Mind-Body Approaches to Cancer - Dr. Ahn


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Dr. Eugene Ahn of Sylvester Comprehensive Cancer Center discussed mind-body approaches to cancer healing at the 2011 WellBeingWell Conference in Miami.

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Mind-Body Approaches to Cancer - Dr. Ahn

  1. 1. Mind-body approaches to cancer – Current evidence and what lies ahead Eugene Ahn MD April 26th, 2011 Well Being Well Conference Assistant Professor Hematology/Oncology Sylvester Comprehensive Cancer Center “ Education” (1890) by Louis Comfort Tiffany Chittenden Hall, Yale
  2. 2. Overview <ul><li>Current evidence and understanding regarding mind-body approaches to healing </li></ul><ul><li>Conceptual framework and practical tools on how we can optimize mind-body approaches </li></ul>
  3. 3. An aging paradigm of western medicine <ul><li>Matter is primary, and consciousness is a function of matter or the brain </li></ul><ul><li>Disease is best understood based on molecular cause and effect </li></ul><ul><li>Endorses “reductionism” which assumes breaking processes down to the smallest order will produce the solutions of re-creating order on the next higher level </li></ul><ul><li>Therefore, consciousness is a passive observer </li></ul>
  4. 4. Observable effects on health care <ul><li>Increasingly sub-specialized doctors </li></ul><ul><li>Time spent with patient relatively undervalued versus diagnostic tests and medicine </li></ul><ul><li>Devaluation of the importance of empowering the individual for their own health </li></ul><ul><li>Our cultural definition of “wellness” tends to be rather substandard since we are disease-focused </li></ul>
  5. 5. Growth of integrative medicine <ul><li>In the clinic: shared team-decision making process that respects the right of the individual to choose and direct their healing plan </li></ul><ul><li>In academics: a cooperation between complementary practitioners and clinical scientists to study whether complementary approaches are truly helpful </li></ul><ul><li>Although complementary medicine/integrative medicine is increasingly popular, still the modalities most chosen are reductionist in nature </li></ul><ul><ul><li>supplements 91% , diet change 27%, Exercise 23%, acupuncture 20%, Yoga/Qi-gong 16%, meditation/imagery 14%, energy healing 7%, prayer 6% 1 </li></ul></ul><ul><li>Yet clinical studies have established that consciousness much more than a passive observer </li></ul><ul><ul><li>profoundly influences physiology of stress </li></ul></ul><ul><ul><li>modulates perception of pain </li></ul></ul><ul><ul><li>mind-body interventions can treat depression without pharmaceuticals </li></ul></ul><ul><li>However, I would argue we are all using mind-body approaches at least subconsciously 100% of the time </li></ul>1 Frenkel et al. Integrative Cancer Therapies 9 (2010)
  6. 6. What is the placebo response? <ul><li>Placebo is defined as “any therapeutic procedure (or that component of any therapeutic procedure) which has an effect on a patient, but which is objectively without specific activity for the condition being treated” </li></ul><ul><li>Mammary ligation surgery experience 1 and arthroscopic surgery 2 </li></ul><ul><li>Cases and studies which illustrate importance of expectancy and conditioning (krebiozen), and others that show sometimes that is not even necessary 3,4 </li></ul><ul><li>Factors that influence placebo effect include physician’s outfit, manner and language, reputation of treatment 5-7 , brand, color and shape/size of pill, cost, perceived intensity of treatment </li></ul>1 L Cobb et al NEJM 1959, EG Diamond et al 1960 2 JB Mosley et al NEJM 2002 3 B Klopfer et al Journal of Prospective Techniques 1957 4 TJ Kaptchuk et al PLoS One 2010 5 DW Blumhagen Ann Intern Med 1979 6 EH Uhlenhuth et al Psychopharmacologia 1966 7 H Brody et al J Fam Pract 1980
  7. 7. Placebo or “meaning response” pervades everything we do?
  8. 8. The evolving “integrative” paradigm <ul><li>The reductionist western medicine paradigm is valid but only one dimension of treating a disease </li></ul><ul><li>Integrative medicine entails two evolutions </li></ul><ul><ul><li>Individual responsibility for lifestyle choices and healing plan </li></ul></ul><ul><ul><li>The role of mind in the healing process </li></ul></ul><ul><li>Mind-body medicine involves a recognition that consciousness is not a passive observer </li></ul>
  9. 9. Dysregulation of stress due to allostatic load Domain of mind Domain of mind Domain of mind Domain of mind Domain of mind All modifiable except age/gender!
  10. 10. Current evidence for mind-body approaches <ul><li>Cognitive therapy – QOL in cancer, psychiatric disorders </li></ul><ul><li>Meditation – psychiatric disorders, chronic pain, insomnia, QOL in cancer </li></ul><ul><li>Biofeedback – HTN, headaches, back pain, constipation, incontinence </li></ul><ul><li>Hypnosis – acute and chronic pain, burns, QOL in cancer, irritable bowel </li></ul><ul><li>Guided imagery – pain, QOL in cancer </li></ul><ul><li>Yoga/Tai-chi - stress reduction, addiction, QOL, HTN, osteoarthritis, epilepsy, heart disease, psychiatric disorders </li></ul><ul><li>Hallucinogens – QOL in terminal cancer </li></ul><ul><li>What is the evidence for overall survival benefit in cancer? </li></ul>
