Rapid-onset disasters pose a particular challenge to oncology services, especially radiation oncology, which is highly technical and dependent on complex equipment and digital infrastructure. Thoughtful preparation can anticipate vulnerabilities and improve disaster response; however, recommendations are still emerging and individual clinics are largely left to develop and activate their own disaster preparedness plans. A principled conceptual framework for system design is therefore needed. In this article, we discuss such a framework, mapping disaster preparedness considerations onto the widely-used Donabedian model of healthcare quality, which evaluates care across 3 interdependent domains: Structure, Process, and Outcome. We draw on examples from outside oncology-including humanitarian surgical programs and institutional pandemic responses-that have applied this model at the clinical and operational level. We demonstrate that previously reported experience of disaster response in radiation oncology maps coherently onto this framework, and we present specific design principles and practical approaches that organizations can employ. Current guidance from professional societies and accreditation bodies is reviewed, and future directions-including formal risk assessment and commercial disaster-recovery solutions-are discussed. When thoughtfully applied, these principles of system design can help oncology programs build meaningful resilience before the next disaster arrives.
Radiation oncology departments are uniquely vulnerable to disruptions such as cyberattacks, pandemics, and natural disasters, which can result in unacceptable treatment delays. Using the National Academy of Medicine Crisis Standards of Care framework and lessons learned from the University of Vermont Medical Center cyberattack, an ethical framework is proposed to guide decision making in radiation oncology during a crisis.
Radiation oncology incident reporting requires consideration of several parallel authorities and systems: Federal authorities governed through NRC Code of Federal Regulations, Agreement State regulations, additional state laws and regulations, voluntary reporting through incident learning systems such as the Radiation Oncology Incident Learning System (RO-ILS), and hospital enterprise safety platforms. Each system serves a distinct purpose and addresses a different audience. A single serious incident can activate multiple platforms simultaneously. Forty states have assumed Agreement State status with the NRC, and their reporting thresholds, timelines, and procedural requirements can differ substantially from the federal baseline. Many states have their own additional laws, regulations, and licensing requirements. Most hospital safety reporting systems were designed to capture and describe general medical incidents rather than radiation therapy incidents. As such, RO-ILS is a specialty-specific online safety tool administered through the Clarity Patient Safety Organization (PSO), with accompanying confidentiality and privilege protections outlined in the federal Patient Safety Act. The current goals of PSOs and incident learning systems are to reduce errors, improve quality, and promote safety. We describe the institutional model developed at UCLA, centered around the Quality and Safety Oversight Committee (QSOC) and a Medical Event Determination Committee (MEDC), which serves as an authoritative triage body for incident reportability determinations. The MEDC convenes within 24 hours of incident discovery, makes reportability determinations, and works with the institutional radiation safety officer to produce the necessary documents for reporting. This framework is replicable and adaptable to programs of any size.
Quality improvement in radiation oncology has historically focused on technical precision, yet the management of acute medical emergencies during the radiation course remains under-addressed. The radiotherapy environment is defined by patient isolation and immobilization paired with high-density shielding and remote monitoring, creating a unique barrier to rapid intervention. This review analyzes critical scenarios including cardiac arrest, pediatric anesthesia complications, cardiac device malfunctions, and acute neurological events, along with other acute medical scenarios. By synthesizing current guidelines and modern data, we propose institutional frameworks to ensure clinical resilience and foster a culture of safety for this vulnerable patient population.
Radiation oncology is uniquely vulnerable to disasters and emergencies because safe treatment depends on specialized infrastructure, accurate treatment-state information, coordinated multidisciplinary workflows, and continuity across multiple fractions. Disaster preparedness and emergency management are therefore core components of safe, timely, and effective cancer care rather than separate administrative obligations. In radiation oncology, emergency management includes acute clinical events and immediate operational response, whereas disaster preparedness includes mitigation, continuity planning, recovery planning, and institutional learning after large-scale or sustained disruptions. Natural disasters, cyberattacks, pandemics, equipment failures, medical emergencies, and infrastructure interruptions differ in mechanism but converge on a common operational problem: how to continue time-sensitive, technically complex treatment when usual systems are unavailable. This special issue examines that problem from multiple perspectives, including acute medical emergencies during treatment, MR-specific safety hazards, incident reporting, cyber resilience, workflow redundancy, software tools, natural disasters, pandemic planning, ethical decision-making, trainee roles, and resilient system design. Across these topics, several themes emerge. Generic health care emergency plans must be translated into radiation oncology-specific workflows. Business continuity must become treatment continuity; data backup must become usable treatment-state knowledge; and facility resilience must include safe recommissioning and quality assurance. Preparedness also requires trained personnel, clear authority, scalable plans across practice settings, tested downtime procedures, communication pathways, transfer agreements, recovery processes, and post-event learning. Ultimately, continuity of radiotherapy should be regarded as a clinical outcome worthy of deliberate protection across the care continuum.
The Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO) collaboratively developed evidence-based guidelines supporting selected integrative therapies for common cancer-related symptoms, specifically pain, cancer-related fatigue, depression, and anxiety. Despite growing evidence supporting their use, implementation in routine oncology practice remains limited. In this review, we summarize the SIO-ASCO guidelines and examine barriers to their implementation in clinical settings. We then explore strategies to improve guideline adherence using a "carrot and stick" framework that combines incentive-based approaches with accountability mechanisms. Finally, we present practical strategies to integrate the SIO-ASCO guidelines into routine clinical care. We conclude by discussing future directions for implementing integrative oncology in real-world clinical settings. These approaches aim to overcome the barriers associated with guideline adoption in clinical practice, supporting the widespread use of evidence-based integrative therapies across academic and community settings, improving patient symptom management and quality of life, and ensuring equitable access to integrative therapies for all patients. Together, these efforts will help to establish integrative oncology as a standard part of routine cancer care.
Radiation oncology has long paired precision with compassion, technical excellence with daily human connection. Integrative oncology extends that legacy, advancing a shift from reactive symptom management to proactive, coordinated care; from fragmented referrals to integrated pathways; and from isolated pilot efforts to implementation-ready science. In this volume of Seminars in Radiation Oncology international experts reflect on the collective toolbelt of integrative oncology, the maturation of the science, and the exciting opportunity before us in radiation oncology. By integrating complementary approaches alongside conventional treatment, integrative oncology seeks to improve symptom control, functional outcomes, treatment adherence, and quality of life, with emerging evidence supporting benefits in disease-free and overall survival in select settings. Integrative approaches include nutrition and the microbiome, physical activity, mind-body and nature-based interventions, acupuncture and East Asian medicine, Ayurveda, massage and manual therapy, yoga, tai chi, qi gong, music therapy, stress management, sleep medicine, herbs and supplements, psycho-oncology, and supportive care. Across this collection, three central themes emerge: (a) patient-centered care targeting symptoms that matter most to patients and caregivers; (b) data-driven practice grounded in clinical trials, guidelines, and mechanistic science; and (c) operational compatibility with radiation oncology workflows. We hope readers leave with two clear outcomes: practical integrative strategies applicable to patients beginning radiation therapy tomorrow, and a sharper understanding of the research and systems infrastructure required to make integrative oncology a standard and equitable component of care. The work presented here signals a structural evolution -aligning tumor control and survival with symptom science, biologic insight, and whole-person care. In doing so, radiation oncology is uniquely positioned not merely to participate in, but to lead the redefinition of integrative cancer care for the decades ahead.
Radiation therapy (RT) is central to cancer treatment, yet pain from RT-related toxicities remains common and often inadequately controlled with pharmacologic care alone. Integrative medicine modalities are increasingly used to complement standard analgesic strategies, but their role in RT-related pain has not been comprehensively synthesized. In this narrative review, we summarize clinical evidence for nonpharmacologic approaches to RT-related pain, including acupuncture, massage, hypnosis, yoga, and exercise. We further include strategies for incorporating these modalities across the RT care continuum, from pretreatment assessment and on-treatment symptom control nonpharmacologic strategies may reduce pain, while some may also reduce analgesic use or improve quality of life, supporting a more proactive, integrative model of pain management in RT. However, further rigorously designed prospective studies focusing on radiation-related pain and care delivery process are needed to examine the specific efficacy and optimal integration in the context of radiation oncology.
Integrative oncology interventions for patients undergoing radiation therapy (RT) may relieve symptoms (including procedural anxiety) and improve quality of life, though gaps remain in the evidence base to adequately guide implementation efforts. In this article we review clinical trials specifically for psychological (ie, mindfulness), physical (ie, exercise, acupuncture), and combination approaches (ie, yoga, tai chi, and qigong), in which several symptom-based clinical outcomes are impacted (ie, fatigue, sleep disturbance, pain, mood, and xerostomia). We identified at least 90 clinical trials and 15 systematic reviews and meta-analyses related to this topic, but note the predominance of early-phase investigations and some heterogeneity in study findings. We also assess opportunities across the radiation treatment continuum, noting most interventions were targeted during active radiation treatment. Future research ought to leverage novel hybrid study designs and multi-center community-based clinical settings (including cooperative groups) to confirm effectiveness and generalizability of findings of existing earlier phase clinical trials. Meanwhile, opportunities to improve clinical trial efficiency such as integrating advanced practice providers and patient-reported outcomes in routine care should be considered. As a field with procedural elements, established symptom trajectories, and often daily patient engagement, radiation oncology is poised to develop and implement interventions that advance symptom science and clinical outcomes for patients with cancer.
Breast cancer remains one of the most commonly diagnosed cancers worldwide. Cancer treatments often cause a variety of physical and psychological symptoms that can last beyond the end of therapy. This article reviews the current evidence on integrative medicine approaches, including diet, exercise, and other modalities studied for managing symptoms often reported by breast cancer survivors. For each symptom, we highlight integrative medicine interventions with the strongest available evidence, including mind–body approaches (eg, mindfulness-based interventions, yoga, and hypnosis), acupuncture, massage therapy, and selected dietary supplements. This symptom-focused framework aims to help clinicians identify integrative interventions that, based on the existing evidence, may be suitable for addressing individual patient concerns.
