Complementary therapy for cancer works alongside standard treatments

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. How often are people with cancer turning to complementary health approaches during and after their treatment? A team of researchers at Upstate has published a paper on this topic in the Journal of Cancer Survivorship, and I'm speaking with two of the authors. Dr. Kaushal Nanavati is the director of integrative medicine, and Jamie Romeiser is an assistant professor of public health and preventive medicine at Upstate. Welcome to "The Informed Patient," Dr. Nanavati and Dr. Romeiser.

[00:00:41] Jamie Romeiser, PhD: Thank you so much for having us.

[00:00:43] Kaushal Nanavati, MD: Thank you.

[00:00:43] Host Amber Smith: Now, what made you want to explore this question, about the prevalence of the use of complementary health approaches?

[00:00:52] Jamie Romeiser, PhD: Well, the number of cancer survivors in the U.S. is steadily growing, and cancer survivorship really has quadrupled in over the past 40 years. This rise is largely due to advances in early detection through screening programs, as well as significant improvements in how we treat cancer. So this is really encouraging, that people are living longer with a diagnosis of cancer.

But increased survivorship also brings a shift in healthcare needs for cancer survivors. And many cancer survivors report lower quality of life during and after treatment, and they face ongoing physical, mental and emotional challenges. And these could include depression, pain, fatigue, stress, anxiety, all of which can persist long after the completion of cancer treatment. So as a result, it's the quality of survivorship. And my wonderful colleague will call that "thrive-ership.". This is an emerging critical issue in oncology. There's a growing interest not only in people with cancer, but also among providers in exploring non-pharmaceutical options to manage these lingering symptoms or increase the quality of life.

And there's really a growing body of evidence that supports certain complementary health approaches that can be used to help address these issues in cancer survivors. And this moves more towards that patient-centered approach to cancer survivorship care in treating the whole person and not just the cancer.

[00:02:20] Kaushal Nanavati, MD: I guess some things that I'd like to add -- I think that was beautifully explained -- is just some basic definitions. So what's complementary, right? So there's conventional cancer care that relates to medical oncology, surgical oncology, radiation oncology. And then we have these complementary approaches which span a spectrum.

And again, there's a difference between alternative and complementary. Alternative is often something that doesn't necessarily have great data or research as an alternate to. Whereas, complementary is in conjunction with, in a complement to conventional care. So, one of the things that we focused on is recognizing that survivorship spans the spectrum from high risk individuals all the way through end-of-life care, and to understand where a complementary approach is can both empower the patient and the caregiver, to feel a sense of control in their journey, to feel a sense of empowerment, and the ability to navigate in their direction is really important. And I think this data, and just looking at what is done currently, helps us not only as an institution that's a comprehensive cancer center, but even in terms of health care moving forward of what we can do to optimize the quality of life of the people that we serve.

[00:03:38] Host Amber Smith: So let me ask you, when we talk about complementary practices or approaches, what are we talking about?

[00:03:44] Jamie Romeiser, PhD: So, at least in the data that we examined for this study, there were eight different complementary health approaches that were included in the survey data. Survey responders were asked whether they visited a specialist in the past year for chiropractic care, acupuncture, massage therapy, meditation, guided imagery, yoga, and then also music therapy and art therapy.

[00:04:08] Host Amber Smith: And did you have an assumption before you began looking into this?

[00:04:14] Jamie Romeiser, PhD: Sort of. In a way, which also relates to whether or not our results are surprising. We sort of assumed that we were going to be finding certain results in relationships to recency of cancers. But you know, you don't want to take those assumptions into any type of research study. So we really just wanted to explore the data.

[00:04:38] Host Amber Smith: Sure. Well, tell me about the data set that you used.

[00:04:42] Jamie Romeiser, PhD: Sure. We used data from the National Health Interview Survey, which is a survey that's conducted by the National Center for Health Statistics. And it's done on a yearly basis.

[00:04:54] Host Amber Smith: How many people were included in the set that you were analyzing?

[00:04:59] Jamie Romeiser, PhD: In the data that we analyzed, there was over 26,000 people. And the nice thing about that survey data is that it's nationally representative, which means that the NCHS goes to these great lengths to ensure that people who are surveyed every year represent the U.S. population as a whole.

[00:05:17] Host Amber Smith: Did it tell you what years you were looking at?

[00:05:21] Jamie Romeiser, PhD: Yeah. So we looked at the most recent data available at the time of our analysis, which was collected throughout 2022.

[00:05:30] Host Amber Smith: Well, I'm curious about the results. And I know that you divided it between recent, non recent and then no cancer. Why was it divided that way?

[00:05:42] Jamie Romeiser, PhD: We wanted to understand potential differences in complementary health approaches at various stages of cancer survivorship, so looking at acute versus longer term survivorship. Those with a more recent diagnosis are in that more acute survivorship stage where there's a focus on fighting the disease, managing side effects and physical and emotional challenges. And those who have been cancer free for a few years might be more focused on maintaining overall health, but there also might be late effects of cancer treatment and remaining physical and emotional needs.

So we looked at the differences in using these complementary health approaches between recent and longer term survivors, and then we also compared that to people who have never been diagnosed with cancer. And we did find a couple important findings when we examined the data this way. So we adjusted for a number of different characteristics like age, sex, education, income. And we did find that longer term survivors were about 20% more likely to use complementary health approaches in the past year compared to those without a history of cancer. And then that relationship was even stronger for recent cancer survivors who were 40% more likely to have used complementary health approaches in the past year, compared to people who were never diagnosed.

So when we also broke that down into larger umbrella categories of manipulative therapies and mind based therapies, this relationship persisted too. We saw the same thing, and it was significant, and of significant magnitude. So recent survivors are more likely to use mind-body and manipulative therapies followed by long-term survivors, followed by people without a history of cancer.

[00:07:30] Kaushal Nanavati, MD: Which kind of makes sense, right? Because when you think about somebody who's been diagnosed recently, there's a lot of potential stress, a lot of emotions that come up. And so mind-body therapies are quite beneficial in this realm.

The fact that in the general population, nearly 40-plus percent of people use some type of complementary approach in their care. To see a 1.2 x and a 1.4 x jump for people who have been diagnosed with cancer tells you nearly 50% or more of patients are seeking something that's complementary to the conventional treatment and care to help support them in their journey.

And I think this is fascinating information. Is it surprising? Not so much surprising as it is valuable in how we create programs that support the community and improve access.

[00:08:24] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Kaushal Nanavati, the director of integrative medicine, and Jamie Romeiser, an assistant professor of public health and preventive medicine at Upstate.

So it seems like certain segments really like having the complementary therapy, whether they're using it for mind-body, or manipulative or complementary approaches of other sorts. But you're not saying that it extends their life -- or are you?

[00:08:58] Jamie Romeiser, PhD: No. Well, so you can use these treatments for certain things, right? So these are not going to cure cancer. That's not something that is the function of these types of complementary health approaches. But they can be incredibly useful for, to enhance your health and wellbeing.

[00:09:17] Kaushal Nanavati, MD: We have this institute at our health system, the Nappi Wellness Institute. And at one point we were talking about having the word, "longevity" and the idea of redefining longevity as the life in your years versus a year in your life. Some of these complementary approaches help to enhance the quality of the living experience, and that actually, I don't know how you would value that in terms of being priceless in the journey of life because frankly, diagnosis or not, none of us are guaranteed tomorrow. That's just a fact.

And if we live by statistics, then we feel that at least this data helps to support the potential for an improved quality of life. Duration is something that has multiple factors, even beyond what was studied here or what's even done with conventional care, because there are socioeconomic factors, other determinants of health that can impact that specific statistic.

[00:10:17] Host Amber Smith: What did the cancer survivors say that they used mind-body approaches for?

[00:10:22] Jamie Romeiser, PhD: So the mind -body approaches were mostly used for overall general health, restorative general health purposes, with some pain management.

[00:10:34] Host Amber Smith: So we're talking about yoga?

[00:10:36] Jamie Romeiser, PhD: Yeah. So we included in the mind-body general category, this is yoga, guided imagery, and meditation.

[00:10:46] Host Amber Smith: And then I know there's manipulative approaches. Is that chiropractic?

[00:10:52] Jamie Romeiser, PhD: Yes. In our data, this included chiropractics, massage therapy, and acupuncture. And these are manipulative therapies, more used for physical pain management, and manipulation of the body.

[00:11:08] Host Amber Smith: And then what other complementary approaches were included?

[00:11:11] Jamie Romeiser, PhD: This was actually exciting for me. This was one of the reasons why I looked into this data in the first place was creative therapies. So the use of music therapy and art therapy. These are therapies that include the arts in a therapeutic way. Unfortunately, use was really low, I guess, in this survey. It might truly reflect the population. But it was actually exciting to see that it was included for the first time with this survey.

