..Lese Dunton..
An Interview with Dr. Barrie Cassileth
Improving Quality of Life for Cancer Patients

Barrie Cassileth, Ph.D. founded the Integrative Medicine Service at the Memorial Sloan Kettering Cancer Center, where she remains the chief, and holds the Laurance S. Rockefeller Chair in Integrative Medicine. She also founded the Society for Integrative Oncology, which publishes a medical journal.

The following interview was conducted in 1999, when she first came to Memorial Sloan Kettering to create the Integrative Medicine Service.

Dr. Cassileth has had an interest in complementary and alternative medicine for more than 20 years. It grew out of her work with cancer patients who combined mainstream medicine with other approaches.

Barrie received her Ph.D. degree in medical sociology from the University of Pennsylvania. She was an adjunct faculty member at Duke University Medical Center and a visiting lecturer at Harvard University.

She is also the author of The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies.

Lese Dunton: Can you describe the experience, or the potential experience, of a Sloan Kettering cancer patient? They're in the Pavilion as an outpatient being treated for cancer and they would really like to explore complementary medicine. How does that work?

Barrie Cassileth: There is an outpatient Pavilion, where patients go for their outpatient care. It's a separate building, which is on 53rd Street. It's the new one.

LD: Right...which I visited. It's very nice.

BC: It really is beautiful. Integrative Medicine has a whole department there, on the 11th floor. Patients have information about our existence and they can just stop up to the 11th floor, or they can call in advance and say, "I'm coming in for a chemotherapy next Thursday. Can I make an appointment for x, y, z therapy before my chemotherapy" or after or whatever.

The therapies that we offer are music therapy — live music therapy — and in addition to that we have portable CD and cassette players that people can just sit and listen to, or take with them into a chemotherapy area when they get their chemotherapy. We have chair massage, and a variety of mind-body therapies, such as imagery and meditation and relaxation techniques in general. We will soon be in a position to take these therapies into the waiting areas where patients are, prior to receiving their treatments, throughout the building.

We'll be doing something similar with regard to the Breast Center, which is, at this point in time, the only patient group that is not receiving treatment on 53rd Street. They have their own building. Breast cancer patients receive their chemotherapy and other treatments on 64th Street. We will be going there, bringing therapies to those patients in their space. We are in the process of renovating an entire floor of a building that Memorial owns on 65th Street and that floor will become the Integrative Medicine Outpatient Center. It is large and it's going to be gorgeous. It's going to be more beautiful than any spa that exists in New York. We will offer a much wider range of therapies there.

It will be available to any cancer patient and family members, regardless of whether they're affiliated with Memorial. That center on 65th Street will have every rational complementary therapy that you can think of. We will organize this by appointment so that we make sure that we are providing the therapies that patients want, and if there are some therapies that people call in for that we don't have, we will add them — although I can't think of any that we don't have.

We're going to be offering all kinds of massage, including reflexology and so on, art therapy, music therapy. We will have group activities such as Yoga and Tai Chi. Also, a getting back into shape exercise program, which is a combination of Yoga and exercise for patients who have finished their treatment and want to get back in shape. We will have hypnosis, biofeedback, acupuncture....what am I leaving out?

LD: Nutritional counseling?

BC: We'll have nutritional counseling, and virtually all the mind-body therapies.

LD: Will it still be at the Pavilion on 53rd Street or will it sort of be moving...

BC: No. This is in addition to the Pavilion.

LD: In addition to — but more will be offered.

BC: It's a different situation. When people come in for their therapy (at the Pavilion), they're there for a limited period of time. They're usually highly stressed. What we we're providing at the Pavilion are services to help them get through their treatment, or their check-up or whatever — it is it's always very stressful. And because they're going to be able to come to us or we're going to go to them for a relatively brief period of time before they go in for their appointment, we're providing therapies that are appropriate under those circumstances.

LD: And complementary to whatever else they're doing, such as chemo.

BC: Exactly.

LD: Do you ever offer complementary therapies all on its own? Or, they're there for chemo or whatever and it just goes along with it?

