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

1. WHY MIND-BODY-SPIRIT MEDICINE SHOULD BE STANDARD OF CARE Rob Rutledge, MD, FRCPC

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

3. TREATING THE BODY • Surgery, systemic therapy and radiation • What we do to the patient • Outcome - death rates, recurrence rates • 95% of resources • VERY IMPORTANT

5. STRESS • Physiological reaction • Emotional trauma • Ongoing stressors • Effects all the body • Impaired immunity • Vicious cycle of irritability and stress Cathrine Burris, Tranfigured

6. 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

7. PSYCHOLOGICAL CARE • “Empower the patient and facilitate healing” • Improve quality life and social function • What’s important to patient • Help the family

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

9. BEYOND REFERRING • Tailor information and practical advice • “Take care of yourself” • Get enough sleep • Balanced diet low in fat

10. PRESCRIBE EXERCISE • Improves quality of life • The best stress-buster • Cariopulmonary and musculoskeletal health

11. PROSTATE AND BREAST CANCER EXERCISE TRIALSJ Clinical Oncology May 2003 • Segal et al “Resistance exercise in men receiving ADT for prostate cancer” • 155 men to receive Hormones for > 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 • N=52 after 15 weeks - improved peak oxygen consumption and quality of life, p=.001

12. 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

13. 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

14. The effect of mindfulness meditation and stress reduction on mood and symptoms of stress in cancer patientsSpeca et al, Psychosom med 2000 • Randomized trial, n=90, 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

15. CAN LIFESTYLE CHANGES REVERSE PROSTATE CANCER? • Dr. Dean Ornish, UCLA - presented at AUA • Randomized trial, n=87 men with biopsy-proven prostate cancer, psa 4-10, Gleason<7 • 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

16. CAN LIFESTYLE CHANGES REVERSE PROSTATE CANCER? • Experimental arm - PSA down 3% at one year • Control - PSA up 7% (p=0.034), 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

17. 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

18. SPIRITUALITY AND CANCER CARE

19. SPIRITUALITY • Multiple definitions • Personal • Often intangible

20. DEFINING SPIRITUALITYLarsons, 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

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

22. 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

23. 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

25. THE PARADIGM OF SPIRITUAL CARE The patient and the caregiver are on the journey together.

28. 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,

29. 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

30. Alterations in brain and immune function produced by meditationDavidson et al. Psychosom Med July 2003 • Randomized trial n=41 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.

31. 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

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