Two weeks ago, I was fortunate to be involved as a presenter, along with a group of dynamic, international and interdisciplinary cancer care providers, for a workshop on Cancer Related Cognitive Impairment at the annual Society for Integrative Oncology (SIO) conference. I have summed up some of our findings for this blog post, which follow.

Cancer related cognitive impairment (CRCI) refers to changes in cognitive processing from cancer treatments which can involve memory, learning, concentrating, speed of processing, and even coordination of movements often leading to adverse effects on everyday tasks and quality of life. While the prevalence of CRCI is quite common, estimated to occur in about 75% of cancer survivors, it is still unknown exactly what causes it and there is no consistent way to diagnosis or measure it. Some studies have found that up to 40% of patients had some form of cognitive impairment following cancer surgery prior to starting systemic therapy (e.g., chemotherapy and/or hormonal therapy). About 35% of individuals have lingering symptoms for months to years following treatment.

While CRCI is often thought of in relation to chemotherapy, commonly referred to as “chemobrain”, it is also associated with hormonal therapies and radiation treatments to the brain. There are a number of theories about the physiologic changes leading to CRCI in addition to direct and indirect brain toxicity from cancer treatments, such as a genetic predisposition (e.g., presence of the APOE mutation associated with Alzheimer’s Disease), effects of inflammatory chemicals on the brain, blood vessel changes in the brain altering blood flow, and reductions is estrogen and testosterone. Both blood tests of various biomarkers and functional MRIs (fMRI) of the brain have shown changes that appear to relate with some of the symptoms described with CRCI (e.g., attention and memory issues). Psychological explanations for CRCI include depression, anxiety, pain and cancer-related fatigue. Most likely these are factors that contribute to the worsening of CRCI.

Most of the studies addressing CRCI have been conducted in breast cancer survivors, however CRCI has been described in patients with colorectal, prostate, ovarian, and testicular cancer, as well as those with hematologic malignancies (i.e., leukemia, lymphoma, and myeloma) . Because there are no consistent ways to diagnosis this problem, health care providers often rely on the use of self-report questionnaires and other neuropsychological tests, but they have limitations and comprehensive neurological evaluations may not always be practical in clinical oncology settings.

Despite the challenges with diagnosis and assessment of this distressing problem, practical non-medication strategies exist to help reduce the burden of CRCI. While some of them include the usual healthy lifestyle practices such as regular physical activity, healthy nutrition, and adequate sleep, others are more specific such as acupuncture, yoga, Qigong, meditation, relaxation breathing exercises, and cognitive training often with the use of computerized programs.

In a recent study among breast cancer survivors, acupuncture was shown to improve CRCI based on self-reported questionnaires and it was also related to higher levels of a blood biomarker called brain-derived neurotrophic factor (BDNF), compared to pre-treatment with acupuncture. BDNF is associated with neurological diseases such as depression, Alzheimer’s disease and Parkinson’s disease. Higher levels are associated with better cognitive functioning. Another study among breast cancer survivors found that yoga significantly improved perceived cognitive function compared to a group of breast cancer survivors who did not receive yoga. Another study tested Qigong, which is a gentle movement exercise involving controlled breathing and meditation, and findings revealed improvements in perceived cognitive impairment, as well as a reduction in an inflammatory blood marker called C-reactive protein. Lastly, the evidence on cognitive training utilizing computerized programs indicates significant improvements in cognitive functioning, especially with memory, executive functioning and speed of processing. Some of these programs are commercially available and can be done in the convenience of one’s home, while others must be used as part of a program with a trained professional. Two of the programs that are available for public use are Luminosity and BrainHQ. Although the number of studies using computerized programs is small, the majority were conducted with the BrainHQ program.

While further studies are needed to search for better diagnostics, assessments and treatments, at least there are some effective strategies available that can help improve the quality of life for those affected. Integrative health coaching can be very effective for helping with lifestyle changes around exercise, nutrition, sleep, and mind-body approaches. Some of the other treatment interventions are accessible through either cancer centers or cancer community programs, while the computerized programs can be done in the comfort and convenience of an individual’s home. Keeping the brain healthy is paramount to overall good health and wellness so if you know someone affected by this impairment please share this information with them.

To improved brain health!

For many, yoga is often thought of as a physical exercise, but in fact it is comprised of three equally important components – the physical poses or asanas as they are referred to in Sanskrit; controlled breathing techniques, or pranayama (prana – “life force” and ayama – “extension”), which can both energize and relax the body and mind; and finally, mindful exercises or meditation (a contemplative practice for “resting the mind”). The word yoga literally means “to yoke” or join together. The union of the mind and body is the essence of yoga. For many, yoga can become the most powerful mind-body practice for moving towards the achievement of a state of equanimity or a state of mental calmness, especially during times of distress and upheaval, such as when a serious illness occurs. It is thought of as achieving emotional balance, both accepting life’s challenges and joys with a calm state of being. It is a virtue embedded in many ancient spiritual and religious philosophies and it is one that can be cultivated through a regular yoga practice. The following quote from the famous Swiss psychiatrist and psychoanalyst, Carl Jung, exemplifies the value of equanimity:

“Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness. It is far better to take things as they come along with patience and equanimity.”

For so many, a cancer diagnosis creates disharmony and imbalances physically, mentally and spiritually. Some have described the “shock” of a cancer diagnosis as turning their “world upside down” and as a time of “loss of control” over the familiar. Emotional distress in fact is one of the most commonly experienced adverse effects of a cancer diagnosis and often lingers well beyond the time of diagnosis and end of treatments. Not only are individuals “struggling” to make sense of the situation, they often have to contend with a myriad of other unpleasant side effects (e.g., fatigue, loss of muscle strength, cognitive changes, insomnia, pain, etc.) from treatments and/or the cancer itself.

