News From The Colleges
Nursing Professor Joyce K. Anastasi Merges East and West to Help Chronically Ill Patients Manage Symptoms

Joyce K. Anastasi, PhD, DrNP, was recently named the Independence Foundation Professor of Nursing and Founding Director of the Division of Special Studies in Symptom Management at the NYU College of Nursing. The Division's aim is to provide a comprehensive site for multidisciplinary scientific inquiry, clinical research, and education in the area of symptom management. Dr. Anastasi is one of the country's leading nurse scientists in the area of symptom management for individuals living with chronic conditions, including those suffering from HIV/AIDS and its sequelae. Dr. Anastasi brings extraordinary resources to the NYUCD/NYUCN alliance and specifically, to an area that complements the professional focus of Dr. Brian Schmidt, the newly appointed Director of the Bluestone Center for Clinical Research, who specializes in symptom management and care of patients suffering from oral cancer (See related story).

As a doctoral student in the 1980s, Joyce K. Anastasi worked as a registered nurse to support her graduate studies. She was assigned to Tim, a banker in his late 20s. She knew little about him, but the isolation cart outside his room with a meal tray announced that he had scant human contact. Dr. Anastasi could not imagine what his illness was, but it soon became clear.

At the time, AIDS was not yet considered an epidemic, but it was very much present in New York City's healthcare system. According to Dr. Anastasi, Tim's face expressed his fear: fear that he wouldn't be visited, that he wouldn't live, that he might have to disclose to his family that he was gay.

"I became his confidante," she says, "and I learned right away that in addition to what we think of as nursing care, he needed emotional care, family support, advocacy, help coping with stigma."

Dr. Anastasi dedicated her dissertation to Tim, who died before his illness was named "HIV." His situation inspired her belief that nurses need to lead the way in caring for people with AIDS and forged her professional orientation.

Dr. Anastasi, an NYU alumna, joined the College of Nursing faculty in 2009. She came to NYU from Columbia University, where she was a faculty member for 17 years, teaching thousands of nurses, serving on numerous committees and boards, and directing the Center for AIDS Research.

Fighting the Stigma and the Symptoms of AIDS
During the 1980s, as the AIDS crisis grew, Dr. Anastasi worked as a clinical nurse specialist at Bellevue Hospital Center, which had one of the city's first AIDS units. Paramount among the nurses' duties was to work with a multidisciplinary team to ensure that patients who went home after suffering serious opportunistic infections like pneumocystis carinii pneumonia (PCP) continued to receive the care they needed - whether it was housing, homecare, or even help talking to their landlords as they began receiving large shipments of medication.

"There was so much stigma - we sometimes lose sight of this now," she says.

From Bellevue, Dr. Anastasi was recruited to St. Luke's Roosevelt Medical Center to help design a designated AIDS center - one of the first under the auspices of the AIDS Institute of the New York City Department of Health. In 1992, with her first doctoral degree completed, she was recruited by Columbia to develop a graduate nursing specialty program in HIV - one of the first in the country.

Although HIV care was improving rapidly, many hospitals around the country did not have the financial or human resources to handle their growing cases. With a grant from the Pfizer Foundation, Dr. Anastasi developed an award-winning interactive video that was used widely to educate healthcare professionals and destigmatize the illness. Former U.S. Surgeon General C. Everett Koop was quoted saying, "I've never seen a better educational tool in my life."

In thinking about the direction of her research, Dr. Anastasi looked at her patients - not only those with AIDS, but with other chronic illnesses - and saw that many were seeking non-invasive ways to manage chronic symptoms and medication side effects. Her first National Institutes of Health (NIH)–funded work was a study that used a combined dietary and behavioral intervention to manage chronic diarrhea in patients with HIV. The results of that study have led to care protocols that are used in hospitals today.

Caring for hundreds of people with AIDS, Dr. Anastasi increasingly heard reports that acupuncture had worked for them. "At first I told them: As long as it's working, you're going to someone licensed, and it doesn't interfere with your medication, who am I to say no?"

But a turning point in her interest in alternative therapies came in 1994 when a friend who is a nutritionist and is Chinese took her to a Chinese medicine practitioner. She was so intrigued by the treatment methods used by the practitioner and about the possibilities that traditional Chinese medicine could offer to her patients that Dr. Anastasi immediately enrolled in a three-year course in acupuncture at the New York College of Health Professions, while carrying a full teaching load and conducting research.

Throughout the course, Dr. Anastasi continually sought out research on acupuncture, but few gold-standard studies had been conducted, at least in the United States. At one point, she hired a translator to translate Chinese studies into English. Yet her goal of testing the efficacy, safety, and usage practices of traditional Chinese medicine (TCM) within the structure of a randomized controlled clinical trial was significantly hampered by a lack of funding for this kind of research.

Breaking Ground
In 1999, Dr. Anastasi received one of the largest, single-center research grants for acupuncture that had been granted by the NIH. She was awarded a $2.1 million grant to test acupuncture and moxibustion for chronic diarrhea in persons with HIV in a randomized controlled trial. (Moxibustion is a traditional Chinese treatment in which pulverized mugwort leaf, or Artemisia vulgaris, is compressed into a cigar-shaped cylinder, lit, and held over acupuncture points.) The knowledge and experience gained from this trial served as a model for her future research.

To date, Dr. Anastasi's most significant findings have been that acupuncture is a promising option for managing gastrointestinal disorders such as nausea and non-pathogenic diarrhea - that is, diarrhea caused by side effects of medication rather than from a viral or bacterial source. In the decade since this study began, the use of acupuncture for nausea, even pregnancy-related nausea, has steadily increased. Dr. Anastasi is one of only a few scientists testing the use of moxibustion - which in TCM is considered another form of acupuncture, using the warming qualities of the lit herb instead of, or in combination with, needles to stimulate acupuncture points.

"Designing acupuncture research studies can be challenging because specific treatment protocols, in terms of acupuncture point selection or number of treatment sessions, may not be the best approach for all patients. In my current studies, my team and I have tried to use a real-world approach while maintaining the rigors of a randomized clinical trial," Dr. Anastasi says. "For example, the decision of which acupuncture points or which herbal formula to use for HIV or for diarrhea is complicated and requires integrating a patient's whole profile to develop the optimal treatment plan."

Integrating Eastern and Western health care in teaching is also challenging, yet increasingly important as the line separating these very different approaches grows thinner. On a recent trip to Hong Kong, Dr. Anastasi noticed that nurses there are more likely to integrate the two worlds at the bedside. And even in the United States, the nursing profession is moving toward a greater openness to studying Eastern ideas. State nursing exams now include questions about supplements, and thousands of people are taking supplements such as ginkgo biloba, glucosamine chondroitin, echinacea, or milk thistle.

"It's important for nurses today to understand the impact of the substances their patients are already taking - to help patients understand why they're taking them, the risks, the side effects, and potential benefits. For example, nurses need to be aware of supplements that can affect bleeding time in terms of coagulation, especially for patients undergoing surgical procedures," Dr. Anastasi says. "We teach students to search for the evidence, and the availability or lack of availability of evidence is great fodder for classroom discussion."

Dr. Anastasi maintains a private practice in women's health, and many patients see her for treatment for infertility. She is decidedly unique on the NYU faculty, having two doctoral degrees (a PhD and DrNP) and licensure in traditional Chinese medicine. Smiling, she says, "That's the yin and yang of my career."

- Barbara Kancelbaum