I was recently interviewed by Stacey Richter for the Relentless Health Value podcast on the topic of integrative oncology in hospital settings.
During our spirited discussion we covered lots of ground, including the growing science supporting integrative oncology and the profound opportunity for hospitals and cancer centers to engage and educate their communities on true cancer prevention focused on smart lifestyle—read: beyond vaccines, colonoscopies, mammograms and early detection.
Relentless Health Value is one of the oldest and largest podcasts dedicated to healthcare industry decision-makers. Its mission is to “help transform health care by fostering collaboration and breaking down silos”. So when asked to participate, I seized the opportunity to reach a wider group of influencers to discuss both the health and economic value of integrative oncology within hospital and health system settings.
I’m excited to share our conversation. You can access the podcast here—or read the entire transcript just below.
Stacey Richter: 00:00
Episode 233, Integrative Oncology Is A Clinically Proven Approach. Here’s to hoping that news gets out to payers and patients.
Stacey Richter: 00:10
Today I speak with Glenn Sabin, an integrative oncology consultant at FON Consulting.
American healthcare entrepreneurs and executives who want to know. Talking. Relentlessly seeking value.
Stacey Richter: 00:32
The Society for Integrative Oncology recently completed a systematic evaluation of peer reviewed randomized clinical trials for patients with breast cancer. The researchers assigned letter grades to therapies based on the strength of the evidence. Meditation got an A. It had the strongest evidence supporting its use. Music therapy, yoga, and massage received a B grade. Hypnosis got a C. By the way, the letter grade varied, depending on the symptoms that were involved. You can go on the website of the society if you want to look up the trial itself.
Stacey Richter: 01:11
Here’s my question. Are insurance carriers paying for music therapy, meditation, and yoga? How about cooking classes? Some are, generally, if it’s part of the services provided by the cancer center. It’s striking, though, that every single insurance carrier will pay for the downstream costs of unfettered anxiety, stress, poor nutrition. You get the idea. Things that an integrative oncology focus would aim to attenuate.
Stacey Richter: 01:42
Do employers know about integrative oncology? I think I’d rather have an employee on a cocktail of music therapy and yoga than a cocktail of pretty much anything else. I’m thinking about this, because if these therapies are not covered benefits, then I’m going to doubt that the middle of the bell curve employees or patients can afford them. Whose going to “splurge” on meditation classes when GoFundMe has a whole section to help people pay for their traditional cancer care?
Stacey Richter: 02:09
Today I speak with Glenn Sabin, an integrative oncology consultant at FON Consulting. Glenn is a nationally recognized thought leader with a reputation for successfully positioning integrative health organizations for sustainable growth. My name is Stacey Richter, and this podcast is sponsored by Aventria Health Group.
Stacey Richter: 02:29
Welcome to Relentless Health Value, Glenn.
Glenn Sabin: 02:33
Good to be with you.
Stacey Richter: 02:33
Just to kick this off and give us all a grounding, what is integrative oncology?
Glenn Sabin: 02:39
The comprehensive definition, which I will read, is, “Integrative oncology is a patient centered, evidence informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.”
Stacey Richter: 03:14
If I’m going to distill that down, what I’m hearing you say is that cancer care is more than just treating the disease.
Glenn Sabin: 03:21
If not enough attention is given to the host, the person who’s hosting the disease, then it really makes it difficult for many folks to have the same quality outcomes or the same potential positive outcomes. By focusing on the core tenets of lifestyle medicine, for instance, movement, stress reduction, quality diet, and other aspects, it really helps position the patient for success and helps ensure good quality of life during treatment and post-treatment as a survivor. There shouldn’t be any disconnection. They should be one and the same. Just as much focus should be on the host, how they’re feeling emotionally, physically, psychologically, while undergoing a treatment schema for the disease itself.
