Introducing an ICON

The Tom Baker’s Integrative Complementary Oncology program expands education and access to unconventional therapies

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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.

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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

Dr. Linda Carlson (lindacarlson.ca) is the Enbridge Chair in Psychosocial Oncology at the University of Calgary and a clinical psychologist at the Tom Baker Cancer Centre.

2 Responses to Introducing an ICON

  1. Terry Hill, PhD says:

    Does your work incorporate any applications from Xavier Amador’s “LEAP” (listen, empathize, agree, partner) relationship roadmap? Ref.: ISBN: 978-1-4013-0346-4
    This would apply only to your “patient counselling” element.
    Recently, I assisted in the development of the Disease Pathway Management for Prostate Cancer project, supported by Cancer Care ontario (CCO), on the ‘panel of experts’ team. Regrettably, this venture did not incorporate psycho-social variables. This document is now published (May, 2013), and the regional community information tours are headed up by Dr. Michael Brundage. I am developing a layman’s seminar on psycho-social aspects of prostate cancer, from the standpoint of medical sociology.

  2. Hi Terry,
    Our patient counselling as described in the Integrative Oncology program is more like a consultation service and treatment planning around integrating conventional and complementary therapies throughout the cancer treatment trajectory. The counsellors will be trained health care staff (nurses, physicians) with expertise in integrative medicine and certainly will use a framework like the “LEAP” roadmap you describe.

    Our other patient counselling programs through Psychosocial Resources is provided by trained clinical and counselling psychologists, clinical social workers and psychiatrists who all apply various therapies and techniques they are specially trained in, including patient empowerment as described in the LEAP model.

    We feel taking into account the whole patient experience including their individual values and preferences is critical both for IO consultation, treatment planning and general patient counselling. Thanks so much for letting me know about your work!
    Linda

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