In a world where there’s a pill for everything, a Calgary-based researcher and psychologist is prescribing mindfulness and tai chi to tackle persistent cancer recovery symptoms.
Linda Carlson is a professor in the department of oncology at the University of Calgary. Her work suggests that mindfulness techniques and the ancient practices of tai chi and qigong help cancer patients manage pain and fatigue and improve sleep quality.
Cancer and its treatments are varied. Surgery, chemotherapy, radiation or hormone therapies and often combinations of these are used.
Despite the wide range of disease and treatments, there are several common symptoms for patients in recovery.
“Some of the most common things that can persist months or even years post-treatment are things like fatigue, difficulty sleeping, pain, anxiety, depression,” Carlson said.
And these types of symptoms can be notoriously difficult to treat, Carlson said.
When a pill won’t do
“The traditional approach is, there’s a pill for that,” Carlson said.
But for many who are going through or just completed cancer treatment, more medication is either not an option or unappealing, Carlson said.
“They’ve had enough medications. They don’t want to take more,” Carlson said. “Sometimes the [medications] can interfere with treatments they might be having.”
Some drugs for pain and sleep can also become addictive. There is also a psychological and social component that medications cannot address.
“A person is not just a body that you feed treatments and medication to,” Carlson said.
There is an established connection between the mind and body when it comes to cancer recovery because cancer is not just a “physical disease,” Carlson said.
“It affects the family. It affects a person emotionally, psychologically, socially,” Carlson said.
Add to this the anxiety and fear of cancer recurrence and death and a person’s mental state can directly impact their physical well-being.
A whole-body approach
Tackling cancer from the emotional, social, psychological and physical dimensions is known as psychosocial oncology, and it’s been around for decades, Carlson said. Mind-body practices are key to this approach.
Both practices combine breathing techniques and gentle movement. Mindfulness incorporates more analytical techniques such as self-reflection and group discussions, while tai chi focuses more on physical movements. Both, however, have physical and psychological effects.
Both affect the nervous system by downregulating heart rate, blood pressure and stress hormones. They also relieve tension in muscles that may be exacerbating pain.
And both help patients deal with anxiety by being more present in their lives and not allowing their dread or anxiety to dominate their lives.
“Both have elements of mindfulness because you’re focusing in on the breathing and the movement and that mind-body connection and not really dwelling on all the worries,” Carlson said.
But there are subtle differences. Using data from a large comparison study between mindfulness techniques, tai chi, as well as qigong and patients not doing either, Carlson is teasing these apart.
“We thought that perhaps the mindfulness program would be more focused on stress reduction and those psychological outcomes and the tai chi program might be better for some of the physical functioning, like balance and strength,” Carlson said.
“What we’re finding is that there’s a little of that nuance, but generally they’re both effective for most symptoms.”
When it came to the three specific symptoms of pain, fatigue and sleep both were effective and provided clinically meaningful improvements in fatigue, meaning the reported effects were not just statistically significant but would likely translate to improvements in daily life.
Tai chi also improved sleep and both improved an aspect of pain called interference.
“We know that the total amount of suffering that a person experiences from pain is the physical sensation, but it’s multiplied by our resistance to it,” Carlson said.
This resistance is physical, like tension, or the psychological effects of living with chronic pain — both of which decrease quality of life.
Carlson examined pain intensity and how much pain is interfering with day-to-day activities.
“We saw a small effect on pain intensity, but a larger effect on pain interference,” Carlson said. “So the way people approach their pain made it less of a problem for them.”
10 years of positive reviews
Niki Fehr, program director with the non-profit cancer support foundation Wellspring Alberta, has seen the benefits first-hand. Fehr said they’ve offered mindfulness-based cancer recovery and tai chi for years.
“Our programs have very high ratings,” said Fehr, adding the mindfulness program is regularly full.
“It’s a program that’s consistently filled up over 10 years now and it’s not unusual for people to take it multiple times.”
Having gone through cancer treatment herself, Fehr credits mindfulness breathing techniques with getting through difficult moments like radiation therapy.
“I took my visualization techniques into the radiation machines. When you’re lying there and you can’t have your phone with you, there’s nothing else you can do. You have to be completely still and hold your breath for long periods of time,” Fehr said. “Those visualization techniques are what got me through.”
Fehr is happy to see more research too, because it can encourage new participants to give it a try.
“It’s about getting people into the programs, people who historically may never have considered mindfulness as an option,” Fehr said.
Carlson also wants to encourage people to give these techniques a try, and stresses these are not replacements for conventional medical approaches but designed to work in combination.
“It’s integrating all these psychosocial and complementary therapies with your conventional care and that can lead to the best outcomes,” Carlson said.
She said that because both show benefits it allows patients the option to choose which methods suit them best.
“Find a program, try it for yourself. If it works, great. If it doesn’t, not much lost, right?” Carlson said.
Mindfulness programs have been offered since 1998, said Carlson, and are now available at the Arthur J.E. Child Comprehensive Cancer Centre.