By Ian Lipski, M.D., and Lorenzo Cohen, Ph.D.
You know that feeling of being so wrapped up in a good book or great movie that you lose track of time or self? That's very similar to what hypnosis is like; it's a state of highly focused attention that allows a patient to concentrate on a self-created image so that the awareness of his or her current environment becomes less important and less clear.
In the context of cancer treatment, it involves the use of imagery and relaxation to reduce anxiety or pain or overcome some other obstacles.
Hypnosis within a medical setting involves a shift in consciousness precipitated by a self-induced concentration exercise. Medical hypnosis empowers patients who are faced with a perceived loss of control and generally improves satisfaction with medical procedures and the hospital experience.
Extensive research indicates medical hypnosis can decrease pain and anxiety and the amount of medications needed in the interventional radiology suite. It can also shorten procedure time.
For claustrophobic patients undergoing MRIs, it has been shown to decrease the non-completion rate for some scans. Relieving pre-operative anxiety has been shown to lower intraoperative anesthetic requirements for some surgeries.
Recently by Lorenzo Cohen Ph.D
By Ian Lipski, M.D., and Lorenzo Cohen, Ph.D.
By Peiying Yang, Ph.D., and Lorenzo Cohen, Ph.D.
In the past 50 years, the use of nutritional supplements for the prevention of cancer has increased dramatically in the United States. However, emerging scientific evidence strongly supports the beneficial effects of whole foods for cancer prevention, yet little support from any single nutrient or combinations thereof.
More than 200 recent epidemiological studies indicate that whole nutritionally dense foods, especially fruits, vegetables and high-fiber foods provide more benefits than isolated nutrients in preventing various cancers.
Whole foods contain a wide array of nutrients including vitamins, minerals and a number of other biologically active compounds, collectively known as phytonutrients. These phytonutrients, such as 3,3'-diindolylmethane (DIM) in broccoli or isoprenoids and polyphenols in other vegetables, may work in concert to provide the best support for cancer prevention and control.
For example, fruit and vegetable combined, such as tomato and broccoli extracts or mushroom and green tea, exhibit strong antioxidant and antiproliferative activities in prostate cancer and potential to reduce breast cancer risk compared to that of the individual foods alone.
By Alex De Alvarado and Lorenzo Cohen, Ph.D.
If you're a patient with cancer, most likely you've experienced fatigue -- and you're not alone. Fatigue is one of the most common cancer-related symptoms described by cancer survivors.
The National Comprehensive Cancer Network defines cancer-related fatigue as "an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning." For people with cancer, chronic fatigue can be distressing and can dramatically interfere with quality of life.
Understanding the causes of fatigue and finding the right approach for managing it could help to improve your quality of life and daily functioning.
By Alex De Alvarado and Lorenzo Cohen, Ph.D.
More than two-thirds of adults and one-third of children in the United States are obese or overweight. Mounting evidence links excess body weight with an increased risk for many types of cancer.
In fact, the American Institute for Cancer Research suggests that more than one-third of the most common cancers could be prevented if Americans maintained a healthy diet, increased their level of physical activity and stayed lean. The federal government recently released new dietary guidelines that echo the recommendations of many cancer experts, and may help to reduce this risk.
The U.S Department of Agriculture (U.S.D.A.) and the U.S. Department of Health and Human Services (D.H.H.S.) outline the guidelines in their latest edition of the Dietary Guidelines for Americans 2010. The guidelines are published every five years and are designed to help promote health, prevent chronic diseases and reduce the risk of becoming overweight or obese.
By Alex De Alvarado, Michael Richardson, M.T.-B.C., Ingrid Sevy, M.A., M.T.-B.C., Richard Lee, M.D., and Lorenzo Cohen, Ph.D.
For many people, music connects them to their emotions and is often a way to be socially connected. That is why music can be an effective form of therapy for people with cancer.
The use of music as a therapeutic tool in health and medicine dates back to ancient times. In modern Western medicine, music therapy started being formally used in the 1950s and is now often incorporated into conventional medical care. Music therapy is a key therapeutic tool used within most integrative medicine programs at large cancer centers around the nation.