BC: Well, yes. That's what we're doing at our Center (on 65th Street). We're providing complementary therapies independent of anything else for people who are or were patients (of Sloan Kettering or not). And that floor, that building, does not provide any medical services. It's just us. It's just complementary medicine. The building is going to have a canopy or a plaque or whatever and it will say, "Memorial Sloan Kettering Integrative Medicine Outpatient Center." And that's all that's going to be there.

So, that's a direct answer to your question. Yes, you're exactly right. This is an opportunity to provide complementary therapies independent of a medical setting, which is...a very conscious reason for setting it up this way. So, you see it's very different from what goes on in the Pavilion. On 65th, unlike the Pavilion, we're going to be open evenings and weekends. The Pavilion hours are not up to us to decide. It's open 8am - 6pm. The Pavilion is set up specifically for patients to get their treatment or their blood tested or transfusions or whatever they need to get, or chemotherapy, whatever.

They're just starting the renovation for the Integrative Medicine Center and we hope it will be ready by mid-Fall. I don't know exactly what that means, but we're hoping. It always takes longer than one hopes.

LD: And that's a very large floor?

BC: It's a very large floor. It's going to be absolutely, spectacularly gorgeous. I was being literally accurate in saying that this will be the most beautiful spa in anywhere near New York, because that's the way we're setting it up. We've spent a huge amount of time with architects, interior designers and decorators, and purchasing the right fabrics and wall coverings and so on. So, it's a very nice, spa-like atmosphere.

LD: So, with the Pavilion and this new Center, you have been and will be doing clinical studies as you go along to see...to further prove how it's working?

BC: That's not really a clinical study, that's just sort of evaluating what's going on, but we certainly will be doing that, you're absolutely right. We will be having ongoing evaluations to make sure that the therapies maintain a quality level that we want. But also that they are what patients want. As I said before, if we find that there's something that patients are requesting that we don't offer, then if we think it's a rational therapy, we'll offer it. Or, if we find that some of the therapies we're offering, no one ever calls for, we'll drop them. In addition to that kind of evaluation, we're going to be doing a lot of clinical trials. In fact, I'm just sitting here at the computer finishing the protocol for the first one we're going to begin.

LD: Can you reveal either what you have done or what you're about to do?

BC: We're going to be doing studies looking at the benefits of acupuncture, not only for pain control but for other things as well. We're going to be looking at Ginger as an anti-nauseant for people on chemotherapy. We're going to be looking at the physiologic benefits of music therapy prior to major procedures like colon cancer surgery and bone marrow transplantation.

The study I was just working on, on the computer, concerns the problem of fatigue that many cancer patients experience. We're going to be doing a randomized, prospective study to see whether Hypericon — which is also called St. John's Wort — can reduce fatigue.

LD: Great.

BC: If it does, it will be phenomenal. And we hope that it works. But we're going to be doing a lot of research, and I hope that we will be able to begin some of the clinical trials with some of the more promising Asian herbal remedies.

LD: These services are out of pocket at the moment but who knows down the road what will happen with insurance, right? I know that some strides are being made in the insurance world.

BC: Some insurance companies will reimburse for massage therapy and for acupuncture and for things like hypnosis and biofeedback — if they're provided by people who are appropriately trained, licensed and certified, which of course all our people are.

The other therapies are not covered and some insurance companies don't even cover something like massage, but that's really not an issue because people pay for massage and these other treatments very readily out of pocket, and our prices will be reasonable.

Right now there's no charge for what we're providing because we are just in the process of trying to organize ourselves, but eventually we will have charges for all of the services we provide on an outpatient basis, both in the Pavilion and at 65th Street, but they'll be less expensive than the same services at spas in the area.

LD: What do you like about your new position? What's fulfilling and fun about it? Also, what are your plans and goals — well, you've told me some of them — for the future?

BC: Well, it is always very rewarding seeing patients and trying to be helpful to patients. I am seeing a lot patients on my own. Since I've been here, starting in April, I've seen well over 100 patients myself for over an hour each. It's really much more than one person can handle and I hope I'll be getting some help with that, but that's a very rewarding experience. It's sometimes a little difficult, but I know that in most cases I can be helpful to patients and that's a saving grace, and a blessing for me.

