mind-body medicine Archives > Absenger Cancer Education Foundation

Tai Chi and Breast Cancer Survivors: Friends with Benefits?

April 9, 2013 by Werner Absenger

Image for the post of Tai Chi and Breast Cancer Survivors

Tai Chi is a mind-body medicine practice that has positive effects on aerobic capacity, muscular strength, and quality of life among breast cancer survivors.

Tai Chi and Breast Cancer Survivors Introduction

As I am examining Janelsins et al.’s (2011) paper¹, I cannot help but develop a clear vision of a middle-aged woman, lets call her Evalyn, moving gracefully about with slow, deliberate, mindful movements. How did we get to this tranquil picture of Tai Chi Evalyn?

The inner struggle of staying a breast cancer survivor without worrying herself senseless probably adds a considerable amount of pressure to Evalyn’s daily routines. I can only imagine the many burning questions that could be hurrying through Evalyn’s head. These enigmas most likely hurled Evalyn into self-education on staying a long-term breast cancer survivor.

Factors Contributing to Quality of Life in Breast Cancer Survivorhsip

She might have found out that weight gain in breast cancer survivors is of notable concern. Weight gain after diagnosis with breast cancer has negative effects on quality of life¹. In the process of educating herself, Evalyn might have discovered that weight gain after diagnosis of breast cancer can lead to increased risk of all-cause mortality². [Read more…]

Mind-Body Medicine in Sexual And Reproductive Health & Sexual Wellbeing

February 28, 2013 by Werner Absenger

My colleague Alex Baker and I just had an article published in the peer-reviewed journal Sexual and Relationship Therapy. The article introduces a hypothetical group model of Sexual Wellness Enhancement and Enrichment Training (SWEET) that focuses on a number of research-based healing modalities, including conscious breathing, mindfulness meditation, mindful eating, movement exercises, autogenics and biofeedback, as a possible option for improving sexual wellness through adequate and informed self-care.

In the article, we address not only the potential benefits of a mind-body skills group that is modified to address sexual and reproductive health and sexual wellbeing from a behavioral perspective, but we also elaborate on the potential impact of the intervention on stress and reproductive hormones.

Much credit goes to Alex Baker because she laid the groundwork for this article with her Master’s project on sexual and reproductive health and sexual wellbeing. We just put our heads together to see how we could demonstrate the impact of the mind-body approaches of the group on a person’s stress and reproductive hormones. In our conclusion, we pen that the model seems to be solidly grounded in the scientific literature to address sexual and reproductive health and sexual wellbeing.

Alex is toiling on the mind-body facilitator’s handbook. Once Alex completes this piece, addressing sexual health with SWEET in the real world will be our next step. Follow-up studies to quantify the influences of SWEET on sexual and reproductive health are planned.

The elegance about SWEET is that it is not a magic bullet approach (presupposing one particular modality will be the key); alternately it offers participants a variety of modalities to pick and choose from so they may append their toolbox from which participants then can commit themselves to their most appropriate tool for self-care.

Whys is this important to cancer patients? Cancer affects many couples’ most intimate aspects of their lives. Maintaining/improving sexual wellbeing as well as sexual and reproductive health is one way to increase the quality of life for cancer patients.

You can subscribe below to stay tuned for regular updates on our progress with the next steps… Here is the citation.

Baker, A. C., & Absenger, W. (2013). Sexual Wellness Enhancement and Enrichment Training (SWEET): A hypothetical group model for addressing sexual health and wellbeing. Sexual and Relationship Therapy, 1–15. doi:10.1080/14681994.2013.770142

Werner

Oh et al., 2010 – Medical Qigong, quality of life and inflammation in cancer patients

February 26, 2013 by Werner Absenger

Could you benefit from a moving meditation to harmonize body, mind and spirit?

Mindful movement such as Qigong can help circulation and balance energy, improve health and prevent disease.

[Read more…]

The Continuum Center for Health and Healing is Expanding!

October 22, 2012 by Werner Absenger

Image Credit: CCHH

Located
in the heart of New York City, the Continuum Center for Health and Healing
(CCHH) offers a wide range of integrative treatment approaches. Physicians and
practitioners of diverse healing traditions provide primary and specialty care
to address physical, emotional, and spiritual needs.

[Read more…]

Mravec et al. (2008). Neurobiology of Cancer and Mind-Body Medicine’s Hypnotherapy

June 26, 2012 by Werner Absenger

In this paper Mravec, Gidron, & Hulin, (2008) discuss some of the known facts about the nervous system and tumorigenesis, but also ask if the brain is capable of monitoring and/or modulating the creation of cancer cells (tumorigenesis). This is crucial especially if we would like to consider the mind-body modality of hypnotherapy to be utilized by cancer patients.

The Abstract:

The interactions between the nervous, endocrine and immune systems are studied intensively. The communication between immune and cancer cells, and multilevel and bi-directional interactions between the nervous and immune systems form the basis for a hypothesis assuming that the brain might observe and regulate the processes associated with the development and progression of cancer. The aim of this article is to describe the data supporting this hypothesis.

The Bottom Line:

According to Yapko (2003) the premise of hypnotherapy is “…the client has valuable abilities that are present but hidden, abilities that can be uncovered and used in a deliberate way to overcome symptoms and problems” (p. 18).

Division 30 of the American Psychological Association has this to say about hypnotherapy: “When using hypnosis, one person (the subject) is guided by another (the hypnotist) to respond to suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behavior” (Division 30, APA, n.d.).

As part of an assignment in one of my graduate hypnosis courses, I was asked to come up with my own interpretation of hypnotherapy, given that there seems to be no definitive answer so far. Based on the readings of Hammond (1998), Krippner (2004) and Yapko (2003) my working definition of hypnosis would be:

“Clinical Hypnosis is a COMMUNICATIONS technique between hypnotist and subject to AMPLIFY (to a possible power of a gazillion) the subject’s AWARENESS of his/her innate ability to heal and thus directly impact the subject’s physiology in order to overcome deliberately symptoms and problems.”