Stacey Richter: 04:16
I could see how this is starting to gain some traction in that collecting patient reported outcomes will only become more prevalent. The FDA just included patient reported outcomes in their evaluation of new drugs, for example. Maybe the reason for that is because especially with oncology … I can think of a bunch of reasons, but one of them is especially in oncology, it’s like what’s the quality of life that is being led here? Is that an avenue that you’ve been thinking about?
Glenn Sabin: 04:51
When you can help ensure the highest level of quality of life from the point of diagnoses through long-term hopefully survivorship, it helps create value.
Stacey Richter: 05:01
I find it interesting that you called the patient the host, which just seems terribly evocative of things from the disease’s standpoint almost. You know what I mean?
Glenn Sabin: 05:13
Sure. The patient, in theory, doesn’t have a disease. The patient is hosting the disease. So the concept around integrative oncology is how to become an inhospitable host to the disease to create an environment where it’s harder for the disease to manifest.
Stacey Richter: 05:31
It sounds like what you’re saying is that actually by I was going to say integrating integrative oncology … Say that three times fast … there is the potential to actually produce better survivorship, like better quantitative outcomes.
Glenn Sabin: 05:47
Not always, but often it is lifestyle choices that contributes heavily to various types of malignancies, the more lifestyle driven malignancies, such as breast, colon, prostate. So if folks after diagnoses, after they’re diagnosed, if they make certain changes in their lifestyle and continue with these better lifestyle choices through a treatment and into long-term survival, this can help ensure a deeper and more durable remission as opposed to those that don’t make any changes during treatment or post-treatment. That’s a critical really profound opportunity for those that are diagnosed sometimes with life-limiting challenges to be able to impact at some level both their quality of life and potentially their survival long-term.
Stacey Richter: 06:39
Is there evidence to suggest that this is true?
Glenn Sabin: 06:41
There’s certainly a growing body of irrefutable evidence around the core tenets of lifestyle medicine. Stress reduction, physical activity, and nutrition in terms of other areas of integrative oncology, in terms of the guidelines that have been developed for breast cancer treatment, specifically the highest levels of evidence supports meditation, relaxation, yoga, massage, and music therapy. There’s a growing body of evidence, many of which are included in a growing group of clinical guidelines. So it’s really heartening to see this.
Stacey Richter: 07:19
The Society for Integrative Oncology has created guidelines which are to be incorporated in let’s just say the more traditional ASCO pathways. What does this look like?
Glenn Sabin: 07:32
ASCO has supported these guidelines by communicating to their large community about this paper, about these guidelines with the hope, of course, that they will be included and considered for the management of cancer patients.
Stacey Richter: 07:49
Do you feel like at this juncture this is mainstream what we’re talking about here?
Glenn Sabin: 07:52
We’re absolutely getting close to a tipping point, especially when you have the majority of the NCI designated cancer centers and then that subset within that 69 or 70 centers being NCI designated comprehensive cancer centers. The major academic centers—Sloan Kettering, MD Anderson, Dana-Farber, Fred Hutch. All these centers of note, these major institutions have had an integrative oncology program, some going back to the early 2000s.
Stacey Richter: 08:26
Who comprises the Society for Integrative Oncology? Who is that?
Glenn Sabin: 08:31
The Society for Integrative Oncology was founded in 2003 by the leading integrative oncology leaders from Sloan Kettering, Dana Farber, and MD Anderson. So they’re into their 16th year, and this was originally created as a forum for investigators doing research around these different modalities and natural products as a forum to discuss the literature. Over time, it grew and the amount of abstracts and research that is being considered, reviewed, discussed has really grown.
Stacey Richter: 09:06
This society, in other words, is not some industry sponsored coalition led by the vitamin industry. This is a peer…
Glenn Sabin: 09:14
Stacey Richter: 09:14
This is an organization led by NCI designated cancer center researchers who are doing peer review types of studies.
