integrative cancer care in an academic cancer centre in the u.s

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Integrative Cancer Care in an Academic Cancer Centre in the U.S.

Gary Deng, MD, PhDIntegrative Medicine Service

Memorial Sloan-Kettering Cancer CenterNew York, NY

Integrating Wellness in Cancer CareToronto, OntarioOctober 4, 2007

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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Overview• History

• Clinical service

• Research activity

• Educational efforts

• Future direction

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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Memorial Sloan-Kettering Cancer Center Integrative Medicine Service

Clinical Services

Research Education& Training

212-639-4700 212-639-4700 http://www.mskcc.org/mskcc/html/1979.cfm

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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Clinical Services

• Outpatient center

• Inpatient treatment

• Oncology clinic

• Classes for employees

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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• Acupuncture• Massage• Mind-body therapies• Exercise, fitness• Nutritional counseling

MSKCC Integrative Medicine Clinic

• 1429 First Avenue (74th Street)

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

6Treatment Room of Integrative Medicine Outpatient Center

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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Clinical Services

• Clientele– Newly diagnosed cancer patients– Cancer patients undergoing treatment– Cancer survivors

Non-cancer patients– Employees

• Interacting departments– Medical, surgical and radiation oncology– Pain and palliative care, psychiatry, physical medicine

and rehabilitation, sexual health clinic, geriatric program, survivorship program

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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Research

Efficacy

Safe

ty harmful

useless

safehelpful

safeinsignificant

with effectsbut also risk

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

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Active Symptom Control Trials at MSKCC

• Cancer pain (massage)

• Post-chemo fatigue (acupuncture)

• Shoulder pain and dysfunction in H&N cancer (acupuncture)

• Post-operative ileus (acupuncture)

• Thoracotomy pain (acupuncture)

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Completed Symptom Control Trials at MSKCC

• Mood disturbance (music therapy)

• Post-chemo fatigue (acupuncture)

• Symptom control (massage)

• Dyspnea (acupuncture)

• Hot flashes (acupuncture)

• Functional MRI (acupuncture)

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Botanical Trials at MSKCC • Breast cancer (Maitake extract)• Solid tumor (Huanglian extract)• Lung cancer (JFK herbal formulation)• Hepatitic C (SST herbal formulation)

• More Information: 212-639-4700

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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MSKCC Research Center of Botanical Immunomodulators

• Setting: One of the six Centers in the nation (NIH P50 Grant)• Theme: Immunomodulators and cancer • Study Agents: Echinacea, Astragalus, Turmeric, Maitake,

Coriolus and other botanicals• Institutions: MSKCC, CUHK-ICM, Cornell, Rockefeller U. • Goals: to study the effects, mechanisms of action and active

constituents of botanicals purported to boost the immune system for their potential application in prevention and treatment of cancer or infectious diseases

Botanical Research Center

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Immunomodulation

• Facilitate antigen presentation

• Improve innate immunity

• Enhance antibody mediated cytotoxicity

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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MSKCC Integrative Oncology T32 Research Fellowship Training Program

• Setting: The first of the kind program in the country• Funding: NIH T32 Grant• Goals: To foster the development of cross-trained young

investigators in Integrative Medicine and Cancer Care• Candidate: MD or MD/PhD completing or having completed

residency training in the U.S. • Program:

– Three years of training

– Core curriculum in Integrative Medicine and research methodology

– Clinical practice

– Laboratory and clinical research projects

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Integrative Oncology Training Courses• Acupuncture for cancer patients

– Level I, II, III, twice a year

• Medical massage for cancer patients– Level I, II, twice a year

• Integrative Oncology Summer Research Fellowship– Three medical students/year, NCI funded

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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www.mskcc.org/aboutherbswww.mskcc.org/aboutherbsPublished by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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MSKCC AboutHerbs Website

• More than 220 monographs, updated monthly

• More than 1.5 million hits per year• Cited in JAMA, Nature, Washington Post,

Wall Street Journal• Named one of the top five websites in all of

Medicine by Scientific American. • More hits than MSKCC home page

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Integration with Mainstream Care

• Clinical Practice– Review medical chart prior to providing treatment

– Collaborate with members of the healthcare team

– Document all treatment, response and plan in medical chart

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Expertise of Therapists

• Professional accreditation required

• Hiring process individualized

• Staff only with highly experienced clinicians with related work experience

• Continually monitor practitioners and provide advanced training/education

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Factors Helping to Ensure a Successful Program

• Use evidence based therapies

• Follow norms of clinical practice

• Develop a strong administrative component

• Maintain a professional image

• Assure excellence of staff

• Deliver superior service

• Remain adaptable and responsive to client needs

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Past Challenges and Our Approaches• Unfamiliarity

• Give seminars, grand rounds, in-services, demonstrations

• Write book chapters, reviews• Conduct join research

• Skepticism• Establish trust and credibility• Have patients provide positive feedback• Conduct high quality research• Get NIH grants• Participate in institutional committees

• Competition for resources• Provide value-added services• Elicit support from institutional leadership• Bring in external funding

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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Future Directions• Raise awareness among patients

and health care professionals

• Implement closer integration throughout a patient’s journey through cancer treatment and beyond

• Develop more efficient and effective programs

• Elevate the level of sophistication in research

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc