Integrative Services Such As Nutrition Counseling Boost Cancer Patient Survival, Study Finds

The key findings of the study include that low-mid institutions posted 5-year survival odds three times higher than low institutions, and mid-high institutions posted 5-year survival odds 48% higher than low institutions. “Crossing the threshold beyond ‘low’ involvement in integrative oncology represents a new path to incremental survival benefit for many cancer patients,” the study’s co-authors wrote.

The study’s co-authors recommend that oncology institutions should boost education, access, and funding for a core set of six integrative oncology services: nutrition counseling, exercise counseling, patient support groups, spiritual services, meditation, and psycho-oncology support. The core set of six therapies were offered significantly more often at high integrative score institutions than low integrative score institutions:

• 76% of low integrative score oncology institutions offered nutrition consultation compared to 100% of high integrative oncology institutions
• 68% of low integrative score oncology institutions offered exercise counseling compared to 100% of high integrative oncology institutions
• 80% of low integrative score oncology institutions offered patient support groups compared to 100% of high integrative oncology institutions
• 48% of low integrative score oncology institutions offered spiritual services compared to 100% of high integrative oncology institutions
• 20% of low integrative score oncology institutions offered meditation compared to 97% of high integrative oncology institutions
• 56% of low integrative score oncology institutions offered psycho-oncology support compared to 97% of high integrative oncology institutions

“Although 12 [integrative oncology] modalities were researched in this study, five are highlighted in the results that are more commonly adopted. These are exercise counselling, nutrition counselling, psycho-oncology support, chaplain services, and patient support groups. … We recommend adding meditation as a sixth key ‘core modality.’ These six represent an attractive bundle that addresses patients’ needs physically, mentally, socially, and spiritually, is often accepted as part of usual care, and provides some degree of choice for patients,” the study’s co-authors wrote.

Interpreting the data

There are clear benefits to having integrative services as part of an oncology program, the senior author of the study told HealthLeaders.

“Multiple cancer organizations such as the American Society of Clinical Oncology and the American Cancer Society have emphasized the importance of enhancing supportive care for cancer patients, both during and after specific cancer treatments. These guidelines are based on extensive evidence and documentation of value. Often these recommendations focus on behavior change and lifestyle, including nutrition, stress management, and exercise. Growing evidence in both cancer and non-cancer populations have shown non-pharmacological approaches such as acupuncture, yoga, mind-body, and other practices can enhance quality of life. Some of these have indicated a possible extension of life as well,” said Wayne Jonas, MD, executive director for integrative health programs at the Samueli Foundation.

The study demonstrates the benefits of integrative oncology, he said. “Since it is known that these practices improve quality of life, we did this study specifically to explore whether a combination of these efforts at cancer institutes across the country also had an impact on survival. It did. This would indicate that incorporating integrative oncology into routine cancer care could have benefit both in enhancing the quality of life and prolonging the life span of cancer patients.”

The core set of six therapies such as nutrition counseling should be widely adopted in cancer care, Jonas said. “These core six therapies are those with the strongest evidence for enhancing quality of care and quality of life, and many of them are already incorporated into international guidelines for cancer care. In the case of spiritual care, this had high demand from patients. Thus, we think it behooves cancer institutions to integrate at least these six therapies into the routine management of patients with cancer.”

Integrative oncology should be a best practice for all cancer patients—not just patients with breast cancer, he said. “These supportive and integrative oncology approaches are not unique to breast cancer patients. Many of them are basic wellness approaches that enhance healing in any condition. Thus, we think they should be incorporated into the care of any type of cancer.”