Glenn Sabin: 09:22
Absolutely. Originally, this was formed also because there’s so much confusion. There’s confusion—a lot that remains out there, of course—but this was specifically to help delineate between alternative cancer cure or management claims versus evidence based or minimally evidence informed approaches. It was to really shed light on what this is and how these terms should be differentiated.
Stacey Richter: 09:51
When you say these terms should be differentiated, I’m assuming that what was happening, and maybe this was part of the impetus for beginning this society, is that obviously if I’m anybody but a regulated industry, I can say whatever I want. So people were potentially running around making what could be construed as let’s just say not super well-substantiated claims. Then it becomes really incumbent upon if you’re an NCI designated cancer center dedicated to improving cancer outcomes to be able to separate the modalities that don’t work so well from the ones that might?
Glenn Sabin: 10:28
It’s important for all oncologists, including the academic clinical investigators, to be able to communicate to their patients about what integrative oncology is versus alternative cancer care treatments or products that are some folks will use in lieu of proven conventional therapies that are provided or recommended with curative intent. There still remains a problem communicating what this is. So it’s important for the information to get out there in a meaningful way for consumers to have better access and to understand what these profound differences are as well as oncologists.
Glenn Sabin: 11:09
A lot of oncologists do not take the time to communicate about even the core tenets of the lifestyle approaches. So that remains a problem, even though this is evidence based, even though this is what should be done, because at the end of the day, the health of your patient and to help them create just underlying a healthy body and making them stronger emotionally is going to help them get through active treatment and it’s going to help them in terms of long-term survival.
Stacey Richter: 11:42
You said that around the country there are a subset of the NCI designated cancer centers which consider themselves integrative medicine enabled or maybe they’re integrative medicine centers. What’s the correct term?
Glenn Sabin: 11:55
Most of these major academic centers and even at this point many major health systems and even small just hospitals that even aren’t part of systems, they have either integrative medicine program, an integrative medicine center, an integrative oncology center. These are pretty well established at this point.
Stacey Richter: 12:16
Are they credentialed in any way?
Glenn Sabin: 12:17
The Society for Integrative Oncology, SIO, is not a credentialing body. However, a large portion … I’m not going to say all, but by and large, those that are in leadership positions within an integrative medicine or integrative oncology center or program have gone through either a bona fide fellowship or have otherwise been credentialed for the work that they’re doing.
Stacey Richter: 12:43
Let’s walk through a patient experience. What does it essentially look like? Say that a patient walks in the door of an institution which embraces integrative oncology. When does this kick in? Is it prior to diagnosis when someone is completely stressed out waiting for their biopsy results? Does it come in at a survivorship level? When does this start and what does it look like?
Glenn Sabin: 13:08
That’s a great question. Ideally it would be at the very beginning while a patient perhaps is waiting to get results back and a clear diagnoses is being formed waiting for pathology, etc. But more realistically, it happens at the point of diagnosis. If there is an integrative medicine program within the institution or hospital setting, that’s when at the time of diagnosis that the treating or managing oncologist would communicate. “Hey, by the way, we have an integrative medicine program. This is where you can get one-on-one guidance in terms of different core components of lifestyle.” So it should be as a clinician recognizes, perhaps, the need for psychological support, emotional support.
Stacey Richter: 14:01
So it’s not necessarily something that’s integrated into what I’m going to call the traditional patient journey per se. In other words, the oncologist who tends to be talking to the patient might not necessarily do anything differently. It’s that there’s this affiliated office, maybe, that takes care of the integrative aspects of the patient journey. Maybe they’re working side by side, but it’s kind of like a separate group.
Glenn Sabin: 14:29
There are a lot of silos still, and each system or each institution handles it a bit differently. There’s no bona fide best practices, if you will. Cancer Treatment Centers of America, they pride themselves on an integrative approach that everyone is on board for at the very beginning. Some of these silos are starting to fall downward.