A more academically correct term would be to the nth power! I guess I like a gazillion, because it illustrates the scope and impact of hypnosis much better than nth power.

To continue down this path, lets look if hypnotherapy has ever been used successfully to bring about physiological changes in the body. One such physiological change that comes to mind is accelerated healing. Two papers, Ginandes, Brooks, Sando, Jones, & Aker (2003) and Ginandes & Rosenthal (1999) shed more light on the possibility. The lead author of both papers, Dr. Ginandes of Harvard Medical School, showed that subjects hypnotherapy groups experienced accelerated healing for postsurgical wound healing (2003) and the healing of bone fractures (1999). Dr. Dabney Ewin, M.D. (1983) of Tulane University, on the other hand, has extremely compelling cases for the efficacy of hypnosis in burn patients.

This brings me back to the article “Neurobiology of cancer: Interactions between nervous, endocrine and immune systems as a base for monitoring and modulating the tumorigenesis by the brain by Mravec et al. (2008).

The authors start with a brief review of the neuro-endocrine-immune interaction as the base for the neurobiology of peripheral diseases such as cancer. Mravec et al. (2008) cite research that points towards the existence of a “sixth sense” so to speak, that is able to detect signals that otherwise are undetectable by the body’s five senses.

They say

“The role of the immune system in tumorigenesis is of relevance to the CNS [central Nervous system] since the nervous and immune systems can bi-directionally communicate by using a conventional chemical language employing peptide and non-peptide neurotransmitters, hormones, cytokines and common receptors” (p.151).

Then Mravec et al. (2008) go on to elaborate on known clinical and experimental data that substantiate the notion that the brain monitors and modulates the creation of cancer cells.

They cite different animal studies which“…might support the assumption that CNS receives signals related to tumorigenesis” (p. 152), before elaborating on human studies that show differences in the activity of brain regions, such as “… reduced prefrontal activation in cancer patients versus control…” (p. 152).

Mravec et al. (2008) then go on to explain their views on the impact of psychosocial factors and stress on cancer incidence and progression. I will elaborate on these in a future post, as they deserve independent analysis.

This brings us to part three of their paper (my favorite) titled “Nervous system and tumorigenesis: questions, assumptions, and hypotheses” (Mravec et al., 2008, p. 154).

The immune system’s sensory functions to detect and monitor tumor cells and Mravec et al. (2008) hypothesize that the cancer cells release molecules that might serve as messengers to directly “inform” (p. 154) the brain about the state of the creation of cancer cells.

Mravec et al. (2008) explore two indirect pathways, a slow, less informative, non-specific humoral pathway. Cytokines are part of this pathway and the authors go on to say that cytokines stimulate the production of prostaglandins, which in turn might be “…crucial messengers that constitute the links between circulatory cytokines and CNS” (p. 154).

The other indirect pathway mentioned by the authors is the neural pathway, which might be exceedingly location-specific and fast. In other words, the immune system can reach the CNS via peripheral nerves with cytokines playing a significant role, as well. This is illustrated by data that show “…vagal sensory neurons themselves express mRNA for IL-1 receptors, suggesting a direct reaction of afferent vagal fibers to peripheral IL-1” (Mravec et al., 2008, p. 154). This means that cytokines might activate the vagus nerve to disseminate information from the immune system to the CNS.

One last example I’ll list here is a situation in which levels of pro-inflammatory cytokines are low, but nonetheless, somehow these low levels of cytokines are able to contribute to the formation of cancer cells. This involves paraganglia (visceral sensors) that support the transmission of data from the immune system to the brain via the vagus nerve. These structures contain cells that are able to manifest IL-1 receptors, providing a vital link between immune and nervous system (Mravec et al., 2008).

What about direct transmission of information about cancer to the brain?

Mravec et al. (2008) speculate that chemical compounds during tumorigenesis provide enough information to the brain in order for the brain to recognize cancer cells. While uncertain, Mravec et al. (2008) speculate that there might a signaling model specific to tumorigenesis at play, which would allow the brain to “detect” cancers.

Because of this “detection” Mravec et al. (2008) speculate that tumorigenesis could be modulated via neurotransmitters that act on cancer cells.

Then the authors go on into a long explanation (which will be explored in future posts) on how the brain might modulate tumorigenic activities. I am going to jump to the last two points Mravec et al. (2008) make, as it pertains directly to mind-body medicine and hypnosis.

Modulation of tumorigenesis by the brain as a new therapeutic approach.

Mravec et al. (2008) hypothesize and cite research that immunomodulation of the autonomic nervous system could represent a new approach to cancer therapy. This could be achieved by mapping areas of the brain, which regulate various immune functions. For example, natural-killer cell (NK) activity is germane to quash cancer cells, whereas elevated right-hemisphere activity is associated with reduced NK cell activity.

So, if one could then modify the activity of the specific brain regions and structures that are associated with the regulation of specific immune functions, as suggested by Mravec et al. (2008), one then could claim to use immunomodulation effectively as cancer treatment.

And finally, we have come full circle in the role of the CNS, tumor interactions, and mind-body medicine as a therapeutic approach.

Hypnotherapy has been shown to affect brain structures in many different shapes and forms (Halsband, 2006; Halsband, Mueller, Hinterberger, & Strickner, 2009; Rainville, Hofbauer, Bushnell, Duncan, & Price, 2002).

Hypnotherapy has also been used successfully in the cancer patients (Montgomery et al., 2007; Richardson, Smith, McCall, & Pilkington, 2006; Spiegel & Bloom, 1983) just to name a few.

