The AMICO Clinic Approach to Integrative Oncology in Breast Cancer Care: Structure and Clinical Framework From a Southern Italian Hospital

Abstract

With increasing survival rates for breast cancer (BC)—91% at 5 years and 80% at 15 years post-diagnosis—there is growing recognition of the importance of addressing long-term patient well-being. Beyond standard medical treatments, factors such as diet, psychological health, and quality of life significantly impact BC outcomes. Integrative oncology, which combines conventional oncology therapies with evidence-based complementary approaches (including nutrition, mind-body practices, and lifestyle modifications), has emerged as a patient-centered model aimed at improving symptom management, treatment adherence, and overall quality of life. This work describes the introduction of integrative oncology practices through the “AMICO” clinic, located within the Breast Surgery Unit at IRCCS-CROB in Rionero in Vulture, Southern Italy. As the first initiative of its kind in a public hospital in Italy, the clinic aims to provide a patient-centered approach for BC patients undergoing chemotherapy, radiation therapy, and/or breast surgery, with the mission to alleviate common side effects and improve their quality of life. During its first year of activity, the clinic has conducted joint consultations with nutritionists, organized mind–body laboratories (including Qigong sessions) and collected real-time clinical data These activities provide a foundation for the development of robust clinical databases and support a structured approach to patient-centered integrative care. By combining conventional oncology with evidence-based complementary therapies, the AMICO Clinic provides an example of a structured approach to personalization of cancer care. Ongoing and future research will further clarify the clinical value and potential benefits of integrative oncology in enhancing patient well-being.

Introduction

Breast cancer (BC) currently represents the most prevalent cancer among women. ¹ Over the past few years, there has been a race against the clock, with a plethora of new studies and research projects, to address this important health issue. This scientific commitment has resulted in the achievement of significant milestones for disease treatment and improvements in patient overall survival (OS) and disease-free survival (DFS). Owing to more accurate and tailored treatment regimens and earlier diagnosis, BC survival rates are increasing worldwide, reaching 91% at 5 years and 80% 15 years after diagnosis. ² Since BC patients live longer after diagnosis, including many different aspects of women’s lives is crucial. In the context of conventional medicine, nutrition and dietary interventions have been regarded as fundamental components of BC prevention and management. ³ For example, foods containing phytoestrogens—such as soy, whole grains, legumes, nuts, and cruciferous vegetables—play a key role in modulating estrogen levels. ⁴ Additionally, reducing fat mass through diet is important since adipose tissue is a primary source of endogenous estrogen production. ⁵ Therefore, a balanced diet with estrogen-modulating foods may help reduce BC risk and support treatment strategies.

However, within the framework of integrative medicine, diet assumes a broader and more holistic role. It is viewed not only as a means of supporting physical health but also as an essential element of overall well-being, interacting synergistically with the psychological impact of a cancer diagnosis and treatment, particularly considering its long-term health implications. For this reason, the incorporation of an integrative approach (also called “complementary”)—encompassing both conventional and evidence-based complementary oncology interventions—into routine patient care is essential. Within this framework, “integrative” denotes the strategic and synergistic combination of standard oncological treatments with complementary modalities, with the objective of optimizing therapeutic outcomes, mitigating treatment-related side effects, and enhancing health-related quality of life, which has increasingly emerged as a key endpoint in clinical trials and survival analyses. ⁶

The aim of integrative oncology is to improve symptom management, adherence to oncology protocols, the general quality of life and well-being of patients before, during, and following treatments.^7,8 By combining standard cancer care with complementary therapies, integrative oncology is a patient-centered approach to cancer care that incorporates complementary remedies, herbal products and supplements, mind-body therapies, lifestyle modifications from various traditions, and a balanced diet and mental and physical disciplines.

