In recent years, the concept of “integrative medicine” has taken on a growing role in oncology care, pairing conventional treatments with complementary approaches aimed at improving quality of life, managing treatment-related side effects, and patient adherence. We spoke with Salvatore Bonanno, director of the Complex Radiotherapy Unit at the Siracusa Local Health Authority, to delve into the experience gained in this field and the prospects for developing radiotherapy that is increasingly mindful of the person as well as the disease.
Dr. Bonanno, the integration between conventional medicine and complementary medicine in oncology is an increasingly timely topic. What is your experience in terms of an integrated approach during radiotherapy?
«I’m convinced that medicine should also make use of integrated and complementary tools to pursue the ultimate aim of our work, which is the patient’s health. The desire to continually improve outcomes has led me to study different methodologies that the WHO defines as unconventional or complementary, provided they are supported by solid scientific documentation and validated by clinical experience. I believe expanding the array of therapeutic options is very useful, especially when patients face demanding and sometimes debilitating cancer treatments. An integrated approach, in fact, helps alleviate the side effects of the more burdensome oncologic protocols, better supporting the body and improving adherence to care».
Which integrative medicine disciplines or methods do you deem most suitable to accompany radiotherapy?
«There are several options, so careful selection is required. Indeed, many therapies and techniques exist; some of them, even centuries-old, originated in cultural and social contexts different from ours and rest on premises far from conventional allopathic medicine. Among the choices, herbal medicine is certainly the closest to us: it revisits the use of medicinal plants and herbs, today analyzed according to rigorous scientific criteria. However, great care is needed regarding potential interactions between plant active ingredients and oncologic drugs. In particular, when discussing isolated, titrated, and standardized phytotherapies with modern technologies, the clinician must possess deep field knowledge to ensure safe and effective use. In this sense, herbal medicine represents a valid option for those seeking to approach complementary therapies with a scientific mindset.»
Another field of great interest is acupuncture, which, thanks to the French school, has strongly entered Europe, translating a centuries-old system into a medical practice understandable in the West. However, a significant cultural effort is required to integrate its concepts—meridians, acupoints, Qi energy—into our view of health. In integrative oncology, essential oils also find space; they help modulate sensations and emotions and support emotional well-being: these are micromolecule-based tools that also require a scientifically grounded approach. Then there is the broad field of homeopathy, which I have been involved with for some time. This system offers a view of health and disease different from what is taught at our universities, but today it is the subject of interesting studies—especially in physics—that gradually delineate and refine its mechanisms of action. Parallel to this, medical research is building a body of evidence to translate homeopathic experiences into a language compatible with conventional medicine, thus fostering a more mature and open scientific dialogue aimed at overcoming prejudices often caused by a lack of knowledge».
What role do mind–body techniques play?
«They are fundamental for improving the patient’s quality of life. For example, I think of shiatsu, which I consider helpful in reducing fatigue, particularly for women who have undergone breast cancer surgery during treatment. Similarly, Eastern medical exercises like Tai Chi and Qigong prove very effective, especially when practiced outdoors in natural settings—parks or by the sea. These disciplines help the patient focus on the “here and now,” the ongoing therapy, lightening the weight of the future and strengthening inner awareness and resilience».
Can you share concrete experiences in this regard?
«Yes. We collaborate with a valuable group of volunteers from associations with whom we organized a canoe course, the “dragon boat,” an exciting experience I personally participated in. It is a rehabilitative practice that involves the shoulder girdle, particularly useful for women who have undergone breast surgery, but it is also a social endeavor: it fosters bonding among people who share the same cancer experience, helping them overcome it by focusing on a concrete and achievable goal. When practiced at the end of treatment, as often happens, this activity also facilitates social reintegration, creating networks of relationships and friendships that extend beyond the cancer experience. For us, it’s an opportunity to engage with professionals from other fields, from nutrition to psychosocial well-being, in the spirit of multi-professional collaboration».
Do these experiences manage to dialogue with the healthcare structure you lead?
