[MUSIC] I have the pleasure to introduce a Professor Ofer Lavie. Professor Ofer Lavie is the Director of the Gynecological Oncology unit in Carmel Medical Hospital in Haifa, Israel. And he's the chairperson of the gynecology and obstetrics department in the hospital. Thank you Ofer for coming here. >> It's a pleasure, thank you. >> I would like, Ofer, to ask you several questions regarding the topic of complimentary medicine and integration from your experience as a gynecological oncologist who is very active in working with us in integrative oncology setting here in Lynn Medical Center. And first of all, if I may open the discussion, if you can elaborate a little bit about changes that happened in your practice as an oncologist and genecologic oncologist in terms of the issue of patient centered care. What happened during the last decade Is genecologic oncology had become more holistic, in a sense? >> 5 to 15 years ago, I somehow got the impression that most of my patients are willing, wishing, demanding for alternative medicine. They do go unofficially to healers, to other professionals in order to seek for what we call nowadays alternative or complimentary medicine. Once we assumed that this is the way they should ask for, we evaluated the percentages. And actually in our department, in gynecology, we quantitate that more than 60% of our patients unofficially are seeking for alternative medicine. Once we noticed that the number is so big, we decided to build a unit, which will be back to back, which will be adjacent to the oncology, to the gynecology rooms. And once we feel like the gut impression that the patient is seeking, willing, demanding for something complimentary, we decided to send her to the professionals who are actually taking care for these issues in the complimentary unit. And nowadays I might say that after I would say ten years, every patient of mine has the opportunity to meet one of the medicine cares and that's of course according to his demands or her demands or her symptoms. So actually there's a tremendous change if I compare the gyneocology at 10 or 15 years ago from the possibility or from the option of getting some kind of alternative medicine or what we call integrative medicine nowadays. >> So what happens when a patient of yours with let's say ovarian cancer is raising the subject of consultation with the complementary or alternative or traditional medicine practitioners. What happens in the room in terms of communication? >> This is an easy case. Because once I get the impression, whether it's directly or indirectly, that the patient is looking, wants some kind of information concerning the alternative care or the alternative medicine, then she's getting direct appointment with one of the alternative health providers. And from there, they are deciding. They are having their own triage, which direction this patient is seeking, and basically she's there, and now once she was addressed to the alternative medicine, or integrative medicine function, then she's getting parallelly, both treatments. And, of course there's a great integration between us, the formal GYN oncologists and the integrative care providers. >> So it means that, concomitant with surgery, with chemotherapy or palliative care, there is an integrative complementary medicine consultation and treatment. >> Yeah, basically it depends how active is the patient. If she ask for information concerning integrative or alternative medicine before the operation, then she's referred before the operation. If she's asking it after the operation or during the [INAUDIBLE] chemotherapy, then this is the time for being referred to the alternative medicine unit. Sometimes we get some demands or questions from the family members, and then we send the family and the patient to the this function, to the alternative medicine function. And that's how the complementary medicine is helping us in dealing with the palliative care and end of life as well. >> You know there were some studies that pointed out that there's a huge amount of disclosure of patient's use of complimentary medicine when they talked with their physicians. Oncologists GYN oncologists and so on. So I assume that some of your patients do not initiate a conversation about complimentary medicine with you. >> Well, basically this atmosphere is relevant to ten years ago. In our practice, I would say that most of my patients, I mean, they will not hesitate to ask me about complementary medicine. And that's because they feel free to speak with me about any subject, this is one issue. And I do know that it is some kind of a change in attitude of the formal GYN oncologist. And sometimes just the atmosphere in the oncology institution here that alternative medicine is part of the formal treatment of our patients. >> So what are the indications of referral, what are your expectations when you refer patients to integrative medicine consultation within the GYN oncology setting? >> Well, I would say that the first indication, or the first driver for sending a patient for complementary medicine, is patient request. However, and that of course once you raise this issue, she's with no delay, she's being sent to one of our expert in order to get formal advice what to deal and what to do. The second option is symptoms control. Once I had the feeling that this patient is very symptomatic, and I have to think outside of the box in order to solve part of the symptoms. Which are not being solved with, I would say conservative options, then this is another indication for sending the patient for our CAM unit. We always try to expend the indications, and we have a lot of trials for each neuropathic trials. Suggesting and trying to find solution in the integrative medicine for unsolved symptom neuropathy. However, these are the exceptions. The major indication for patients to go to the communic is patient request and symptom. >> So what are the leading symptoms or patients concerns that would lead you to decision to refer this patient to consultation. >> I would say that the chemotherapy receiving patient, the leading indication for sending the patient for CAM is neuropathy. I would say nausea, I would say tiredness,- >> Fatigue. >> Fatigue, disability for functioning, and I would say depression as well. Depression is one of the, I wouldn't say the major one, but one of the options to send the patient for an outer integrative care. >> We did a few studies about the impact of integrative treatment here in the department regarding symptom control and about the effect that it might have on what we call adherence to chemotherapy. Do you feel that if there is a better quality of life status, it may assist you as an GYN oncologist to provide the chemotherapy dosage, that you schedule in a,n adjuvant setting for example. >> I would say that patient who adhere to the complimentary medicine, having somehow a better quality of life. And that's because they have another health provider, doctor or staff, and it's always helped patients in this battle against cancer. So this is the first issue. However, once the patient doesn't fit, or is not a good match-up between the care provider, the integrative care provider and the patient, they don't come to these treatments, and they don't come to these meetings. So, patients who adhere to these meetings and to the continuous complimentary care, do have some benefit from the quality of life point of view. That's my impression. >> So, can you distinguish between people that have a high adherance to integrative care, versus the patients that do not adhere or do not match as they said to this practice. Who would adhere to integrated practice versus not? >> I would say as mentioned in the beginning of this interview, that patients who are seeking, asking, or looked for complementary medicine, they will adhere to this direction. I would say that language is a barrier. If the patient does not speak the language, the Hebrew, Arabic, Russian, whatever, but there must be communication, a good language communication between the care provider and the patient. I would say that if you don't have these criterias, then, the chances for adhering to the prolong protocol for CAM is lower. >> So, can you elaborate a little bit about the process that led you and us into a better communication when we just initiated the project. I mean if, assume that some of the people that will watch us will think and consider Initiating project in their own hospitals or clinical setting. I mean, what's the tips that you have to provide to these people? >> Well, changing tradition is always difficult. So, changing the formal GYN oncology treatment, surgery, primary debugging surgery, new adjuvant chemotherapy. Changing these formal fixed protocols into protocols which are integrated with complimentary medicine is not easy. However, once we started the first step was to integrate the care provider, alternative care providers to come and seek with us in the tumor boards. And actually to be part of the staff, to be part of the decision making. So first of all the first step was to teach the care providers all about this ovarian cancer, cervical cancer, etc. Then the second step was to consult them, which is the patient who have the best benefit from getting complimentary treatment. Then afterwards, once we did the, I would say the consultation or the induction of the integration between us and the alternative caregivers, then we actually created a formal consultation which is being sent by mail, or by internet, whatever. A short description of the patient's status, followed by the specific complaint which we want the alternative medicine to try and solve. And then, of course, getting a followup few days or after few meetings with the care providers. So this is the format, this is the triage that is running nowadays, between us, the formal GYN oncologist, and the care providers, or the alternative care providers. >> So if you look at the future, what are the new the horizons of this collaboration that we started ten years ago? And how would you say are there optional collaborations venues in terms of research, of clinical practice. Where should it go from here? >> Well, the future has a few directions. The first direction is that we are actually doing nowadays, is to actually go into the lab, into the in vitro process. And to see and to prove that first of all there's no harm by giving complementary medicine to our oncological patients. And to see that there's no harm due to the integration of the formal chemotherapy, and the medications or the treatment that are being given to our patient. So this we already proven that there's no harm. Actually, patient getting some kind of herbs, these herbs do not interfere with the chemotherapy process of cancer killing. So this was proven in vitro. Nowadays we want to see that there is some benefit by giving these herb. This is one issue. The