NEW YORKA Memorial Sloan-Kettering Cancer Center public forum held to introduce the public to the hospitals new complementary medicine service drew repeated bursts of applause and expressions of thanks from the patients, family, and community members who attended. The audience not only heard from practitioners but also saw slides of relaxing visual imagery, meditated to the sound of a crystal bowl rim being rubbed, and listened to the music of a trio of music therapists.
I want to thank you for taking the initiative for supporting what some people in the medical profession consider nonmedical, said one man in the audience whose remarks were echoed by others. Another person wondered if it was necessary to have cancer to take advantage of the array of therapies available through Memorials new Integrative Medicine Service. (The answer was no; the service is also open to family members of cancer patients.)
The new services include massage, art, music and sound therapy, acupuncture, hypnotherapy, meditation, guided imagery and visualization, yoga, Tai Chi, nutritional counseling, and movement therapies such as the Alexander Technique and Feldenkrais method.
They are available to inpatients, outpatients, and their families at the hospital, and at two outpatient facilities. One of the facilities, the new Outpatient Center for Integrative Medicine, also takes cancer patients who are not receiving medical treatment at Memorial.
Complementary therapies improve the quality of life, Memorials new chief of Integrative Medicine, Barrie R. Cassileth, PhD, told the forum. [See ONI, September, 1999, page 1, for an interview with Dr. Cassileth.] Thats really the role of complementary care. It relieves fear, stress, anxiety, depression, and all these negative emotions.
The difference between complementary and alternative medicine, Dr. Cassileth said, is that alternative therapies are unproved. But complementary therapies such as meditation, biofeedback, and other modalities have been shown to have a positive impact on physiological and psychological states.
David Payne, PhD, staff psychologist with the Department of Integrative Medicine, observed that the search for inner composure goes back thousands of years. One of the enduring searches of mankind is a search for equanimity, and thats what we intend to work for in the area of mind-body medicine.
The underlying rationale behind the mind-body regimens, he said, is that a calm mind equals a calm body. We know that calming the mind can lead to a downward regulation of physiological parameters, and it goes the other way. A calm body can equal a calm mind. Therapies such as relaxation, meditation, and biofeedback are very useful in handling pain and anxiety, which are often a part of the cancer experience.
Dr. Payne also noted that some patients fear that mind-body techniques require them to give up control, but the reality is otherwise. Many people who go through cancer treatment often have a sense that they are out of control, that cancer, or the physician, or life itself is driving the car. Yet, we know from research that with the use of mind-body techniques, cancer patients can gain a greater sense of control.
He cited the example of hypnosis. In order to undergo hypnosis, people must be capable of focusing their attention rather than letting it go. When people are in a hypnotic state, they actually have greater ability to pay attention, and symptom management is much more easily achieved.
Different Kinds of Massage
Wendy Miner, director of the Outpatient Center for Integrative Medicine, talked about the use of massage with cancer patients. The hospital offers many types, she said, including:
Shiatsu, a Japanese manual pressure technique that uses acupressure points, gentle stretching, and joint rotation.
Swedish massage, which is designed to release chronic tension and increase local blood circulation through the manipulation of soft tissue.
Reflexology, which focuses on specific pressure points on the hand and foot.
The type each patient receives is determined after an initial consultation. For many of our patients, particularly those we see in the hospital right after surgery, any kind of massage would be very invasive, Ms. Miner said. But what we can do is offer them reflexology, which is done on their feet, and they often report that their first walk round the corridor is made much easier. Some patients also elect to get massages while they receive chemotherapy.
Music therapists also work with inpatients and outpatients. They give weekly concerts at the hospital on each patient floor, and make rounds with a violin, guitar, tape deck, or CD player, stopping in to see patients in their rooms.
An audience member asked if Medicare or other insurers pay for these complementary treatments. Dr. Cassileth answered that insurers frequently will pay part of the cost of acupuncture and sometimes massage in cases of cancer.
The list of covered complementary therapies will probably grow, she said. Memorial Sloan-Kettering offers these services on a fee-for-service basis, and it is up to the patient to seek reim-bursement.