Integrative Oncology (eBook)

Preface 7
Contents 8
Contributors 10
Integrative Oncology Overview 13
Introduction 14
A Word of Caution 19
Contents 19
2.1 Risk of “Harm” Associated with “Non-conventional” Approaches to Cancer Management 20
2.2 Direct Harmful Effects of Non-traditional Strategies 21
2.3 Conclusion 22
References 22
Using Legal and Ethical Principles to Guide Clinical Decision Making in Complementary/ Integrative Cancer Medicine 24
Contents 24
3.1 Introduction 24
3.2 Major Applicable Legal Rules 25
3.2.1 Licensure and Credentialing 26
3.2.2 Scope of Practice 27
3.2.3 Malpractice 28
3.2.4 Professional Discipline, Third-Party Reimbursement, and Healthcare Fraud 28
3.3 Malpractice Issues in Greater Detail 29
3.3.1 Misdiagnosis in Cancer Medicine 30
3.3.2 Failure to Treat in Cancer Medicine 30
3.3.3 Informed Consent in Cancer Medicine 33
3.3.4 Referral Liability in Cancer Medicine 34
3.4 SomeWays to Help Manage Liability Risks 35
3.5 The Federation of State Medical Board Guidelines for Integrative Medicine 36
3.6 A Broader Ethical Analysis 37
3.7 Conclusion 39
References1 40
Communicating with Patients about the Use of Complementary and Integrative Medicine in Cancer Care 42
Contents 42
4.1 Introduction 43
4.2 Communication in Cancer Care 44
4.2.1 The Patient’s Perspective 46
4.2.2 The Physician’s Perspective 47
4.3 Communication Between Physicians and CIM Practitioners 48
4.3.1 Building the Bridge of Communication 49
4.3.2 A Suggested Approach 50
4.4 Conclusion 52
References 52
Integrative Oncology Programs at National Cancer Institute Comprehensive Cancer Centers 56
The Integrative Medicine Program at The University of Texas M. D. Anderson Cancer Center 57
Contents 57
5.1 Combining the Best Approaches from Conventional and Complementary Medicine 58
5.2 Clinical Delivery 5.2.1 Beginnings 58
5.2.2 Developing our Mission and Scope 59
5.2.3 Screening and Processing Program Proposals 61
5.2.4 Credentialing Process, Programs, and Services 61
5.2.5 Registration and Screening 63
5.2.6 Funding 64
5.2.7 Other Key Operational Areas 64
5.3 Education 65
5.3.1 Programs 65
5.3.2 Internal Collaborations 70
5.3.3 Program Evaluation and Assessment 70
5.4 Marketing 71
5.5 Research 72
5.6 Summary 73
References 73
The Integrative Medicine Service at Memorial Sloan- Kettering Cancer Center 74
Contents 74
6.1 Introduction 74
6.1.1 Emergence of the MSKCC Integrative Medicine Service 75
Memorial Sloan-Kettering Cancer Center Integrative Medicine Service 76
6.1.2 Role of Integrative Medicine at MSKCC 76
6.2 Clinical Services 77
6.3 Therapies Offered and Related Research 79
6.3.1 Touch Therapy 79
6.3.2 Music Therapy 80
6.3.3 Acupuncture 81
6.3.4 Mind-Body Therapies 82
6.3.5 Movement/Fitness Program 82
6.3.6 Nutrition 83
6.3.7 Immune-Modulating Botanicals Research 83
6.3.8 Education and Training 84
6.3.9 Information Program: AboutHerbs Web site ( www. mskcc. org/ aboutherbs) 84
6.4 Summary 85
References 85
Integrative Oncology—Leonard P. Zakim Center 86
Contents 86
7.1 Introduction 7.1.1 Development of the Concept of Integrative Oncology at DFCI and First Steps 87
7.2 Mission Statement 88
7.2.1 Operational Development 88
7.3 Policies and Procedures 90
7.4 Documentation and Scheduling of Integrative Therapies 96
7.5 Zakim Center Collaborations 99
7.6 Growth of the Zakim Center 100
7.7 Financials 102
7.8 Creating an Integrative Education Program for Patients and Families, Physicians, Nurses, and Researchers 104
7.8.1 Professional Education 106
7.9 Development of a Research Program 107
7.10 Concluding Thoughts 109
References 110
The Johns Hopkins Complementary and Integrative Medicine Service 111
Contents 111
8.1 Introduction 112
8.2 Clinical Service Initial Stage Development Process 8.2.1 Overview of the Institution 112
8.2.2 Early Interest and Planning 112
8.2.3 Creation of a Johns Hopkins Research CAM Center 113
8.2.4 Establish an Advisory Board 113
8.2.5 Search for and Hire a Program Coordinator to Create the Program 113
8.3 Practical Aspects in Planning a Complementary and Integrative Medicine Service 8.3.1 Establish a Steering Committee 114
