Integrative Oncology

By Jeremy R. Geffen, MD, FACP 

Today, more than ever before, patients and families are seeking an approach to medicine that is more holistic, comprehensive, and sensitive to their needs and concerns as a whole person. This is especially true for those facing a diagnosis of cancer. Studies show that up to 80 percent of all cancer patients use some form of complementary and alternative (CAM) therapies during the course of their illness. Many patients have numerous questions and concerns about the role of diet, exercise, nutrition, herbs, vitamins, supplements, massage, acupuncture, and other CAM therapies. Many also have questions about support groups and educational programs, as well as questions about how to effectively address their emotional and spiritual needs and concerns.

Why is this happening? First, because cancer often challenges the mind, heart, and spirit as deeply as it challenges the body. Many patients feel that their cancer has robbed them of a sense of control. They want to do all they can to help themselves live and thrive beyond just receiving surgery, chemotherapy, and radiation. Others hope to ameliorate the side effects of conventional treatments which, admittedly, can be very toxic.

Underlying these motivations, however, is an even more basic one. Of course, people certainly want good medical care, but they also want to be treated with love, kindness, and respect. And increasingly, many want care that addresses all their needs and concerns, not just the physical ones. We are all multidimensional beings—a mind, heart, and spirit, as well as a body. All these dimensions deserve attention and care. There is no doubt that an integrative, multidimensional approach to cancer care improves quality of life. One day, it may even be shown to improve survival as well.

As a medical oncologist with years of experience helping thousands of patients and loved ones find meaningful and practical answers to their urgent questions, I have come to understand the experience of cancer as a journey—filled with ups and downs, periods of calm as well as tumult, and extraordinary opportunities for healing and transformation.

In this process, I also discovered a profound, universal pattern. I saw that all of the questions and concerns encountered by patients and loved ones fall into seven distinct, but interrelated domains of inquiry and exploration. I call them The Seven Levels of Healing®, and describe them in detail in my book, The Journey Through Cancer: Healing and Transforming the Whole Person .

The Seven Levels of Healing are a comprehensive guide for navigating all aspects of the cancer journey. They provide a crystal clear map of the entire terrain. They also describe the multidimensional issues universally encountered in the process of confronting cancer and in healing. The Seven Levels of Healing help patients and families understand where they are in their journey while working through the various needs, questions, concerns, and challenges they are facing. It shows people how to focus their time and attention to optimize their care and maximize the chances of arriving at their desired destination. The Seven Levels of Healing can also serve oncologists and other health professionals by providing a powerful tool to deepen their understanding of what their patients and family members are encountering. It can also help them coherently and compassionately guide patients through all the dimensions of the cancer journey.

Briefly, the Seven Levels are:

Level One: Education and Information - provides basic knowledge and information about cancer and current treatment options. This empowers patients to actively participate in and obtain the greatest possible benefit from their care. It enables them to feel clear and confident about their diagnosis and treatment plan, helps put their minds at ease, and facilitates their ability to enter the deeper dimensions of healing.

Level Two: Connection with Others - explores the importance and benefits of finding support and connection with others on the journey through cancer. The simple act of sharing with others is ancient, profound, and deeply healing. A growing body of evidence clearly shows that connection with others—which can occur in a variety of settings—can greatly improve quality of life for patients and family members in numerous ways.

Level Three: The Body as Garden - invites patients and loved ones to regard the human body as a sacred and wondrously complex garden-rather than a machine. Level three is the realm in which a wide array of complementary approaches to healing find their natural home. It explores the benefits of diet, nutritional support, exercise, yoga, massage, acupuncture-and many other modalities-and shows how they can be safely and effectively integrated into mainstream care.

Level Four: Emotional Healing - enters the inner realm of the human heart. Here, attention is gently redirected from the external world of drugs, surgery, and diets toward the internal world of feelings and personal emotional experience. Level four explores the transformative power of releasing fear, pain, and anger-and the healing potential of self-love, forgiveness, and acceptance of all parts of one's self.

