selection criterion. 426 articles were assessed and 18 were included (4 qualitative, 9 quantitative and 5 mixed methods). Patients reported a reduction in some cancer related symptoms and treatment related side effects. Positive psychosocial impacts were reported such as an increased ability to cope with their cancer diagnosis and treatment. The experiences of healthcare professionals highlighted the importance of a collaborative approach among the Multi-Disciplinary Team (MDT), ongoing education and research to ensure Complementary Integrative Therapies (CIT) were evidence-based. The provision of IO impacts positively on patients' self-reported physical and emotional wellbeing and quality of life at all stages of their cancer experience. Patients reported that IO supported their engagement in their own health and wellbeing by increasing feelings of control and empowerment. However, to successfully integrate CIT with conventional cancer treatments it is imperative that cancer centres adopt a collaborative and evidence-based informed approach to CIT.

Complementary and alternative medicine use and recommendations for discontinuation of supplements in an integrative oncology clinic.

12058 Background: It is well established that many patients with cancer are taking dietary supplements (DS) and alternative medicines and often do not disclose such to their care teams. There is potential for harm in several ways: 1) interactions with their medications that may increase side effects, 2) interactions with their treatment that may lead to decreased efficacy, 3) direct toxicity from the supplement 4) financial toxicity. We have recently started a new Integrative Oncology service to help counsel patients about improving lifestyle factors and assist patients with safe and evidence-based integrative treatments and supplements. Methods: Patient data (N=100) were collected prospectively from an Integrative Oncology Clinic. The number and type of DS were documented. Using the Natural Medicines Database (NMD), we determined whether supplements interacted with the patients’ other medications or cancer therapies. We calculated the percentage of patients in which a recommendation for discontinuation of DS was recommended, along with the supporting reasons. We calculated the most common DS being taken and other alternative therapies beyond supplements. Results: Ninety-one percent of patients took DS, with an average of 5.5 per patient (range 0-20). The most common DS patients reported taking (%): Vit D (52), Vit C (41), Multivitamin (34), probiotic (27), B Vitamins (26), Ca (20), zinc (20), fish oil (18), cannabis (18), mushrooms (18), turmeric (17), magnesium (15), melatonin (14), biotin (11), coq10 (7), iron (8), VIT E (5), and glucosamine (5). Eighty-nine percent of patients using DS were on active cancer therapy. In thirty-five percent of patients, we recommended stopping some of their DS or other therapies. Number of patients using alternative therapies beyond DS: IV Vitamin C (5), Rick Simpson oil (high dose THC) (4), extreme diets (4), mistletoe (2), re-purposed meds (2); and one each was using hyperbaric O2, ozone, homeopathic, ayurvedic, insulin-potentiated chemo, miracle mineral cure, chelation, low dose naltrexone Conclusions: Cancer patients both on and off active treatment are using large numbers of DS with potential for adverse effects and/or decreasing efficacy of treatments. This study highlights the prevalence of DS and alternative medicine usage in cancer patients referred to an integrative oncology clinic and demonstrates the need for counseling about safe supplement use; in 35% of patients, discontinuation of DS was recommended. [Table: see text]

Integrative oncology and patients refusing conventional anticancer treatments

• Refusal of conventional anticancer treatment needs to be better clarified. • Patients exhibit multiple and complex reasons for conventional treatment refusal . • Patients often seek complementary therapies, even when refusing conventional ones. • An Integrative Oncology Service may contribute to treatment refusal management. • It may also contribute to clarify the reasons underpinning treatment refusal.

The Experiences of Touch Therapies in Symptom Management of Rural and Regional Cancer Patients in Australia.

IntroductionCancer patients are increasingly combining touch therapies (e.g., remedial massage, lymphatic massage, and/or reflexology) with conventional treatments to deal with the impact of their cancer and treatments on their physical and mental well-being. To understand the impact of integrative oncology services on cancer patients, it is essential to explore the impact that various types of integrative oncology services have on cancer patients.AimsThis paper presents cancer patients’ experiences with touch therapies in a community-based cancer support center and to identify opportunities for better access to these practices and service provision in Australia.MethodsA random selection of cancer patients (n=36) receiving touch therapies at a rural/regional community cancer center completed mixed-methods mail surveys regarding the use of touch therapies, their satisfaction, and the impact on pain, fatigue, nausea and overall well-being.ResultsFindings indicated that these services helped manage both physical and emotional symptoms. Of the participants experiencing pain and fatigue, findings revealed that touch therapies assisted with pain in 90% of participants and with fatigue in 70%.ConclusionGiven the increased and continued use of touch therapies by individuals with cancer, cancer centers should consider establishing touch therapy services or provide referrals to touch therapy services that can assist with symptom management and improve quality care. By more clearly understanding the benefits of the different types of integrative oncology interventions, patients with cancer receive more tailored and effective interventions throughout of their cancer journey.

