Integrative medicine in oncology –⁠ between science, ideology, and pragmatism

Czech version

Authors: M. Světlák ^1,2
Authors‘ workplace: Ústav lékařské psychologie a etiky, LF MU Brno ¹; Úsek klinické psychologie, Klinika komplexní onkologické péče LF MU a MOÚ, Brno ²
Published in: Klin Onkol 2025; 38(4): 264-269
Category: Reviews
doi: https://doi.org/10.48095/ccko2025264

Overview

Background: Integrative medicine, which combines evidence-based conventional and complementary approaches, can significantly contribute to symptom management, improvement of quality of life, and empowerment of cancer patients. However, its implementation requires strict adherence to principles of safety, transparency, and informed decision-making. Non-specific effects of care, such as the placebo effect, the therapeutic relationship, and the meaningfulness of intervention, have measurable impacts on health outcomes and represent a legitimate part of the therapeutic process. Integrative oncology is not an alternative to science but rather an extension that deepens the understanding of the complex human response to illness and treatment. Key elements include open physician–patient communication, respect for individual needs, and critical appraisal of available evidence. Integrative medicine thus enhances not only the effectiveness of cancer care but also its ethical and human dimensions. Aim: This is a narrative review and reflection on current knowledge regarding the use of integrative and complementary therapies in oncology, emphasizing both potential benefits and risks, with a focus on critical evaluation of scientific evidence and a pragmatic approach to patient care. The aim of this article is to introduce the concept of integrative oncology as an ethical and evidence-based approach that extends standard cancer care by addressing psychosocial and existential dimensions of health, without abandoning the principles of evidence-based medicine.

Keywords:

Quality of life – Complementary and alternative medicine – patient-centered care – integrative medicine – oncology care – placebo effect

Sources

1. Marchant J. Consider all the evidence on alternative therapies. Nature 2015; 526 (7573): 295. doi: 10.1038/526295a.

2. Barry MJ, Edgman-Levitan S. Shared decision making –⁠ the pinnacle of patient-centered care. N Engl J Med 2012; 366 (9): 780–781. doi: 10.1056/NEJMp1109283.

3. WHO. Constitution. [online]. Available from: https: // www.who.int/about/governance/constitution.

4. NCCIH. Complementary, alternative, or integrative health: what’s in a name? 2024 [online]. Available from: https: //www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.

5. WHO. WHO global report on traditional and complementary medicine 2019. [online]. Available from: https: //www.who.int/publications/i/item/978924151536

6. Clarke TC, Black LI, Stussman BJ et al. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Report 2015; 79 : 1–16.

7. Kaptchuk TJ, Miller FG. Placebo effects in medicine. N Engl J Med 2015; 373 (1): 8–9. doi: 10.1056/NEJMp1504023.

8. Johns Hopkins Health Library. Complementary and Alternative Medicine (CAM) for Cancer. 2023 [online]. Available from: https: //johnshopkinshealthcare.staywellsolutionsonline.com/library/testsprocedures/90,P02715.

9. Ng JY, Dhawan T, Fajardo RG et al. The brief history of complementary, alternative, and integrative medicine terminology and the development and creation of an operational definition. Integr Med Res 2023; 12 (4): 100978. doi: 10.1016/j.imr.2023.100978.

10. WHO. WHO traditional medicine strategy: 2014–2023. 2013 [online]. Available from: https: //www.who.int/publications/i/item/9789241506096.

11. Power M, Hopayian K. Exposing the evidence gap for complementary and alternative medicine to be integrated into science-based medicine. J R Soc Med 2011; 104 (4): 155–161. doi: 10.1258/jrsm.2011.100271.

12. Masic I, Miokovic M, Muhamedagic B. Evidence based medicine –⁠ new approaches and challenges. Acta Inform Med 2008; 16 (4): 219–225. doi: 10.5455/aim.2008.16.219-225.

13. Rakel D. The salutogenesis-oriented session: creating space and time for healing in primary care. Explore (NY) 2008; 4 (1): 42–47. doi: 10.1016/j.explore.2007.10.016.

14. Ford I, Norrie J. Pragmatic trials. New Engl J Med 2016; 375 (5): 454–463. doi: 10.1056/NEJMra1510059.

15. Chandwani KD, Ryan JL, Peppone LJ et al. Cancer-related stress and complementary and alternative medicine: a review. Evid Based Complement Alternat Med 2012; 2012 : 979213. doi: 10.1155/2012/979213.

16. Howick J, Koletsi D, Ioannidis JP et al. Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis. J Clin Epidemiol 2022; 148 : 160–169. doi: 10.1016/j.jclinepi.2022.04.017.

