Cancer in Young Adults Do Mind/Body Techniques Work? House Call: Tapping into Local and Online Resources Phytoestrogen Consumption May Reduce Lung Cancer Risk DiaLog: Radiation Therapy and Lung Cancer, by James D. Cox, MD, Professor and Head of the Division of Radiation Oncologyhttps://openworks.mdanderson.org/oncolog/1140/thumbnail.jp

Cox, James D., MD

Stuyck, Karen

Williams, Vickie J.

English

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University of Texas MD Anderson Cancer Center OpenWorks @ MD Anderson OncoLog MD Anderson's Report to Physicians (All issues) OncoLog MD Anderson's Report to Physicians 2005 OncoLog Volume 50, Number 11, November 2005 Vickie J. Williams Karen Stuyck James D. Cox MD Follow this and additional works at: https://openworks.mdanderson.org/oncolog  Part of the History of Science, Technology, and Medicine Commons, and the Oncology Commons “self-esteem issues, and uncertaintyabout the future,” said Dr. Askins.“And, like all young adults, they alsostruggle with concerns about datingand marriage, relationships withpeers, becoming independent from parents, and assuming responsibilityfor their own health care.” Throughthe AYA Program, multiple resourcesfrom across the institution and, whennecessary, from within the communi-ty, are mobilized to provide assistancein all of these areas.“It is especially important foryoung patients to share experiencesand coping skills with peers whenthey are undergoing cancer therapy,which can be a lonely and stressfultime,” said Dr. Askins. “We encour-age socialization and provide specialaccommodations, such as Kim’sPlace, to encourage interaction.”Other year-round social activities sponsored through the programinclude outings to theaters, festivals, professional sports events,multicultural celebrations, and themeparks; a weeklong camping trip toCamp AOK (Anderson’s Older Kids);and an annual trip to the slopeswhere patients who have lost a limbto cancer can learn to ski.A concern for adolescent andyoung adult cancer patients is havingtheir education interrupted whilethey undergo treatment. “Theseyoung men and women worry aboutmissing school and falling behind intheir coursework, whether they areenrolled in grade school, college, ortrade school,” Dr. Askins said. “Wecounsel students on the many optionsthat can allow them to continue theireducation without interruption.”Those options include a homeboundprogram, continued participation intheir community-based schools, orparticipation in the M. D. Andersonhospital school, offered in collabora-tion with the Houston IndependentSchool District. Special programs are offered to help international students continue their education and to acclimate tothe hospital milieu. In addition tograde-level coursework, students can participate in creative arts andphysical fitness classes. Counselorstutor patients preparing for collegeentrance exams and help them com-plete applications. A special feature of the education program is its careerplanning and vocational guidance segment, through which patients, including those with cognitive or physical impairments, can explore appropriate job opportunities. Paramount among the concerns of adolescents and young adults withcancer are body image and sexuality.At the critical age when physicalappearance is so important, thesepatients are losing their hair, wearing indwelling medi-ports, gaining or losing weight, and undergoing surger-ies that are often disfiguring. Likewise,just as their sexual identities areevolving, they find themselves strug-gling with the possibility of impairedsexual function and infertility. “These are very sensitive issues,and we approach our patients withcompassion and respect,” said Dr. Askins. “Counselors meet with adolescents and young adults separately in weekly group sessionsheld at Kim’s Place. We encouragethem to form social-support networksin which they can express personalfeelings about the experience of cancer and about cosmetic and functional changes. We advise themabout establishing and maintainingrelationships and provide informationto help them make decisions aboutfertility, if required.” Dr. Askins said. Dr. Askins explained that it isessential to assess for and addresspotential problems and relevant issuesin each of these patients early on.“At M. D. Anderson, the Adolescentand Young Adult Program is a sort ofadvocacy group. Our goal is to helpthese young people develop the psychological and social foundationthey will need to cope with the quality-of-life concerns cancer presents—and to do that in a waythat makes them feel confident andcomfortable.” •FOR MORE INFORMATION, contact Dr. Kleinerman at (713) 792-8110 orDr. Askins at (713) 794-4467.OncoLog  • November 2005 •  3It is especially importantfor young patients to share experi-ences and coping skills with peerswhen they are undergoing cancertherapy, which can be a lonely andstressful time.” – Dr. Martha A. Askins“In collaboration with these scientists, Dr. Cohen recentlycompleted a study of the effects of hatha yoga, an Indian-based yoga practice, on 62 breast cancer patients undergoingradiation treatment. An abstract being presented at theannual meeting of the Society for Integrative Oncologyreports that the researchers found better physical functioningand general health and significantly lower levels of sleep-related daytime dysfunction in the women who practicehatha yoga, compared with the control group. Women in theyoga group participated in hatha yoga two times a week dur-ing the course of their radiation therapy. A grant from theNational Cancer Institute (NCI) is funding a larger trial ofthis research.Expressive writing is another mind/body technique theIntegrative Medicine researchers are exploring. In one recentrandomized trial, patients with renal cell carcinoma wereasked to write their deepest thoughts and feelings about theirkidney cancer experience during four separate 20-minute sessions. “The paradigm for expressive writing is to do verybrief, acute writing sessions. People are instructed to perhapswrite about things they haven’t shared with anyone else,” Dr. Cohen said. In comparison with control group memberswho wrote about neutral topics, the patients in the expressivewriting group reported significantly lower levels of sleep disturbances, with better overall sleep quality, longer sleepduration, and less daytime dysfunction.A larger phase III trial, also funded by NCI, is continuingthis research on a bigger scale. “We’re examining not onlysleep and other aspects of quality of life, but also physiologi-cal function by measuring patients’ immune systems,” he said.The researchers specifically picked patients with kidney cancer because that disease is immunogenic and “expressivewriting interventions have been shown to positively impactaspects of the immune system,” Dr. Cohen said.Other recently completed research is focusing on musictherapy and various relaxation techniques. One study isexamining the effects of music therapy on the mood andquality of life of patients who have undergone bone marrow transplantation. In another, men scheduled to undergo radical prostatectomy were taught stress management skills such as diaphragmatic breathing, guidedimagery, and cognitive therapy strategies for managing stressand having realistic expectations of recovery. The research is evaluating whether or not the pre-surgical stress reduction program affected patients’ psychological well being and other physiological factors.Another study is evaluating the effectiveness of using a custom-designed hand-held computer program to supplement a cognitive behavioral stress management program for breast cancer patients who are receivingchemotherapy. The computer program reinforces the skills patients learned in four individual therapy sessions: diaphragmatic breathing, guided imagery, progressive muscle relaxation, and cognitive therapy.Nurses teach mindfulness relaxation techniques topatients undergoing chemotherapy in a large phase III randomized trial. Patients first are taught the techniquesbefore starting chemotherapy, then are given an audio tape of the mindfulness training, which they are encouraged to use at least once a day throughout chemotherapy. When the pilot phase is over, a larger randomized trial will comparethe effectiveness of mindfulness relaxation and listening to relaxing music.The Integrative Medicine Program has also received a grant from the NCI to develop a center to study traditionalChinese medicine for cancer patients in collaboration with The Fudan University Cancer Hospital in Shanghai, China. The investigators are examining mind/body approaches such as qigong, as well as acupuncture and natural substances. “As a comprehensive cancer center, we don’t just treatcancer, we treat people who have cancer,” said Dr. Cohen.“So it’s incumbent upon us to explore the potential benefit of therapies that have some evidence of efficacy, even nonconventional therapies such as yoga.” •FOR MORE INFORMATION, contact Dr. Cohen at (713) 745-4260.OncoLog  • November 2005 •  5The majority of researchin psychoneuroimmunology explores how stress negatively impacts our hormonal and immune systemsand the negative health implications of that.”– Dr. Lorenzo Cohen

OncoLog, Volume 50, Number 11, November 2005

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OncoLog Volume 50, Number 11, November 2005

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