An evidence-based guide for patients and families A cancer diagnosis brings you and your loved ones into a daunt- ing world of confusing information about treatment options. What do you do first after receiving that diagnosis? Where do you turn now to ensure the best cancer treatment? You may have heard of using integrative medicine to complement main- stream care and alleviate the short- and long-term side effects of cancer treatment, but where do you find accurate information to help you steer away from unfounded promises and quack therapies? For which cancer treatments and side effects are acupuncture, massage therapy, yoga, nutritional counseling, and other integrative approaches helpful? Which promises are false? Survivorship: Living Well During and After Cancer provides up-to-date, evidence-based guidance and information from Dr. Barrie Cassileth, a leader in integrative cancer treatment and founder of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center. Dr. Cassileth will help you and your family begin to separate the facts from the hype and guide you through treatment and beyond. Survivorship Living Well During and After Cancer www.sprypub.com Barrie Cassileth, PhD Memorial Sloan-Kettering Cancer Center Survivorship Cassileth     Survivorship Living Well During and After Cancer Barrie Cassileth, PhD Memorial Sloan-Kettering Cancer Center with Ian Yarett     Copyright © 2014 Barrie R. Cassileth All rights reserved under International and Pan American Copyright Conventions. No part of this book may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. This edition is published by Spry Publishing LLC 2500 South State Street Ann Arbor, MI 48104 USA Printed and bound in the United States of America. 10 9 8 7 6 5 4 3 2 1 Library of Congress Control Number: 2013949027 Paperback ISBN: 978-1-938170-35-5 E-book ISBN: 978-1-938170-36-2 Disclaimer: Spry Publishing LLC does not assume responsibility for the contents or opinions expressed herein. Although every precaution is taken to ensure that information is accurate as of the date of publication, differences of opinion exist. The opinions expressed herein are those of the author and do not necessarily reflect the views of the publisher. The information contained in this book is not intended to replace professional advisement of an individual’s doctor prior to beginning or changing an individual’s course of treatment.     To my husband and children for their forebearance, support, and creative ideas, with all my love and appreciation. To our patients for their remarkable bravery and our integrative therapists and physicians for their devotion and expertise. To patients and cancer therapists everywhere for their ability to give and live to the fullest under the most difficult of circumstances. A special thanks to Ian Yarett. We were fortunate to have him with us at MSKCC for a year before he started medical school, and he worked tirelessly to put together the first draft of this book. Survivorship_Pages_Final_Process_Layout 1 14-01-31 2:42 PM Page 4     Contents Preface Part One Information to Start A Roadmap for Quality Care 11 What Integrative Medicine Is … and Isn’t 23 Part Two Complementary Therapies—The Basics What Complementary Therapies 33 Can Do for You Diet and Supplements 37 Physical Activity 70 Acupuncture 100 Mind-Body Therapies 105 Massage 113 Creative Therapies 119 Part Three Symptom Relief with Complementary Therapies Managing Pain 127 Fatigue 135 Anxiety, Stress, and Depression 143 Nausea and Vomiting 150 Hot Flashes 158 Sexual Dysfunction 163 Xerostomia 167 Insomnia and Sleep Disturbance 170 Lymphedema 174 Neuropathy 179 Appendices Scam Alert 181 Your Healthcare Team 187 Resources 189 Glossary 193 Index 209 Survivorship_Pages_Final_Process_Layout 1 14-01-31 2:42 PM Page 6     Preface Many years ago, I completed a doctorate in medical sociology at the University of Pennsylvania. For my thesis project, I chose to spend a year studying the dynamics of care on the adult leukemia unit of the Penn’s Cancer Center, a small cluster of beds adjacent to the Center's research laboratories. What I found that year not only became my thesis, it molded my lifelong profession. I found a world filled with terribly ill adults, mostly young or in their middle years, and I encountered their husbands, wives, parents, and children, all of whom suffered just as much, knowing that the prolonged and difficult treatments had a small chance of success. Physicians, nurses, and other staff faced similar challenges as they guided their patients through treatment, aware of its limitations and of the gaps in scientific knowledge underlying it. It became clear to me that more was needed than simply caring for each patient’s leukemia, as difficult and consuming as that was. A host of physical, emotional, and interpersonal     problems screamed for attention. Identifying them and outlining ways to approach them became my thesis and later a book, The Cancer Patient: Social and Medical Aspects of Care. After that year, I was asked to stay on to establish a program that could address these issues. We called it the “Psychosocial Program.” Under that rubric we created sup- port services for patients, families, and staff, established the first palliative care and home hospice programs based in an academic medical center, and conducted multiple research studies. In 1999, I was invited to bring all that I had learned and developed over the previous decades to Memorial Sloan- Kettering Cancer Center, the world’s preeminent cancer hos- pital, and to create a new kind of department, an Integrative Medicine department. This was an opportunity not only to bring the field to a new plateau, but to produce a program that could be a prototype for other hospitals around the world, and that is exactly what happened. The various elements of our program focus on patients’ needs throughout the full spectrum of their treatment and well beyond. Helping survivors and their loved ones to live strong and stay well is the major goal of what we do. Survivorship from diagnosis on presents new challenges, and survivorship is what this book is about. — Barrie Cassileth Survivorship_Pages_Final_Process_Layout 1 14-01-31 2:42 PM Page 9 Part One Information to Start