Integrative Oncology: Thriving with Metastatic Breast Cancer (MBC)
by Elissa Chandler, Individual Advocate Member
When the Metastatic Breast Cancer Alliance (MBCA) offered me a scholarship to attend a conference, I jumped at the opportunity to go to the 2024 Society for Integrative Oncology (SIO) Conference in Costa Mesa, California. I saw it as a reconnaissance mission to bring information back to the MBC community, which was not fully benefiting from integrative services.
As a retired nurse and patient advocate with metastatic triple-negative breast cancer, I believe in science, and I use the most advanced conventional medical treatments available. In addition to conventional oncology, I use integrative methods, such as meditation, prayer, yoga therapy, deep breathing, counseling, swimming, and a food-as-medicine plant-based diet to replenish my body, calm my mind, and uplift my spirit.
I have embraced the Integrative Oncology (IO) model because it addresses the whole person and the patient experience of cancer, adding complementary therapies and lifestyle changes to conventional treatment. Research shows that Integrative Oncology can improve cancer outcomes, including for MBC.
According to a 2017 study by Terri Crudup and associates, using the Integrative Oncology model showed improvements in breast cancer quality of life and five-year survival, including for those with metastatic disease, as compared with using conventional treatments alone.
Download a fact sheet to learn more about the basics of integrative oncology available resources.
How I Use Integrative Oncology (IO)
I have found Integrative Oncology, in conjunction with conventional cancer care, to be the most effective way to combat treatment side effects, improve my ability to cope with MBC, reclaim my body, restore my spirit, and feel wellness.
As Burt Rosen, a Stage IV cancer thriver and integrative advocate, says, “When diagnosed with cancer, I wanted to know, what else I could do?” For me, taking action reduces fear and powerlessness of a disease I cannot control.
I have discovered free, simple integrative tools that are easy to learn and implement on the spot, in any location, body position, or condition. Here is how I use them: with a disease I can’t control, I use breathing techniques to take control of this moment, guide my breath, calm my nervous system, and move beyond the anxiety and fear that is swallowing me. With a guided yoga practice, I can return to the kernel of the self — the truth of the pure spirit shining inside that is sometimes eclipsed by cancer. I use meditation and prayer to feel whole and well.
When disease progression and fear of death create uncertainty, I use a variety of IO techniques to find peace and my way back to myself. When I am weighed down by exhaustion or consumed with anxiety, I can simply breathe and relax inside myself, knowing at this moment I am okay. With a clear mind, I can better advocate for myself and others, research new treatments, make medical decisions, set boundaries, and navigate social connections. IO gives me both options and coping mechanisms.
Why Use Integrative Oncology (IO)?
While Conventional Oncology targets the body to kill or retard cancer, our physical bodies are a mere fraction of our lives. MBC can have widespread and devastating impacts on multiple connected dimensions – physical, spiritual, and psychosocial. At times, it may feel like our world is collapsing or being smashed to smithereens.
According to Cancer Choices, a website run by IO practitioners – the state of one’s inner environment or body terrain can promote healthy cell and organ function—or can favor unwanted growth of cancer. Dr. Donald Abrams, a highly regarded hematologist-oncologist whom I worked with on the San Francisco General AIDS Ward (5B) – and who now works in the IO space and with Cancer Choices – says, “Cancer is the weed; we need to tend the garden.”
The website offers a handbook called Optimizing Body Terrain which includes factors such as nutritional status, metabolism, immune function, microbiome, environmental exposures, and others. The theory is that the body’s terrain is believed to directly affect a tumor’s microenvironment – the noncancerous cells and tissues and their processes that directly interact with the cancer. A tumor can change its microenvironment, affecting how it grows and spreads.
In addition to affecting our disease directly, IO can improve our quality of life. For me, treatment has side effects like insomnia, anxiety, depression and fatigue. As my disease progresses, I use IO as an essential healing balm for living with MBC in all of its iterations, which can be soul-shaking, enlightening, life-altering, joyful, exhilarating, grief-striking, confusing, exhausting, fearsome, bone-chilling, and uncertain.
The Role of the Society for Integrative Oncology (SIO)
IO is not yet adopted throughout the healthcare system. Most cancer centers do not provide these services; health insurance rarely pays, and they often cost too much. Most conventional oncologists don’t fully understand IO, including what is most effective. Cancer survivors with limited energy are frequently on their own to find and vet credible providers and practices tailored to their needs.
Society for Integrative Oncology (SIO), is a global organization of oncologists, scientists, and integrative practitioners who research complementary and lifestyle practices and promote Integrative Oncology. According to their website, “The vision of SIO is to have research inform the true integration of complementary modalities into oncology care, so that evidence-based complementary care is accessible and part of standard cancer care for all patients across the cancer continuum.” SIO encourages rigorous scientific evaluation of pre-clinical and clinical science while advocating for transforming oncology care to integrate evidence-based complementary and lifestyle approaches.
