Save for a couple of medical magazines on display, there is nothing about this yoga studio that would indicate it was in a hospital.

There are the usual full-length mirrors, racks of mats, colorful blankets and blocks, and soothing music. As in any beginner class, the poses are simple and slow, and the students are told to look within. 

"Just observe how you feel today," instructor Tali Ben-Josef told eight women and one man in a recent class. "Inhale up. Exhale down."

The class, held each week at Penn Medicine's Abramson Cancer Center, is part of its Integrative Oncology Services, which adds meditation, acupuncture, reiki, massage, aromatherapy, and a writing class to the more customary medical interventions.

Advances in chemotherapy, radiation, surgery and treatments that harness the immune system have reduced cancer mortality. But they often leave patients dealing with fatigue, nausea, pain, and other symptoms that can affect their quality of life. Hospitals have long offered support groups to help with the emotional toll. Now, alternative therapies meant to address body and mind — sometimes in ways that Western medicine has long treated with skepticism — are increasingly becoming an expected component of a comprehensive cancer center.

An article published in November in the Journal of the National Cancer Institute Monographs reported that the use of integrative medicine at U.S. cancer centers is increasing, fueled by patient interest in using non-medical approaches to improve their health.

The authors looked at the websites of 45 National Cancer Institute-designated comprehensive cancer centers and found a substantial growth in the integrative offerings between 2009 and 2016.

Twenty-five years ago, Cancer Treatment Centers of America  was a forerunner in offering programs such as nutrition, naturopathic medicine, and acupuncture as well as physical and occupational therapy to patients, said Kathryn Cantera, director of integrative services at CTCA's Philadelphia location and chief of rehabilitative services for all five of its facilities.

Using CTCA's symptom inventory tool — a basic questionnaire — patients are referred by their care team for additional treatments such as yoga, massage, and music therapy, she said.

"We are making sure the right patient receives the right service at the right time," Cantera said.

At Fox Chase Cancer Center, the Integrative Care program includes music therapy, yoga, stress management, and reiki.

Reiki is a Japanese discipline that uses the body's energy as a healing modality, said Darrin Richman, a certified reiki master and practitioner who helped launch Fox Chase's program. Since 2013, about 1,000 free reiki sessions have been administered, he said.

"Just applying a caring touch will allow the reiki to flow," said Richman, who also serves as the hospital's technology support and development pharmacist. Reiki can also be performed when the practitioner's hands hover over the patient and has the potential to heal at all levels – mental, emotional, spiritual and physical, he said.

Although most patients experience a "deep sense of relaxation" after the treatment, some have also reported a reduction in pain, fatigue, nausea and other side effects, Richman said.

Before patient navigator Laura Galindez arrived at Abramson Cancer Center three years ago, there was little coordination, referrals or scheduling for the various programs. Now, about 1,000 adult patients take advantage of the center's integrative services. Except for acupuncture, all of the programs are free, she said.

Having the ability to choose additional therapies makes the patient an active participant in the  care and helps with adjustment to the "new normal," she said.

"People feel a sense of taking back ownership with their health," Galindez said. They want to know what they can do to stay well once they leave the hospital setting, and the classes are often found in their home communities, she said.

"I really try to push people toward evidence-based therapies," Galindez said.

Jennifer Hook, 60, of West Philadelphia, moves into a pose during a yoga class at the Hospital of the University of Pennsylvania.
DAVID MAIALETTI / Staff Photographer
Jennifer Hook, 60, of West Philadelphia, moves into a pose during a yoga class at the Hospital of the University of Pennsylvania.

Research into some integrative treatments has shown measurable benefits for patients.

About five years ago, yoga instructor Ben-Josef, who trained as an oral surgeon in Israel before moving to the United States, partnered with Neha Vapiwala, an associate professor in the department of radiation oncology, to see whether a twice-weekly yoga class would help prostate patients with the crushing fatigue that often accompanies radiation.

Although the study was small – 68 patients were enrolled – the results were promising.

The men, most of whom were in their mid-60s, reported less fatigue and better sexual and urinary function than those who didn't practice yoga, Vapiwala said. The study did not collect data after radiation ended, but Vapiwala found that many participants "wanted to continue [with yoga], so that was a positive," she said.

Ben-Josef said her yoga class for breast cancer patients and caregivers acts as their "safe haven."

"It gives them reassurance and gets the anxiety to fade away for a little bit," Ben-Josef said.

In the fall, Frank Garnes, 66, accompanied his wife, Charmette Jackson, 71, a cancer survivor, to Ben-Josef's class. After 43 years of marriage, six children, 21 grandchildren and great-grandchildren, and two bouts of breast cancer, the Southwest Philadelphia couple have had their share of joy and pain.

"I have lymphedema," said Jackson, who attended the class with her arm fully wrapped in a compression bandage. Yoga was one of the exercises her care team suggested, she said.

"Since I was the caretaker, I decided to join in," Garnes said. "I look forward to it and I really enjoy doing it."

The two have been taking the classes for more than a year and both have seen benefits. Jackson found that she has more movement in her arm and Garnes found that he was more limber and had better balance. Both said they have learned how to handle the sometimes-overwhelming stress that comes with having cancer or caring for someone who does.

Another popular program at the Abramson Cancer Center involves Zeus, one of four volunteer therapy dogs.

Zeus gets a treat from his owner, Linda Schultz, as Terry Downs, of Bensalem, looks on.
DAVID MAIALETTI / Staff Photographer
Zeus gets a treat from his owner, Linda Schultz, as Terry Downs, of Bensalem, looks on.

The 5-year-old Nova Scotia duck tolling retriever moved about the waiting rooms at the cancer center like a seasoned politician with his owner, Linda Schultz. He wasted no time nuzzling up to bored or anxious patients and getting his fair share of hugs and praise. In return, Zeus would often strike a cute pose that showed off his official identification tag. He was quick to sit up on his haunches or offer up a paw to shake. Schultz was even quicker with a treat when he was done performing.

"He was very shy at first," said Schultz, of Ridley Township. "He's gotten to where he enjoys it."

Zeus ambled over to 10-year-old Lydia and her mother, Debbie Smalley, 42, a breast cancer survivor who was there for a follow-up appointment.  Even the momentary visit from Zeus made the waiting more tolerable, Smalley said.

"Animals are part of my every day. This experience is totally the opposite," Smalley said.