Here, is the website of The Society of Psychological Hypnosis for a bunch of exceptionally reliable information about hypnosis. If you truly desire a front row seat to over one hundred interviews with the world’s greatest hypnosis researchers and clinicians, I encourage you to visit Dr. Eric Willmarth’s site featuring the Willmarth Hypnosis Interviews.

While there are exciting times ahead for hypnotherapy and its role in cancer treatment, please understand that hypnotherapy is used successfully with cancer patients already. As always, please discuss the pros and cons with your primary health care provider, and please, do your homework in finding a reputable hypnotherapist. You might want to start your search by visiting two organizations, which I am a member of The Society of Psychological Hypnosis and SCEH, the Society for Clinical & Experimental Hypnosis.

Image Credit:

Schönpflug, F. (1906). Der Hypnotizeur Fritz Schönpflug. Retrieved from Images from the History of Medicine (NLM) website at http://www.nlm.nih.gov/hmd/ihm/.

References:

Division 30, APA. (n.d.). The official Division 30 definition and description of hypnosis. Retrieved June 26, 2012, from http://psychologicalhypnosis.com/info/the-official-division-30-definition-and-description-of-hypnosis/

Ewin, D. M. (1983). Emergency Room Hypnosis for the Burned Patient. American Journal of Clinical Hypnosis, 26(1), 5–8. doi:10.1080/00029157.1983.10404130

Ginandes, C., Brooks, P., Sando, W., Jones, C., & Aker, J. (2003). Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial. The American Journal of Clinical Hypnosis, 45(4), 333–351. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12722936

Ginandes, C., & Rosenthal, D. (1999). Using hypnosis to accelerate the healing of bone fraactures: A randomized controlled pilot study. Alternative Therapies in Health and Medicine, 5(2), 67–75. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=10069091&site=ehost-live&scope=site

Halsband, U. (2006). Learning in trance: Functional brain imaging studies and neuropsychology. Journal of Physiology-Paris, 99, 470–482. doi:10.1016/j.jphysparis.2006.03.015

Halsband, Ulrike, Mueller, S., Hinterberger, T., & Strickner, S. (2009). Plasticity changes in the brain in hypnosis and meditation. Contemporary Hypnosis, 26(4), 194–215. doi:10.1002/ch.386

Hammond, D. C. (1998). Hypnotic induction and suggestion. Chicago, IL: American Society of Clinical Hypnosis. Retrieved from http://asch.net/books.htm

Krippner, S. (2004). Hypnotic-like procedures used by indigenous healing practitioners. Presented at the Annual Convention of the American Society of Clinical Hypnosis, Anaheim, CA. Retrieved from http://stanleykrippner.com/papers/asch.2004.htm

Montgomery, G. H., Bovbjerg, D. H., Schnur, J. B., David, D., Goldfarb, A., Weltz, C. R., Schechter, C., et al. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. JNCI Journal of the National Cancer Institute, 99(17), 1304–1312. doi:10.1093/jnci/djm106

Mravec, B., Gidron, Y., & Hulin, I. (2008). Neurobiology of cancer: Interactions between nervous, endocrine and immune systems as a base for monitoring and modulating the tumorigenesis by the brain. Seminars in Cancer Biology, 18(3), 150–163. doi:10.1016/j.semcancer.2007.12.002

Rainville, P., Hofbauer, R. K., Bushnell, M. C., Duncan, G. H., & Price, D. D. (2002). Hypnosis modulates activity in brain structures involved in the regulation of consciousness. Journal of Cognitive Neuroscience, 14(6), 887–901. doi:10.1162/089892902760191117

Richardson, J., Smith, J. E., McCall, G., & Pilkington, K. (2006). Hypnosis for Procedure-Related Pain and Distress in Pediatric Cancer Patients: A Systematic Review of Effectiveness and Methodology Related to Hypnosis Interventions. Journal of Pain and Symptom Management, 31, 70–84. doi:10.1016/j.jpainsymman.2005.06.010

Spiegel, D., & Bloom, J. R. (1983). Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine, 45(4), 333–339. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6622622

Yapko, M. (2003). Trancework : an introduction to the practice of clinical hypnosis (3rd ed.). New York: Brunner-Routledge.

Writing an essay, paper, or report? Cite this story:

APA: W Absenger. (2012.06.26). Mravec et al. (2008). Neurobiology of cancer and mind-body medicine [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/mravec-et-al-2008-neurobiology-of-cancer-and-mind-body-medicine.html

MLA: Absenger, Werner. ” Mravec et al. (2008). Neurobiology of Cancer and mind-body medicine.” The Alternative Medicine Blog. The Alternative Medicine Blog. 26 June. 2012. Web. Insert your date of access here.

Pilot Project: Quality Of Life Outcomes Following Mind-Body Skills Training For Cancer Patients Facilitated Either Face-To-Face Or Online Ends Today

June 25, 2012 by Werner Absenger

Image Credit: See Reference List

I finished the final intervention session for the MBM Skills pilot project today. Now I will move on to “crunching the numbers.” Below is a brief overview of the pilot project.
Aim: To answer the questions of whether a Mind-Body Medicine (MBM) skills group facilitated face-to-face and online can improve measures of Quality of Life (QOL) in a population of cancer patients.

Value of Study: Technological advances have contributed to new venues for healthcare delivery. It is imperative that these new delivery methods, for individual and/or group psychological services are sufficiently tested and validated. Owen, Bantum, and Golant (2009) claim that there is very little knowledge about differences in communication styles between online and face-to-face groups, nor is there much knowledge on the overall efficacy of online group interventions.

Phenomenon Studied: Can MBM skills groups improve the quality of life of cancer patients? Is there a difference in outcome between a MBM skills group delivered face-to-face and a MBM skills group delivered online.

