Integrative Oncology with Dr. Santosh Rao - Ad Hoc with a Doc

Dr. Santosh Rao, a board-certified medical oncologist and the medical director of the integrative oncology center at Banner MD Anderson in Gilbert, AZ speaks with Dr. Rubin about the integrative oncology program he's helped to curate.

Together, the doctors discuss what a patient visit is like at the Banner MD Anderson Cancer Clinic, where integrative medicine is heading, as well as some of the present stumbling blocks for naturopathic and integrative medicine at a larger cancer center.

Find out how Dr. Rao advocates for naturopathic oncology among his colleagues, and why in the interview below:


Rubin: Hi, I'm Dr. Dan Rubin with another episode of Ad Hoc with a Doc.  Thank you for joining us.  I am honored to be here with a friend and colleague, and wonderful physician, Dr. Santosh Rao, thank you for being here.  


Rao: Thank you.


Rubin: Dr. Rao, you are a board-certified medical oncologist you specialize in genitourinary oncology and you're also the medical director of the integrative medical…the integrative oncology center at Banner MD Anderson in Gilbert, Arizona, correct?


Rao: Correct.


Rubin: Wonderful, and I know of the work you've done and are continuing to do because we've shared patients before, and everybody speaks so highly and wonderfully of your work.  I visited your Center it's lovely, it's on a lovely campus, it's designed beautifully, but take us through what a typical first patient visit to the integrative center would look like.


Rao: Sure, thanks.  So, we do a variety of things, so different people will come for different reasons.  We pretty much span prevention of cancer, all the way through cancer survivorship.  So, on the prevention side, there's a lot of work that's being done on what we call our tobacco recovery program.


Rubin: Okay.  


Rao: So, some people will come in for a very multidisciplinary program using health psychology, some medications, acupuncture to help with tobacco cessation.  


Rubin: Wonderful.

Rao: On the integrative side, we have now four integrative providers, I'm one of them.  And so we, on an initial visit, somebody will basically do an intake where we talk about what are your concerns…and everybody is at a different stage at where their cancer is and their treatment, so a lot, it's very personalized, and it's really just kind of assessing okay…what are your side effects from treatment, what are your concerns?  Some people are just interested in prevention – 


Rubin: Prevention of recurrence?


Rao: Prevention of recurrence; it may even be prevention of cancer, but usually prevention of recurrence, diet, what your stressors are, and what…how you relieve your stress, sleep, issues related to spirituality…


Rubin: Okay, interesting.


Rao: Exercise, and then natural supplements.  Many of our patients come to us because they have all sorts of questions –


Rubin: I'm sorry; do they self-refer most of the time or are they referred from other oncologists?

Rao: They're referred from other oncologists right now, but they will ask for a referral if they need one.


Rubin: Got it.


Rao: And then we will go through all those things, and if we can address all those areas, we will, otherwise, we'll have a follow-up.  And then we have a team which is great, so we have a health psychologist, we have yoga practitioners, we have multiple acupuncturists, massage therapists, various people, dietician…so we want to use all these different people and we'll personalize the use of these individuals for what that individual needs.  So that's how a visit goes, basically.


Rubin: Do you have any naturopathic oncologist on staff?


Rao: We don't.  We've had a number of naturopathic oncology…or naturopathic students rotate.


Rubin: Okay, certainly.


Rao: And I have great respect for naturopaths and naturopathic oncologists.  I know that we've talked about patients before and we have a collaborative relationship.


Rubin: Wonderful.


Rao: It's something that has been brought up, but I have found that it's not been easy to penetrate for a couple of reasons.  One is having broad, you know, unified approval on bringing in a naturopathic oncologist.  You know, we work in a very conservative environment and so, you know, there's a kind of a fine line there in terms of what will be well-accepted and not. And then I've had trouble justifying, you know, the cost part of it because we cannot bill insurance, but all our programs are billed through insurance.


Rubin: Yeah, that has always been a stumbling block for us, is sort of intermingling the insurance versus the cash-based world.


