Developing your Integrative Self-Care Plan

Size: px

Start display at page:

Download "Developing your Integrative Self-Care Plan"

Nelson Stone
5 years ago
Views:

University [PRESENTER PHOTO] Naturopathic Oncology Red

1 Developing your Integrative Self-Care Plan Erin Sweet ND, MPH, FABNO Assistant Research Scientist Bastyr University [PRESENTER PHOTO] Naturopathic Oncology Red Cedar Wellness Center & Orion Center for Integrative Medicine e

2 Integrative Oncology (IO) BMC Cancer Nov 21;12:539.

3 Diet Previous studies have found whole grain and fruit and vegetable intake to be related to a lower risk of mortality after breast cancer. Breast Cancer Res Treat Feb;53(3):241-53; Br J Cancer Mar;69(3):592-5 Grain and fiber intake has been associated with lower levels of estradiol and previous results suggest a potential protective effect of grain fiber in breast cancer mortality. Breast Cancer Res Treat 53: , 1999; J Clin Oncol 22: , 2004; J Clin Oncol 20: , 2002 In contrast, high consumption of animal fat may jeopardize survival. J Natl Cancer Inst 86: , 1994; J Natl Cancer Inst 85:32-36, 1993; Breast Cancer ResTreat 51:17-28, 1998

4 Diet Dietary Patterns and Survival After Breast Cancer Diagnosis 2,619 Nurses Health Study participants who were diagnosed with invasive breast cancer between 1982 and 1998 Completed a dietary questionnaire more than 1 year after diagnosis Followed through 2002 (median = 9 years) The prudent dietary pattern was characterized by a diet high in fruits, vegetables, whole grains, legumes, poultry, and fish Western pattern was characterized by high intake of refined grains, processed and red meats, desserts, high-fat dairy products, and french fries

5 Diet Before breast cancer diagnosis Prudent diet unrelated to survival Western diet had a slightly higher (nonsignificant) risk of all-cause mortality and a significantly higher risk of mortality from causes other than breast cancer After breast cancer diagnosis Prudent diet unrelated to all-cause or breast cancer mortality but related to a significantly lower risk of mortality from other causes during 20-year follow-up Western diet had an elevated risk of all-cause mortality from causes other than breast cancer Although unrelated to breast cancer specific survival, a higher intake of the prudent pattern and a lower intake of the Western pattern may protect against mortality from causes unrelated to breast cancer. J Clin Oncol Dec 20;23(36):

6 Diet Omega-3 fatty acids for breast cancer prevention and survivorship Omega-3 and omega-6 fatty acids are a group of essential polyunsaturated fatty acids (PUFAs) that play important roles in cell membrane structure, fluidity, and cell signaling Increased incidence of breast cancer and heart disease in western societies with low omega-3:omega-6 fatty acid intake ratios Very low incidence of these two conditions in populations with high marine omega-3 fatty acid intake Dramatic increase in the incidence of breast cancer and cardiovascular disease in cohorts from low-incidence populations who migrate to western countries and/or adopt a western diet Pharmacol Ther. 2014;141: ; Lancet Oncol. 2008;9:

7 Diet Higher intakes of EPA and DHA from dietary sources were reported to be associated with a 25% reduction in breast cancer recurrence and improved overall mortality in a large cohort of over 3,000 women with early stage breast cancer followed for a median of 7 years. J Nutr. 2011;141: A small randomized pilot trial suggests that 3 g/day EPA and DHA inhibits bone reabsorption in individuals taking aromatase inhibitors. Nutr Cancer. 2014;66: A small randomized trial of omega-3 fatty acids to protect against taxane induced neuropathy suggests benefit. BMC Cancer. 2012;12:355. In meta-analyses, DHA supplementation improves attention, processing speed and immediate recall, learning, and memory in individuals with cognitive impairment without dementia. Neurobiol Aging. 2012;33:1482.e Breast Cancer Research (2015) 17:62

8 Diet Fish oil prevents breast cancer cell metastasis to bone The mortality of breast cancer patients is significantly impacted by the metastasis of the cancer cells to bone. Nat Rev Cancer. 2002; 2: Two main constituents of fish oil, DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) suppress breast cancer cell growth in vitro and in animal models. Breast Cancer Res Treat. 1995; 34: ; Pharmacol Ther. 1999; 83:217 44; Breast Cancer Res Treat. 2005; 92: Mice fed a diet enriched in DHA and EPA prevented the formation of osteolytic lesions in bone, indicating suppression of cancer cell metastasis to bone. Fish oil significantly attenuated the migration of breast cancer cells and suppressed expression of CD44, a cell surface protein overexpressed in breast cancer cells which promotes metastases (p = 0.004) Biochem Biophys Res Commun November 26; 402(4):

9 Diet Key Points Healthy dietary habits associated with lower risk of death from causes other than breast cancer and a reduction in comorbidities (diabetes, cardiovascular disease etc.) Whole grains and fiber improve hormone profile in patients with ER/PR+ disease Higher intakes of O3 FA associated with reduced risk of breast cancer and recurrence, taxane-induced neuropathy and bony metastases O3 FA and improves cognitive function and reduces risk of cardiovascular disease

10 Exercise Physical Activity, Biomarkers, and Disease Outcomes in Cancer Survivors: A Systematic Review Research on physical activity and all-cause and cancer-specific mortality as well as research on potential mechanisms of these associations among cancer survivors is relatively new, and the majority of studies have been published since Nearly all of the breast cancer studies report that physical activity is associated with a reduction in breast cancer specific mortality as well as all-cause mortality; this risk reduction was statistically significant in nearly half of these studies, and there is evidence for a dose response effect of decreasing mortality risk with increasing activity in roughly half of the studies.

11 Exercise 45 articles published from January 1950 to August 2011 Consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer specific mortality Preliminary evidence suggests that exercise may result in beneficial changes in the biochemical terrain including circulating levels of insulin, insulin-related pathways, inflammation, and immunity J Natl Cancer Inst Jun 6; 104(11):

12 Exercise The effect of resistance training during radiotherapy (RT) on spinal bone metastases in cancer patients - a randomized trial. 60 patients two groups: resistance training or passive physical therapy with thirty patients in each group during RT. Bone density in metastatic and non-metastatic vertebral bone was assessed at baseline, 3 and 6 months after RT.

13 Exercise Bone density in all metastases increased significantly by 28.3% and 80.3% after 3 and 6 months in group A (both p < 0.01). The bone density in group A was significantly increased compared to control group after 3 and 6months (both p < 0.01, median 59.7 and median 62.9). The bone density data in group B showed no significant increase over the course of time (p = 0.289, median 5.5 and p = 0.057, median 52.1). 23.3% of the patients in group A and 30.0% of the patients in group B had pathological fractures, No difference between groups after 3 and 6 months was observed (p = and p = 0.604). Radiother Oncol Jul;112(1):133-9

14 Exercise Functional benefits are sustained after a program of supervised resistance exercise in cancer patients with bone metastases: longitudinal results of a pilot study. Does a 3-month supervised resistance exercise program results in any sustained functional benefits in prostate and breast cancer patients with bone metastatic disease? 20 men and women with bone metastatic disease secondary to prostate or breast cancer 3-month supervised resistance exercise program followed by a 6-month observation period. Outcomes assessed at baseline, post-exercise, and 6-month follow-up.

15 Exercise Significant improvements in physical function (4-6 %), physical activity levels (~160 min/week), lean mass (3-4 %), and quality of life (5-7 %) were observed at the completion of the exercise program. At the 6-month follow-up, significant improvements in ambulation (4 %), physical activity level (~105 min/week), whole body lean mass (2 %), and quality of life (13 %) remained. A supervised 3-month resistance exercise program may lead to significant improvements in functional ability, physical activity level, lean mass, and quality of life that remain 6 months after completion of the program in cancer patients with bone metastases. Support Care Cancer Jun;22(6):

16 Exercise Key Points Reduces all-cause and breast cancer-specific mortality Exercises changes the biochemical terrain in ways that make it more difficult for cancer to thrive Exercise creates significant improvements in functional ability, physical activity level, lean mass, and quality of life The benefits of exercise are sustained

17 Sleep Actigraphy-Measured Sleep Disruption as a Predictor of Survival among Women with Advanced Breast Cancer 97 women with advanced breast cancer(age = 54.6 ± 9.8 years). Evaluated sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days Sleep efficiency = ratio of total sleep time to total sleep time plus wake after sleep onset.

18 Sleep Participants with advanced breast cancer spent about 8 hours in bed but slept for only about 6.5 hours yielding an average sleep efficiency (SE) of 84.6% Better sleep efficiency (> 85%) was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95%confidence interval [CI], ; P < 0.001) at median 6y follow-up. Mean survival for the efficient sleeper group of 85% or higher (n = 60) was 68.9 ± 4.0 months compared with 33.2 ± 4.3 months for the poor SE group (< 85%; n = 37; log-rank test, χ = 23.13; P < 0.001)

19 Sleep Relationship remained significant (HR, 0.94; 95% CI, ; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Less wake after sleep onset (HR, 0.41; 95% CI, ; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, ; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, ; P < 0.001) also contributed to reductions in overall mortality Sleep May 1;37(5):837-42

20 Sleep Randomized Study on the Efficacy of Cognitive-Behavioral Therapy for Insomnia Secondary to Breast Cancer, Part I: Sleep and Psychological Effects Fifty-seven women with insomnia caused or aggravated by breast cancer were randomly assigned to CBT (n 27) or a waiting-list control condition (n 30). Eight weekly sessions administered in a group and combined the use of stimulus control, sleep restriction, cognitive therapy, sleep hygiene, and fatigue management Measures of subjective and objective sleep, psychological functioning (i.e., depression, anxiety, fatigue), quality of life and immunologic functioning. Follow up evaluations were carried out 3, 6, and 12 months after the treatment.

