ARLINGTON, VaOne measure of the influence of complementary and
alternative medicine (CAM) on the world of conventional medicine may
be the acceptance by major cancer centers of programs designed to
integrate these therapies into their services.
At a panel session of the Comprehensive Cancer Care 2000 conference,
program chiefs from M.D. Anderson Cancer Center, Dana-Farber Cancer
Institute, and Memorial Sloan-Kettering Cancer Center discussed how
they developed and currently manage CAM units at their institutions.
M.D. Andersons Place . . . of wellness offers an
environment for healing opportunities for the mind, body, and
spirit, said administrative director Judy Gerner, LPT. The
center focuses on the current and future quality of life of any
patient diagnosed with cancer, regardless of whether they were
treated at M.D. Anderson, and their personal caregivers, and also
serves as a point of triage for all M.D. Anderson services and
programs used by this population.
The program had its origins in a series of annual workshops on
complementary medicine that began in 1985, but high patient interest
pushed M.D. Anderson to begin strategic planning for a freestanding
unit a decade later. The key to its implementation, Ms. Gerner said,
was getting both the administration and the heads of the medical
departments to sign off on the proposal.
The members in this meeting were scientists, researchers, and,
of course, clinicians. We had no idea how or if they would accept the
proposal, she said. But they gave us enthusiasm and
More than a year before the unit opened, Ms. Gerner put together a
steering committee drawn from M.D. Anderson departments to avoid
overlap and a sense of competition and to bring experienced
perspectives to the new venture in patient education, social work,
and chaplaincy. She also set up a committee of patients and family members.
Dana-Farbers Zakim Center
Dana-Farbers CAM unit is really a multi-institutional
coalition, backed by Brigham & Womens Hospital,
Massachusetts General Hospital, Childrens Hospital, Beth Israel
Hospital, and the Massachusetts College of Pharmacy, said Mary Jane
Ott, MN, MA, a nurse practitioner at Dana-Farber.
Ms. Ott said that the program had its origins in patient interest,
but was especially aided by the patient for whom it is
namedLeonard P. Zakim, who died last December after a long
battle with multiple myeloma. Mr. Zakim was co-chair of the
Complementary Therapy Task Force, and a large fund-raising event was
held in his honor, allowing the center to become a reality.
Planning for the Leonard P. Zakim Center of Integrative Therapy meant
consulting with existing departments, including patient care,
education, and research, she said.
The Dana-Farber Zakim Center, in contrast to M.D. Andersons CAM
unit, is a center without walls. Patients asked us to come to
where they were throughout the institution, Ms. Ott said.
Simone B. Zappa, RN, MBA, program director and administrator at
Memorial Sloan-Ketterings Integrative Medicine Service, said
that ideas have to be adapted to each institution and
location. She describes the Integrative Medicine Service as a
center with and without walls.
Half of the 200 patients seen by Ms. Zappas staff each week are
inpatients. She found that most outpatients didnt want to
linger for CAM sessions after chemotherapy or physician visits. A
second, separate site helped patients feel good about their CAM
experience, she said, and not like cancer patients.
All of these programs concentrate on improving the quality of life
for cancer survivors or those patients undergoing treatment.
Techniques used at the Zakim Center include relaxation techniques,
mindfulness meditation, guided imagery, yoga, Therapeutic Touch, and
Reiki (a Japanese form of healing touch).
A referral patterns showed that patients sought CAM primarily for
stress reduction (25%), anxiety relief (15%), and Therapeutic Touch
(24%), Ms. Ott said.
Memorial Sloan-Kettering uses some of these therapies as well as
reflexology, mind/body work, acupuncture (performed only by MDs) and
inpatient music therapy.
M.D. Anderson offers yoga, tai chi, meditation, art, music, and humor
therapy, support groups, nutrition, stress management, relaxation,
guided imagery, and educational forums.
A critical element in starting and running CAM programs, all three
representatives said, is placing them on a firm medical footing.
Patients want both conventional and complementary therapies. At
M.D. Anderson, we emphasize the complementary, Ms. Gerner
said. We dont use the term alternative.
Ms. Zappa credits the Memorial Sloan-Kettering programs success
to sticking to evidence-based therapies, structuring the unit on a
medical model, and collaborating closely with the health care team.
Power lies with the doctors in a conservative institution,
she said, so the only way to integrate the service is to get
the buy-in of the doctors.
The Integrative Medicine Service acts on referrals from all members
of the health care team as well as self-referrals. Patients are
assessed and receive a treatment plan that might call for anything
from a one-shot therapy to treatment several times a week.
Ms. Zappa said she hires only staff licensed within their
specialties. The panelists noted that not all CAM therapies have
credentialing boards, so staffing decisions may rely on references
and interviews as well as on formal credentials.
Funding sources vary widely at all three institutions. M.D. Anderson
paid for the renovation of an existing but disused space and
contributed $30,000 in startup funds. The Cancer Center also pays
$40,000 per year for expenses plus salaries for a medical director,
administrative director, and three full-time equivalent staff. The
staff must raise funds for additional programming, Ms. Gerner said.
The unit charges no fees to the 10,000 patients per year who visit.
Memorial Sloan-Kettering is currently a fee-for-service program, but
Ms. Zappa is working to make insurance coverage easier to obtain for patients.
CAM lowers costs, added commentator Clem Bezold, PhD, a
consultant and president of the Institute for Alternative Futures,
and that should drive what gets on the list for reimbursable
Selling the Concept
Marketing the programs is critical to success. Persuasive efforts to
gain approval from decision makers within the institution in the
planning stages, ongoing marketing of services to doctors and nurses
to encourage referrals, and external marketing to draw in patients
and their families are all needed.
Even terminology has a mysterious effect on patients, Ms. Zappa said.
Simply renaming a Back in Shape course, Light
Aerobics attracted many more participants, she said.
Finally, research and education are important components of these CAM
programs. Researchers at Memorial Sloan-Kettering are studying Asian
herbal remedies and evaluating quality of life. Dana-Farber is doing
studies on pediatrics and on the immunologic benefits of qi gong, a
type of healing exercise from China.
Ms. Gerner said that M.D. Anderson has more than 70 ongoing research
studies examining issues related to the mind, body, and spirit. She
sees Place . . . of wellness playing an important role in
helping M.D. Anderson develop and implement novel research studies in
the area of psychosocial care and quality of life.