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 support.
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 care.
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.