The continuing rise in cancer rates and longer survivorship underscores the need for effective symptom management. Based on current evidence, meditation is a promising modality for the relief of both psychological and physical symptoms associated with cancer and its treatments. Meditation can reduce stress, control anxiety, improve sleep, and improve emotional health and self-awareness.  It has also been reported to lengthen attention span and reduce age-related memory loss.

CaSfA recently hosted a Meditation Workshop utilizing the free app, Insight Timer.  Recommended by CaSfA members and psychosocial counselors, it contains over 19,000 meditations and offers the “largest free library of meditations and music tracks on earth.”  I’ve recently started using it, and now also recommend it!

 

The app allows you to select from many categories of guided meditations such as:

·     Recovery and Healing

·     Stress and Anxiety

·     Performance (clarity, creativity, leadership, etc.)

·     Health and Happiness

·     Relationships

·     Spiritual

·     Kids

The app allows you to pick a meditation based on time too, varying from less than 5 minutes to over 30 minutes.  

You can choose between verbally guided meditations or those with music.  We experimented with a few short meditations at our workshop.  It became clear that what works for one individual may not work for another, so you have to try different options to find the best meditations for you. 

 

The app also contains courses in meditation.  At our workshop we started the beginner course, “Learn to Meditate in Seven Days”.  The course consists of seven, easy-to-do, 12-minute lessons:

·     All You Do is Breathe

·     Here and Now

·     Witness Your Thoughts

·     Mind-Body Connection

·     Exploring Emotions

·     Power of Intention

·      Finding Inner Stillness

 

There are also courses for those who are more advanced in meditation (although there are fees associated some of these.)

 

New content is added every day, so you really cannot run out of free offerings!  Give it a try!

 

Much has been written in the past weeks about the American Cancer Society’s Annual Report.

(To read the 70+page report visit https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf)

 

Here are some facts from the report:

The Good News

·      The U.S. cancer death rate has hit a milestone, falling for the past 25 years.  The nation’s cancer death rate was increasing until the early 1990s. It has been dropping since, falling 27% between 1991 and 2016

·      This decline translates into more than 2.6 million fewer cancer deaths from 1991 to 2016.  This progress has been driven by steady declines in death rates for the four most common cancer types – lung, colorectal, breast, and prostate. 

·      More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, most of who were diagnosed many years ago and have no current evidence of cancer. 

·      Lower smoking rates are translating into fewer deaths. 

·      Advances in early detection and treatment also are having a positive impact.

·      The 5-year relative survival rate for all cancers combined has increased substantially since the early 1960s, from 39% to 70% among whites and from 27% to 63% among blacks. Improvements in survival reflect advances in treatment, as well as earlier diagnosis for some cancers. 

 

The Bad News:

·      Cancer remains the nation’s No. 2 killer

·      The ACS predicts there will be more than 1.7 million new cancer cases, and more than 600,000 cancer deaths, in the U.S. this year.

·      Obesity-related cancer deaths are rising.  Of the most common types of cancer in the US, all the ones with increasing death rates are linked to obesity, including cancers of the pancreas and uterus.  Another is liver cancer. Liver cancer deaths have been increasing since the 1970s, and initially most of the increase was tied to hepatitis C infections spread among people who abuse drugs. But now obesity accounts for a third of liver cancer deaths, and is more of a factor than hepatitis.  The nation’s growing obesity epidemic was first identified as a problem in the 1990s. It can take decades to see how a risk factor influences cancer rates, so we may just be starting to see the effect of the obesity epidemic on cancer.

·      Prostate cancer deaths are no longer dropping.  The prostate cancer death rate fell by half over two decades, but experts have been wondering whether the trend changed after a 2011 decision by the U.S. Preventive Services Task Force to stop recommending routine testing of men using the PSA blood test. That decision was prompted by concerns the test was leading to overdiagnosis and overtreatment.  The prostate cancer death rate flattened from 2013 to 2016. So while the PSA testing may have surfaced cases that didn’t actually need treatment, it may also have prevented some cancer deaths.

·      There’s been a decline in the historic racial gap in cancer death rates, but an economic gap is growing — especially when it comes to deaths that could be prevented by early screening and treatment, better eating and less smoking.  In the early 1970s, colon cancer death rates in the poorest counties were 20 percent lower than those in affluent counties; now they’re 30 percent higher. Cervical cancer deaths are twice as high for women in poor counties now, compared with women in affluent counties. And lung and liver cancer death rates are 40 percent higher for men in poor counties.