Although the number of facilities and services offering integrated treatments in clinical cancer centers is growing, they are still not common worldwide, especially in Europe. A large number of BC patients would benefit from integrative oncology, supported by an abundance of data concerning their efficacy and safety.^9-13 An increasing number of randomized controlled trials suggest that selected complementary therapies may improve the management of symptoms and side effects following BC diagnosis and treatment. Indeed, in the last 20 years, the use of integrated therapies has steadily increased in Europe and the U.S. 62 patients out of 100 use them, and users are more than 80% satisfied. ¹⁴ For this reason, some of the major cancer centers in the U.S. have begun to establish integrated therapy services (eg, Memorial Sloan-Kettering in New York, ¹⁵ Dana Farber in Boston, MD Anderson in Houston, etc.). The World Health Organization (WHO) launched the Traditional Medicine Strategy 2014 to 2023, aimed at promoting the integration of traditional and complementary medicines into national health systems based on scientific evidence and safety standards. ¹⁶ In line with this initiative, the WHO also established a structured follow-up plan to monitor and evaluate the implementation of this strategy. This plan included the development of key performance indicators to assess progress in policy formulation, regulation, safety, and integration of traditional and complementary medicine into national health systems. Although the strategy officially covered 2014 to 2023, its implementation has been extended through 2025 to ensure continuity while the new WHO Traditional Medicine Global Strategy 2025–2034 is being developed. ¹⁷ In 2018, the American Society of Clinical Oncology (ASCO) approved integrated therapeutic clinical guidelines issued by the Society for Integrative Oncology (SIO) for BC patients, which demonstrated the benefit of adding specific integrated therapies for BC patients.^18,19

On the basis of these tenets, it is essential to establish new projects for the application and promotion of these integrated therapies in various Italian oncology hospitals. In collaboration with the SIO, in 2017, the Italian Association for Integrated Oncology Therapy Research (ie, Associazione Ricerca Terapie Oncologiche Integrate—ARTOI) was established, which represented an initial step toward integrated therapies in Italy. At Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, southern Italy, the “AMICO” clinic (acronym of Ambulatorio di Medicina Integrata e Condotta in Oncologia— ie, Integrated Medicine and Oncology Management Clinic) is located within the Breast Surgery Unit.

The aim of this work is to illustrate the conception and operational framework of an integrative oncology model for breast cancer care within the “AMICO” Clinic at IRCCS-CROB Hospital. This initiative seeks to demonstrate how evidence-based complementary therapies—such as nutrition, mind–body practices, and lifestyle modifications—can be effectively incorporated alongside conventional oncological practice to enhance patient well-being, treatment adherence, and improve overall quality of life. Specifically, we focus on outlining the conceptual framework, program structure, and workflow developed for the establishment of the new Center for Integrative Therapies. It aims to provide an overview and rationale for the integrative oncology approach rather than report on implementation results or clinical outcomes. The AMICO Clinic will soon complete its first year of activity, which will serve as the foundation for future publications evaluating clinical outcomes and program impact. Furthermore, this work highlights the importance of multidisciplinary collaboration, research integration, and continuous education in advancing patient-centered cancer care, while fostering awareness among healthcare professionals regarding the safe and evidence-based application of integrative oncology principles.

By translating these principles into clinical practice, the following section outlines the key components and operational stages of the integrative oncology model as implemented at the AMICO Clinic.

Key Features of the AMICO Clinic’s Integrative Oncology Approach

Integrative oncology’s main principles move through the following stages ²⁰ :

• a) Lifestyle consultations prior to surgery or chemotherapy, including measurements of height, weight, BMI, and body composition, along with an explanation of the main dietary recommendations on the basis of the evidence gathered by the World Fund for Cancer Research;

• b) New patient-oriented treatment for individuals who experienced adverse effects from surgery (lymphedema, postsurgical pain), chemotherapy/radiation, or hormone therapy (such as nausea, hot flashes, insomnia, fatigue, and radiodermatitis);

• c) Recommendations for natural and herbal remedies;

• d) Mind-body therapies, including qigong exercises and mindfulness (a cognitive therapy practice that focuses on symptoms such as anxiety, depression, fatigue, pain, and insomnia).^21-29

Furthermore, systematic reviews and meta-analyses have highlighted that integrative practices—such as balanced nutrition, regular physical activity, mindfulness, and other mind-body interventions—play a pivotal role in reducing modifiable risk factors, including overweight, obesity, and sedentary behavior, which are known to increase cancer incidence, recurrence, and negatively impact overall survival rates. ³⁰ In their latest global review of research, the American Institute for Cancer Research reported that an integrated approach based on nutrition, exercise, sleep hygiene, and psychological resilience represents a fundamental pillar for survival and prevention of BC recurrence ³¹ (Figure 1).

