Stakeholder priorities for advancing integrative oncology across a pluralistic health system: a qualitative study...

In Singapore, more than half of patients with cancer use traditional or complementary therapies after diagnosis. Such use is often self-directed and undisclosed to oncology clinicians, creating safety risks and care coordination challenges. To support evidence-informed integration of such therapies within conventional cancer care, this study explored stakeholder priorities for advancing integrative oncology (IO) in Singapore's pluralistic health system.

We conducted a multi-stakeholder roundtable at the National Cancer Centre Singapore. Twenty-two participants were purposively recruited across oncology, palliative care, nursing, pharmacy, allied health, Traditional Chinese Medicine, research, and service coordination. The session was audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis.

Five themes were identified. First, participants prioritized earlier, recurring discussions about IO therapies across the cancer care trajectory. Second, bridging conventional and traditional medicine required practical infrastructure, including shared documentation and bidirectional referral pathways, allowing patients to be escalated from community to specialists. Third, IO-related decisions were often shaped by family members and community networks, underscoring the need to accommodate relational decision-making when supporting patient autonomy. Fourth, cost and perceived clinical legitimacy shaped access, as patients were less likely to pay out-of-pocket without oncology endorsement. Lastly, cancer centers were viewed as instrumental in providing clinical credibility and workforce training on evidence-informed IO therapies.

In pluralistic health systems where traditional care use is culturally embedded, advancing IO should prioritize making pre-existing therapy use safer, more visible, and better coordinated. Real-world outcomes data on IO uptake in conventional care are needed to inform future subsidy mechanisms.