Integrated cancer care – A different paradigm

by Siegfried Gutbrod

“Hope is not the conviction that something will turn out well, but the certainty that something makes sense regardless of how it turns out.”
Václav Havel

After spending five years overseas, I came back to Australia and rejoined The Gawler Foundation in April this year in the role of Therapeutic Director. I quickly noticed that the overall landscape for the provision of cancer services had changed in Australia in the time I was away. One of the new phenomena was the newly established integrated cancer services offered by the Victorian and other state governments, as well as the building of new integrated cancer wellness centres such as the Olivia Newton-John Wellness Centre, part of the Austin Hospital in Melbourne. I explored, in more detail, the services being offered by these new centres and I was very pleased to recognise that many of the services/therapies offered in these centres fall into the integrated healthcare model.

The services/options include:

• Personal and family support
• Massage
• Meditation/relaxation/Tai Chi
• Exercise
• Nutrition
• Peer support groups
• Emotional/psychological and spiritual support

Wonderful! It seemed that many of the services The Gawler Foundation has been promoting so vigorously over the last 25 years have finally found their way into mainstream medical cancer care. A dream of Ian Gawler’s coming true? After looking more deeply into the reality of 2010, it became clear that the hoped-for miracle has not quite happened yet.

At first glance many of the integrated cancer services/centres offer a range of options for people with cancer and their families/carers that is similar to The Gawler Foundation. All seem to fit well into the model of Integrative Medicine to which The Gawler Foundation is fully committed. This model incorporates evidence-based and safe therapies from conventional medical care, complementary therapies and lifestyle interventions applied in a holistic way and including the physical, mental, emotional, spiritual and social dimensions.

However, there are significant paradigmatic differences between the approach of The Gawler Foundation and that of integrated cancer centres. It is the main purpose of this article to start naming these differences as they have a profound impact on the ‘consumer’ of these services; the people dealing with cancer, their families and carers.

“Integrated cancer care has been the cornerstone of The Gawler Foundation’s programs for twenty five years. So, how are recently established ‘Integrated cancer centres’ similar and different to the approach taken by the Foundation and what does that mean for those seeking cancer support?”

The underlying paradigms for the integrated cancer services/centres as I understand them are:

• The expertise and therapies of conventional medical care represent the primary tools for dealing with the illness of cancer e.g. surgery, chemotherapy and radiotherapy.
• The belief that the application of these tools by representatives of conventional medical care alone can determine the outcome of the treatment in terms of ‘quantity of life’/survival time.
• The application of a ‘curative approach’ to cancer focuses squarely on the diagnosis and elimination of the pathology of cancer through specific cancer-destructive therapies.
• The conventional medical expert knows what is best for the patient and acts accordingly, with a high level of authority.
• The patient is expected to be relatively passive. This has the potential to leave the patient in a disempowered position and when the patient asks what he/she can directly contribute to the healing process, the answer is very often ‘nothing’ except trusting the medical profession and to follow advice.
• The abovementioned complementary therapies and lifestyle options are seen by conventional medicine under the heading of ‘Supportive Care’. This is seen as beneficial to the adjustment and quality of life of the person receiving the treatment for cancer but has a minimal role in healing and survival time.
• Following on from this, the concept of ‘hope’ for survival or increase in survival time is greatly discouraged by ‘Supportive Care’. There is a fear of ‘creating false hope’ with all the legal and other implications that can go with it, creating a passive culture of hopelessness.The underlying paradigm for The Gawler Foundation approach is:
• The person with the illness needs to be encouraged and supported to take charge of his/her own healing process, to be in an empowered position, in the driver’s seat of the healing journey.
• Empowerment requires that the person with the illness be informed of what lifestyle options and complementary therapies are available (in addition to the conventional medical interventions) at the beginning of the healing process. The person with the illness needs to be able to make an informed choice of what interventions he/she consciously chooses to achieve the healing goal. The decision will take into account both quantitative and qualitative measures.
• Hope is real and critical and often is the starting point that leads to remarkable, unexpected outcomes. There is plenty of evidence of people who, against all odds, have survived cancer long term or found a way to co-exist with cancer for long timeframes or simply exceeded their statistical-based prognosis. Hope is not just wishful thinking. Hope, in order to be effective, needs three components. Firstly, it needs to be directed towards achieving a healing goal. Secondly, it needs to include a commitment to a set of specific interventions which have the potential to alter the outcome. Thirdly, it needs to be backed up by the willpower to implement these interventions. There is growing statistical evidence that this form of hope increases survival time.
• There are many intervention options that directly impact the key outcome measure of survival time. The interventions applied by conventional medicine (surgery, chemo, radiotherapy) are important options, however, there is clear and increasing statistical evidence that lifestyle interventions also impact survival time (meditation, nutrition, emotional and spiritual aspects, physical exercise etc).
• The ‘healing approach’ focuses on the whole person by embracing the physical, emotional, mental, social and spiritual dimensions of the ill person.
• Better decisions can be made by the person in the driver’s seat from a state of inner peace. Stress and fear can be transformed by the person with the illness into inner peace using the lifestyle tool of meditation and good therapeutic help.There is no guarantee for achieving the healing goals. Death is an inevitable outcome of life in general. When people can transform the fear of their own mortality, irrespective of whether they are diagnosed with a serious illness, they have a better chance to enjoy life to the fullest and to have a ‘better death’ whenever that may occur.

The Gawler Foundation’s approach does not appeal to everybody diagnosed with cancer. Actually, it only appeals to a minority as it requires a very active role of taking responsibility and usually involves committed, dedicated work related to lifestyle interventions such as using food therapeutically and alleviating stress on a deep level.

Many people diagnosed with a serious illness are very happy to stay in a passive role and hope that the medical experts will do the right thing to ‘fix the problem’. I respect that choice without judgment. However, we see many people who reach the end of the medical road and are told that there is nothing more that conventional medicine can do except to provide palliative care. Only then the search begins in earnest for other options outside of mainstream medicine. Ideally people diagnosed with cancer would be told at the early stage of all the options in the model of ‘Integrative Medicine’. Unfortunately this is not happening.

“Ideally people diagnosed with cancer would be told at the early stage of all the options in the model of ‘Integrative Medicine’. Unfortunately this is not happening.”

As indicated above, at first glance there seems to be a narrowing of the difference in paradigms between conventional medical care for cancer patients and the approach of The Gawler Foundation. However, below the surface there remain significant paradigmatic differences which are not easy to bridge and are important to acknowledge. Nevertheless, I very much welcome the growing significance of ‘Supportive Care’ in the field of integrative cancer services/centres as this directly benefits the people who have been diagnosed with cancer, their family and carers.

Siegfried Gutbrod, Therapeutic Director at the Foundation, is a counsellor, group facilitator and spiritual care consultant for dying people. He holds a Masters degree in Counselling and a Diploma in Psychophonetics Counselling.