Principles to guide integrative oncology and the development of an evidence base.

BACKGROUND: Integrative oncology uses both conventional and complementary medicine to meet the needs of individual patients and to focus on the whole person. The core principles of integrative oncology include individualization, holism, dynamism, synergism, and collaboration, but the nature of the evidence to guide the development of integrative oncology has been given little attention. OBJECTIVES: To discuss the need for evidence to support the integration of complementary therapies for integrative oncology care. To emphasize that the evidence base must be valid and respect the underlying principles of individual complementary therapies and integrative oncology practice. To suggest ways to begin developing the evidence base. REVIEW AND DISCUSSION: Although the evidence for safety and efficacy seems paramount for supporting the integration of an individual complementary therapy into mainstream cancer care, the need for evidence to support the overall practice of integrative oncology has to be considered as well. We argue that developing an evidence base for integrative oncology requires a contextual and comprehensive research approach that assesses a range of outcomes over a suitable period of time that the patient and the patient's family, in addition to the health care providers, deem important. CONCLUSION: A whole-systems framework to the development of the evidence base for integrative oncology can guide the development of evidence that respects the complex nature of many complementary and integrative practices and their underlying principles of care delivery.

Family health and the palliative care trajectory: a cancer research agenda.

This article reviews the published literature related to families of palliative care patients with cancer within the context of the Cancer Control Framework of the National Cancer Institute of Canada. Three themes emerged: 1) the impact of terminal cancer on the family; 2) family functioning--responses to terminal cancer; and 3) quality of palliative care from the family perspective. The most substantial body of research describes family needs, family caregiving burdens, caregiving costs and the impact of the patient's terminal cancer on the health of family members. Small samples, high nonresponse rates, selection biases and a lack of standardized outcome measures have impeded the advancement of knowledge. Method development studies are warranted, including the development of instruments to measure family care constructs. Longitudinal studies to examine the long-term impact of the patient's functional status, mood, symptom distress and quality of life on family members are needed. Research should also explore the effects of family composition, socioeconomic factors, culture and spirituality on families' experiences with terminal illness. Identification of families at risk as well as development and rigorous testing of appropriate interventions should become priorities.

Critique of the National Cancer Institute of Canada's framework for cancer control.

This paper offers a critique of the National Cancer Institute of Canada's (NCIC) framework for cancer control. The critique has been prepared by researchers who used the framework to review the literature in 5 substantive areas. These reviews, published in the current and previous issues of CPC, were designed to begin to outline a research agenda for the Sociobehavioural Cancer Research Network. In this paper, the authors reflect on the strengths and limitations of the framework. Perceived strengths are that the framework (a) facilitates systematic thinking about research options and priorities, (b) helps foster clear communication, (c) links science and practice, (d) may assist grant review panels to place proposed studies in context and (e) emphasizes important values. Perceived concerns include the following: (a) potential users are not familiar with the framework, (b) lack of clarity of definitions and classification criteria, (c) the utility of the framework is not immediately self-evident to potential users, (d) the framework lacks emphasis on environmental and policy interventions and (e) it is not clear how the values espoused are to be integrated with other dimensions of the framework. The concerns were seen as remediable. In short, the framework was seen to be valuable in its current form; refinement may enhance its value.