Clinical Delivery and Effectiveness of Music Therapy in Hematology and Oncology: An EMMPIRE Retrospective Study.

Music therapy (MT) has been shown to improve outcomes for patients with sickle cell disease (SCD) and patients with hematologic and/or oncologic conditions excluding SCD (HemOnc) in prior randomized trials. While few studies have described the clinical delivery (ie, volume, clinical settings, patient characteristics, referrals, and session characteristics) of MT and examined its real-world effectiveness, no studies have compared responses between hematology/oncology populations. The purpose of this study was to examine the clinical delivery and effectiveness of MT at a freestanding academic cancer center and compare the effectiveness of MT on pain, anxiety, and fatigue between adult patients in the HemOnc and SCD groups. A retrospective review was conducted of all MT sessions provided at a freestanding academic cancer center between January 2017 and July 2020. The unadjusted single-session effects of MT on pain, anxiety, and fatigue were assessed among patients reporting symptoms ≥1 out of 10 on a 0 to 10 scale. Adjustments were made for multiple sessions on the same patient using a mixed model to compare pre-session and change scores between the HemOnc and SCD groups. Patients' comments were analyzed using conventional qualitative content analysis. Music therapists provided 4002 sessions to 1152 patients including 1012 in the HemOnc group and 140 in the SCD group. In the combined sample, statistically significant reductions in pain (1.48 units), anxiety (2.58 units), and fatigue (0.84 units) were observed, with changes in pain and anxiety exceeding clinically significant thresholds. After adjustment, the SCD group reported significantly greater pre-session pain (7.22 vs 5.81) and anxiety (6.11 vs 5.17) as well as greater anxiety reduction (2.89 vs 2.23) than the HemOnc group. Patients' comments contained themes including enjoyment, gratitude, and improvements in mood, pain, and anxiety. This study supports the delivery and clinical effectiveness of MT for addressing the needs of patients throughout their course of treatment at an academic cancer center and justifies the inclusion of individuals with SCD within integrative oncology services.

Patients’ lived experiences and recommendations for enhanced awareness and use of integrative oncology services in cancer care

BackgroundConsuming educational content, adhering to treatment plans and managing symptoms and side-effects can be overwhelming to new oncology patients. ObjectiveThe purpose of this study is to engage patients in conceptualization of enhanced clinic processes and digital health tools to support awareness and use of integrative oncology services. Patient InvolvementWe engaged patients in participatory design to understand lived experiences surrounding use of integrative oncology services during and after conventional cancer treatment. MethodsTen participatory design sessions were held with individual participants. Sessions began with patient story telling regarding diagnosis and paths to awareness and use of integrative oncology services. We then reviewed prototype mobile app screens to solicit feedback regarding digital health functionality to support patient navigation of symptom-alleviating options. ResultsOncology patients are active participants in the management of symptoms and side effects. Patients who utilize yoga, acupuncture, and massage report a need for earlier patient education about these services. Patients express interest in digital health tools to match symptoms to options for relief, provide access to searchable information, and facilitate streamlined access to in-person and remote services. DiscussionPatients co-produce wellbeing by seeking solutions to daily challenges and consuming educational content. Clinics can collaborate with patients to identify high priority needs and challenges. Practical ValueActive collaboration with patients is needed to identify unmet needs and guide development of clinic processes and digital health tools to enhance awareness and use of IO services in conventional cancer care. FundingThe principal investigator was supported by the U.S. Agency for Healthcare Research and Quality (AHRQ K12HS026370). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. The sponsor had no role in the study design, data collection, analysis, report writing, or decision to submit for publication.

Rapid Practice Change During COVID-19 Leads to Enduring Innovations and Expansion of Integrative Oncology Services

The COVID-19 pandemic forced cancer programs and practices to rapidly adapt how they deliver integrative oncology services that help patients manage symptoms and optimize their quality of life. Additional stressors imposed by COVID-19 increased the need for mind-body practices, natural products, and lifestyle modifications. However, literature on best practices for the provision of integrative oncology services during a pandemic is sparse. Our article seeks to describe strategies, challenges, and enduring innovations for successful integrative oncology practice during and beyond the COVID-19 crisis. Effective strategies include expanded telemedicine, online resource libraries, virtual interactive groups and classes, and additional infection prevention protocols. We also describe telemedicine challenges, such as technical difficulties and access to technology, “Zoom fatigue,” inability to perform hands-on physical exams, distractions outside the clinical environment, and obstacles to maintaining a virtual therapeutic relationship. Leveraging its skilled facilitators, Levine Cancer Institute in Charlotte, N.C., overcame many of these challenges through proactive responses, flexibility—demonstrated by staff and patients—and the use of virtual platforms. Our experience led to enduring telehealth expansion, livestream groups and classes, on-demand digital repositories of integrative practices, and targeted services delivered at the most clinically appropriate time(s). These insights may be adapted by other institutions to maintain integrative oncology services during and after unprecedented events, like a global pandemic.

