Alternative medicine as part of cancer treatment is almost standard now in leading American hospitals. Dr Barrie Cassileth is Chief of the Integrative Medicine Department at Memorial Sloane Kettering Cancer Center in New York and she tells us how the system there works. Integrative Medicine describes the attempt to bring together mainstream medicine with complementary therapies like massage, acupuncture and self hypnosis. But you'd think cancer is an area where integrative medicine would fear to tread. Not so. Here's a transcript of an interview by ABC program "Health report".

Barrie Cassileth is Chief of the Integrative Medicine Department at Memorial Sloane Kettering Cancer Centre in New York, one of the top three or four cancer treatment and research centres in the world.

Barrie Cassileth: My department has a little over 60 people, most of them are practitioners and therapists. We have an acupuncture program, a mind/body program where we teach meditation, self hypnosis, relaxation therapies and so on. We have a major fitness program because exercise following a cancer diagnosis is absolutely vital, nutritional counselling, herbal counselling, many classes in yoga and anything you could think of that we consider useful and rational.

Barrie Cassileth: Insurers do not cover these services but many patients will go to various areas of the city where they can get massage therapy, they can get acupuncture and so on but they are receiving it from people who are not trained to take care of cancer patients. It's very dangerous for that to happen.

Barrie Cassileth: Massage therapy for example - we offer a two and a half days certificate course to teach certified licensed massage therapists how to take care of cancer patients and we have a similar course for acupuncturists. People have come from Australia and from all over the world to take these courses. There are dangers inherent of massage therapists pressing on the wrong thing and not understanding what cancer is about, not knowing how to work around ports and lines and so on. You have to be able to read a chart and figure out what's going on with that particular patient that you are about to treat. You're going to touch a patient with cancer so you really have to know a lot about the disease because there have been a number of very serious consequences when that's not been the case. For example chiropractic or any kind of manipulation is not permitted in our institution because patients receiving chemotherapy almost always have fragile bones and those bones can be broken. It's not the same as taking care of the average person who you know just has some aches and pains and wants some massage therapy or some acupuncture, or some fitness training.

Norman Swan: So how do you make a decision about what you are going to use? I mean you've already said you're not going to use chiropractic because there are dangers there but there are a lot of people out there claiming benefits. What do you decide you're going to invest time and effort on?

Barrie Cassileth: We offer therapies that we consider rational and that are evidence based and we also study everything that we do. We have two main areas of research, one is to look at the value of the therapies that we provide such as massage therapy, music therapy, fitness and so on and reducing a particular physical or emotional symptom. And we study it always with first pilot studies and then in randomised controlled trials. The other area of our research is anti-tumour botanicals, we have a very active, very large research program from the laboratory leading up to and conducting randomised clinical trials with patients and we look at botanicals which we have selected because they have something promising about them either in the traditional Chinese medicine literature or in some other literature. The government has funded five botanical research centres, we are the only one dealing with cancer.

Norman Swan: And have you found anything yet?

Barrie Cassileth: Well we're very early on.

Norman Swan: What about the other areas? For example, what have you found in the areas such as acupuncture, music therapy and the other things?

Barrie Cassileth: We know for example that acupuncture has an important role in the management of nausea, pain, neuropathic problems where nerves have been crushed and patients frequently experience not only pain but itching and just very unpleasant feelings. Acupuncture seems to work with that. We even have people come in for problems such as erectile dysfunction and acupuncture seems to be able to help many people along those lines; hot flushes, serious fatigue, the extraordinary fatigue that afflicts many cancer patients.

Norman Swan: If you asked them about what bothers them most they'll often say it's the fatigue.

Barrie Cassileth: It's often the fatigue that's most bothersome. Many patients respond very well to acupuncture for fatigue so acupuncture has many roles but the nice thing about it is there really is no down side to trying it, if you have a problem, if you have anxiety, depression, extreme dry mouth plus the other things I've mentioned it's absolutely worth a try. You go two or three times, if it doesn't work then drop it.

Norman Swan: But ideally you want to go to an acupuncturist who knows about cancer?

Barrie Cassileth: Yeah, because I can tell you about one of the earlier studies we initiated was to look at hot flushes. Now in the community acupuncturists treat hot flushes but those points did not work, those acupoints were not effective.

Norman Swan: And the reason, just to explain, you get hot flushes with chemotherapy is that you knock off the ovaries sometimes and therefore you induce an early menopause.

Barrie Cassileth: Exactly but the consequences of an early menopause and the physiology behind it are quite different from a normal menopause and so the set of acupoints that works in one case doesn't work in another. So you need someone who knows what they're doing.

Norman Swan: And what about nutritional therapy because there are diets out there that people promote for cancer in which you end up losing weight and the last thing you want to do when you've got cancer probably is to become skeletal or go on something that's nutritionally unbalanced. What have you done with nutrition?

Barrie Cassileth: We know that no diet cures cancer, that's very clear, there have been bogus diets promoted as cancer cures probably for over 100 years and no diet has ever been shown to cure cancer. Eating well, eating a plant based diet is very important but it doesn't cure the disease, it keeps your body as strong as it can be to get through the treatment and to the other side of the treatment.

Norman Swan: So it's a helper.

Barrie Cassileth: It's a very important helper.

Norman Swan: When you evaluate it, I mean there's a push in Australia to move towards integrative medicine centres such as you've got in the United States in an increasing number of cancer centres, but they cost money and it's money in the Australian context that would otherwise be spent on patient care in a public system. When you've evaluated the things people say and the effects that you've had and you put your hand on your heart according to the best evidence, what benefits have you got for the money invested?

Barrie Cassileth: Oh I think there are numerous benefits. Patients often tell us that they could not have gotten through their cancer treatment were it not for the complementary modalities that were available to them both as in-patients and out-patients. It makes a world of difference to how people feel but there are so many other benefits that we can document. For example when patients have an enduring problem such as pain or dysfunction in muscles, or something of that kind, I'm talking about quantifiable physical problems as well as the emotional - anxiety and stress and so on. Sometimes those are so serious that they are ready to give up on the treatment, they are ready to give up on the chemotherapy, or the radiation.
 

Norman Swan: So you're more likely to stay with the program.

Barrie Cassileth: You're more likely to stay with the treatment that in the end is going to be effective in bringing about a cure in about 65% of the cases. So we do everything we can to make that happen. But there's a whole other level of preference on the part of patients, they want to participate in their care, they want to have some control over their well being and their lives and their health and complementary therapies play a very important role there. Not only in dealing with the symptoms but also in allowing patients to come in and say OK, I have to take more pain medication than I really want to take, I want to reduce that, how can I reduce it? Well I'm going to come in and try some massage therapy - yes, you can reduce the amount of opioids that you take, you can relieve pain with massage therapy, acupuncture - ditto, mind/body therapies - very important.

Norman Swan: Things like hypnosis?

Barrie Cassileth: Things like self hypnosis. Self hypnosis is like a deep meditation, a deep meditative state that patients can learn and apply during stressful situations. There is even a cost benefit here because it is pretty well established, there are many papers in the medical literature that patients who use self hypnosis prior to surgery do much better in the recovery room, their vital signs come back more quickly, they get out of the recovery room more quickly, they get out of the hospital more quickly thereby representing a savings of more than $1000 per patient because the patient leaves the hospital earlier.