Photo by Josh Belzman / Fred Hutch News Service
When Yetta Marcus Jaworski was diagnosed with breast cancer back in 2009, she decided to try a blended approach to treatment. Along with standard therapies like chemotherapy and radiation, she sought out the traditional Chinese practice of acupuncture to combat her treatment’s side effects.
“I’m a huge fan of acupuncture and massage, which helped with side effects of chemo and radiation,” said the a 57-year-old project manager from Indian Rocks Beach, Florida. “When I was first diagnosed, I had to go to my own acupuncturist, but now I have one that comes to the oncology office.”
Like many cancer patients today, Jaworski doesn’t have a problem using what are often referred to as complementary or integrative therapies to help her tolerate the pain, nausea, fatigue and other toxic effects of standard treatments. She appreciates the integrated approach her cancer center in Florida and others across the country have come to embrace.
Photo by Robert Hood / Fred Hutch News Service
Headed by Dr. Heather Greenlee, a national authority on integrative therapies, the program will offer cancer patients access to practices like acupuncture, massage and meditation to ease the side effects of treatment or cancer progression. Only therapies that are evidence-based will be used; integrative therapies will only be used as an adjunct to traditional cancer treatment.
“Patients have been using these tools for a long time,” said Greenlee, a Fred Hutch epidemiologist, SCCA naturopathic physician and former president of the Society for Integrative Oncology. “But we want patients to receive state-of-the-art, consistent information, and we want to provide education to both patients and clinicians. We want to be very honest with patients where we do and don’t have evidence and maximize their resources, time and energy using therapies where there’s good evidence that the therapies can achieve what they want them to achieve.”
Providing more ‘seamless care’
SCCA has been working with integrative medicine practitioners in the community for several years, Greenlee said, but decided to create the in-house program to provide patients with more seamless care.
“Now patients can receive services from our integrative clinicians who can easily confer and consult with the full oncology care team,” she said. “The idea is to provide ‘integrated integrative medicine’ to cancer patients.”
Housed on the third floor of SCCA's main clinic near South Lake Union, the Integrative Medicine Program is part of the Division of Wellness and Supportive Care Services, which includes palliative care, physical therapy, nutrition, pain management and other psychosocial services. Currently, the staff consists of a naturopathic physician (Greenlee); an acupuncturist (Jonathan Siman); and a nurse practitioner trained in mindfulness-based stress reduction, mindful eating, guided imagery and integrative medicine (Kathleen Sanders). Greenlee said the team will grow over time.
Photo courtesy of Yetta Marcus Jaworski
While there are other integrative oncology programs at academic cancer centers, Greenlee said the new program at SCCA will be one of the only, if not the only, program in the region to offer these services within a cancer treatment center.
Greenlee and colleagues from Fred Hutch, the University of Washington and SCCA will also be conducting research on the use of integrative techniques, which have become more mainstream but remain understudied.
“That’s what we’re really excited about,” Greenlee said. “Being able to offer services that have an evidence base and also conduct research in new, promising areas.”
Last year, Greenlee co-authored a paper on the first-ever randomized controlled trial assessing acupuncture’s efficacy in reducing pain in breast cancer patients, based on research she did with Dr. Dawn Hershman at Columbia University, where Greenlee retains an adjunct appointment as associate professor of clinical epidemiology. Their study, published in JAMA, showed acupuncture was effective at relieving the arthritis-type joint pain caused by a common class of breast cancer drugs called aromatase inhibitors.
Greenlee also led the development of clinical guidelines for the use of acupuncture and other integrative therapies with breast cancer patients with the Society for Integrative Oncology. Those guidelines were recently endorsed by the American Society of Clinical Oncology, or ASCO.
“Aromatase inhibitors cause substantial joint pain and joint stiffness, and it causes some women to stop their treatment,” she said. “Now we have a nonpharmacologic treatment that’s been shown to be effective at decreasing these symptoms and decreasing their pain over a long period of time.”
Photo courtesy of Jodi Monroe
Separating snake oil from science
Breast cancer patient Jodi Monroe, a 52-year-old community land trust executive from Mt. Vernon, Washington, who participated in the blinded acupuncture study, said she appreciates SCCA’s holistic approach to cancer treatment.
