[ Englisch] Mind-Body Medicine: How Can Cancer Patients Utilize Supportive Care Therapy Tools?

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Topics include: Exercise and Fitness

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What supportive care tools are available to help with the many side effects of cancer treatment? Recent studies support mind-body interventions, like yoga and mindfulness, as being responsible for helping to stabilize and manage symptoms and side effects of treatment. Can yoga help lessen fatigue, anxiety, respiratory toxicities and emotional distress? Certified yoga therapist Raquel Jex Forsgren and expert oncologist Dr. Ishwaria Subbiah, from The University of Texas MD Anderson Cancer Center, discuss the research-based benefits mind-body practices for cancer patients, and share simple ways to incorporate the techniques at home. Join us to learn more on how to access supportive care tools before, during and after treatment.

This is a Patient Empowerment Network program produced by Patient Power. We thank Celgene Corporation, Genentech, Helsinn and Novartis for their support. 

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

And hello.  I'm Andrew Schorr with Patient Power.  And Esther Schorr. We're going to help you be more in control of your cancer journey, you as a patient or you as a care partner.  And I want to thank our sponsors for the program, Celgene Corporation, Genentech, Helsinn and Novartis for their financial support. 

Now, you can send in questions if you haven't already.  Send them to questions at patientpower.info, [email protected], and we'll take your questions later on with our experts.  Okay. 

What are we discussing today?  Well, think about it.  If you have lung cancer or, like me, chronic lymphocytic leukemia—I have another cancer too, 22 years I've been dealing with this, some of it—myelofibrosis, a myeloproliferative condition, if you have multiple myeloma or pancreatic cancer, whatever it may be, you may get hit with heavy duty treatment, and that has side effects.  How do you cope with that?  And then you have all the issues that go with your diet, if you feel like eating, your mental health, your physical health.  Are you moving?  What are you doing?  The same for your care partner as well, because they're there along the way. 

We're going to be discussing all that, and we have some leading experts and I want to introduce them.  First of all, I want to start with my wife, Esther Schorr, who has been on this journey with me for 22 years.  Esther, welcome to the program and being my partner in life and on this.  Hi, Esther.

Esther Schorr:

Oh, I can't say that it's been easy being your partner all these years, but it's my pleasure to be here, and it's been a pleasure to go along on this—not a pleasure, but I'm happy to go along on this journey. 

Andrew Schorr:

Right.  In a minute, we're going to talk about some of our coping strategies, but I want to introduce you to our two other experts on this.  First of all, let's go to Houston, Texas, to the MD Anderson Cancer Center where we're joined again, because she's been with us before, Dr. Ishwaria Subbiah, who is Assistant Professor of Palliative, Rehabilitation and Integrative Medicine. Dr. Subbiah, welcome back. 

Dr. Subbiah:

Thank you so much for having me.  It's a pleasure to be here. 

Andrew Schorr:

Okay.  We've got a lot to talk about.  And now let's go up to Chicago where we're joined by an expert in yoga, a certified yoga therapist, and that's Raquel Forsgren who is an expert in yoga as it applies to cancer.  Raquel, welcome to the program. 

Raquel Forsgren:

Thanks, Esther.  Thanks Andrew. 

Andrew Schorr:

Okay.  Let's go back to Esther for a minute, and we're going to catch up with you two in just a minute.  So, Esther, a little about our story, when I was diagnosed with leukemia, when we were diagnosed, if you will, 22 years ago with chronic lymphocytic leukemia I didn't say this to you, but I thought I'd be dead in short order. 

Esther Schorr:

Well, I didn't say it to you, but I was concerned the same way, Andrew.  It was very, very frightening. 

Andrew Schorr:

So the diagnosis sends any of us reeling, and the care partner as well.  So let's talk about that.  Esther, you had me getting distilled water for the house. 

Esther Schorr:

Distilled water for the house.

Andrew Schorr:

Wondering if we should move away. 

Esther Schorr:

Yeah.  We wanted to move away from power lines and went to an energy therapist.  I think you even had hot stone therapy.  I can't remember all of the things.  We were juicing at the time Andrew Weill had his…

Andrew Schorr:

…he had me stop drinking coffee because you saw a program with Dr. Weill from University of Arizona, an integrated medicine expert, and he said, well, maybe you shouldn't drink coffee.  We lived in Seattle where there's a Starbucks on every corner.

