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A comprehensive approach to integrative treatment of colorectal cancer (CRC) patients involves three spheres of intervention: lifestyle, biology, and conventional treatment. Individualization of treatment is emphasized. The lifestyle sphere includes nutritional therapies, biobehavioral strategies with circadian interventions, and physical care modalities. The biology sphere comprises six host factors in the patient's internal biochemical environment or "terrain": inflammation, glycemia, oxidative stress, immune dysregulation, coagulopathy, and stress chemistries. Laboratory testing of these factors guides integrative lifestyle and supplement recommendations. The conventional treatment sphere includes individualized lifestyle recommendations, and supplements or drugs used to enhance tolerability or effectiveness of conventional treatments. Innovative strategies are implemented, including chronomodulated chemotherapy, chemosensitivity testing, and using results of molecular genomic testing to guide nutritional infusions and supplement recommendations. In the lifestyle sphere, substantial evidence from cohort studies supports recommendations for a diet that emphasizes plant and fish proteins, healthful fats in amounts that are tailored to the clinical circumstance of the patient, and carbohydrates based on unrefined whole grains, vegetables and whole fruits. High glycemic diets and refined carbohydrates, especially sugar-sweetened beverages, should be avoided. Biobehavioral strategies include practice of the relaxation response and related approaches. In addition, specific strategies to promote robust circadian organization (CO) are used to combat quality of life concerns and worsened survival that accompany disrupted CO. Physical activity, including aerobic activity and muscle strengthening, is recommended at all disease stages. In the biology sphere, supplements and lifestyle recommendations for inflammation and glycemia are discussed. In the conventional treatment sphere, supplements and innovative and complementary therapies that may remedy treatment toxicities are reviewed. Approaching CRC treatment with a comprehensive, individualized intervention enables safe and beneficial outcomes in this patient population, which can vary widely in individual biology, treatment toxicities, and disease complications. Further research in integrative therapies for CRC patients is needed. [ABSTRACT FROM AUTHOR]

Integrative cancer care (ICC) is the treatment of patients with cancer, under physician supervision, with appropriate conventional treatments in a healing context based on insights from research on nutrition, biochemistry, exercise, and psycho-oncology. It uses validated techniques and practitioners of complementary and alternative medicine (CAM), and strategies for enhancing treatment and side-effect management such as chronomodulated chemotherapy, therapies to reduce treatment resistance, and innovative assessments for individualizing treatment plans. The elements of ICC align well with the concepts of optimal healing environments (OHE). Expectations of well-being are fostered; transformative self-care practices are common therapeutic tools; development of healing presence among staff and therapeutic alliances with patients are emphasized; instruction in health-promoting behavior is standard; and collaborative integration of CAM in the practice is typical. Based on the authors' clinical experience, an OHE for patients with cancer is described and suggestions for meaningful research are identified. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Probable hepatotoxicity related to Nerium oleander extract in a patient with metastatic synovial sarcoma of the knee," by E. Altan and colleagues.