ATYPICAL RESPONDERS LANDSCAPE REVIEW ∙ OCTOBER, 2017 24 trial of 88 women showed that telomere length is maintained in distressed patients with Stage I-III breast cancer undergoing mindfulness-based cancer recovery or supportive-expressive group therapy compared to controls [67]. A separate randomized trial of 71 women demonstrated that mindful awareness practices reduced stress and pro-inflammatory gene expression in young breast cancer patients who had completed cancer treatment [68]. The above studies show that CIM practices influence patient QOL, overall survival, and biological outcomes, and additional clinical trials are warranted to further assess these impacts. Although some funding has been available to investigate the effects of CIM on QOL, capital for the far more expensive assays (e.g., blood tests, etc.) needed to test the impact of CIM, supplements, and other non-regulated therapies on biological outcomes is scarce. For these promising modalities to become part of the standard of care, considerable funding for a stepwise process leading to large- scale studies in both normal and atypical responders is required. CUSIOS (NCT02494037) is an observational registry that will compare overall survival outcomes of consecutively recruited advanced stage breast, colorectal, pancreatic, and ovarian cancer patients treated at one of several advanced integrative oncology specialist clinics in North America to those published in the current medical literature and Surveillance, Epidemiology and End Results (also known as SEER).  Advanced integrative oncology (AIO) as well as conventional oncology treatment information will  also be collected  across the cohort, along with  health-related QOL data from a subgroup of Canadian AIO-treated patients. The data obtained from CUSIOS and similar studies may further enhance overall cancer patient care.  Alternative Medicine Alternative medicine, defined by NCCIH as utilizing a non-mainstream practice and/or product in lieu of standard medical care, has not been well studied.  Anecdotes abound regarding patients who far outlive their prognosis when following alternative therapies or whose condition has significantly improved while undergoing an unconventional treatment. Multiple hypotheses have been developed in an attempt to explain these outcomes, including the impact of reducing toxicity in the patient and modulating immune system function.  Performing scientific studies to identify the reasons for successes attributed to alternative or unproven treatments is difficult because funding is scarce, many factors may work together to mediate the patient’s response, and record-keeping regarding these patients has been minimal.  Ethical issues arising from substituting an alternative therapy for conventional therapy are also problematic. As is the case with conventional medicine, clinicians currently cannot accurately predict which cancer patients will respond favorably to specific alternative protocols and which patients will not.  Some terminally ill patients experience an unexpectedly favorable outcome while practicing a variety of alternative therapies as reported by the author in the book, “Radical Remission: Surviving