Esther Schorr:

It was really hard. 

Andrew Schorr:

And expanding, so. 

Esther Schorr:

Yeah, but there were other things, Andrew, really more relevant.  I mean, those are the things that I think you and I thought, well, maybe we can get some control over what's going on.  But really at the root of some of this is the things that really helped us, at least I can talk for myself.  I know you and I went into counselling to try to figure out how to cope together, and for me knowing that I had to be your care partner—and we also had two small children at the time—I'm a very anxious person by nature, and I found, and it may not be right for everybody, but I found that medication really helped me. 

And that started about the time that—it started at the time when you were diagnosed and to this day it's really been helpful to me and I can't wait to talk to Raquel, because I now do yoga, and we'll talk about that.  Yoga has helped me tremendously along the way. 

Andrew Schorr:

And we did continue to exercise.  Esther and I have been joggers, if you will, and so we did that, and we continued that as I got chemo and other treatments.  Maybe we couldn't run as far, or I didn't run as far or as fast, but we're big believers in exercise to this day.  And it's helped.  And the one other thing I would say is the religious component, we're Jewish, so we would consult with our clergy and trying to get my head on straight related to our faith.  And if life would be shorter, how did we live our life, what would we say to our children or whoever would follow about what our life was.  So religious, psychological, exercise, medication support, right, Esther, related to anxiety. 

Esther Schorr:

And leaning on community.  You know, I know for some people it's hard to ask for help, but if you can find it in yourself to let go a little bit of your ego and pride.  I know for me and I think for you too, Andrew, just reaching out to our closest friends and family and saying, hey, we need some extra support.  Give us what you can, was really, really helpful. 

Andrew Schorr:

Right.  All right.  Dr. Subbiah, let's have some terms that we understand as we begin.  So, first of all, your palliative care, you've explained this to us in other programs, it's not about necessarily you're near death.  It's about helping support you on your cancer journey.  Supportive care, what does that mean?  Mind-body medicine, what does that mean?  So maybe you can define some of this for us today, so we all have a common lexicon, if you will. 

Dr. Subbiah:

Absolutely.  And so when you hear the terms "palliative care" most people, the first thing they think of is hospice care.  So something that, a service that's engaged towards the end of life.  But the reality is that palliative care is symptom management.  It's been taking care of that whole person and the people around them who matter to them as they go through the treatment for cancer. 

So palliative care, we're involved more and more, really from the time of diagnosis, because most people feel the burden of this diagnosis, sometimes even before, because you know that something is wrong leading up to the diagnosis for many people.  And so a bulk of my practice is taking care of a person as they go through cancer treatment.  So we refer to that as supportive care.  We're supporting you through the treatment.

So things that may come up, cancer pain, nausea, trouble breathing, depression, anxiety, distress, spiritual distress, spiritual pain.  So there are many elements that go with this diagnosis of cancer.  So our multidisciplinary team helps with managing that in the supportive care realm. 

Palliative—supportive care falls under palliative care, and so there is a component that is closer towards the end of life where the—your body is going through the changes that are very natural.  And we want to make sure that the suffering that you're afraid of or somebody who cares about you is afraid of, we can minimize that to a great extent.  The pain of that moment of life may not change, but the suffering that we associate with our passing from any reason doesn't have to be there with the engagement of a palliative care physician. 

Andrew Schorr:

Okay.  I want to get to mind-body connection.  So this has been a debate in the medical profession for years, both for you and maybe your care partner.  So do we have like some control with the way we live our life or think about things that affect cancer? 

Dr. Subbiah:

So mind-body, there are many schools of thought on what it is, but if you put all the academic aside, the meaning comes down to exactly what's words are.  Your mind is very closely related to your body, and your body function is very closely related to your mind. 

So what it means for us in the realm of cancer care either as a provider or as a patient is there is a component of everything that you're feeling that can potentially be modified by mindful practices.  It may not change it altogether, it may not make it go away altogether, but there's a component of symptom management that is beyond medications, that's beyond a pill that involves practices that are what fall under the realm of mind-body practice.  And so some of these are ones you're heard of, acupuncture, massage therapy, guided imagery, music therapy and certainly yoga as well. 

