For much of my career in cancer care, I have seen a contradiction play out in the exam rooms of my colleagues and across the country. Cancer patients ask how to manage pain, fatigue, anxiety, immune suppression, and the daily toll of the disease. Clinicians often prescribe only medication, even though they know other evidence-based treatments could help: acupuncture for chemotherapy-induced nausea; exercise and nutrition counseling to improve clinical outcomes; and mindfulness-based programs to ease distress, sleep problems, and even immune dysfunction.
When doctors and patients do discuss these treatments, too often the conversation ends with a shrug: “Insurance doesn’t cover that.”
This disconnect is indefensible.
Over the past two decades, the field of integrative oncology — the evidence-informed use of mind-body practices, lifestyle interventions, and selected complementary therapies alongside conventional cancer treatment — has evolved from a fringe idea into a mature clinical discipline. The field now has clinical practice guidelines jointly developed by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), and recommendations embedded throughout the National Comprehensive Cancer Network (NCCN) guidelines.
When ASCO and NCCN agree that a treatment is effective and safe, that should carry decisive weight in coverage decisions. Yet coverage remains inconsistent, fragmented, and inequitable. This is no longer primarily a scientific problem. It is a policy failure.
Integrative oncology earned legitimacy by embracing science and evidence-based medicine. Leaders in the field demanded better research, standardized methods, and clinical trials to confirm safety and efficacy. We studied what patients were already using, rigorously tested what worked, and built clinical guidelines grounded in evidence rather than ideology.
That approach paid off. Randomized clinical trials and meta-analyses now show that specific integrative interventions meaningfully reduce cancer-related pain, fatigue, anxiety, depression, sleep disturbance, neuropathy, hot flashes, and treatment-related nausea. Many of these outcomes are not subjective. Integrative oncology therapies can influence immune function, inflammation, stress hormones, and patients’ ability to tolerate and complete lifesaving therapies. Better symptom control often means patients stay on treatment longer and recover better.
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This evidence base is why ASCO endorses integrative oncology guidelines and why NCCN incorporates integrative therapies throughout symptom management pathways. Acupuncture is recommended for pain and nausea. Mindfulness-based interventions are recommended for anxiety, depression, and fatigue. Exercise and nutrition counseling are no longer optional extras. They are foundational components of comprehensive cancer care.
We now tell patients these interventions work, then ask them to pay for them out of pocket.
In the United States, access to integrative oncology often depends on where a patient lives, which insurer they have, or whether their employer negotiated the right benefits. Two patients with identical diagnoses can receive very different supportive care based not on science, but geography.
That inequity has no place in evidence-based medicine.
If a therapy is recommended by SIO, ASCO, or NCCN guidelines, it should be covered. At a minimum, coverage policies should align with the same evidentiary standards used to develop those guidelines. These guidelines are built using the standards applied to chemotherapy, radiation, and supportive medications. Insurers routinely cover extraordinarily expensive drugs with modest benefit. Failing to cover lower-cost, evidence-based integrative therapies makes little clinical or economic sense and perpetuates a two-tiered system of care.
Even on economic grounds alone, failing to cover these evidence-based services undermines both efficiency and value-based care. Acupuncture sessions cost far less than nerve blocks. Group-based mindfulness programs cost a fraction of an emergency department visit for uncontrolled symptoms. Exercise and nutrition interventions reduce downstream costs related to deconditioning, metabolic disease, and hospitalizations, not to mention progression or recurrence of disease.
Coverage gaps are not accidental. They reflect deliberate choices.
Many insurers still view integrative therapies as optional, rather than as evidence-based components of cancer care, despite recommendations from major oncology organizations. Some coverage policies may also reflect outdated perceptions of these interventions rather than the current state of evidence. In addition, many of the benefits appear as avoided complications, better symptom control, fewer
hospitalizations, and better treatment adherence, making them less visible than the
immediate cost of providing the service.
As integrative oncology has matured, so have the research questions. Early work focused on symptom relief and quality of life. That research was essential and remains so. But the field is now asking deeper biological questions and doing so using the most rigorous scientific methods. Some of this work remains in an early stage, but it reflects a broader shift toward applying rigorous methods to previously untested questions.
One of the most controversial areas of recent investigation involves biofield therapies: approaches such as reiki and healing touch, where practitioners gently touch clients or hold hands above the skin without touching. For decades, these therapies were dismissed by mainstream researchers because they relied on subjective outcomes and lacked plausible biological mechanisms. Recently, researchers have started investigating more objective outcomes, studying immune markers in clinical trials and controlled preclinical experiments designed to eliminate placebo effects. This line of inquiry reflects how integrative oncology has evolved as a discipline: by applying modern scientific tools to questions patients have long been asking.
My colleagues and I have examined whether biofield therapy could produce measurable biological effects in a series of preclinical studies. In work we recently reported in Cancer Medicine, we found that biofield therapy delivered through a standardized protocol was associated with significant inhibition of growth and invasiveness of pancreatic cancer cells in vitro, along with reduced liver metastasis in mouse models. At a cellular level, this included changes in mitochondrial structure, cell cycle regulation, membrane voltage potential, and key oncogenic pathways, including FOXM1, a major driver of cancer proliferation and metastasis. Our earlier studies in lung cancer models showed changes in immune cell infiltration, macrophage balance, and tumor necrosis, findings consistent with others.
We do not yet know what these findings mean clinically. That uncertainty is exactly why more careful study is essential.
The uncertainty exists alongside a clinical reality many health care professionals already recognize. The Department of Veterans Affairs now includes biofield therapies such as reiki, healing touch, and therapeutic touch among its integrative health offerings. Across major U.S. hospitals, these approaches are quietly becoming part of routine supportive care, often delivered by trained nurses working alongside conventional medical teams.
Cancer patients are already exploring these therapies. Ignoring that reality does not protect them; it abandons them. The ethical responsibility of medicine is not to prematurely endorse unproven approaches, but neither is it to dismiss promising signals because they challenge existing frameworks.
If biofield therapies ultimately prove ineffective in clinical settings, patients deserve to know that so they can direct their time, energy, and money elsewhere. If they prove helpful for specific outcomes or populations, we have an obligation to define those boundaries clearly and responsibly. Either way, we need more study, not silence. The worst option is intellectual inertia.
Integrative oncology’s future no longer hinges on scientific credibility. That work has largely been done. What remains is a lack of political will.
The evidence has advanced. Coverage policies have not. Medicare, Medicaid, and private insurers should update coverage policies to reflect NCCN and SIO-ASCO recommendations, just as they update coverage when other standards of cancer care evolve.
Mandating coverage aligned with these guidelines would immediately expand access, reduce disparities, and bring cancer care closer to what it claims to be: evidence-based and patient-centered. Our health care system must keep pace.
Cancer patients deserve care guided by evidence, not by what insurers choose to cover. So do the clinicians trying to practice evidence-based medicine within a system that has not yet caught up with the science.
Lorenzo Cohen, Ph.D., is a distinguished professor and integrative oncology researcher at a cancer center in Houston, co-author of “Anticancer Living: Transform Your Life and Health with the Mix of Six” (Penguin Random House), and a stage 3 melanoma cancer survivor.
