A Conversation with Barrie R. Cassileth, PhD

Separating quackery from legitimate integrative oncology care practices


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Barrie R. Cassileth, PhDBarrie R. Cassileth, PhD, Chief, Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, recently spoke with The ASCO Post about her quest to stamp out the illegitimate use of alternative medicine in cancer care and the results from her latest research.

A researcher and educator about complementary practices for more than 30 years, Dr. Cassileth launched the Integrative Medicine Service at MSKCC 12 years ago to provide patients with integrative oncology care, to research the effectiveness of complementary therapies in improving patients’ specific symptoms, and to investigate the potential adjunctive antitumor effects of botanical agents.

Role of Integrative Oncology

What is the role of integrative medicine in cancer care?

Complementary interventions in oncology are adjunctive. They are not substitutes for conventional cancer treatment. Integrative medicine offers something that is much needed in oncology: a greater focus on controlling the serious physical and emotional symptoms that patients experience primarily as a consequence of today’s often effective cancer treatments. There is substantial evidence that a range of complementary modalities can, in fact, relieve many common symptoms, including pain, hot flashes, sexual dysfunction, urinary problems, fatigue, xerostomia, anxiety, depression, stress, osteoarthritis, shortness of breath, neuropathy, and lymphedema.

What types of integrative therapies are used in cancer care?

We focus on six main categories of integrative care at MSKCC. These include acupuncture, massage therapies, and mind/body therapies, such as meditation and self-hypnosis. We also have a heavy emphasis on fitness and movement therapies because there is a survival advantage for many patients with cancer who engage in regular physical activity after diagnosis. Music therapy is profoundly helpful, particularly for those who are noncommunicative or terminally ill. Not only does it relax patients and reduce stress and pain, music therapy also reduces mood disturbance. We showed that in a randomized clinical trial. Nutrition and supplement counseling is the sixth main area of our clinical and research focus.

We established the About Herbs website (mskcc.org/aboutherbs) because it was clear that this kind of information was sorely needed by both oncology professionals and patients. The site is free and now contains more than 250 continuously updated entries of evidence-based information. Judging by the number of hits and e-mails we receive, this award-winning website is clinically useful to oncology professionals from around the world. A second portal contains simplified information for patients. Anyone can enter either portal at no cost.

We have also been studying botanicals, particularly medicinal mushrooms. We are exploring whether their immune-enhancing ability makes them potentially useful as adjuncts to mainstream cancer treatment. Many herbal compounds are used for medicinal purposes in areas of the world that rely on traditional medicines. In the developed world, they are often promoted and used inappropriately.

Acceptance of Integrative Medicine

Are oncologists in the United States more receptive to the inclusion of integrative practices in traditional cancer therapies than oncologists in other parts of the world?

There’s no question about it. Today, virtually every U.S. cancer program has an integrative medicine service of some kind. It may be as small as a massage therapist a half-day a week or a music therapy program once a month, but most major cancer programs in North America have more substantial sets of activities. They may not be as full-blown as ours in the sense that we cover every academic base: inpatient and outpatient care, research, education, and training.

I see the United States as about a decade ahead of other countries in this regard, but the rest of the world is catching up. Our department at MSKCC was consciously developed as a prototype that others could learn from and use parts of in their own hospitals. We have had the heads of hospitals from the U.S. and many other countries come to visit seeking advice about developing their own integrative medicine program, and they leave with a plan to develop an integrative medicine unit at their institutions.

Ongoing Research

Talk about your research in botanicals and herbs, as well as in other integrative disciplines in cancer care.

In general, I think the most important issue concerning medicinal herbs, other botanical agents, and most dietary supplements is that they should be avoided by people on active cancer treatment. Herb-drug interactions represent a serious concern. Herbal remedies can prolong bleeding and create other problems. There are a number of really good reasons not to use dietary supplements during cancer treatment. Avoiding them is MSKCC policy.

Our current research focuses on an extract from the maitake mushrooms, which has immune-enhancing potential. We have a study underway involving patients with myelodysplastic syndromes (MDS), to see whether the mushroom extract makes a difference clinically. We know, for example, that the extract increases neutrophil count and function in laboratory animals and in an early clinical study of patients with cancer. Our current phase II trial seeks to determine whether the extract enhances hematopoiesis in patients with MDS. Hopefully, we’ll find that neutrophil count and function are improved, and if that’s the case, we’ll move toward a larger study to look at survival and other responses. (For information about patient accrual, contact principal investigator Kathleen Wesa, MD, at 646-888-0845 or visit the Memorial Sloan-Kettering Cancer Center website at mskcc.org/mskcc/html/2270.cfm?IRBNO=09-094.)

We are also doing a very important study with vitamin D. Our retrospective analysis of banked sera from patients with colorectal cancer showed a strong relationship between length of survival and vitamin D levels. We’re now working on a similar study of data from patients with breast cancer and toward a prospective study to see whether replenishing patients’ vitamin D levels improves survival.

We are also enthusiastic about our acupuncture research program, and we’re about to complete a study of acupuncture treatment for lymphedema. We first conducted a small pilot to make sure that acupuncture was safe. It was. The study had a stopping rule: achieving at least a 30% reduction in lymphedema in a minimum of 40% of patients. The study stopped very quickly. Now we are embarked on a larger pilot with a mechanism component.1 The regimen is two acupuncture treatments a week for 4 weeks and then monthly follow-up phone calls to make sure that no adverse late events occur. These are important areas of research for us. ■

Disclosure: Dr. Cassileth reported no potential conflicts of interest.

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Reference

1. Cassileth BR, Van Zee KJ, Chan Y, et al: A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema. Acupunct Med. June 18,  2011 (early release online).


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