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The World Health Organization (WHO) defines health broadly as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."1 This far-reaching definition reminds us of the powerful influence we can have as practitioners not only on the number of days our patients live but also on the quality and depth of their lives. For many patients, a cancer diagnosis provides an opportunity to examine their mortality and their lives. For some, this may enable them to make considerable health-supporting changes in their lifestyle including discontinuing tobacco use, improving their diet, and adding physical activity and stress management techniques to their health regimens. Others may find themselves exploring their spiritual beliefs and examining other aspects of their life. As health care providers, we can support our patients in their efforts to achieve their optimal health throughout the life cycle.
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An understanding of integrative oncology, quality of life (QOL), supportive and palliative care, symptom management, and end-of-life (EOL) care can inform our ability to address our patients' global health needs (Figure 22-1).
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The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health defines complementary, alternative, and integrative medicine (CAM) as follows: Complementary medicine refers to use of CAM together with conventional medicine. Alternative medicine refers to use of CAM in place of conventional medicine. Integrative medicine refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness. Practitioners describe integrative oncology as both a science and a philosophy that focuses on the complexity of the well-being of cancer patients and proposes a multitude of approaches to accompany conventional therapies to facilitate health.2 In addition, integrative oncologists strive to support the innate healing abilities of the individual, using techniques for self-empowerment, individual responsibility, and lifestyle changes that could potentially reduce both cancer recurrence and second primary tumors. Integrative medicine includes biologically based practices (eg, diet, dietary supplements, herbs), mind-body medicine (eg, guided imagery, hypnosis, meditation, stress management), manipulative or body-based practices (eg, massage therapy, chiropractic, reflexology), energy medicine (eg, acupuncture, qigong, Reiki, yoga), and whole system approaches (eg, Ayurveda, traditional Chinese medicine [TCM], homeopathy) (Table 22-1).
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For a number of reasons, ongoing tension exists between some aspects of integrative medicine ...