From OncoLog, November 2005, Vol. 50, No. 11

Do Mind/Body Techniques Work?

by Karen Stuyck

More than ever, people with cancer are opting to use a variety of mind/body techniques that they hope will decrease their stress, lower their pain, and improve their health. In fact, in a recent study, nearly half of the patients with cancer who responded said they’d used mind/body techniques such as visualization and relaxation.

But do these methods really have any effect? That’s often the question physicians have when grappling with the best way to advise patients who ask about these techniques. Now, researchers at M. D. Anderson’s Integrative Medicine Program are evaluating the scientific merit of various mind/body techniques. Recent and ongoing studies have focused on stress management, yoga, music therapy, meditation, expressive writing, and several other behavioral approaches.

While studies have shown that people with cancer use complementary medicine approaches for a variety of reasons—including to increase hope, to improve quality of life, to gain a sense of control, and to alleviate their symptoms—many also are hoping that mind/body practices will benefit their health by boosting their immune systems. “Theoretically, a mind/body intervention that is found to decrease patients’ stress levels could, therefore, have an impact on the immune system,” said Lorenzo Cohen, Ph.D., associate professor in the Department of Behavioral Science and director of the Integrative Medicine Program at M. D. Anderson. “There is extensive evidence that stress suppresses cell-mediated immunity, a component of the immune system involved in tumor surveillance.” Dr. Cohen cited the field of psychoneuroimmunology as providing growing evidence of the negative physical effects of stress. Researchers at M. D. Anderson are using animal models to evaluate how psychological stress impacts disease processes and outcomes.

“We know that chronic stress can have a negative impact on aspects of physiologic functioning that, in turn, have negative health implications,” said Dr. Cohen. “For instance, stress increases the body’s production of the stress hormones cortisol, epinephrine, and norepinephrine; dysregulates the immune system; and decreases cell-mediated immunity, which is specifically relevant for cancer patients.”

Dr. Cohen thinks it’s logical to consider, then, that interventions to decrease stress may have health benefits. “The majority of research in psychoneuroimmunology explores how stress negatively impacts our hormonal and immune systems and the negative health implications of that. We also know that psychological stress is extremely detrimental for patients’ quality of life in both psychological and physical aspects. It is now important for us to examine the psychological and physiological benefits of reducing stress.” Dr. Cohen cites a study he conducted, published last year in the journal Cancer, which determined that patients with lymphoma who participated in a Tibetan yoga program had lower levels of sleep disturbances than patients in a control group. Tibetan yoga incorporates controlled breathing and visualization, mindfulness techniques, and low-impact postures. Patients in the yoga group reported that their sleep quality was better, they slept significantly longer, they fell asleep faster, and they used less sleep medication. Since sleep disturbances are a common problem for patients with cancer, determining methods for improving sleep quality is especially important, Dr. Cohen said. In a second study of Tibetan yoga—this one with women with breast cancer—the Tibetan yoga group also had fewer intrusive thoughts about their disease and, after one week, had fewer cancer symptoms. A larger phase III clinical trial will study the effects of Tibetan yoga on patients with breast cancer undergoing chemotherapy. “We expect the Tibetan yoga will buffer the negative effects of chemotherapy on aspects of the women’s quality of life,” Dr. Cohen said.

To further test the belief that yoga benefits cancer patients, M. D. Anderson scientists recently have signed an agreement to enter into a research collaboration with Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA Research Foundation) in Bangalore, India. The largest yoga therapy research Health Home Arogyadhama in India, the foundation has conducted extensive research on the effects of yoga on both healthy people, people with various medical conditions, and those with cancer.

In collaboration with these scientists, Dr. Cohen recently completed a study of the effects of hatha yoga, an Indian-based yoga practice, on 62 patients with breast cancer undergoing radiation treatment. An abstract being presented at the annual meeting of the Society for Integrative Oncology reports that the researchers found better physical functioning and general health and significantly lower levels of sleep-related daytime dysfunction in the women who practice hatha yoga compared with the control group. Women in the yoga group participated in hatha yoga two times a week during the course of their radiation therapy. A grant from the National Cancer Institute (NCI) is funding a larger trial of this research.

Expressive writing is another mind/body technique the Integrative Medicine researchers are exploring. In one recent randomized trial, patients with renal cell carcinoma were asked to write their deepest thoughts and feelings about their kidney cancer experience during four separate 20-minute sessions. “The paradigm for expressive writing is to do very brief, acute writing sessions. People are instructed to perhaps write about things they haven’t shared with anyone else,” Dr. Cohen said. In comparison with control group members who wrote about neutral topics, the patients in the expressive writing group reported significantly lower levels of sleep disturbances, with better overall sleep quality, longer sleep duration, and less daytime dysfunction.

A larger phase III trial, also funded by NCI, is continuing this research on a bigger scale. “We’re examining not only sleep and other aspects of quality of life, but also physiologic function by measuring patients’ immune systems,” he said. The researchers specifically picked patients with kidney cancer because that disease is immunogenic and “expressive writing interventions have been shown to positively impact aspects of the immune system,” Dr. Cohen said.

Other recently completed research is focusing on music therapy and various relaxation techniques. One study is examining the effects of music therapy on the mood and quality of life of patients who have undergone bone marrow transplantation. In another, men scheduled to undergo radical prostatectomy were taught stress management skills such as diaphragmatic breathing, guided imagery, and cognitive therapy strategies for managing stress and having realistic expectations of recovery. The research is evaluating whether or not the presurgical stress reduction program affected patients’ psychological well being and physiologic factors.

Another study is evaluating the effectiveness of using a custom-designed hand-held computer program to supplement a cognitive behavioral stress management program for patients with breast cancer who are undergoing chemotherapy. The computer program reinforces the skills patients learned in four individual therapy sessions: diaphragmatic breathing, guided imagery, progressive muscle relaxation, and cognitive therapy.

Nurses teach mindfulness relaxation techniques to patients undergoing chemotherapy in a large phase III randomized trial. Patients first are taught the techniques before starting chemotherapy, then are given an audio tape of the mindfulness training, which they are encouraged to use at least once a day throughout chemotherapy. When the pilot phase is over, a larger randomized trial will compare the effectiveness of mindfulness relaxation and listening to relaxing music.

The Integrative Medicine Program has also received a grant from the NCI to develop a center to study traditional Chinese medicine for patients with cancer in collaboration with The Fudan University Cancer Hospital in Shanghai, China. The investigators are examining mind/body approaches such as qigong, as well as acupuncture and natural substances.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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