Integrative Medicine in Neuro-oncology: Virtual Group Visits

This transcript has been edited for clarity. 
Kathrin LaFaver, MD: Hello and welcome, on behalf of Medscape. I am Dr Kathrin LaFaver, a neurologist and lifestyle medicine specialist in Saratoga Springs, New York.
I have the great pleasure of talking with Dr Soma Sengupta today, a clinical professor of neurology, who is also the division chief of neuro-oncology and vice chair of research for the Department of Neurosurgery at University of North Carolina (UNC) in Chapel Hill.
Welcome, Dr Sengupta.
Soma Sengupta, MD, PhD, MBA: Thank you, Dr LaFaver. It’s a pleasure to be here today. 
LaFaver: The topic we’re going to talk about today is integrative medicine in neuro-oncology. To start us off, I’m very interested to hear more about where your interest in integrative medicine came from and also about the training you did. I understand you’ve completed a fellowship in integrative medicine.
Integrative Medicine Fellowship
Sengupta: I’ll start with the fellowship first and then come full circle to my interests. I did my fellowship in integrative medicine at the Andrew Weil Center for Integrative Medicine; that’s linked to the University of Arizona. I became very interested in integrative oncology through my training.
Dr Donald Abrams at UCSF and Dr Lise Alschuler at the University of Arizona and the Andrew Weil Center, really got me hooked into the area. I was very taken with the approaches to improve the quality of life of cancer patients. 
The reason I became interested as a neuro-oncologist is that I often didn’t like the approach that I was trained to do, which was you give chemotherapy, you take care of their day-to-day chemotherapy needs, and monitor the patient. Then you didn’t really offer anything else in terms of lifestyle advice. 
I went to clinic as a fellow at the Massachusetts General Hospital–Dana-Farber Cancer Institute–and Brigham and Women’s Hospital Neuro-Oncology Fellowship Program. I noticed that one of my mentors, Dr David Reardon, would talk about nutrition and exercise with his patients. I thought, wow, this is an interesting approach. I noticed that patients were always asking for that additional angle.
What if I took this supplement? What if I did this herb? What if I did this exercise? There were many what-if-I-dids. As a clinician scientist, I learned very early on that you should never disregard data points. If patients were asking for these alternative approaches, I needed to be educated in them.
I felt that the best way to be educated was to embark on a fellowship. I was very fortunate that the Schiff Foundation, when I was at the University of Cincinnati, paid for me to do the fellowship in integrative medicine. 
Learning from all my mentors at the Andrew Weil Integrative Medicine Center, including the ones I mentioned, Dr Alschuler and Dr Abrams, was just a life-changing experience. Of course, Andrew Weil himself is such a legend in the sphere of integrative medicine and the way mindfulness, nutrition, and supplements can really impact the way that people can live. I applied it to the brain tumor and neuro-oncology space.
LaFaver: Wonderful. That’s a good segue. Why don’t you tell us more about the program you have started for your patients with brain tumors? 
Virtual Group Visits
Sengupta: Dr Abrams let me sit in on his integrative medicine group visits in the integrative oncology setting. At the University of North Carolina, I offer integrative oncology virtual group visits that are billed, but at a low tier, and each week is a different theme.
I have a 5-week series and up to 12 patients can sign up. Each week, I have a different expert with me. For example, the current series that I’ll be running will have a pharmacist who’s integrative medicine trained and will be there to discuss herbs and supplements. 
Then, we have a break-off session after the talk as to what kind of supplements might be helpful, and if patients have one-to-one questions, we can utilize the breakout rooms. Often, my groups of patients have not wanted this. They’ve been more than willing to discuss things openly. 
The other week is going to be on mindfulness. We have a mindfulness expert, who’s funded by the National Institutes of Health (NIH) in the area, talking about this. Then we will break away and do mindfulness exercises and also talk about ways to implement mindfulness in each patient’s lifestyle.
We have nutrition, so we have a naturopath, who has worked in the space of integrative oncology for many years, discussing that. Then we have a nurse practitioner in integrative oncology who will discuss exercise, and she directs the Integrative Translational Oncology Program at the Lineberger Comprehensive Cancer Center.
