islands of hope that patients can rely on to provide the
best evidence-based “whole person” cancer care.Where Do We Go From Here?
It may be too late to expect major cancer centers to
pull the rug out from under clinics or services touted as
integrative therapy. One could argue that this is not
necessary if steps are taken to ensure that these serv-
ices demonstrate the same level of evidence-based
practice demanded by the cancer centers of their sur-
geons, medical and radiation oncologists, nurses, and
other health professionals.
First,the “integrative oncology” movement
thrives on its emphasis on the “whole person,” being
“patient centered” or “holistic,” as if this sets apart the
field of “integrative oncology.” If these treatments
were truly “holistic” or focused on the “whole person”
then they would also work directly on the disease it-
self—as medical and radiation and surgical oncolo-
gists do. It is artificial marketing to promote these
practices in such a way, implying that while others
only care about “the tumor,” they possess a monopoly
on caring for the whole person. During my (MS) years
working in cancer centers, I have known many physi-
cians, nurses, and many other health professionals
who feel strongly that they also care for the “whole
person.” As noted, if caring for the whole person is
central to the approach, then sharing information
about the effectiveness of each intervention—who it
works for and how much benefit might be derived—
should be a discussion that occurs between each inte-
grative practitioner and his or her patient.
Second,the Society for Integrative Oncology
should support moving practices that have estab-
lished effectiveness out of the integrative oncology
framework. Indeed, their 2017 guidelines for breast
cancer care did not include physical activity because
this intervention has a strong evidence base and is
considered mainstream. Thus, there is no longer any
need to “integrate” them into standard patient care.
Including them in publications touting integrative
oncology^12 artificially inflates the numbers of cancer
centers incorporating integrative therapies and links
other questionable practices with more established
practices under the label of “integrative”—a slippery
slope that encourages cancer “quackery”. Likewise,
those many interventions not found to be helpful or
found to be only minimally helpful in systematic re-
views should not be “integrated” therapies but rather
“abandoned” therapies.
Third,those centers promoting integrative oncol-
ogy need to adequately define the term “evidence-
based.” In the past, the Office of Complementary andAlternative Medicine of the National Cancer Institute
funded “best case series” proposals, a standard for
funding far below the bar of any other NIH Institute or
office. How do they define “evidence”? Patient anec-
dotes? Single case studies? Randomized clinical trials?
Most randomized trials involving integrative oncology
practices simply compare the given integrative therapy
approach with “usual care.” This is a very low bar to use
when promoting effectiveness. What is needed is com-
parative effectiveness research to determine how inte-
grative therapy approaches compare to not only “usual
care” but to any “active” treatment (e.g., more time
speaking with counselor or a support group interven-
tion). This allows one to determine if there is any true
advantage to the given integrative therapy. In addition,
studies with larger sample sizes are needed so results
can be interpreted with more confidence. Relevant to
research needs, one could reasonably claim that all pa-
tients receiving any type of integrative therapy should
be formally enrolled in a research protocol given we
know so little about what works, how well interven-
tions work, and who they work for. Clearly laying out
the benefits and costs in an informed consent docu-
ment would also serve to ensure patients are well in-
formed about any therapy offered, and may well help
to standardize treatment across different practitioners.
Fourth,the call for credentialing integrative medi-
cine therapists^12 is very premature. What is needed is
more research in those areas showing any benefit with
more powerful research designs in order to determine
what works for who and what credentialing of any kind
should look like. Should there be credentialing for
every practice noted in the survey so that we might
have practitioners “credentialed” in Qigong, “healing
touch,” etc.?
Finally, the FDA sends out warning letters to com-
panies touting fake cancer cures.^20 These letters are
sent to ensure consumers do not fall victim to false
claims of cancer cures. Perhaps we should institute a
similar process for those promoting integrative thera-
pies to ensure that patients are aware that many of
these practices have not demonstrated any convincing
evidence of benefit. While the “cost” of the use of such
therapies most often pales in comparison to the threat
posed by fake cancer medicinal cures, such messages to
cancer centers may help alert them to bogus interven-
tions being implemented with their blessing, within
their institutional walls.Conclusion
A large number of major cancer centers provide sup-
port for, in many cases, unproven “integrative thera-
pies,” and many provide direct integrative therapy38 SKEPTIC MAGAZINE volume 25 number 1 2020