Reasons Leading to Proposing the Project: Despite encouraging research showing that psychosocial interventions have positive effects in the lives of cancer patients, more research is needed due to lack of use of technological advances such as use of video conferencing and relatively few existing studies on the effectiveness of MBM therapies in the oncological setting.

Hypothesis 1: There is no difference between baseline QOL measures and QOL measures at the end of face-to-face facilitated MBM skills groups (Operational null hypothesis).

Hypothesis 2: There is no difference between baseline QOL measures and QOL measures at the end of online facilitated MBM skills groups (Operational null hypothesis).

Hypothesis 3: Participation in either, online facilitated MBM skills groups or face-to-face facilitated MBM skills groups will improve QOL measures when compared to control group (Literary alternative).

Hypothesis 4: Patients in the control group (waitlisted control, care as usual group) will have no improvement on QOL measures (Operational Alternative).

Brief Description of the Research Design Study Type

Interventional Study Design: Supportive Care, Parallel Assignment, Open Label, Efficacy Study

Primary Outcome Measure: Change in Quality of Life as assessed by the World Health organization Quality of Life (WHOQOL-BREF) Instrument

Secondary Outcome Measure: Change in distress, anxiety, depression and need for help as assessed by the Emotion Thermometers Tool© (ET5)

Time Frame: Baseline, Week 4

Data Collection, Analysis, and Reporting: Data was collected at baseline and at week 4. Data analysis will be performed using IBM® SPSS® Statistics Software Version 19. Significance threshold is set a p < .05. Pre- and post-skills training comparisons of WHOQOL-BREF and ET5 scores will be performed.

Anticipated Value to the Larger Community: According to the National Center for Complementary and Alternative Medicine (NCCAM) “…there is a need for reliable, objective, evidence-based information regarding the usefulness and safety—or lack thereof—of CAM” (National Center for Complementary and Alternative Medicine, 2011, p.3). This study will add to general scientific knowledge of CAM.

Treatment Procedures: The mind-body skills group is a form of educational intervention, combining the learning of such mind-body skills as meditation, breath exercises, relaxation, and imagery, with a sharing of emotions and experiences in a small group (6-10 participants) setting. The mind-body skills group provides a setting for the development of increased self-awareness and self-discovery, along with the mastery of mind-body skills that are useful for personal health and wellness.

Risk-to-Benefit Ratio: Mind-Body interventions seem to carry with them relatively little risk when compared to the potential benefits. Thus the benefits of participation in this proposed research seem to outweigh the potential adverse events significantly.

The Bottom Line: As mentioned above, today was the last day for group intervention with final collection of data. Over the next couple of weeks, I’ll crunch the numbers and write up a final report. I will announce the final outcomes of this pilot project right here on The Alternative Medicine Blog. I am also looking to have the data scrutinized via peer review by locating an appropriate scientific journal.

In the meantime, if you are a cancer patient, loved one/caretaker of a cancer patient or a health care professional wanting to participate in an Online MBM Skills group, please go to my cancer support group page or check out the entry titled “Dealing with Cancer is Crazy Enough; Attending a Support Group Shouldn’t Be!” right here on The Alternative Medicine Blog.

On the other hand, if you are a fellow researcher interested in investigating Mind-Body Medicine modalities in the oncological setting, please do not hesitate to contact me for possible research collaboration for existing projects or to develop, plan and implement future research projects.

Image Credit:

National Institutes of Health (U.S.). Medical Arts and Photography Branch. (1994). Mind-body interactions and disease a symposium on the relationships between mental states, immune function, and health. Retrieved from Images from the History of Medicine (NLM) website at http://www.nlm.nih.gov/hmd/ihm/

References:

National Center for Complementary and Alternative Medicine. (2011). NCCAM’s Third Strategic Plan: Exploring the Science of Complementary and Alternative Medicine (No. Third Strategic Plan) (p. 62).

Owen, J. E., Bantum, E. O., & Golant, M. (2009). Benefits and challenges experienced by professional facilitators of online support groups for cancer survivors. Psycho-Oncology, 18(2), 144–155. doi:10.1002/pon.1374

Writing an essay, paper, or report? Cite this story:

APA: W Absenger. (2012.06.25). Pilot Project: Quality of life outcomes following mind-body skills training for cancer patients facilitated either face-to-face or online ends today [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/pilot-project-quality-of-life-outcomes-following-mind-body-skills-training-for-cancer-patients-facil.html

MLA: Absenger, Werner. ” Pilot Project: Quality of Life Outcomes Following Mind-Body Skills Training for Cancer Patients Facilitated either Face-To-Face or Online Ends Today.” The Alternative Medicine Blog. The Alternative Medicine Blog. 25 June. 2012. Web. Insert your date of access here.

de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema

June 23, 2012 by Werner Absenger

Image Credit: See Reference List

Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.
The Abstract (de Valois et al., 2012, p. 301).

Purpose: Within a three-step mixed-methods study to investigate using acupuncture and moxibustion (acu/moxa) in the management of cancer treatment-related upper body lymphoedema, Step 2 obtained preliminary data about: 1) whether acu/moxa can improve quality of life, 2) the most troublesome symptoms, and 3) adverse effects.

Methods and sample: An exploratory single-arm observational clinical study included breast (BC) and head and neck cancer (HNC) survivors with mild-to-moderate uncomplicated lymphoedema for ≥3 months, ≥3 months post active-cancer treatment, no active cancer disease, undergoing routine lymphoedema maintenance. Participants received seven individualised treatments (S1), and six optional additional treatments (S2). MYMOP, SF-36 and PANAS were administered at baseline, during each series, and at follow-up 4 and 12 weeks after end-of-treatment. The primary outcome was change in MYMOP scores at the end of each series.