Level Five: The Nature of Mind - looks carefully at how one's entire experience of life—including life with cancer—is profoundly influenced by thoughts, beliefs, and the meanings we give to events. It shows how we can escape the tyranny of the mind. As fear and anxiety are replaced with knowledge and understanding, patients and loved ones can move forward more effectively on the healing path.

Level Six: Life Assessment - helps patients and loved ones explore the aspirations, goals, and purposes of their lives. It is very empowering to discover the deepest purpose of one's life, especially in the face of cancer. Answering three important questions can help clarify priorities and liberate enormous time, energy, and resources for healing:

o What is the meaning and purpose of my life?
o What are my most important goals for the coming year?
o How do I want to be remembered by those whom I love?

Level Seven: The Nature of Spirit - explores the spiritual dimensions of life and healing. It embraces the nonphysical aspect of everyone's being that exists beyond time and space, and even beyond illness and health. This is the source of the love, joy, fulfillment, and vitality that all people seek. Recognizing and experiencing the nature of spirit relieves anxiety and distress, calms the turbulent waves of human existence, and deepens the potential for healing.

Over a decade of running an integrative cancer center that used The Seven Levels of Healing as a foundation for its multidimensional approach to care, I discovered that this approach has many benefits—not just for patients and loved ones, but for physicians and medical staff as well. To begin, the very context of such an approach helps patients and family members feel respected and cared for in ways that build trust and confidence in their medical team. They know that their myriad questions will be coherently addressed, and it helps them be able to relax. This yields not only better-informed patients and family members, but happier and more proactive ones as well.

Next, providing patients with sound, clear, and rational advice regarding concerns such as diet, nutritional support, exercise, and the appropriate use of CAM therapies, eliminates tremendous confusion and gives them immediate, positive steps they can take towards improving their health overall. The Seven Levels of Healing also helps patients and loved ones skillfully deal with the psychological and spiritual challenges so commonly encountered on the cancer journey. This greatly eases emotional pain and distress, and empowers them to focus on what is truly most important to them. For most, their focus will be on continuing to do all they can to get well. For some, it may mean choosing to let go with comfort and peace. Either way, everyone benefits.

Implementing a program such as The Seven Levels of Healing, which consciously and coherently addresses the multidimensional needs and concerns of patients and loved ones, also helps restore the heart and soul of medical practice, which for many physicians has been eroded. It humanizes a process that can be highly technical, mechanical, and impersonal. It can save precious time and energy by providing a coherent way of responding to the universal and often complex questions posed by patients and families, and may have significant long-term cost benefits as well. Moreover, this way of responding is ethical, compassionate, and inspiring—and can be made consistent among all the providers and staff members. This creates meaningful cohesion and continuity for the patients and staff members alike.

Last but not least, caring for patients and loved ones in a multidimensional way also creates an environment that fosters compassionate care and attention to the needs and concerns of one's colleagues and one's self. Advancing the scope and practice of oncology to include the multidimensional needs and concerns of both patients and practitioners ultimately serves the highest aspirations of everyone involved. It can give us the strength and inspiration to be more whole and complete, and thus better able to serve those who need our help. Since we cannot give what we don't have, this is a gift of great and long lasting value.

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Jeremy R. Geffen is a board-certified medical oncologist, a Fellow of the American College of Physicians, and a renowned pioneer in integrative medicine and oncology. He is founder of Geffen Visions International and director of integrative oncology  for P4 Healthcare and Caring4Cancer.com. He is also author of the highly acclaimed book The Journey Through Cancer: Healing and Transforming the Whole Person  (Three River Press, 2006) and the integrative medicine program The Seven Levels of Healing®. In 1994, he founded the Geffen Cancer Center and Research Institute in Vero Beach, Fla., which he directed until 2003. It was one of the first cancer centers in the United States explicitly designed to provide a working model of truly holistic, comprehensive cancer care for the twenty-first century. In addition to his academic medical education and training, he has more than 30 years of experience exploring the great spiritual and healing traditions of the world.

Dr. Geffen lectures widely and offers seminars and retreats on the multidimensional aspects of medicine, wellness, and life. He also advises organizations on integrative programs for medicine and healing. For more information, visit www.geffenvisions.com.

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