The research is probably one of the few most important reasons that I agreed to come here. The research opportunities are marvelous. The senior physicians throughout Memorial have been extremely interested, responsive, willing, and eager to collaborate and that's wonderful. I'm looking forward to collaborating with many of the departments here.

LD: When did you know you wanted to get involved in this line of work?

BC: I've been involved in alternative complementary therapies not as a promoter or as a therapist, but really as a scientist and someone who has set up programs for close to 20 years. I've been publishing research in this area in the medical literature throughout that period.

LD: Can you tell me something about the music therapy?

BC: It's really wonderful. Music therapy can be very well documented to produce measurable, specific, physiologic changes. For example, it slows the heart rate, it lowers blood pressure, it has effects on the brain which can be measured by MRIs. It raises endorphin levels, it relaxes muscles. It has tremendous benefits which can be very easily documented because they're physiologic changes. Music therapy is extremely useful to help patients relax and go through something as difficult as chemotherapy or even a surgical procedure, with great facility.

LD: Do you have statistics on what percentage of patients are interested in or go ahead and try integrative medicine? I'm assuming it's on the rise.

BC: If we talk about cancer patients specifically, I think that it depends very much on the age of the person and the diagnosis and also women are more interested than men. I think that at least seventy percent of cancer patients are into something, or at least talk to people about the possibility of trying something.

LD: Is there one method that's on the top of the list?

BC: Not really. It's very interesting. People are drawn to different kinds of things for different reasons. Some people area very kind of mind-body oriented and some people are more oriented towards spiritual kinds of things, which, by the way, is another very important component of our program — spirituality and meditation. We're going to have a spiritual and meditation program which combines meditation with kind of a non-religious spirituality so that anyone, regardless of their religious background or lack of religious background, can participate.

LD: It's interesting, it's sort of human nature, if you're in a position where your life is may be in trouble, you very quickly start to go inward and ask yourself some spiritual questions.

BC: Absolutely, and it's very, very important, very helpful to patients when they can join with others in some kind of a spiritual gathering. It doesn't even have to be in the same place at the same time. I'm not talking about literal gathering, although that does help, but to know that you're part of a group focused on the same kinds of spiritual concerns and issues is very reassuring, comforting, and helpful to patients.

LD: So you have music tapes, guided imagery tapes, spiritual type meditation tapes?

BC: We have all that, but we also have something better which is people who can work with patients individually or in groups and do the guided imagery, meditation and so on.

LD: So they can do it with someone there and/or take a tape...purchase a tape...

BC: Exactly. There's another component of the program that I didn't mentioned, which is also housed in the Pavilion on the 11th floor, and that's an information service. In addition to being able to use any of the computers throughout the Pavilion to get information, we will have information experts who are available to help patients, or to provide information to physicians, as needed. Not only in general, but also about some of the large problems in this area, such as herb-drug interactions. We're going to have a hotline for physicians on that topic.

LD: When you say information experts, these are sort of specialists in the medical and holistic...

BC: We are hiring someone who is a pharmacist and an ethno-botanist (someone who's an expert in herbal remedies).

LD: So both patients and physicians can consult with information experts.

BC: Right. Exactly. That's something that I'm doing now. That's a major reason that patients come to see me for consultations. They want to find out what they should be taking, and what's dangerous to be taking. In the Pavilion we will have people there all the time, full-time, whose job it is to collect this information, computerize it, prepare material for a Memorial website, prepare material for patients, answer phone calls, see patients when they come in and answer questions, and so on.

LD: What's the ideal vision for the future? How would you like to see it go?

BC: I think there are three main goals for our program: 1) to improve quality of life of cancer patients. That's the overriding purpose of all of this. 2) To produce really high-quality research. To show the optimal use of these therapies, under what circumstances they can best use it, and what ways they can be most effective. To carefully study what herbal remedies might be used for cancer. 3) Education.

One of my goals with education is to have a program for certified massage therapists to come and learn how to take care of cancer patients. We're going to have a big educational program for that purpose. We also have a graduate program.