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Impact of a combined integrative oncology and palliative care program on quality of life of patients with advanced cancer

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Abstract

Many oncology centers provide integrative oncology (IO) care, many within palliative care settings. The primary study objective was to examine the impact of IO-palliative patient-tailored program on quality of life (QoL) among patients with advanced cancer. In this pragmatic prospective controlled study, patients with advanced cancer undergoing chemotherapy/palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation and weekly IO treatments. Patients with high adherence to integrative care (AIC; ≥ 4 IO sessions/6 weeks) were compared with moderate (2–3 sessions) or low AIC patients (regarded as control group). Outcomes were assessed at 6- and 12-week follow-up with Edmonton Symptom Assessment Scale (ESAS) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Change in QoL scores (ESAS fatigue in particular) was considered a primary study outcome. Of 225 eligible patients, 153 underwent baseline and 6-week optimal assessment (high AIC, 100; moderate AIC, 22; low AIC, 31). High AIC patients reported greater improvement on ESAS scores for fatigue (vs. low–moderate AIC, P < 0.001), depression (vs. moderate AIC, P = 0.01) at 6 weeks, and sleep (P = 0.007) at 12 weeks. High AIC patients had significantly improved EORTC global health status/QoL at 6 weeks (vs. moderate–low AIC, P = 0.01), cognitive functioning (vs. moderate AIC, P = 0.043), and social functioning (vs. moderate AIC, P = 0.032). High AIC patients had lower rates of hospitalizations at 12 weeks (19% vs. 35% in low AIC, P = 0.02; 44% in moderate AIC, P = 0.003), hospitalization days (vs. low AIC, P = 0.003), and opioid use (vs. low AIC, P < 0.001). High adherence to integrative care was associated with a significant effect on fatigue, depression, global QoL at 6 weeks, and need for hospitalizations at 12 weeks.

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Acknowledgements

We would like to thank Mr. Yossi Heymann and the Eshel Joint Israel and the Division of Geriatrics, Israeli Ministry of Health, for their financial support through a research grant for the research project “Improving palliative care by a cross-cultural integrative medicine approach tailored to Arab- and Russian-speaking patients’ preferences on the continuum from the oncology ward to home hospice.” We would also like to thank Dr. Irit Laxer and the National Project for Palliative Care and End of Life Situations, Israel Ministry of Health.

Funding

National Project for Palliative Care and End of Life Situations, Israel Ministry of Health (Grant No. 00-3-2018).

Author information

Author notes

  1. Eran Ben-Arye and Yonatan Yakubov should be considered as co-first authors, based on their equal and significant contribution to this study.

Authors and Affiliations

  1. Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, 35 Rothschild St., Haifa, Israel

    Eran Ben-Arye, Orit Gressel & Jamal Dagash

  2. Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Eran Ben-Arye, Yonatan Yakubov, Orit Gressel, Elad Schiff & Walid Saliba

  3. Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel

    Noah Samuels

  4. Palliative Care Service, Carmel Medical Center, Haifa, Israel

    Alexander Yosipovich & Mattan Ophir

  5. Department of Internal Medicine & Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel

    Elad Schiff

  6. Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel

    Walid Saliba

  7. Palliative Care – Home Care Hospice, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel

    Jamal Dagash

Authors
  1. Eran Ben-Arye
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  2. Yonatan Yakubov
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  3. Noah Samuels
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  4. Orit Gressel
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  5. Alexander Yosipovich
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  6. Elad Schiff
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  7. Mattan Ophir
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  8. Walid Saliba
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  9. Jamal Dagash
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Contributions

EB-A: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, drafting the article and revising it critically for important content, and final approval of the version to be submitted. YY: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, drafting the article and revising it critically for important content, and final approval of the version to be submitted. NS: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, drafting the article and revising it critically for important content, and final approval of the version to be submitted. OG: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, revising the article critically for important content, and final approval of the version to be submitted. AY: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, revising the article critically for important content, and final approval of the version to be submitted. ES: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, revising the article critically for important content, and final approval of the version to be submitted. MO: Conception and design of the study, drafting the article and revising it critically for important content, and final approval of the version to be submitted. WS: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, revising the article critically for important content, and final approval of the version to be submitted. JD: Conception and design of the study, acquisition of the data, analysis and interpretation of the data, revising the article critically for important content, and final approval of the version to be submitted.

Corresponding author

Correspondence to Eran Ben-Arye.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Ben-Arye, E., Yakubov, Y., Samuels, N. et al. Impact of a combined integrative oncology and palliative care program on quality of life of patients with advanced cancer. Med Oncol 38, 93 (2021). https://doi.org/10.1007/s12032-021-01544-4

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  • DOI: https://doi.org/10.1007/s12032-021-01544-4

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