Jun Mao recently joined MSK as Chief of the Integrative Medicine Service. In addition to overseeing patient care, he also conducts research on the benefits of complementary therapies for people with cancer.
You have an undergraduate degree in chemical engineering and clinical training in family medicine and in acupuncture. Did you always envision bridging Eastern and Western medicine in your career?
I stumbled into medical research and became really fascinated with medical science, so that’s how I became a doctor. But because of my undergraduate background, I’ve always been intrigued by how a process works. Engineering is a very process-oriented major.
I’m always interested in the system as a whole, while paying attention to the parts. If you look at a human being in that way, you can see cancer in the context of the entire body. As I pursued Western medicine training, it felt like some of that was missing —sometimes we focus so much on figuring out the exact parts of the body that we sort of forget the whole.
That led me to turn to Eastern medicine. Being the Chief of Integrative Medicine is my dream job. The goal is really to bring the best of conventional medicine together with therapeutics that originate from other cultures and traditions and apply scientific method to research them and eventually disseminate them into clinical practice. Ultimately, we want to allow cancer patients and their family members to have more tools available to them to deal with the physical, emotional, and spiritual impacts of cancer.
How do Eastern and Western techniques complement each other?
One good example is my research on helping women with breast cancer deal with side effects of hormonal therapy, such as tamoxifen or aromatase inhibitors. Those drugs are meant to decrease the activity of estrogen in the body and therefore are very powerful tools against hormone receptor–positive breast cancer. But estrogen is also vital for other parts of women’s well-being. Without it, many women have hot flashes, joint aches, mood instability, insomnia, and other problems.
My research in acupuncture has shown that when used for these women, it can help reduce joint pain, decrease hot flashes and anxiety, and improve sleep. By combining Eastern and Western approaches, we allow them to have the best symptom control, hopefully adhere to their lifesaving drugs, and improve their longevity.
Another way to think about it may be that conventional drugs are more about targeting the disease and integrative medicine focuses more on healing the whole person.
What’s the difference between integrative medicine and alternative medicine?
Integrative medicine as a discipline, especially in the context of cancer, was pioneered at MSK. The department was established by Barrie Cassileth with support from the Rockefeller family in 1999.
Unlike alternative medicine, integrative medicine focuses on using research to inform evidence-based practice of complementary therapies. Integrative medicine is also better integrated into patients’ treatment and survivorship care plans to help them adhere to conventional treatments while augmenting their symptom control and improving their quality of life through other means, such as yoga, acupuncture, or meditation.
As President of the Society for Integrative Oncology, I help lead our group to advocate for scientific research to understand both the safety and the efficacy of complementary therapies. There’s a continually emerging body of literature that suggests many of the therapeutics we use, such as massage, acupuncture, meditation, and yoga, have beneficial effects for psychological distress, insomnia, pain, and fatigue. And those are very common in cancer patients.
Alternative medicine often completely operates on empirical experience. In some contexts, there are people who take advantage of that and make unsubstantiated claims that some herbs or substance can cure cancer without scientific proof. And that’s really why integrative medicine tries to separate itself from alternative medicine.
Why is it better for a person with cancer to come to MSK for an integrative medicine treatment like massage or acupuncture or yoga, rather than a gym or a spa?
Great question. There are a number of reasons. First, our clinicians are very experienced. For a lot of our patients, especially those going through active treatment, a lot of their symptoms and side effects and toxicity require specialized knowledge about their cancer treatments and potential interactions.
For example, our oncology massage therapists have specific training in addressing fibrosis and lymphedema after patients have had radiation or surgery. You won’t find that skill set in a gym or in a spa, or with a community practitioner.
Another example is side effects like chemotherapy-induced peripheral neuropathy or some of the gastrointestinal symptoms — nausea, vomiting, diarrhea, constipation —related to chemotherapy. Those are not really commonly seen by a community acupuncturist. Our acupuncturists have a tremendous amount of experience and can also monitor laboratory results. In the case of a patient’s red blood cells, platelets, or white blood cells being very low, they need to modify the treatment to ensure optimal safety.
Why did you decide to come to MSK?
I was incredibly impressed with the singular mission of MSK in providing the best cancer care. That really resonates with what I want to do in the context of integrative oncology.
And seeing the level of support from the institution for advancing rigorous integrative medicine for cancer patients and caregivers — that really excited me. Integrative medicine has a deep tradition at MSK. It was a great opportunity for me to come here and work with my colleagues to continue to push the boundaries, advance the scientific understanding of the therapeutic effects of many interventions, and develop large-scale, sustainable clinical practice. We can truly transform the care we deliver for cancer patients, both at MSK and eventually broadly in the United States and around the world.
But what excites me the most is the opportunity to conduct novel large-scale clinical research that can establish the scientific basis for many integrative medicine treatments.
Do you have any trials currently open for MSK patients?
We just opened a trial here funded by the Patient-Centered Outcomes Research Institute. It’s called the CHOICE study. It’s a comparison between acupuncture versus cognitive behavioral therapy [CBT] for insomnia in cancer survivors.
It’s a two-site study between MSK and the University of Pennsylvania. We’re going to enroll 160 cancer survivors with all different types of the disease and evaluate which therapy is more effective for addressing insomnia. In addition, we’re going to try to investigate whether acupuncture or CBT may be more effective in certain types of insomnia in certain patients. The study is going exceedingly well, with 25 patients already enrolled in the last two months.
What are your other plans for the department?
We are actively bringing our integrative medicine services and our clinical research program to MSK’s outpatient sites in New York and New Jersey. So far we’ve brought acupuncture to MSK Westchester and most recently to MSK Basking Ridge, but we’re planning to eventually expand to MSK Monmouth [opening in December 2016] and MSK Bergen [opening in 2018].
What do you tell people who are skeptical about the benefits of integrative medicine?
I think skepticism is a healthy thing. Just like for a lot of conventional cancer treatment, there’s always skepticism, and that helps us to push the envelope more. Clinicians are always asking whether a therapy is working or whether it’s safe. I actually don’t think we should have a blind acceptance of everything.
In terms of people being concerned about a placebo effect, it’s a really great question. I am very intrigued and actually studying that.
Think about placebo effect as a mind-body effect: If you actively engage your mind in wanting a specific outcome, you achieve the outcome. I think the way we are answering whether acupuncture or other types of therapies are better than placebo is by trying to understand the mechanisms underlying the pain, depression, anxiety, and distress that people are experiencing, whether a lot of that is driven by the mind-body effect.
What do you like to do when you’re not in the office?
I have a 9-year-old daughter and a 7-year-old son. They love to run and swim. Those are my hobbies too. Central Park is my favorite place.
On the weekends, we try our best to explore the city because there’s so much to see and experience, whether it’s the museums, the parks, all the foods — we love eating foods from all cultures. I think it will take a while for us to savor the richness of New York City.