Integrative Modalities Are ‘Extremely Safe’ in Kidney Cancer Care

Santosh Rao, MD

University Hospitals Connor Whole Health and Society for Integrative Oncology

The use of integrative treatments, including acupuncture and music therapy, to manage pain may reduce the possibility of adverse effects among patients with kidney cancer compared with other pain management strategies, like opioids, according to Santosh Rao, MD.

In tandem with Kidney Cancer Awareness Month, recognized in March, Rao spoke with CancerNetwork^® about broad developments in integrative and palliative care for kidney cancer, including research shared at the Annual Society for Integrative Oncology (SIO) International Conference as well as collaborative guidelines with the American Society for Clinical Oncology (ASCO) informing the use of non-clinical tools including acupuncture, reflexology, massages, and acupressure.

“If you can potentially reduce opioid use with all their [adverse] effects, even if it’s just limiting the amount of opioid use, then that’s a win,” Rao said. “You’re not going to get [adverse] effects from music therapy or massage, for example.”

Rao, medical director of integrative oncology for University Hospitals Connor Whole Health and president-elect for the SIO, also described the pain management guidelines that the National Comprehensive Cancer Network (NCCN) established for integrative modalities in kidney cancer.

CancerNetwork^®: Can you give an overview of what integrative oncology and palliative care look like at University Hospitals Connor Whole Health?

Rao: We’re building our integrative oncology program. … We work very closely with supportive oncology and palliative care, and we have a lot of strategies on how we can work together both on the inpatient and outpatient side.

A lot of these things are plans at this point. As of now, a lot of it is just collaboration between the different programs. But there’s a lot of synergy in many places around the world with palliative care, integrative medicine, and integrative oncology. We plan to pattern ourselves after that, some of which will happen in the hospital, where we really plan to offer complementary therapies alongside supportive oncology to help our patients with pain and other symptoms. And then we’ll try to do some of that on the outpatient side, as well, and to have referrals that make sense for some of the patients who have symptoms.

What kind of integrative oncology strategies have you found to be most effective in alleviating conditions for these patients?

When I think of integrative oncology, I think of a couple of different things. For people where we’re trying to reduce chances of recurrences—that often [involves] lifestyle strategies—that can be important when somebody has been diagnosed and is going through treatment, although it’s often very important afterwards, as well. And that [involves] diet, exercise, and stress management, primarily.

The other side of it is how can we alleviate symptoms and reduce toxicity from treatments? And that’s where things like acupuncture really come into play [along with] massage and stress management. We know all of these techniques help with a variety of symptoms, including pain and anxiety. There’s different evidence for each one. Neuropathy is something that we see a lot with chemotherapy, for example. How can we reduce some of those symptoms?

I found acupuncture is high on the list when it comes to pain, neuropathy, hot flashes, and joint aches. Massage can be very helpful as well for stress management; we’ve seen in some studies [that it] improves pain and anxiety. And then you want to personalize these approaches to what the patient would benefit from the most and maybe what their interests are, which is partly based on cultural aspects and past experiences. You have to tailor the approach based on what we have available, and what you think will help for those specific symptoms.

What kind of initiatives has SIO led to improve kidney cancer care?

The SIO is a really broad group that includes medical oncologists, radiation oncologists, surgeons, [and more]. We have a large group of yoga therapists, acupuncturists, nurses, [and more]. We also have a lot of patient advocates. It’s a broad group where we have voices from different perspectives.

Some of the more useful things we’ve done [include] an annual conference that helps inform our members on the different things that we offer. We have also created guidelines that have been really impactful. There are a variety of guidelines, and one of the more recent ones is around pain management. This was a guideline that was collaborative between the [SIO] and [ASCO].

It was very impactful and really outlined where we are in terms of evidence right now with different modalities in managing pain. We have a new guideline that’s coming out soon [that focuses on] anxiety and depression. Like a lot of other types of patients with cancer, those with kidney cancer often have anxiety, depression, and pain.

Other guidelines that are informative and that we take a lot of pride in is the National Comprehensive Cancer Network [NCCN] guidelines. If you look at the NCCN guidelines, whether it’s for survivorship; pain, and different symptoms like cognitive dysfunction, anxiety, depression, and fatigue there are integrative modalities that are represented there and are now really considered standard of care. That impacts our patients [with kidney cancer], as well.

The SIO is an international society, so engaging with things that are done in other countries and strategies when it comes to complementary therapies and lifestyles have been informative, as well. We also do a lot of communication, and we have a podcast.

What are some of the more important suggestions outlined in these guidelines?

I’ll go over the pain guidelines; it was pretty conservative. Although we may expand these guidelines in the future or the evidence might be more robust, it was really a statement of where we’re at right now. For general cancer pain, there was moderate evidence for the use of acupuncture, reflexology, or acupressure and massage. There was weak evidence for things like yoga and guided imagery.

For neuropathy, there was weak evidence for acupuncture, reflexology, or acupressure. For procedural pain, hypnosis had moderate evidence. For pain during palliative care, massage had moderate evidence. For surgical pain, acupuncture and music therapy had weak evidence.

You contrast the guidelines with the fact that these therapies are extremely safe. My interest in this kind of approach is that the contrast to using these modalities is to usually use opioids, which have lots of potential [adverse] effects. … And we have guidelines around that. It’s important for people to be educated on the safety guidelines when we use these things. That has been really useful.

Reference

Mao JJ, Ismaila N, Bao T, et al. Integrative medicine for pain management in oncology: Society for Integrative Oncology-ASCO guideline. J Clin Oncol. 2022;40(34):3998-4024. doi:10.1200/JCO.22.01357