Mind-Body Medicine: How Can Cancer Patients Utilize Supportive Care Tools? | Transcript | Living Well | Patient Power


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

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.

Dr. Subbiah:

Absolutely.  So this concept of cancer cachexia is very complex.  So from a medical standpoint it's the loss of good muscle in your body and fat, and the reasons are not clear because you're eating but you're going through active treatment for cancer.  And what we attribute it to is the cancer itself, the chemicals, the cytokines that the cancer releases, the changes that it has on the body causing it to break down good muscle. 

And so that has tremendous implications on body image.  If you don't look the way you used to and you feel your appearance, your identity changing on a weekly basis, that can have a tremendous impact on your whole person well-being.  And so at the moment there are really no effective treatments to stop cancer cachexia or even reverse it.  There are ways to potentially slow it down, and that may well mean meeting with the dietician to optimize the food that you take to make sure that you are getting enough calories, the right kind of calories. 

Working with physical therapy on strength building, not necessarily to run a marathon but to have enough strength to go about your daily activities around the home, be able to walk and do things here.  These are ways to try to combat the physical changes that you feel.  So we brought up the anxiety as well.  So it's—mind-body practices have a very important role in anxiety management.  And in fact I would say that the most robust data for mind-body interventions, be it yoga, or massage therapy, meditation, guided imagery, is the management of mood and anxiety. 

Andrew Schorr:

Right.  You talked about body image.  It's all tied together in how you feel, how worried you are about the future, etc., so anything like Raquel was demonstrating to us is so important. 

Here's a question we got in from Pam.  I'm willing to bet she may be dealing with multiple myeloma, I'm not sure, but she says, what effect, if any, does high calcium levels have on the ability to exercise?  So anything—I don't know whether Raquel, you would comment or Dr. Subbiah, let's start with you.  Calcium, you know, you have all these bone lesions and stuff like that, you can have this calcium problem but yet you want to do this stuff.  Any thought there, Dr. Subbiah? 

Dr. Subbiah:

Sure.  And so hypercalcemia, it's a very real medical entity, so you have to work very closely with your oncologist, with your physician, the provider team to make sure that the calcium is kept at a reasonably safe level.  What your body experiences as a result of hypercalcemia is real.  There is changes in energy pattern, changes in the strength, changes in your bowel function, changes in your mind and mood.  So hypercalcemia has real implications on really the whole body experience. 

So it's one of the electrolytes imbalances.  You know, you have—I'm sure people listening to this have their potassium checked, their magnesium checked, the phosphorus checked among all other things at some point time during this journey.  Hypercalcemia is one where the person feels it a lot more than maybe another electrolyte that may be low or high.  So it's very important to work with the provider team to get it down to a reasonable level, and know that some of what you're feeling may be not necessarily the cancer per se or the treatment for the cancer.  It may be because of the electrolyte imbalances. 

Andrew Schorr:

Wow.  Okay.  Raquel, go ahead.  You're muted, so—there you go. 

Raquel Forsgren:

Yeah.  I think the one thing that I also would add to that too, Dr. Subbiah's point about it affecting—hypercalcemia affecting the whole body, the deep relaxation that I spoke about earlier, the way that that works specifically is around turning off that fight or flight mechanism in that part of our nervous system that kicks in when our body is in a state of trauma, which is kind of what's happening in hypercalcemia from a just simplistic perspective. 

And so when you're in that deep relaxation state and leveraging the breathing, you're reducing cortisol levels that are pumped out from your adrenal glands, and that entire cascade that happens in your body just starts to slow and relax.  And the neurotransmitters, the chemicals in the brain that are released, it's just a cyclic event. 

And so even though one might not be able to do any particular movements even, the breathing, the imagery and those deep relaxations shouldn't be underestimated for the role they play in boosting the overall health of the inside off the body and all of the other mental components with it.  So I just wanted to add that little spin on what those do even if you feel like you can't move out of your bed. 

Andrew Schorr:

Well, thank you.  Here's a question we got from Susan.  Susan wants to know, how can I protect myself from the effects of chemo outside of massage and meditation?  So chemo and even some of the non so-called chemo drugs are very powerful and they have effects.  So, Dr. Subbiah, what about protecting yourself?  What can you do? 

Dr. Subbiah:

So it's—there are added effects that one experiences.  That's very different from therapy to therapy.  And so the interventions are, what you would do is dependent on the side effects of what you are taking at the moment.  So it starts with that discussion with your provider team.  What are the most common side effects, and what are some of the more rare side effects?  So it gives you a sense of what you're most likely to experience and also to be on alert in case you happen to be that person who has a rare side effect as a consequence of the therapy. 

Now, there are side effects from chemotherapy and targeted therapy and immunotherapy and cell therapy if anyone is on CAR-T.  There's only so much that can be done to protect yourself from this.  So the preventative aspects of the side effects is not there yet.  That is something that we work towards.  That's something we hope to have so that the person doesn't have the side effect to begin with. 

So at the moment the way symptom management is is we have to—we address the side effect after it happens.  And so the approach—some of the most common side effects that are fatigue, nausea.  Some of—there are medications there.  You can talk to your medical provider about if there's a role for a small, lower dose of steroids to help with fatigue.  If there's a role for a lower dose of methylphenidate to help with fatigue, which is a stimulant.  So there are some data to support these in smaller trials. 

There's—as with many medication interventions for fatigue management, the data is always mixed, and so there are some trials that think it's important, others that don't, and so at the end of the day my approach to it is if somebody's having severe fatigue and they're on a treatment that's helping their cancer, treating their cancer, keeping it under control--and we have a lot to gain from having the cancer under control—let's try a medication or two for the fatigue and see if it helps.  If it doesn't help you, then stop it and move on. 

But there's so much variation from person to person, how you respond to a medication that's there for supportive care and the side effects of the original cancer treatment. 

Andrew Schorr:

Okay.  Raquel, here's a question we got in from India.  I'm going to read that in a minute.  I just want to mention, if you have a question—we have a few more minutes—send them to questions@patientpower.info.  So this one is from India, and they didn't give their name, but they said, how helpful is yoga for interstitial cystitis and with pelvic discomfort for a cancer patient? 

So here's somebody with that problem or I don't know what the gynecologic cancer is, well, can yoga help at all just for the pain? 

Raquel Forsgren:

Interstitial cystitis is a complex condition. 

Andrew Schorr:

Amen.  It is. 

Raquel Forsgren:

Even aside from the cancer component.  I see Dr. Subbiah smiling and nodding.  It would be kind of similar to the other mind-body practices we talked about.  So the number one thing is relaxing the body.  It's just relaxing the muscles.  Your pelvic floor and everything around it will tighten just as much as your shoulders or the other parts of your muscles, and the more you can relax them the better. 

The more you can defocus away from that pain with guided imagery, that has also been known to help.  I don't know specifically for interstitial cystitis, but I'm just talking about other types of internal pain, bone metastases, things that very—you some things that are not on the outside of the body.  So I would say deep relaxation for sure. 

Dr. Subbiah, for you, do you believe that pelvic floor postures could benefit someone in that way, or do you think that it could potentially aggravate the pain?  That could be kind of a follow-on question because making posture is in really pulling the bellybutton in towards the spine and engaging that pelvic floor.  What do you think? 

Dr. Subbiah:

So that's along the lines of what I was thinking because you're asking—the person who asked the question is asking about a very specific condition, and so to my knowledge I'm not aware of any particular trials for mind-body interventions for the purpose of interstitial cystitis.  And so then you start to think about, okay, what are—what do we have data for where the symptoms may be similar and in a similar part of the body?  And so you immediately think of the gynecologic cancers where a person may have had surgery or radiation in that area of the body and causing over time that inflammation turns into a fibrosis. 

And so I'm thinking of a woman who may have had a gynecologic cancer and having discomfort and pain, frankly, in that area and a pain that's probably not going to go away because it's a sequela, a consequence of the treatment.  And so in those contexts there is some support for mind-body interventions. 

The pelvic floor exercises are one that we do suggest, and so would it help with particularly interstitial cystitis?  I'm not quite sure simply because I can't think of any data or a study where a person has asked that question.  And so my recommendation, as with all of these interventions, is to, number one, speak with the physician or provider who knows you the best, and have this discussion on, number one, do you think there is data, number two, do you think it will help, and number three, do you think it's okay if I try it?

And then you take that information, you absorb it, as with all things, and then you make an informed judgment for yourself.  Okay, do I want to try this mind-body practice?  I know that there isn't a big randomized trial to show its benefit, but my doctor said it may not necessarily hurt me to try it, and so should I go ahead and make that attempt to see if this mind-body practice will help me in any symptom that you could be feeling. 

Andrew Schorr:

I want to ask about trying.  So we have women probably watching and some of them have had maybe lymph node surgery and maybe even dealing with lymphedema and may even wear sleeves and things like that for breast cancer.  We have people who've had debilitating treatment for lung cancer.  We have people going through or have gone through transplant of various kinds, things like that.  So you see it, Dr. Subbiah, Raquel probably as well. 

So you say, well, okay.  Do I—how do I assess what I can do?  I can't, you know I can't—maybe I can't go to a class and Esther goes to classes and there are like 20 people in there and they do these different positions, and that's a little a daunting to me, right?  So how do I celebrate what I can do and maybe increase that over time but at least I start.  So, Raquel, let's start with you.  The whole idea of starting or trying even if it's just like that, you know? 

Raquel Forsgren:

Yeah, and I think that is one of the biggest things that stops people from trying, from thinking there's something else they could do to help take control of what they're going through.  It's the daunting task of do I go to the yoga studio on the corner that I see people going in in these outfits and doing different things.  Like, I'm not that person.  And that's the most important take-home message I know I could give as I educate oncologists and nurses and people that are diagnosed with cancer to do is to do the research, do what Dr. Subbiah talked about, speak to the nurse, talk to the nurse navigator. 

Look for classes within a hospital, number one.  Because they will be modified and tailored to people that are going through what you are.  And I know from a yoga therapist's perspective I tailor yoga therapy sessions based upon the type of cancer, the stage of disease, even the types of treatment that the person's going through.  I will tailor the entire practice around that with modifications.  And it changes.  It changes from at diagnosis maybe at second round of chemo to tenth round of chemo to post chemo, it all changes. 

And so I would just be open, step through the fear, use this as a way to take control where you have the control.  You can't control what the cancer's doing, you can't control the treatments the oncologist is giving you, but you can control your own lifestyle changes and your own quality of life.  And that's what I love about yoga therapy is because it really does empower you because, as you all saw from just the small five minutes, you felt something.  You felt something shift, and that's what will happen even if you do it for six minutes or 12 minutes. 

And you do not have to be in a class at a studio.  You can do it within the context of even your own home.  And after you do some research you'll find there's a lot of online options.  You're more than welcome to send questions in to Patient Power, and they can forward them to me.  I'm happy to try to help you find somebody in your local community that could even help you from a yoga perspective.  And I so I'm more than happy to help you as much as I can as well. 

Andrew Schorr:

Wow.  You're so devoted.  Thank you. 

So, Dr. Subbiah, part of this is communication.  I think Raquel really explained about putting it in context and resources for people to start.  But there you are in your white coat.  All of us have doctors and be maybe we have multidisciplinary teams.  We have nurses and sometimes other kinds of therapists that we can draw on, but we've got to speak up, right?  So what would you say about whether it's the patient themselves or the care partner, like Esther, to advocate so that we get these approaches brought to bear, whether we need training or medication in concert so that we get what we deserve? 

Dr. Subbiah:

Sure.  So the field of complementary medicine, integrative medicine, it's coming more and more to the forefront, but the reality is it's always been on the periphery for really decades.  And so when you present a—when you bring up an option of a particular mind-body practice that you may want to try, the person listening to it on the other end, whether it's your nurse, your nurse navigator, whether it's your nurse practitioner, your physician or whomever it may be, they may not have been exposed to that in the course of their training and their years of experience. 

And a person responds to that in different ways.  Sometimes if they don't know about it they may dismiss it.  Other times they may be more supportive to say, okay, let's look into it a little bit more.  But if they don't have that background experience with it—and that's the way medicine has been for decades, so it's not so much a fault of their own.  They just haven't been exposed to it as much. 

Then ask them is it okay if I pursue it a little more, do some more research and bring some information to you to help me interpret it.  And so I think we—when we—when you as the patient and the caregiver are gathering the information, just be aware that the person reading it may already be familiar with it or may not.  And then based on their level of comfort with it go forward in that discussion. 

