Overview of Integrative Medicine Program at MD Anderson Cancer Center

Richard T. Lee, MDAssistant Professor

Medical Director, Integrative Medicine Program

March 4, 2011

Overview of Integrative Medicine

Integrative Medicine Program at MD Anderson Cancer Center

Therapies of Interest

Objectives & Outline

Complementary and Alternative Medicine (CAM)

National Center for Complementary and Alternative Medicine (NCCAM) – National Institutes of Health (NIH) Office of Alternative Medicine (1991)

Definition A group of diverse medical and health care

systems, practices, and products that are not presently considered to be part of conventional medicine.

Categories of CAM - NCCAM1. Alternative Medical Systems

◦Traditional Chinese medicine, homeopathic, naturopathic

2. Mind-Body Interventions◦Meditation, prayer, mental healing, music

therapy

3. Biologically Based Therapies ◦Dietary supplements, herbal products,

shark cartilage

4. Manipulative and Body-Based Methods◦Chiropractic, osteopathic, massage,

manipulation

5. Energy Therapies ◦Qi gong, Reiki, therapeutic touch,

magnetic fields

MD Anderson Cancer Center, 2000◦ ~450 patients

CAM Use Among Cancer Patients

Richardson et al. JCO 2000

2007 CAM Use in United States

Therapy Prevalence (%)

Natural Product 17.7%

Meditation 9.4%

Chiropractor 8.6%

Massage 8.3%

Yoga 6.1%

Acupuncture 1.4%

The Difference Between Alternative, Complementary, and Integrative

Alternative medicine is used in place of conventional medicine.

Complementary medicine is used together with conventional medicine.

Integrative medicine is used together with conventional medicine in a deliberate manner that is personalized, evidence-based, and safe.

The practice of medicine that reaffirms the importance of the relationship between practitioner and patient

Focuses on the whole person Informed by evidence Makes use of all appropriate therapeutic

approaches, providers, and disciplines to achieve optimal health and healing

Integrative Medicine Center Philosophy

The Integrative Medicine Center aims to work collaboratively with the oncology team to build a comprehensive and integrative care plan that is personalized, evidence-based, and safe with the goal of improving clinical outcomes.

Physical

Psycho-Spiritual

Social

Integrative Medicine Center Model

Health

Optimal Health

● Pharmacy

●Chemotherapy ●

Surgery ● Radiation

Physical● Nutrition

● Acupuncture

● Massage

● Exercise

● Rehabilitation

Psycho-Spiritual●

Chaplaincy

● Psychiatry

● Tai Chi

● Cognitive Behavior

● Meditation ● Yoga

Social

● Music Therapy

● Family/Friends

● Patient Advocacy

● Social Work

● Education

● Support Groups

● Integrative Oncology Consultation

Integrative Medicine Center Model

= Improved Clinical Outcomes

● Chaplaincy

● Nutrition

● Family/Friends

Physical

Psycho-Spiritual

Social

● Pharmacy

● Psychiatry

● Patient Advocacy

● Music Therapy

● Tai Chi

●Chemotherapy ●

Surgery ● Radiation

● Acupuncture

● Massage

● Exercise

● Rehabilitation

● Cognitive Behavior

● Meditation ● Yoga

● Social Work

● Education

● Support Groups

Integrative Medicine Center● Integrative Oncology

Consultation

Optimal Health

● Chaplaincy

● Nutrition

● Family/Friends

Physical

Psycho-Spiritual

Social

● Pharmacy

● Psychiatry

● Patient Advocacy

● Music Therapy

● Tai Chi

●Chemotherapy ●

Surgery ● Radiation

● Acupuncture

● Massage

● Exercise

● Rehabilitation

● Cognitive Behavior

● Meditation ● Yoga

● Social Work

● Education

● Support Groups

Integrative Medicine Center● Integrative Oncology

Consultation

Optimal Health

Integrative Medicine Last 12 years… Over 60,000 clinical encounters

involving over 22,000 individuals◦ 50% were patients

Massage – 16,596 Music Therapy – 6,780 Yoga – 5,838 Acupuncture – 4,803 Consultations (FY ‘10) – 500+

When to Refer?

Continuum of Cancer CareDiagnosis Surgery Chemotherapy Radiation

MeditationDiet & Exercise

AcupunctureMusic Therapy

Active TreatmentPrevention Survivors

Oncology Massage Therapy

Mood Disturbance (1C)• Anxiety• Depression

Pain (1C) Neuropathy

Mind-Body Practices

Stress (1B) Pain Mood Disturbance (1B)

◦ Anxiety Quality of Life (1B) Insomnia (1B)

Music Therapy

Stress (1B) Mood Disturbance (1B)

◦ Anxiety Quality of Life (1B)

Pain (1A) Nausea (1A) Xerostomia (1B) Hot Flashes (1B) Fatigue (2C) Neuropathy (2C) Insomnia

Acupuncture

What is the best way to delivery acupuncture?

What points? How deep? How often? Is electroacupuncture really better? What about acupuncture is really working?

Acupunctre Research

Mushrooms◦ PSK, AHCC

Oleander

Mistletoe/Iscador

Milk Thistle

Does is work, how does it work, and does it interfere with treatment?

Natural Products of Interest

Thank You