Transcript Disclaimer – Please note that the following transcription has been machine generated by an AI software and therefore may include errors or omissions.

Robin Daly
Hello and welcome to the second series of CancerTalk, the podcast that explores the benefits of integrative oncology, an approach that brings together standard oncology practice for the raft of lifestyle and complementary approaches in order to provide broader, more holistic care to improve quality of life and outcomes for people with cancer.

Robin Daly
I’m Robin Daly, founder of Yes to Life, the UK’s integrative cancer care charity, and one of the hosts for the podcast. Series 1 of CancerTalk was aimed at initiating conversations about integrative oncology and bridging the gap between mainstream and integrative medicine practitioners. And the Series 1 episodes are still available from YestoLife.org.uk forward slash podcasts and major podcast platforms.

Dr Penny Kechagioglou
Hello, I’m Dr Penny Kechagioglou, I’m an NHS Clinical Oncologist and co-host for the broadcast and in addition to treating patients with all the regular modalities in use within healthcare, I have a passion for integrating evidence- supported lifestyle and complementary medicine into patient protocols. I’ve witnessed first have the enormous benefits this can deliver to patients and their carers. So in Series 2 of the broadcast we are planning focused conversations with healthcare professionals, working directly with people with cancer and applying integrative oncology in contemporary clinical practice with the aim of strengthening the clinical voice and evidence for integration, influencing the wider community including academia and research and beating the case for an integrated UK model of care.

Dr Penny Kechagioglou
Hi Robin, lovely to see you.

Robin Daly
So we’ve got a very influential guest for this episode, someone we’re both familiar with through different connections, but who I’m really interested to speak to in this context where we’ve got your medical and my patient perspective to talk about the many developments in Israel. So we have Prof Eran Ben-Arye and he’s the co-founder and director of the unit of complementary and traditional medicine at the Department of Family Medicine in Haifa and the director of the integrative oncology program within the Haifa and Western Galilee Oncology Service. And he’s also on the faculty of the Bruce Rappaport Faculty of Medicine and he’s been the chairperson of the Israel Society for complementary medicine of the Israel Medical Association. He’s got a connection with all us over in the West here because he’s an elected member of the board of trustees of the Society of Integrative Oncology in the States and he’s the regional ambassador to Europe and the Middle East and co-director of the SIO online task force.

Robin Daly
So very connected around the globe. He’s a nominate member of an expert panel that’s charged with developing the American Society of Clinical Oncology and Joint Guidelines which are called an integrative approach to cancer-related pain management. So loads of stuff to talk about. Maybe you’d like to just start off by telling us that you set out on family medicine and here you are in integrative oncology. What’s been the catalyst for this move?

Prof Eran Ben-Arye
I mean, it’s actually started with dealing with patients. I mean, I’ve seen a lot of patients during my family medicine practice. I’m still practicing it in a tiny clinic in Northern Israel. And the journey that people just initiate through these breaking bed needles, you know, moment when the cancer and diagnosis arrive, it’s something that is, at that time, I felt that there was a lot of need, you know, unmet needs for patients who were looking at the same time for what was called at that time alternative or complementary alternative medicine or CAM, and that there is a need for integration of the two worlds, the complementary medicine world and the conventional medicine world, particularly oncology and palliative care. And that was the start of these romance that we presently call integrative medicine or integrative oncology from my perspective.

Robin Daly
Well, you’ve obviously been a big part of the developments in Israel, which are quite a way ahead of us here in the UK. So it would be great to hear more about what you’ve been able to achieve in terms of bringing those two together, which are a little bit oil and water, let’s say the least, over here, and we’re struggling to find ways to bring them together because obviously Penny and I both feel exactly the same need as you were responding to the need for these things to all be together under one roof to bring the rounded care to patients that they really need.

Prof Eran Ben-Arye
I’m actually highly interested in the in the dialogue between oil and water, you know, actually, we’ve been it is called emulsion. And, and it’s nice, it’s nice to see the connections, you know, the on one side, the kind of antipathy between the two and the other side, some some longing for for an sympathy for for bringing bridges together. So, my personal journey started in the oncology realm, 16 years ago or 16 years ago, when I was looking for different integrative medicine models, and as a family practitioner, I particularly was looking for that in the rich cross cultural setting in northern Israel, where half of the population are Jewish and half are Arabs. And we were looking for an integrative model of care in the community. And at that time, it was there was much more openness. And actually, that the medical director was looking for something that would, would be that we would be able to create these integrative impulse in oncology.

