Bridging the Gap. James Eugene Munson
even more patients per day. Considering the demands, the acupuncturists remained focused and provided immeasurable concern, compassion and care for their patients.
Similar to the other IO hospitals researched, neither moxibustion or Chinese herbal medicine was permitted. A request for an air filter or secluded space for moxa was denied. The reasons included available space and according to the acupuncturist who made the request, moxibustion was not science-based and was therefore not a proven, useful modality to integrate. Despite a conversation with a medical oncologist who condoned Chinese herbs and made attempts to introduce them on-site, he was met with skepticism and concern by colleagues and administration. Thus, basic herbal therapy was recommended by naturopaths and only what was available for purchase at the pharmacy.
The most distinctive feature of this internship reflected the aspect of “the language of medicine.” In a small meeting led by an ND, attended by one acupuncturist, medical oncologist and research analyst, the idea of a scientific study on the merits of a particular acupuncture protocol for a pain-related condition was discussed. The first impression of this subject matter was encouraging. This discussion was a true picture of integration, and an opportunity to create a clinical study that warrants acupuncture for a particular condition as a result of cancer treatment. The barrier was evident within moments. The ND and medical oncologist were merely focused on the point combinations based on their individual indications to treat the pain syndrome. In an attempt to contribute and describe the theory and principles of TCM, the acupuncturist explained that there is more depth to be measured. Diagnosis, pattern differentiation, tongue, pulse — all of these elements contribute to the selection of acupuncture points to treat any condition. Protocols cannot be haphazardly applied without considering the constitution supported by the current presentation. This would essentially compromise the efficacy of the study.
The information was not met with a willingness to understand, and communication quickly faltered. There was no open discussion that considered alternative approaches for the study. The meeting ended abruptly with no resolution. While this is just a mere moment and glimpse into an honest attempt at integrative partnership, it appeared to reflect the larger issue of the IO paradigm. Conventional medicine along with disciplines that are scientifically affiliated and evidence-based, to a significant extent, control how complementary therapies, such as TCM, are accessed and studied. The range of application is grossly limited, relying upon a singular pillar to do all the work. This contradicts the nature of integration. It not only diminishes the capacity to build upon medical skills, but it also limits the ability to embed them into new paradigms, and most importantly, to heal patients.
The internship at CTCA was invaluable on many counts. It created a tangible, visual overview of an IO hospital that emphasized compassionate cancer care. While the components of integration were lacking, there was a genuine intention to that end. Following this experience, the doctoral research continued, and the investigation for the nebulous definition of integrative oncology went on. However, it became apparent that the concept and its application were indeed left up to interpretation. This was illustrated in a meta-analysis survey study performed by the Journal of the National Cancer Institute (JNCI). The conducted research reviewed 20 extensive definitions of IO. Predominant themes revolved around concepts of evidence-based medicine, management of symptoms, improving quality of life and complementary medicine in conjunction with conventional methods.
The compilation of terms and defining characteristics of IO overlap extensively. They are ingredients to a larger recipe, some parts unique and other elements predictable. Nonetheless, these formed a grouping that allowed deeper analysis toward a unified definition. The following statements are examples discovered by JNCI that highlight the varied components that encompass this growing specialty. Statements include:22
“Integrative oncology is the term being increasingly adopted to embrace complementary and alternative medicine (CAM), but integrated with conventional cancer treatment as opposed to being considered a rival or true ‘alternative’.”
“In the United States, the term ‘integrative oncology’ may be variably defined, but most definitions would include the idea and practice of adding complementary and alternative medicine (CAM) approaches to the range of therapeutic options provided to cancer patients in previously strictly conventional medical environments.”
“…comprehensive, evidence-based approach to cancer care that address all participants at all levels of their being and experience.”
This definition adapts current notions of “integrative medicine” — the judicious integration of CAM and conventional therapies in the best interest of patient — to oncology, with emphasis on aspects of patient care including attention to “body, mind, soul and spirit within the self, and within the specific culture and the natural world.”23
The analysis of 20 definitions identifies characteristics, philosophies and themes that reflect a cohesive whole. With deliberation, a reliable foundation emerges upon which the definition is clearly derived in order to delineate clear guidelines within this specialty. Of the entire list, the shortest quote in length and description, stood out as a simple, approachable, all-encompassing framework, “Integrative oncology aims to combine the best practices of conventional and complementary oncological therapy (the ‘best of both worlds’).”24 Indeed, it is often the remarkable features and strengths that an individual entity can bring that contribute to a greater whole. Equal balance optimizes better integration.
However, simplicity is not well received in the field of oncology. This has been demonstrated for hundreds of years as doctors, researchers, scientists, patients and caregivers strive toward a cure. It is evident that this nefarious disease demands complex, innovative treatments that eradicate the cancer cells and not the whole organism. To this end, the agreed upon definition of integrative oncology, finally unveiled in 2017 at the international conference led by SIO, reflects this inherent complexity:25
“Integrative oncology is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.”
When we encountered this long-awaited definition, it was encouraging. It references mind-body medicine and natural therapies that occur in conjunction with allopathic methods. But, closer examination reveals the concept and ideology grossly differ from the practical application evident in analyses of IO facilities. It exemplifies a harmonious balance among disciplines, that does not easily exist. This suggests that practitioners of all backgrounds, skills and education collaborate alongside one another without a medical hierarchy. However, current systems do not reflect these standards. This standard of integration is inherently compromised by a myriad of logistical challenges, impaired by differing therapeutic views and practices, and then further hindered by an inability to communicate in one medical language.
The definition is a starting point, but it is not the ultimate guide. A window of opportunity is open to establish proper integrative dynamics that recognize the value of each medical modality. This fluidity aligns with the nature of the disease itself. As it evolves, so too must the providers and patients. Within that construct, there is an ebb and flow of interpretive understanding and from this evolution, improved application. This is what we aim to do by exploring the therapeutic capacity of traditional Chinese medicine for cancer. Peering beyond the romanticized version of acupuncture therapy and demonstrating the refined approaches and inherent value of this ancient medicine.
References
Abrams, D. I., & Weil, A. (2009). Integrative Oncology. New York, NY: Oxford University Press.
Balneaves, L. (2018). President’s Message. SIO NewsWire August 2018, 1–2.
Kaptchuk, T. J. (2008). The Web That Has No Weaver: Understanding Chinese Medicine. New York, NY: McGraw-Hill.
MD Anderson Cancer Center. (2018). Acupuncture. Retrieved September, 7, 2018, from MD Anderson Cancer Center: