Tuscany is the first region in Italy to have a therapeutic-assistance diagnostic path (PDTA) for integrated medicine in Oncology. This means that any cancer patient can be treated, in addition to standard therapies, also with complementary therapies such as acupuncture, following clear indications, shared by all cancer centers and within the regional health system. A change already “experienced” by women with breast cancer, as we report in the new newsletter of Breast Health.
In the area there are about twenty integrated oncology centers and over one hundred integrated medicine clinics that belong to the Tuscan health service, where visits and services (although not preparations or phytotherapics) are free. The oncologists themselves, or the AID Points (service and contact points for reservations), send patients to these clinics. But it can also be accessed directly, without a referral from the attending physician. As a rule, however, the integrated medicine visit is scheduled after the meeting with the oncologist or with the multidisciplinary oncology group, which must establish the treatment path and therapies.
Acupuncture in the hospital, the census of the facilities where it is practiced has started
by Paola Emilia Cicerone
Why a PDTA?
There is a reason why all this has been regulated: “The data speak of 30% of cancer patients who normally resort to complementary medicines, but this does not always happen in the appropriate way. This data cannot be ignored and, precisely for instead, to guarantee the appropriateness of what is offered, we have created a common path, the result of many years of interdisciplinary work between oncologists and integrated medicine specialists from Tuscany “, he explains Gianni Amunni, oncologist and Director General of the Institute for the study, prevention and oncology network of the Tuscany Region (Ispro).
“The Pdta for Integrated Medicine in Oncology – continues Amunni – is a tool that defines the opportunities offered by complementary therapies, clarifying what to use for which symptom, and when. Let’s say clearly that cancer is cured with treatments and drugs oncologists, but we are open to having help from this world. Which here is represented not by gurus and healers, but by professionals who have chosen to work together with oncologists on the basis of scientific evidence “.
Acupuncture and acupressure, an extra help against cancer pain
by IRMA D’ARIA
Take the example of acupuncture for the control of chemotherapy nausea: there is solid evidence behind it, and it must be done according to very specific criteria. “The message – explains the Director General – is that patients are not left to fend for themselves and do not have to resort to do-it-yourself, but can turn to public facilities within a path that already includes and includes complementary therapies “.
Breast Cancer First How Did It Get Here? The story begins over 25 years ago: Tuscany was the first region to issue a law to recognize the training path of complementary medicine doctors. Since 2009, a close collaboration has started between the specialists of these therapies and the then Istituto Toscano Tumori (today Ispro).
Breast cancer: it’s time for acupuncture
by Tiziana Moriconi
“Much has been achieved since then,” he says Elio Rossi of the Regional Center for Integrated Medicine at the USL Toscana Nord Ovest: “Working groups, censuses, studies. And communication projects to explain to the population that complementary therapies support official medicine and are never alternatives to it “.
In 2015, Ispro initiated a process of integrating complementary medicine disciplines that had a level of scientific evidence considered adequate. This led, in 2019, to the development of a first regional diagnostic therapeutic assistance pathway for breast tumors which also includes the use of complementary therapies.
Another first in Italy: “The document was officially approved about a year ago, in February 2021, and today it is available to all Breast Units in Tuscany”, underlines Rossi: “At that point we said to ourselves: why reserve these Treatments only for those with breast cancer? And since it would not have made much sense to do a Pdta of integrated medicine for each tumor, we then considered all the symptoms common to different cancers and the adverse effects related to cancer treatments, and we realized this Pdta for all cancer patients, based on complementary therapies that have greater scientific solidity. This extraordinary milestone, unique to date in Italy, will pave the way for greater recognition and we also hope for greater dissemination of integrated oncology as an effective, safe resource. and sustainable for cancer patients “.
Integrated oncology, increasingly based on scientific evidence
by Tiziana Moriconi
What the itinerary entails
In Pdta, various conditions are taken into consideration: from anxiety to insomnia, to possible post-surgical complications such as lymphedema, to the adverse effects of chemotherapy (such as the so-called chemobrain), of endocrine therapy, of radiotherapy.
Three approaches to complementary medicine are considered: acupuncture, herbal medicine and homeopathy. The scientific validity of the latter, however, raises doubts. “There are some services that are accepted more easily and others that historically have elements of suspicion and raise doubts: homeopathy in particular”, comments Amunni: “We also want to work on this aspect with methodological rigor, but with a secular approach. The goal is to fully take care of the patients, who in a large percentage resort to homeopathy without control. Again, therefore, we want to ensure the appropriateness and that there is no risk for the patients. It seems to me essential that there both a dialogue between official medicine, which I represent, and this world that is willing to collaborate “.
The US guidelines for complementary therapies in breast cancer
In the US, where a lot of research is being done on integrated medicine in oncology, guidelines on the use of complementary therapies for breast cancer from the Society for Integrative Oncology (SIO) were already published in 2018.
For each approach the “strength” of the scientific evidence is specified and on this basis the recommendations are drawn up, exactly as happens for the ‘official’ treatments. “It is a work that in Tuscany, and in Italy in general, has not yet been done, but which we intend to continue”, concludes Rossi: “This first document sets out a series of important general principles, which will be followed by operational guidelines more precise “.
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