Integrative Medicine in Oncology at UCLA
Anne Coscarelli, Ph.D.
Integrative medicine and complementary and alternative medicine (CAM) therapies have become increasingly popular reflecting the growing interest of patients in not just treating illness, but in maximizing health and enhancing well being. Historically, the practice of conventional western medicine was considered separate and incompatible with any other style or system of medical care. Practices outside of traditional Western medicine have been considered complementary (if done in conjunction) or alternative (if done instead of traditional medicine). This line has blurred as patients have sought broader clinical options and combined conventional care with alternative modalities. This blending is more apparent as conventionally trained health care practitioners use more complementary approaches for themselves and their patients and scientists study herbs, supplements, mind-body techniques and many other non-Western therapeutic traditions. In response to this trend, a style of medicine has emerged which focuses on the treatment of the whole patient and incorporates a wide variety of healing techniques, both conventional and alternative. It is called Integrative Medicine.
Integrative medicine and CAM techniques are popular with a broad spectrum of patients including those who are undergoing treatment for cancer. All patients want to know how they can optimize their wellness (mind, body and spirit) throughout all phases of their cancer and its treatment. During active cancer treatment, managing symptoms and minimizing side effects are the most urgent priorities. Recovering and maintaining good physical health as soon possible, for as long as possible are critical goals, and maximizing quality of life through attention to the psychological, social and spiritual well being of the person are an essential part of treatment in the Integrative Medicine model. The Resource Center--with its focus on the whole person perspective, psychosocial care and mind/body approaches--has had a growing interest in providing a broader base of services to help patients and family members optimize their health and wellness. We are interested in integrated oncology care that offers the best medicine for the mind, body, and spirit. Fortunately, our advisory board shares this holistic approach to care, especially board member Victoria Mann Simms, Ph.D. who is an acknowledged leader in the philanthropic community with an interest in maximizing wellness. She champions the use of integrative medicine in oncology as well as other parts of medicine. She serves as the west coast representative for the Bravewell Collaborative, a group of philanthropists which support programs and institutions aimed at developing a “new medicine.” This new medicine, Integrative Medicine, shares many of the values which guide us at the Resource Center:
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treatment of the individual in a holistic manner and the fulfillment of the needs of mind, body and spirit
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sacred and healing nature of the relationships between patients and healthcare providers and acknowledgement of humanism, compassion and caring
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importance of healers being restored
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importance of patients feeling empowered
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importance of giving voice to the patient and creating open communication
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highest standards of excellence in a full and complete array of care modalities.
According to the literature, most patients who want to have their spiritual and psychological needs fulfilled, who want to use alternative and natural therapies, and who want to feel empowered, do not want to leave the conventional medical system. They want these services and values included or integrated with their traditional medical care. Many patients want to share this information with their providers and seek guidance to make certain that the combining of modalities are safe. Patients desire reliable information and value practitioners who are willing to talk to them about multiple approaches.
In order to understand the feelings and interests of our own patients on these issues, we conducted a survey to determine what kinds of complementary or integrative techniques they are currently using and whether they would like to see additional programs added to our array of services oriented toward care of the whole patient with cancer and their families. In addition, we asked our physicians and nurses about their perception of patient needs. The findings are interesting and have led us to develop some exciting new programs.
We administered the survey over the course of two months during the summer (2005) in clinics where cancer patients are served, including the 200 Medical Plaza Oncology Center, community practices in the 100 building and in Santa Monica, the Revlon/UCLA Breast Center and the Clark Urologic Center. We want to express our appreciation to the 346 patients who took the time to share their opinions and strategies with us.