If they have recommendations, that's great.  If they don't, we mentioned some of the resources where you can search online to find appropriately certified and trained personnel to deliver these mind-body practices.  And so if you happen to be in a smaller area of the country or even in the larger area but don't have immediate access to an integrative medicine center to at least get you started, then it's a great way to—it's a great opportunity to do some of the leg work yourself and then work with your care team to find what's right for you. 

And you're right.  The circumstances are that you may end up having—when you end up doing your research you may actually know more than the person sitting across from you just because of the way medicine has been but not where medicine is going, which is we're all becoming much more cognizant. 

Andrew Schorr:

Well said.  Esther, I want to get a final comment from you.  When I was diagnosed 22 years ago with chronic lymphocytic leukemia, we were in tears.  I felt like a victim, maybe you did too.  This came out of totally left field.  And I think our whole time with this has been what Raquel and Dr. Subbiah have been saying, trying to take back control.  And we've had providers along the way.  Some have been knowledgeable and some have not, but we've been trying to be advocates in doing what we can do, right? 

Esther Schorr:

Right.  And what rings very true for me and our experience is Andrew shared and I guess I did too in a sense, some of these supplementary things that we researched and tried and it was always is this all right.  Let's talk about this with his oncologists, his medical team.  And in one instance, I don't know if you remember, Andrew, in one instance there we had read and done some research about accelerating the amount of a certain vitamin to help you when you were diagnosed with leukemia. 

And we had the conversation with your oncologist at the time and he said, what vitamin supplement are you taking.  And when we told him, he said, I think you should probably not do that because in your particular case, in your particular kind of cancer there are studies that say that's not a good idea.  So I bring that up in that this dialogue has always been really important for us, and I would think that that's really what you both have been saying is research it, but before you dig in whole hog with some of these other complementary and supplementary things, have the dialogue with your medical team because some may be really helpful and some of it, there may be evidence that it's not.  So, you know. 

Andrew Schorr:

Well, you can see that Esther and I have been on a long journey together and just—for those of you watching, not always, but there are people living longer with lung cancer now.  There are people living longer with advanced prostate cancer, with advanced breast cancer.  We have a long way to go with a lot of the cancers, but we have are making progress with some of them, the blood cancers that I've been affected with.  Twenty-two years ago, I didn't know I'd be there for the next month or the next year, and you're stuck with me.  Here I am, and I hope Esther and I are going to be together for many, many years with our 33rd wedding anniversary coming up. 

So then you say, well, how can I take control back from this where I started maybe feeling like a victim.  And that's what we're talking about here.  So this field that Dr. Subbiah talks about and now Raquel is very involved in on her end, these are relatively new and not having proliferated everywhere.  But you have the benefit here.  Take this into your life, we hope.  Have conversations with people like this or seek them out, seek the online resources.  All right.  I'm not going to preach anymore.  I just hope this program has been helpful. 

I want to thank our guests.  Dr. Subbiah, thank you for being with us once again from MD Anderson and your work in integrative medicine.  Thank you so much. 

Dr. Subbiah:

Absolutely.  Thank you so much for having me and this opportunity to talk with all of you. 

Andrew Schorr:

Well, we'll do it again.  And Raquel Forsgren joining us from Chicago and taking us through a guided program.  I'm going to look up those videos.  Thank you so much. 

Raquel Forsgren:

Thank you. 

Andrew Schorr:

Esther, here's a big hug and kiss.  Thank you for being with us. 

And one other thing is we're going to have some resources for you that we'll put with this program on the Patient Power website.  It will have links to all the things we're talking about.  So be sure to look out for that.  We'll be sending you emails with alerts.  Tell others about this.  Have them sign up with Patient Power so they always are in the know as we do more programs.  And let and Esther and Tamara, our producer, know.  You can always send a comment to questions@patientpower.info.  Let us know if this was helpful.  Okay?

I want to thank the Patient Empowerment Network for this program and achieving wonderful support from Celgene and from Genentech and Helsinn and Novartis, and we really appreciate them being part of the cancer community, not just developing drugs but supporting our discussions like this one.  I'm in California.  We have our guests around the country and Esther upstairs where we live here.  I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  Thanks for joining us.  

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