Andrew Schorr:

Yeah, and generally exercise.  Okay.  So you mentioned yoga.  So, first of all, there has been a study to show I think preliminarily that yoga, and I'm not sure if it was done at MD Anderson or where it was done, where there was a benefit they said for yoga, for yoga participation, both for the patient and especially the care partner, right? 

Dr. Subbiah:

Absolutely.  And so that study was done at MD Anderson, and it was spearheaded by our department.  So what we wanted to show is that for a person who is going through chemotherapy and radiation for their lung cancer, that would a structured yoga intervention help them as well as their caregivers.  So what you're looking at is an intersection where we not only acknowledge the distress of the person with the cancer and going through treatment but also of the person who is going with them on that journey. 

And so this yoga intervention was structured to be given to both—to be practiced by both the patient as well as their caregiver.  And so it was done for a 12-week period with follow-ups subsequently.  And we were able to show that there was a statistically significant and clinically meaningful difference improvement in the level of fatigue, in the level of activity in that person, which we measured by a six-minute walk test. 

So if the person was able to do a bit more physically as a consequence of participating in this program when compared to the control arm, which did not receive this structured yoga intervention.  And so there are implications on your functional standards, your mood, your energy level of adopting mind-body practices. 

Andrew Schorr:

And this was done for the caregivers as well, wasn't it? 

Dr. Subbiah:

Absolutely.  And so the caregivers also reported an improvement in their overall mood as a consequence of this. 

Esther Schorr:

I'd just like to interject as a caregiver, a care partner, and I know that Raquel probably will mention this, but I know that there's a whole range of things that fall into the category of yoga and mindfulness, and again people talk about that, but I know for sure that I have experienced the mind-body connection in controlling anxiety.  The anxiety thoughts about what-if in the future for you, what if for user family, that in the mindfulness and the breathing and the things that come with yoga, not just the positions that you do, and I know we'll talk about that, but it's more about centering your thinking more positively and turning inward and visualizing good instead of bad scenarios was tremendously helpful.  So?

Andrew Schorr:

Okay.  All right.  So, Raquel, I've got some questions for you.  So you have a background related to yoga and cancer and sort of yoga tied in with cancer.  Tell us what that means and how you got involved in that because normally you wouldn't think of that. 

Raquel Forsgren:

Yeah, how it came to be.  Well, I started researching breast cancer on the bench about 28 years ago and into the pharmaceutical side, on the drug development with side as a pharmacologist, and obviously it worked with a multitude of different types of cancer, and it's been my passion my whole entire adult life.  And I've also had several family members that have gone through the battle, some have won, some have lost, and so it's very personal for me. 

And then on the flip side with yoga therapy, just as Dr. Subbiah was talking, I like to see the entire person, the whole person be addressed.  And we need the oncologist to focus on the treatment and doing all they can to really fight at the disease level, but I think, as all three of you a have just mentioned, a yoga therapist comes in on the other side with what else can you do to help empower the person to actually take control over what they can.  Because there's so much of a loss of control.  So I'm inspired by that. 

And then I work with a lot of the other tools that we'll talk about in a minute to just help that person control their mind, their breath, their thoughts, their rituals, all positive things that Esther was just talking about.  So that's sort of my background and my interest in how it became to be working with cancer patients. 

Andrew Schorr:

Okay.  So Esther is into yoga.  Esther, you started doing that what about four or five months ago, and now you do it two, three times a week. 

Esther Schorr:

Right.  And actually I'm kind of sad I didn't do it sooner.  But I will say I came into it because I was transitioning to much more let's say aggressive exercise, running, some weight lifting.  But I found that the combination of yoga—you know, a combination of yoga and the mindfulness and somewhat medication is really not hard on my body and really good for attitude.  So, yeah, I mean, I'm a big advocate. 

Andrew Schorr:

Okay.  So, Raquel, so yoga might be foreign to people.  I mean, I knew—I learned how to run and jog, but if you had asked me until Esther has been exposed to yoga, I'd say that's foreign.  So maybe you could ease us into it.  Maybe there's some simple things you could show Esther or you two could demonstrate together that would be helpful for maybe the bulk of us who have never gone near any of this stuff, but we do want to feel more in control. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on May 21, 2019