I’ve talked about a wide range of complementary therapies in this column over the years – from meditation and yoga to acupuncture, creative therapies and natural health products like herbs and vitamins. But what about those more esoteric martial arts you occasionally see people practising in movies or out in the park? The two most common are tai chi and qigong, both derived from traditional Chinese medicine. Increasingly, they have been studied as potentially helpful practices for people living with cancer.
Tai chi is a shortened name, from tai chi ch’uan, a form of martial art derived from traditional Chinese medicine. It is actually a sub-set or adaptation of the older qigong practices, and involves a series of slow, specific movements or “forms,” done in a meditative fashion. It is purported that focusing the mind solely on the movements of the form helps to bring about a state of mental calm and clarity. Over the years, the practice itself has been separated from its martial arts roots, and is now widely taught as a gentle practice and exercise.
What are complementary therapies? Basically, CTs are any product or therapy used to improve health or treat symptoms outside of conventional medicine. Specific therapies that are considered complementary versus conventional are constantly changing, as evidence mounts to support their efficacy. For example, 25 years ago support groups for cancer patients were thought to be a terrible idea – a bunch of sick people getting together to talk about it would surely do more harm than good!
Now, nearly every cancer centre offers such support groups because there has been so much research and evaluation supporting their helpfulness, and they are just part of conventional care.
I did a survey in 2012 with psychology honours student Ngaire King of nearly 500 people with cancer and 100 health care providers at Calgary’s Tom Baker Cancer Centre. We asked about patients’ knowledge, communication and support-making decisions about which CTs to use in cancer care.
We call them “mind-body” interventions for a reason. Things like meditation, relaxation, hypnosis, imagery – even yoga – are often classified as mind-body interventions, meaning they are typically things you intentionally do with your mind that also affect your body. Of course, this division or split between mind and body is a false one to begin with. We are not walking heads somehow disconnected from everything else below the neck! Every state of mind has a corresponding state of body. When we are nervous, we feel butterflies in our belly or pounding in our chest; when we are sad, we feel tightening in our throat or heaviness in our chest. Other things are also going on that we may not directly feel, like changes in our immune cells and hormones.
So just what is going on at a cellular level when we experience various psychological states like stress or depression? A large body of research has associated stress with enhanced vulnerability to viruses such as the common cold. More recently, researchers have looked at molecules called “telomeres,” which are markers of cell aging. These are specialized proteins that form the protective ends of chromosomes, and provide stability to the cells.
Q: “Is SAD (seasonal affective disorder) a real thing? I feel like my mood is affected by the shorter days and cold weather. How do I know if I have it and what can I do?
SAD is most definitely a real disorder, says Linda E. Carlson, a clinical psychologist at the Tom Baker Centre, and Enbridge Chair in Psychosocial Oncology at the University of Calgary.
“It is recognized in the Diagnostic and Statistical Manual of Mental Disorders V (the handbook of all psychiatric conditions) as a subset of recurrent major depression with a seasonal pattern,” explains Carlson.
She goes on to say research shows the prevalence of the disorder in the U.S. ranges from 1.4 per cent in Florida to 9.7 per cent in New Hampshire. It is estimated to be higher in more northern climates, including Canada, where exposure to daylight decreases substantially in winter months.
I’ve written in this column over the last three years about a lot of complementary therapies and programs for cancer prevention and treatment. Those therapies include meditation, yoga, vitamins and natural health products, group support, distress screening, creative arts and exercise.Lately I’ve been talking to colleagues in the States who run integrative oncology programs, and over and over they’ve told me that acupuncture is one of their most popular offerings. This interested me as we don’t offer acupuncture yet at our treatment centres in Alberta, and I wondered what the current evidence is to support acupuncture use in cancer care.
Lately I’ve been talking to colleagues in the States who run integrative oncology programs, and over and over they’ve told me that acupuncture is one of their most popular offerings. This interested me as we don’t offer acupuncture yet at our treatment centres in Alberta, and I wondered what the current evidence is to support acupuncture use in cancer care.