Figure 1.

Flowchart of the AMICO clinic integrative oncology protocol and therapeutic plan.

Overview of the AMICO Clinic Workflow and Procedures

The mission of the “AMICO” clinic is to provide integrated therapies and prescribe lifestyle recommendations for patients with BC undergoing chemotherapy, radiation therapy, and/or breast surgery; these recommendations are aimed at managing symptoms and side effects following BC diagnosis and treatment (eg, postsurgical pain and pain from aromatase inhibitors, hot flashes, fatigue, radiodermatitis, neuropathy, etc.).

The breast surgeon is formally postgraduate in lifestyle medicine and integrated oncology therapies and affiliated with the American College of Lifestyle Medicine and the Foundation for Research on Integrative Oncological Therapies (ARTOI). The breast surgeon, supported by a team of researchers and nutritionists, conducts a thorough evaluation of the patient’s oncological history and gathers detailed clinical data on the oncological condition, current health status, and overall quality of life. A questionnaire for an overall evaluation is given to the patient at each stage of the cancer care program for the assessment of the following:

• a) The perceived stress scale (PSS) and the patient fragility index. Specifically, the medically unexplained symptoms (MUS) and coping symptoms (chronic fatigue, sleep or appetite disorders, colon irritability or constipation, mood or tone disorders, anxiety, panic, melancholy, nonspecific pain syndromes, etc.).

• b) Overall quality of life, including lifestyle factors (eg, smoking and alcohol consumption), dietary patterns (eg, number of daily meals, intake of fruits, vegetables, red meat, fish, and sugary beverages), and levels of physical activity.

Following the collection of questionnaire responses, patients will undergo a comprehensive biological health status evaluation consisting of the following:

• c) Nutritional assessment with the evaluation of body mass index (BMI) and body composition through bioelectrical impedance analysis (BIA). This includes key parameters such as the basal metabolism rate, daily energy expenditure, fat mass, lean mass, body hydration, sodium‒potassium pump activity, bone mineral density, and measurements of resistance, reactance, impedance, and phase angle parameters. Importantly, BIA has emerged as a powerful and reliable clinical tool for longitudinal monitoring throughout integrative oncology care, providing dynamic insights into patients’ nutritional and metabolic status over time.^32-36

• d) Hematochemical analysis of serum biomarkers, including sodium, potassium, chloride, blood glucose, glycosylated hemoglobin, total proteins, albumin, fibrinogen, proteinogram, cholesterol, triglycerides, and inflammatory markers (C-reactive protein, cytokines, IFN-γ, TNF-α, IL-1, IL-6, IL-8, etc.).

• e) Behavioral intervention with the implementation of mind-body practices such as mindfulness, yoga, Qigong, and Pilates.

• f) Integrated therapies involving the prescription of nutraceuticals, including indole-3-carbinol, curcumin, and polydatin. The selection of these 3 nutraceuticals was guided based on existing evidence in the scientific literature and in compliance with the guidelines of ARTOI and SIO.^19,36-39

Upon completion of the initial evaluation, the specialist, on the basis of the predominant clinical presentation, prescribes an individualized therapeutic regime along with a comprehensive summary of lifestyle recommendations. This summary serves as a practical guide for both the patient and the attending physician, providing valuable medical information on previous treatments and future care strategies.

Discussion

The first recommendations in integrative oncology involve adopting a balanced and evidence-based dietary pattern, such as the traditional Mediterranean diet. This nutritional model emphasizes a high intake of whole grains, fruits, vegetables, legumes, and olive oil, with moderate consumption of fish, poultry, eggs, and dairy products, and limited intake of red and processed meats. Several studies have demonstrated that adherence to the Mediterranean diet is associated with reduced systemic inflammation, improved metabolic profiles, and decreased risk of cancer progression and recurrence.^40-42

In parallel, patients are encouraged to maintain an active lifestyle consistent with current American College of Sports Medicine (ACSM) guidelines. ⁴³ Moderate aerobic exercise, resistance training, and mind-body practices such as Qigong and yoga (either in-person or web-based events) are highly suggested for cancer patients who are experiencing fatigue, insomnia, and anxiety.^22,44 These mindfulness practices promote self-regulation of both mental and physical elements through controlled breathing and gentle movements aimed at relaxation, health enhancement and rehabilitation.

