"I am a big time meditator and do lots of energy work. Frankly, I think that has had some impact on my being alive eight-plus years with metastatic cancer. We all have to die of something. I am not afraid to die, but I am afraid to die before I am able to fully accept myself with no judgments. That is what I am devoting my remaining time to." -- Ellen M.
Rethinking "palliative" care
The website www.getpalliativecare.org defines "palliative care" as "a specialized care focused on the pain, symptoms, and stress of serious illness." Wikipedia defines it as "a specialized area of healthcare that focuses on relieving and preventing the suffering of others."
When people think of palliative care they typically associate it with one of two things:
• Providing relief from the pernicious side-effects of treatment such as chemotherapy and radiation therapy.
• As an adjunct to end-of-life and hospice care.
Although palliative care certainly has been used in this way, I would like to suggest that palliative care has a potential third benefit: reducing the risk of cancer.
Linking stress and cancer
The Sister Study being conducted by the National Institute of Environmental Health Sciences has been following 50,000 women between the ages of 35 and 74 in a effort to discover biological and environmental factors that predict risk of cancer. It is just beginning to yield results.
All of the women enrolled in this landmark study have at least one sister who has been treated for cancer. One of the biological factors the researchers are following is something called "telomere length." Telomeres are strands of DNA that extend from the ends of chromosomes and basically protect them. As we age, telomere length gradually shortens, making the cells that contain them more vulnerable to dying. According to the Genetic Science Learning Center at the University of Utah, as a cell begins to become cancerous it divides more often, and in the process its telomeres become shorter and shorter, and so it may die. Now comes the critical part: The precancerous cell can avoid dying by turning itself into a cancer cell. Studies have in fact found shortened telomeres in many cancers.
What does the above have to do with the risk of getting cancer, or of cancer returning? According to some of the early findings of the Sister Study, women who reported living under above average stress had shorter telomeres. Stress produces a hormone called epinephrine, and women whose epinephrine levels were the highest had the shortest telomeres. The researchers put it this way: "Among women with both higher perceived stress and elevated levels of stress hormone the difference in telomere length was equivalent to or greater than the effects of being obese, smoking, or 10 years of aging."
What we know about complementary treatments
The past decade has seen the emergence of sound research on a variety of complementary and alternative treatments, ranging from yoga to therapeutic massage and physical therapy, to meditation and acupuncture. Many of these treatments are incorporated into rehabilitation programs for cancer patients. I wrote about them in an earlier series of blogs. The bottom line of this research is this: complementary and alternative treatments all have the potential to significantly reduce stress levels, and some can relieve pain and certain side effects of cancer treatment such as nausea. Moreover, these treatments work best if a person follows them consistently. So perhaps Ellen, quoted above, has a point to make about why she has survived so long.
What we know about cancer
According to surveys published in the journal The Oncologist, approximately 30 percent of women who are diagnosed with and treated for early stage breast cancer will go on to stage 4 (metastatic) cancer at some point. The late Elizabeth Edwards is a typical example. Despite medical advances this statistic has not changed for many years.
Rehabilitation, complementary treatments and cancer prevention
In my last blog I cited the efforts of Julie Silver, M.D. (herself a cancer survivor) to advocate for rehabilitation services for women who are treated for cancer. Dr. Silver believes (and I agree) that such services should be routinely provided as part of comprehensive treatment for cancer. Unfortunately, they are not. According to a survey jointly sponsored by the AARP and the National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) only a minority of patients say that they discuss the kinds of complementary treatments often associated with rehabilitation with their doctors.
We cannot at this point state with certainty that rehabilitation aimed in part at stress reduction can decrease the risk of cancer (or of cancer returning). However, research is surely pointing us in that direction. If the communication gap between patients and those who treat them for cancer were closed, and if rehab services were to become a routine part of cancer treatment, who knows how many cancer patients' lives might be extended or even saved?
To learn more about rehabilitation services for cancer patients visit www.oncrehab.com.
To learn more about coping with a terminal or potentially terminal illness visit www.newgrief.com.
Follow Joseph Nowinski, Ph.D. on Twitter: www.twitter.com/NewGrief