Key results: Of 35 participants recruited, 30 completed S1 and S2, 3 completed S1, 2 were lost to the study. Mean MYMOP profile change scores for BC participants were 1.28 points improvement on a 7-point scale (sd = 0.93, p < 0.0001, n = 25) for S1; and 1.41 for S2 (sd = 0.94, p < 0.0001, n = 24). S1 HNC change scores were 2.29 points improvement (sd = 0.62, p < 0.0001, n = 7); and 0.94 for S2 (sd = 0.95, p = 0.06, n = 6). Changes in some SF-36 scores for BC participants were significant to 4 weeks after treatment. No serious adverse effects were reported.

Conclusion: This small study suggests acu/moxa is an acceptable adjunct to usual care for cancer survivors with lymphoedema. Further rigorous research is warranted to explore the effectiveness of acu/moxa in reducing the symptom burden.

de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema

The Bottom Line:

Cancer patients at risk of developing lymphedema want to learn how to recognize early signs and symptoms, and once diagnosed, treatment aims to reduce size, physical dysfunction and complications (de Valois et al., 2012).

de Valois et al. (2012) cites research showing that lymphedema has negative psychosocial effects for women and is “One of the most troublesome and feared consequences of breast cancer surgery” (Ganz 1999, as cited in de Valois et al., 2012, p. 302).

The treatment should address quality of life, physiological and psychosocial problems associated with lymphedema. Complementary and Alternative Medicine (CAM) is increasingly desired by cancer patients (de Valois et al., 2012).

Acupuncture, part of Traditional Chinese Medicine, is a CAM modality cancer patients are drawn to for improvement of symptoms and better physiological and psychosocial coping (de Valois et al., 2012).

Based on previous research by one of the authors with breast cancer patients that demonstrated “…measurable improvements in wellbeing, improved quality of life, and symptom relief…” when using acupuncture de Valois et al. (2012) set out to investigate if acupuncture could be successful in the management of lymphedema asking the questions (p. 302):

Can acu/moxa improve wellbeing in cancer survivors with lymphoedema?
What symptoms are most troublesome for these individuals?
Is acupuncture a safe intervention for people with lymphoedema?

Because of the nature of lymphedema, acupuncture is considered a controversial treatment. People with lymphedema should focus on reducing the possibility of further infection and swelling via accidental or non-accidental (as in acupuncture) skin punctures in the affected area (de Valois et al. 2012). Many practitioners suggest that it is considered a good idea for lymphedema patients to avoid acupuncture altogether. However, this is not the case according to de Valois et al. (2012, p. 302) who state “In lymphoedema and cancer policy documents, acupuncture is not contraindicated, and guidance is the same as for all NASP [non-accidental skin punctures] interventions, in that needling the affected area should be avoided.”

De Valois et al. (2012) selected to use the following three validated instruments to use as outcome measures:

Medical Outcome Profile (MYMOP) “…is widely used for evaluating interventions based on holistic and participative principles, and allows patients to define and evaluate outcomes that are pertinent to them” (de Valois et al., 2012, p. 303).

The Medical Outcomes Study Short Form (SF-36) “…is a generic 36- item functional status questionnaire that assesses eight domains of physical and psychological health” (de Valois et al., 2012, p. 303).

The Positive and Negative Affect Schedule (PANAS) “…is a 20-item validated measure used to assess mood states” (de Valois et al., 2012, p. 303).

The acupuncture protocol was designed to replicate “usual clinical practice,” (de Valois et al., 2012, p. 303) with treatments focusing on “presenting signs, symptoms and priorities” (de Valois et al., 2012, p. 303) of the patients, as this “real-world” acupuncture study design has high external validity.

de Valois et al. (2012) mention in their paper that, for further studies, they will eliminate the PANAS questionnaire due to higher than expected proportion of missing data. The authors also make a note of some limitations of their study, which are: uncontrolled study design, single setting, small number of head & neck cancer patients participants, and research acupuncturist acted as principal investigator as well (de Valois et al., 2012).

The authors also point out that they never set out to cure lymphedema, rather they wanted to show that patients with lymphedema can use acupuncture safely to address “…a range of physical and emotional conditions, and reduce symptom burden (de Valois et al., 2012, p. 307).

Because of the significant improvements (as mentioned in the abstract) further research is warranted to investigate the effects of acupuncture in lymphedema. The authors have plans for a randomized controlled trial investigating the effects of acupuncture in breast cancer related lymphedema.

What do the study results mean for a cancer patient wanting to use acupuncture addressing lymphedema?

This trial can not be generalized, due to some of the limitations mentioned above. It was simply not designed to this. It was designed as a pilot trial to determine if further research might be warranted.

That does not mean you should not discuss this option with your primary health care provider. She/he might be open to working with an expert acupuncturist to see if acupuncture could be a viable treatment, to address the physical and emotional conditions and to reduce the symptom burden you might be experiencing, especially if lymphedema is the result of breast cancer treatment.

References:

de Valois, B. A., Young, T. E., & Melsome, E. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema. European Journal of Oncology Nursing, 16(3), 301–309. doi:10.1016/j.ejon.2011.07.005

Ganz, P.A. (1999). The quality of life after breast cancer – solving the problem of lymphedema. New England Journal of Medicine 340 (5), 383-385.

Image Credit:

École supérieur d’acupuncture française. (n.d.). Images from the History of Medicine (NLM): Acupuncture. Retrieved from Images from the History of Medicine (NLM) website at http://ihm.nlm.nih.gov/luna/servlet/view/all.