Look, you’re not a pharmacist, right? So, why do we need a pharmacist? We’ve studied all these things in medical school. They’re specialists in that area, right? And the same thing with a naturopath, their area of expertise doesn’t completely overlap with our area of expertise, and there are some things they know better than I do.
— Santosh Rao. MD

Rao: Right, and I can't explain it to my colleagues, so when I’ve told my colleagues, they don't understand…they don't understand what naturopaths bring to the table; and I feel like I do, at least better than they do.  So, I explain to them that – “Look, you're not a pharmacist, right?  So, why do we need a pharmacist?  We’ve studied all these things in medical school.  They're specialists in that area, right?  And the same thing with a naturopath, their area of expertise doesn't completely overlap with our area of expertise, and there are some things they know better than I do.”


Rubin: Well said, thank you.


Rao: And they could not…they couldn't really understand that, and then the other part of it is you know…how am I going to tell the patient ‘You need to see our naturopath, but it's gonna cost you money’…you know?  We didn't know what the demand would be.  But personally, I'm in favor of that, and I know a lot of others are as well.


Rubin: Well, that's one stumbling block, I imagine there's been several along the way.  What are a few key stumbling blocks that you've overcome, or maybe, that are still in your way if you will?


Rao: Well, I think that there are certain things that we can't do in our center, for example, we don't offer medical marijuana. That's just part of being in a – 


Rubin: You mean recommendations, not the actual product?


Rao: Right, well, we recommend medical marijuana, but we have to send somebody out to get it.


Rubin: Right, all right, so you're saying you don't have a dispensary?


Rao: Correct, yes.


Rubin: Because that would have been a big deal.


Rao: That would have been a big deal, but those kinds of things you just can't offer in, you know, a main Cancer Center.


Rubin: Sure.


Rao: I think other things…


Rubin: I think, hold on, I think it's a wonderful idea though.


Rao: Oh, yes.


Rubin: Thank you for broaching the subject, because do the oversight and the ability to really work with the patient one-on-one on the types and how to use it etcetera.  So, okay, interesting.


Rao: I think someday that'll be better accepted.


Rubin: Yeah.


Rao: I think it's just, politically we're not quite there yet.


Rubin: Okay, well I think it's great that you're that there's not a stopgap for you to be able to make a recommendation.


we want to do what we think is not only scientifically evidence-based but also well accepted.  Those things are not exactly the same thing. 
— Santosh Rao. MD

Rao: I'd be all for it.  But beyond that, I think, you know, we’re conservative in the sense that we want to do what we think is not only scientifically evidence-based but also well accepted.  Those things are not exactly the same thing.  To some people they are, but I think that sometimes we often will do something that's not quite, you know, scientifically proven, but is well accepted.


Rubin: Well, and also, we know clinically works, and I think, you and I have talked about that.  Which, you know, you're a physician, and just because there's lack of data doesn't necessarily mean lack of efficacy, but that might be a stumbling block in an academic institution.


Rao: Right, and you know, more than anything else, it's a closed environment, so because it's not a private practice where you're really just dealing individually with patients, you're dependent on, and have to answer to in many occasions, to your colleagues who are consulting you.  And that's good, I think it can kind of actually strengthen the practice, but at the same time you may not do everything you just feel like. You have to substantiate it and I think all those things can be healthy.


Rubin: Agreed.


Rao: But it's just, the pace at which you have to move is really dependent on where the science is.


Rubin: Understood, got it.  Wonderful.  Well, you are certainly a unique practitioner, and I'm very curious; from your viewpoint from where you stand, what's the outlook, then, for integrative oncology from your perspective?  What do you see? 


Rao: Yeah, I think that first of all, it's so well accepted now, you know, whereas when I started it was something that I had trouble talking about; now everybody talks about it, and there are many people who are, in some way or another, even if they don't say they're an integrative practitioner are interested in doing research in some of these areas. So, it's become in vogue.  It's not difficult to tell somebody you're interested in integrative, it actually can be a job creator instead of a job killer that way.


Rubin: Interesting, well put.