For me, The SIO Conference was like a breath of fresh air, with patients, scientists, and doctors exchanging information and schmoozing without pretense or barriers. Patient advocates are required for each panel session, and participants engaged with each other in multiple venues. Heck, we were having meals and doing yoga and tai chi together on the beach.
I felt welcomed as a patient advocate to fully participate and express myself. Typically, what’s called a medical “society” in the US refers to a group of doctors. This organization is different – it welcomes the perspectives of all manner of healthcare professionals and people from various backgrounds and countries. It is genuinely multi-disciplinary, global, and multi-cultural. From what I have seen, SIO is the most culturally diverse group of medical professionals in the U.S.
At this conference, I had a free energy healing from Julie Deleemens, a cancer survivor who lost her voice box and speech at age 18 and is now a scientist at the University of Calgary studying the microbiome and psychosocial interventions. The experience was intimate and otherworldly for me – leaning in closely to hear her instructions like an ear to a seashell. Then through noise-canceling headphones, I was transported by chants ‘Be in the now,’ ‘You are the now.’
The conference helped me understand how Western scientific methods are used to evaluate and analyze data, and do research on integrative practices; these are Western-trained professionals, after all. For example, the keynote topic was translational integrative oncology from the bench to the bedside and back again. There were sessions on AI, and testing for biomarkers and genomic mutations is now included in some IO studies. I could see that IO is not that far from conventional cancer care.
How IO Works to Improve Quality of Life & Outcomes
Integrative oncology services can significantly enhance well-being and even survival by targeting both physiological and psychological well-being.
Lifestyle and Environmental Factors
Scientists believe cancer has multiple causes and contributing factors. It is not simply changes in DNA that cause and drive cancer. The environment in which we live and lifestyle habits such as obesity, alcohol, smoking, and sedentary behavior can contribute to cancer development and progression.
Promoting a Healthy Immune System
A healthy immune system can help fight cancer and counter treatments that break the body down. Sleep, Physical Activity, and Exercise have been studied and proven to improve breast cancer patients’ lives.
Physical Activity/Exercise
According to research, movement is one of the most effective things to counteract cancer fatigue and depression and improve the immune system. In my experience, exercise makes me feel more alive: my blood is flowing and I have more connection with my body and more joy in my life. Physiologically I know exercise can increase endorphins and Improve lung capacity and cardiovascular function.
MBC is exhausting, and many of us cannot do strenuous exercise. Studies show that light physical activity is enough to improve cancer outcomes, and we don’t need to exercise rigorously. Even small body movements, like swaying to music in the kitchen or raising the arms or legs when lying down, help with cancer-related symptoms and our health.
Yoga therapist Bernadette Milan, whom I met at the conference and now work with through Unite for HER specializes in cancer and chronic health issues and teaches patients to do yoga on their own with simple moves customized to meet patients where they are according to their needs and physical function.
Sleep and Fatigue
Cognitive Behavioral Therapy for Insomnia (CBT-I) is proven by randomized clinical trials to treat insomnia. Studies presented at SIO show CBT-I alone or with Yoga and/or psychotherapy can improve sleep, decrease fatigue, and combat anxiety and depression in breast cancer patients. CBT-I has helped me improve my sleep, which helps with my fatigue from ongoing chemotherapy.
Mind-Body Interventions
Mind-body interventions include mindfulness, other forms of meditation, yoga, Tai Chi, and relaxation techniques. UCLA psychologist Dr. Julienne Bower studies the impacts of mindfulness on breast cancer, including decreased stress and improved immunity, which is defined as “paying attention to our present moment experiences with openness and curiosity and a willingness to be with that experience.” It’s really about helping yourself come into the present moment. If you were to check in with your mind at any point in the day, it’s probably lost in the past or the future, worrying about something that happened or that’s coming—especially now. Mindfulness is an invitation to come back into the present moment and connect with ourselves in a way where we can see that actually, I can be OK. I can take a breath, I can pause. UCLA offers free training sessions to teach mindfulness skills through the UCLA mindful app on iTunes or Google.
SIO Guidelines for Integrative Therapies in Breast Cancer
SIO and the American Society of Clinical Oncologists (ASCO) collaborate to review data and issue integrative clinical practice recommendations jointly.
SIO/ASCO clinical guidelines for the use of integrative therapies during and after breast cancer are based on a systematic review of the literature and recommend the following practices:
- Use of music therapy, meditation, stress management, and yoga for anxiety/stress reduction.
- Use of meditation, relaxation, yoga, massage, and music therapy for depression/mood disorders.
