Center News Magazine: The Integrative Medicine Service Marks a Decade of Caring for Patients

Thursday, October 1, 2009
Barrie Cassileth, Gary Deng, Simon Yeung, and Kathleen Wesa Barrie Cassileth, Gary Deng, Simon Yeung, and Kathleen Wesa

Since 1999, Memorial Sloan Kettering’s Integrative Medicine Service has provided complementary therapies that improve quality of life for Memorial Sloan Kettering patients by alleviating symptoms of cancer. As the service has grown, so has its array of programs addressing the physical and emotional needs of individuals as they receive treatment for their disease.

In ten short years we’ve grown from just me in a tiny office to a department of about 60 people doing around 20,000 inpatient and outpatient visits per year,” said Barrie R. Cassileth, Chief of the Integrative Medicine Service and incumbent of the Laurance S. Rockefeller Chair in Integrative Medicine. Prior to coming to Memorial Sloan Kettering in 1999, Dr. Cassileth — who holds a PhD in medical sociology — worked in the field of integrative medicine as a researcher, educator, and planner and was a professor of medical sociology at the University of Pennsylvania School of Medicine. “We have expanded to offer a variety of services to assist patients, from diagnosis through survivorship or end-of-life care, as well as very active research and education programs.

Integrative medicine supplements mainstream cancer treatments with complementary therapies, many of them ancient healing methods, to control physical and emotional symptoms and speed recovery. It includes touch therapies such as massage, mind-body therapies such as meditation and self-hypnosis, nutrition consultations, yoga and fitness training, music therapies, and acupuncture.

Dr. Cassileth emphasized that complementary therapies are not alternatives to mainstream medical care. Rather they serve as adjuncts to traditional treatments to help alleviate stress and anxiety, reduce pain, promote well-being, and speed recovery. They also must be evidence based with measurable results that can be tested and evaluated. “We do not do fringe or quack therapies based on anecdotal claims,” she explained.

The benefits of complementary therapies can be dramatic. For example, one large study led by Dr. Cassileth found that cancer patients reported a 50 percent reduction in symptoms such as pain and stress after one 20-minute massage session. And multiple studies have established that acupuncture helps control symptoms related to cancer and its treatments, including pain, anxiety, depression, dry mouth, and shortness of breath.

The Integrative Medicine Service The Integrative Medicine Service has expanded to provide a wide range of complementary therapies.

Alleviating Effects of Cancer and Its Treatments

The Integrative Medicine Service provides therapies to inpatients at Memorial Hospital and to outpatients, family members, faculty, and staff at the Bendheim Integrative Medicine Center on First Avenue at 74th Street, where the service is based. (Massage and acupuncture will be available in the future to patients at Memorial Sloan Kettering Basking Ridge, in New Jersey.)

Massage, music therapy, and guidance for meditation are provided to inpatients free of charge, and other remedies are available as needed. Referrals to the Integrative Medicine Service come from medical staff as well as from patients themselves and their caregivers. “We receive numerous inpatient requests and respond to as many as possible,” Dr. Cassileth said.

For inpatients, hospital visits from therapists and practitioners provide relief from physical and emotional symptoms and treatment side effects. “In the case of massage, for example, it’s something pleasant and nonthreatening because it’s a different kind of touch — it’s not part of administering medication or doing a procedure,” said Wendy Miner, Program Director for Touch Therapy at Memorial Sloan Kettering. “Patients look forward to it.

The outpatient center is designed to create a calm, spa-like atmosphere that promotes feelings of serenity and well-being. Coming for a massage or yoga session is a respite for many patients and caregivers amid a period of stress and anxiety. “It lends patients a sense of control at a time when many feel things are out of their control,” said Kathleen M. Wesa, one of two attending physicians on the service. The outpatient center is also open to the general public, and it takes referrals from oncologists at other hospitals and in private practice.

Training for Treatment

Yoga Class The service offers classes in yoga and fitness training to improve mobility and reduce stress.

The Integrative Medicine Service recently combined two existing objectives — stress reduction and physical activity — into a new initiative called Training for Treatment and Beyond. The program is designed to provide newly diagnosed patients with tools to withstand the consequences of a cancer diagnosis.