Writing an essay, paper, or report? Cite this story:

APA: W Absenger. (2012.06.23). de Valois et al. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/de-valois-et-al-2012-assessing-the-feasibility-of-using-acupuncture-and-moxibustion-to-improve-quali.htm

MLA: Absenger, Werner. “de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema.” The Alternative Medicine Blog. The Alternative Medicine Blog. 23 June. 2012. Web. Insert your date of access here.

Bhattacharjee & Khuda-Bukhsh. (2012). Two Homeopathic Remedies Provide Protective Effects Against Hepatotoxicity Induced by Carcinogens…

June 21, 2012 by Werner Absenger

This team of researchers looked at the effects of potentized cholesterinum used with another homeopathic remedy, Natrum Sulphuricum on carcinogen-induced hepatotoxicity. In other words, the researchers wanted to see if these two homeopathic remedies could reduce damage of cancer causing agents fed to mice.

The Abstract

The purpose of the study was to evaluate whether potentized cholesterinum (Chol) intermittently used with another homeopathic remedy, Natrum Sulphuricum (Nat Sulph) can provide additional benefits in combating hepatotoxicity generated by chronic feeding of carcinogens, p-dimethylaminoazobenzene (p-DAB), and phenobarbital (PB).

Mice were categorized into subgroups: normal untreated (Gr-1); normal + alcohol “vehicle” (Alc) (Gr-2), 0.06% p-DAB + 0.05% PB (Gr-3), p-DAB + PB + Alc (Gr-4), p-DAB + PB + Nat Sulph-30 (Gr-5), p-DAB + PB + Chol-200 (Gr-6), p-DAB + PB + Nat Sulph-30 + Chol-200 (Gr-7), p-DAB + PB + Nat Sulph-200 (Gr-8), and DAB + PB + Nat Sulph-200 + Chol-200 (Gr-9).

Hepatotoxicity was assessed through biomarkers like aspartate and alanine aminotransferases (AST and ALT), acid and alkaline phosphatases (AcP and AlkP), reduced glutathione content (GSH), glucose 6-phosphate dehydrogenase (G6PD), gamma glutamyl transferase (GGT), lactate dehydrogenase (LDH), and analysis of lipid peroxidation (LPO) at 30, 60, 90, and 120 days and antioxidant biomarkers like superoxide dismutase (SOD), catalase (CAT), and glutathione reductase (GR) were assayed.

Electron microscopic studies (scanning and transmission) and gelatin zymography for matrix metalloproteinases were conducted in liver. The feeding of the homeopathic drugs showed intervention in regard to the increased activities of AST, ALT, AcP, AlkP, GGT, LDH, and LPO and decreased activities of G6PD, SOD, CAT, GR, and GSH noted in the intoxicated mice, more appreciable in Groups 7 and 9. Thus, combined therapy provided additional antihepatotoxic and anticancer effects (Bhattacharjee & Khuda-Bukhsh, 2012, p. 1).

The Bottom Line:

If you are unfamiliar with homeopathy, here is a little more information to become familiarized with the principles of homeopathy. The Western medical tradition generally frowns up homeopathy. That is because remedies are usually diluted to the point at which one could say that too few molecules remain of the original substance in the heavily diluted remedy. In other words, the remedy has been subjected to trituration, dynamization and succession, sometimes beyond Avogadro’s limit (Bhattacharjee & Khuda-Bukhsh, 2012), thus causing great controversy among scientist.

The authors of this paper talk about Natrum Sulphuricum (Nat Sulph) -30 and 200 and cholesterinum (Chol) -200.

To put this in perspective here is a paragraph from Creighton University School of Medicine:

“Supposing 40g of calcium (one mole) were diluted by homeopathic principles starting from 100% pure substance. Avogadro’s number tells us that we have 6.02×10²³ molecules per mole. By 7C the remedy would be expected to contain about 6 billion calcium molecules, and by about 11C, it would be expected to have only about 60 ((1/100)¹¹ x 6.02×10²³ = 60.2). At the 12C (or 24X) dilution, there is a 50/50 chance of one molecule being present. The dilution at which one would expect to have only one molecule does depend upon the starting number of molecules, but assuming that we started with all the atoms estimated to be in the universe, about 6×10⁷⁹ then we end up with a 50% chance to have one molecule left at 40C (or 80X), still far more concentrated than the 200C dilutions that are commonly dispensed (Creighton University School of Medicine, n.d.).

To add to the dilemma of understanding and providing evidence for homeopathic remedies is the clinical trials are plagued with problems. Pitari (2007) points out that, amongst others, homeopathic research requires more rigorous trials and more specific trail methodology. The author presents and illustration in her paper on how to more effectively design research in homeopathic medicine in order to provide credible evidence either for or against efficacy.

Having show that homeopathy is not without controversy, lets look at the results from Bhattacharjee & Khuda-Bukhsh (2012). Because this research was performed on mice, it was possible to tightly control the experiment’s condition.

Observers were blinded as to whether the samples came from the homeopathic remedy groups or placebo treated group and mice were randomized into 9 groups (24 animals in each group), each group receiving a different diet consisting of (Bhattacharjee & Khuda-Bukhsh, 2012, p. 2):

Group 1- Diet 1: Normal
Group 2 – Diet 2: Normal + Alc
Group 3 – Diet 3: p-DAB+PB
Group 4 – Diet 4: p-DAB + PB + Alc
Group 5 – Diet 5: p-DAB + PB + Nat Sulph-30
Group 6 – Diet 6: p-DAB + PB + Chol-200
Group 7 – Diet 7: p-DAB + PB + Nat Sulph-30 + Chol-200
Group 8 – Diet 8: p-DAB + PB + Nat Sulph-200
Group 9- Diet 9: p-DAB + PB + Nat Sulph-200 + Chol-200

In the result section Bhattacharjee & Khuda-Bukhsh (2012) report that on autopsy groups 1 and 2 showed healthy liver, while all the other animals showed tumor growth who received the carcinogens for 60 days or more.