«Most of these are activities promoted by volunteer associations or foundations, with direct involvement from professionals who chose to put themselves to the test, asking questions and nurturing doubt. In Italy, unfortunately, it remains difficult today to stably integrate these pathways into the public health system, though some experiences are being realized and consolidated. Acupuncture, for example, is now the most recognized and integrated practice within the National Health Service. Nevertheless, we are trying to integrate complementary therapies; for instance, we proposed acupuncture in the three-year projects proposed by the Ministry of Health. However, there are persistent challenges: regional fragmentation with uneven healthcare services, scarce funding and personnel, and limited diffusion of these methods. Despite this, the results of the initiatives started, even on a small scale, are very positive».
In what terms?
«First, in the quality of the doctor–patient relationship that forms, becoming more direct and empathetic. We can thus enter the person’s world, understand often unexpressed needs, and accompany them along the care journey. The real goal is to be present, to share, to build personalized solutions together».
What other benefits have you observed in patients undergoing integrated pathways, for example in managing radiotherapy side effects such as fatigue or mucositis?
«I can cite the experience with patients with head-and-neck tumors (ENT). In these cases, a multidisciplinary approach involving surgeons, oncologists, nutritionists, and rehabilitation specialists from the time of diagnosis is essential. I’ve established for these patients a support program based on supplements, phytotherapeutic extracts, topical therapies, etc.: this has kept side effects within very mild bounds and preserved good local and overall hygiene.
It doesn’t mean there aren’t side effects, but they tend to be more tolerable and, above all, adherence to oncologic therapies increases—crucial because stopping treatments can compromise effectiveness. I’ve also seen faster and higher-quality functional recovery, with a positive impact on daily life. In these pathways I’ve trialed less invasive methods, such as using plant-based anti-inflammatory agents as alternatives, at least temporarily and partially, to corticosteroids, or using acupuncture and homeopathy. At the core is a willingness to adopt a broader view of the care process: an approach that helps patients complete therapies and often even overcome the disease. This integrative medicine also carries a deep added value: it is born from and for people, bridging the traditional gap between doctor and patient. In this context, we’ve carried out interesting experiences of “narrative medicine,” building with the main stakeholders emotionally shared journeys also with high school students.
How important is building networks of professionals who share this broader view? What are the challenges and opportunities for consolidating integrative medicine in oncology?
«It is essential. With the ARTOI Foundation, of which I am the regional contact for Sicily, we are first and foremost laying the groundwork for proper information on this topic. One of the main obstacles in relationships with oncologists is misinformation: many patients turn to “Dr. Google” or buy products online of questionable quality, and all of this undermines dialogue and creates barriers. If, on one hand, it is essential to strengthen scientific evidence, on the other we must ensure that patients consult qualified professionals, avoiding the risk of DIY and, in a scattered way, the risk of being swindled. The credibility of integrative and complementary therapies is built with seriousness, scientific rigor, and interdisciplinary collaboration».
What specific competencies do you believe are necessary for healthcare personnel to effectively manage an integrated oncology model?
«Universities are showing increasing sensitivity to integrative medicine: in several universities, programs have been launched, even if not curricular, including master’s degrees and continuing education courses—especially in acupuncture, herbal medicine, and nutrition. There is still a long way to go, but with the support of foundations like ARTOI and through national and regional conferences and workshops, we are consolidating training and research. The focus must be on quality, presenting solid clinical experiences and objective data to strengthen our credibility. This applies to clinical practice as well as education.
Results are already manifesting in a growingly constructive dialogue with colleagues.
The integration of oncology and complementary approaches is not an alternative, but an evolution of the care model: a paradigm capable of uniting scientific rigor, a global, person-centered approach, and a more human, sustainable vision focused on the quality of life of the oncologic patient».
| Who is Salvatore Bonanno |
| A graduate in Medicine and Surgery from the University of Catania, Salvatore Bonanno subsequently earned his specialization in Radiotherapy from the University of Genoa and in Oncology in Catania. Since 2021 he has served as Director of the Complex Radiotherapy Unit of the Siracusa Local Health Authority. He is active in the community, collaborating with the Italian League Against Cancer, with the ANGOLO OdV association (National Association of Cancer Survivors) and with Lions Club International. His areas of expertise include the treatment of cancers of the head and neck, lungs, brain, gastrointestinal tract, breast, urologic, gynecologic, hematologic, skin, and bone. He is the regional contact for Sicily for the ARTOI Foundation. |
Abbonati a Karla Miller
