Center made for inpatient/outpatient services
All therapies are backed by good research data
Upon admission, patients at the Memorial Sloan-Kettering Cancer Center in New York City receive a brochure that lists the therapies offered by the integrative medicine service. During their hospitalization, they can either self-refer, or their physicians can refer them to the center for one of a multitude of therapies offered at no cost to the patient.
"When patients see a therapy in the brochure they think would be helpful to them, they call the center, make an appointment and the practitioner will evaluate them to see if it is an appropriate request," says Barrie R. Cassileth, PhD, chief of the integrative medicine service.
For example, if the request is for acupuncture, the acupuncturist will do the evaluation; and if it is for massage, the massage therapist would see the patient. Requests are granted if the patient has a symptom that needs to be controlled, such as pain, nausea, depression, or anxiety.
Service is open to the public
Therapies are only provided on an inpatient basis if there is a problem because there are more requests than staff members can handle. The most commonly requested therapies by inpatients are massage and music therapy.
On an outpatient basis, therapies are all widely used and a variety of people come to the freestanding integrative medicine center, which is open to the public. Practitioners see Memorial Sloan-Kettering cancer patients and their families, staff, cancer patients being treated at other facilities, and people from the community. All outpatient services are fee-based.
They come to the center for such therapies as progressive relaxation, self-hypnosis, meditation, massage, music and art therapy, acupuncture, and a multitude of classes including yoga, tai chi, special aerobics, and dance aerobics. Cancer patients are self-referred, as well as physician- or nurse-referred.
While there is a wide selection of therapies offered at the integrative medicine center, they all were chosen on the basis of their validity, says Cassileth. "All the therapies that we employ have very good data supporting their value, and we don’t use any irrational therapies. All are very solid approaches that are backed by good data and medical literature indicating that they have benefits," she explains. For example, homeopathy and therapeutic touch are not offered at the to support their validity.
Just as the therapies have been carefully selected, so are staff. All practitioners are licensed and certified in the area of their expertise according to New York state law. In addition, they have to be highly experienced, know how to work with cancer patients, and have experience working with them. Also, they must have good interpersonal skills, because many of the people they see are going through a lot of stress.
Staff see both sides to disease
Staff are rotated on a regular basis so that they see both inpatients and outpatients. It helps provide variety in their job, reducing the potential for burnout, explains Cassileth. It also helps practitioners understand the cancer experience a little bit better by working with hospitalized as well as outpatients. "It is difficult to work with patients who are terribly ill," says Cassileth.
Often, the patients who come to the center already have read the brochure that explains the various modalities offered and know what therapy they want. Most are familiar with the therapies, but if they aren’t, they can discuss their choices with a practitioner. It is common for patients to use a variety of services available taking a class such as yoga, and regularly scheduling massage and acupuncture or some other therapy.
To help staff understand the therapies offered at the integrative medicine center, Cassileth has given grand rounds for most of the departments. In addition, three or four practitioners representing different interventions will visit departments to explain to staff what services the center provides. "It helps staff understand that the service is available to their patients so they encourage their patients to call, or they make a recommendation," says Cassileth.
Complementary therapies are an extension of the supportive care that has always been a part of oncology — they are just more sophisticated. The benefits are both physiologic and psychological. They can help relieve symptoms such as pain and nausea, and help people cope with anxiety and depression. "We can help patients get through a difficult time, and the same is true for their family members," says Cassileth.
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