17. Colloca L, Barsky AJ. Placebo and nocebo effects. N Engl J Med 2020; 382 (6): 554–561. doi: 10.1056/NEJMra1907805.

18. Eippert F, Finsterbusch J, Bingel U et al. Direct evidence for spinal cord involvement in placebo analgesia. Science 2009; 326 (5951): 404. doi: 10.1126/science.1180142.

19. Benedetti F. Placebo effects: understanding the mechanisms in health and disease. Oxford University Press 2008.

20. Benedetti F, Amanzio M, Vighetti S et al. The biochemical and neuroendocrine bases of the placebo effect. Nat Rev Neurosci 2006; 7 (8): 545–552. doi: 10.1038/nrn1954.

21. Lin WF, Zhong MF, Zhou QH et al. Efficacy of complementary and integrative medicine on health-related quality of life in cancer patients: a systematic review and meta-analysis. Cancer Manag Res 2019; 11 : 6663–6680. doi: 10.2147/CMAR.S195935.

22. Belloni S, Bonucci M, Arrigoni C et al. A systematic review of systematic reviews and a pooled meta-analysis on complementary and integrative medicine for improving cancer-related fatigue. Clin Ther 2023; 45 (1): e54–e73. doi: 10.1016/j.clinthera.2022.12.001.

23. Mayo Clinic. Integrative oncology –⁠ overview. 2024 [online]. Available from: https: //www.mayoclinic.org/departments-centers/integrative-oncology/overview/ovc-20542190.

24. Memorial Sloan Kettering Cancer Center. Integrative Medicine. 2024 [online]. Available from: https: //www.mskcc.org/cancer-care/integrative-medicine.

25. Rosenthal DS, Doherty-Gilman AM. Integrative medicine and cancer care. Virtual Mentor 2011; 13 (6): 379–383. doi: 10.1001/virtualmentor.2011.13.6.msoc1-1106.

26. Baldassarre AJ, Palmer A. Marketing cancer care: A content analysis of ethical compliance in television advertising by top-ranked U.S. cancer centers. J Cancer Policy 2025; 44 : 100591. doi: 10.1016/j.jcpo.2025.100591.

27. Back AL, Arnold RM, Tulsky JA et al. Teaching communication skills to medical oncology fellows. J Clin Oncol 2003; 21 (12): 2433–2436. doi: 10.1200/JCO.2003.09.073.

28. Greenlee H, DuPont-Reyes MJ, Balneaves LG et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. CA Cancer J Clin 2017; 67 (3): 194–232. doi: 10.3322/caac.21397.

29. Greenlee H, Balneaves LG, Carlson LE et al. Integrative oncology for anxiety, depression, and pain in cancer survivors: Society for Integrative Oncology –⁠ ASCO Guidelines. J Natl Cancer Inst 2022; 114 (8): 1113–1124. doi: 10.1093/jnci/djac064.

30. Stanford Medicine. Center for integrative medicine. 2024 [online]. Available from: https: //stanfordhealthcare.org/medical-clinics/integrative-medicine-center.html.

31. Dymáčková R, Sláma O. Acupuncture in the treatment of symptoms of oncological diseases in the Western world. Klin Onkol 2014; 27 (4): 291–293.

32. Halámková J, Dymáčková R, Adámková Krákorová D. Akupunktura z pohledu medicíny založené na důkazech –⁠ možnosti klinického využití na podkladě doporučení National Comprehensive Cancer Network (NCCN). Klin Onkol 2022; 35 (2): 94–99. doi: 10.48095/ccko202294.

33. Svoboda M, Halámková J et al. Péče o pacienty po ukončení kurativní onkologické léčby. 1. vyd. Praha: Grada Publishing 2023. ISBN 978-80-271-5021-2.

34. Neuwirthová T, Slíva D, Vavříková E. Imunostimulační a protinádorový účinek extraktů z Reishi a Coriolu na úrovni klinických studií. Klin Onkol 2020; 33 (6): 422–427. doi: 10.48095/ccko2020426.

35. Kocák I. Alternativní medicína v léčbě rakoviny. Klin Onkol 1992; 5 (2): 41–43.

36. Latte-Naor S, Mao JJ. Putting integrative oncology into practice: concepts and approaches. J Oncol Pract 2019; 15 (1): 7–14. doi: 10.1200/JOP.18.00554.

37. Mustian KM, Alfano CM, Heckler C et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol 2017; 3 (7): 961–968. doi: 10.1001/jamaoncol.2016.6914.