The term ‘integrative’ has been corrupted by fringe elements that suggest ‘alternative’ therapies can be used in addition to, or in lieu of mainstream cancer treatments. This is grossly inappropriate because there are no alternatives to mainstream cancer care.
—Barrie R. Cassileth, MS, PhD, Ian Yarrett, and Dawn Lemanne, MD, MPH
Over the past decade, integrative oncology has gained wide acceptance as an evidenced-based way to improve the lives of patients with cancer throughout the continuum of their care. The ASCO Post recently spoke with Barrie R. Cassileth, MS, PhD, Chief of the Integrative Medicine Service and Laurance S. Rockefeller Chair in Integrative Medicine at Memorial Sloan-Kettering Cancer Center, New York. An early proponent of integrative oncology, Dr. Cassileth founded the Integrative Medicine Service at Memorial Sloan-Kettering as well as the Society for Integrative Oncology, which will hold its 10th International Conference later this year.
Mission and Its Components
Please give the readers a snapshot of integrative oncology at your center.
Sloan-Kettering’s Integrative Medicine Service was established in 1999. The fundamental mission is to employ a variety of nonpharmacologic therapies to help manage the difficult physical and emotional symptoms associated with cancer care, which can last through survivorship. I feel very strongly that cancer care should not be limited to the delivery of oncology therapies; treatment should be balanced by careful and nuanced attention to the patient’s physical and emotional needs.
How is the integrative service at your center organized?
There are a number of categories and programs in integrative oncology that are delivered at Sloan-Kettering. Each program has a manager and several assistants, all of whom are also therapists or practitioners. The main programs are physical fitness programs, acupuncture treatment, massage and touch therapies, mind/body therapies such as meditation and self-hypnosis, music therapy that promotes a general sense of well-being, and nutritional counseling.
Perhaps the most important component of the collective integrative oncology approach is physical fitness, because it is the only program that has definitely been associated with a survival benefit in cancer. Although the data are not totally in, studies in breast, prostate, and colorectal cancers have indicated that there is an actual survival benefit for patients who engage in appropriate exercise. That finding needs further study in the greater clinical picture, because patients who perform routine fitness activities tend to have other healthful habits such as proper diet, so the benefits we see might be part of a broader healthy lifestyle in that group of patients.
Growth and Acceptance of Integrative Oncology
Has the field seen growth since you first began the program at Sloan-
Yes, integrative oncology has spread widely over the past decade, to the point that virtually all NCI-designated comprehensive cancer centers in the United States, as well as many of the nation’s smaller clinical centers, offer some form of integrative oncology services. The scope of these programs differs from center to center.
I believe that Sloan-Kettering has one of, if not the most comprehensive programs in the country, in the sense that we offer all the major services in the field, as well as inpatient and outpatient care, an intensive research program, and a great deal of patient and professional education, so we can be seen as a model for institutions that want to develop or expand their programs.
Do you feel that integrative oncology is fully understood in the broader cancer population?
Everything we do is evidence-based, but the term “integrative” has been corrupted by fringe elements that suggest “alternative” therapies can be used in addition to, or in lieu of mainstream cancer treatments. This is not only grossly inappropriate but also frightening, simply because there are no alternatives to mainstream cancer care, which is now producing cure rates of about 66% and growing. Alternative therapies are bogus cures promoted primarily on the Internet by those who seek to mislead and profit from vulnerable people with cancer.
Unfortunately, the FDA’s ability to stop false advertising of bogus cancer therapies has its limits. The people behind these charlatan Web-based companies are very creative and quickly resurface under new names. Medical quackery is a $40 billion per year industry in the U.S. alone.
Teasing out valid information about herbs and botanicals from the millions of Web pages of spurious cancer-related content is very difficult. One of the first things we did at the outset of our program, which is now 14 years old, was to establish our free “About Herbs” website. It has two entry portals—one for patients and the public, the other for oncologists and other medical professionals. The site provides objective information, including a clinical summary for each agent and details about constituents, adverse effects, interactions, and potential benefits or problems. And we just launched a free app that was created by Memorial Sloan-Kettering, which is downloadable to most of the portable technologies.
Are there any ongoing research programs you’d like to share with the
We’ve studied a variety of interventions such as acupuncture, massage therapy, and botanicals and herbs. One of the promising areas we’re looking at is acupuncture, a modality that has a huge amount of data supporting its use in relieving pain and nausea. We did a study with our head and neck cancer group looking at acupuncture in xerostomia, a debilitating side effect of radiation oncology, leaving many patients housebound. We found that acupuncture actually enabled salivation, a rare and significant step in this clinical setting.
Based on results from early published pilot studies looking at acupuncture in lymphedema, we recently initiated a large randomized trial. The pilot studies showed that acupuncture reduced arm circumference, so this is another exciting area of research. Depending on the results, we may look at acupuncture in leg lymphedema, which sparked this line of investigation.
Several years ago, I mentioned acupuncture during a presentation to a group at Sloan-Kettering. Some months later, as I was walking through the center’s lobby, a woman came over to me and said that she was at my lecture. After explaining that she had very bad leg lymphedema following gynecologic surgery (a common side effect), she said that she sought acupuncture as a last resort. To my surprise, she lifted up her dress and said, “look.” Both legs were normal, absolutely no sign of swelling. That incident was the catalyst for our pursuit of acupuncture for lymphedema.
It is very important to note that acupuncture is safe in lymphedema, without complications or infections from the needles. Many patients, and even doctors, operate under the assumption that acupuncture might exacerbate the swelling, which has been proved to be an unfounded concern.
Any last thoughts on your work in the field?
I receive e-mail and telephone inquires about integrative oncology from practitioners and patients across the country and internationally. We are constantly expanding our efforts to serve as a useful, easily accessible asset to cancer patients, survivors, families, and oncology professionals. I would urge oncologists and leaders of cancer centers of all sizes to develop integrative oncology programs and offer the information and services that are very much needed by our patients and survivors. Contemporary cancer care requires both expert oncologic treatment and attention to the physical and emotional symptoms that often endure well into survivorship. Integrative medicine provides the tools that patients can use to control many such symptoms on their own. ■
Visit the About Herbs website at www.mskcc.org/aboutherbs
The “About Herbs” site (http://www.mskcc.org/cancer-care/integrative-medicine/about-herbs-botanicals-other-products) provides objective information for oncologists and health-care professionals, including a clinical summary for each agent and details about constituents, adverse effects,...
The Society for Integrative Oncology (SIO) will be holding its 10th International Conference in Vancouver,
Canada, from Sunday, October 20, 2013 to Tuesday, October 22, 2013. This year’s SIO theme: “From bedside, to bench, to best practices.” The conference will include keynote speakers, plenary...