Glenn Sabin: 14:52
For instance, at the Dana Farber Cancer Institute, there is the Zakim Center for Integrative Therapies, which David Rosenthal, past president of American Cancer Society, launched in early 2000s. It was a separate facility, and you had to get a referral from an oncologist. Some referred and some didn’t, so a lot of this has evolved.
Stacey Richter: 15:13
What happens when the patient walks in the door of that department—is it another physician that greets them? Is it a coordinated care group of nurses and coaches? Who’s in there?
Glenn Sabin: 15:24
It depends if it’s an inpatient or outpatient program. If it’s a traditional outpatient program, typically it would be an MD. Often it can be an oncologist within an academic setting, but not necessarily. So they would take lead, and they would then refer further internally for various services, depending on what their challenge may be related to active treatment. If they’re dealing with a lot of anxiety or pain of different types, then they’re making recommendations for massage or acupuncture. Or in some cases, some well-placed dietary supplements or movement. Whatever it may be that can help support the patient in an evidence informed or evidence based way.
Stacey Richter: 16:09
Okay. This probably is a good time to pivot this conversation a little bit into value based care … obviously we’ve got the new oncology medical home model. There’s a lot of stuff that’s happening right now relative to value based care, even in oncology. In more traditional, and I’m going to say not oncology settings, it’s obviously becoming … Social determinants of health, for example, are becoming a very well proven, if you will, factors that drives outcomes just as much as or maybe even more so than what diabetes medicine got prescribed. So it sounds like it’s the same type of general idea that’s happening in oncology, but given how other parts of institutions are pouncing on social determinants of health in order to meet value based care and population health management goals, I would assume that this is a similar paradigm.
Glenn Sabin: 17:08
Integrative oncology approaches tend to be low tech, high touch, and low margin, and heavy on education and engagement as compared to where margins still exist in radiation oncology, systemic care and surgery. So there’s an opportunity to engage patients in this area of integrative oncology, especially around preventing disease, preventing malignancy, and by doing so and engaging in a meaningful way, to create more brand loyalty to the institution, because there’s certainly downstream revenue opportunities for where high margins still exist.
Stacey Richter: 17:56
Obviously there’s different implications of this, but if we’re talking about the guideline driven integrative oncology, is this something where the hospital is basically hosting yoga classes and anybody can go, but someone could be referred there from integrative oncology practice?
Glenn Sabin: 18:13
It kind of slices both ways, but when you mention yoga or yoga therapy within the physical setting, absolutely. There is a number of institutions and programs where it’s heavy on experiential, where they have a kitchen in-house, and they’re showing people how to read labels and purchase foods, healthy food and with cooking demonstrations.
Glenn Sabin: 18:35
There’s certainly therapeutic yoga classes and other discussions and lectures. This is a way to bring community together. Not just for the patient, but the family, caregivers, and even going deeper into the community for those that are looking for prevention opportunities to have influence, the prevention of disease, the prevention of cancer. This goes beyond mammograms and colonoscopies and vaccines and what’s typically attached to the term prevention. This is prevention largely via lifestyle choices.
Glenn Sabin: 19:10
Folks are hungry for this, and so it’s taking an institution that again focuses mostly on acute and emergency care and does that very well and pivoting to engaging around information that will be more attractive to millennials and the younger boomers and the coming generation of folks that are going to be more putting themselves at the center of their own care and looking for more than just a plain clinical setting just to be used for emergency care.
Stacey Richter: 19:42
What I’m understanding here is that there are additional benefits beyond improving patient outcomes of patients that already have cancer. It also follows the consumerism trend and enables the cancer center to put a toe in that water as well.
Glenn Sabin: 19:57
It could be an economic driver, yes.
Stacey Richter: 20:00
It’s an economic driver in the sense that if I’m on a risk based pay for outcomes kind of deal, then I could improve outcomes, which technically if the system is functioning properly, would also increase revenue. But then also because the oncology center is part of the community, it might enable less network leakage maybe or more patients who choose that center for their care?
