Integrative Oncology Gains Ground in Radiation and Supportive Care

Integrative oncology is moving from reactive symptom management toward proactive, coordinated care in radiation oncology, according to an editorial introducing a special issue of Seminars in Radiation Oncology, but a global survey shows that knowledge gaps, cost, and missing referral pathways still limit clinician recommendations.^1,2

Kavita K. Mishra, MD, MPH, professor of radiation oncology at the University of California, San Francisco (UCSF) and Osher Foundation Endowed Chair in Clinical Programs in Integrative Health, coauthored the editorial with Jun Mao of Memorial Sloan Kettering Cancer Center. In an interview with Oncology Nursing News, Mishra described proactive care as offering “the right intervention for the right patient at the right time.”

What does the evidence show?

Exercise carries the clearest signal, Mishra said. The editorial highlights the phase 3 CHALLENGE trial, in which 889 patients with resected stage II or III colon cancer were randomly assigned after adjuvant chemotherapy to 3 years of structured exercise or health education. Five-year disease-free survival was 80.3% with exercise vs 73.9% with health education (HR, 0.72; 95% CI, 0.55-0.94; P = .02).^1,3

“If this was a medicine or a drug, we would be giving every patient the exercise pill,” Mishra said.

The editorial also cites acupuncture for xerostomia, fatigue, pain, nausea, and oral mucositis, and mind-body interventions for anxiety, depression, fatigue, and sleep disturbance. A review in the issue identified more than 90 integrative trials in radiation oncology, though many are early phase.¹

What keeps clinicians from recommending integrative care?

In a joint survey of 282 members of the Multinational Association of Supportive Care in Cancer (MASCC) and the Society for Integrative Oncology (SIO), more than 80% cited clinicians’ lack of knowledge and lack of insurance coverage or out-of-pocket costs as barriers, and about 80% cited a lack of referral pathways.² Integrative oncology professionals were more likely than general physicians to cite concern that integrative care would delay conventional treatment (OR, 3.62; P = .0003).²

“It all comes down to communication,” said corresponding author Alexandre Chan, PharmD, PhD, MPH, professor of clinical pharmacy and founding chair of the Department of Clinical Pharmacy Practice at the University of California, Irvine, and president of MASCC, who has previously discussed the survey with Oncology Nursing News.⁴ “If patients are not being referred to these modalities that have shown to be helpful…that’s not going to impact patient care.”

Cost also affects adherence. With acupuncture, “you need at least six sessions in order to start seeing some improvement,” Chan said, yet many patients pay out of pocket per session.

How can nurses bring integrative care into practice?

Mishra recommended that nurses first learn which services their system offers, then consider “adding one question either to an intake form or when you do your assessment,” such as how much a patient is moving. Patient-reported outcome screening can trigger automatic referrals, and nurses and advanced practice providers often introduce these options at the bedside.⁵

Chan advised watching for cues, such as hot flashes, neuropathy, or aromatase inhibitor–related arthralgia in patients who prefer to avoid more drug therapy. A well-timed conversation is “a lot more successful than giving a leaflet to a patient,” he said.

What are the key takeaways for oncology nurses?

• Ask one targeted question about activity, nutrition, or mind-body interest at intake.
• Know the institution’s integrative services and referral pathways.
• Frame integrative modalities as complements to, not replacements for, conventional treatment.
• Use patient-reported outcomes and patient cues to time referrals.

References

1. Mishra KK, Mao J. Integrative oncology and radiation therapy: an essential evolution. Semin Radiat Oncol. 2026;38:151028. doi:10.1016/j.semradonc.2026.151028

2. Chan A, Kagramanov D, Nasr R, et al. Barriers to recommendation of integrative oncology modalities in supportive care: a MASCC/SIO survey. Support Care Cancer. 2026;34(8):791. doi:10.1007/s00520-026-11020-2

3. Courneya KS, Vardy JL, O’Callaghan CJ, et al. Structured exercise after adjuvant chemotherapy for colon cancer. N Engl J Med. 2025;393(1):13-25. doi:10.1056/NEJMoa2502760

4. Chan A. Bridging the integrative oncology knowledge gap in cancer care. Oncology Nursing News. August 7, 2026. Accessed October 29, 2026. https://www.oncnursingnews.com/view/bridging-the-integrative-oncology-knowledge-gap-in-cancer-care

5. The role of integrative medicine in oncology: expert perspectives on nutrition, exercise, and symptom management. Oncology Nursing News. March 25, 2026. Accessed October 29, 2026. https://www.oncnursingnews.com/view/the-role-of-integrative-medicine-in-oncology-expert-perspectives-on-nutrition-exercise-and-symptom-management