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

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

4.  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.

5. 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

7.  MD Anderson Cancer Center, 2000 ◦ ~450 patients Richardson et al. JCO 2000

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

9.  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.

10.  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

11. 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.

12. Physical Psycho- Spiritual Social Integrative Medicine Center Model Health

13. 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

14. ● 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

15. ● 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

16.  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+

17. DiagnosisSurgeryChemotherapyRadiation Meditation Diet & Exercise Acupuncture Music Therapy Active Treatment PreventionSurvivors

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

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

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

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

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

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