Glenn Sabin: 20:28
Yes. It supports value based care. It also supports, if it’s done right, downstream revenue for fee-for-service. So as things evolve in how care is delivered and how it’s incentivized, it’s right there. It’s helpful as these models evolve and as these incentives evolve.
Stacey Richter: 20:48
We’ve got obviously these economic incentives. I’m also considering here the recently released Edleman Trust Barometer, which showed that trust in hospitals has nosedived seven points this year. So I would assume that anything like this also probably is a positive in that equation.
Stacey Richter: 21:06
Let me ask you this, Glenn. You mentioned yoga. You mentioned cooking demonstrations. There’s also crystal therapy. You start getting into complementary medicine, if you will, or these alternative therapies. There’s a lot of them. If I am a data driven oncologist and I am looking for ways I want to measurable improve my patient outcomes, if I do a search on the internet for …
Glenn Sabin: 21:34
Stacey Richter: 21:35
… things that improve and fill in the blank, how do I know what works better than others? Is there guidelines for that?
Glenn Sabin: 21:43
Well, you stick with the literature. If you look at the guidelines that have been created for during and after breast cancer treatment, you focus on nutrition, stress reduction, which may include mindfulness-based stress reduction. You stick with these core areas. In yoga, the evidence for yoga for reducing anxiety and stress reduction, therapeutic yoga with certified instructors that specialize in this area, this is quite important. Even around body movement, whether it’s tai chi or qi gong or weight training or cardiovascular exercise. These are all important areas. The evidence is there to support these sensible recommendations.
Stacey Richter: 22:27
I actually did take a look at the guidelines that the Society for Integrative Oncology had put out relative to breast cancer. There’s a list of potential integrative therapies, and they all have grades. Yoga gets an A, and then there’s other things on the list that might not fare so well, because there actually were, I’m assuming, some sort of trial that was done that compared outcomes of patients that receive X integrative therapy versus some other ones. I found it fascinating.
Glenn Sabin: 22:56
Even the use of acupuncture, acupressure and acupuncture for reducing chemo induced nausea and vomiting. This is very useful, and I hope that oncologists really read it and incorporate it where they can and share it with patients who are coming in with all kinds of questions about what else they might do to support the conventional treatment. Unfortunately, a lot of patients don’t even communicate with their oncologist about what they’re doing. So that’s an issue as well. The communication is really key.
Stacey Richter: 23:29
Yeah. Considering that side effects management, if a patient is experiencing extensive nausea, that’s a reason why patients fall off or “non-adherence” to their therapy.
Glenn Sabin: 23:42
That’s an important point.
Stacey Richter: 23:43
I can definitely see how by enabling patients to be adherent to the best practice oncology care and drugs and therapies would certainly improve outcomes, because there’s plenty of research that shows that non-adherence significantly reduces outcomes.
Glenn Sabin: 24:01
Stacey Richter: 24:02
Is there anything else that you want to mention relative to this, Glenn? Anything I forgot to ask you that you think is an important point?
Glenn Sabin: 24:09
I think that administrators and leadership, hospital and health system leadership that currently don’t have an integrative health program or an integrative oncology program attached to their cancer service line really should take a look at integrative oncology and in general integrative health and how this is an opportunity to engage the population on relentless health creation.
Stacey Richter: 24:34
Glenn Sabin from FON Consulting. That’s F-O-N Consulting. Thank you so much for being on Relentless Health Value today.
Glenn Sabin: 24:41
Thank you. It’s been a pleasure.
Stacey Richter: 24:43
Links to everything discussed on the program today can be found at RelentlessHealthValue.com, where you will also find a complete listing of all of the shows that we have published thus far with leading entrepreneurs and executives in the healthcare space today. Another cool feature is you can subscribe to the show so that every week the episode is automatically sent to you so you don’t have to remember to go to the website to download it.
Stacey Richter: 25:19
Thanks so much for listening.
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