I’ve been thinking a lot lately about how to bring together everything we know about the best possible care for cancer patients, the best way to offer people education, services and treatments that will optimize their physical, mental and spiritual health throughout the cancer journey. I’m not the first person to consider these questions.
Some people faced with a cancer diagnosis turn to complementary therapies. The question remains, for patients and health-care providers, how do they make sure those therapies are backed by evidence and actually work? Another concern to address is, how do complementary therapies work with more conventional ones? One solution we’re working to develop here in Alberta is called the ICON program, which stands for integrative complementary oncology.
Our vision is to develop a truly integrated program which incorporates research, service and education. We are still seeking funding but, as envisioned, the program will incorporate the following four elements:
1. Patient and provider programs: This year we conducted surveys with about 500 patients and 100 health-care providers at the Tom Baker Cancer Centre (TBCC). About half of all patients surveyed said they were using some form of complementary therapy (CT) such as vitamins, herbs, meditation, acupuncture and more. Yet only 20 per cent said their health-care providers asked if they were using, or considering using, any CTs. For their part, the health-care providers said they had very little education about the efficacy and safety of CTs and wanted to learn more. Meanwhile, patients felt their oncology care team should be knowledgeable about CTs.
In response to this stated need, we have revamped monthly patient education seminars and are currently developing training materials for health-care providers, but this is only the beginning. We plan to provide evidence-based training materials and workshops, perhaps in-person, on the web, or through educational videos and seminars. These would be to ensure people know which therapies are proven to be helpful, who they’re meant for and under what circumstances. Programs will be tailored to different groups of patients and providers.
2. Patient counselling: Patients are using CTs to help optimize their cancer treatments, decrease symptoms and improve overall quality of life. However, the evidence about which therapies to use when, for which symptoms and types of cancer, in combination with conventional treatments, is daunting. People need individualized guidance through the process since recommendations depend on their specific medical history, their current diagnosis, treatments they will be undergoing, medications they are taking and a host of other individual factors. Individualized consultations will be the heart of the ICON program, potentially run by trained oncology nurses, naturopathic and conventional doctors, counsellors and CT providers.
3. Service provision: In a truly integrative oncology program, provision of recommended CT services would be available at the TBCC for patients along with their conventional treatments. These would include a full range of evidence-based CTs, such as mind-body interventions like meditation and yoga, advice on nutrition and natural health products (herbs, vitamins, foods), energy medicine like acupuncture and Tai Chi, and body-based modalities like massage and exercise programs.
4. Clinical trials: Finally, where treatments show promise but evidence is inconclusive, development of a fully functional integrative oncology clinical trials unit qualified and equipped to conduct research on a range of CTs, including natural health products, would be the cornerstone of the program. Where evidence doesn’t exist but treatments are promising or in-demand, our job is to create the evidence and learn not only which treatments are helpful, but also if some are potentially harmful and should be avoided.
While this entire program is a vision for the future, many of the pieces are already in place. With the new Calgary cancer centre in development, this may be an ideal opportunity to bring truly integrated whole-person care to Alberta.
Dr. Carlson wrote a column in Leap‘s spring 2012 issue (Integrative Oncology: What is it?) that has some related and interesting information you may want to check out if you missed it. Also check out the new website for Tom Baker Cancer Centre’s Integrative Complementary Oncology program at tbccintegrative.com