I’ve been thinking a lot lately about how to bring together everything we know about the best possible care for cancer patients, the best way to offer people education, services and treatments that will optimize their physical, mental and spiritual health throughout the cancer journey. I’m not the first person to consider these questions.
Some people faced with a cancer diagnosis turn to complementary therapies. The question remains, for patients and health-care providers, how do they make sure those therapies are backed by evidence and actually work? Another concern to address is, how do complementary therapies work with more conventional ones? One solution we’re working to develop here in Alberta is called the ICON program, which stands for integrative complementary oncology.
It’s pretty hard to imagine being diagnosed with cancer and not feeling some level of distress. Distress is defined by the National Comprehensive Cancer Network as “a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioural, emotional), social and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis.”
Cancer or not, I imagine we’ve all been there.
The general public and cancer patients specifically have a huge interest in the use of so-called natural health products (NHPs). Of course we want to know if they’re helpful and when we should use them. Beyond that, we want to know which ones to use and how.
There’s a lot of information available online, but it can be overwhelming and confusing trying to make sense of what’s what in a world where everyone is trying to make a profit.
The first thing we should figure out is what they are. NHPs are the most commonly used category of complementary therapies in cancer care, and include vitamins, minerals, food products, food derivatives and some hormones.
Mary’s mother is Polish and her father is from Nigeria; she was born in France and has lived in Canada since she was six. What does she call herself? Is she Polish-Nigerian? Or maybe just Canadian? What does she look like, and how does she sound on the phone? How many languages does she speak? More importantly, how will all of this impact the care she receives if she is diagnosed with cancer this year?
Canadians tend to be averse to labelling people based on ethnic or cultural characteristics, and while this is generally commendable, there are certain social contexts where there may be advantages to categorizing people on some measure of ethnicity.
The theme of the summer issue of Leap is neuro-oncology, treating people with brain and other central nervous system cancers. This made me think of the work we do in Psychosocial Oncology to help people with these tumours – and their families. Brain cancer is particularly difficult to live with for a number of reasons. First, it often strikes younger people, who are either just becoming established in their careers and family life, who have small children or who are not as financially stable as older cancer patients. And it can also cause side-effects that are uncommon in other forms of cancer, such as changes in personality, apathy, angry outbursts, impulsive behavior or severe problems with planning, concentration and memory, depending on what part of the brain is affected. Family members are often called upon to provide a higher level of caregiving than in other types of cancers, and, in many cases, the tumours are likely to reappear or survivals rates are low.
March 2012 | Dr. Linda E. Carlson
You may have heard the term “integrative oncology” bandied about quite a bit lately. According to Dr. Steven M. Sager, (in the Journal of the Society for Integrative Oncology, winter 2006) integrative oncology “combines the discipline of modern science with the wisdom of traditional healing. It is an evolving evidence-based speciality that uses complementary therapies in concert with medical treatment to enhance its efficacy, improve symptom control, alleviate patient distress and reduce suffering.”
You would be forgiven for thinking this sounds very similar to what people usually refer to as complementary and alternative medicine (CAM). Integrative oncology, as a subspecialty of integrative medicine in general, stems from a philosophy of treating the whole person: body, mind and spirit. It uses many CAM approaches such as natural health products (botanicals, vitamins and minerals), nutrition, acupuncture, meditation and other mind/body approaches, music therapy, touch therapies (such as massage) and physical activity, to name a few.
December 2011 | Dr. Linda E. Carlson
The theme of this issue of Leap is how cancer stories help us cope with disease. Telling stories is a central human trait; for millennia our ancestors sat around campfires and repeated the narratives that helped them make sense of their experiences. They passed on crucial elements of our collective identity to us. One program offered through Alberta Health Services Cancer Care builds on the idea that narratives and other forms of expression can help people cope.
In Edmonton at the Cross Cancer Institute, it’s called the “Arts in Medicine” program, and at the Tom Baker Cancer Centre it’s been known as “Healing Through the Creative Arts.
