Summary

Many people with cancer use complementary therapies alongside conventional anticancer treatments to alleviate side effects and cope with the stress of treatment. This can be dangerous if the person’s care team are not aware of the treatments they are receiving. In Tuscany, Italy, a hospital established an integrative oncology clinic, run by an oncologist and a doctor with expertise in complementary medicine, where people with cancer can receive complementary therapies as part of their wider care plan. Since the establishment of the clinic, complementary medicine has been further integrated into the regional oncology network through two new care pathways, and new clinics have opened across the region. People who have received treatment at the clinics have experienced reductions in side effects.

 

Challenge

In Europe, around 40% of people diagnosed with cancer report that they have used complementary therapies, such as acupuncture and herbal remedies in addition to conventional anti-cancer treatments such as chemotherapy and radiotherapy.1 This is often to alleviate symptoms of cancer and side effects of  treatment, such as sickness and diarrhoea due to chemotherapy, or skin problems due to radiotherapy.2 Others use complementary therapies to help them cope with the long-term effects of cancer, such as early menopause in women who have received hormonal treatment for breast cancer.3 Using complementary therapies in this way is distinct from using the same methods as ‘alternative treatments’ to replace conventional oncological treatment.4

Some people with cancer do not disclose their use of complementary therapies to their family members and healthcare professionals.4 5 In the Italian region of Tuscany, a 2014 study found that almost 38% of people with cancer were using at least one kind of complementary therapy.6 However, around a third had not informed their oncologist that they were using these therapies.

Using complementary therapies can be harmful when a person’s care team is unaware of them,3 because there is a risk of adverse effects when conventional anticancer treatments interact with other substances.3 7 As well as risking the person’s safety, these effects can also interrupt conventional treatment.3

However, some complementary therapies can be used safely and effectively to alleviate the side effects of anticancer treatments, during palliative care and after cancer.

 

Solution

Since the 1990s, the cancer network of the Italian region of Tuscany  has been integrating complementary medicine into the regional oncology service, having recognised the high levels of complementary medicine usage among people diagnosed with cancer in the region.3 8

In 2013, the Tuscan Oncology network opened an outpatient clinic for complementary medicine and diet in oncology at the Campo di Marte Hospital in Lucca.3 The centre is run by an oncologist and an expert in complementary medicine. It offers complementary therapy, including acupuncture and phytotherapy (the use of medicines derived from plants or herbs), with the aim of reducing the side effects of conventional anticancer treatments such as chemotherapy and radiotherapy, and improving people’s quality of life.8

People with cancer receive most of these complementary therapies through the public health system, but must pay for some herbal treatments and oils used during aromatherapy themselves. Staff at the centre can also provide advice on diet and physical activity to help people deal with the impact of cancer and anticancer treatment.3

Oncologists working in the hospital and at other facilities in the local area may refer people with cancer to the centre, or people can self-refer. Most people treated at the clinic in Lucca (90%) are referred by their oncologist.3

 

What has been achieved?

In 2019, a new Diagnostic and Therapeutic Care Pathway (DTCP) for breast cancer was released in Tuscany, containing a new section on the use of complementary and integrative medicine.9 This was followed by a wider DTCP – Integrative Medicine for Cancer Patients in 2021.10 The latter pathway states that all people with cancer being treated in the Tuscan Health Service should receive adequate information on integrative medical treatments at every stage of the patient pathway.

People with cancer who have been treated at the clinic in Lucca have reported reductions in side effects, including sickness and diarrhoea, and reductions in the use of pharmacological interventions to alleviate these side effects.3 People who are living with the long-term effects of cancer have also reported improvements in their quality of life when accessing complementary therapies through the clinic.

As of August 2022, there are 20 integrative oncology clinics across Tuscany.3 The region of Emilia Romagna and the autonomous province of Bolzano have both opened public integrative oncology clinics, following the Tuscan example.8 The Abruzzo region has also approved breast cancer guidelines that include recommendations for the use of complementary therapies in combination with conventional anticancer treatments.

 

Next steps

An integrative oncology working group has been put together to work on implementing the new Integrative Medicine for Cancer Patients Diagnostic and Therapeutic Care Pathway across Tuscany.3 The first meeting is scheduled for September 2022.

The local oncology network has also commissioned three new research projects in the field of integrative oncology, including investigations of how complementary therapies might benefit people experiencing fatigue or cognitive difficulties as side effects of chemotherapy.

 

Further information

Contact

Professor Elio Rossi, Director of the complementary medicine and diet in oncology clinic at Hospital Campo di Marte, Lucca:  e.rossi@mednat.it

References:

  1. Frass M, Strassl RP, Friehs H, et al. 2012. Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner J 12(1): 45-56
  2. Satija A, Bhatnagar S. 2017. Complementary Therapies for Symptom Management in Cancer Patients. Indian J Palliat Care 23(4): 468-79
  3. Rossi E. 2022. Interview with Catherine Hodge at The Health Policy Partnership [video call]. 18/08/22
  4. Cancer Research UK. 2022. The safety of complementary and alternative therapies. [Updated 13/04/22]. Available here: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/about/safety
  5. Chang KH, Brodie R, Choong MA, et al. 2011. Complementary and alternative medicine use in oncology: A questionnaire survey of patients and health care professionals. BMC Cancer 11(1): 196
  6. Bonacchi A, Fazzi L, Toccafondi A, et al. 2014. Use and Perceived Benefits of Complementary Therapies by Cancer Patients Receiving Conventional Treatment in Italy. Journal of Pain and Symptom Management 47(1): 26-34
  7. Jermini M, Dubois J, Rodondi PY, et al. 2019. Complementary medicine use during cancer treatment and potential herb-drug interactions from a cross-sectional study in an academic centre. Sci Rep 9(1): 5078
  8. European Regional and Local Health Authorities (EUREGHA). 2021. Cancer: A showcase of best practices from EUREGHA's members. Brussels: European Regional and Local Health Authorities (EUREGHA)
  9. Istituto per lo studio lpelro, Servizio sanitario della Toscana. 2019. Percorsi diagnostici terapeutici e assistenziali Tumori della mammella. Florence: Istituto per lo studio lpelro
  10. Istituto per lo studio lpelro, Servizio sanitario della Toscana. 2021. Percorso diagnostico terapeutico e assistenziale medicina integrata per i malati oncologici. Florence: Istituto per lo studio lpelro