I do a segment on mushrooms and supplements. We then tie everything together and ask whether there is anything that people want to know more about. Each clinic visit has notes that go into Epic so that the patient can access all these resources at their own time when they want to look things up through MyChart.
It is a comprehensive program, and it repeats itself after. There’s a 5-week series, there’s a week break, and then it starts up again so that other patients can join. 
I’ve found that it’s not only useful from an integrative medicine standpoint, but also very useful as a support group. The groups of patients begin to know each other, some of them open up to each other, and then after the series is over, sometimes they connect with each other. I utilize a HIPAA-compliant Zoom platform, which is provided through the institution. So far, it has been very rewarding for me.
LaFaver: That sounds wonderful. It is, certainly, as you mentioned, a very comprehensive approach to looking at different aspects that could help with people’s coping skills and general quality of life. What feedback have you have gotten from patients? Are you measuring outcomes in any more systematic way? I’d be interested to hear more about the feedback from people. 
Sengupta: Several patients have wanted to do it again. I’ve had one that did the series three times because they find that the information is never exactly the same. There’s always more information to learn as other people join. 
In terms of outcome measures, my hope is to eventually, with one of the providers in the group — actually, the mindfulness expert — she and I are planning to submit an NIH grant on mindfulness. I’m just taking one of the angles and going further with it.
On the supplement side, there are things that I’m interested in, but not necessarily for this angle. I think that really understanding how this series can help patients, how we can implement mindfulness, and how we can do mindfulness in a virtual setting is helpful.
Tips and Tricks for Group Visits
LaFaver: I’m really happy to hear about your plans, and good luck with the grant submission. You touched on that a little bit already, but tell us a bit more about your decision to offer this as group visits and maybe some tips and tricks for people who are trying to offer group visits in their own setting.
Were there some surprises as you were planning this or anything else you learned? 
Sengupta: I was very fortunate. In the Andrew Weil Integrative Center fellowship, they had a whole section on group visits. That helped. When I came to UNC, one of my colleagues in physical medicine and rehabilitation was already doing integrative medicine visits for patients with chronic pain.
I was able to do some modeling and get a large amount of support from my colleagues within UNC. They’re generously offering their time. It’s a question of having a system that’s willing to support this. 
My colleague at the Lineberger Cancer Center offers the one-to-one visits. These are usually 60-90 minutes. Many patients have told me, especially the brain tumor group, that this is difficult for them. They have so many hospital visits and doctor’s appointments that they don’t want to do that as well. Is there another way of doing it? 
That’s why I offered this strategy of the group visit because it’s information that would be beneficial to a number of different patients. In terms of time conservation, it’s a better way for patients to get things they want. Also, this way, they are able to use resources within the cancer center more efficiently because they know what they want once they’ve done the series. 
LaFaver: It sounds much more doable and less overwhelming for a number of reasons, as you pointed out. I really love this and it’s a really excellent demonstration of an innovative new way of bringing this type of information to more people while also supporting them, as you mentioned, with this support group aspect.
I really congratulate you on starting this fabulous program. Where can people go if they want to learn more either about integrative medicine or maybe starting group visits for patients? Do you have any resources you can share?
Sengupta: Yes. The Andrew Weil Center for Integrative Medicine has quite a few resources that are free. If you link up to my name on the UNC website, they can see the format of the group visits. There are group visit providers throughout. 
As I mentioned, my mentor — Dr Abrams, at UCSF, a radiation oncologist there — is also doing integrative brain tumor visits as well. There are more of us that need to offer these resources. I think that it would be very useful, not only in the brain tumor space but also in the neurology space in general.
Each of these group visits needs to be tailored to the disease. You can’t really do an integrative oncology group visit for migraine sufferers, for example. That needs to be tailored toward migraines, and it needs to be a provider that understands the pathophysiology of the migraine sufferer well.
There’s potential for this. Trying to work with foundations and patient advocacy groups to increase the reach of these resources would be incredibly useful. 
LaFaver: Absolutely. You are an inspiration. Thanks again for sharing this. This was Dr Soma Sengupta, talking to us about integrative medicine approaches for neuro-oncology.
Thank you all for watching, on behalf of Medscape. Have a good rest of your day. 
Sengupta: Thank you very much.