The general idea behind both of these programs is that expressing yourself through creative outlets can be a very healing process – another way to make sense of your journey and work through the feelings, thoughts, worries and anxieties you might have. In both programs, various creative modalities are used, including expressive writing, journaling, drawing, painting, sculpting, movement to music and vocalization. The instructors are social workers, artists, art therapists and psychologists.
September 2011 | Dr. Linda E. Carlson
Many things that cause cancer are not under our control. These include genetics, family history and early environmental exposures. That’s the bad news.
But the good news is that current research has identified a number of factors in the development of many types of cancer that are under our control. Modify these and we may mitigate risk. There are a few big ones: we can avoid too much sun exposure, quit smoking, eat better and become more physically active. It’s the last one, physical activity, that many people find surprising.
June 2011 | Dr. Linda E. Carlson
Cancer patients sometimes joke that this is the only time in their lives when they truly have license to lie in bed all day. Indeed, some days you may not be able to do anything else; this is expected and you should be taking it easy during intense treatments. But what if you find yourself feeling down and out, with no energy, motivation or interest in life months later? When is enough enough?
This is an important question, especially considering that current research shows people with cancer who suffer from clinical levels of depression consistently over time also have shorter survival times. Research indicates that depression is a risk factor for poorer outcomes across many other types of cancer.
Most recently, a study published in the Journal of Clinical Oncology lead by Dr. Janine Giese-Davis, a psychologist at the Tom Baker Cancer Centre, confirmed this link. Women with metastatic breast cancer who had decreasing levels of depression over a period of one year survived more than twice the time of women who had increasing levels of depression (54 months versus 25 months). This effect was found even taking into account other important medical information.
March 2011 | Dr. Linda E. Carlson
Support groups for people going through cancer are so commonplace these days it may be hard to imagine a time when they weren’t available. But it wasn’t always that way, and it turns out that social support affects not only mood and quality of life, but potentially also cancer survival.Support groups are accepted as a helpful part of treatment for a number of reasons.
First, you can meet other people who understand what it’s like to go through a cancer diagnosis and treatment. Second, you can learn how people managed the difficulties you may now be encountering. Third, it’s a safe place to talk openly about the things that your family and friends might be tired of hearing or are too scared to discuss.
But rewind 25 years and support groups were rare. When Dr. David Spiegel, a psychiatrist from Stanford University, spearheaded a study of Supportive-Expressive Group Therapy for women with advanced breast cancer, many people considered him quite misguided, if not completely crazy. In these groups people with metastatic cancer got together weekly to express their feelings and thoughts. Inevitably some would fall ill and die – how could that be helpful, people asked, to see your close friends dying from the same disease you have? Wouldn’t it just be too traumatic?
Last column, I introduced the notion of mindfulness and outlined how applying this way of being can decrease your stress level and improve your overall mood and ability to cope with daily life. Mindfulness, you may recall, is simply the practice of paying attention to whatever is happening in the present moment, with an open, accepting, nonjudgmental and kind attitude. It is simple, but by no means easy. In this issue, I’d like to provide specific instructions so you can begin applying mindfulness meditation in your daily life.
Actually, for mindfulness meditation, it doesn’t matter what’s on your mind – your worries, plans, fears, aches and pains can all be the focus of your mindfulness practice. Your mind can be calm and placid or full of metaphorical storm clouds. To meditate, you simply have to be where you are and focus your awareness on your direct experience in each moment.
One of the programs we have been offering to patients at the Tom Baker Cancer Centre since 1996 is called “mindfulness-based cancer recovery.” It’s based on a similar program developed in the United States called “mindfulness-based stress reduction.” If you look up this term on the Internet, you’ll find thousands of links to books, articles and training programs.
Essentially, understanding mindfulness begins by asking yourself the question, “where is my mind right now?” and beginning to see how easy it is to metaphorically “lose your mind.” Try it. Monitor your thoughts for a while and you’ll likely find yourself planning your day, worrying about all the things you have to do, writing lists, reviewing the fight you had with your spouse last night, thinking of emails you have to send, being angry at someone for something they did or wishing you’d said or done something different yesterday, last week or last year. All these thoughts of the past and future can easily result in feeling angry, depressed, frustrated, worried and stressed out!