A whole person care approach for people with cancer improves their quality and length of life. Including wellness and integrative approaches in cancer care helps patients cope with treatment side effects that reduce their quality of life and promotes healing and wellbeing by adding self-care, behavior and lifestyle resources, and evidence-based complementary therapies to conventional cancer care.
The James M Stockman Cancer Institute at Frederick Health, a community health system in Maryland, has incorporated a whole person, integrative approach that makes these services a routine part of cancer care. Their work demonstrates that community health systems can implement whole person cancer care.
Integrating whole person cancer care into routine cancer care has enabled the James M Stockman Cancer Institute to deliver these services within the budget and staff constraints of a community hospital. The program focuses on four complementary therapies with strong evidence supporting their use in cancer care: acupuncture, massage, meditation, and yoga. About 15% of patients at the cancer institute use integrative services compared to about 5% in academic centers.[1]
THE PROBLEM
Approximately 85% of patients with cancer in the United States receive care in community settings, not at academic centers.[2] Community hospitals provide convenient, high-quality, affordable care to patients located outside of metropolitan areas and help meet the increasing demand for cancer care. But they often lack the resources academic centers have to deliver whole person cancer care.
Whole person cancer care helps patients cope with side effects of chemotherapy, radiation or surgery that reduce their quality of life and also promotes healing and wellbeing.[3] Whole person care involves self-care, behavior and lifestyle resources, as well as evidence-based complementary therapies, to restore quality of life.[2] These resources include complementary therapies such as acupuncture, meditation, massage, nutrition, and yoga.[4] Most people with cancer are interested in integrative services. Research shows this to be true even for those patients enrolled in clinical trials.
Cancer Patient Interest in Integrative Services | |
| Strongly believe in complementary therapies | 60%[5] |
| Want their health systems to offer complementary therapies | 71%[5] |
| Have used at least one complementary therapy | 64%[6] |
THE SOLUTION
Whole person cancer care is a comprehensive approach that helps the person improve their overall wellbeing, not just treating the cancer. It seeks to promote recovery and health while managing disease. What matters to the person guides treatment planning alongside what’s the matter (the disease).
As patients go through cancer treatments, they may experience issues with sleep, pain, anxiety, financial barriers, sexual health, and many other challenges that occur outside of the exam room, infusion center, or operating theater. Inevitably, these patients look to their medical team for advice on how to manage those outer issues.[7] Many academic centers have established integrative and supportive cancer programs to help patients cope with disease and treatment effects.
CASE STUDY
Frederick Health is a not-for-profit community health system in Maryland, between Washington, DC, and Baltimore. In 2015, Frederick Health’s James M Stockman Cancer Institute brought in Patrick Mansky, MD, a nationally recognized integrative oncologist, to develop a whole person, integrative approach to cancer care. Because the James M Stockman Cancer Institute did not have the financial or staff resources to establish an integrative cancer center, Dr. Mansky and his team integrated whole person cancer care into routine cancer care. They focused on evidence-based complementary therapies.
Developing the Program
A stakeholder group composed of cancer survivors, integrative service practitioners from the community, patient advocates, supporters of Frederick Health, and community members provided input. Dr. Mansky, his team, and the group chose four complementary therapies to offer:
- Acupuncture
- Massage
- Meditation
- Yoga
The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) evidence-based guidelines support the use of these therapies in cancer care.
| SIO-ASCO Recommendations for Complementary Therapies* | ||||
| Acupuncture | Massage | Mindfulness-based interventions (meditation) | Yoga | |
| Pain management[8] | Aromatase inhibitor-related joint pain in breast cancer General or musculoskeletal pain | All pain, including post-breast cancer (non-surgical) treatment and during palliative and hospice care | ||
| Anxiety and depression[9] | After breast cancer treatment | During and after treatment | During treatment for breast cancer | |
| Fatigue[10] | During and after treatment | After treatment | ||
*Moderate or strong recommendations.
All services are provided onsite and delivered by practitioners with experience working with cancer patients. They are independent contractors from the community.
Connecting Patients with Integrative Services
From the initial intake to recovery or palliative care, the cancer care team at the James M Stockman Cancer Institute continually assesses patient needs and develops personalized treatment plans that include integrative services when appropriate.
Nurse navigators, social workers, and oncologists all refer patients to integrative services, and patients can self-refer. A web page describes the integrative services, and the team posts flyers throughout the cancer center and hosts special events to promote these services.
Funding Integrative Services
Charitable contributions, primarily from pharmaceutical companies, and subsidized patient payments using a sliding fee scale, fund integrative services. Philanthropy includes proceeds from pharmaceutical fairs, which the James M Stockman Cancer Institute hosts quarterly.
| Type of Integrative Service | Co-pay at the James M Stockman Cancer Institute (as of 2025) |
| Class | $0-$15 |
| Individual service | $0-$65 |
Read the full case study here.
Promoting Healing and Wellbeing while Treating Cancer
Integrative services are now a routine part of cancer care at the James M Stockman Cancer Institute:
- Frederick Health has demonstrated that community health systems can provide whole person cancer care. Any community health system with a strong leader and a care team that uses the right framework and systems can do this.
