By Kathy LaTour

When a woman is diagnosed with breast cancer at Hoag Cancer Center in Newport Beach, California, she hears it from her doctor. But in the room with them is Sandra Finestone, PsyD, coordinator of cancer patient services. “We have been doing this for 11 years at Hoag, and our approach is to treat the patient, not the disease. When the woman receives the diagnosis, I am in the room to talk about what is available.” Dr. Finestone begins the first week of her six-week introductory class for the newly diagnosed by giving each woman a notebook for all the paper and notes that accompany diagnosis. She brings in experts over the next four weeks to address pathology, nutrition, hair loss, skin care, prosthetics, and relaxation techniques. In the last session, Dr. Finestone talks about what’s next. She says some women transition into one of the existing support groups, opt for one-on-one, or take part in many of the other complementary healing classes offered. Others identify other support systems. But the point, says Dr. Finestone, is that they know about their choices.

Hoag also offers yoga, tai chi, qigong, art therapy, and meditation—all free, as are Dr. Finestone’s services. The staff hopes to soon add a massage therapist to the program’s offerings.

“I bring into the support groups what I know about complementary and alternative medicine (CAM). There is so much information out there. My job is to help them sort through what is appropriate and what isn’t.”

Cure versus Healing
It’s amazing how far the cancer community has come in accepting that cancer is a multidimensional disease and a journey with dual paths—one purely medical, the other addressing the more obtuse parts of our lives (our souls, hearts, spirits, and minds)—and that these two aspects of our humanness may interact in ways that we are only beginning to understand.

What most in the cancer community now see is that true healing requires addressing both of these aspects, a complicated task in a field that demands rigorous standards for study. And yet, it is well known that 60% of those persons diagnosed with cancer use forms of healing other than medical as a complement to their medical therapy.

The aspects of nonmedical healing are referred to by many terms. Barrie Cassileth, PhD, chief of the Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, uses the increasingly common term “integrative oncology,” which she describes as the synthesis of the best of complementary and mainstream cancer care.

According to Dr. Cassileth, this term is replacing CAM, which includes potentially harmful or disproved “alternative” therapies, and includes only data-based complementary modalities backed by scientific evidence of safety and effectiveness.

“This use of ‘integrative oncology’ in words and practice omits the alternative approaches, the collection of questionable methods that are of major concern to oncology professionals,” says Dr. Cassileth.

The National Center for Complementary and Alternative Medicine (NCCAM), one of the 27 institutes and centers that make up the National Institutes of Health, was founded in 1998 to research CAM, to train researchers in CAM, and to disseminate information to the public and professionals on which CAM modalities work, which do not, and why.

NCCAM defines the therapies into five domains: alternative medical systems such as those from non-Western cultures; mind-body interventions that enhance the mind’s ability to affect bodily function and symptoms; biologically based therapies or those found in nature, such as herbs, food, and vitamins; manipulative and body-based methods, including chiropractic or massage; and energy therapies such as biofield therapies (reiki and therapeutic touch) and bioelectromagnetic-based therapies that involve the use of magnetic fields.
Dr. Cassileth explains that the explosion of interest in CAM by patients and mainstream physicians has resulted in some additional coverage of complementary therapies by health insurers, and the publication of research articles in major medical journals is a major indicator of mainstream interest.
At MSKCC, the Integrative Medicine Service was established in 1999 to complement mainstream medical care and address the emotional, social, and spiritual needs of patients and families (with specific focus on symptom control) by providing inpatient and outpatient clinical care in addition to conducting research, education, and training in these areas.

Today, patients at MSKCC seeking integrative medicine for any diagnosis can take advantage of a veritable smorgasbord of offerings (to see a complete listing, go to www.mskcc.org/integrativemedicine). Most are provided free of charge to inpatients. Outpatient services are available on a fee-for-service basis.
Indeed, a number of well-known cancer centers offer integrative programs, including M. D. Anderson Cancer Center and Duke University Medical Center.

“Our many classes, including yoga, qigong, chair aerobics, nutrition, and fitness, are very popular. All of these techniques increasingly are seen in mainstream medical centers in North America and in much of the developed world,” Dr. Cassileth says.

