When Barrie R. Cassileth, MS, PhD, began researching complementary medicine and its potential for use in oncology care over 30 years ago, not much was known about the importance of complementary therapies for the well-being of patients with cancer. She chose to conduct her doctoral dissertation research at the University of Pennsylvania Cancer Center’s inpatient leukemia unit. It was there that Dr. Cassileth realized patients with cancer needed more than just access to first-rate medical treatment. They needed relief from the physical and emotional toll of cancer and its treatment.

“That put me on this path of researching the effectiveness of complementary therapies and the importance of integrating them into oncology care,” said Dr. Cassileth. Her thesis later became the basis for her first book, The Cancer Patient: Social and Medical Aspects of Care (Williams & Wilkins, 1979), among the earliest to stress the importance of adding rational, helpful interventions to control cancer patients’ physical and emotional symptoms when under treatment and beyond.

Early Research

With equal levels of concern about cancer quackery and the prevalent promotion of nonviable “alternatives” to mainstream cancer care, Dr. Cassileth conducted the first national survey of cancer patients’ use of unconventional methods in the 1980s. She continued to study the clinical effects of complementary and alternative medicine on patients.

Her research showed that patients were using an array of therapies—some ineffective and potentially harmful, and others that were helpful—but that there was no mechanism in place to alert patients (and clinicians) to the risks involved in using untested therapies along with conventional cancer treatment. Worse still, some patients were forgoing proven cancer therapies altogether for unproven alternative remedies touted as “cancer cures.”

In 1999, Dr. Cassileth created the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York, which includes inpatient services at the hospital as well as outpatient services, principally at the Bendheim Integrative Medicine Center. The goal of the department is to provide inpatient and outpatient care, study the ability of specific complementary therapies, such as mind/body, acupuncture, music, and herbal therapies, to reduce specific symptoms associated with cancer and cancer treatments, and provide professional education and training. She holds the Laurance S. Rockefeller Chair in Integrative Medicine and is Chief of the Integrative Medicine Service.

 A prolific writer, Dr. Cassileth has published a dozen books on complementary, alternative, and integrative medicine in oncology care. Her latest book is Survivorship: Living Well During and After Cancer (Spry Publishing, April 2014; see sidebar below). Dr. Cassileth is also a sought-after lecturer on integrative medicine and complementary therapies and will lead an educational session at the 2014 ASCO Annual Meeting on Integrative Oncology: The Evidence Base.

The ASCO Post talked with Dr. Cassileth about the progress that has been made over the past 3 decades in the understanding and integration of complementary or integrative therapies in cancer care, the misconceptions about complementary therapies that still exist, the big business of so-called “alternative medicine” scams, and how oncologists can help their patients steer clear of worthless remedies and benefit from integrative therapies that control symptoms associated with mainstream oncology care.

Spread of Integrative Oncology

Please talk about the progress you have seen in the integration of complementary practices in conventional oncology care.

I think the pivotal change that has occurred over the past 30 years is in the understanding of how important it is to take care of the emotional and physical aspects of having cancer, in addition to treating the disease itself. Cancer is such a difficult problem for patients and their family members to face, as it is for members of the medical community. Today, there is wide recognition and acceptance of the benefits of adjunctive complementary therapies. Virtually all of the comprehensive cancer centers in the United States have an integrative medicine programs, as do many major hospitals.

And the good news is that the practice of integrative medicine is spreading also to many countries around the world.

Terminology Problem

What are some of the lingering misconceptions about complementary medicine by both physicians and patients?

I think the greatest hurdle still to be overcome is the “complementary and alternative medicine” terminology. Twenty years ago, the National Institutes of Health established the Office of Alternative Medicine, which later became the National Center for Complementary and Alternative Medicine. The problem is that the title conflates two very different practices and is especially dangerous in oncology because there are no viable alternatives to mainstream cancer care. So-called “alternative remedies” are bogus. That is one of the great problems we continue to face.

Widely promoted unproved “alternative” cancer cures represent a $40 billion dollar a year business in the United States and are big business in other countries as well. The human toll from alternative remedy scams is devastating. Patients use their savings or sell their homes to pay for these bogus treatments because they are terrified of cancer or mainstream treatment. They don’t realize the danger they are putting themselves in. In the end, these alternative “cures” shorten patients’ lives because they forgo or seriously delay seeking timely, appropriate care at a legitimate cancer center.

Alleviating Side Effects

How do complementary therapies in conjunction with conventional cancer treatments help alleviate the physical and emotional effects from cancer and its treatment?

That is the key point: Integrative medicine helps alleviate the physical and emotional symptoms associated with cancer and with cancer treatment. Integrative therapies do not treat cancer. They reduce the physical and emotional symptoms associated with cancer and its treatment. Cancer treatment is very difficult to get through and often presents a crisis well beyond the physical manifestations of the cancer itself.

Complementary therapy takes advantage of such modalities as acupuncture, massage, meditation, guided imagery, and yoga together with good nutritional guidance and physical exercise to help manage both the short- and long-term effects of cancer therapy, including pain, anxiety,
stress, and fatigue.

Latest Book

What propelled you to write your new book on survivorship at this time?

I kept coming across so many smart, educated patients who asked the most basic questions about cancer treatment and its side effects and what they could do to help themselves. I realized that my previous books were directed toward health professionals or knowledgeable patients. I wanted to provide basic information, readily understandable to all patients, about what complementary therapies can and cannot do and to provide information about scams to steer people away from unproven dangerous
therapies.

I have several hopes for this book. One is that the book is straightforward and simple enough that everyone will be able to understand the information and come away with a sense that they are not alone. I also hope the book gives readers a sense of empowerment over the devastating effects of cancer and the tools through complementary modalities to help themselves overcome treatment-related side effects.

I also wanted to convey the importance of being diagnosed and treated first at a National Cancer Institute (NCI)-designated comprehensive cancer center. I give a list of the 41 NCI-designated cancer centers nationwide to help patients find a center in or near their home state. And, of course, I wanted to warn people about cancer cure quackery and included a “Scam Alert” section in the book.

Important Messages

What should oncologists tell newly diagnosed patients about the experience they may face ahead?

First, I hope oncologists warn patients to be wary of statements online or in publications that tout ­“alternatives” to mainstream cancer care. I hope that oncologists emphasize the importance of initiating proper care as soon as ­possible.

Another important message for patients is that while this is a frightening time and there may be unpleasant side effects from the recommended treatment, there are complementary modalities available to help reduce both the emotional effects of cancer such as anxiety, and the severity of physical side effects, such as pain, and keep them comfortable throughout their treatment. ■