Prof Eran Ben-Arye
She felt that this is really missing and that there is an added value of this movement, and beyond evidence evidence based medicine, that something in the inner language of healing would be enriched. And she was very open to that. And from there, we moved on to the to to that lady who was the the chief of the oncology service, we have a very a particular integrative oncology service, which which is based both in the community and in the hospital. And it’s part also of the home hospice system. And, and they were quite open to that. So it was a process where we explore together the the evidence that the needs the expectations of patients of healthcare providers, of integrated practitioners, of paramedical practitioners, surgeons that are dealing with oncology and so on, in order to tailor an integrative approach.

Prof Eran Ben-Arye
And from day one, the wish of that oncology service director was that it would be provided free of charge. And in order to do that, I mean, the only way that the legal way to do that at that time was to do that through a research based service. And that’s why we we produce so many articles and research on problematic trials on what is going on in real life practice in integrative oncology. So we had to focus ourselves more into a specific group of patients or people that undergoes active oncology treatment, adjuvant or neuroadjuvant treatment, or palliative treatment and advanced disease. And that’s the community of patients that we are still very focused in. And then it expanded to the surgical setting and the palliative setting. And we understood better the idea of continuity of care, the continuum of care, of integrative care.

Prof Eran Ben-Arye
So we practice today integrative oncology in seven different settings in the community and in the hospital in ambulatory care and so on. So that’s how it developed. But simultaneously, other projects developed in Israel and now we have 10 different integrative oncology centers working the inside of established oncology centers. So it’s quite a huge thing here. And many of the projects are free of charge. And that’s, of course, it’s a challenge. It is not really recognized by the health system view. And in other projects, it’s a fee for service and so on. But that is the extent of what we do on a national perspective, let’s say.

Dr Penny Kechagioglou
And I’m aware of a big piece of research that you did with surgical oncology around pain management and you published and you presented extensively. Do you want to tell us a bit about that?

Prof Eran Ben-Arye
Yeah, well, first of all, it’s quite modest. I mean, the model is focused presently in gynecologically oncology setting. And there was a very good collaboration along the last years with this team of gynecological oncologists. And we all felt, I mean, that there is a need to establish the continuum of care as early as possible. So, and we have designed this project, which was randomized control and so on, but the really, let’s say the real motivation was to establish this continuum of care, to meet patients as early as possible, actually during the prehabilitation stage, before the surgery, some of the patients, you know, we have met in following the neuroalgae setting, of course, and so on. But that was their idea. And we suggested integrative oncology on the day of surgery, which included mind, body, and touch therapies.

Prof Eran Ben-Arye
We did it in different stations, you know, from the bed in the gynecology department, along the different stations, you know, as you approach the operation, the operating room, you know, there’s different stations where the patient is there and so on, up to the intubation. And then some of the patients, about two thirds of them received also intra-operational acupuncture, which was performed in close collaboration with the anesthesiologist and the monitor and the surgeon. So the idea was to decrease what we can call, we didn’t call that at that time, we said intra-operative pain, but of course it doesn’t exist as pain because people are anesthetized, but it’s actually intra-operativeness exceptions. So the, so you can, I mean, the body feels the pain, but the mind is in somewhere else. And of course, if you decrease that, you know, like what you feel with the dentist operation, when you wake up, let’s say when there’s a connection with post-operative pain.

Prof Eran Ben-Arye
So we have shown that there is a decrease in real-operative anxiety and post-operative pain. And then we analyzed different objective parameters during the operation, like menial-terrion pressure and B-spectral index and heart rate and so on. And we have shown that the group that have received intra-operative acupuncture also had better hemodynamic parameters. So there is a way to explain that in a sense. It’s not complete, but let’s say we understand that it works through less nociception and lessening the nociception and then the patients feel post-operatively less pain.

