Living Well, with Cancer
Melissa Sciortino was tired of being tired.
She was eight months pregnant in 2014 when she was diagnosed with thyroid cancer. A week after her daughter was born, she had surgery to remove that endocrine gland and nearly 70 lymph nodes from her neck. Without the hormones the thyroid produces, Sciortino, now 36, began to experience a new, ongoing fatigue, on top of new motherhood.
About a year later, she had another surgery to remove almost 100 lymph nodes from her collarbone, chest and armpit area, where the cancer had spread. Last year, she found out the microscopic malignant cells had moved into her lungs.
Despite all of this, Sciortino stays active with her daughter, who is now 5. And then, last year, Sciortino learned that her cancer had spread, bringing a whole new level of exhaustion.
“For me, it was like, look, I know I’m never going to fully treat it. I’m always going to be tired,” she says. “But if I could figure out a way to wake up and not just feel mentally exhausted, I would participate in it all day long.”
Her search led her to the new Pluta Integrative Oncology & Wellness Center at Wilmot Cancer Institute. The center, which opened in October 2018, emphasizes overall well-being during and after cancer treatment. It addresses the physical, mental and emotional aspects of living with cancer, keeping a focus on mitigating or preventing the side effects of cancer and its treatment, not treating the cancer itself.
“The idea that you can go through cancer and still be well is important,” says Judy Zeeman-Golden, LCSW, who coordinates the Integrative Oncology Center, located on the second floor of Wilmot’s Pluta Cancer Center in Henrietta.
It is central to the concept of integrative oncology, a relatively new approach in cancer care that emphasizes connection, healing and less invasive, evidence-based practices. It incorporates complementary, or integrative, therapies that have been shown to
be effective such as nutrition, yoga, meditation and acupuncture that are used alongside — not in place of — conventional treatments.
The goals of integrative oncology are “to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment,” according to the .
Put simply, the field is aimed at helping people feel better, which has an important impact on their treatment. By mitigating or preventing side effects, integrative oncology practices have been shown to help patients tolerate their therapies better. They have been shown to help manage some of the long-term health effects of treatment and help prevent cancer recurrence.
Most people undergoing cancer treatment experience side effects that can include fatigue, insomnia, anxiety, stress, pain and nausea that arise with treatment, and they have long sought relief for these issues that can range from irritating to debilitating. National studies have found that as many as 30 percent to 50 percent of cancer patients use acupuncture, yoga, massage and meditation to address their side effects.
As the number of cancer survivors nationwide continues to rise and as people live longer with and beyond cancer, complementary therapies and the field integrative oncology continue to gain traction. Cancer care providers now have evidence from years of clinical research that shows these approaches are safe and effective.
Research in these areas continues, and it is helping to shape the field.
“We’re adding science to modalities that have been around for a long time,” says Alissa Huston, M.D., a medical oncologist and co-director of the Integrative Oncology Center. “We’re seeing further growth as patients’ interest grows.”
While the Pluta Integrative Oncology & Wellness Center is one of the only programs of its kind in upstate New York, it joins a growing number of centers nationwide at places like MD Anderson Cancer Center, Dana-Farber Cancer Institute and Memorial Sloan Kettering Cancer Center.
“Cancer impacts every cell in your body,” Zeeman-Golden says. “Having practitioners who are trained in this area helps advise patients about what’s appropriate and not appropriate for their specific needs.”
Precision Medicine for the Whole Person
The acceptance of integrative oncology also reflects a shift in care away from a model that has a physician focused on a tumor to one where a team is partnering with an individual and their caregivers to treat their cancer. It’s about encouraging optimal health and empowering individuals to participate actively in achieving that, whatever it means for them.
"You can still feel better than where you’ve been,” says Marilyn Ling, M.D., a radiation oncologist and co-director of the Integrative Oncology Center.
To achieve that, the center offers consultations with patients to determine their specific needs — a process that Ling likens to precision medicine for the whole person. During these sessions, Ling, for example, will review the patient’s diagnosis and treatment plans, but also discuss concerns the patient has about side effects and any goals they may have. She will then use these details to develop a personalized plan for each patient.
For Sciortino, that meant addressing her fatigue by focusing on nutrition, physical activity, and connection.
Before coming to the Integrative Oncology Center, she had tried services in the community but struggled because they weren’t designed for her.
“I was trying to do fitness classes with healthy folks, and I would take away the mindset that I couldn’t keep up,” she says. “A massage therapist I was going to would say, ‘I’m overcharging you because the amount of pressure I can put on you as a cancer patient is minimal, where someone else coming in for relief, I can do deep tissue and justify that price.’”