Role of Integrative Oncology and Palliative Care Services in Improving Comfort Level and Compliance among Patients with Advanced Fungating Breast Cancer - Experience from a Rural Hospital of North Eastern India during the COVID-19 Pandemic.

Objectives:Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care nursing care, particularly in resource poor settings, is not well understood. Hence, this study was undertaken to assess the change in the degree of comfort achieved before and after treatment of these fungating breast cancer wounds along with issues regarding compliance to such treatment in a peripheral rural medical college hospital.Materials and Methods:A total of 20 patients were selected from the medical records files of the RT department of North Bengal Medical College and Hospital who were registered and treated during the period 1 June 2019– 31 July 2021. Palliative care nursing of malodour, bleeding, maggots, pain and assessment of psychological parameters was done based on the 11-point revised Edmonton Symptom Assessment Scale at the beginning and at each subsequent follow-up visits. Patients were also individualised for receiving palliative RT, chemotherapy, surgery and hormone therapy based on their clinicodemographic profiles. Informed consent was taken from all patients and every treatment was in accordance with the ethical permissions as sought from the Institutional Ethics Committee. Statistical analysis was done based on descriptive statistics and SPSS version 22.Results:Median follow-up was 13 months. Overall, there was a significant improvement in comfort and well-being as assessed by paired t-test before and after treatment (paired t-test = 16.548; P = 0.000). However, there was no significant correlation with palliative radiation dose and schedule as per spearman’s correlation coefficient. The mean radiation dose was BED 48.56 Gy3 (EQD2 = 29.3 Gy3) and the median number of fractions used was 10. Almost 50% of patients were noncompliant to treatment and this might be attributed to the prevailing COVID-19 pandemic situation. There was maximum relief with regard to bleeding control (100%), malodour dissipation (76.9%) and control of maggots infestation (71%) and these results were also found to be strongly associated with treatment as per analysis done by Chi-square test of difference of proportions.Conclusion:Effective comfort can be achieved with proper judicious combination of palliative care nursing and other oncological treatment such as radiation, chemotherapy and surgery.

A survey of cancer patients, caregivers, and providers regarding familiarity, importance, and utilization of supportive and integrative oncology services.

Supportive and integrative oncology services aim to improve the quality of life of cancer patients. This study characterizes the views of these services among cancer patients, caregivers, and providers at a comprehensive cancer center. A cross-sectional survey was administered in 2017-2018. The survey asked about participants' familiarity, perceived importance, use, accessibility, and barriers to 19 supportive and integrative oncology services using a Likert scale. Data were analyzed using the Kruskal-Wallis test and a proportional odds regression model. A total of 976 surveys were obtained (604 patient surveys, 199 caregiver surveys, 173 provider surveys). Patients were mostly female (56.3%), ≥60 years old (59.4%), and Caucasian (66%). Providers were an even distribution of nurses, physicians, and advanced practice providers. Patients felt social work and nutrition services were the most familiar (36.4% and 34.8%) and the most important (46.3% and 54.5%). Caregivers were also most familiar with those two services, but felt that nutrition and learning resources were most important. Social work and nutrition were easiest to access and used the most by both patients and providers. There was a positive correlation between accessibility and perceived importance. Being unaware was the most common barrier identified by patients (38.4%), providers (67.1%), and caregivers (33.7%). Social work and nutrition services were most familiar to respondents, and also generally the most important, accessible, and utilized. Lack of awareness was the most common barrier cited and suggests that increased efforts to educate patients and providers about other services available are needed.

Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required.

Objectives: This study aimed to explore barriers and facilitators to integrative oncology (IO) service provision and access in Australia. Design: The study design was mixed method with two substudies: a cross-sectional national cancer service survey of public and private sectors; and focus group interviews and an online survey of cancer survivors. Triangulation analysis of qualitative and quantitative data was used to identify and interrogate meta-themes. Subjects: The cancer service response rate was 93.2% (n = 275/295); 71/275 (25.8%) provided IO. Thirty-three cancer survivors from Anglo-European, Arabic, Vietnamese, and Chinese backgrounds were interviewed, and 121 survivors answered the online survey. Results: IO gaps were substantial, with no services in many regions and cities; a lack of diversity and availability of therapeutic options, including culturally appropriate services; and a mismatch between the high use of natural health products by survivors and types of IO services provided. Two overlapping meta-themes were identified: "barriers and facilitators" and "peoples and institutions"; each with four subthemes, respectively, "access/provision, affordability/funding, information/evidence, and culture/values" and "cancer survivors, healthcare professionals, organizations, and policies." While affordability/funding was the greatest barrier to survivors and providers, solutions varied (e.g., building a stronger evidence-base, business model advice) and often conflicted (e.g., public verses private sector funding). The most insidious barrier was professional/corporate cultures and values that influenced hospital policies (or lack thereof), conceptions of evidence and the therapeutic alliance. Survivors called for a change of mindset in the culture of medicine and value-based health care. Conclusions: The barriers and facilitators to IO services were more complex than building the evidence-base and demonstrating value to justify funding. To achieve a better alignment of patients' preferences with service provision, providers require more guidance on clinical governance, business models, local service gaps, and interprofessional collaboration. National strategies and funding models are needed to ensure appropriate, equitable IO service provision.

