Integrative Oncology : Where we have been . . . Where we are now . - PowerPoint PPT Presentation

Integrative Oncology : Where we have been . . . Where we are now . . . Where we are headed . . . Margaret A. Chesney, PhD Cancer Support Community East TN June 1, 2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Facing Cancer Together - a program of Cancer Support Community East Tennessee

Overview  Define integrative oncology and describe how it created the foundation for integrative health and medicine  Highlight why there is a growing focus on integrative medicine and health now Discuss the importance of integrative oncology  as the cornerstone for cancer wellness Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Oncology -  Patient-centered,  Evidence-informed cancer care, that integrates Mind, body & purpose Optimal Movement Healthy Conventional Lifestyles Cancer Care Nutrition Social Wellness Connection Commitment Facing Cancer Together - a program of Cancer Support Community East Tennessee

Origins of “Integrative Oncology” Long before integrative oncology emerged … Research from 1952-1960 by Arthur Sutherland and  colleagues studied the “adaptation” and “rehabilitation” of cancer patients…  He focused on the stress of cancer care for patients and their caregivers. TIMELINE 1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Dr. Arthur Sutherland: Psychological Adaptations to Cancer Sutherland, A., Papers, Cancer 1952-1959 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Origins of “Integrative Oncology” Long before integrative oncology emerged …  Research from 1952-1960 by Arthur Sutherland and colleagues studied the “adaptation” and “rehabilitation” of cancer patients…  Research documented the relationship between risk behaviors and disease - 1964 Surgeon General’s report on cigarette smoking   1969 Blue Ribbon Panel drops Diet Only Study and calls for MRFIT (Multiple Risk Factor Intervention Trial) TIMELINE 1952/59XXXX1964 1969XXX978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

1974  The First Lady, Betty Ford is diagnosed with Two weeks later, Happy Rockefeller, wife of the VP breast cancer is diagnosed with breast cancer  1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

1974  The First Lady, Betty Ford is diagnosed with Two weeks later, Happy Rockefeller, wife of the VP breast cancer is diagnosed with breast cancer  1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Psychosocial Treatment of Patients with Breast Cancer  86 women with metastatic breast cancer – 1 year  Psychosocial Treatment (PT) N = 50 - weekly supportive group therapy Spiegel - self-hypnosis for pain - routine oncological care  Usual Care (UC) N = 36 - routine oncological care Yalom  After 1 year, women in the PT group had less anxiety, depression and fatigue, and more vigor than UC Bloom Spiegel, Bloom, Yalom, Arch of Gen Psychiatry, 1981 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Psychosocial Treatment of Patients with Breast Cancer  86 women with metastatic breast cancer – 1 year  Psychosocial Treatment (PT) N = 50  Usual Care (UC) N = 36  Ten year survival  PT Group: Survival 37.6 months  UC: Survival 18.9 months  Survival twice as long as seen in Kaplan-Meier plot Spiegel, Bloom, Kraemer, Gottheil, Lancet , 1989 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Psychosocial Treatment of Patients with Breast Cancer B = PT Group – Psychological Treatment A = UC – Usual Care What’s led to the difference? - Social Support - Stress Reduction Kaplan‐Meier survival plot Spiegel, Bloom, Kraemer and Gottheil, Lancet, 1989 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Late 1970-1980s: Cancer Research was the Impetus for New Studies  Research on stress and health proliferated!  From interventions for psychological aspects of breast cancer …  To studies of stress as a cause of heart disease, with Type A behavior  Stress as a risk factor for hypertension  The effects of stress on auto-immune diseases …   1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2017 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Late 1970-1980s: Cancer Research was the Cornerstone for New Fields  From smoking cessation studies to stress triggers, smoking and mood/weight, and relapse prevention …  To interventions for psychological aspects of coping with chronic conditions, such as cancer …  To studies of stress effects on the immune system  New fields of research were founded founded 1978 founded 1979   1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2017 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Oncology = the Foundation for Integrative Medicine Integrative medicine programs emerged in the1990’s in Academic Health Centers  1991 Univ of Maryland’s Center was founded  1994 Univ of Arizona Center for Integrative Medicine  1995 Univ of Minn. Center for Spirituality and Health But wait . . .  1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Oncology = the Foundation for Integrative Medicine  1982 ! The Wellness Community was founded in Santa Monica By Harold and Harriet Benjamin, and Shannon McGowan - To provide support groups, education and other programs, - To conducts research to quantify and document the benefits of psychosocial support for people with cancer 1982  1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Oncology = the Foundation for Integrative Medicine  1990 ! Knoxville founds the Wellness Community, East TN now the Cancer Support Community  1995 Wellness Community offers Mindfulness-Based Stress Reduction (MBSR)  1997 Rachael Patterson Young defends her dissertation showing benefit of MBSR for people with cancer 1990 1997   1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2019 Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Oncology = the Foundation for Integrative Medicine Integrative medicine programs emerged in the1990’s in Academic Health Centers  1991 Univ of Maryland’s Center was founded  1994 Univ of Arizona Center for Integrative Medicine  1995 Univ of Minn. Center for Spirituality and Health  1998 Congress authorized funds for NCCIH 1998 Duke Integrative Medicine founded   1999 Osher Center at UCSF is founded Jon Kabat-Zinn Invites 8 Integrative Medicine Centers to a Meeting 1952/59XXXX1964XXX…1978/79XXXX1991XX1998/99XXXXXXXXXX2017 Facing Cancer Together - a program of Cancer Support Community East Tennessee

1999: Consortium Formed - 8 Centers University of Minnesota University of Massachusetts University of California, San Francisco Harvard University Stanford University University of Maryland Duke University University of Arizona Facing Cancer Together - a program of Cancer Support Community East Tennessee

Overview  Define integrative oncology and describe how it created the foundation for integrative health and medicine  Highlight why there is a growing focus on integrative medicine and health now Discuss the importance of integrative oncology  as the cornerstone for cancer wellness Facing Cancer Together - a program of Cancer Support Community East Tennessee

$10,224 $4,717 78.5 84.2 2018 Data – Organization for Economic Cooperation and Development, 35 Countries US Rank 27 th of 35 Facing Cancer Together - a program of Cancer Support Community East Tennessee

“The disease-driven approach to care has resulted in - spiraling costs as well as - a fragmented health system that is - reactive and episodic as well as - inefficient and impersonal .” IOM Summit, 2009 IOM - Now NAM - National Academy of Medicine Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Oncology Integrative Medicine Disease-driven care  an integrated a fragmented health o patient-centered team system reactive and  focuses on whole o episodic person and lifestyle  reaffirms relationship inefficient and o between practitioners impersonal.” and each patient Facing Cancer Together - a program of Cancer Support Community East Tennessee

Integrative Medicine Complementary Conventional Medicine* Medicine* Acupuncture Stress Management Surgery Physical Activity Yoga/Tai Chi Medication Meditation/Breathing Radiation Diet/Nutrition Massage Social Support Immunotherapy * Examples Facing Cancer Together - a program of Cancer Support Community East Tennessee