Dietary supplements and phytochemicals are introduced within a monitored framework, based on evidence of their biological and clinical effects. Preliminary studies have shown that compounds such as Indole-3-carbinol, curcumin, and polydatin have the potential to modulate apoptotic pathways, inhibit tumor cell proliferation, and enhance immune function.^36-38 Curcumin and polydatin, for example, have been reported to enhance the efficacy of antitumor agents in drug-resistant glioblastoma cells by modulating key mechanisms involved in cell survival, differentiation, and tumor invasiveness. ³⁷ Likewise, indole-3-carbinol exerts anticancer effects through the regulation of estrogen metabolism, cell-cycle arrest, and induction of apoptosis, providing an additional natural compound with multitarget activity relevant to integrative oncology. ⁴⁵

These lifestyle interventions are supported by general evidence-based recommendations on diet, physical activity, and stress management, as discussed in the context of integrative oncology and lifestyle medicine.^19,39,42 While organizations such as SIO and ARTOI recognize the potential benefits of lifestyle modifications for patient well-being, formal guidance regarding their impact on cancer recurrence or survival remains cautious. Similarly, the American College of Lifestyle Medicine (ACLM) emphasizes lifestyle-based strategies primarily for overall health promotion and chronic disease prevention.

The primary objective of the AMICO integrative oncology program is to assess the clinical feasibility and overall effectiveness of combining lifestyle-based interventions—such as nutrition, physical activity, and mind–body practices—with standard oncological treatments. Patients are guided through a structured step-by-step process aimed at adopting healthy and conscientious lifestyle behavior, through regular consultation and targeted clinical assessments. Follow-up evaluations are conducted at 3, 6, and 12 months to monitor progress and support adherence to the recommended integrated therapies.

The secondary objective of this program is to demonstrate that combining healthy lifestyle interventions with conventional oncological therapies can lead to measurable improvements in quality of life, treatment tolerance, and survival outcomes. These outcomes are being assessed through longitudinal analysis using validated quality-of-life questionnaires (SF-12 and ESAS), BIA, and biochemical markers.

The AMICO Clinic integrates clinical care with a structured academic and research mission. During its first year of activity, the clinic has systematically collected extensive real-time clinical data during patient visits, including bioelectrical impedance analysis (BIA) parameters, nutritional profiles, psychological assessments, and patient-reported outcomes. Patients have participated in joint consultations with nutritionists and mind–body laboratories, particularly Qigong sessions. Importantly, integrated therapy visits are officially recognized: when a prescription is provided, patients do not pay for the specialist consultation. These activities have laid the foundation for robust clinical databases and will support future analyses on the effectiveness and safety of complementary therapies in breast cancer care. Future clinic plans include to expand the patient base, broaden and diversify mind–body programs, and develop multicentric research projects in collaboration with ARTOI to further evaluate the mechanisms, efficacy, and clinical impact of integrative oncology approaches.

Education and training will represent an essential component of this model. Plans include providing nurses and allied healthcare professionals with specialized instruction in integrative oncology practices, patient communication, and standardized data documentation. This structured program is intended to ensure a consistent, patient-centered approach and to enhance interdisciplinary collaboration, thereby improving the continuity and quality of integrative care.

Ultimately, this integrative approach is an example of how supportive care needs of cancer patients can be addressed by combining evidence-based complementary modalities with conventional oncological treatments. Through structured follow-up, rigorous data collection, and interdisciplinary cooperation, the model achieves high standards of safety, quality, and transparency in patient care. Further research is warranted to evaluate the long-term impact of integrative care on patient-reported outcomes, survivorship, and cost-effectiveness, particularly among women at different disease stages, to consolidate its role within mainstream oncological practice.