Complementary medicine for cancer can be successfully embedded into hospital settings but there are barriers to overcome, say the team who set up an integrative oncology service at Sydney’s Chris O’Brien Lifehouse.
Writing in Supportive Care in Cancer, Dr Suzanne Grant (PhD) and co-authors examine the barriers and enablers of the establishment of the integrative oncology (IO) at the 125-bed comprehensive cancer centre.
Starting in 2015, the centre has been offering therapies including yoga, massage, acupuncture, reflexology, qigong and meditation classes as part of its ‘LivingRoom’ for supportive services.
Believed to be the most comprehensive of its kind in Australia, the five-year-old centre – the vision of the late oncologist Professor Chris O’Brien – provided services to 60,000 patients last year.
The majority of patients are women in their 50s living within 10 km of the centre, and exercise physiology, acupuncture and massage therapy are the most popular therapies.
The authors describe how internationally there has been a shift to focus on wellbeing in cancer care as new therapies mean more people are living with cancer for longer.
For the Lifehouse, the key to the model’s success has been the integration of a team of complementary therapists into the western medicine model of care.
This has been aided by the integrative oncology (IO) team holding weekly multidisciplinary meetings and a monthly ‘journal club’ where the latest evidence on complementary medicine in cancer care is reviewed.
Also important was the employment of a supportive care physician who acts as a bridge between medical staff and complementary medicine practitioners.
“A paradigm shift was required by hospital staff to embrace a more holistic approach to patient wellbeing,” they write. “This merging of two cultures cannot be rushed, but nor will it just happen, rather thoughtful facilitation is most helpful.”
Shifting the focus from complementary therapies as being separate or outside of usual care to “being an integral component of standard care” has also aided integration, the authors said.
“There continues to be a slow cultural shift toward understanding the benefits of complementary medicine for patients by oncologists, nurses, surgeons and other staff”.
Choice of therapies is based on safety record and evidence of benefit, however those with little evidence that have no known side effects and low opportunity costs may also be selected, writes Dr Grant, a senior acupuncturist at Chris O’Brien Lifehouse, and her co-authors.
Therapists meanwhile are selected based on their experience with cancer patients, and a tightly defined scope of practice is included in work contracts.
But there have been barriers on the way, the authors noted.
These have included clinicians’ reluctance to refer patients to a fee-for-service therapy and lack of understanding of how or why to refer patients.
Financial viability has been one of the “greatest challenges”, and currently complementary therapists work on a fee-for-service basis while allied health and medical services are funded by Medicare and private health insurers.
Meanwhile, in WA the experience of Australia’s first cancer centre to incorporate integrative medicine shows just how much attitudes have changed in the past 20 years.
Since Solaris Cancer Care opened in Perth in 2001, there are now 71 (of a total 295) cancer centres offering some form of CM therapy.
In an interview with the West Australian in September, Solaris founder and haematologist Professor David Joske described the pushback he faced from cancer specialists when he set up the centre.
In contrast, he notes that now the Clinical Oncology Society of Australasia (COSA) has subcommittees for complementary therapies.