Interestingly enough though the authors report that

As compared to all carcinogen fed mice showing distinct sign of tumor formation in the form of pale reddish multiple nodules, the incidence and intensity of tumor was found to be greater in the carcinogen fed mice (more pronounced in the p-DAB+PB and p-DAB+PB+Alc fed series) at 60, 90, and 120 days, the incidence and growth of tumors found in the drug fed series was less, both numerically and qualitatively. Further, in the conjoint drug fed series, the number of tumors was also lesser than in the single drug fed series (Bhattacharjee & Khuda-Bukhsh, 2012, p.5).

Differences were statistically significant and Nat Sulph-30 plus Chol-200 fed mice positive activities were most pronounced at the 90 day and the 120 intervals, with Nat Sulph-200 alone showing considerable ameliorative effect, while a combination of Nat Sulph-200 and Chol-200 showed the greatest effects (Bhattacharjee & Khuda-Bukhsh, 2012, p. 5).

Here is table 1 from their paper:

In their conclusion the authors reiterate that we don’t know the mechanism of action involved for homeopathic remedies, but proposed a hypothesis that

…Potentized homeopathic drugs might have the ability to act as a ‘molecular trigger’ for switching ‘on and ‘off’ certain relevant gene action/interaction, a series of biochemical changes could follow, that in turn could bring about the alteration observed in the parameters of the present study (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).

Furthermore the authors point towards nanoparticle research that demonstrated alteration of the “…physico-chemical property of the drug and its biological action during the process of homeopathic dynamization” (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).

Based on this research one could speculate that both homeopathic remedies could be used to treat human liver disorders associated with cancerous lesions (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).

But there is one caveat of course, more studies should be performed by other researchers to either confirm or refute these most peculiar findings.

Why peculiar? Remember, based on the tenets of classical physics, chemistry and other know facts about the universe these results should have NOT manifested in the first place.

References:

Bhattacharjee, N., & Khuda-Bukhsh, A. R. (2012). Two homeopathic remedies used intermittently provide additional protective effects against hepatotoxicity induced by carcinogens in mice. Journal of Acupuncture and Meridian Studies, In Press. doi:10.1016/j.jams.2012.05.004

Creighton University School of Medicine. (n.d.). Dynamization. Retrieved June 21, 2012, from http://altmed.creighton.edu/Homeopathy/philosophy/dilution.htm

Pitari, G. (2007). Scientific Research in Homeopathic Medicine: Validation, Methodology and Perspectives. Evidence-Based Complementary and Alternative Medicine, 4(2), 271–273. doi:10.1093/ecam/nel085

Image Credit:

Monnier, H. (n.d.). L’Homéopate et l’alléopate, en présence chez Mr. Jobard, se traient de polissons, se prennent à la gorge et le malade meurt faute de Secours. Retrieved from the Images of History of Medicine website http://www.nlm.nih.gov/hmd/ihm/

Writing an essay, paper, or report? Cite this story:

APA: W Absenger. (2012.06.21). Bhattacharjee & Khuda-Bukhsh. (2012). Two homeopathic remedies provide protective effects against hepatotoxicity induced by carcinogens [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/bhattacharjee-khuda-bukhsh-2012-two-homeopathic-remedies-provide-protective-effects-against-hepatoto.html

MLA: Absenger, Werner. “Bhattacharjee & Khuda-Bukhsh. (2012). Two homeopathic remedies provide protective effects against hepatotoxicity induced by carcinogens ” The Alternative Medicine Blog. The Alternative Medicine Blog. 21 June. 2012. Web. Insert your date of access here.

Shu-Chuan Lin & Ming-Feng Chen (2010). Increased Yin-Deficient Symptoms and Autonomic Nervous System Function in Patients with Metastatic Cancer

June 15, 2012 by Werner Absenger

Image of journal title ACEF-Yin-Deficient Symptoms and Autonomic Nervous System Function

Yin-deficient symptoms (YDS) and Metastatic Cancer

The objectives of this study were to investigate the differences in severity of yin-deficient symptoms (YDS) and function of the autonomic nervous system (ANS) between patients with cancer with metastasis and those without metastasis.

[Read more…]

Andreescu, A. (2011). Rethinking Prayer and Health Research

June 14, 2012 by Werner Absenger

This post is based on an article submitted by the author of Rethinking prayer and health research: An exploratory Inquiry on prayer’s psychological dimension, Adrian Andreescu.

Click here to find out how you can share your work with the readers of the Alternative Medicine Blog.

In this paper Andreescu (2011) tackles various issues pertaining to cancer research in the realm of transpersonal psychology. The problem of current cancer research is that we do not know for certain if psychosocial intervention is attributable to increased survival. Psychoneuroimmunology researchers are working diligently on finding key ingredients and conditions that might reveal pathways related to outcomes in cancer care. Andreescu (2011) illustrates the difficulty in the following way.

He writes that in order to overcome the medical prognosis regarding a cancer patient’s survival expectations, a cancer patient would need to change a homeostatic equilibrium via psycho emotional resources, an equilibrium already compromised by cancer, a cancer that in turn has successfully adapted to the internal conditions of its host (Andreescu, 2011). I believe Andreescu (2011) very appropriately draws a parallel between healing from cancer and playing professional sports. He writes that recovery from such a serious illness requires for a cancer patient to maximize all their resources, certainly testing the limits of human capabilities, just as world-class sports events do.

