WHY MIND-BODY-SPIRIT MEDICINE SHOULD BE STANDARD OF CARE

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WHY MIND-BODY-SPIRIT MEDICINE SHOULD BE STANDARD
OF CARE

• Rob Rutledge, MD, FRCPC

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COMPLETE CARE

• BODY / MIND / SPIRIT MEDICINE
• Use what works for you
• Individualize care
• Take care of yourself and each other

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TREATING THE BODY

• Surgery, systemic therapy and radiation
• What we do to the patient
• Outcome - death rates, recurrence rates
• 95 of resources
• VERY IMPORTANT

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STRESS

• Physiological reaction
• Emotional trauma
• Ongoing stressors
• Effects all the body
• Impaired immunity
• Vicious cycle of irritability and stress

Cathrine Burris, Tranfigured
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DISTRESS AND DEPRESSION

• 40 will suffer major depression or anxiety
  at some time
• Previous angst or denial
• Disruption of family, relationships, and
  social function
• Distress is costly

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PSYCHOLOGICAL CARE

• Empower the patient and facilitate healing
• Improve quality life and social function
• Whats important to patient
• Help the family

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TREATING DISTRESS

• Refer to psycho-social specialists !!!
• Screen at every visit
• Go deeper with questions
• Listening is therapeutic
• All professionals need to refer patients

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BEYOND REFERRING

• Tailor information and practical advice
• Take care of yourself
• Get enough sleep
• Balanced diet low in fat

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PRESCRIBE EXERCISE

• Improves quality of life
• The best stress-buster
• Cariopulmonary and musculoskeletal health

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PROSTATE AND BREAST CANCER EXERCISE TRIALS J
Clinical Oncology May 2003

• Segal et al Resistance exercise in men receiving
  ADT for prostate cancer
• 155 men to receive Hormones for gt 3months
• Workout 3/week for 3 months vs wait list
• Improved fatigue and quality of life, p.002
• Courneya et al RCT of exercise training in
  postmenopausal breast cancer survivors
• N52 after 15 weeks - improved peak oxygen
  consumption and quality of life, p.001

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THE RELAXATION RESPONSE

• Breathe into your belly
• Think of a time when you were safe and happy
• Physiological response
• Natural state of being
• Triggers deep relaxation, mediation, or prayer
• Can re-learn this skill

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MEDITATION

• An exercise in awareness and concentration
• Deep relaxation response
• Brain waves change
• Activation of prefontal lobe positive emotions
• Immune function improves
• Effect persists for months

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The effect of mindfulness meditation and stress
reduction on mood and symptoms of stress in
cancer patientsSpeca et al, Psychosom med 2000

• Randomized trial, n90, different cancers
• Seven weekly meditation group meeting
• Overall reduction in total mood disturbance was
  65 in study group vs. 31 in controls
• Subscales less depression, anxiety, anger,
  confusion, and more vigor
• Less stress cardio GI symptoms, emotional
  lability, depression, cognitive problems,
  habitual patterns of stress

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CAN LIFESTYLE CHANGES REVERSE PROSTATE CANCER?

• Dr. Dean Ornish, UCLA - presented at AUA
• Randomized trial, n87 men with biopsy-proven
  prostate cancer, psa 4-10, Gleasonlt7
• All men were on observation no active Rx
• Experimental arm stress management, low-fat
  vegan diet with antioxidants, moderate exercise,
  and psychosocial group support
• PSA measured at baseline, q3months for 1 year

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CAN LIFESTYLE CHANGES REVERSE PROSTATE CANCER?

• Experimental arm - PSA down 3 at one year
• Control - PSA up 7 (p0.034), 7/43 needed Rx
• Control group followed diet 75 as well as
  experimental group yet PSA increased
• 2nd experiment Serum from men inhibited
  prostate cancer cell growth in test tubes in
  67 in experimental group vs 12 in controls
• Greater adherence to program inhibited prostate
  cancer cells more often

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CANCER SUPPORT GROUPS

• Emotional support, education and coping
  strategies
• Better survival ?
• Improves QOL, mood, depression, tension
• Physiology of connection
• Helps to find purpose and meaning

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SPIRITUALITY AND CANCER CARE
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SPIRITUALITY

• Multiple definitions
• Personal
• Often intangible

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DEFINING SPIRITUALITY Larsons, Swyers,
McCullogh (NIHR)

• The feelings, thoughts, experiences and
  behaviours that arise from the search for the
  sacred.
• Search attempts to identify, articulate,
  maintain or transform
• Sacred Divine Being, Ultimate Reality,
  Ultimate Truth perceived by the individual

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SPIRITUALITY

• Gives meaning, vitality and integrity to life.
• Transcends the personal
• Looking at oneself from outside

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WHY ASK ABOUT SPIRITUALITY?

• Helps caregiver to understand patient
• Some patients want to talk
• Can benefit health and coping
• Opportunities to intervene
• Spiritual community can be supportive

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HOW TO ASK ABOUT SPIRITUALITY

• Gentle and respectful!
• Would you like to talk about your religious or
  spiritual views?
• Attitude spirituality is important
• Respect the privacy of patient
• Be aware of your own beliefs

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THE PARADIGM OF SPIRITUAL CARE

• The patient and the caregiver are on the
  journey together.

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More ideas

• Meta message is complete care, take care of
  ourselves and each other.Beyond the cancer
• Interject advice in physical realm at end of body
  see body as wonderful vehicle
• Story of david hitting the baseball homerun.
  Pure joy.
• Body/mind is empowerment. Self care. Beyond
  cancer. Exercise, nutrition. Fatigue
• Bridge is stress level of mind and the
  physiology
• Mind/spirit is support groups physiology of
  connection
• Spiritual define it. Show that cancer patients
  need it. Studies
• My stories of spiritual care. I start to realize
  why do I want to be alive
• plug the weekend retreat as a joke
• Where to fit in complementary medicine, humour,

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Ideas and plan

• Looks at adjuncts exercise support groups,
  recognize severe stress
• Looks at the societal effects sees the family
  as part
• Paradigm we are in this together. We learn
  from each other.
• Process is the critical
• Story of first patient and I ask god to give
  me the strength to face this
• My Story from med student, to psyche, to
  spiritual why do I want to live, what is this all
  about.
• Self-care

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Alterations in brain and immune function produced
by meditationDavidson et al. Psychosom Med July
2003

• Randomized trial n41 for healthy employees
• Weekly program mindfulness meditation
• EEG before, after and four months later
• Increased activity in left prefontal lobe that
  persists at least four months after practise
• More able to produce antibodies in response to
  flu vaccine.

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STRESS

• Physical / psychological reaction
• Ongoing psychological and physical stressors
• Physical effects in body
• Poor repair of tissue
• Depleted immune system
• Vicious cycles of poor sleep and irritability

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SPIRITUALITY

• Experiences, beliefs, phenomena that pertain to
  the transcendental and existential aspects of
  life.
• Richards and Bergin