Barrie Cassileth, an integrative medicine pioneer

ABSTRACT: A career devoted to improvingcancer patients’ quality of life

When you remodel an old bank building, you may wind up with your office in a vault, as did two staff members at the Bendheim Integrative Medicine Center, Memorial Sloan-Kettering Cancer Center’s outpatient facility for complementary services and therapies.

Yet despite its beginnings as a bank, the Bendheim Center, located on Manhattan’s bustling Upper East Side, is a calm and welcoming place for cancer patients to explore the body-mind-spirit connection and receive non-invasive therapies to control difficult syptoms.

“We spent a huge amount of time with architects, interior designers, and decorators to create a spa-like atmosphere for our patients. The atmosphere is actually part of the wide menu of complementary treatments, all designed to help improve patients’ quality of life as they undergo treatment for their cancer,” said Director Barrie R. Cassileth, PhD.

Dr. Cassileth, who is chief of MSKCC’s Integrative Medicine Service and the Laurance S. Rockefeller Chair in Integrative Medicine, invited Oncology News International to the Bendheim Center to discuss her pioneering work for more than 30 years in the field of integrative medicine. While there are always skeptics who will dismiss integrative medicine as “touchy-feely,” there is nothing New Agey about Dr. Cassileth.

“She runs a tight ship,” her assistant said as he led this writer to her office (not one of those in the vault).

The ‘whole patient’ of Pownal

Dr. Cassileth was born in Philadelphia, which she described as a wonderful place to grow up, full of opportunities and rich in art and history. “After graduating from high school, I went to Bennington College in Vermont. It was a cauldron of intellectual freedom. My years there molded what I later became,” Dr. Cassileth said.

While at Bennington, she borrowed an old truck from the school and spent a year in the small backwater town of Pownal. “It hadn’t changed much in more than a century,” Dr. Cassileth said. Full of the Bennington spirit-which requires students to direct the course of their own education-she established herself in the close-knit, cloistered community of Pownal, teaching art and music in the town’s one-room schoolhouse.

It wasn’t long before the engaging teacher became friendly with the parents of two of her students who lived across from the school.

“Unfortunately, the young mother was diagnosed with late-stage cancer; her condition was terminal. I helped in her care, doing whatever small things I could. When she died, the overall experience had a profound affect on me,” said Dr. Cassileth, who would go on to become one of oncology’s most ardent advocates for treating the “whole” patient.

Work with leukemia patients

After Bennington, Dr. Cassileth moved to New York for graduate work at Albert Einstein University. However, she was interrupted mid-dissertation when her husband was called into military service; they lived a peripatetic life for several years.

Ultimately, she returned home to Philadelphia, where she earned her doctorate in medical sociology from the University of Pennsylvania (UPenn).

“I did my dissertation at the UPenn Comprehensive Cancer Center’s inpatient unit for leukemia patients. We did a poor job managing adult leukemia,” she said.

Nonetheless, her intimate interaction with terminal cancer patients was very meaningful-she wrote several journal papers based on her experience as well as her first book, The Cancer Patient: Social and Medical Aspects of Care (Lea & Febiger, 1979). “More important, a foundation of learning and knowledge was firmly set while I was there,” she said.

Uncharted territory

After receiving her PhD, Dr. Cassileth stayed on at the UPenn cancer center as an assistant professor, teaching medical sociology. Both she and the center’s director knew that they wanted her to continue her work at the cancer center, but the direction she would take was uncharted territory.

“At first, neither of us really had any idea of what I would do,” Dr. Cassileth recalled. “I ended up initiating what I think was the first palliative care program in the academic setting in the U.S.”

Specifically, Dr. Cassileth pooled the University’s collective resources, including a large number of graduate students, and created cutting edge programs, known collectively as Psychosocial Programs.

One of her highlight projects was the first national survey of cancer patients’ use of complementary and alternative (CAM) therapies.

“The research showed that cancer patients were using a wide array of therapies on their own, some ineffective and potentially harmful, others very helpful,” she said.

She also led studies of the clinical effects of these therapies.

“I started a substantial research program that would later become an invaluable part of my career path,” she said.

“We had years of very productive research in which we developed prototypic clinical and research programs in patient and family support, medical education, home care and hospice, and the complementary therapies that now comprise integrative medicine.”

Building a program at MSKCC

After leaving UPenn, Dr. Cassileth continued her work in integrative medicine at the University of North Carolina, Duke University, and Harvard University, and continued writing on the subject, including The Alternative Medicine Handbook (W.W. Norton, 1998).

Then, in 1999, Paul Marks, MD, then president of Memorial Sloan-Kettering Cancer Center, recruited Dr. Cassileth to develop a program in integrative medicine at MSKCC. “I started out in one tiny office at Sloan-Kettering and today there are 60 people in my department and we occupy a 4-story building.”

Dr. Cassileth credits Laurance S. Rockefeller, the philanthropist and long-time supporter of MSKCC, for convincing the Sloan-Kettering leadership that an integrative medicine program was needed at MSKCC.

“Mr. Rockefeller emphasized that we could no longer take care of only the physical aspects of cancer; we needed to focus on the broader needs of the patient-body-mind-spirit, which he would talk about as all one word.”

The program Dr. Cassileth built at MSKCC over the next decade now offers individual therapies in many areas, including various types of massage; mind-body therapies such as meditation, guided imagery, and self-hypnosis; creative therapies involving music and sound; acupuncture; nutrition counseling; fitness classes; education programs for patients, caregivers, and healthcare professionals; and evidence-based information on herbs, botanicals, and other products.

Dr. Cassileth has continued to emphasize research, and she and her colleagues in the Integrative Medicine department serve as principal investigators for a number of ongoing trials at MSKCC, including studies of acupuncture and massage therapy.

She has further promoted research of complementary therapies as founding president of the International Society for Integrative Oncology (SIO) and as a founding member of the advisory council to the National Institutes of Health Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine (NCCAM).

For Dr. Cassileth, integrative medicine reflects the new era of oncology, one in which our excellent and growing survival rates permit attention to survivor needs. Physical and emotional sequelae of treatment now are important emphases.

Complementary modalities can control many symptoms and enhance quality of life with safe, non-invasive, non-toxic interventions in which patients themselves can play an active role.