Dear Navigators, This fall, the Journal of Oncology Navigation & Survivorship (JONS), the official publication of the Academy of Oncology Nurse & Patient Navigators (AONN+), will bring you the best [ Read More ]
September 2016 VOL 7, NO 8
Complementary Medicine Can Be Effectively Integrated into Cancer Patients’ Lives
Nutrition, meditation, engaging the limbic lobe of the brain, and other forms of complementary medicine can offer cancer patients an opportunity to participate in their treatment and can provide them with a sense of control in their recovery.
At the East Coast Regional Meeting of the Academy of Oncology Nurse & Patient Navigators, Penny Daugherty, RN, MS, OCN, Oncology Nurse Navigator, Northside Hospital Cancer Institute, Atlanta, GA, presented attendees with an overview of complementary and alternative medicine.
Learning to Eat Well
The foundation of integrative medicine is learning to eat well. Advise patients to strive for color-filled meals, with fruits and vegetables as the basis. All plant foods are good, she said, but brighter varieties contain more diverse phytochemicals. Many patients have never heard of phytonutrients, “and this is a magic word,” said Ms Daugherty. “It gives them power to do something for themselves, for their family, for the people that they love.”
She continued, “We talk about what they can fill their plates with, because not only does this help them, but it helps them feel like they’re alive and that there’s something that they can do. We talk about phytochemicals and the darker colored vegetables, and all these lovely things, because those represent the natural world, and the natural world will help them.”
Dark-colored leafy vegetables, such as broccoli, brussels sprouts, spinach, kale, and collard greens, are plentiful in phytochemicals, as are mangoes, cantaloupes, oranges, kiwis, and berries.
The honor roll of foods includes oily fish, intact grains, and plant proteins. Quinoa has an abundance of protein, “and we want our patients to eat protein because it builds muscle while they’re getting chemo,” said Ms Daugherty. Whole grains take longer to digest and thereby stabilize blood sugar as well. Other good sources are brown rice, barley, kasha, and whole wheat and organic corn pasta.
To obtain protein in the diet, choose plant proteins, such as those from nuts, dried beans, and lentils, and fragmented dairy products (ie, yogurt and kefir), she said.
Cancer promoters to be avoided include:
- Energy-dense foods
- Sugary drinks
- Salty and processed foods
- Red meats, including processed meats
- More than 1-2 alcoholic drinks
- Soy/sunflower/corn oils and trans fats
- Omega-6 fatty acids
In contrast, foods to consider are green tea/pomegranate juice, herbs and spices (turmeric, garlic), fish, vegetable proteins (lentils, tofu), a glass of red wine (pinot noir), olive or canola oil, and omega-3 fatty acids.
“Alcohol is a little sore subject,” she said. “We want people to limit the consumption. We want them to maybe have a little red wine, which has resveratrol. Resveratrol is a polyphenol, part of the phytonutrients. One glass, 4 ounces, is gracious plenty.” Organic wine is preferred because it does not contain sulfites.
Food choices by cancer patients should support methylation because cancer cells have low levels of DNA methylation and thereby switch off tumor suppressor genes, Ms Daugherty explained. Foods that support methylation are green tea, cruciferous and green leafy vegetables, beans, peas, sunflower seeds, liver, whole grains, natural cereals (ie, oatmeal), cold-pressed olive oil, spinach, fatty fish, and choline-rich foods. These are components of the Mediterranean diet.
Glucose in Perspective
The average American consumes 70 kg/year of sugar, but our genes developed in an environment in which a person consumed 24 kg/year of honey, at most. The body produces insulin to process the sugar, but it can’t process the high amount of sugar we’re consuming. The body ramps up production of insulin to get the excess glucose into the cells. Insulin-like growth factor production then increases to process the insulin being secreted, which enhances inflammatory responses in cells. “Today, we know that peaks of insulin and secretion of insulin growth factor stimulate the growth of cancer cells,” she said.
Vitamin D and Other Supplements
Testing cancer patients’ vitamin D levels (25-hydroxy) is important because patients receiving chemotherapy are advised to avoid the sun. Vitamin D3 supplements must be taken with vitamin K, which helps transport vitamin D into the bone marrow. Unless the patient has a clotting problem or is on warfarin or another anticoagulant, the latest recommendation is for 5000 IU/day of vitamin D with vitamin K.
Many patients will be taking supplements on their own. They should be informed about considerable leeway in manufacturing, ingredients, and fillers in these supplements, which do not have to be approved by the FDA.
Excipients, also known as fillers, are inert substances added to raw materials to achieve a desired consistency or form. The molecular structure of synthetic ingredients differs from natural ingredients; the body can tell the difference and responds by creating inflammation to process the synthetic ingredients at the same time it is trying to process and eliminate chemotherapy and ancillary drugs that cancer patients take, Ms Daugherty said.
Another concern is the yeast base in synthetic supplements, which may present difficulties for people allergic to yeast or who have Candida overgrowth, she said. Have your patients pay attention to the labels on supplements. An incomplete label is a red flag.
The limbic lobe sits in the basal ganglia; the structures of the limbic system function together to generate emotional responses. Many of the limbic structures developed in relation to the olfactory system. Making use of the limbic lobe, as with aromatherapy, during cancer treatment can have therapeutic effects, said Ms Daugherty. Lavender, thyme, and lemon/peppermint can have soothing effects in patients on chemotherapy.
Meditation and breathing exercises serve to calm the mind, slow the heart rate, and increase energy and positive sensory perception. An easy form of meditation is to sit or lie comfortably, close the eyes and bring awareness to the body, and consciously instruct the body to relax the jaws, shoulders, and hips. Pay attention to breathing, ideally slowing the breath to 12 to 16 breaths per minute. Meditation is ideally practiced twice daily for 20 minutes during each session.
Deep breathing (yoga breathing) massages the organs with infusion of oxygen and increases circulation, she said.
Chakras, in some religions, are centers of energy in the body that start at the base of the spine and move upward to the crown of the head. There are 7 major chakras connected to different glands or organs in the body. Negative feelings can cause misalignment of the chakras, which can be rebalanced through breathing and meditation exercises.
The Healing Touch
Healing touch, or therapeutic touch, is derived from the ancient “laying on of the hands,” and is based on the premise that the healing force of the therapist affects the patient’s recovery.
“We talk to patients about massage because everybody wants to be touched,” Ms Daugherty said. “Of course, common sense tells us we’re not going to do a shiatsu massage...massage can just be rubbing, connecting, showing you and I can connect. That’s what we do as navigators, because we connect in a way that no other person on the healthcare team can.”
Find out what your patient likes, whether it be music or art, and formulate a plan to engage, using group support where possible, she said.
Physical issues often lead patients to avoid intimacy even though they desire it. Sensuality programs and couple-specific sessions can help promote ways to experience intimacy when a patient’s body image has changed due to disease.
“If you can find out what it is that your individual patient finds soothing and help them actualize that in their heart and in their mind, you will help them in their experience,” Ms Daugherty said. “Every patient is just as precious to us as another patient. Every patient is just as fragile. We have to grasp that and be humbly joyous that we have the opportunity to help patients on this journey that they never asked for but that they’re in.”
Patient and Primary Care Practitioner Confidence in and Perceptions of Cancer Treatment Transition and the Shared Care Model of Cancer Care
Purpose: To examine cancer survivors’ satisfaction in the transition of care from oncologist to primary care physician (PCP), to identify patient and PCP concerns with the transition process, and to [ Read More ]