We asked what kinds of techniques patients were using in addition to their traditional oncology care and learned that 48% of our patients use diets and supplements, 31% touch therapies, 53% movement, 40% mind/body approaches and 45% other techniques. The table below provides more detail. The most commonly used techniques include exercise, multi-vitamins (with or without anti-oxidants) and prayer. The next most common techniques include massage, psychological support services, relaxation and meditation exercises, and acupuncture. Patients also told us that they reported the use of physical medicine approaches to their physicians more frequently (65-75%) compared to the other areas.
| Techniques | % Patients Using Technique |
| Diet/Supplements | |
| Ayurvedic | 3% |
| Chinese Medicine Herbs | 12% |
| Detox Program | 3% |
| Naturopathy | 2% |
| Nutritional Counseling | 13% |
| Herbs | 14% |
| Special Diets | 13% |
| Vitamins (Multi-vitamin only) | 48% |
| Vitamins including antioxidants | 37% |
| Touch Therapies | |
| Acupuncture / Acupressure | 14% |
| Aromatherapy | 3% |
| Chiropractic | 7% |
| Massage | 21% |
| Movement Therapies | |
| Exercise | 48% |
| Feldenkreiss/Alexander | 0% |
| Pilates | 6% |
| QiGong/Tai Chi | 6% |
| Yoga | 13% |
| Mind/Body Therapies | |
| Art Therapy | 4% |
| Guided Imagery/Self-Hypnosis/Relaxation | 15% |
| Journal Writing | 11% |
| Meditation | 16% |
| Music Therapy | 9% |
| Psychological Counseling or Social Work Support | 17% |
| Support Groups | 14% |
| Other (please specify) | |
| Prayer/Spiritual Practices | 41% |
| Magnetic Therapy | 1% |
| Homeopathy | 5% |
| Energy Healing/Reiki | 4% |
We also asked patients what they would like to see here at UCLA and whether they would value having these services as part of their oncologic care. Approximately 47-59% of patients wanted nutritional counseling, guidance with herbs and supplements, consultations with an integrative medicine physician, acupuncture, and massage to be available as part of their cancer care.
We asked our oncology physicians and oncology nurses which services they thought were important for patients. They supported the importance of the current programs, which include individual counseling, a range of psychosocial services and support groups, but 54-96% thought that nutritional counseling, guidance with herbs and supplements, consultations with an integrative medicine specialist, acupuncture/acupressure, QiGong/Tai Chi, yoga and mind/body techniques were important or very important potential additions.
Based on the information that we obtained, we are delighted to announce new programs. With the help of the Simms/Mann Family Foundation we are beginning a pilot Integrative Medicine program for oncology. Our goal is to complement the best cancer treatments that Western medicine has to offer with programs that seek to maintain or restore health and wellness, improve quality of life and help each person and his or her family to live as fully as possible. These new integrative medicine services will be fee-for-service.
Mary L. Hardy, MD, has joined the hematology-oncology faculty and our Center to develop and implement the specific components of our integrative medicine program. She is an internist and integrative medicine physician with over 15 years of experience in guiding patients who are seeking to combine the best practices of conventional and alternative medicine. She was the Associate Director of the UCLA Center for Dietary Supplement Research in Botanicals and the founding Medical Director of the Cedars-Sinai Integrative Medicine Program. Her clinical practice focuses on integrating the best of western conventional medicine with appropriate complementary therapies for a wide variety of patients, including people with cancer. She has a special interest in botanical medicine and has trained with scientists and herbalists all over the world including China, Peru, Kenya and South Africa. Her current research interests at UCLA focus in using modern scientific methods to validate traditional herbal knowledge as well as developing methods to document the effectiveness of integrative medicine and complementary therapies. We know that you will find her to be empathic and caring in addition to being knowledgeable. Dr. Hardy is in the process of recruiting others to work with us including Karen Duvall, MD, MPH, who is well known to the Center as a speaker at Insights Into Cancer on the topic of nutrition. She has a background in clinical nutrition with a variety of populations, but has had a special interest in patients with cancer as well as women at risk for developing breast cancer. Dr. Duvall is an Assistant Clinical Professor in the Department of Family Medicine and Associate Director of the Preventive Medicine Residency Program at the David Geffen School of Medicine at UCLA where she trains residents in the field of preventive medicine. She is also involved in breast and prostate cancer prevention research and the associated debates on nutrition and supplements. Like Dr. Hardy, she is a compassionate and caring physician who understands the needs of the whole patient.