A framework that makes integrative services a routine part of cancer care is far more feasible for community hospitals than the typical framework of developing an integrative cancer center used by academic centers. This was easier and less expensive to implement and enabled the James M Stockman Cancer Institute to provide integrative services to more patients.
- About 15% of cancer patients at the James M Stockman Cancer Institute use integrative services, compared to about 5% in academic centers. Anecdotal evidence shows that these patients find relief for their symptoms and treatment side effects, relieve stress, improve their energy and mood, and use fewer drugs than other patients.
- Patient and caregiver voices are included in care plans and, to some extent, in programming through an in-depth and personalized intake process performed by nurse navigators and social workers, stakeholder input, and patient surveys.
- Integrative services are anchored to “what matters” to the patient. The assessment and intake process focuses on what matters to each patient along with treating their cancer. Staff use free tools such as the Personal Health Inventory for Oncology.[11] Healing Works Foundation developed this tool and an integrative oncology solutions guide[12] in collaboration with members of the Integrative Oncology Leadership Collaborative.[13]
TIPS FOR WHOLE PERSON CANCER CARE IN COMMUNITY HEALTH SYSTEMS
Gain support from leaders. Lack of leadership support is a key challenge in implementing whole person cancer care. Although leaders at Frederick Health brought Dr. Mansky in to improve cancer services, he had to understand how leaders viewed whole person cancer care and then demonstrate and advocate for his vision.
Create a culture that supports integrative services. When leaders support integrative services and physicians, nurses, social workers, and other members of the cancer care team believe integrative services can help their patients, it is easier to implement these services. Also, patients are more likely to try integrative services when trusted members of their care team recommend them.
Choose the right integrative providers. The integrative service providers at the James M Stockman Cancer Institute live and work in the community. They helped develop and implement the integrative services and are very committed to providing them to cancer patients.
Use available free resources. Free resources on whole person cancer care are available, including from the Healing Works Foundation.[14]
REFERENCES
[1] Interview with Patrick Mansky, MD. January 2024. Healing Works Foundation.
[2] National Cancer Institute. Bringing Research to the Community to Reduce Cancer Disparities. (2017, September 21). https://www.cancer.gov/research/areas/disparities/chanita-hughes-halbert-clinical-trials-community-access.
[3] Healing Works Foundation. A whole person approach to cancer care. Retrieved February 12, 2025, from https://healingworksfoundation.org/whole-person-cancer-care/
[4] Healing Works Foundation. Integrative Oncology Solution Guide. Retrieved February 12, 2025, from https://healingworksfoundation.org/wp-content/uploads/2023/11/Integrative_Oncology_Solution_Guide-1.pdf
[5] Healing Works Foundation. Wave 2: US Patient & Oncologist Awareness, Usage, & Attitudes Toward Whole Person Integrative Oncology. Retrieved February 12, 2025, from https://healingworksfoundation.org/CancerSurvey2023/
[6] The ASCO Post. Patients With Cancer May Be Interested in Complementary Therapies, Survey Says. (2023, October 13). https://ascopost.com/news/october-2023/patients-with-cancer-may-be-interested-in-complementary-therapies-survey-says/
[7] Healing Works Foundation. A whole person approach to cancer care. Retrieved February 12, 2025, from https://healingworksfoundation.org/whole-person-cancer-care/
[8] Jun J. Mao et al. (2022). Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline. Journal of Clinical Oncology, 40(34), 3998-4024. https://ascopubs.org/doi/10.1200/JCO.22.01357
[9] Linda E. Carlson et al. (2023). Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline. Journal of Clinical Oncology, 41(28), 4562-4591. https://ascopubs.org/doi/full/10.1200/JCO.23.00857
[10] Julienne E. Bower et al. (2024). Management of Fatigue in Adult Survivors of Cancer: ASCO–Society for Integrative Oncology Guideline Update. Journal of Clinical Oncology, 42(20), 2456-2487. https://ascopubs.org/doi/10.1200/JCO.24.00541
[11] Healing Works Foundation. Personal Health Inventory (PHI) Oncology. https://static1.squarespace.com/static/61857176ceeec825cd1591e4/t/65f1f59e2310a93466d026e6/1710355870462/PHI-24-Oncology-Interactive-V3.pdf. Accessed 2/13/25.
[12] Healing Works Foundation. Personal Health Inventory (PHI). Retrieved February 13, 2025, from https://healingworksfoundation.org/wp-content/uploads/2023/11/Integrative_Oncology_Solution_Guide-1.pdf
[13] Alyssa Claire McManamom et al. (2024). From what works to what matters: Whole person cancer care and the integrative oncology leadership collaborative (IOLC). Journal of Clinical Oncology, 42(16_suppl), e13567. https://doi.org/10.1200/jco.2024.42.16_suppl.e13567
[14] Healing Works Foundation. A Whole Person Approach to Cancer Care. Retrieved February 13, 2025, from https://healingworksfoundation.org/whole-person-cancer-care/