  11. 11. Trials looking at overall survival impact of mind-body interventions in cancer <ul><li>Spiegel et al unable to replicate survival benefit with support-expressive group therapy 2007 1,2 </li></ul><ul><ul><li>Interestingly subset analysis indicated triple negative breast cancer patients did benefit (OS 29.8 mo vs 9.3 mo in control arm) </li></ul></ul><ul><li>5 randomized trials and 1 matched cohort trial showed survival benefit </li></ul><ul><li>6 studies, 4 involving breast cancer patients found no overall survival benefit </li></ul><ul><li>1 systematic review and 2 meta-analyses found no survival benefit </li></ul><ul><li>Two meta analyses suggested one-on-one treatments are more effective than group therapy 3,4 </li></ul><ul><li>Importantly, no harmful effect detected </li></ul>1 D Spiegel et al Lancet 1989 3 RL Osborn et al Int’l J Psych Med 2006 2 D Spiegel et al Cancer 2007 4 G Smedslund et al J Psychosom Res 2004
  12. 12. What is spontaneous remission? <ul><li>Fact: spontaneous remission of disease, even what science calls incurable metastatic cancer, has occurred and has been reported </li></ul><ul><li>Dr. Andrew Weil “If this kind of healing [miracles] can happen in one human being, I believe it can happen in all. All the circuitry and machinery is there, the problem is simply to discover how to turn on the right switches to activate the process.” </li></ul><ul><li>Hypothesis: What if the “problem” is that we are all carry potentials for miracles, but that we are culturally conditioned to deactivate them? </li></ul>
  13. 13. Optimization of a comprehensive mind-body approach to cancer <ul><li>Must recognize/address the importance of the subconscious mind </li></ul><ul><li>Must shut down the fear and stress (fight or flight state) response </li></ul><ul><li>Useful to discuss the meaning of death </li></ul><ul><li>In individuals with less anticipated survival time, greater need for rapid insights </li></ul><ul><li>Current mind-body approaches tend to be focused on patient-reported problems, but a comprehensive approach needs to recognize that ego is not always aware of what needs to be healed </li></ul>
  14. 14. Basic anatomy of consciousness <ul><li>Conscious and subconscious mind </li></ul><ul><li>Conscious mind is a very small part of who we are </li></ul><ul><li>The subconscious mind is like a hard drive that records our past experiences AND the ascribed meaning of them </li></ul><ul><li>Without awareness of what we have in our subconscious, we tend to be rather unconscious in terms of how we live and make choices (conditioned response) </li></ul><ul><li>Critical issue here is that the conscious mind tends to be an unreliable reporter of what needs to be healed within* </li></ul>Conscious mind Subconscious
  15. 15. Framework of why clinical studies have not yet been able to detect survival benefit in cancer Always filtered by the subconscious mind Conscious intention, visualization, prayer or medical treatment Negative result
  16. 16. spiritual mental emotional physical spiritual mental emotional physical Paradigm of true healing “ to be whole again” shadow ego/conscious Materialist paradigm
  17. 17. Perspectives on true healing <ul><li>Has been proven that self-censorship of emotions and thoughts (a side effect of the “think positive movement”) does not help patients </li></ul><ul><li>First order of business in mind-body healing is self-love and acceptance </li></ul><ul><li>The great difficulty is recognizing the shadow (subconscious) that needs integration. The process can feel terrifying, incredibly saddening </li></ul><ul><ul><li>St. Catherine of Siena “The more violence you to do yourself, the more, also, you will advance in virtue…They who most advance in virtue are those who force themselves to overcome those matters that to them are most grievous and contrary.” </li></ul></ul><ul><ul><li>Sri Aurobindo “On each height we conquer we have to turn to bring down its power and its illumination into the lower mortal movement.” </li></ul></ul>
  18. 18. Recommended mind-body approaches <ul><li>Journal keeping – encourages the detached observer, non-judgment of self and others </li></ul><ul><li>Cognitive therapy –cognitive-behavioral therapy, hypnosis, NLP </li></ul><ul><li>Biofeedback – Heartmath TM , RESPeRATE TM </li></ul><ul><li>Reiki/subtle energy based healing – healer dependent </li></ul><ul><li>Meditation/yoga/Qi-gong/Conscious breathing - lifestyle </li></ul><ul><li>Evolutionary Healing TM – great for skeptics </li></ul>
  19. 19. Evolutionary Healing TM developed by Dr. Paul Canali <ul><li>Advantage: does not rely on accurate reporting by ego, no agenda by the healer as to what the first insight will be, excellent first step for skeptics </li></ul><ul><li>Disadvantage: takes 30min-1hr, difficult emotions and memories likely will be confronted </li></ul><ul><li>Common insight is “I never realized I was holding on to that belief/trauma for so long” </li></ul><ul><li>Awakens a recognition that healing takes place not just on the physical battlefield, but also in the mind as well </li></ul><ul><li>A state of emotional wellness is often experienced, and then serves as a stark contrast to what the ego once believed was “OK” to begin with </li></ul>
  20. 21. Framework of how consciousness contributes to healing Subconscious mind Conscious intention, visualization, prayer or medical treatment True healing Remove all resistances If framework is correct, both complementary and western medicine should work more effectively
  21. 22. Closing thoughts on an integrative approach to cancer <ul><li>Exciting frontier for cancer treatment is a comprehensive mind-body approach </li></ul><ul><li>Allow cancer to become a catalyst for greater life wisdom </li></ul><ul><li>Trust, listening and compassion are potent medicine </li></ul><ul><li>Culturally, we need to expand the definition of healing to more than just overcoming disease. It is about connecting people with a life worth living passionately. </li></ul>
  22. 23. <ul><li>“ It is no measure of health to be well adjusted </li></ul><ul><li>to a profoundly sick society.” </li></ul><ul><li>Jiddhu Krishnamurti </li></ul>“ Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” Marie Curie