Drs. Hardy and Duvall believe in preventing illness (if possible) and in promoting healing and seeking wellness in every individual, in all states of physical health. They recognize the impact that cancer treatment has on the quality of life of patients and their families and will utilize their knowledge base to help patients live as well as possible during treatment, to promote their recovery and to develop life long strategies for disease prevention and general wellness. They will be a valuable asset in supporting patients, but will also be able to offer their knowledge to family members who are dealing with the stresses of caring for a sick family member and who may also need to develop strategies to minimize their risk of developing cancer or other chronic disease later in life.
We are very excited to be able to offer these new services:
Individual Integrative Medicine Counseling Consultations
These consultations will provide patients with the opportunity to review their overall wellness plan or to create a personalized wellness plan with one of our physicians on a 1-to-1 basis. Issues that might be addressed in these consultations include use of nutrition to prevent recurrence and enhance well being; selection of appropriate nutritional and dietary supplements or herbs; development of strategies to manage specific symptoms through the addition of other complementary therapies (such as acupuncture and massage therapy). We also know that cancer affects the family as well as the patient, and these consultations can be used by family members to develop their personal wellness plan for preventing disease and improving their health and wellness. We will provide referrals for services that we do not currently offer.
Small Group Counseling Consultations
When possible, patients with a similar condition will be combined in a small group for a one and a half hour consultation with a physician knowledgeable in integrative medicine. The enrollment will be limited to no more than eight patients in each group consultation to maximize individual attention. These small group consultations are focused on topics commonly faced by our patients. Our physicians will provide participants with the most up-to-date information regarding the small group topic. Not only will patients in these sessions be able to discuss their own concerns and develop an action plan to handle them, they will have the benefit of seeing how others are dealing with similar problems. Patients will develop their own personalized management plan with the assistance of the integrative medicine specialist. Handouts and practical resources will be given to each person in the consultation. The following small group consultations have been developed and are open for enrollment. Please let us know if there are other topics that you would like to see covered as we will be adding topics as the program expands.
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Bring Your Medicine to the Doctor: A Chance to Have Your Personal Questions Regarding Supplements, Herbs and Drugs Answered
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Turning Down the Heat: Natural Strategies to Help Manage Menopause Even after Cancer
Large Group Informational Education Sessions
These educational programs are designed to help patients or their family members understand the range of services that may be helpful to them in developing a personal integrated oncology care. General recommendations will be provided regarding diet, supplements, mind/body approaches and how to maximize well being during cancer treatment. Enrollment will be limited to 25 patients or family members. The first topic is:
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Complementary and Alternative Therapies: How Do I Know What to Do? Get a good orientation to what CAM therapies can do for you during your cancer care.
Selected Integrative Medicine Products in Reflections
We know that it is often difficult to choose which supplements to purchase. Dr. Hardy is developing a list of products and manufacturers that she knows and feels comfortable suggesting to patients. We will be adding some of these products to the Reflections Boutique to make it easier for patients to obtain what they need and to insure that patients get what Dr. Hardy, and other physicians in the program, suggest to patients. Please note that Dr. Hardy or other healthcare providers will not benefit from the sales of these products nor will they have a financial interest or connection to the companies that make these products. All proceeds will continue to go back to support the operations of Reflections and the psychosocial and mind/body services already provided through the Center which are offered to everyone regardless of their ability to make donations.
Final Notes
With the varying levels of individualized attention, patients can select the service that best meets their needs. Some of you may only want the more general, larger group session or only an individual consultation, while others may choose all of the services.
We are very excited to be able to offer you these new tools and professional guidance on enhancing wellness and improved quality of life in your individual journey through your cancer diagnosis and treatment. We encourage you to participate in these new offerings as well as the array of current programs. For more information, to enroll in a group consultation, or schedule an appointment, please call 310 794-6644. This is our beginning, so remember to stay tuned for new developments!
Anne Coscarelli, Ph.D.
Wallis Annenberg Director’s Initiative in Psychosocial Oncology
© Anne Coscarelli, Ph.D. All rights reserved.
For reprint authorization, contact SimmsMannCenter@mednet.ucla.edu.