Rao: I think it's more popular than it ever was, patients are interested.  I think where we're going, though, is gonna depend on how much funding we have for research.  I think if you look and I'm talking from an oncology perspective, there are so many billions of dollars spent on oncology research and drug development, and I feel like that's far ahead and outpacing the research in these other integrative areas especially in things like natural supplements.


Rubin: Mm-hmm.


Rao: And so, we're making great strides on conventional treatment, which is amazing, but if the integrative side is going to catch up at all, it has to catch up in terms of research.  Especially now that we're getting more and more precise, what we really need to know is the mechanisms for how these things work. I think testing and personalizing and really being very precise with how we apply things…we don't even understand the dose and the effective dose for a lot of natural supplements for example. We don't understand the mechanism of action for things like acupuncture and Reiki.  There are so many things we don't know.


Rubin: Yeah.


Rao: And so, when you're working in a system where we're really, really, really fine-tuned with our understanding of cancer and drugs, and then on the flip side you have all this stuff that you think works, but you have no idea about the precise nature of how, or how to apply it, that's a misfit.  So, I feel like eventually, that's where things have to go, and then we'll get a better appreciation of where, and how important some of these things are.


Rubin: Wonderful, I think it sounds like a wonderful intersection because we can certainly extract an isolate from a plant or call it a natural supplement and then figure out the mechanism that we're dosing it upon and then figure out, you know, the effective dose based on the parameters of the study.  But talking about Reiki or acupuncture and mechanisms of action, I'm curious if you think that science has to catch up to those mechanisms before we can elucidate what we believe the mechanisms are because they're so energetic in nature.  And I mean, if we stick a needle into an area that may have an anatomical specialized neurological structure that's one thing, but Reiki?  Very curious how somebody who's so interested in energy medicine would see an intersection here, what are we, you know early 2019?  Do we think that there even could be a scientific explanation for Reiki if that were subjected to study?


Rao: I think so.  I think that it's not a popular thing to talk about, even on the integrative side.  It's considered just, kind of, we don't understand.


Rubin: Is it too soft?


Rao: No, I think that because people don't understand the science behind it, it's thrown into this bag of, you know, ‘does it even work’ or is it, you know, ‘is it placebo’ etc…but it's interesting to me – 


Rubin: Seems highly advanced, I would say, if we were to look into it.


Rao: Yes, but at the same time, it's also very popular.


Rubin: Mm-hmm.


Rao: And so, it's interesting to me how it's offered in so many places even though we don't understand it.


Rubin: Yes, good point.


it’s fine if people want to kind of believe in in the way that those modalities are explained, but I would like things to have a common scientific expression.
— Santosh Rao. MD (On what it will take for certain modalities to gain acceptance for use in treatment)

Rao: But for me, I think that we can learn a lot by studying things that we don't understand.  I think the other part of it that I find challenging…there's various different energy healing modalities and I've studied many of them.  And I think that the way they're taught, and the explanations that are given kind of fly in the face of science.  And, you know, it's fine if people want to kind of believe in in the way that those modalities are explained, but I would like things to have a common scientific expression.  Where we don't…you don't have to believe in something that is very difficult to explain, you know, and I think they lose people probably there.  Anybody who actually studies any of these things, it gets a little bit ‘out there’.  And so I think, for me, as somebody who actually has done these things and experienced them and seen how they can affect people, I really do believe there's something real, and let's start from there as really getting a sense of what's going on, and what are the real clinical impacts. And some of that stuff has already been studied, but I think just more elucidation, and you know major centers, like Cleveland Clinic, does a lot of research using Reiki in various areas.  And so, I don't think it's necessarily so alternative you can't study it, but that's one example of a modality that is not accepted by everybody whether it's conventional medicine or even in the integrative side, and I think it's just a lack of understanding, or the way it's explained.


Rubin: Well, Dr. Rao, thank you so much for being on Ad Hoc with a Doc, I appreciate it.  It's been wonderful to sit and talk with you in this regard and your words really seem truly spoken from the heart of a true integrative oncologist.

Rao: Thank you so much, I really appreciate it.

Michael Nelson