Prostate cancer is most common malignancy among men in the United States. As men are now living longer with prostate cancer due to advances in treatment, there exists a growing need to manage the long-term physical and psychological sequelae of this disease, which range from genitourinary dysfunction to cardiometabolic and psychosocial consequences. Over half of men with prostate cancer report unmet needs in symptom management. Integrative oncology, a patient-centered, evidence-informed field combining lifestyle, natural product, and mind–body interventions with conventional treatments, offers a promising approach to prostate cancer symptom management. This review summarizes the current landscape of integrative oncology research in prostate cancer and discusses the clinical implications.
Studies show that patients with cancer use herbal products more often than the general population. Lowering the risk of disease recurrence, symptom control, and improving quality of life are often the reasons cited for such use. However, a major concern is that few patients communicate with their oncology providers about such use. Although herbal products are perceived as natural and safe, they can lead to adverse effects and interact with prescription medications, including cancer treatments. Herb-drug interactions can render some treatments less effective or potentiate adverse effects of others. Therefore, patient-physician communication is critical to guide safe and appropriate use of herbal products and to minimize potential harm. The About Herbs website, developed and maintained by the Integrative Medicine and Wellness Service at Memorial Sloan Kettering Cancer Center, contains up-to-date, evidence-based information on purported uses, adverse effects and herb-drug interactions for 317 and growing number of herbs, vitamins, and other dietary supplements. The 5 most frequently accessed entries in 2025 were ashwagandha, Boswellia, active hexose correlated compound, reishi mushroom, and turmeric. In this article, we describe their uses and current evidence of effectiveness in oncology settings including radiation treatment.
The purpose of this review is to examine lifestyle-related risk factors for digestive tract cancers, outline integrative oncology strategies for managing nutrition and gastrointestinal symptoms during treatment, and summarize post-treatment recommendations for reducing cancer risk. Key modifiable lifestyle factors in both the prevention and survivorship setting include engaging in regular physical activity and consuming a diet rich in plant-based foods with limited red meat and processed foods. The review also centers integrative approaches to manage gastrointestinal toxicities due to radiation therapy and/or chemotherapy, including practical nutrition tips, mindfulness-based interventions, tai chi/qigong, yoga, acupuncture/acupressure, and selected natural products and herbal supplements. We aim to offer clinicians a holistic framework for caring for patients with digestive tract cancers and to provide both clinicians and patients alike with pragmatic, evidence-based integrative strategies that can reduce risk of cancer, complement pharmacologic treatment, and improve survival.
The purpose of this review is to provide a practical and clinically relevant overview of the role of the microbiome in the development and treatment of digestive tract cancers. We describe the established associations between microbes and malignancy, such as Helicobacter pylori and Fusobacterium nucleatum, in gastric and colorectal cancer, respectively. We also review emerging evidence identifying additional microorganisms that may play a role in digestive tract cancer initiation and progression. We discuss the impact of microbial composition on the efficacy and toxicity of cancer-directed therapies, including radiation therapy and systemic chemotherapy. Beyond outlining gut microbial risk factors, we also highlight interventions on the oral and gut microbiome to prevent or alleviate symptoms associated with dysbiosis, along with proposed strategies to improve therapeutic outcomes in the future. Finally, we examine opportunities to support gut microbial health, including suggestions to reduce exposure to environmental toxins that may increase cancer risk.
Physical activity has demonstrated positive impact on cancer outcomes, including survival and quality of life, in patients throughout the trajectory of cancer treatment. Government and leading health organizations have included exercise among cancer-prevention guidelines based on substantial evidence demonstrating clear benefits, including reductions in treatment-related side effects, higher chemotherapy completion rates, improved physical fitness and functionality, and increases in health-related quality of life. Despite clear consensus-based recommendations, a gap exists between what is known to benefit patients with cancer and the implementation of an intervention which has consistently demonstrated a positive impact on patient outcomes. It is critical to develop customized programming, reimbursement and thoughtful strategies that consider both patient and provider barriers to implementing exercise as part of cancer treatment.
Radiation therapy is a cornerstone of cancer treatment, but it is often associated with a range of acute and late toxicities that can significantly impact patients' quality of life. Integrative oncology, which combines conventional cancer treatments with evidence-based complementary therapies, is gaining increasing recognition as a means of managing these side effects and improving patient well-being. Acupuncture, a key component of traditional Chinese medicine, has emerged as a promising intervention for a variety of radiation-induced toxicities. This review synthesizes the current evidence for the use of acupuncture in managing common side effects of radiation therapy, including xerostomia, fatigue, pain, nausea and vomiting, and oral mucositis. We also discuss the proposed mechanisms of action of acupuncture, the challenges in acupuncture research, and future directions for the field. The evidence suggests that acupuncture is a safe and effective intervention for several radiation-induced toxicities, and its integration into routine oncology care has the potential to improve patient outcomes and enhance survivorship.