Exploring Mind-Body Options
While a number of CAM therapies have been shown to have efficacy, among the most accepted and widespread are those in the mind-body area such as patient support groups and cognitive behavioral therapy. While the importance of understanding mind-body modalities has been increasingly embraced, standards and best practices for such areas have only begun to be explored, often leaving the patient on her own to decide what is appropriate, what is available, and how to find it, a daunting task for someone undergoing treatment for breast cancer.

From state to state, community to community, facility to facility, and doctor to doctor, the programs offered vary as does the training of those providing them and the ways in which they are delivered.

Larry Dossey, MD, the author of nine books and numerous articles and executive editor of the peer-reviewed journal Alternative Therapies in Health and Medicine, says that today there is excellent training for therapists in mind-body therapies. “The field of mind-body has matured tremendously in the past 20 years. No one raises an eyebrow to words like relaxation and imagery. Yoga and meditation are used a lot in major medical centers.”

But Dr. Dossey is also quick to point out that while there are wonderful people in the field, there are also many levels of expertise, and patients must exercise extraordinary diligence and self-responsibility.

Dr. Finestone became interested in mind-body issues after her own breast cancer diagnosis in 1982. She became a volunteer with the American Cancer Society (ACS) after attending a meeting with her husband to hear a plastic surgeon speak when she was considering breast reconstruction.

“I noticed all the men were off by themselves, so I called the ACS and asked if there was a group for husbands, and they said, ‘No, do you want to start one?’ So I did.”

Dr. Finestone, a CPA at an accounting firm with her husband at the time, earned her PsyD in psychology in 1996 because she wanted more credibility with the medical community. The next year she took over the Hoag program.

Support groups have received the most attention in the mind-body realm since the publication of research by David Spiegel, MD, a psychiatrist at Stanford University School of Medicine, California. While no one argued that support groups helped women with breast cancer have a better quality of life, Dr. Spiegel presented research showing women with metastatic breast cancer lived longer when they attended a support group.

Since then his findings have been challenged. But whether or not support groups prolong life, researchers agree that support improves life, which CAM supporters would say is the point since healing may not include cure.

Healing Intentions
Perhaps as important as the coming together in a support group are the compassionate feelings that grow from relationships developed by those sharing a cancer experience. What Dr. Dossey calls “healing intentions”—the feelings of love and caring for others that may be called prayer, which can be accomplished at all times whether in the same room or not—are an area he and others are exploring for their healing effects.

Like Dr. Finestone, Dr. Dossey became interested in mind-body healing in what he calls self-defense. Dr. Dossey suffered from incapacitating migraine headaches that seemed impervious to treatment. He was on the verge of quitting medical school when research came out about biofeedback and its effect on migraine headaches. He began biofeedback and his migraines practically went away.

Dr. Dossey went on to use biofeedback with his patients in his internal medicine practice in Dallas. He says it was a short leap from biofeedback to exploring other mind-body therapies such as prayer and its impact on healing. His first book, Healing Words, was a New York Times best seller. Dr. Dossey says the verdict on many CAM approaches is still out. The field is largely immature and needs the type of peer-reviewed science that is crucial to all therapies.

In examining integrative medicine programs, Dr. Dossey says he has seen a number that are creating a blueprint for success, such as the Institute for Health and Healing at California Pacific Medical Center in San Francisco, where William Stewart, MD, provides a customized approach for each patient at the first integrative medicine clinic certified by the state of California.

“If CAM disappeared tomorrow, we would still be here,” Dr. Stewart says of the Institute, “because the thrust of our work is not about modalities, it’s about relationship and connection. It so happens that our work is grounded in what is described as CAM therapy, but the essence of it is more around engaging the multifaceted areas around optimal well-being and illness.”

Dr. Stewart says the programs offered at the institute range from basic support groups to one-on-one counseling to a consumer-oriented resource library to a retail outlet for healing products that include teas, vitamins, and lotions. “On the hospital site we provide massage and guided therapy, expressive art therapy, and spiritual support through the chaplains,” he adds.

Dr. Dossey sums it up: “Healing means you integrate all parts of who you are to whatever the outcome. If you get cure and healing, you are doubly blessed, but the healing should be our goal.”