[00:11:42] Host Amber Smith: Well, let's talk about the conclusion. What did you find?

[00:11:46] Jamie Romeiser, PhD: The first thing that I guess I'll talk about is, we did find those utilization patterns more in recent, versus non recent, versus no cancer. But one of the things that kept coming up, no matter how we looked at this data, whether it was in the whole sample, whether it was just among all cancer survivors, just amongst recent survivors or longer term, is that you also have these other factors that are predicting use. And these factors are women.

Women are more likely to utilize complementary health approaches, but also people who have higher education, higher income, and people who are younger. So these relationships are really persisting no matter how we look at this data. And unfortunately this has been something that I don't think has changed in the last 20 years that we've, researchers have really been looking at this question. This really indicates a potential sustained socioeconomic barrier and, maybe, an information barrier to using complementary health approaches.

[00:12:51] Kaushal Nanavati, MD: I think one of the other things that's important, well, a couple of other things. You know, one is coverage, right? So with a lot of complementary health approaches, people are paying out of pocket to be able to access them. Health systems, comprehensive cancer centers, are starting to incorporate some more of these. But then there's access to information, and then really getting it out into the community.

And so I can say one of the things that we've done with our survivorship program is really re-engaging the primary care team because patients come from a broad region, and for them to be expected to come to one central hub to only be able to access a lot of this, information and these services isn't practical. So what we've started to do is, get patients once they're done with their active treatment, to get them back into their primary care team with the primary care team being informed of many of these resources that are available both online and in the community as well.

And so we've done programs such as what they call ECHO (Extension for Community Healthcare Outreach) programs, that engage the community providers to help them understand resources that are available. And as we expand the offerings we have, even through web access and linking everything from yoga sessions, to mindfulness sessions on our website, that creates an opportunity for people who are in a broader region to be able to access this.

And I think that's the big thing, is we know that in general, women tend to access the healthcare system more. They tend to be the primary decision makers for health in households up to nearly 70% or more depending on the data you look at. And then the other stuff isn't surprising. Higher education, higher income and younger generations. And those things are fascinating because when we understand people in the context of their circumstance, whether it be generational, socioeconomic, then we get a sense of their motivation, their drivers and their barriers. And I think data like this helps us to bring clarity to that, which then allows us to create systems that can overcome those barriers.

[00:15:08] Host Amber Smith: So you've got to make people aware of these things that are available, and convince them that they might benefit from them. Is that right?

[00:15:17] Kaushal Nanavati, MD: Absolutely. The three words available, affordable, and then affable. And even though they can't see our smiles right now, you know, we're definitely affable. We're trying to be more available. And then affordability is a system-wide issue that everyone is trying to work on making access that much easier for people.

[00:15:37] Host Amber Smith: For someone who maybe is just wrapping up cancer treatment, what would you say to them about what they could expect to get out of a yoga class, or an art therapy session?

[00:15:49] Kaushal Nanavati, MD: I would say -- and then Jamie, you can definitely share some of your thoughts on this as well -- from my perspective, any treatment, if you think about it, what is the goal? What is our purpose? Right? So conventional thinking is the curative thinking, which is curing the cancer.

Integrative thinking is about healing the person, which has to do with helping them to embrace the stage of life, helping them to optimize their presence in their stage of life, and to be able to create joyful moments, to be able to create happiness and to recognize that contentment and peace are dynamic in our life's journey. And so at different stages they mean different things.

A lot of complementary approaches help people to kind of redefine their journey moving forward, and our goal is to help them recognize what contentment and peace might look like in the context of their individual life and their relationships within their community and with their place within the world as a whole.

[00:16:52] Jamie Romeiser, PhD: I think that was really beautifully said. I don't have too much to add to that, but just recognition that there are options for people if they are struggling with different symptoms.

[00:17:03] Host Amber Smith: Well, that's good to know. And it's very good information, and I appreciate both of you making time to tell us about it.

[00:17:09] Jamie Romeiser, PhD: Thank you so much for having us.

[00:17:11] Kaushal Nanavati, MD: Thank you.

[00:17:12] Host Amber Smith: My guests have been Jamie Romeiser, an assistant professor of public health and preventive medicine at Upstate, and Dr. Kaushal Nanavati, the director of integrative medicine at Upstate. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe with sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please tell a friend to listen too. You can rate and review "The Informed Patient" podcast on Spotify, Apple podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.