When used in conjunction with conventional cancer treatments, music therapy has been found to help reduce pain and discomfort; improve mood and diminish stress; increase quality of life; and allow patients to better communicate their fears, sadness or other feelings.
By: Lorenzo Cohen, Ph.D. and Anil Sood, M.D., Ph.D.
We live in a world filled with stress. Everything from the pace of daily living to more difficult life situations, such as loss of a job, divorce and health issues, make it almost impossible to avoid stress.
The big problem is that the prolonged experience of stress affects almost every biological system in our bodies.
It all begins in the brain with a cascade of neuropeptides and stress hormones that flood the body. These changes dysregulate the immune system, negatively affect intracellular functioning of all cells in our body and can directly affect gene expression. For example, chronic stress has been found to shorten telomeres (which are on the ends of our chromosomes), which are intricately involved in the process of aging.
At MD Anderson we're often asked if stress can influence risk of cancer and progression of disease once you have cancer. While short-term or acute stress is adaptive in our lives, chronic stress can result in adverse effects on health.
Although most patients believe stress had a role in causing their cancer, the evidence doesn't support a direct link. This may in part be because of the difficulty in conducting this kind of research, but also due to the multitude of factors that influence cancer growth. However, research has found a stronger association between chronic stress and the progression and spread of existing cancer.
There are many ways to help reduce the stress we feel in our everyday lives. Some factors that cause stress cannot be controlled. But for the things you can control, it's important to find ways to avoid them or balance them with stress-reducing activities. For the stressors in your life you can't control, you have to focus on yourself, make time to do things you enjoy and engage in regular stress management.
Try these strategies for stress management:
1. Practice yoga or seated meditation.
Movement-based mind-body activities like yoga are very helpful forms of stress management. Yoga's focus on gentle movements, breathing and meditation helps relax both the mind and body. Yoga's benefits include improving sleep, mood and quality of life. Any kind of mind-body practice can get the job done. This includes practices from the Chinese tradition, such as Tai Chi or Qigong, or practices from Tibetan traditions that focus on meditation and quieting the mind. In fact, meditation has been found to influence gene expression.
2. Sign up for art or music therapy.
People have been making music and art for thousands of years to heal -- and express -- themselves. Today, many people are working with art and music therapists to curb stress and improve self-esteem and communication. Best of all, you don't need to be a talented artist or musician to reap the benefits.
3. Take a hike.
Ward off the stress of urban crowds, noise and traffic by putting on your tennis shoes and taking a hike. People who spend time walking through the forest experience far less stress and have a lower heart rate, pulse rate and blood pressure than those stuck in the city, according to a recent study. Regular physical activity is, of course, important for overall health and it also reduces stress.
4. Get a massage.
By stroking, kneading or stretching different muscle groups, a masseuse can relax areas that have tensed up. Plus, research shows that massage can reduce pain and anxiety. Massage won't eliminate stress in the long run, but it can help reduce short-term tension.
5. Resist sugar cravings.
While sugar may cheer you up and give you a big energy boost, it's very short-lived. When the sugar rush disappears, you end up feeling worse than before and in many cases, people end up feeling depressed or guilty for eating unhealthy, which just feeds their stress. If you really need your sugar fix, eat a piece of fruit. The fiber will keep you from crashing after your sugar high and keep you full longer. Plus, you won't feel guilty about making unhealthy food choices -- and you'll pack on cancer-fighting nutrients, according to the American Institute for Cancer Research.
6. Accept help and support from others.
Having a network of friends, family, neighbors and others in your life to rely on can provide you support and help you to manage stress. Several studies have found that cancer patients with the most social support had better quality of life and lived longer than those with the least amount of social support.
It is OK if these stress-reduction strategies don't appeal to you. Different things work for different people. You can reduce stress just by doing your favorite hobby. The most important thing is to find what works for you and regularly make time for relaxation.
Many people think they do not have time to manage their stress. But five minutes a day is often enough, and the reality is we need to make time to take those five minutes.
Excerpts of this post originally appeared in Focused on Health, MD Anderson's healthy living newsletter.
Department of Integrated Medicine at MD Anderson
J Clin Oncol. 2010 Sep 10;28(26):4094-9. Host factors and cancer progression: biobehavioral signaling pathways and interventions.
Cancer Res. 2010 Sep 15;70(18):7042-52. The sympathetic nervous system induces a metastatic switch in primary breast cancer.
J Soc Int Oncol. 2010 8(2): 43-55. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer
By Lorenzo Cohen, Ph.D., and Richard Lee, M.D.
While going through cancer treatment, people often ask, "What can I do to help?" The answer is to adopt a healthy lifestyle. A healthy lifestyle might help people feel stronger and fitter. It also may help support the cancer treatments so that they work better. We encourage all patients to do all they can to strengthen their body's natural defenses to improve health, well-being and clinical outcomes.
Diet plays an important role during and after cancer treatment. A healthy diet can help manage treatment side effects, improve outcomes and lower cancer risk. Use the tips below to eat well.
Choose to Eat Mostly Plants
- Eat at least five servings of fruits and vegetables daily. Choose a variety of colors and preparation/cooking methods.
- Eat fiber-rich foods, such as beans, peas, lentils, nuts and seeds. Whole fruits and vegetables have more fiber and less sugar than juices or canned foods.
- Limit red meat and limit meat portions to less than 4 ounces per meal (size of a deck of cards). Avoid high-fat and highly processed meats such as hot dogs, bologna, bacon and salami.
Choose Healthy Fats That Help the Body Prevent Disease
- Increase omega-3 and monounsaturated fats in your diet. Good sources are olive and canola oils, olives, nuts, avocado and cold water fish, such as salmon, sardines, trout and tuna.
- Limit saturated fats and large amounts of omega-6 fatty acids. These are found in fatty meats; high-fat dairy products, such as whole milk, cheese and butter; and fried foods.
- Avoid trans fats typically found in packaged snack foods, fried foods and shortening. Do not buy foods with "hydrogenated" or "partially hydrogenated" listed on the food label.
Change Unhealthy Eating Habits
- Learn to recognize when you feel hungry and when you feel full.
- Eat fewer high-calorie, low-nutrient foods like sodas, fruit flavored drinks, candy and processed sweets or other foods. If you want something sweet, eat a small portion of a high-quality, homemade dessert. Or, eat a small piece of dark chocolate.
- Limit alcohol to no more than two drinks per day for men and one drink per day for women.
Physical activity includes all movement, and it is important for good health. Exercise helps us maintain weight, lower disease risk, fight fatigue and improve overall health. While exercise may be tough at first, it will get easier over time.
Aim for 30 to 60 minutes of moderate to hard physical activity every day. Judge the level of an activity by how easy it is to talk. While doing moderate activity, you should be able to talk, but not sing. With harder activities, you should only be able to talk in short phrases. Always talk with your doctor before starting an exercise program.
It is important to choose activities that fit your lifestyle and will motivate you. A few examples include the following:
Be as lean as possible within the range of your normal body weight. A healthy diet and physical activity are the keys to weight loss for people who are overweight or obese.
Stress occurs when a demand is placed upon your body and mind that exceeds your ability to cope. A demand can range from actual physical danger to the excitement of buying a home to a family disagreement. Long-term stress may increase cancer risk, promote tumor growth and interfere with treatment.
It is healthy to practice stress management for at least 10 minutes every day. This is good for your body and mind. Listed are a few tips to manage stress:
Accept Help and Support From Others
Having a network of friends, family, neighbors and others in your life to help and comfort you is important for good health. During your cancer treatment, you might feel afraid, alone or confused. Having people around who care about you can help you feel better. Several studies have found that cancer patients with the most social support had better quality of life and lived longer than those with the least amount of social support.
Use your support system:
- Ask for help or for a listening ear.
- Join a support group that meets your needs.
- Be support for others.
For more information about making the most of your cancer care, visit the Department of Integrative Medicine at MD Anderson. www.mdanderson.org/integrativemed
People often do not make a distinction between the terms integrative medicine and alternative medicine. Below is the mission statement of the Society for Integrative Oncology:
The Society for Integrative Oncology (SIO) is a non-profit, multi-disciplinary organization of professionals dedicated to studying and facilitating cancer treatment and the recovery process through the use of integrated complementary therapeutic options. Such options include natural and botanical products, nutrition, acupuncture, massage, mind-body therapies, and other complementary modalities. Our mission is to educate oncology professionals, patients, caregivers, and relevant others about the scientific validity, clinical benefits, toxicities, and limitations of state-of-the-art integrative therapies. SIO provides a forum for presentation, discussion, and peer review of evidence-based research in the discipline. We advocate for responsible public policy and the highest standards of practice in integrative medicine through appropriate training and the certification of health care professionals.
You will note that the word "alternative" is not contained in the mission statement because the SIO is not a proponent of alternative therapies in lieu of conventional evidenced-based medicine. This is also true of most academic organizations including MD Anderson, Memorial Sloan-Kettering Cancer Center, Dana-Farber Cancer Institute, University of California, San Francisco, and others.
Supporters of integrative medicine never advocate withholding proven interventions. As a matter of course, they embrace only the utilization of viable evidence-based treatments. We are wholly committed to quality research in the area of integrative cancer therapies.
While additional research is needed in the area of integrative oncology, there is nonetheless a sizeable and growing body of well-designed, high-quality science that clearly supports specific interventions as evidence-based (http://www.ncbi.nlm.nih.gov/pubmed/19706235). Locating well-conducted randomized trials of integrative therapies in oncology is not a difficult matter.
As funding for this area of research is relatively new and not supported by big pharma, many of the trials are small Phase II studies and lack appropriate control groups (often just usual care). As more positive Phase I and II trials are completed, we will start to see the larger, necessary, better-controlled Phase II and III trials to know the true benefits of some of these treatments.
One of the other challenges of research in this area is that with the exception of the natural product clinical trials, it is difficult to develop studies using the gold standard double-blind, placebo-controlled design. However, even using single-blind designs, it is possible to at least determine if the patients remained blinded to group assignment and assess patients' baseline treatment expectations. This can help to account for placebo effects.
It is uncommon to find scientists or practitioners who support evidence-based medicine unsupportive of well-designed clinical trials. However, this can sometimes still happen in designing, conducting and publishing integrative oncology clinical trials. Scientific observation should never be trumped by a personal belief. In fact, substituting one's own belief instead of supporting rigorous research and scientific observation is similar to what alternative medicine practitioners advocate -- deliver or withhold treatments without evidence to support that action.
If we simply followed people's predictions and beliefs then the field of medicine would not be where it is today, as many medical discoveries went against what was commonly believed and/or predicted. A good historical example of this is the story of Dr. Ignaz Semmelweis who documented that washing hands with chlorinated lime solution prior to delivering a baby dramatically decreased the rate of puerperal fever. The germ theory of disease had not been developed at the time and Dr. Semmelweis was largely ignored, rejected or ridiculed.
Another good example in oncology is the late Dr. Judah Folkman, who discovered angiogenesis and pioneered anti-angiogenic treatments. He also was initially dismissed and ridiculed by the medical community due to his ideas, which are now, of course, widely accepted.
As the majority of cancer patients use some form of complementary and even alternative medicine, it is the medical establishment's responsibility to provide proper medical advice in this area. Good research is what is needed to determine what is beneficial and what is not beneficial to provide practitioners and patients the information they need to make informed decisions about medical care.
The field of integrative oncology continues its ascent as medicine shifts toward a more personalized care model. Delivering many common and accepted modalities such as diet, exercise and stress management using a patient-centered, comprehensive approach is what distinguishes integrative medicine from reductionist and fragmented models of care. As more and more cancer survivors proactively participate in a patient-centered wellness approach, integrative oncology practitioners will continue to grow in numbers to meet this demand.
We invite all interested oncology professionals to join us for the 7th International Conference for the Society of Integrative Oncology at the New York Academy of Medicine, Nov. 11-13.
By: Alex De Alvarado, Lisa Gower and Lorenzo Cohen, Ph.D.
As cancer survivors know, there is much more involved in the cancer journey than just the treatment of the disease. Patients are searching for ways to be active participants in their recovery to ultimately improve their health and quality of life; this is the goal of an integrative approach to oncology care.
The Integrative Medicine Program at MD Anderson focuses on three main areas: education, research and patient care. The seeds for the program we have today began in the early 1990s when overflow crowds attended workshops involving meditation, music therapy and yoga at the annual Anderson Network Cancer Survivorship Conference.
In the beginning
In 1998 MD Anderson established Place ... of wellness, a center offering complementary therapies. In addition, caregivers, family members and anyone who has been touched by cancer can attend programs (most at no cost). At that time, Place ... of wellness was the first of its kind located on the campus of a comprehensive cancer center. Participant attendance for the first year was just under 2,000.
The education component of the Integrative Medicine Program was established by Stephen Tomasovic, Ph.D., senior vice president, Academic Affairs in 2001 to better educate faculty and staff on complementary and alternative therapies. The Complementary and Integrative Medicine Education Resources (CIMER) website was created to disseminate evidence-based information on complementary and alternative therapies to help patients and health care professionals decide how best to integrate such therapies into cancer care. A monthly lecture series also was established to have expert speakers from around the world present state-of-the-art research and clinical programs in the area of integrative medicine.
In fall 2002, a working group recommended to senior administration that MD Anderson develop a formalized integrative medicine program. The goal was to unify and expand the areas of clinical care, education and research being conducted in integrative medicine across the institution. Under the direction of Lorenzo Cohen, Ph.D., the program was formally established.
Fast forward to 2010
Since those early years, the Integrative Medicine Program has expanded to include two centers and provides acupuncture, massage and music therapy services, as well as a host of classes on everything from yoga and Tibetan meditation to art classes. Participants have grown to more than 10,000 last year alone.
In addition to these patient services, the Integrative Medicine Clinic, which began consultation services in 2007 (started by Moshe Frenkel, M.D.), is led by Richard T. Lee, M.D., medical director of the Integrative Medicine Program. Dr. Lee, along with a team of health care professionals, provides guidance to patients who wish to integrate complementary and integrative medicine into their conventional cancer care.
Ongoing clinical trials funded by the National Cancer Institute are being conducted in the area of mind-body medicine (meditation, Indian-based yoga, Tibetan yoga, Tai Chi/Qigong), preclinical and clinical trials of natural products, and acupuncture. In addition to the CIMER website and monthly lecture series, the educational component offers an array of courses and training opportunities including: introduction and overview to integrative medicine; rotations for medical students; training courses for massage therapists; and an internship training program for undergraduate and graduate students. Observers and visitors come from around the world to learn about what we are doing.
Integrative medicine is now firmly established at MD Anderson and it is now time to expand the clinical services, research and education across the cancer care continuum.
On Friday, Sept. 24, Dr. Cohen will be the keynote speaker at the annual Anderson Network Cancer Survivorship Conference presenting "Improving outcomes in cancer care: Integrative Oncology and the Power of Lifestyle Change." Conference participants also will have the opportunity to attend breakout sessions and workshops with Integrative Medicine practitioners. The conference is open to anyone wishing to learn more about all aspects of cancer survivorship, new treatments, complementary therapies and breakthrough research, and to connect with others who have been touched by cancer.
By: Sat-Siri Sumler and Lorenzo Cohen, Ph.D.
Oncology massage is an approach to massage therapy based in both compassion and specialized massage treatments to help people manage their experience with cancer.
Review of the scientific literature indicates oncology massage helps improve quality of life. Benefits include improved relaxation, sleep, and immune function as well as relieving anxiety, pain, fatigue and nausea.
Oncology massage therapists are trained to meet people where they are in their experience with cancer and apply a highly individualized massage treatment to comfort, nurture and support them in their process.
The treatments are modified according to the full spectrum of cancer-related issues: the physical, psycho-social and emotional consequences of cancer.
By: Alex De Alvarado and Lorenzo Cohen, Ph.D.
Tea is the second most consumed beverage in the world after water. Its origins are in Southeast Asia, where tea has been consumed for thousands of years.
In China, tea has long been part of cultural practices and incorporated within traditional Chinese medicine. Recently, there has been a dramatic increase in scientific research examining the health benefits of green tea, including epidemiological studies, preclinical research and clinical trials.
Of particular interest is the examination of ECGC -- a powerful antioxidant that is thought to be one of the main components of the health benefits of tea.