He criticizes current trials that examine the effects of psychotherapeutic interventions in cancer survival, as not adequately addressing relevant research designs. He makes an extraordinarily valuable point for three key elements relevant to psycho-oncological trials. These three key elements are the participant’s “…worldview, intentional normative dissociation (IND), and psychosomatic plasticity proneness (PPP) (Andreescu, 2011, p. 25). He hypothesizes that these factors might impact final results of a clinical trial, especially those trials designed to explore potential health benefits associated with a variety of spiritual paths. He briefly expands into explaining “… curing (clinical recovery from disease) is not considered a synonym for healing (how regained health is subjectively experienced by the former patient)” (Andreescu, 2011, p. 25).

He also argues that a spiritual practice brings together worldview, IND and PPP. Let’s briefly define these three key elements.

Worldview

Worldview is defined by Andreescu (2011) as “… a set of beliefs and assumptions that describe reality and define the boundaries of what possibly can be done towards healing by the patient himself or herself with and without additional support (medical, spiritual, etc.) (p. 25).

Intentional Normative Dissociation (IND)

is described by Andreescu (2011) as a “… State of consciousness that is not induced organically, does not occur as part of a psychiatric disorder, and involves the alteration or separation of what are usually experienced as integrated mental processes lasting a limited amount of time (p. 27). He further explains that IND is “…accompanied by an increase in the cognitive and emotional functioning,” thus possibly responsible for “…inducing positive consequences on one’s consensus consciousness” (Andreescu, p.28). Interestingly enough, he elaborates that this consciousness is consistently influenced by the shared assumptions and cultural values of the society one lives in.

Psychosomatic Plasticity Proneness (PPP)

is the 3rd dimension Andreescu (2011) relates to the healing process. The author proposes PPP as a way to conceptualize “…personal psycho emotional content into bodily reality” (Andreescu, 2011). He argues that if this element is valid, then without PPP, psychosocial factors are unable to significantly alter the progression of disease, or for that matter play a role in regaining health.

Andreescu (2011) proposes that a spiritual practice brings together worldview, IND, and PPP in promoting health. But how?

Simply put, because of the intentional dimension and wide acceptance in cultures around the world, and due to social narratives, the sustained practice of any spiritual regimen might be able to piece into a single body the previously discussed elements of worldview, IND, and PPP as they relate to healing (Andreescu, 2011).

So what does that mean for the cancer patient?

While there is research indicating that psychosocial practices could prolong life in the oncological setting, the jury is still out. That is partly, because as Andreescu (2011) points out, that we have not developed and tested the relevant research protocol in the oncological setting as it pertains to spiritual practice and cancer. However, in the context described by Andreescu (2011), spiritual practice could certainly affect a cancer patient’s biopsychosocial factors and thus relate to disease outcome.

Not directly pertaining to spiritual practice, but loosely related to Andreescu’s (2011) paper, one research team is flat out calling for a discontinuation of research to answer this question (Coyne, Stefanek, & Palmer, 2007). This petition to inaction might be premature because other research teams found “…an RCT [Randomized controlled trial] accruing women with regional breast cancer found that a 1-year, 26-session psychologic intervention was associated with improved survival 11 years later” (Andersen et al., 2008, p. 3457).

More recently, Giese-Davis et al., (2010) showed that a decrease in the Center for Epidemiologic Studies-Depression Scale (CES-D) scores resulted in median survival time of 53.6 months compared to 25.1 months for women with increasing CES-D scores (p. 413).

If spiritual practice could employ the same effects as the above mentioned studies on bioscychosocial factors, then it is reasonable to speculate that spiritual practice could certainly prolong life. Unfortunately, we just do not know and more research is needed that specifically addresses shortcomings in clinical trials as pointed out by Andreescu (2011) in his paper.

In the meantime, there is probably no harm following your familiar spiritual practice or even adopting a new spiritual practice if the goal of the cancer patient is to deal with cancer in the “big scheme of things.”

Adrian Andreescu’s (2011) paper “Rethinking prayer and health research: An exploratory inquiry on prayer’s psychological dimension” can be retrieved from the International Journal of Transpersonal Studies website by clicking on the link.

Writing an essay, paper, or report? Cite this story:

APA: W Absenger. (2012.06.14). Andreescu, A. (2011). Rethinking Prayer and Health Research [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/andreescu-a-2011-rethinking-prayer-and-health-research.html

MLA: Absenger, Werner. “Andreescu, A. (2011). Rethinking Prayer and Health Research.” The Alternative Medicine Blog. The Alternative Medicine Blog., 14 JUNE. 2012. Web. Insert your date of access here.

References:

Andersen, B. L., Yang, H.-C., Farrar, W. B., Golden-Kreutz, D. M., Emery, C. F., Thornton, L. M., Young, D. C., et al. (2008). Psychologic intervention improves survival for breast cancer patients. Cancer, 113(12), 3450–3458. doi:10.1002/cncr.23969

Andreescu, A. (2011). Rethinking prayer and health research: An exploratory inquiry on prayer’s psychological dimension. International Journal of Transpersonal Studies, 30(1-2), 23–47. Retrieved from http://www.transpersonalstudies.org/ImagesRepository/ijts/Downloads/Andreescu.pdf

Coyne, J. C., Stefanek, M., & Palmer, S. C. (2007). Psychotherapy and survival in cancer: The conflict between hope and evidence. Psychological Bulletin, 133(3), 367–394. doi:10.1037/0033-2909.133.3.367

Giese-Davis, J., Collie, K., Rancourt, K. M. S., Neri, E., Kraemer, H. C., & Spiegel, D. (2010). Decrease in Depression Symptoms Is Associated With Longer Survival in Patients With Metastatic Breast Cancer: A Secondary Analysis. Journal of Clinical Oncology, 29(4), 413–420. doi:10.1200/JCO.2010.28.4455

Image Credit: Rubens, P. P. (n.d.). Ignatius von Loyola Besessene und Kranke heilend. Retrieved from http://ihm.nlm.nih.gov/luna/servlet/view/search?q=A024370

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