Richard T. Lee, MD Assistant Professor Medical Director, Integrative Medicine Program March 4, 2011

 Overview of Integrative Medicine  Integrative Medicine Program at MD Anderson Cancer Center  Therapies of Interest

 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.

1. 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 Richardson et al. JCO 2000

TherapyPrevalence (%) Natural Product17.7% Meditation9.4% Chiropractor8.6% Massage8.3% Yoga6.1% Acupuncture1.4%

 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

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-SpiritualSocial ● 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-SpiritualSocial ● 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

 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+

DiagnosisSurgeryChemotherapyRadiation Meditation Diet & Exercise Acupuncture Music Therapy Active Treatment PreventionSurvivors

 Mood Disturbance (1C) Anxiety Depression  Pain (1C)  Neuropathy

 Stress (1B)  Pain  Mood Disturbance (1B) ◦ Anxiety  Quality of Life (1B)  Insomnia (1B)

 Stress (1B)  Mood Disturbance (1B) ◦ Anxiety  Quality of Life (1B)

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

 What is the best way to delivery acupuncture?  What points?  How deep?  How often?  Is electroacupuncture really better?  What about acupuncture is really working?

 Mushrooms ◦ PSK, AHCC  Oleander  Mistletoe/Iscador  Milk Thistle  Does is work, how does it work, and does it interfere with treatment?