New SIO-ASCO practice guideline addresses the use of integrative therapies for cancer pain management

Reviewed by Emily Henderson, B.Sc.Sep 19 2022

A new joint practice guideline from the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology, Inc. (ASCO^®) has been published to address gaps in healthcare providers' knowledge of how to safely and effectively treat common cancer symptoms and side effects using integrative medicine approaches.

Pain is a clinical challenge for many oncology patients and clinicians, and there's a growing body of evidence showing that integrative therapies can be useful in pain management. But to date there has not been clear clinical guidance about when and when not to use these approaches."

Heather Greenlee, ND, PhD, co-chair of the SIO Clinical Practice Guideline Committee

SIO joined forces with ASCO to develop a clinical practice guideline on the use of integrative therapies and pain management, building off of ASCO's existing guideline focused on cancer pain. "This new guideline takes a deeper dive on the use of integrative therapies, which is important because clinicians and patients need to have access to the latest evidence-based information to make clinical decisions," said Jun J. Mao, MD, MSCE, co-chair of the SIO-ASCO guideline on use of integrative therapies for pain management.

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.

"Practice guidelines are a critical way to ensure healthcare providers use treatments that are based on quality evidence from scientific studies that have shown the treatment to be effective and safe," said Immediate Past Chair of the ASCO^® Evidence-Based Medicine Committee, Scott T. Tagawa, MD, MS, FACP. "The guidelines focus on important concerns in patient care that greatly impact quality of life and will help equip the oncology community with the essential knowledge needed to manage integrative therapy approaches."

The SIO-ASCO guideline was developed following a rigorous review of published literature, including literature only from randomized clinical trials-;the gold standard in healthcare research. A large panel of oncology experts was convened, co-chaired by Jun J. Mao, MD, MSCE, of Memorial Sloan Kettering Cancer Center representing SIO, and Eduardo Bruera, MD, of MD Anderson Cancer Center representing ASCO. The panel reviewed existing evidence and assessed the quality of studies; once consensus was reached, recommendations were made based on the strength of the evidence available.

Among the guideline's strongest recommendations are that acupuncture be offered to breast cancer patients experiencing joint pain related to the use of a medication common in breast oncology called aromatase inhibitors. Because there was moderately strong evidence supporting its effectiveness and its low risk of harm, the expert panel also recommended acupuncture for general cancer pain or musculoskeletal pain as well as for chemotherapy-induced peripheral neuropathy.

The guideline also recommends the use of massage therapy for patients in palliative care or hospice who are experiencing pain.

"Clinician uptake of evidence-based treatments is always a concern, which is one of the reasons why we create practice guidelines," said Dr. Bruera. "We are hoping that by showing the growing evidence that is out there, healthcare systems will start hiring these kinds of practitioners and insurance systems will start covering these treatments, because more and more, these are being shown to be effective at managing pain for cancer populations."

Because the expert panel was conservative in making their recommendations, the guideline also includes areas identified as potentially relevant to cancer care but needing more research. This distinction is important because the lack of endorsement for a given therapy is not an indication that the therapy is necessarily ineffective or unsafe. Rather, it indicates that the expert panel felt the evidence was insufficient to support its recommendation. For instance, said Dr. Greenlee, more studies are needed to assess the safety and effectiveness of natural products.

To ensure patients can play a role in the treatment decision-making process and to inform their discussions about integrative therapies with their oncologists, ASCO and SIO have also posted a listing of integrative medicine patient resources on their respective websites.

"This is the first of three evidence-based guidelines for adults that SIO and ASCO are developing together, which combines the strengths of these two organizations," added Linda E. Carlson, PhD, President of SIO. "The goal of this important collaboration is to inform as many clinicians and patients as possible about where the evidence for integrative therapies lies to support the best clinical outcomes possible for all cancer patients. And we believe this new guideline accomplishes that."

SIO received an unrestricted grant to fund guideline development from the Samueli Foundation.

ASCO^® is a registered trademark of the American Society of Clinical Oncology, Inc. and is used with permission. ASCO is not a partner or affiliate of SIO and does not recommend or endorse any organization, product, or service.