The Guidelines are referenced in MedLine and are the only comprehensive evidence-based guidelines for incorporating complementary therapies into conventional clinical practice. The published guidelines are available FREE
The Society for Integrative Oncology (SIO) published its first edition of Integrative Oncology Practice Guidelines in 2007. 1 Experts who specialize in defined categories of integrative or complementary therapies were asked to review the scientific literature and categorize the interventions into specific levels of utility that take into account the methodological strength of supportive evidence, benefits versus risks, practicality, and value. Members of the SIO Executive, who are responsible for the final recommendations, peer reviewed and critiqued the submissions, so the final product is a consensus. The 2009 edition2 updates and expands on the previous version and provides practical recommendations for the use of complementary therapies in the supportive care of cancer patients. This is not a formal meta-analysis; in other words, no attempt was made to specify the inclusion criteria or which studies would be excluded. There was no intent to formulate a quantitative analysis but simply to use all of the evidence found in the literature for that particular intervention. The authors for each section were given the freedom to use their personal expertise to search the literature and used MeSH headings that are appropriate to their expertise in the field. This approach is partly subjective, albeit presenting a more realistic clinical application, especially given that a more formal analysis would be restricted by trying to compare apples with oranges and would exclude many interventions for which randomized clinical trials have not yet been done. The authors are cautious in their approach to recommendations and are clear in emphasizing the potential for safe interventions, especially when pharmaceutical approaches are not helping or require complementing or when patients have a preference for a nonpharmaceutical intervention.
The guidelines are not intended to remove the freedom of individual decision making, and the authors emphasize the importance of having degrees of freedom. It is useful, however, for clinicians to refer to these guidelines when making clinical choices with their patients. They will also be useful for quality assurance, clinical governance, and medical legislation and will provide indications for reimbursement that add value to clinical programs. They clearly illustrate the importance of multidisciplinary health care teams that jointly use their skills based on the expanding evidence base for integrative medicine. I hope that the guidelines will prevent inappropriate variation in clinical practice and underline the professional basis for integrative medicine, clearly distinguishing it from unacceptable alternative therapies. As such, this will provide a useful resource for all clinicians as well as administrators. So, why publish guidelines? These are tools, not rules. We need to formulate clinical decision making that is based on the best research evidence available, based on knowledge of relative safety and possible adverse effects, and that is economical compared with other interventions. One of the tenets of integrative oncology is to involve our patients in the decision-making process, so we place emphasis on the clinical encounter and the safe integration of combined modalities that suit the patient’s culture and belief system. However, economics includes not only financial costs but also the cost of missed opportunities and adverse events. It is imperative that all practitioners concerned for cancer patients have the knowledge and skills to design personalized programs that wisely support patients through their anticancer therapies. The consultation is an opportunity for education and must include clear guidance as to what is complementary and what is deemed alternative and, therefore, by definition, should be avoided. The guidelines clearly advocate evidence-based complementary therapies that support patients through their standard anticancer treatment, help reduce adverse effects, and improve their quality of life. I am hopeful that the research will eventually show that using these evidence-based guidelines for integrative oncology will have economic advantages by supporting patients through their anticancer treatment, by teaching improved coping skills, by encouraging more rapid rehabilitation, and by teaching tertiary prevention strategies. By standardizing these approaches, we will be able to collect high-quality data that can be used to compare programs in various institutions and implement quality assurance.
Stephen M. Sagar, BSc (Hons), MBBS, MRCP, FRCR, FRCPC, DABR
President, Society for Integrative Oncology
1. Deng GE, Cassileth BR, Cohen L, et al. Integrative oncology practice guidelines. J Soc Integr Oncol 2007; 5: 65 – 84.
2. Gary Deng, Moshe Frenkel, Lorenzo Cohen, Barrie R. Cassileth, Donald I. Abrams, Jillian L. Capodice, Kerry S. Courneya, Trish Dryden, Suzanne Hanser, Nagi Kumar, Dan Labriola, Diane W. Wardell, and Stephen Sagar. Evidence-Based Clinical Practice Guidelines for Integrative Oncology: Complementary Therapies and Botanicals. Journal of the Society for Integrative Oncology, Vol 7, No 3 (Summer), 2009: pp 85–120.