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Integrative Oncology

Integrative Oncology by Donald Abrams and Andrew Weil (eds). New York, NY: Oxford University Press, 2009; Hardcover, 581 pages. ISBN-13: 978-0-19-530944-7. $35.00. Available in ABC’s online store.

Integrative Oncology provides a comprehensive overview of this multidisciplinary field and demonstrates the diversity of healing modalities available in integrative cancer care. While the field of integrative oncology has been limited by a paucity of widely accepted evidencebased therapies, this book contains an extensive review of the volumes of research that have been published and may be clinically relevant for the integrative oncology practitioner. This book is visually well organized for quick reference, while it also maintains a natural flow for those who wish to read it cover to cover. For the healthcare practitioner or layperson who wants to gain a greater appreciation for the growing body of scientific evidence supporting the use of integrative healing modalities in oncology care, this text is a great resource.

Readers will be empowered to consider the important role of integrative oncology in cancer prevention and adjunctive treatment, with topics ranging from a review of the epidemiology of cancer prevention to the current evidence-base for integrating the use of nutritional therapy and botanical medicine into cancer care. Cancer preventive topics include the impact of diet, lifestyle, and physical activity for reducing risk. The scientific rationale for nutritional intervention in cancer care is reviewed, and a general summary of nutritional recommendations based upon current research is included for reference. An extensive review of the current research in botanical medicine for cancer prevention and adjunctive treatment includes research regarding medicinal mushrooms, curcumin (from turmeric [Curcuma longa, Zingiberaceae]), green tea (Camellia sinensis, Theaceae), plant enzymes, and flavonoids. A short but useful section is included on the use of botanicals for mitigating side effects of conventional cancer therapy. The statistics for most of the research is presented qualitatively, but confidence intervals or p values were unfortunately omitted from most of the tabled summaries. This information can be cross-referenced, however, as all references for research presented is available.

Controversial topics in integrative oncology are discussed in the context of evaluating risk versus benefit. For example, a chapter devoted to “the antioxidant debate” describes the evidence both in support of and cautioning against the use of antioxidants in cancer care. While the authors conclude that the use of high doses of antioxidants is contraindicated during radiation therapy, the evidence is made available for the reader to dig deeper into this issue, if so desired. Another chapter describing potential mechanisms of herbchemotherapy interactions provides a good foundation for predicting potential interactions between many herbs and chemotherapeutics. A good review of alternative therapies purported to cure cancer in the absence of conventional oncology treatment provides an excellent reference for the integrative clinician whose patients may inquire about such therapies. (An interesting chapter covering cannabinoids and cancer discusses the historical context of traditional medicinal use of cannabis, as well as the pharmacology and clinical application of cannabinoids in cancer care.) The discussion of controversial topics in this text gives readers the opportunity to improve their understanding of these issues and formulate their own clinical opinions.

Integrative Oncology also provides a rich source of mind-body medicine modalities available for enhancing care of the patient with cancer. The roles of mind-body medicine, spirituality, and energy medicine in oncology care are discussed at length. For those more interested in evidence-based therapies, the chapter that covers mind-body medicine also includes a literature review of the current mindbody medicine research in the oncology setting.

A few chapters are devoted to specific aspects of managing patients in integrative oncology, including symptom management, palliative care, mitigating toxicity, and radiation therapy. A closer look at the integrative management of specific cancers is limited to 3 cancer types: breast cancer, prostate cancer, and colon cancer. For the reader interested in learning more about integrative oncology patient management, this book lays a good foundation, and it also includes references and resources for further study. This book is not a comprehensive resource for the healthcare practitioner seeking cancer-type and treatment-specific guidance for individual therapeutic recommendations. It does include some evidence-based therapies for managing symptoms and toxicities commonly encountered in the oncology setting such as nausea, constipation/diarrhea, fatigue, and peripheral neuropathy, which the reader may find clinically useful.

Also included are chapters describing international systems of healthcare: Traditional Chinese Medicine (TCM), Ayurveda, homeopathy, and anthroposophic medicine. These sections are both meant to introduce the reader to each of these traditional systems of healthcare as well as show how these healing systems can be integrated into conventional cancer care. For example, in China, physicians regularly weave TCM into conventional oncology treatment, and early clinical research shows improvements in clinical outcomes and patients’ quality of life. One unfortunate omission is the lack of a chapter describing the role of naturopathic medicine in integrative oncology. While a number of licensed naturopathic physicians who specialize in integrative oncology were contributing authors to this text, there is no section that helps the interested reader understand how naturopathic medicine can contribute to integrative cancer care. For a book that is so thorough in its review of the many diverse modalities available in integrative oncology, omitting a discussion of the field of naturopathic medicine creates a blind spot for the reader expecting to learn about all of the systems of healthcare that may be integrated into oncology care.

Integrative Oncology weaves together a patient-centered, holistic approach to cancer care with the scientific rationale behind integrative therapies used in the oncology setting. For the reader who desires a comprehensive, evidence-based review of the evolving interdisciplinary field of integrative oncology, this book is an excellent resource.

—Debi Walker, ND, Adjunct Professor of Biological Sciences, Sierra Nevada College, Incline Village, NV