Robin Daly
It’s interesting, because you were wanting to deliver free service, you’ve gone down this research route, which is actually beneficial for everybody, because you’re producing lots of great research results. I’m interested, you’ve obviously been practicing in this way for many years now, and you’ve been pouring out great data as well, but still the health service doesn’t recognize your service. What’s it going to take?

Prof Eran Ben-Arye
Oh, we are doing tremendous work nowadays with the parliament and with the Ministry of Health in order to recognize that should be part of the health basket, what we call. And we even published a paper following the SAO ASCO guideline, pain management with integrative oncology, a consensus and qualitative research assured by the SAO guideline and chairs, and then leading Germans of different Israeli medical societies of oncology, and the athlete oncology, hermata oncology, palliative care, and so on, pain, and so on, supporting that. But we still have, on the later side of things, we have tremendous challenges in order to bring that in.

Prof Eran Ben-Arye
I mean, the key question is, who’s going to do that in order to, who’s going to do the acupuncture and things like that? I mean, in terms of, let’s say, shackles, I mean, it costs something so modest, it’s about 5 million shackles for the entire population to do something like basic, and then just thinking of the cost of that night, two nights ago with the Iranian missiles and so on, which costs about 4 million shackles. So you can just imagine how modest it is in order to do that on a national level. It’s slow tech, I mean, what we do. It’s slow tech, but if you do that in an evidence-based manner, if you do it in an integrative setting, working together, it produces a significant added value to patient’s quality of life and to the success of the entire process,

Prof Eran Ben-Arye
the entire oncology and surgical process. It’s quite amazing and specifically with symptoms that we currently do not have any good conventional remedies. For example, cancer-related fatigue and how to improve appetite, how to ameliorate and neuropathy and so on. So we are really trying to find those niche where we can contribute to what is missing. What is missing from, I mean, the clients of this process are both patients, caregivers, informal caregivers, and the oncology health providers. So we’re trying to find creative ways how to do that. And at the end of the day, it’s evidence-based and it’s very, very cheap, really.

Dr Penny Kechagioglou
And we are talking about very difficult symptoms to treat. You mentioned peripheral neuropathy. And clearly those symptoms are the ones that are going to get the patients maybe out of work or, you know, with visiting the GP or visiting other specialists trying to find out a solution when you’ve got a solution that’s evidence based and cheaper.

Prof Eran Ben-Arye
Yeah. And Penny, you know, as an oncologist, that it’s not just a matter of quality of life or feeling better. I mean, the clinical aspect of that is that if the patients suffer from this neuropathy, from this neurological damage due to specific chemotherapy agents, especially toxins and clotting agents, I mean, what happens is that the oncologist would not be able to provide the full protocol, the full dosage and the intervals designed for that patient. So we actually work, and we have proved that at least in the genealogical oncology and breast cancer settings, that if we provide sufficient or if patients are adhered weekly to that integrative oncology treatments, they don’t just feel better, but they have better adherence to the chemotherapy protocol. So it’s really not just about, you know, feeling good. It’s about the the fundamentals of therapy, of providing oncology therapy. That’s right.

Robin Daly
So it seems like you demonstrated the case for integration quite adequately. So I assume that you’re really up against the status quo at this point. It’s just change that is difficult to maneuver as I arrive to get people to actually change the way things are done and reposition everybody slightly within the picture.

Prof Eran Ben-Arye
But you know, there is an additional aspect here. It’s not just about, you know, evidence-based medicine. It’s not just about acceptance of something that looks at first glance as weird, you know, as non-conventional. It’s also sociological and cultural phenomenon. Because what we do corresponds with, in a sense, with traditional medicine, with patients’ health relief models, and in places like the UK, and many other places in Europe, and actually in the US, actually in the whole world it’s like that, that you are dealing with cross-cultural medicine, with patients that have a variety of health relief models of expectations.

Prof Eran Ben-Arye
And this language, this integrated language, is important in order to enrich the way we communicate with our patients. Imagine, for example, people that come from the Middle East to the UK, or from Pakistan and India and so on, who have very high affinity, let’s say, all of them, of course, but with traditional medicine like Ayurveda, like Islamic medicine, or Greco-Arab medicine, what we call, or other sorts of medicine. Imagine the way they are confronted with conventional paradigm, which does not accept what they believe, for example, their affinity to traditional urban medicine. They would expect us as a system, as a medical system, to provide consultation as part of the entire process. They would look for someone that would be a kind of mediator between the two worlds. So it’s also about being more open to those two worlds, cultural-sensitive approach. And I think that should be acknowledged more.

