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A 'whole' in one center

Conquest - Summer 2012

Integrative medicine addresses physical, mind-spiritual and social health

Lorenzo Cohen, Ph.D., speaks to groups about 
integrative medicine and the importance of 
combining oncologic treatments with massage, 
acupuncture, mind-body exercises, physical 
activity and nutrition support.
Photo: Kevin McGowan

By Maggie Newell

Lorenzo Cohen, Ph.D., practices what he teaches.

Exposed to Asian philosophy at a young age, the director of 
MD Anderson’s Integrative Medicine Program learned mind-body practices at his grandmother’s knee.

“She was a vegetarian, a yoga master and, most important, led a yogic life,” says Cohen, professor in MD Anderson’s departments of General Oncology and Behavioral Science. “I was surrounded by that every summer I spent with her in Italy.”

His childhood culture led to a doctorate in medical psychology, where he looked at the negative effects that stress can have on biology and health.

When he joined MD Anderson in 1997 and shifted his focus to oncology, he realized that patients with cancer suffer from tremendous stress. So he set out to develop resources to help them manage their cancer experience.

As he and his colleagues expanded their work, they discovered that reducing stress and improving patients’ overall health would likely improve clinical outcomes.

It’s a passion that drives Cohen to this day and has led to significant growth in the clinical services and research efforts of the Integrative Medicine Program.

Integrative, not alternative

Education for patients and health care providers is essential to the program’s efforts.

“When the program began, there was a misperception that integrative medicine advocates and prescribes unproven things for patients to do in place of standard medical care,” Cohen says. “That’s what alternative medicine is. It has nothing to do with us.”

Weekly professional meetings, internship and observership programs, training conferences and patient outreach continue to spread the word about integrative medicine. And, in 2013, the program is launching the Integrative Oncology Training Conference for Health Care Professionals.

These efforts increase awareness of and draw attention to the importance of an integrative approach to patient care, supporting the whole patient through a combination of:

  • Oncologic treatments and massage
  • Acupuncture
  • Mind-body approaches
  • Physical activity
  • Nutrition support
  • Other approaches

A patient-centered philosophy

Part of the increased interest in integrative medicine comes from an increased understanding of how people’s lifestyles affect their health.

“Research increasingly shows that lifestyle choices have a dramatic influence on cancer-related outcomes,” Cohen says. “From initial risk of disease to how well a cancer treatment works, physical activity, appropriate diet, having a healthy weight and managing stress are important factors in predicting response to treatment and favorable or unfavorable outcomes.”

“We create a comprehensive approach to each patient’s cancer treatment,” says Richard Lee, M.D., clinical medical director for the Integrative Medicine Center. “We collaborate with the oncology teams to build that plan because our philosophy is truly integrative. We look at the conventional care plan together with treatments that aren’t traditionally part of that plan, but that ultimately can improve their well-being.”

The center offers individual consults for patients with a medical oncologist. It provides massage therapy, music therapy, acupuncture, meditation and clinical nutrition support, as well as a number of group programs.

“We think about patients’ physical, mind-spiritual and social health. We really focus on having a conversation with patients to learn their goals and create an optimal plan for them, even in the middle of treatment, to improve their outcomes,” Lee says.

The team also leverages other institutional resources, such as chaplains, patient advocates, social workers and the Smoking Cessation Program, to create a whole-patient plan.

“We take advantage of every tool available to us to help each patient,” Lee adds.

Tried and true

Most important, integrative medicine uses only methods that have been scientifically proven to be effective.

Richard Lee, M.D., helps patients assess and 
understand the dietary supplements they're 
Photo: Kevin McGowan

The program’s researchers — Cohen, Lee, Peiying Yang, Ph.D., and Alejandro Chaoul, Ph.D., assistant professors in the Department of General Oncology — have pursued studies in acupuncture, mind-body therapies and natural products.

Recently, they launched a research program to investigate comprehensive lifestyle changes. Each research area offers significant potential in helping to improve the whole-patient experience.

For instance, Cohen’s research with acupuncture in symptom control showed a significant reduction in dry mouth for patients with head and neck cancers.

His research with mind-body medicine showed that incorporating yoga into treatment plans of women undergoing radiation therapy improved their physical functioning, general health perceptions and ability to find meaning in the illness experience.

Equally important is separating the wheat from the chaff, especially with natural products. Lee observes that patients often think of herbs and drugs differently.

“I tell patients that morphine is derived from a plant. But when it’s processed into a pill, it’s suddenly a medicine, not a plant,” Lee says. He adds that supplement use may cause unintended interactions, and that one of the biggest concerns is the risks that exist when medicine, herbs and supplements are combined without health care guidance.

“All our natural product research is being investigated like any novel drug discovery,” Cohen explains. “Every natural product Dr. Yang is investigating, such as fish oil, sweet gum and sweet leaf tea, is actually a very potent therapy that targets multiple cancer-related pathways.”

With the new, larger Integrative Medicine Center and plans to expand clinical care staff, the Integrative Medicine Program is poised to grow.

“We want to meet the needs of our patients, make a difference in their care using an evidence-based approach and increase our understanding of this approach through research,” Lee says.

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