second issue is to try and to go from the outpatient clinics, from the outpatient oncology institute to the hospital instituted that basically or specifically to the OR. To see whether if we start this complimentary integrity of treatment before the major surgeries of this oncology patient, we get any benefit. Benefit I'm not speaking about the of survival or progression for survival, but I do speak from the patient point of view. Less anxiety, better nausea and vomiting control, and other symptoms which are not solved nowadays. The third issue is trying to control unsolved symptoms like neuropathy. We're in the middle of launching a study that will tackle the issue of neuropathy and see whether the complementary medicine has any benefit concerning controlling and controlling and reducing symptoms of neuropathy. The last future direction, horizon, I would say is to put the integrative medicine into the palliative care much more extensively. I do want the complementary care provider to be with me not only when I make the diagnosis of cancer and giving new or adjuvant chemotherapy. I do want the care provider to be side by side next to me on the palliative phase of the patient. I think that for the palliative care provider there's a great role in the end of life as well. But this issue, we have to organize it, we have to think about it and we have to see. How we integrate the care providers of complimentary medicine into this phase of life. >> I would like to ask you one of the controversial issues in terms of integrative oncologies, the use of herbs. And we've seen that in a setting, in a social cultural setting where we operate here in the Middle East. I mean, it's not easy to tell patients don't use that, don't use that, because most of them are using herbs as part of nutrition or as part of traditional medicine or as part of complimentary medicine. And as you have said more than 60% of your patients are doing that in any case. Now when you refer a patient to our practice, and I'm suggesting to supplement the care of let's say cancer related fatigue with a specific plant. Like ginseng, that has an evidence-based research behind it, what is your approach? I mean, do you feel that it might harm, in a sense, your own chemotherapy protocol or treatment? How do you feel in terms of openness into that, and on the other hand, do you feel that it can risk somehow your treatment, or the well being of the patient? >> That was my attitude before ten years ago, or before we decided to create some kind of integrative institute. Once I have the calm specialist like you. I give all my confidence that you will choose the right herb that will not, I would say that will not hurt or will not interfere with my conventional treatment. That, I didn't mentioned it, but one of the indication for sending a patient to your consultation. Or in the early phase is once they come with a list of herbs which I really don't know nothing about, and they want to know whether this is better than the other one. This is your job. It's just as I give all confidence for my remedial therapist and my oncologist I'm just giving the confidence that you're the expert. You will tell me whether there's some kind of interference between the herb treatment and the formal chemotherapy. So far from the in vitro trials that we did together, we saw that there's not inferiority in the plate for cancer cells to receiving herb on the contrary. It might be a very cautious about it, it might be that even it accelerate the chemotherapy reaction, but this is still to be proven in vitro and then afterwards of course in vivo. So basically, I give my confidence, you're my expert concerning the interference of herbal treatment. You know where to look for the information and which information exists in the literature. Basically, I send a patient to you to judge whether this is the correct treatment or not. >> So last but not least I would like to get your advise for gynecologic oncologists in our region in the Middle East, in the Mediterranean. Someone that considers to integrate complementary medicine within his or her own practice somewhere in Turkey or in Jordan or in Egypt or somewhere else? What are your advises or tips for such a person, for such a professional GYN oncologist? How should he or she open up the scene for these kind of integration. >> So my answer to you will be on two phases, the short-term phase and the long-term phase. The short-term phase, since we know that more than 60% of our GYN oncology patients are seeking for complementary advices, complementary treatment. So this is there. So you can't ignore it. So for the short term point of view, I would say go ask by the Internet, try and find your personal consultant for integrative or complementary medicine for herbal specialist you have to ask for consultation. You have to learn the subject. You have to try and have some kind of a group that is a specialist because you can't learn the novel this large amount of information. From the long-term point of view, the issue is to try and create some kind of an institute which is integrated with your formal institute in order to create like we did some kind of formal triage. And formal integration between formal oncology or formal gynecology, and herb or modern herb or alternative treatments. >> I would like to thank you for coming here and sharing your ideas with us. >> As usual, it was a pleasure to integrate with you. >> [LAUGH] [MUSIC]