Prof Eran Ben-Arye
I mean, when there was that big war in the Middle East with a lot of refugees from Syria and from Iraq that came all over Europe, it was a big thing, how to then negotiate the different cultures and the challenge not just of acute disease, but chronic diseases that those people are developing as part of being foreigners in a very affluent society. So I think that integrative medicine, including integrative oncology, but the context is wider than integrative oncology. I think that we have a role in that sense as well. I mean, being there to listen openly, non-judgmentally to what patients expect, the way they perceive healing, and to be able to integrate that with the more modern or high-tech concepts that we have So on the one hand, you see tremendous achievements in biological and targeted therapies in oncology.

Prof Eran Ben-Arye
Amazing, you know, people that died a few years ago from advanced lung cancer. And now you see miracles. And on the other hand, you have this craving for another language, a complementary in a sense to that high-tech inbox. So it’s, I mean, you can minimize all that or you can look, you know, very, very wide, or you can look at very specific facts, but the picture is much more, it has more colors than the evidence-based language. Of course, it’s highly important. It’s more than, you know, risk, safety, effectiveness, efficacy. It’s much more than that.

Robin Daly
that presents a real challenge to embrace all of that within the current model. Yeah. Makes sense.

Dr Penny Kechagioglou
And the problem is real is, you know, I experience in my UK clinics exactly what you are describing. But now more and more people, even from UK or from other countries are asking such an approach. And I think there is something which you have worked quite hard to get integrative medicine into the health care curriculum and the medical curriculum. Do you want to say something around that?

Prof Eran Ben-Arye
I mean, that’s really the guarded fortress, to go into the academy, to be acknowledged with that. And we are blessed, I mean, with our medical school. It’s the Israeli Institute of Technology called Tefanyon, it’s very high ranked in Israel. And the faculty of medicine opened itself, something like 24 years ago, to that gesture or stream of complementary, alternative traditional, and then integrated medicine. So now we are acknowledged as an academic, on academic ground. And we have several positions of leading physicians who are full professors. I mean, my degree as a full clinical professor is based entirely on integrative or complementary medicine. So it’s not something that you need to hide. And we are now, I mean, actually two weeks ago, we have received the first, the decision that it would be an obligatory part of the medical curriculum for fifth year medical students. So we now teach in two of the six medical schools in Israel, medical faculties.

Prof Eran Ben-Arye
And I think that many, many others would join that. So students, medical students are exposed to integrative medicine very early on the required and elective courses. And I’m very proud that the mentors of these courses are not just physicians. It’s also, it’s multidisciplinary, it’s nurses, biomedical therapists, and most importantly, those practitioners, integrative practitioners were not part of the system, the usual system who are mentoring as well. And that is actually a scene for international collaboration that we presently have with all sorts of European medical schools. So it’s highly important, we have also produced an international course available to everybody with no cost on the platform of Coursera about traditional herbal medicine and supportive cancer care. And so people that come from professional medical grounds are highly interesting, especially nurses, I would say, but more and more physicians as well. So it’s part of what we do, and that’s based on a multinational collaboration.

Prof Eran Ben-Arye
And now we have our first training for integrative oncology practitioners, which is recognized by all the relevant Israeli medical associations. And it’s supported by the SAO as well by people that are from the Society for Integrative Oncology with a group of leading integrative oncology practitioners that work with us and mentor us and so on. So the medical education setting is highly important that you are right, Penny, it’s really the heart of medicine. It’s the ancient Greek shrine of medicine or Egyptian shrine. I don’t want to insult you, you know, so there was before Greece, but we really feel like that, you know, that it’s a call for us and that we are invited into the Holy.

Dr Penny Kechagioglou
That’s truly transformational, how inspiring.

Robin Daly
So how many years has the training been going on, the integrated training?