- Use of meditation and yoga to improve quality of life
- Use of acupressure and acupuncture for reducing CINV (chemotherapy-induced nausea and vomiting)
A complete list of current SIO/ASCO guidelines, including anxiety and depression, and fatigue can be found here.
Getting Started With Integrative Therapies for MBC
At first, it might be overwhelming to figure out and prioritize your needs and sort through the different IO practices. I have found there are many free resources and websites that can help. For example, the Cancer Choices website is chock full of resources.
Here are some tips on where to start:
- Consult with a licensed integrative oncology physician. Insurance may cover the consult if the provider is an MD or DO. The Cancer Choices website can help you find a provider. Or ask your cancer center if they can recommend an IO provider.
- Consult with an IO navigator, often a nurse, who may assist with your search. You can ask your cancer center navigator to help. Free IO navigation services are also available through the Smith Center.
- Read through the Cancer Choices website’s IO guidance for advanced cancer and its information about integrative practices and lifestyle changes such as nutrition.
- Join Unite for HER’s free Wellness Program to learn about complementary therapies and create a personal plan, and apply for their Wellness Passport Program to receive free integrative therapies and services.
Research is showing that we can live longer and better if an integrative model is used. What can it look like? While getting chemo, a massage therapist or energy healer could give therapy. Patients and advocates can ask for these services, and advocates should formally request them.
These are questions that can be asked of the oncology center to determine what integrative services they offer:
- Is there an integrative doctor I can meet with? Will insurance cover a consult?
- Is there a nutritionist who offers both conventional and integrative diets? Will insurance cover a consult?
- What services are provided: acupuncture, massage, reiki, yoga, support groups, referrals to peer supporters and advocates? Is there a cost, or can these services be paid for under my insurance? You can add Unite for HER as a resource for the medical teams to share for these therapies.
Download a fact sheet to learn more about the basics of integrative oncology available resources.
Acting as an IO Advocate
Through my experience at the SIO Conference, I re-evaluated my role as a patient advocate. A lightbulb went off – I can be an IO Advocate and fold in my knowledge of conventional and integrative care together – they can fall under the same umbrella. Using the IO model supercharges my patient advocacy: with integrative practices, I restore my mental and physical energy that has been depleted by conventional cancer treatment.
Here’s how I work as an Integrative Advocate:
- I advocate for conventional care – to help individuals get the best traditional care, including navigating the fractured healthcare system.
- I advocate for complementary practices, lifestyle change, and the whole-person empowered approach. This includes helping people find integrative resources and teach simple practices.
- I promote the integrative whole-person empowered model, which listens intently to learn the unique characteristics of each individual and what they want and need. I have learned that listening and acting as a mirror to give emotional support and to help each individual see their most pressing needs can help me gather critical resources and information. As an integrative advocate, I can bring together all the tools I have learned in my journey to face life and death in a meaningful, joyful, and practical way. I respect and honor each person’s journey, validate their concerns, and strive to bring self-empowerment to all my interactions. The point is to meet people where they are and help them find the modality most fitting for them. It is not a one-size-fits-all approach. It is not about what you do but finding what feels right for each individual – whatever brings us to our true self and joy.
I also joined the SIO Integrative Patient Advocacy Committee over a year ago. I encourage MBC advocates to join the SIO and the SIO Patient Advocate Special Interest Group (SIG)Committee. Advocates get a reduced rate on membership and can apply for grants to attend the conference.
The Bottom Line on IO and MBC
Paradoxically, to me, the ultimate message from my immersion in IO and the SIO conference was that it’s okay to do nothing. Rather than striving to learn new practices or add to my “to-do” list, the point is to be in the present moment. This way of being jibes with a disease that challenges me to “accept” and “be” no matter what the situation. I want to live each day and moment with intention and do things I love and care about most.
Along these lines, Tricia Hershey, NY Times published author and creator of The Nap Ministry, has started a movement of ‘restful resistance’ to counter the trap of our constant ‘doing.’ Though not specifically for cancer and meant for Black women to counter the effects of racism, I believe her message is universal, and we can all relate. Tricia’s upcoming book explores the themes of “escape and the trickster energy we will all need to thrive in a culture that refuses to see our divinity as human beings.”
Personally, I can feel trapped by the assault of MBC life and the imperative to respond instantly to texts and emails, test results, and notes from worried friends and family. I am truly exhausted. Can’t we all just rest and be? Yes, but it may take practice and conscious effort! The point is to find out what truly brings you joy and to do that or to do absolutely nothing at all. If needed, you have my permission.
I left the SIO conference invigorated and hopeful, gaining many empowering tools to help my IO advocacy and me. I can envision a future where my oncologist appears before me, offering both conventional and integrative methods as one cancer care package, and insurance pays for it all. Science has proven IO’s effectiveness. Seeing the system move in a positive direction toward better and more integration will be a welcome relief.
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