 

End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This care does not happen only in the moments before breathing stops and the heart stops beating.  People living with one or more chronic illnesses may need a lot of care for days, weeks, and even months before death.  In addition, we don’t always know when death is near, so it is important that we figure out a plan in advance.

 

According to the National Cancer Institute, “End-of-life care includes physical, emotional, social, and spiritual support for patients and their families. The goal of end-of-life care is to control pain and other symptoms so the patient can be as comfortable as possible. End-of-life care may include palliative care, supportive care, and hospice care.”

 

Some interesting statistics:

·       90% of people say it’s important to discuss end of life care with their families, but only 27% have done so.

·       80% of people say it’s important to discuss end of life treatment with their physicians, but only 7% have done so.

·       82% of people say it’s important to put their wishes in writing, but only 23% have done so.

Visit these sites for help in documenting your end-of-life care wishes:

http://www.massmed.org/Patient-Care/Health-Topics/Health-Care-Proxies-and-End-of-Life-Care/Important-Differences-Between-Health-Care-Proxies-and-Living-Wills/#.WntrpGaZMzU 

There is a physical (and mental) decline in our bodies as we age—and studies have shown that biologic aging begins in our 20’s!  Add cancer and the effects of its treatments to this decline and we can end up with significant weaknesses.

 

It can be extremely challenging to do any exercise or fitness program during treatment and even after treatment is completed.  I remember some days, just getting out of bed was a major accomplishment.  There is pain and limited abilities that may be secondary to surgeries and radiation.  Cancer and its treatments may also leave one with disorders of the nervous system, such as peripheral neuropathy, making even walking painful, and disrupting balance.  Many of these issues can take a very long time to improve, but research has shown that a program of fitness and exercise can not only aid in recovery, but also reduce the risk certain cancers forming and/or returning.

 

Here’s great info from National Cancer Institute:
(From: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet; Go to link for references)

 

Physical activity:

·      Any movement that uses skeletal muscles and requires more energy than does resting

·      Can include working, exercising, performing household chores, and leisure-time activities such as walking, tennis, hiking, bicycling, and swimming.

·      Is essential for people to maintain a balance between the number of calories consumed and the number of calories used.

 

Consistently expending fewer calories than are consumed leads to obesity, which is linked to increased risks of 13 different cancers:

            Adenocarcinoma of the esophagus

            Colon and Rectal cancer

            Gastric cancer

            Liver cancer

            Gallbladder cancer

            Pancreatic cancer

            Breast cancer (postmenopausal)

            Uterine cancer (endometrial)

            Ovarian cancer

            Renal Cell (Kidney) cancer

            Meningioma (Brain)

            Thyroid cancer

            Multiple Myeloma (Blood cancer)

 

Evidence also indicates that physical activity may reduce the risk of getting several cancers through other mechanisms, independent of its effect on obesity. 

(From: https://www.health.harvard.edu/exercise-and-fitness/does-regular-exercise-reduce-cancer-risk)

Exercise has a number of biological effects on the body, some of which have been proposed to explain associations with specific cancers, including:

·      Lowering the levels of hormones, such as insulin and estrogen, and of certain growth factors that have been associated with cancer development and progression [especially important for reducing risk of breast and colon cancer]

·      Helping to prevent obesity and decreasing the harmful effects of obesity, particularly the development of insulin resistance (failure of the body's cells to respond to insulin)

·      Reducing inflammation

·      Improving immune system function

·      Altering the metabolism of bile acids, resulting in decreased exposure of the gastrointestinal tract to these suspected carcinogens [especially important for reducing risk of colon cancer]

·      Reducing the amount of time it takes for food to travel through the digestive system, which decreases gastrointestinal tract exposure to possible carcinogens [especially important for reducing risk of colon cancer]

 The benefits of physical activity/fitness for cancer survivors (and remember, by current definition, you are considered a survivor from the day you are diagnosed):

·      Not only reduces chance of getting certain cancers, but also reduces incidence of recurrence

·      Improves prognosis and likelihood of survival

·      Improves quality of life—including self-esteem, emotional well-being, sexuality, sleep disturbance, social functioning, anxiety, fatigue, depression and pain