Prof Eran Ben-Arye
We just started now. It’s a two-year training with 110 official hours which are, you know, which are based on and meetings and so on. And then there is an additional 170 practically mentored hours. So that’s the basic. And following that, there is quite a lot of courses in specific areas of integrative oncology like surgery, palliative care, end of life care, and so on.

Robin Daly
Fantastic. So that has to make a difference at some point.

Prof Eran Ben-Arye
And again, we have succeeded to establish this mentoring and this process of medical education with no cost on behalf of three needs. So they actually have to pay something very, very modest in order to register to our society in the Israel Medical Association, but actually it’s with no cost. So we managed to receive other grants, you know, but we don’t pay for that. But they have to commit on behalf, I mean, their hospitals have to commit that following the training, they would be granted a protected time of at least five hours. You know, it’s not easy. And you can imagine for an oncologist to have five weekly hours of protected time for integrative oncology, it’s quite a wow. Oh, it may sounds not a lot, but it’s quite a lot.

Dr Penny Kechagioglou
But clearly, you try to remove the barriers and the cost of education is one of them and get a commitment. I mean, how important that is.

Prof Eran Ben-Arye
I think that I really was so attracted to those ideas of DEI, of diversity, equity, and inclusion. It’s, you know, it’s in the heart of socialism, I must say. I mean, when I’m thinking about, I don’t know if it’s appropriate to say it in the UK platform, but you know what happened, the model that you have created following World War II, the NHS of that time, you know, the social commitment for the welfare of people, and all that. I assume that you feel that it’s really the past or something like that, but you know, in Israel, we were so influenced by that. It was also a socialist government and the socialist impulse in terms of commitment to patients. The best physicians went to the borders, not to the periphery, rather than, you know, working in Tel Aviv or, you know, in the center of Israel. It was like, you know, that was something that people cherish.

Prof Eran Ben-Arye
And in a way, what we call today diversity, equity, and inclusion, which I must say that it’s part of the mission today of the Society for Integrative Oncology. And it was Anna Maria Lopez, the oncologist who was able, you know, to persuade the board of DSIO that that’s a key concept in DSIO. And I think that it’s really something that we have to develop in each of the countries we are working. So it should be something that it’s not, I mean, you know, it’s based on economics, of course, but the consideration, the main purpose should be ethical and really medical, rather than making money or making profit and so on. I think it’s in the heart of what we do in integrative medicine.

Robin Daly
Okay, I wonder if you finish off by speaking to medical practitioners in the UK. Say you have a healthcare professional, they’ve been working in the system and they decide they want to branch out, they realize that integrative oncology is the way to go and they’d like to set up on their own. What kind of advice would you give them about setting up a clinic so that it offers an integrative service?

Prof Eran Ben-Arye
You know, I don’t speak in the profound sense, you know, the British language for how it is to be a healthcare provider, you know, within the system. I’m acquainted with quite a lot of people in the UK that do that on a certain level and so on. And but I would say that the most important aspect is to explore those areas in medicine where we feel that we need integrative practice. I mean, to map what are the areas or what are the symptoms, if you like, that we need an additional solutions. And to start with that, what is really missing? What’s the expected added value that we are looking for? And to try and to bridge the gap with the resources that we may have in that hospital. I would encourage that UK healthcare providers to do that in the public service rather than to open it in a private sector. Otherwise, it’s not really integrated, you know. It’s integrated when you do that inside the system. Even myself, in my infant seeing patients, you know, in a private clinic, this is not an integrative setting.

Prof Eran Ben-Arye
I may consider myself as the leader in integration, you know, but it’s not. I mean, to be integrated is actually when you work with other people who are not from this discipline. In order to be integrative, I need that oncologist who is not a complementary medicine trained physician or the surgeon and so on. To be integrative, you can be integrated within yourself. But if you want to learn something that is integrated on a deep level, you need to look for those partners. Those partners that understand, I mean, you can see their eyes, the look in their eyes, that they crave for something that would be additional, that they really feel it is needed. I mean, if I can quote from my colleague, the head of the Chanecological Oncology Unit, he said to me a few years ago, if I need an expert for bone metastasis, I have this expert, but I need also an expert in your field, and I would like you to be the expert that I can work with.

Prof Eran Ben-Arye
So they have to feel that they need it. That’s the key person. The key person is not necessarily myself or my colleagues, it’s the collaboration between us and the people with the bottom of the ground, you know, to be a little American, you know, those people that work inside the core of oncology practice or palliative care. So we need to look for that partner, and that partner may guide us what is really needed. So it’s a kind of dialogue that we need to establish, not just to persuade the NIH or NICE that there is enough evidence for that, for that, for that, for that, but it comes from a very personal level. You want to call it professional, maybe, but it’s a professional, personal level. And then people are becoming more open, and they look for solutions, how to find resources. Maybe sometimes it’s based on research, it might be based on other solutions, let’s say, or other other way to finance it and so on. But that’s the start.

Dr Penny Kechagioglou
And you clearly through the, um, SIO and being an ambassador of the society of integrative oncology, you try to open those conversations, aren’t you? Amongst the professional patient advocates, people with lived experience. And how can we attract more clinicians and even, you know, people who are working in policymaking, we need them. I know we can approve and write guidelines. However, those needs to be endorsed by every nation process, isn’t it? And that needs the endorsement of the clinical professionals first before, let’s say, royal colleges approve those guidelines and we get a session on the European conferences, like the Astro coming up, for example, for radiation oncologist, and we need the integrative medicine aspect to picture in every, every conference that deals with cancer, in my view.

Prof Eran Ben-Arye
Yeah. I mean, in order to collaborate, you need to offer something that they really need. And one of the ways to do that is to co-author articles and to submit that to the leading UK Germans, which are, you know, the shipping Germans in the world, the BMJ, the Lancet, and so on. I mean, the way to do that is really to target the work that you do together, the model that you design into those publications. When their names and your name is in the same article, there is a scientific impulse that generates something that is beyond pure talking or purely presentation in one of the many… That’s the way to do that. You know, years ago, Catherine Zollman wrote a column or something like that, you know, in the BMJ about complementary medicine. What was it? 25 minutes ago or something like that.

Prof Eran Ben-Arye
But actually, the Lancet and the BMJ are not so open to that. But I think that, you know, as the UK ambassadors, I mean, what you do and what Catherine does, and Nina, and so on. I mean, I think that’s the most important aspect, to write together, to publish together, and to be able to receive recognition from the academy, academic appointments, and so on. I mean, that should be the way, as I see it. It works together, you know, the clinical realm, the medical education realm, and the research realm. That’s the way politics, and when I’m saying politics, it’s not a bad politics, but the way to advance recognition through working together in a very conventional language, and they would be delighted, I think, to have that opportunity to write in a way that would be more creative,

Prof Eran Ben-Arye
multidisciplinary, something that they are looking maybe interesting, let’s say, and actually integrated oncology and integrated medicine is a great coin today in order to get academic recognition. It’s not like it was in the past, you know, that if you do those things, that your witchcraft, and so on, and it’s more accepted. And when people see that you are a serious person, and you publish, and you do that within a multidisciplinary group of people that are leaders in the field, the acceptance will derive. And I really believe that, and I think that we can all assist each other in order to promote that. I don’t know why it is like that, but you know, when you share this, when you ask a person from abroad, you know, the prince from abroad, to be part of that, it generates an impulse, you know, people don’t recognize usually what talent they have in their own country. When it’s international, they open the gates more willingly.

Dr Penny Kechagioglou
That’s a great message, you know. I think writing is really important, authorship, publications. They are very, very powerful.

Robin Daly
Mm, marvelous advice. Yeah, thanks so much. We’re going to have to end it, but actually, it’s been so great to hear. You’re so thoughtful on this subject. You’ve got so much experience. You’ve been absolutely up to your neck in it for years, and it’s really great to hear what you’ve learned.

Prof Eran Ben-Arye
Thank you for your inviting me.

Dr Penny Kechagioglou
That’s just a fantastic insight of how to build a scale and integrative oncology model around and you are definitely my role model in this one. Thank you so much.

Robin Daly
Thank you for listening to CancerTalk. Do subscribe and look out for the next edition of our podcast. And if you have friends and colleagues interested in the development of UK Cancer Care, do pass on the details of CancerTalk. Goodbye.