Practical Tactics and Patient Trust With an Integrative Oncology PA

Onc Nurse On Call is the new podcast by Oncology Nursing News, hosted by editors-in-chief Patricia Jakel, MN, RN, AOCN, and Stephanie Desrosiers (formerly Jackson), DNP, MSN, RN, AOCNS, BMTCN, delivering maximum impact in minimum time.

This week, our hosts sat down with Lillian Rodich, PA-C, MPH, an integrative oncology specialist at Memorial Sloan Kettering Cancer Center Bendheim Integrative Medicine Center in New York, New York, which was among early and more robust integrative cancer centers.

Rodich explained that her clinic offers a multitude of services and programs for patients, from physical interventions like acupuncture, to psychological interventions like music therapy, to accessible options like virtual sessions. She shared that the price of virtual sessions has remained the same over the years, ensuring that it remains a more cost-effective service for patients who may not have access to more involved integrative strategies.

Building Trust With Patients

She also touched on how to talk to patients about outside herbs and other supplements, emphasizing that being open to discussing these with patients—and finding out for patients whether there may be interactions between the herb and the patient’s treatment instead of rejecting the topic—can build trust with patients and make them feel more comfortable being transparent with providers.

Particularly, Memorial Sloan Kettering’s integrative services have a website and mobile application called “About Herbs,” which serves as a database for identifying whether an herb or supplement will have interactions with a patient’s medications.

“Now the patient and you have this really great level of trust, and now they’re more likely to also discuss with you other things they’re taking, other ideas they have, vs if … the provider goes, ‘No, don’t take that. That kind of stuff doesn’t work. Forget it,’” said Rodich. “How much more likely are they to then take things that we don’t even know about?”

Practical Advice for Treating Patients on Active Treatment

In terms of priorities for patients on active treatment, Rodich said that checking whether patients are taking their antiemetics is a tactic that is often overlooked. For those receiving treatments that cause nausea, this can be another opportunity for building trust and understanding a patient’s motives and concerns.

After establishing a baseline with factors like antiemetics and other prescribed supportive care, providers can then investigate further integrative options such as acupuncture, herbs, teas, and diet changes.

Rodich advised being practical about nutrition advice: patients’ taste buds may change during treatment, so capitalizing on what they do still enjoy can be key to delivering nutrition. Further, she highlighted that patients benefit from specific ideas for how to maintain nutrition while on treatment, rather than general advice.

“Patients need really specific ideas. Just telling someone to eat more or eat small meals many times throughout the day is not specific enough,” said Rodich. “Give them little tidbits, little ideas, of how to sneak different things in to optimize calorie intake so it all adds up at the end of the day.”

Counteracting Fatigue From Cancer Treatment

Rodich stressed that patients experiencing fatigue because of their disease or its treatment should not just rest, but maintain a healthy level of physical activity. Desrosiers and Rodich, who share a background in bone marrow transplantation, agreed that it is in the best interest of patients experiencing such fatigue to challenge themselves to stay active.

Lower-impact exercise regimens like walks, tai-chi, qigong, or yoga can be used to incorporate physical activity into a patient’s routine.

“It doesn’t have to be an all-or-nothing approach,” said Rodich. “That sentence [is one] I find myself saying almost every single visit.”

Making Treatment Accessible

While some insurance companies cover some aspects of integrative care like acupuncture, it is still not a guarantee that a patient’s care will be covered: not every plan covers acupuncture, and many other aspects of integrative care are still not covered.

Rodich explained that there are ways to make integrative medicine more accessible to patients, regardless of what their insurance they have or what their financial situation is.

“Integrative medicine shouldn’t be for the privileged few,” said Rodich. “It should be standard-of-care practice for all patients, no matter where they’re receiving care.”

Specifically, Rodich mentioned that Medicare now covers up to 12 acupuncture treatments within 90 days for chronic low back pain, which can make integrative treatment more affordable for those who rely on Medicare, since low back pain is not an uncommon symptom in oncology.

She emphasized that even if the clinic’s lower cost options like virtual sessions are a financial burden, they encourage patients to use free resources like YouTube videos on physical activity.

Further, for patients who are already financially burdened, Rodich explained that integrative care can prioritize connecting patients with services that provide free or low-cost food and planning nutrition around those resources.

Becoming an Integrative Oncology Specialist

Rodich explained that for advanced practice providers (APPs) who want to become involved with integrative oncology, there is no formalized path as of yet; instead, APPs should seek out training, conferences, and organizations that allow providers to enrich their knowledge of integrative medicine in order to be ready when an opportunity in integrative oncology is available.

“If it’s something you’re passionate about, get the certification. Keep teaching yourself about it. Keep educating yourself on this topic. Join [the Society for Integrative Oncology]. Go to integrative conferences,” said Rodich. “Then the job will come and you’ll be the perfect candidate for it, rather than having a position open up at your institution or somewhere else and thinking, ‘This sounds great, but I don’t have any of the training.’”

According to Rodich, the wait list of patients seeking treatment in her institution’s integrative oncology program testifies to the need for more integrative care providers.

Tune in to Onc Nurse On Call every other week for more insights on all things oncology nursing.

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