Integrative Oncology: Supportive Care Guidelines and What Is Recommended Alongside Cancer Treatment

Urgent first

In a medical emergency, such as chest pain, signs of a stroke, trouble breathing or a severe allergic reaction, call 911 in the US. If you are thinking about suicide, call or text 988. If someone may have swallowed too much of a supplement, herb or other product, call Poison Help at 1-800-222-1222 (see poisoning: what to do first). For new or worsening symptoms during cancer treatment, contact your cancer care team promptly. This page is information only and does not replace the advice of your oncology team.

Two very different uses

"Integrative oncology" here means using complementary approaches alongside standard cancer treatment, mainly to relieve symptoms and side effects. NCCIH calls an approach "alternative" when it is used in place of conventional medicine. [1] The National Cancer Institute gives an example: a special diet used to treat cancer instead of the cancer drugs an oncologist prescribes. [2]

These are not interchangeable. NCCIH says the Society for Integrative Oncology (SIO) guidelines state that, when used in addition to conventional therapies, some approaches help control symptoms and enhance well-being. [3] The guidelines also warn that unproven methods should not be used in place of conventional treatment, because delayed treatment reduces the likelihood of remission or cure. [3] NCCIH also states that no complementary approach has been shown to cure cancer or cause it to go into remission. [3] Label for cure claims: no good evidence of benefit.

What the guidelines recommend

The SIO and the American Society of Clinical Oncology (ASCO) have published joint guidelines, built from systematic reviews and trials, for specific symptoms. Each recommendation is for one symptom, one approach and one stage of care.

Label for these uses: promising but limited. The anxiety and depression guideline itself lists limits: nonstandardization of therapies, lack of diversity in study samples and lack of active control conditions. [4] Most of these approaches cannot be blinded, so expectation may play a part. For pediatric patients, the pain guideline found insufficient or inconclusive evidence to make recommendations. [7]

What the guidelines advise against or do not support

• Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced nerve damage, because of a possibility of harm. [8]
• Clinicians should not recommend L-carnitine to manage cancer-related fatigue. [6]
• No strong evidence supports ingested dietary supplements to manage breast cancer treatment side effects, and other supplements did not improve fatigue. [8][6] The evidence for natural products for pain is low or inconclusive. [7]
• Cannabis or cannabinoids should not be used as a cancer-directed treatment outside a clinical trial. [5]

Other products promoted for cancer: NCCIH says black salves are neither safe nor effective, a 2019 review found no clinical evidence that laetrile works, and evidence on high-dose intravenous vitamin C is mixed. [3] See natural cancer cures and clinic claims and IV vitamin drips and high-dose vitamin C.

What happens when treatment is replaced

A study of 281 people with nonmetastatic breast, prostate, lung or colorectal cancer who chose alternative medicine as their only anticancer treatment compared them with matched people who had conventional treatment. [9] Alternative medicine alone was associated with greater risk of death (hazard ratio 2.50). [9] The authors describe such use as rare. [9] It was an observational study, not a randomized trial, but it matches the guideline warning. Label: evidence of harm when used in place of treatment. More: what studies found about choosing alternative medicine instead of cancer care.

Who provides care, and getting it

The guideline panels included integrative oncology, medical, radiation, surgical and palliative oncology, nursing and patient advocacy members. [7] The anxiety and depression guideline discusses provider training and credentialing and quality assurance of natural health products as open issues. [4] Reviewers say implementation in routine oncology practice remains limited, [10] and a commentary lists limited insurance coverage and provider availability. [11] Check each practitioner's license; see credentials, titles and scope of practice.

Proper evidence not found: in the guideline abstracts we read, no integrative therapy was reported to improve cancer survival. They address symptoms and quality of life. We checked the SIO-ASCO guideline abstracts and the NCCIH cancer page for survival findings; the NCCIH page reports mixed evidence for one product, intravenous vitamin C, on overall survival.

For what to tell your team, see integrative care during cancer treatment.