Integrative and complementary approaches to cancer treatment, such as exercise, dietary changes, acupuncture, and mind-body therapies, are gaining more attention in gastrointestinal (GI) cancers due to their potential benefits with regard to patient symptoms and survival outcomes. The available evidence and clinical guidelines on these and other approaches were presented at the recent 2025 ASCO Gastrointestinal Cancers Symposium.

Following these presentations, featured expert Diane Reidy-Lagunes, MD, was interviewed by Conference Reporter Editor-in-Chief Tom Iarocci, MD. Clinical perspectives from Dr Reidy-Lagunes on these findings are presented here.

I am thrilled that integrative and complementary approaches for patients with GI cancers are coming into the mainstream and that we are testing these approaches from not only a quality-of-life perspective but also a potential cancer treatment perspective. Patients want to be empowered to take care of themselves, and it is a little unsettling when we do not have data on approaches that would enable them to do this. I think that we owe it to our patients to test integrative therapies in a rigorous way.

Researchers are investigating the role of exercise and dietary changes in helping our patients with cancer to live longer. Lee W. Jones, PhD, an exercise physiologist at Memorial Sloan Kettering Cancer Center, has dedicated his career to conducting randomized controlled trials to determine if there is a survival benefit from doing exercise. While most of us might think that there is nothing wrong with exercise, and, in fact, the more the better, it actually turns out to be nuanced based on factors such as whether it is aerobic or anaerobic exercise. It also turns out that if a patient’s heart rate is much higher than their normal resting heart rate when they want to exercise, it is probably not a good day for them to exercise. So, we have to understand when it is the right time to do these interventions as opposed to assuming that they are always going to be beneficial, because that is not the case.

In terms of dietary changes, a study by Neil M. Iyengar, MD, and Urvi A. Shah, MD, compared a ketogenic diet with a plant-based diet and found that the ketogenic diet was not superior and was potentially even detrimental. Plant-based diets, however, cannot be used as a one-size-fits-all approach because every patient is different. For example, if the cancer is taking away a patient’s energy and/or ability to eat, it is very hard for them to eat a plant-based diet exclusively when trying to get enough calories. The same thing is true of physical activity, as discussed by Heather Leach, PhD, at the 2025 ASCO Gastrointestinal Cancers Symposium.

I loved that discussions about integrative approaches were a part of the ASCO symposium. For so long, integrative and complementary therapies were considered taboo and were not included in any of our programs or symposiums. But now we are saying, “Wait a second, let’s take a deeper look here to see what we know, and let’s start studying in a more rigorous, thoughtful way to get answers.”

A presentation by Richard T. Lee, MD, FASCO, at the 2025 ASCO Gastrointestinal Cancers Symposium reviewed clinical guidelines for acupuncture/acupressure for patients with GI cancers. There was wide agreement that they can help with nausea, vomiting, and probably some types of pain, but there was less agreement about whether they help with anxiety. He also reviewed available clinical guidelines regarding cannabis consumption and a prospective observational study reporting that cannabis consumption during immunotherapy in patients with cancer correlated with poor clinical outcomes, so that is something to be mindful of since we may also use it for palliative reasons.

Another talk at the ASCO symposium by Chloe E. Atreya, MD, PhD, reviewed the mind-body approach to GI cancer treatment and ASCO guidelines for using massage therapy, yoga, relaxation therapy, and even hypnosis. I think that there is a lot of excitement about hypnosis, but the jury is still a little bit out on that. There is definite evidence, however, for mindfulness-based interventions helping to alleviate the symptoms of anxiety, depression, and fatigue, which is exciting.

I think that a challenge in our health care system is how to get these interventions to patients outside of clinical trials. Thankfully, with smartphone apps, there are ways to use at least some of these techniques, but not all. I would recommend that patients go online to find these resources and work with social workers and nurses to identify opportunities. I think that we also really need to ask questions about insurance coverage and, once we get more data, figure out how these interventions can get to the right patients.

My take-home message is that, on the one hand, it is incredibly exciting that we are starting to test and think about integrative approaches, including exercise and/or nutritional optimization, but, on the other hand, we do not know how much other types of programs that integrate acupuncture, mind-body therapies, and other mindfulness techniques help. So, I do not want patients to think that they are being withheld a critical service because they do not have the financial means or insurance coverage to receive them. This is why more studies are needed.