Over the past decade or more there has been a growing body of literature showing the many benefits of yoga for individuals affected by cancer. While the physical postures of yoga can lead to improved strength and flexibility and better physical balance, yoga has also been found to enhance sleep, lower fatigue, decrease musculoskeletal symptoms, and reduce cognitive impairment among cancer survivors, either during and/or beyond active cancer treatments. In addition to relieving physical symptoms and side effects of treatments, yoga can help provide emotional stability through relief of anxiety and depression, which are commonly experienced at some point along the cancer trajectory as previously mentioned. Then there are the more subtle benefits that touch on the spiritual realm, helping to cultivate patience, equanimity, self-compassion and kindness. These qualities of yoga are not as easily quantified through experimental studies as the physical and mental health benefits, but in fact may be more profound and meaningful to an individual affected by cancer and lead to a deeper level of healing.

Earlier this summer I was fortunate to attend a 10-day intensive yoga teacher training entitled, Yoga of the Heart: Cardiac and Cancer Certification Training. It was led by a gifted spiritual yoga teacher who was one of the co-founders of the yoga and stress management program developed for cancer survivors at the non-profit Commonweal in Bolinas, California over 30 years ago. The training provided me with greater insight and a deeper understanding of the multitude of benefits that a regular yoga practice can bring to those affected by cancer, as well as those affected by heart disease and other life-threatening illnesses. While yoga can help one achieve physical balance through the poses (balancing both effort and ease in a pose), it can perhaps more importantly help one attain mental calmness and to more gracefully flow with, and through a cancer experience.

Many cancer centers, local health clubs, and even some yoga studios offer low-cost or free yoga classes specifically for cancer survivors. Check with your cancer center and/or in your community for a class with a certified yoga instructor trained to teach individuals affected by cancer. Begin to experience the peaceful sense of CALM that can develop from a regular yoga practice.

Namaste

(The light and love in me honors the light and love in you)

I recently had an opportunity to write the following article for the newsletter, Health & Healing in the Triangle and wanted to share it on my blog. It was published July 2019 by Health & Healing, Inc. in Volume 22, No. 1.

When someone receives a cancer diagnosis, their world can quickly turn from one that is routine and comfortable to one filled with uncertainly and anxiety. An overwhelmed state and sense of loss of control can develop as the newly diagnosed patient is bombarded with new information about treatment strategies such as surgery, chemotherapy, targeted therapies, and radiation therapy that they never imagined they would have to personally consider. Once the shock of a new diagnosis settles in and decisions are made about treatments individuals often begin to ask, ‘what else can I do to help gain control over this cancer’.

Taking a holistic approach to cancer care extends beyond conventional therapies and addresses not just physical health, but emotional, social, spiritual and environmental factors as well since there is much more to healing than medical treatments alone. Integrating standard care with nutrition, physical activity, and mind-body therapies takes into consideration the whole person, not just the cancer. Embracing other healing practices can provide a sense of control and empowerment to a person affected by cancer.

However, it is well known that behavior change can be challenging without support and guidance. It often takes weeks or months before a new healthy behavior becomes embedded in one’s new way of life. This is where an integrative health coach specializing in cancer can be valuable as part of an individual’s “anti-cancer” team. There are a growing number of evidence-based complementary therapies that can be beneficial for not only symptom management and treatment-related side effects, but also may decrease risk for recurrence, secondary cancers, and co-morbid illnesses such as heart disease and osteoporosis.

Pre-surgery Integrative Health Coaching

Surgery is a typical part of conventional cancer treatments, and it is often recommended prior to other treatments, however it can also follow other modalities that are utilized to reduce tumor size pre-surgery (e.g., neo-adjuvant chemotherapy).

Sarah was a 42-year-old woman diagnosed with Stage II hormone receptor positive breast cancer who was receiving neo-adjuvant chemotherapy when she came for her first Integrative Health Coaching visit. She was very interested in how she could improve her immune function and decrease fatigue while undergoing chemotherapy and overall to optimize her health prior to breast-conserving surgery. Admittedly she was not eating a healthy diet and craved foods high in refined carbohydrates. She was gaining weight while on chemotherapy and was not engaging in any exercise. Additionally, she was extremely anxious about her upcoming surgery.

During our initial meeting it was discovered that Sarah had once loved yoga, but since raising a family she no longer felt she had time for yoga. After we explored what was most important for Sarah to work on we developed three concrete, realistic goals for the next several weeks which focused on reducing refined carbs and adding more vegetables to her diet, engaging in yoga 2-3 times/week, and utilizing meditation 5-7 days/week for ten minutes to manage anxiety. Through meetings every other week for the next six weeks, Sarah was successful at achieving her goals and felt she was in a healthier state both physically and mentally for surgery.

Post-surgery Integrative Health Coaching

I continued working with Sarah several more weeks following surgery and her main concerns shifted to preventing recurrence and reducing negative effects of hormonal therapy. We continued to work on improvements in her diet and adding in other forms of physical activity that could further enhance her bone and heart health, while also educating her on modalities to help manage bothersome menopausal symptoms. Building on her prior successes and feeling less stressed, more energetic and empowered, Sarah was well on her way to living a healthier, happier “anti-cancer” life despite the continuation of hormone therapy following her surgery. Sarah was proud of her health accomplishments and also felt as though she could now serve as a healthy role model for her family.