PhD Candidate: Ding Quan (Quinton) Ng, BS Pharm
Integrative oncology, as defined by the Society of 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. Some common modalities include acupuncture, yoga, mindfulness meditation and biofeedback, and these are increasingly used by patients with cancer experiencing multiple neuropsychiatric symptoms. In clinical practice, co-occurrence of two or more neuropsychiatric symptoms (i.e., cognitive impairment, fatigue, distress, insomnia, and pain) is prevalent among cancer patients and these symptoms can be detrimental to their quality of life. However. pharmacological management of these symptoms may involve concurrent use of multiple medications to treat different symptoms, leading to a higher risk of adverse events. Integrative oncology has great potential for closing this clinical gap but faces significant resistance from skeptics citing a lack of scientific evidence and concerns about placebo effects.
This dissertation proposes an evidence-, science-, and value-based framework for assessing integrative oncology in managing neuropsychiatric symptoms in cancer patients. Given that reduced hippocampal neurogenesis may underlie these symptoms, we first examined whether plasma BDNF, a neurogenesis marker, could serve as a monitoring biomarker for cancer-related neuropsychiatric symptoms. This was investigated through a review of published human studies and a secondary analysis of a prospective cohort of adolescent and young adult cancer patients (n = 74) compared against age-matched controls (n = 118). These results supported the use of plasma BDNF as an objective surrogate outcome in a randomized, sham-controlled, double-blinded pilot trial on electroacupuncture for neuropsychiatric symptoms in breast cancer survivors (n = 35). Preliminary findings suggested that treatment at disease-specific acupoints, but not in sham control, significantly improved memory and attention as measured on a computerized neuropsychological test (CANTAB®), and psychological distress as recorded on a patient-reported outcome tool (RSCL) after adjusting for multiple testing with the Benjamini-Hochberg method (effect sizes = 0.488-0.708, p-adjusted < 0.05). Neurogenesis (BDNF) and reduced inflammation (IL-6 and TNF-α) may play a role, but findings were inconclusive. Finally, from a value-based and healthcare payers’ perspective, we evaluated the real-world impact of acupuncture using a commercial claims database and the difference-in-difference methodology. Exploratory analyses revealed that patients treated specifically for pain used fewer opioids and NSAIDs and those with high acupuncture utilization incurred lower healthcare costs (p < 0.05). Our findings underscore acupuncture’s potential role in symptom management within cancer survivorship and supportive care. Future studies can apply this framework to evaluate other integrative oncology therapies.