·      Reduces incidence and severity of other chronic conditions which may complicate care, such as cardiovascular disease and Type 2 diabetes

·      Reduces body weight and body mass index (which may have increased as a result of cancer therapy)

·      Improves cognitive function

(https://www.ncbi.nlm.nih.gov/pubmed/25444575 )

·      Reduces side effects of some cancer therapies (Dr. Ligibel of Dana Farber has done studies that showed exercise reduced the side effects of aromatase inhibitors used to treat some breast cancers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372849/ and http://www.breastcancer.org/research-news/exercise-helps-ease-ai-side-effects)

 

How much exercise should we be getting?

From https://www.cdc.gov/physicalactivity/basics/adults/index.htm

 

A new website that offers FREE guided meditations has been created for cancer survivors.  Kara (https://thisiskara.com ) features 12 meditations including the four core qualities whose initials give Kara its name—kindness, awareness, rest and allowing.  The remaining eight tracks are designed to help with specific difficult emotions or challenges that survivors experience, such as feeling overwhelmed, afraid or angry; feeling alone or like you are a burden; or being in pain or sleepless.

 

Recommended by CaSfA member, TM:  Buddha in Blue Jeans by Tai Sheridan (https://www.amazon.com/Buddha-Blue-Jeans-Extremely-Sitting/dp/1466480033?ie=UTF8&dpID=61GkWLXz52L&dpSrc=sims&preST=_AC_UL160_SR104%2C160_ ).  You can download it for free to your kindle or buy the paperback for less than five dollars.  “Poet-philosopher and Zen Priest Tai Sheridan's 'Buddha in Blue Jeans' is an extremely short, simple and straight forward universal guide to the practice of sitting quietly and being yourself, which is the same as being Buddha. Sitting quietly can teach many ways to accept life, meet pain, age gracefully, and die without regret. The book encourages sitting quietly every day. Topics include: Sit Quietly; Care For Your Body; Accept Your Feelings; Give Thoughts Room; Pain is Natural; Be Who You Are; Live Each Moment Well; Love Indiscriminately; Listen to Others; Be Surprised; Wonder; Live gratefully; Do No Harm; Benefit life; A Wish for The World. The book is for people of any faith, religion, race, nationality, gender, relationship status, capacity, or meditation background.”

 

Another short, easy and helpful read is Jon Wortmann’s Mindfulness is Sublime:  9 Ways to Sleep Better, Shake the Nerves and Finally Get Happy (https://www.amazon.com/Mindfulness-Sublime-Jon-Wortmann/dp/1507602634/ref=sr_1_1?s=books&ie=UTF8&qid=1483999093&sr=1-1&keywords=mindfulness+is+sublime )

“The power to feel rested, in control, and happy already exists within your own brain. But too many of us are so busy and stressed we simply don’t enjoy our lives. We finish the week and can’t remember how we spent our time. Tired of missing the precious moments? Want to change? Now you can. The way is called mindfulness. Mindfulness is a philosophy, a series of exercises, and now a scientifically validated therapeutic treatment for emotional suffering like chronic stress and depression. But it doesn’t take a trip to a monastery or a 10-week class to begin experiencing the benefits of transforming your body and mind. Mindfulness Is Sublime is a series of nine invitations. Each invitation explores a different avenue into the most important thing too many of us ignore: this moment. Whether you need the scientific or the spiritual way into this essential discipline for every human being, this little book begins your journey. Buddha, Thoreau, and your favorite yoga teacher figured out how to grab the beauty of this moment. You can experience the same pleasure they discovered. Unwrap the present.”

 

BTW, CaSfA member, LW attended a workshop led by Jon Wortmann.  After hearing her glowing recommendation, I have been in contact with him and am hoping to schedule a FREE workshop for our group the end of April.  Stay tuned for more details….

CaSfA's most recent newsletter contains my notes from the American Cancer Society's 2016 Facts and Figures.  It's a lengthy document that summarizes current scientific information about cancer in the United States. To download the document visit: http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf.

Here's just a few of my notes from the report:

“A substantial proportion of cancers could be prevented.” Tobacco use is a major cause of some cancers. “In 2016, about 188,800 of the estimated 595,690 cancer deaths in the US will be caused by cigarette smoking”.   It is also estimated “that about 20% of all cancers diagnosed in the US are related to body fatness, physical inactivity, excess alcohol consumption, and/or poor nutrition, and thus could also be prevented.” “Certain cancers are related to infectious agents, such as human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Helicobacter pylori (H. pylori). Many of these cancers could be avoided by preventing these infections through behavioral changes or vaccination, or by treating the infection. Many of the more than 5 million skin cancer cases that are diagnosed annually could be prevented by protecting skin from excessive sun exposure and not using indoor tanning devices.”

 

Incidence of New Cancer Cases and Deaths from Cancer in 2016                                     About 1,685,210 new cancer cases are expected to be diagnosed in the US; 37,620 in Massachusetts.  About 595,690 Americans are expected to die of cancer; 12,630 in Massachusetts.  Cancer is the second most common cause of death in the US, exceeded only by heart disease, and accounts for nearly 1 of every 4 deaths.

“The total cancer death rate rose for most of the 20th century because of the tobacco epidemic, peaking in 1991 at 215 cancer deaths per 100,000 persons. However, from 1991 to 2012, the rate dropped 23% because of reductions in smoking, as well as improvements in early detection and treatment. This decline translates into the avoidance of more than 1.7 million cancer deaths. Death rates are declining for all four of the most common cancer types-lung, colorectal, breast, and prostate.”

Cancer usually develops in older people; 86% of all cancers in the United States are diagnosed in people 50 years of age or older. Smoking, eating an unhealthy diet, or not being physically active will increase one’s risk of developing cancer. “Lifetime risk refers to the probability that an individual will develop or die from cancer over the course of a lifetime. In the US, the lifetime risk of developing cancer is 42% (1 in 2) in men and 38% (1 in 3) in women.”

Interested in reading more?  Join CaSfA to receive my newsletters containing relevant information about cancer!

Cancer doesn't just affect the patient.  It affects our loved ones too.  I recently read two very moving essays by loved ones and caregivers of cancer survivors.  Read them:  

http://blog.dana-farber.org/insight/2015/10/how-to-care-for-a-partner-with-cancer/

http://www.sarah-levy.com/blog-1/2015/10/7/mymomhercancerandme

Today I met with some CaSfA members.  Among other topics, we did discuss end of life issues.  The conversation reminded me of an episode of Frontline I recently watched, “Being Mortal”, on PBS. (http://www.pbs.org/wgbh/pages/frontline/being-mortal/).  Although it was very emotional, I highly recommend watching the program.  

According to PBS’ website,

“The United States has a problem when it comes to conversations around death and dying, says Dr. Atul Gawande. Patients with life-threatening illnesses tend to focus on how to beat the steep odds against them, he says, without hearing from their doctors about how certain kinds of treatment might actually worsen their remaining time alive. It’s understandable, says Gawande, but ‘hope is not a plan.’”

“For Gawande, a New Yorker writer and a renowned surgeon at Boston’s Brigham and Women’s Hospital and the Dana-Farber Cancer Institute, too many questions are going unasked. Questions like: What are your priorities if your time is limited? What are your goals for treatment? What are your fears? And what trade-offs are you willing to accept as a result of your care?”

60 minutes recently did a piece on the use of the polio virus to treat glioblastoma brain tumors.  Watch the episode if you have a chance:  http://www.cbsnews.com/news/polio-cancer-treatment-duke-university-60-minutes-scott-pelley/ 

In a recent blog post, Dana Farber discussed this study out of Duke and some other studies in which viruses are being used to successfully treat cancer. Check it out at (http://blog.dana-farber.org/insight/2015/05/from-foe-to-friend-viruses-show-new-promise-as-cancer-treatment/)

There’s another study showing the anti-cancer properties of Vitamin D. “According to a new study led by researchers at Dana-Farber Cancer Institute, clinical trial patients with metastatic colorectal cancer who had high levels of vitamin D in their bloodstream prior to treatment with chemotherapy and targeted drugs, survived longer, on average, than patients with lower levels of the vitamin.” 

These findings were recently reported at the 2015 American Society of Cancer Oncology (ASCO) Gastrointestinal Cancers Symposium in San Francisco. Read more at http://www.dana-farber.org/Newsroom/News-Releases/new-study-shows-high-vitamin-D-levels-increases-survival-of-patients-with-metastatic-colorectal-cancer.aspx