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The Integrative Medicine and Palliative Care Team Karen Moody MD, MS Children’s Hospital at Montefiore Albert Einstein Cancer Center Retreat May 5, 2010
Background ,[object Object],[object Object],[object Object]
Progressive transition to palliative care
The need for palliative care ,[object Object]
Improvements in palliative care delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* = p<.03
Needs assessment ,[object Object],[object Object],[object Object]
Needs assessment ,[object Object],[object Object]
Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Demographic characteristics 3% Multi-racial 28% African American 16% White 2% Native American 4% Asian or Pac Islander 43% Hispanic Race n  = 102 Category Variable
Clinical characteristics 42% Leukemia Cancer Diagnosis 6% Other 14% NHL or HD 8% Neuroblastoma 15% Sarcoma 16% Brain Tumor n  = 102 Category Variable
Top 10 parents’ needs ( n  = 91 ) 81 Hotlines I can call for information 82 Tests used to find cancer 82 Immediate side effects of treatment 84 Genes and cancer 86 Relaxation and stress management strategies 87 Alternative & natural treatments for my child’s type of cancer 88 Healthier ways to eat 91 Long-term side effects of treatment 91 What my child can eat to help with treatment side effects 94 Things I can do to reduce my child’s chance of getting another cancer I would like to learn more about: % Endorsed Item
Top 10 children’s needs ( n  = 49 ) 61 What I can do about pain 65 Genes and cancer 65 Alternative & natural treatments for my child’s type of cancer 67 Relaxation/stress management 67 Tests for different types of cancer 67 My type of cancer 76 Healthier ways to eat 81 Long-term side effects of treatment 84 Things I can do to reduce my chance of getting another cancer 84 What I  can eat to help with treatment side effects I would like to learn more about: % Endorsed Item
Conclusions from needs assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Development of IMPACT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Impact assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is CAM? ,[object Object],Roth, M J Ped Heme Onc Mar 2009
Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object]
IMPACT business plan ,[object Object],[object Object],[object Object]
IMPACT ,[object Object],[object Object]
IMPACT services ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],IMPACT  SERVICES
IMPACT staff education ,[object Object],[object Object],[object Object]
IMPACT medical student education ,[object Object],[object Object],[object Object],[object Object]
IMPACT Research ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Effectiveness of the Neutropenic Diet ,[object Object],[object Object],[object Object],[object Object],Karen Moody, MD
The Effectiveness of the Neutropenic Diet ,[object Object],[object Object],Karen Moody, MD
The Effectiveness of the Neutropenic Diet  ,[object Object],[object Object],[object Object],[object Object],Karen Moody,MD
Aromatherapy for the Reduction of Nausea ,[object Object],[object Object],[object Object],Karen Moody, MD
The Effects of Yoga on Pain and Anxiety in Children with Cancer and Sickle Cell Disease.  ,[object Object],[object Object],[object Object],[object Object],Karen Moody, MD
These data indicate there was an average increase in pain scores for 2 patients (case 11 and 14).  It should be noted that the patients both received intra-muscular medication administration during the yoga session. Where there is no bar, it indicates that that patients had 0/10 pain pre and post yoga
Anxiety Graph 2. Patient Mean Baseline and Follow-Up Anxiety T-scores
Table 2. Summary of Collected Data A paired, two-tailed t-test comparing pre- and post- yoga pain scores when we censored the two cases where patients received shots changes the score, which becomes statistically significant: p-value = 0.005  -9.62 -0.57 Average Change in Score <0.0001 0.079   P-Value 44.7 54.3 Anxiety T-Score  2.73 3.30 Pain Score  Average Post-Yoga Score Average Pre-Yoga Score  
 
 
 
Patient Quotes ,[object Object],&quot;Do you think my neck pain/shoulder pain is related to stress?&quot; &quot;I think that worked.&quot; &quot;It was nice and very relaxing, and I want to do it again.&quot; &quot;I feel more relaxed.  I have pain but I don’t feel it.&quot; &quot;I feel very relaxed, and want to do it again…I want to learn different ways to help me fall asleep.&quot; “ I feel more relaxed in my body and brain. I am thinking about less things.”  “ I was feeling tense…now I feel more relaxed.” “ I enjoyed it.” Sample Patient Quotes Post Yoga
Questions ?

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Session 5.4 Moody

  • 1. The Integrative Medicine and Palliative Care Team Karen Moody MD, MS Children’s Hospital at Montefiore Albert Einstein Cancer Center Retreat May 5, 2010
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  • 3. Progressive transition to palliative care
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  • 9. Demographic characteristics 3% Multi-racial 28% African American 16% White 2% Native American 4% Asian or Pac Islander 43% Hispanic Race n = 102 Category Variable
  • 10. Clinical characteristics 42% Leukemia Cancer Diagnosis 6% Other 14% NHL or HD 8% Neuroblastoma 15% Sarcoma 16% Brain Tumor n = 102 Category Variable
  • 11. Top 10 parents’ needs ( n = 91 ) 81 Hotlines I can call for information 82 Tests used to find cancer 82 Immediate side effects of treatment 84 Genes and cancer 86 Relaxation and stress management strategies 87 Alternative & natural treatments for my child’s type of cancer 88 Healthier ways to eat 91 Long-term side effects of treatment 91 What my child can eat to help with treatment side effects 94 Things I can do to reduce my child’s chance of getting another cancer I would like to learn more about: % Endorsed Item
  • 12. Top 10 children’s needs ( n = 49 ) 61 What I can do about pain 65 Genes and cancer 65 Alternative & natural treatments for my child’s type of cancer 67 Relaxation/stress management 67 Tests for different types of cancer 67 My type of cancer 76 Healthier ways to eat 81 Long-term side effects of treatment 84 Things I can do to reduce my chance of getting another cancer 84 What I can eat to help with treatment side effects I would like to learn more about: % Endorsed Item
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  • 30. These data indicate there was an average increase in pain scores for 2 patients (case 11 and 14). It should be noted that the patients both received intra-muscular medication administration during the yoga session. Where there is no bar, it indicates that that patients had 0/10 pain pre and post yoga
  • 31. Anxiety Graph 2. Patient Mean Baseline and Follow-Up Anxiety T-scores
  • 32. Table 2. Summary of Collected Data A paired, two-tailed t-test comparing pre- and post- yoga pain scores when we censored the two cases where patients received shots changes the score, which becomes statistically significant: p-value = 0.005 -9.62 -0.57 Average Change in Score <0.0001 0.079 P-Value 44.7 54.3 Anxiety T-Score 2.73 3.30 Pain Score Average Post-Yoga Score Average Pre-Yoga Score  
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  • 36.

Editor's Notes

  1. Can add pictures here to illustrate the variety of impact’s activities
  2. Average within patient baseline and follow-up anxiety T-scores are displayed in Graph 2. One patient (case #1) had an increased anxiety score after a yoga intervention.
  3. The average within patient pain score before yoga was 3.30, and after yoga was 2.73 with a mean reduction in pain score of 0.57. A paired, two-tailed t-test comparing pre- and post- yoga pain scores resulted in a p-value of 0.079. The average within patient state anxiety T-score before yoga was 54.3, and after yoga was 44.7, with a mean reduction in anxiety T-score of 9.62. A paired, two-tailed t-test comparing pre- and post- yoga anxiety T-scores resulted in a p-value of 0.000004.
  4. Patient quotes collected post-intervention illustrate relaxation