Lessons learned from the delivery of virtual integrative oncology interventions in clinical practice and research during the COVID-19 pandemic.

The outbreak of the coronavirus disease 2019 (COVID-19) and subsequent need for disease transmission mitigation efforts have significantly altered the delivery of cancer care (e.g., rise of telemedicine), including within the field of integrative oncology. However, little has been described about how National Cancer Institute-Designated Cancer Centers have transformed integrative oncology care delivery in response to the COVID-19 pandemic. The purpose of this commentary is to describe the delivery of integrative oncology clinical services and conduct of research at The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute during the COVID-19 pandemic. Clinical services transitioned from an array of in-person appointment-based services, such as acupuncture and massage, and group programs, such as yoga and nutrition seminars to a combination of live-streamed and on-demand virtual group programs and one-on-one virtual appointments for services such as acupressure and self-care massage. Group program volume grew from 2189 in-person program patient visits in the 6 months prior to onset of the COVID pandemic to 16,366 virtual (e.g., live-streamed or on-demand) patient visits in the first 6 months of the pandemic. From a research perspective, two integrative oncology studies, focused on yoga and music therapy, respectively, were transitioned from in-person delivery to a virtual format. Participant accrual to these studies increased after the transition to virtual consent and intervention delivery. Overall, our clinical and research observations at Dana-Farber Cancer Institute suggest that the delivery of virtual integrative oncology treatments is feasible and appealing to patients. Trial Registration: NCT03824860 (Yoga); NCT03709225 (Music Therapy).

Being in touch: narrative assessment of patients receiving online integrative oncology treatments during COVID-19.

OBJECTIVE: We examined the qualitative impact of an online integrative oncology (IO) treatment program, designed in response to the restrictions created by the current COVID-19 pandemic. METHODS: Patients undergoing chemotherapy were seen by an integrative physician (IP), together co-designing an IO treatment program of ≥ 6 weekly treatments to alleviate symptoms and improve quality of life (QoL). IO practitioners guided patients and their caregivers online in self-treatment with manual/touch, movement, and/or mind-body modalities. Narratives of both patients and IO practitioners were analyzed for systematic coding, identifying barriers and advantages of the online treatment program. RESULTS: Narratives obtained from 30 patients and eight IO-trained practitioners were examined. The patients had undergone 169 online IO sessions with a total of 327 IO interventions during the 3-month study period. Patient narratives included reflections on both non-specific effects (e.g., less of a "sense of isolation") and specific QoL-related outcomes with the online intervention. IO practitioner narratives focused on barriers to providing manual-movement and mind-body modalities, suggesting practical recommendations on how to address specific QoL-related outcomes using the online IO "toolbox." CONCLUSIONS: Effective online IO practitioner-guided treatments are feasible and may induce both specific and non-specific QoL-related effects. Future research needs to explore online IO interventions for additional situations in which access to IO care is limited.

Integrative oncology from a bibliometric point of view.

OBJECTIVES: The aim of this article is to analyze the development of integrative oncology from a bibliometric point of view. The publication and citation patterns of publications are analyzed and their contents mapped. DESIGN: This study is based on bibliometric methods. The data sets consist of 7 025 respectively 4 990 publications over the time period 1966-2016, shown in PubMed and Web of Science. RESULTS: The expansion of the numbers of these publications took place in the late 1990s/early 2000s. Research is dominated by authors located in the USA, China and Germany who are working at well-established research universities and university hospitals. The clinical share of publications is relatively small, and few studies are classified according to clinical phase. Content analysis revealed that much of the clinical research is based on surveys, and that content reflects the intersection of complementary therapies and cancer research. The latter aspect is less obvious in pre-clinical research. The most frequent journals in the material show a focus on complementary and alternative therapies or on integrative oncology, although journals focused on oncology or general/internal medicine were well-represented in the material as a whole. The most-cited publications were review articles and surveys. CONCLUSIONS: Integrative oncology has been established as a small, but distinct, research domain. There are several signs of specialization in integrative oncology, but also in its integration into general medical and oncological research.

Transitions in palliative care: conceptual diversification and the integration of palliative care into standard oncology care.

Palliative care acknowledges the historical origin of the hospice developed in the UK during the 20th century. Palliative care initially focused primarily on end-of-life care provided at hospices, but then changed to at-home care, leading to the formation of a support system provided by the palliative care team. The palliative care team further coordinated with acute care hospitals and became involved in earlier stages of care as well, such as providing symptomatic relief in conjunction with cancer treatment. On this backdrop, the concept of palliative care itself also evolved over time. In recent years, attempts at early-stage palliative care from the initial stages of treatment are being studied with respect to cases with complications such as advanced cancer. Early-stage palliative care has been reported to improve patient quality of life (QOL), improve depression, reduce the burden on the family, and possibly improve survival prognosis for some advanced cancers. Currently, efforts to integrate palliative care into standard oncology care regimens by providing specialist palliative care and cancer treatment as a single unit are anticipated to enter more widespread practice. Such a care approach differs from conventional palliative care, which is started around the time when the end of conventional cancer treatment, and consists of applying specialist palliative care from the stage where cancer treatments are administered to address with multiple problems. Many breast cancer patients have severe problems such as esthetic outcome, sexuality and psycho-social effects associated with breast cancer itself and treatment. And it effects their QOL for a long time not only during therapy but also having done therapy or recurrence. Therefore, it may be effectiveness for patients to integrate of palliative care into standard oncology care in breast cancer, but the effect of it for only breast cancer patients has not been reported on yet. In this paper, after reviewing the concepts and historical evolution of palliative care, we describe the integration of palliative care into standard oncology care that has been making progress recently.