Patient-reported outcome measures and supportive care need assessment in patients attending an Australian comprehensive care centre: a multi-method study.

Patient-reported outcome measures (PROMs) are useful clinical tools to recognise symptoms, patient needs and their severity. Whilst PROMs are routinely utilised in integrative oncology (IO) and supportive care (SC) services to improve patient care, they are not as common in general oncology. We explored our patients' symptom burden, the approach taken by clinicians to identify and manage patient needs, and barriers and facilitators to using PROMs in an Australian tertiary comprehensive cancer centre to inform wider implementation of PROMs. From 2017 to 2018, PROM data collected for patients accessing IO and SC was retrospectively analysed. Semi-structured interviews with oncology doctors and nurses explored their approach to patient needs assessment and their use of PROMs. A total of 404 patients completed the Edmonton Symptom Assessment Scale (ESAS). The most frequently identified symptoms were sleep disturbance, fatigue and lack of wellbeing. Symptom clusters included drowsiness, fatigue and shortness of breath; anxiety and depression; sleep and pain; appetite and nausea. In total, 9 nurse consultants, 5 surgeons, 7 medical and 5 radiation oncologists were interviewed. Most participants took an intuitive approach to identifying and managing patient needs and did not routinely use PROMs. Perceived risks, barriers and facilitators to using PROMS are presented. High and complex symptom burden was found in our IO and SC patient population, reinforcing the need for screening. Whilst wider clinical use of PROMs within the hospital may improve clinical outcomes, the barriers and facilitators identified by Health Care Professionals (HCPs) need to be addressed before implementing PROMs more broadly.

Integrative Oncology: An International Perspective from Six Countries.

In June 2019, a meeting was held in Paris in which experts from different countries (Israel, Spain, Belgium, Italy, USA, and France) met to discuss a selection of topics in integrative oncology (IO). The objectives were to draw on the delegates’ experience and expertise to begin an international collaboration, sharing details of differing existing models and discussing future perspectives to help define and guide practice in IO and define unmet needs. This report presents a summary of the meeting’s main presentations, and also reports on the experts’ responses to a questionnaire examining different aspects of IO service delivery, infrastructure, and utilization.

Cancer Patients' and Healthcare Providers' Perceptions About Supportive and Integrative Oncology Services (S834)

1.Describe cancer patients' and healthcare providers' perceptions of supportive and integrative oncology services.2.Compare cancer patients' and healthcare providers' perceptions of supportive and integrative oncology services. Supportive and integrative oncology services improve quality of life for cancer patients and are increasingly popular. To characterize and compare the perceptions of supportive and integrative oncology services among cancer patients and healthcare providers. A cross-sectional survey was administered at Seidman Cancer Center (SCC), an NCI designated Comprehensive Cancer Center, to providers and patients in the spring of 2018. We inquired about familiarity, perceived importance, and frequency of use, accessibility and barriers of 19 supportive and integrative oncology services. Data analysis included the Chi-square test and Spearman’s rank correlation (ρ). A total of 585 surveys were obtained (421 patients and 164 healthcare providers). Patients were generally over 60 (58.2%), female (57.4%), Caucasian (64.2%) with most at >1 year from starting treatment (59.9%). Healthcare providers were physicians (38.7%), RN partners (38.1%), and advanced practice providers (APPs) (23.2%). Most were female (74.3%), Caucasian (80%) and worked at SCC for >5 years (56.4%). Providers were more familiar with palliative care (71.7%) and felt it was more important (92%) than patients did (25.2% and 43.6%, p<0.001). Patients who were in treatment for a longer length of time were more familiar with social work, palliative care and psychiatry (ρ= 0.17, 0.14, 0.20; p<0.01). Most providers (>85%) of all types regarded palliative care, social work and diet & nutrition services as important. The most common barrier for both patients and providers was being unaware of the services (41.6% and 67.1%). Overall, healthcare providers were more familiar and considered most services to be more important than patients with many supportive and integrative oncology services. Being unaware of the services was a common barrier.