The National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps.

The Division of Cancer Treatment and Diagnosis, Office of Cancer Complementary and Alternative Medicine, at the National Cancer Institute (NCI) held a symposium on "Acupuncture for Cancer Symptom Management" on June 16 and 17, 2016. Invited speakers included 19 scientists and scholars with expertise in acupuncture and cancer research from the United States, Europe, and China. The conference reviewed the NCI's grant funding on acupuncture, analyzed the needs of cancer patients, reviewed safety issues, and assessed both the current scientific evidence and research gaps of acupuncture in oncology care. Researchers and stakeholders presented and discussed basic mechanisms of acupuncture; clinical evidence for specific symptoms; and methodological challenges such as placebo effects, novel biostatistical methods, patient-reported outcomes, and comparative effectiveness research. This paper, resulting from the conference, summarizes both the current state of the science and clinical evidence of oncology acupuncture, identifies key scientific gaps, and makes recommendations for future research to increase understanding of both the mechanisms and effects of acupuncture for cancer symptom management.

Challenges to complementary and alternative medical research: focal issues influencing integration into a cancer care model.

Complementary and alternative therapies are increasingly used by cancer patients for palliative and postcancer preventive and/or wellness care. It is critical that evidence-based models be employed to both provide information for patients' use and informed consent and for physicians to advise patients and assess relative risk:benefit ratios of using specific complementary and alternative medicine (CAM) approaches within the cancer care paradigm. Research models for biomedicine have been somewhat limited when applied to broader, more holistic conceptualizations of health common to many forms of CAM. Thus, while numerous challenges to studying CAM exist, a fundamental question is not just what CAM practices should be studied but how CAM should be studied. The authors propose a model that emphasizes methodologic rigor yet approaches CAM research according to relative levels of evidence, meaning, and context, ranging from experimental, quantitative studies of mechanism to qualitative, observational studies of noetic/salutogenic variables. Responsibility for training researchers prepared to meet such challenges rests on both CAM and mainstream academic institutions, and care must be taken to avoid philosophical and practical pitfalls that might befall a myopic perspective of integration.

Integrating Chinese traditional medicine into a U.S. public health paradigm.

Chinese traditional medicine (CTM) is a health care system with an extensive history of practical clinical experience. The foundation of CTM, while relatively simple, is substantively different from much of allopathic medicine. Such differences are difficult to explain using a Western medical vocabulary, and extend beyond linguistic foundations. This proves challenging when trying to identify appropriate teaching and research methods that are sensitive to the CTM paradigm and yet relevant to a public health orientation. Given the increased use of CTM, it becomes important to address possibilities that would ensure successful integration of CTM into a public health framework. We propose a model in which both CTM and biomedical clinical services could be offered to provide diverse, yet truly integrative, therapeutic approaches. Within this model, it is critical to enhance reciprocal educational and research-directed opportunities for both CTM practitioners and allopathic clinicians. Considerable responsibility rests upon academic institutions in becoming proactive in developing and implementing educational curricula and research programs that illustrate more effectively the potential bilateral benefit(s), limitations, and, ultimately, roles that CTM and biomedical approaches may assume within an integrative system of care.

Complementary and alternative medicine in mainstream public health: a role for research in fostering integration.

In light of the increased utilization of complementary and alternative medicine (CAM) in recent years, there is an increased possibility that CAM approaches could prove to be important factors in public health, particularly if used within an integrative framework together with mainstream medicine. There exists a defined need for research to explore the integration of conventional health care and CAM approaches, as well as define mechanisms of CAM-based therapies to facilitate such integration. Essential to these goals is the accumulation of a database derived from outcomes-based clinical and basic science investigations. We posit that that CAM clinicians need to be more thoroughly trained as researchers, skilled in developing and recording results of pragmatic studies that could provide credible evidence for the use of CAM in the public sector health care. It is proposed that this may be best achieved through a three-tiered system in which (1) clinician-scientists of both mainstream and alternative disciplines recognize the value of research designed to foster such integration; (2) educational and health care institutions must develop academic and clinical training programs that examine and delineate each disciplines' respective strengths and weaknesses; and (3) such programs are attractive to, and receive continued extramural subsidy. In the broadest sense, such a paradigmatic approach to CAM integration could create a common basis for scientific dialogue, encourage exchanges between medical communities, and establish policies for the development of a true multidisciplinary health care cooperative that is consistent with the current public health model.