Sciortino met Zeeman-Golden at Wilmot’s Cooking for Wellness class, a hands-on, plant-based cooking class held in collaboration with and the . After an integrative oncology consultation, she joined , an exercise program designed for cancer survivors offered in collaboration with the YMCA of Greater Rochester. She has since branched out to participate in the art classes led by Gilda’s Club and signed up for yoga. She’s also interested in more personalized training through the ReNew fitness program, developed by scientists in Wilmot’s Cancer Prevention and Control Research program.
Every service offered at the Integrative Oncology Center is provided by specially trained and certified practitioners who understand the needs of people with cancer. Not only can they provide safe modifications to exercises or therapies such as massage, they can communicate with the individual’s treatment team through the electronic medical record.
“Everything we do, every modality we offer and every person we hire is vetted by our two doctors who are the medical directors of this program,” Zeeman-Golden says.
The Integrative Oncology team also works closely with the researchers in the Cancer Prevention and Control Research program who are national leaders in addressing the side effects of cancer treatment through non-pharmacologic approaches like exercise and nutrition.
Since she began coming to the Integrative Oncology Center, Sciortino says she can feel the difference.
“I feel good, I feel better,” Sciortino says. “I do have bad days, but when I go to these programs, I’m excited. It gives me purpose. I’m doing something, and I’m going to see my friends.” The center is also a place where cancer isn’t always front and center, she says.
“Doing these programs, you are free to talk about your disease, your journey, as you wish,” Sciortino says. “There are many programs where we really didn’t talk about anything related to cancer. It was life, it was having fun, making something, enjoying each other’s company. Whether it was an hour or 45 minutes, you were living in that moment and you forget that you have cancer.”
Meeting a Growing Need
The Pluta Integrative Oncology & Wellness Center is open to all Wilmot Cancer Institute patients, and it brings together services like massage, yoga and qi gong that had been offered through Wilmot before but in a decentralized fashion.
The center is a collaboration between Wilmot Cancer Institute and the Pluta Cancer Center Foundation, which helped secure $1.35 million to construct the facility. It features two treatment rooms for massage and acupuncture, a meditation room, a fitness area, and a multipurpose space where different classes are held.
With generous donor gifts, the Foundation also covers the costs of the individual therapies and group programs at the center so that patients do not have to pay for these services, which typically are not covered by insurance. This funding helps remove a barrier for patients and survivors who are facing other significant costs and may be out of work for treatment.
“I don’t have to worry about financing wellness activities that will help me,” Sciortino says. “This resource works, and it’s one less financial cost that you have to worry about.”
Since opening, more than 2,000 patients have participated in the center’s programs, far exceeding projections for the center.
“Everyone comes for different reasons,” says Zeeman-Golden. “We have patients with a stage 4 diagnosis and have a ton of joint pain and bone pain and are looking for relief of those symptoms. We have people who are going through chemotherapy who have high anxiety, poor sleep, stress, and they’re coming for that.”
Anne Wells, 59, started with massage therapy at Pluta a few years ago. She had been diagnosed with metastatic breast cancer after bouts of abdominal pain and other issues that no one suspected were cancer. During what was supposed to have been a minimally invasive procedure, her surgeon found metastatic disease throughout her body. Her minor procedure became major surgery and a long, hard recovery.
“The beauty of the massage was to be touched in a therapeutic setting that felt good and felt healing, but with no pain or discomfort associated,” Wells says. “It was a wonderful experience.”
Since the opening of the Integrative Oncology Center last fall, she has participated in Livestrong and is looking forward to joining ReNew for a more customized fitness program to help her build strength.
“I’ll be in treatment for as long as I’m alive, so it’s important to me while I’m in treatment to feel the best that I can and to do as much as I can and keep challenging and pushing myself,” she says.
The Integrative Oncology team is now looking to expand its offerings and how best to reach patients in the region who may not be able to reach the center.
Projects include gathering data on why patients are coming and on the effectiveness of integrative modalities in managing specific symptoms. The center is also developing a nurse ambassador program that will train nurses to provide bedside and chairside strategies such as hand or foot massage techniques and aromatherapy.
Meanwhile, the offerings at the Integrative Oncology Center continue to evolve with patient needs and participation.
“It’s the constellation of services that helps you feel well,” Wells says. “It helps you feel like there’s hope and it’s worth doing these positive things that support your treatment.”
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