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Integrative Medicine
Excerpt from "A Patient's Guide to Understanding Cutaneous Lymphoma"

Integrative medicine is the methodology of integrating all aspects of care – from traditional Western medicine modalities to acupuncture, homeopathy, Chinese medicine, ayurvedic, yoga and more. Complementary and alternative medicines are therapies that may assist patients in coping with cancer, treatments, and side effects. Doctors do not recommend using such therapies in place of traditional medical care. Some effective methods to combat treatment side effects and ease tension, anxiety, and other illness-induced emotions, include meditation, yoga, acupuncture, exercise, nutrition, and relaxation techniques.

Stress Management
There are many effective ways to manage stress. While one patient finds a relaxation CD soothing, another may find the sounds of breaking waves stressful. Yoga works for some people, but others are too tired so they fall asleep when the class takes them down to poses on the floor.

Keep in mind some general ideas as you work toward creating a system of coping mechanisms to manage stress that can work for you. Do not allow your treatments to overtake you. Stay organized so you do not feel out of control. Observe and respect the natural limits of your body. If you are tired – rest!

Review your normal routine, and learn what makes you tick. What stresses you out? What soothes you? Understanding yourself and having realistic expectations of your nature will guide you in determining effective coping methods. Look at your past efforts to manage stress and consider what has or has not worked. Know your strengths and exploit them. Ask for help and take suggestions; other people offer great ideas that you may not be considering. Most importantly, never let having cutaneous lymphoma become the most important thing in your life. You can have a normal life once you accept your situation.

Managing Anxiety
Anxiety can be one of the toughest emotions for patients and loved ones. Anxiety often peaks around the time of doctor visits or when new symptoms arise. This is completely normal. Sometimes anxiety fades; sometimes it does not. A recent study of anxiety found that more than one-third of patients in remission reported levels of clinical anxiety about the possibility of relapse. It’s normal to be concerned about your disease returning.

The best way to manage anxiety is to identify when it is at its highest for you. Then, there are numerous techniques to manage it. Do not suffer alone. Seek support from a mental health professional. Talk with others who have cutaneous lymphoma or have battled it in the past and who share other characteristics with you – age, geography, family situation, etc.

Watch and Wait: Living with the Unknown
People with indolent (slow-growing) lymphomas learn to adapt to the cycle of starting active treatment, finishing treatment, wondering if the treatment worked, re-establishing a life routine and then wondering when disease will return. You will discover your own unique adaptation. If you are newly-diagnosed, take solace in knowing that most people feel the shock of diagnosis. Being thrust into the world of the unknown peaks at diagnosis, which means it gets more manageable over time.

Watching and waiting can be hard; no one handles “waiting” inherently well, especially when dealing with cancer. Some people refer to this as “watch and worry.” A study of young adults with relapsed/refractory lymphoma in their twenties revealed that those with indolent disease adapt to “living in the gray” by finding a balance between knowing lymphoma will return at some point and not letting worrying about “when” affect daily life.

Some people find balance by investing wholly in personal relationships, fulfilling work, and healthy living. A reasonable first step is to acknowledge that it is scary to have an incurable cancer. From a place of acknowledging that this is not what you choose, you will identify strategies for living your life to the fullest.

Philosopher Paul Tillich suggested that anxiety of the unknown – that which can never be known - is the toughest of all.  In a scenario where physicians do not have the ability to predict when, if at all, your disease may require treatment, you are left with the task of finding a way to live with the unknown.

Taking Care Of The Whole Person: Body, Mind, and Spirit*
Today, the definition of a cancer survivor has dramatically changed.  The Institute Of Medicine (2005) defines a survivor as: Any individual from the point of their cancer diagnosis moving forward is a SURVIVOR.  The goal is to help individuals not only SURVIVE with their cancer but THRIVE in the face of a life-limiting or life-threatening illness as long as possible.  

Therefore, it is essential to decrease emotional stress and improve quality of life. Patients and families are often so focused on “making it” through a course of treatment that there is not much focus on other important aspects of life. However, we cannot heal the body if the mind is muddled and spirit unfocused.

It is imperative to assess how a cancer diagnosis affects the “whole” person. What happens to a patient on every level – physical, behavioral, emotional, cognitive? Integrative medicine modalities can help achieve that ever-important balance of mind-body wellness.

In 2007, the Institute of Medicine published a report entitled Cancer Care for the Whole Person: Addressing the Psychosocial Health Needs of Cancer Patients. This report reveals how important it is to ensure a person’s psychosocial health, and the impact psychological well-being plays in the course of cancer. Cancer doesn’t occur just to the patient; cancer affects every member of a family.

