Integrative oncology – the medical community must take responsibility

Kristina Lindemann

doi:10.4045/tidsskr.25.0807

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Integrative oncology – the medical community must take responsibility

Norwegian

Kristina Lindemann

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Kristina Lindemann

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klinde@ous-hf.no

Kristina Lindemann PhD, specialist in obstetrics and gynaecology, senior consultant at the Section for Gynaecological Cancer and head of the Centre for Gynaecological Cancer at Oslo University Hospital. Professor at the University of Oslo. She leads the National Quality and Competence Network for Gynaecological Oncology in Norway and is a member of the scientific committee of the Nordic Society of Gynaecologic Oncology – Clinical Trial Unit (NSGO-CTU).

The author has completed the ICMJE form and declares the following conflicts of interest: she has received consultancy fees from AstraZeneca, Nycode, GSK, Eisai, MSD and Regeneron, and speaker fees from GSK. She advises Karyopharm and, together with oncologist Elisabeth Areklett, is co-founder of LifeHouse, a non-profit retreat for patients during or after cancer treatment.

Article

Lifestyle, self-management and secondary prevention have a proven impact on health and quality of life after cancer. Nevertheless, the medical community has offered little in the way of structured, evidence-based patient guidance in these areas.

When medical care is primarily focused on diagnosing and treating tumours, there is a risk of neglecting the patient's overall well-being. This gap in care is often filled by individuals or organisations with varying medical expertise – particularly on social media – offering advice that is frequently unsubstantiated by evidence, potentially harmful and costly for patients. The fact that Norway's National Cancer Strategy 2025–2035 does not provide clear guidance on integrated lifestyle follow-up further reinforces this gap (1). A cancer diagnosis can be the catalyst for lifestyle changes, but follow-up must be evidence-based, and the medical community needs to engage actively in the public debate.

Gaps in the current cancer strategy

The focus of the National Cancer Strategy is on prevention, patient-centred care and comprehensive care pathways, but there is little detail on systematic, evidence-based lifestyle follow-up as part of treatment. One example is nutrition, which is primarily discussed in the context of cancer-related undernutrition and treatment-induced changes in appetite and nutrient absorption. Nutrition is therefore largely reduced to preventing undernutrition, rather than being an active intervention to improve prognosis, reduce long-term effects or lower the risk of subsequent cancers. The cancer strategy makes no mention of concepts such as integrative oncology and structured secondary prevention, and no clear guidance is offered on how to implement evidence-based lifestyle interventions.

When the health service does not offer structured, evidence-based guidance on lifestyle and self-management, patients must navigate these areas on their own, often relying on sources of varying quality

A growing patient volume – and a fragmented service provision

Nearly 350,000 people in Norway have or have had cancer; an increase of over 100,000 compared with ten years ago (1). Many live with chronic illness and considerable long-term effects. Cancer treatment is becoming increasingly complex, with precision diagnostics, tailored therapies and an ageing patient population with multifaceted needs. Health services are primarily structured around surgery, radiotherapy and pharmacological treatment, while interventions aimed at nutrition, physical activity, stress management and psychosocial care are fragmented and dependent on individual providers. When the health service does not offer structured, evidence-based guidance on lifestyle and self-management, patients must navigate these areas on their own, often relying on sources of varying quality.

Cancer as a catalyst of secondary prevention

Receiving a cancer diagnosis can be a powerful motivator for patients to consider lifestyle changes, an effect that may also extend to their families. This presents a unique opportunity for secondary prevention: preventing relapse/recurrence, new cancers, long-term effects and other chronic diseases. Lifestyle factors such as nutrition, physical activity, weight management, sleep and stress impact on the risk of cancer-related and non-cancer-related conditions, including cardiovascular disease and diabetes. Yet these factors are seldom structured elements of cancer care, with defined goals, appropriate expertise and ongoing follow-up. Meanwhile, unstructured or poorly substantiated lifestyle advice can increase stress, create financial strain, delay or discourage treatment, and, in the worst cases, compromise survival. The fact that many patients do not disclose their use of alternative therapies to their doctor further increases the risk of adverse interactions.

The medical community must take ownership of the entire patient journey and provide up-to-date, nuanced and practical advice

The medical community must take more responsibility

Patients and their families cannot be expected to distinguish between evidence-based and unproven information on their own. The medical community must take ownership of the entire patient journey and provide up-to-date, nuanced and practical advice. It is not enough to tell patients that they should 'live as normal'. The health service should actively support healthy lifestyle choices that promote physical, mental and social well-being, both during and after cancer treatment. This should be reflected in everything from hospital meals to structured follow-up after treatment. Nutrition, physical activity, stress management and psychosocial and sexual health should be held to the same standards of quality and evidence as surgery and pharmacological treatment. Internationally, several cancer centres have incorporated integrative oncology into treatment pathways, supported by a robust evidence base.

Norway should move in the same direction. If we do not address this need for evidence-based, multidisciplinary follow-up, others will. As a result, well-meaning but unsubstantiated advice may influence critical decisions, to the detriment of patients and public confidence in the health service.

Comments ( 1 )

Dette kommentarfeltet modereres, men kommentarer blir ikke redaksjonelt behandlet ut over å sikre at de følger retningslinjer for vårt kommentarfelt.

13.04.2026:

Lindemanns innlegg om integrativ kreftbehandling i oppfølgingen av kreftpasienter er viktig. I Norge faller deler av integrativ kreftbehandling inn under lov om alternativ behandling (1).

Slike behandlingsformer vet vi brukes oftest for å øke livskvalitet, håndtere stress, mestre sykdom og å bedre sitt velvære. De aller fleste kreftpasienter som bruker slik behandling, gjør det som supplement til helsetjenesten. Fra-valg av medisinsk kreftbehandling forekommer svært sjeldent hos brukere av alternativ behandling.

«Behovsvakuumet» som Lindemann omtaler, er betydelig i dagens kreftomsorg. Studier ved Nasjonalt forskningssenter innen komplementær og alternativ behandling (NAFKAM) viser at 40 % av den generelle norske befolkning har forsøkt alternativ behandling, mens dette forekommer bortimot dobbelt så ofte blant kreftpasienter (2).

Disse brukerne gir uttrykk for ønske om å diskutere deres «egeninnsats» med legen. Majoriteten opplever imidlertid utfordringer i kommunikasjonen, og informerer – ofte av frykt for avvisning – ikke legen. Når denne dialogen uteblir, kan sårbare pasienters behandlingsvalg bli stående uten medisinskfaglige korrigeringer.

Informasjonen om emnet er enorm, fragmentert og til dels polarisert. Pasienter eksponeres for feilinformasjon fra uregulerte kilder, som ikke imøtekommer ønske om troverdig, tydelig og praktisk informasjon om nytte og risiko, eller om og hvordan slik behandling kan kombineres trygt med ordinær helsetjeneste.

Samtidig er det unyansert å betrakte alternativ behandling ensidig som skadelig eller belastende for kreftpasienter. En kreftdiagnose utløser hos mange kreftpasienter et behov for å være aktiv og å ha kontroll. Brukere av alternativ behandling sier at de opplever dette, og at de tiltrekkes av alternative behandlere sitt helhetlige fokus og gode tid.

Det pågår forskning for at pasienter skal kunne ta kunnskapsbaserte valg av alternativ behandling. Eksempler på dette er akupunktur ved fatigue etter avsluttet brystkreftbehandling (3), og hvorvidt naturbasert rehabilitering har effekt på livskvalitet hos unge kreftoverlevere (4).

Grensen mellom legitime og problematiske alternative tilbud går ofte ved risikoen for direkte skade og interaksjon (f.eks. urter som interagerer med kreftmedisin) eller indirekte skade (forsinket diagnostikk og utsatt behandling). Legitimitet kjennetegnes av tiltak som støtter livskvalitet uten å motstride medisinsk behandling, i samarbeid med helsepersonell, og uten urealistiske terapeutiske løfter.

Litteratur:
1. LOV-2003-06-27-64. Lov om alternativ behandling av sykdom mv. Lov https://lovdata.no/dokument/NL/lov/2003-06-27-64om alternativ behandling av sykdom mv - Lovdata Lest 9.4.2026.
2. Nasjonalt forskningssenter innen komplementær og alternativ medisin. NAFKAM-undersøkelsen 2024. https://nafkam.no/nafkam-undersokelsen-2024 Lest 9.4.2026.
3. Høyskolen Kristiania. Acubreast. https://www.kristiania.no/forskning/forskningssamarbeid/acubreast/ Lest 25.3.2026.
4. Leithe I. Skal undersøke hvilken effekt friluftsliv gar på unge kreftoverlevere. NAFKAM 23.2.2024. https://nafkam.no/skal-undersoke-hvilken-effekt-friluftsliv-har-pa-unge-kreftoverlevere Lest 25.3.2026.

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Published: 23 February 2026

Tidsskr Nor Legeforen 23 February 2026 Vol. 146.

doi:

10.4045/tidsskr.25.0807

Received 22.12.2025, accepted 7.1.2026.

Published: 23 February 2026

Tidsskr Nor Legeforen 2026 Vol. 146.

doi: 10.4045/tidsskr.25.0807

Received 22.12.2025, accepted 7.1.2026.

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Integrative oncology – the medical community must take responsibility

Gaps in the current cancer strategy

A growing patient volume – and a fragmented service provision

Cancer as a catalyst of secondary prevention

The medical community must take more responsibility

Integrativ kreftbehandling og bruk av alternativ behandling

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