“They threw everything but the kitchen sink at my cancer and then went over my diet and talked about exercise,” she said. “I’m still getting acupuncture and it’s still helping me, and I’m also doing yoga and mindfulness stuff now. I strongly believe that a little bit of everything is what’s making the difference. And I love the science part of it.”
The science is what it’s all about, said Greenlee.
“This will be a dedicated space for patients to come in and ask all the questions they have about integrative medicine,” she said. “We want to be a resource for patients and their families. We’re really interested in giving patients tools to make informed decisions about what to use, and what not to use.”
Fred Hutch’s Dr. Gary Lyman, a thought leader in cancer care who worked with Greenlee on the ASCO endorsement of the Society for Integrative Oncology guidelines, called the program a “long-awaited and important addition” to patient care.
“While many of these approaches, such as yoga and mindfulness, are beneficial and are unlikely to cause harm, others can cause side effects or interactions with standard therapies,” he said. “The integrative oncology program will provide expert, evidence-based guidance as to what is likely to work and what may even cause harm, financial and otherwise. Supplements and other integrative approaches are a multibillion-dollar industry in the U.S., and it’s extremely important that patients and their providers be properly informed.”
Both Lyman and Greenlee said cancer patients are particularly vulnerable to misinformation in the realm of dietary or herbal supplements. Oncologists frequently report patients coming in with dozens of supplements, recommended not by doctors or dieticians but friends, family, coworkers and shop clerks. Patients will use the supplements in combination with, or at times in lieu of, traditional cancer treatment, which can cause them harm. One recent study found patients who used supplements during cancer treatment frequently experienced drug-drug or herb-drug interactions.
Photo by Josh Belzman / Fred Hutch News Service
Delving deeper into the ‘whys’
The clearest message, Greenlee said, is that more research is needed. She and colleagues plan to delve deeper into supplements, mind-body techniques and therapies like acupuncture through research collaborations.
“With acupuncture, we’re very interested in the physiological process,” she said. “We want to understand why [these therapies] work, as well as how to implement them in the clinical setting.”
Greenlee is currently involved in a pilot study with a multidisciplinary team exploring diet and the microbiome; she also hopes to work with Hutch’s immunology researchers to explore the immune system’s role in practices like acupuncture.
“We’re interested in looking at dietary interventions, physical activity interventions, acupuncture interventions,” she said. “We’d like to do studies with different stress management techniques and massage studies and would love to do a yoga study. We’re just getting started.”
The key takeaway, Greenlee said, is that the Integrative Medicine Program will only offer therapies that Fred Hutch stands behind.
“We want to be leaders in conducting the trials of promising new therapies, and we’re very open-minded as to potentially what that could mean,” she said. “But we want data to support their use and we’re not offering anything in lieu of standard of care to treat the cancer.”
Photo courtesy of Seattle Cancer Care Alliance
Establishing healthy habits
Another important aim: helping patients establish and maintain healthy lifestyle habits.
“We can help develop a supportive structure, so patients can effectively make changes and maintain them over time,” said Greenlee. "We can address some of the things that can get in the way of making those healthy lifestyle changes [such as pain, fatigue and lack of sleep].”
The program's nurse practitioner, Kathleen Sanders, who has practiced integrative therapies like relaxation, breath work, guided imagery and self-hypnosis for 10 years, said mind-body techniques are not only effective, they’re safe and drug-free.
“These are techniques that can help with pain management, with sleep, as a nonpharmacological treatment for anxiety,” she said. “Mind-body therapies are so safe, it’s a wonderful thing to offer all patients. And integrative medicine is appropriate from time of diagnosis to end of life.”
Sanders, who has provided integrative therapies to SCCA patients this year during the program’s pilot phase, said the response so far from patients and clinicians has been overwhelmingly positive.
“People are very happy to finally have this kind of service available,” she said. “They’re quite excited and willing to try the mind-body modalities. Overall, it’s been a wonderful experience working with both patients and providers.”
SCCA breast cancer oncologist and Hutch clinical researcher Dr. V.K. Gadi seconded that emotion.
“The patients love it,” he said. “It’s great to be able to offer them these tools and offer them here on site.”
Monroe, who has been getting acupuncture to ease symptoms from treatment outside of SCCA, agreed.
“It just makes sense to me, especially with cancer,” Monroe said. “It’s one-stop shopping. You can get all the care right there for your mind, body and soul.“
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at firstname.lastname@example.org.
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