Without going into too many details, my spa visit this past weekend included hours spent in an indoor garden, relaxation sessions, acupressure, a videophone attached to my lounge chair, an on-site library for quiet reading, a farm table for communal meals, and a gallery space featuring work by local artists. Where is this amazing sounding place? And considering that this luxurious facility is right in New York City, there was one feature that just put the whole experience over the top: free parking.
Okay, fine, I spent this past weekend procrastinating, playing with my children, and seeing a movie. But the place I describe above is absolutely real. Only, it’s not a spa. It’s the Brooklyn Infusion Center, an offshoot of Memorial Sloan-Kettering Cancer Center. This satellite facility, nearly 8,000 square feet in size, was built to handle the burgeoning Brooklyn-based contingent of MSKCC (about 15% of the approximately 23,000 patients served by Sloan-Kettering). Equipped to serve about 30 patients per day in 12 treatment rooms, the Center is a logical step for the busy cancer center.
But as the above description makes clear, the Brooklyn Infusion Center takes cancer care one, or really several steps further. And this place is not alone. Increasingly, cancer centers are offering more and more services, as if the mere mention of the word “massage” is enough to woo patients through the revolving door. As if serving appetizing food is something novel. As if providing quality medical care is not enough. As if seriously ill people will benefit from a bright, well-lit atmosphere, comfortable chairs, and plants. But they – we – do, don’t they?
Try as I might to be skeptical about the cancer center-turned-spa experience, I can’t. These places are pleasant. They help really sick people feel better, whether for the short-term of an infusion or, perhaps, for the longer term (it’s impossible to measure). We know that stress can have all kinds of physical manifestations, and while the absence of stress may not prolong the life of a cancer patient (and it might), it surely makes the time available more pleasant. And studies do indicate that stress can impact cancer progression. I have seen chemotherapy chairs in a traditional hospital and I’ve seen them at a recently renovated center designed around whole-person wellness. The difference is – well, have you ever been in a luxury car with a seat warmer on a frigid winter’s night? It’s like that. You know you don’t need it, but you can’t deny how nice it feels. And if someone is suffering from a painful, life-threatening and a seat warmer can help take the edge off, then by all means.
And yet, the flags are raised. Fears of a hidden agenda are impossible to submerge. Why do the Cancer Treatment Centers of America have (squirm-inducing) commercials? Why does Sloan-Kettering take out ads in magazines? Why do hospitals have billboards along the highway? Why does the Brooklyn Infusion Center have a farm table for communal meals? (Full disclosure: I have not visited this facility.) The problem is that we know there’s money at stake—that cancer centers are businesses—and that makes the wellness pill a little hard to swallow.
Like anything and everything to do with healthcare these days, the cancer center business is complicated. Just look at the agenda for the 2010 Cancer Center Business Summit. Not all cancer centers are profitable every year. But the fact remains that most cancer centers are businesses, and their market is cancer patients. This fact doesn’t mean that the staff are uncaring – clearly there is plenty of care going on, and plenty of talent and medical know-how. But at the same time, understanding how the cancer center business model works is important.
And increasingly, part of that business model includes wellness services. Does this mean that our healthcare model is shifting to one that looks at a patient as a whole person, for whom healing can come from a high-powered dose of chemotherapy and/or a river view from their infusion chair? Or does it mean that Reiki is trendy these days?
Clearly, integrative oncology is on the rise. Don Abrams, the world-renowned oncologist who heads the Osher Center for Integrative Medicine, once told me that he intentionally drinks green tea in front of his patients to reinforce in them the idea that this might be a good thing for them to do, too. His approach comes from a reasoned belief in the potential benefits of green tea. Many studies of acupressure and acupuncture indicate a role in cancer care, such as for relieving fatigue or nausea and vomiting. (Although the results of acupuncture studies seem to depend on the investigator’s home country.)
But when wellness becomes a gimmick for getting patients in the door, is it less useful? Is it less okay? Does the motive make a difference in the benefit of the services being offered? And if so, why? The problem is that adding wellness services like a menu special preys on the hope of people who are potentially very desperate for anything that might improve their health. By contrast, designing a cancer center that addresses the person, not the patient, offers an entirely different outlook on healing. Detecting the difference is the tricky part.