To help patients control emotional stress, a self-hypnosis CD is available in the Memorial Sloan Kettering Gift Shop (next to main lobby of Memorial Hospital at the 1275 York Avenue entrance) or directly from the Integrative Medicine Service. “Self-hypnosis is a wonderful tool,” Dr. Cassileth said. “It’s easy to learn, and quite effective. For example, data show that self-hypnosis shortly before surgery, even for a few minutes, results in shorter stays in the recovery room and the hospital.

The other component of the initiative involves incorporating physical activity as part of the treatment plan following a cancer diagnosis. To test whether this is feasible at a major cancer center, the Integrative Medicine Service is undertaking a pilot effort with the Memorial Sloan Kettering prostate surgery group. The service recently developed an exercise DVD that will be issued to patients scheduled for prostate surgery as part of standard preparation, just as every patient receives a chest x-ray or has blood drawn. During follow-up care, the patients will be asked if they have adhered to the exercise guidelines, either by using the DVD or engaging in related activities.

Our long-range goal is to determine whether staff and patients follow through,” Dr. Cassileth explained. “If so, we will then try to make this exercise-related approach a routine practice throughout the institution after a cancer diagnosis.

Laboratory and Clinical Research

The service also conducts extensive research in collaboration with other senior laboratory and clinical scientists at Memorial Sloan Kettering. Much of the research relates to whether a complementary therapy alleviates cancer-related symptoms such as pain or anxiety. But the service also investigates treatments that may help fight cancer itself.

In 2005, the National Institutes of Health awarded Memorial Sloan Kettering $8 million over five years to serve as one of six botanical research centers — and the only one focused on cancer. With Dr. Cassileth and immunologist Philip O. Livingston serving as co-directors, the Memorial Sloan Kettering Research Center for Botanical Immunomodulators works in collaboration with the Institute of Chinese Medicine in Hong Kong to investigate the potential of beta glucans, the essential constituent of medicinal mushroom extracts, to modify the immune response in ways that could fight cancer.

As part of this effort, a small, proof-of-principle clinical trial in collaboration with Stephen D. Nimer, Chief of the Hematology Service, is about to begin testing this extract in patients with myelodysplasia (a bone marrow disorder that impairs production of normal blood cells) to see whether it can delay or prevent progression to leukemia by stimulating the activity of immune cells called neutrophils.

Additional botanicals research includes a clinical trial, led by Gary E. Deng, an attending physician on the Integrative Medicine Service, in collaboration with Robert C. Kurtz, Chief of the Gastroenterology and Nutrition Service, of an herbal medicine called Sho-saiko-to (SST). The study investigates whether SST is effective in treating liver inflammation and injury caused by chronic hepatitis C. “Hepatitis C can lead to liver cancer, so we’re looking into whether giving SST to patients would slow down the damage to the liver and reduce the chance of cancer,” Dr. Deng said.

An internationally popular component of the Integrative Medicine Service is its About Herbs Web site. Launched in 2003, the site contains comprehensive, evidence-based information regarding approximately 250 herbs, botanicals, vitamins, and other over-the-counter agents, as well as unproved methods. “I started the site because I had gone through decades of phone calls from oncologists all over the world asking, ‘My patient is taking this herb. Is it helpful? Harmful? Okay during cancer treatment?’” Dr. Cassileth said.

Managed by pharmacist K. Simon Yeung, the site is accessible at no cost to visitors. For each herb, vitamin, or botanical, there are two listings — one for patients and one for oncology professionals — which include purported uses, possible side effects and interactions, and any clinical trials of the supplement. About Herbs is popular among patients and the medical community alike, drawing a high number of visits. It has been cited by Scientific American and the New York Times as a top health resource.

Modeling Success

From the start, the Integrative Medicine Service was intended to be a prototype program that could be modeled at other institutions. Dr. Cassileth provides consultations to leaders of hospitals around the world to develop evidence-based programs and conduct research.

In addition, physicians can visit for one- or two-week “observation experiences” to learn how integrative medicine is practiced. The service also offers training programs and certification courses for practitioners. Finally, Dr. Cassileth and colleagues have helped establish a nonprofit professional group called the Society for Integrative Oncology, which has annual meetings and publishes a journal.

Our goal has always been not only to have an excellent program for Memorial Sloan Kettering, but also to grow the field,” she said. “We’ve entered a new era of oncology. As survival rates have improved, the control of treatment-related physical and emotional symptoms and patients’ quality of life has become a major focus.