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Integrative Care at Israel's Davidoff Comprehensive Cancer Center: Report from Nimrod Sheinman, ND PDF Print E-mail
Written by John Weeks   

Integrative Care at Israel's Davidoff Comprehensive Cancer Center: Report from Nimrod Sheinman, ND

Summary: Two Israeli's leave their country to be trained in integrative practice. One, Nimrod Sheinman, ND, the author of this article, attends a naturopathic medical school in the mid 1980s. A dozen years later the other participates in a residential integrative medicine fellowship. Each are pioneers. Each returns then to their own country where they are presently collaborators in the Davidoff Comprehensive Cancer Center at the Rabin Medical Center. Here is Sheinman's account of the Center, the clinical services and the broader public responsibilities, including keeping the practitioners who serve these cancer patients from being ground down in their practices. Take a look.

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Rabin Medical Center, home of the Davidoff
The Davidoff Center at Rabin Medical Center includes an Integrative Medicine Unit in which the author of this article, Nimrod Sheinman, ND serves as the director of the Mind-Body Medicine section. The unit was founded by an early graduate of what was then a residential Fellowship in Integrative Medicine at the Arizona Center for Integrative Medicine, Opher Caspi, MD.

Sheinman
is a 1986 graduate of the naturopathic medical program at the National College of Natural Medicine (NCNM), Portland, Oregon. He subsequently completed a residency at Bastyr University where was later a member of the faculty. Sheinman is the founder of the Israel Naturopathic Association and co-founder of the Israel Center for Mind-Body Medicine.

_____________________________

Integrative Medicine at Davidoff Comprehensive Cancer Center, Israel

- Nimrod Sheinman, ND
Director, Mind-Body Unit, Integrative Medicine, Rabin Medical Center

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Author Sheinman: Director of mind-body program
Four years ago, the first Integrative Oncology Unit in an Israeli Hospital was founded at the Davidoff Comprehensive Cancer Center, part of Rabin Medical Center. The Rabin Center is owned by Clalit HMO, the biggest HMO in Israel, with about 4 Millions insurers. The Integrative Unit offers cancer patients a wide variety of complementary therapies, integrated with their state of the art oncological medical care.


The Davidoff Cancer Center is the most sophisticated and innovative facility in the Middle East for the treatment of malignant diseases, delivering comprehensive medical treatment to approximately 15% of Israel's cancer patients.

The Integrative Medicine Unit was founded and is headed by Opher Caspi, MD PhD, a board certified internist who completed seven years of training at the University of Arizona, and in China. The Unit is now seeing more than 12,000 patient's visits a year, and is serving about 1000-1500 new patients each year.

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Caspi: U Arizona Fellow runs program
Integrative therapeutic services & treatment process


The Unit's functional design was inspired by programs that operate successfully in leading cancer centers such as Memorial Sloan Kettering, M.D. Anderson, and Dana-Farber, with various features that are unique to the Israeli Unit. The complementary medicine modalities and methods include:

  • Traditional Chinese Medicine, including Acupuncture and Chinese herbs
  • Naturopathic Medicine, including clinical and functional nutrition, supplements and herbal medicine
  • Mind-Body Medicine, including MBSR, Interactive Guided Imagery, Health Psychology, medical Hypnosis, and preparation and support for surgery or other invasive procedures.
  • Manipulative and Body-based Therapies, including Shiatsu, Massage, Reflexology, and Integrative Pain Management
  • Movement Activities, such as Yoga, Chi-Qong and Tai-Chi, Pilates and Feldenkrais.
  • Group sessions, such as Meditation, Imagery, Nutrition and Lifestyle groups. 

The initial visit at the unit is dedicated to designing each patient's individual integrative treatment plan, based on the nature of the cancer, the specifics of the oncology treatment plan, the timing (i.e. before or after surgery, radiation, chemo-therapy etc.), and each patient's unique situation, preferences and needs. This intake is being performed by an oncology nurse (with extensive knowledge in natural and mind-body medicine), and the Unit's Medical Director.   

The tailored-made treatment plans usually involve at least 2-3 modalities, chosen with the patient at the end of his first visit. The treatment sessions, given by a competent team of some 30 CAM providers, may last for periods between weeks (i.e. preparation for surgery), to over a year (support during chemotherapy, radiation and after). Cases are discussed or supervised in small group meetings or in the whole unit's meetings, which are a two hours session, each week. Complicated cases have a case manager.

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Rabin's logo
Business model

The business model is based on the patients paying for their visits, and then being reimbursed by their health insurance plan (being on Health Insurance is required by law), according to their insurance policy program. Price per visit is about 200 shekels, which is about 50$. Typical local fees in a private CAM practice in Israel is about 300 Shekels for a Naturopathic or Chinese Medicine.

Each patient's visit is documented in an Electronic Medical Record (EMR) system, which was designed specifically to accommodate the different therapeutic "languages" available in the unit. We are now in the process of assessing patients' profiles (such as disease stage, chief complaints, needs and hopes), therapeutic combinations' profiles and patient's processes. We recently went through a process of defining our outcome and assessment measures, and we began delivering them to each new patient.   

Other core tasks, including self-care for practitioners

Beyond the focus on clinical services, the Unit's other three main tasks are:

  • Research    Both qualitative and quantitative research is under way.
  • Education   Two post graduate courses, one in Chinese Medicine and Integrative Oncology, and one on Touch therapies and Shiatsu in Oncology Care, has been conducted last year. 
  • Policy  Contribution to Health Policy through lectures in medical schools, contributions in local and international conferences, participation in local and international boards and committees, and more.

Working non-stop with cancer patients is not always easy. Therefore, we create yearly events to support our own psycho-spiritual well-being and sense of connectedness. This last year only, for instance, we've opened a Balint 'support group for the therapists' project, created a whole unit Nature Walk, enjoyed a one day Buddhist meditation retreat, and (before the Jewish New Year) had a midnight-to-sunrise walk through Jerusalem Synagogues.

If you are around, come visit us!

Peace, Shalom,

Nimrod Sheinman, ND
( )

Comment: Interesting to note that both Sheinman and Caspi were educated in the United States. The former attended the mothership of naturopathic medicine, NCNM, back in the day, as well as its well-known offspring, Bastyr. A little over a decade later, Caspi attended the University of Arizona program founded by Andrew Weil, MD that has had a similar generative relationship to the spread of its practice; in this case, that of integrative medicine as practiced by (principally) MDs. Each is a pioneer in his own field who went abroad to study then brought it all back home. I had the good luck to encounter each of them back in their early years.

Reflections aside, I am sure I am not the only person who would like to go fishing inside the Davidoff Center's electronic medical record. The Integrator will be open to sharing such useful data or outcomes as you would like to make available. Thanks, Nimrod.

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for inclusion in a future Integrator.



 



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