The following mind-body techniques have proven helpful for patients and family members when facing a major life stress such as cancer:

Relaxation Techniques
Herbert Benson, MD is considered the father of the relaxation response.  He wrote about the importance of relaxation in his book: The Relaxation Response. Stress comes from any outside force or event that affects our body or mind. There is good stress, which is healthy or provides a sense of fulfillment, and bad stress, or distress. In stressful situations, the brain jumps into fight or flight response, preparing a person to handle dangerous situations. Adrenaline surges, increasing heart rate, blood pressure, and muscle tension.

Relaxation techniques offer strategies to help manage stressors.  One technique includes basic diaphragmatic or belly breathing - breathing fully into your lungs and expanding your belly. Belly breathing essentially shuts off the fight or flight response and triggers a relaxation response. The goal is to learn to recognize stress-induced rapid breathing and instead take deep breaths to create calm.  

Guided Imagery
Imagine lying on a beach under the warm sun, a cool breeze caressing your face. You are listening to the ocean lap at the shore.  

Imagine that you are sitting in front of a fire on a cool autumn night. The fire crackles and sparks. You stare at no particular point but rather to the flicking orange flames. The night sky is filled with sparkly stars. All is quiet.

Visualizing images like these may cause a person to feel less distressed, taking their minds away from a stressful situation. When dealing with a cancer diagnosis, our minds may race with conflicting, scary, unanswerable thoughts. At such a time, transporting the mind to specific soothing imagery allows us to retreat to a relaxing situation.

Guided imagery is integrated into cancer care in a variety of ways. Patients may develop guided imagery that includes seeing their immune system as Pac Men cruising through their body and eating up cancer cells. Or, they may see their tumors being melted like ice under a hot sun. Perhaps they choose to visualize their immune system as a surveillance system that recognizes intruders (cancer) and destroys them on impact.

For some, it’s as easy as seeing a white light or healing light enter the body and heal cancer cells, leaving their bodies healthy and strong. Research shows that just imagining an event can result in the brain actually experiencing it as though the event were happening.

Medical Hypnosis
Medical hypnosis is defined as a state of focused awareness.  This is simply a relaxed state where individuals “put to sleep” thoughts from their conscious mind and tap into a deeper level of consciousness to increase focus. Similar to relaxation and guided imagery, in medical hypnosis a patient hears a set of suggestions that have meaning for that individual, transporting them into a calmer state of being.

Mindfulness
Modern Western psychology has several definitions of mindfulness:

  • A psychological quality that involves bringing one’s complete attention to the present experience on a moment-to-moment basis.
  • Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.
  • A kind of non-elaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises is acknowledged and accepted.

In a fast-paced world, with scary news like a cancer diagnosis, it becomes easy to be preoccupied with what the future may hold or what the next test, scan, or treatment will reveal.  Mindfulness allows us to be present and disseminate random, scary, unknowable thoughts coursing through the mind.  

Tony Horton, a trainer and developer of the popular P90X exercise regimen, begins his yoga workout by saying: “Forget what happened prior to starting, let go of what you need to do after, and just allow yourself to be in the moment and be ready for a ride you won’t forget.”  A core tenet of yoga practice is learning to be mindful and in the moment. Truly, the past is gone, the future has yet to exist, so all we really have is this moment. If we can embrace it, it becomes easier to set aside fears and what-ifs.

Yoga
Yoga, an ancient tradition originating in Central Asia, is the practice of engaging mind, body, and spirit in the present and with clear focus on the worthiness of an endeavor.

Yoga has grown significantly in the West; today, more than 15 million individuals engage in a yoga practice. Yoga is ranked as the 6th most common complementary/integrative medicine therapy in the U.S. cancer survivor population and the 3rd most common practice behind deep breathing and meditation.

Practicing yoga during cancer treatments can resolve insomnia, improve mood, and enhance quality of life.  Additional benefits include enhanced breathing, improved appetite and bowel habits, increased sense of peace and tranquility, and fewer side effects. A recent study found that lymphoma patients who practiced yoga had improved sleep quality and decreased use of sleep medications.

Today there are many options for adding to the support system of living with cutaneous lymphoma.  Check out your local gym, yoga studio or holistic health center and try a new class or practice.  See what works for you and incorporate that into your overall long-term healthy living program.


*Taking Care Of The Whole Person: Body, Mind, and Spirit content previously printed in the Fall Forum 2011 newsletter in article by the same name authored by Janine Gauthier, Ph.D.. Dr. Gauthier is the Director of the Cancer Integrative Medicine Program and Psychosocial Oncology Assistant Professor for the Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL.