Advances Symposium Seeks Cancer Dream Team
Madison, Wisconsin - During her remarks at UW Carbone Cancer Center's 10th annual "Advances in Multidisciplinary Cancer Care," UW Health acupuncturist and doctor of naturopathic medicine Mihal Davis talked about a "dream team."
She wasn't referring to Michael Jordan-led basketball team that represented the United States in the 1992 Olympics. Davis' dream team had to do with cancer care and is emblematic of the most effective ways to blend integrative medicine and more conventional approaches to cancer care.
"We want to make sure we're taking care of the whole person," Dr. Davis said. "When we work synergistically, it's much better for the patient."
Thus, the cancer care dream team, which can include not only an oncologist and perhaps a surgeon, but also "teammates" whose knowledge spans the wide spectrum of integrative care - the healing touch/massage therapist who can help the patient relax, the herbalist who can complement the patient's medicinal therapies with the right supplements, the nutritionist who advocates a low-fat, high-fruit and vegetable diet, the mindfulness practitioner who can help the patient link mind and body in the most beneficial way.
Not Alternative Medicine
Dr. Victoria Maizes, the executive director of the University of Arizona's Center for Integrative Medicine and an "Advances" featured speaker, insisted that integrative strategies do not work in opposition to or in spite of conventional therapies. In doing so she expressed the symposium's predominant theme.
"Integrative medicine is not alternative medicine," she said. "We highly value the wisdom and the learned innovation in conventional medicine. We just don't think it's quite enough. We believe we have to take care of the whole human being."
Doing so requires a paradigm shift, Dr. Maizes said. She sees cancer care as a balance of opposites, both individually valid but perhaps incomplete without acknowledgement of its converse. Conventional cancer care tends to focus on "dispelling evil," she said, or destroying the offending tumors with some combination of surgery, chemotherapy and radiation therapy.
Integrative approaches, on the other hand, should strive to "support the good" through techniques that improve a patient's diet and exercise habits, decrease stress and anxiety, and increase the patient's self-awareness.
Take acupuncture as an example. No responsible health care provider would suggest it as a comprehensive cancer treatment on its own. But it can mitigate the unpleasant side effects, such as pain and nausea, that often accompany chemotherapy.
"Some of these integrative therapies help you get through conventional therapy," Dr. Maizes said, and added that such an approach serves a greater good of incorporating patients as participants in their own care. "It gives the patient a sense of control. They want to be active partners."
Acknowledgement and Acceptance
UW Health Mindfulness-based Stress Reduction director Katherine Bonus uses her discipline to involve patients as care partners by addressing a facet of cancer diagnosis no medicine or surgical procedure can cure - chaos.
Cancer attacks not only the physical structures of the body but also the habits and rituals that impose order on patients' lives. In a very real way cancer patients must recognize and adjust to the new life their diagnosis has so rudely and remorselessly created.
"The life we have prepared for has been turned upside down," Bonus said. "The question becomes, 'What do I do when my world drops out from underneath my feet? How do I find my way?'"
Mindfulness stresses the importance of paying attention - to the body, to the mind, to all aspects of a person's life. In her practice, Bonus uses simple and brief meditations to encourage patients to identify first what they are feeling, then how they are feeling. She might ring a bell in an otherwise silent room and ask patients to pay attention to how the mind and body respond to it. Or she might have the patient breathe deeply and focus on specific parts of the body.
Doing so, Bonus said, allows patients to become "intimate with the moment in which they are living," a crucial first step in a process that, at its most effective, helps a person move from the physical facts of attention to the less literal truth of emotional being.
"The secret of transformation through the lens of mindfulness is to recognize what you are feeling," she said. "We're conditioned to run away from what is not pleasant and what is not comfortable. Mindfulness is really about waking up to our lives while we still have time to live."
A cancer diagnosis carries with it a slew of negative emotions - fear, anxiety, anger, despair. But the awareness that mindfulness spurs assists patients in creating an essential gap between those negative emotions and the totality of their existence. Cancer patients may be frightened and despondent, but that's not all they are, and identifying the negative emotional byproducts of cancer allows patients to not be overwhelmed by them.
"'Awareness of' creates space between," Bonus said. "If I feel fear, I feel fear. If I'm in pain, I'm in pain. When we train ourselves to feel and see what is really happening, we might be able to respond to our current situation in the most effective manner."
Hope: The Doctor's Highest Calling
Perhaps the most inspired response to cancer is hope, the subject of UW Health Integrative Medicine physician Lucille Marchand's keynote address. To Dr. Marchand, the medical profession does not consist merely of therapeutic regimens, surgical techniques and prescription pads. The physician's highest calling, she said, is as a purveyor of hope.
"I see hope at the very heart of healing," Dr. Marchand said.
For cancer patients, hope doesn't necessarily have to be defined as a definitive cure. That's every patient's goal, of course, but not all patients will eventually be cancer-free. Does that mean they shouldn't have hope? Not in the least, Dr. Marchand declared.
"Hope can be about just having the urge to move forward," she said. "It can be seeing options and possibilities, and having choices, real choices, that provide empowerment and a sense of control."
Dr. Marchand mentioned a UW Carbone Cancer Center patient with whom she had recently worked. The man had been told by his oncologist that despite all efforts his life would now be measured in months, not years or decades. For him, there would be no cure.
Some may have branded the man's case hopeless, but as Dr. Marchand talked to him, she realized his hope resided in being able to feel well, for however long he had. Chemotherapy had inflicted a considerable amount of pain over the previous six months, and he hadn't been eating well because of esophageal problems that flared when he swallowed.
So they started talking, and their conversation turned into a brainstorming session. Medication hadn't reduced the man's pain. Maybe acupuncture was worth a try. And they decided to consult a speech pathologist to investigate the source of his throat difficulties.
Dr. Marchand hadn't promised the false hope of a cure. But she had introduced the plausible possibility of improvement, however limited. The man slept comfortably through the night, and told Dr. Marchand, "I haven't felt hopeful in a really long time. But even though I got bad news, I feel hopeful today."
A prescription for hope. It might be a good idea to leave room for Dr. Marchand on the cancer Dream Team.
Date Published: 10/24/2011