Several epidemiologic studies in East Asia have found associations between green tea and lower cancer incidence. For example, in 1994 the Journal of the National Cancer Institute published the results of a study indicating that drinking green tea reduced the risk of esophageal cancer in Chinese men and women by nearly 60%.
The research on green tea
In a recent study, MD Anderson researchers examined the effects of green tea extract on people with a precancerous condition called oral leukoplakia. Results were encouraging, showing less progression towards development of cancer in more than half of those who took the extract.
A study presented at the 2010 annual meeting of the American Society of Clinical Oncology showed preliminary evidence that the ECGC component of green tea may reduce the number of leukemia cells in patients with chronic lymphocytic leukemia (CLL). The Mayo Clinic researchers are looking forward to more controlled clinical trials to confirm these benefits as well.
Ask your doctor
Although drinking green tea is generally considered safe, patients with cancer should discuss possible contraindications or side effects with their physician, especially if consuming green tea as a supplement versus as a drink. Green tea contains caffeine, which could have different stimulatory effects on individuals. In addition, green tea may interact with certain anticancer drugs and supplements.
The initial promising research on the benefits of green tea warrants further investigation to conclusively determine its role in the prevention and treatment of cancer. In the meantime, tea will continue to be a source of refreshment, relaxation and ritual.
MD Anderson Resources:
News Release - Green Tea Shows Promise as Chemoprevention Agent for Oral Cancer, M. D. Anderson Study Finds
Integrative Medicine Program
Place ... of wellness
Reduced risk of esophageal cancer associated with green tea consumption. Gao YT, McLaughlin JK, Blot WJ, Ji BT, Dai Q, Fraumeni JF Jr.J Natl Cancer Inst. 1994 Jun 1;86(11):855-8.
Phase II randomized, placebo-controlled trial of green tea extract in patients with high-risk oral premalignant lesions.Tsao AS, Liu D, Martin J, Tang XM, Lee JJ, El-Naggar AK, Wistuba I, Culotta KS, Mao L, Gillenwater A, Sagesaka YM, Hong WK, Papadimitrakopoulou V.Cancer Prev Res (Phila Pa). 2009 Nov;2(11):931-41.
Phase II trial of daily, oral green tea extract in patients with asymptomatic, Rai stage 0-II chronic lymphocytic leukemia (CLL). T. D. Shanafelt, T. Call, C. S. Zent, B. LaPlant, J. F. Leis, D. Bowen, M. Roos, D. F. Jelinek, C. Erlichman, N. E. Kay J Clin Oncol 28:7s, 2010 (suppl; abstr 6522)
National Cancer Institute Fact Sheet
I n chronically ill people, yoga helps improve biological parameters, lessen the severity of symptoms, and improve quality of life at a physical and psychological level.
A new study presented at the 2010 American Society of Clinical Oncology Annual Meeting provides further support for the benefits of yoga in an oncology setting.
The study, conducted by Dr. Karen Mustian at the University of Rochester within the Community Clinical Oncology Program, randomly assigned 410 people who had been treated for early-stage cancer who were having sleep problems two to 24 months after the end of treatment. The participants were mainly breast cancer survivors and were assigned to either the yoga group - who had yoga classes two days a week for four weeks - or a comparison control group who were simply monitored.
Sleep disturbances and fatigue are two of the most common long-term side effects experienced by people after cancer treatment. Conventional treatments for sleep disturbances and fatigue are of limited benefit and usually have unwanted side effects. Longer follow-up from this unprecedentedly large study is needed to determine the long-term benefits of the yoga program.
Our own research at MD Anderson suggests that yoga helps improve sleep outcomes, decreases the side effects of treatment, improves physical functioning aspects of quality of life, and leads to an increase in finding meaning from the illness experience as patients transition from active treatment to cancer survivorship.
Yoga will benefit people when they are practicing on a regular basis. However it is a challenge to get people to continue to engage in these healthful practices after the initial instruction phase. Although some changes may be permanent, in the absence of practicing the improvements will likely be short lived without consistent follow-up.
Mind-body practices are many and varied; yoga is especially useful as it is a quintessential mind-body practice that combines movement, breathing practices and meditation all with the purpose of creating a life with unity and complete awareness. The key is to find a practice that resonates with you and make it a daily practice.
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- Medical Hypnosis Demystified
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