21 Sleep On average, treated patients increased their sleep efficiency from 69% to 84% at post-treatment. Considering that a sleep efficiency of 85% is typically used to distinguish clinical insomnia from normal sleep, this is a significant finding. Participants who received the insomnia treatment had significantly better subjective sleep indices (daily sleep diary, Insomnia Severity Index), a lower frequency of medicated nights, lower levels of depression and anxiety, and greater global quality of life at post-treatment compared with participants of the control group after their waiting period. Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinically significant. J Clin Oncol Sep 1;23(25):

22 Sleep Key Points More than two thirds of women with metastatic breast cancer experience poor sleep Poor sleep is associated with numerous negative physical and mental health outcomes including all-cause mortality Better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer

23 Stress Management The psychoneuroimmunologic (PNI) model of cancer proposes that psychological difficulties can influence cancer progression through alterations of immune functioning. Some studies have suggested a relationship between clinical sleep difficulties and immune downregulation, as indicated by reduced natural killer (NK) cell activity or reduced levels of some lymphocyte subpopulations in the circulating blood. Psychosom Med 54:10-21, 1992; J Behav Med 17: , 1994 Research suggests that psychological interventions can improve immunologic functioning of breast cancer patients, including increased lymphocyte numbers, NK cell activity, lymphocyte proliferation, and IFN- production. J Clin Oncol 22: , 2004; Biofeedback Self-Regul 18:1-22, 1993; J Psychosom Res 48: , 2000; J Psychosom Res 56:1-8, 2004

24 Stress Management Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: Immunologic effects. Fifty-seven women with chronic insomnia secondary to breast cancer were randomly assigned to CBT (n 27) or to a waiting-list control condition (WLC; n 30). Peripheral-blood samples were taken at baseline and post-treatment (and post waiting for WLC patients), as well as at 3-, 6-, and 12-month follow-up for immune measures. Enumeration of blood cell counts (i.e., WBCs, monocytes, lymphocytes, CD3, CD4, CD8, and CD16/CD56) and cytokine production (i.e., interleukin-1-beta [IL-1β] and interferon gamma [IFNγ]).

25 Stress Management Patients treated with CBT had higher secretion of IFN-γ (p<0.01) and lower increase of lymphocytes (p<0.05) at post-treatment compared with control patients. Pooled data from both treated groups indicated significantly increased levels of IFN-γ (p<0.01) and IL-1β (p<0.05) from pre- to post-treatment. Significant changes in WBCs (p<0.01), lymphocytes (p<0.01), and IFN-γ (p<0.01) were found at follow-up compared with post-treatment. J Clin Oncol Sep 1;23(25):

26 Stress Management Yoga for women with metastatic breast cancer: results from a pilot study. Eight-week protocol included gentle yoga postures, breathing exercises, meditation, didactic presentations, and group interchange. Outcome was assessed using daily measures of pain, fatigue, distress, invigoration, acceptance, and relaxation during two preintervention weeks and the final two weeks of the intervention Thirteen women completed the intervention (mean age=59; mean time since diagnosis=7 years; two African American, 11 Caucasian).

27 Stress Management Pre-to-post multilevel outcomes analyses showed significant increases in invigoration and acceptance. Length of home yoga practice (controlling for individual mean practice time and outcome levels on the lagged days) showed that on the day after a day during which women practiced more, they experienced significantly lower levels of pain and fatigue, and higher levels of invigoration, acceptance, and relaxation.

28 Stress Management Key Points Chronic stress supports cancer growth by suppressing immune functions Stress management interventions improve immunologic and quality of life measures including sleep, pain, fatigue, distress, invigoration, acceptance and relaxation More exercise leads to more improvement in quality of life measures

29 THANK YOU! Erin Sweet, ND, MPH, FABNO (425)

Physical activity, Obesity, Diet and Colorectal Cancer Prognosis. Jeffrey Meyerhardt, MD, MPH Dana-Farber Cancer Institute Boston, MA

Physical activity, Obesity, Diet and Colorectal Cancer Prognosis Jeffrey Meyerhardt, MD, MPH Dana-Farber Cancer Institute Boston, MA Colorectal Cancer Incidence ~148,000 cases in US annually and ~50,000