8.3.2 Survey Other Institutions 114
8.3.3 Survey Current Hopkins Employees to Identify Qualified CAM Practitioners 114
8.3.4 Conduct Administrative Meetings with Representatives from Key Departments 115
8.3.5 Key Issues Discussed in the Initial Planning Stages 115
8.4 Services Now Being Provided 8.4.1 Acupuncture 116
8.4.2 Massage Therapy 118
8.4.3 Mind-Body Class 119
8.4.4 Integrative Medicine Consult Service 119
8.5 Administration of the CIM Service 8.5.1 Credentialing 119
8.5.2 Policies/Procedures 120
8.5.3 Job Descriptions 120
8.5.4 Developing Clinical Forms 120
8.5.5 Liaisons 121
8.6 Financial Aspects 8.6.1 Negotiating Billing Procedures 121
8.6.2 Space 121
8.6.3 Equipment 122
8.6.4 Scheduling 122
8.6.5 Referrals 122
8.6.6 Marketing 123
8.7 Education Programs 123
8.8 Case Study 124
8.9 Challenges Faced by the Complementary and Integrative Medicine Service 125
8.10 Conclusions/Summary 126
References 127
Integrative Oncology at Mayo Clinic 128
Contents 128
9.1 Research in Integrative Medicine and Oncology 129
9.1.1 Hot Flashes 130
9.1.2 Pain 133
9.1.3 Anorexia/Cachexia 133
9.1.4 Treatment for Advanced Cancer 135
9.2 Research Summary 136
9.2.1 Education 136
9.2.2 Patient Care 138
9.3 Conclusion 139
References 139
The Research 141
Mind–Body Research in Cancer 142
Contents 142
10.1 Utilization of Mind-Body Practices 143
10.2 Mind-Body Connection 144
10.3 Mind-Body Research at M. D. Anderson 146
10.3.1 Background on Yoga, Meditation, and Qigong 146
10.3.2 M. D. Anderson’s Past and Ongoing Studies of Yoga, Meditation, and Qigong 151
10.4 Limitations of Mind-Body Research 156
References 157
Herbs and Other Botanicals: Interactions with Pharmaceuticals 164
Contents 164
11.1 Introduction 164
11.2 Definitions 165
11.3 Cancer Patient Use of Herbal Supplements 165
11.4 Botanicals Research 11.4.1 Huanglian — A Phase I Study of the Chinese Herb Huanglian ( Coptis chinensis) in Patients with Advanced Solid Tumors 166
11.4.2 Jin Fu Kang —Safety and Pharmacokinetic Study of Jin Fu Kang in Combination with Docetaxel for Patients with Non- Small Cell Lung Cancer. 169
11.4.3 Maitake—A Phase I/II study of Maitake Extract in Breast cancer Patients 173
11.4.4 Sho-Saiko-To—Sho-Saiko-To for Patients with Chronic Hepatitis C Who are Intolerant to or Have Contraindication to Interferon- Based Therapy: A Phase II Study 175
11.4.5 Problems Associated with Botanicals Research 178
References 179
Acupuncture in Cancer Care at Dana-Farber Cancer Institute 184
Contents 184
12.1 Overview and Background 185
12.1.1 Acupuncture at DFCI 185
12.1.2 Documentation 187
12.1.3 Developing Standardized Acupuncture Protocols 188
12.2 Oncology Acupuncture, a New Medical Specialty? 188
12.2.1 Requirements and Challenges for an Oncology Acupuncturist 188
12.2.2 Potential Sources of Oncology Acupuncturists 189
12.3 Clinical Applications for Common Conditions in Cancer Care 190
12.3.1 Acupuncture for Chemotherapy-Induced Nausea/Vomiting 191
12.3.2 Acupuncture for Radiotherapy-Induced Xerostomia 191
12.3.3 Acupuncture for Post-Chemotherapy-Related Fatigue 192
12.3.4 Acupuncture for Chemotherapy-Related Neuropathy 192
12.3.5 Acupuncture for Cancer Pain 192
12.3.6 Acupuncture for Insomnia and Anxiety 193
12.3.7 Acupuncture for Other Clinical Issues 193
12.4 Contraindications and Precautions in Acupuncture in Cancer Care 12.4.1 Neutropenia 193
12.4.2 Thrombocytopenia 194
12.4.3 Anticoagulants 194
12.4.4 Metastatic Sites 194
12.5 Acupuncture Use Inside a Cancer Center 12.5.1 Daily Clinical Pathways of Acupuncture Care 194
12.5.2 Pre-Clinical Time Preparations 195
12.5.3 Record Review Prior To Treatment 196
12.5.4 New Patients 197
12.5.5 History Taking 197
12.5.6 Clinical Referral Paths of Acupuncture Care 199
References 201
Acupuncture for the Side Effects of Cancer Treatments 203
Contents 203
13.1 Introduction 203
13.2 Side Effects of Cancer Treatment 13.2.1 Oral Mucositis 204
13.2.2 Peripheral Neuropathy 207
13.2.3 Nausea/Vomiting 208
13.2.4 Fatigue 209
13.3 Conclusion and Summary 210
References 210
Index 214