Integrative oncology: the last ten years--a personal retrospectve.

In the last decade, there has been dramatic changes in all areas of integrative patient care. None has been more dramatic than those in the field of cancer care, which has gone from alternative and complementary treatments delivered outside the conventional setting to the integration of many of these approaches into the care of the cancer patient. In many cases, these changes have been driven by patient demand and supported by private funding and out-of-pocket payments by patients themselves. Virtually all major medical centers have departments devoted to integrative patient care--whether true stand-alone centers or departments with a research interest in this area. This is particularly true of the major cancer centers, many of which-including Memorial Sloan Kettering Cancer Center, New York; M.D. Anderson Cancer Center, Houston, Tex; Johns Hopkins University, Baltimore, Md; Duke University, Durham, NC; and the Dana Farber Cancer Institute, Boston, Mass--have developed integrative cancer programs. In addition, programs such as the Cancer Treatment Centers of America have inpatient and outpatient programs with teams of practitioners, including medical oncologists, surgeons, and radiation therapists, as well as credentialed naturopathic doctors, nutritionists, mind-body specialists and other integrative practitioners. Despite the increased interest in developing integrative approaches to cancer, many medical oncologists remain skeptical about the value of these modalities.