Mind, Body & Spirit Practices
Dr. Donald Abrams
Integrative Cancer Therapies
Mind, body, and spirit practices are becoming more popular, especially when dealing with major stresses and traumas like cancer.
Dr. Donald Abrams, leading integrative oncologist at UCSF’s Osher Center for Integrative Medicine, shares his thoughts on everything from physical activity, yoga, meditation, and traditional Chinese medicine, including acupuncture.
Physical Activity & Exercise
When do patients most benefit from physical activity and what kind do you recommend the most?
Keith Block, my friend, and colleague in Evanston, Illinois, has the Block Medical Center. He’s one of the founders of integrative oncology. He has his patients running on a treadmill while they’re getting chemotherapy because he thinks that oxygenates and delivers more of the chemotherapy to the cancer cells.
When you exercise, you release endocannabinoids and endorphins and they get you a little bit high and energize you and then you wind up sleeping better.
In general, even though you think you’re too tired to exercise, if you do exercise, you’re going to actually feel better.
Physical activity decreases the risk of developing breast, colon, and prostate cancer are the three most common malignancies. In patients with those cancers and even in pancreatic cancer, which is a very serious malignancy, physical activity has shown to increase survival.
What do we mean by physical activity in the 2007 iteration of the guidelines that I use? It said to be physically active for at least 30 minutes a day, the 20 18 guideline says move more, sit less, which I think is less prescriptive. People doing the equivalent of 30 minutes of vigorous walking each day is a good thing.
Aerobic exercise increases your quality of life, and decreases fatigue. But it’s also important to do some resistance work against weight for people that are on hormonal therapies that weaken the bones. Yu need to do resistance activity to keep your bone strong and your muscles toned.
I really like yoga because is about strength, flexibility, and balance.
I always say Jewish boys can’t meditate. But at the end of a 60-minute yoga class, when we do savasana, the corpse pose, and they say, you can come back now, I really feel like I’ve been someplace. It’s because I’ve been moving with my breath for 60 minutes and not thinking about other things.
The breath is the link between mind-body interventions. In yoga, we inhale and exhale (like this).
Hypnosis is based on the breath, some guided imagery, and meditation. Moving with your breath and concentrating on your breath is the link between mind-body interventions, which we use to help decrease stress.
Physical activity should be aerobic resistance and then yoga. Or some people prefer tai chi or pilates as other interventions that I think are useful.
How do we build up to full-on physical activity when in chronic pain?
You need to do something to get the pain under control. A lot of people have the inability to be physically active because of painful joints, painful limbs, painful whatever. And they’re just not enthusiastic about doing physical activity.
We at UCSF have a personal trainer who works with patients at the Cancer Center who’s in touch with all of those issues that may arise. They help people initiate a program of physical activity that may not exacerbate their pain.
Traditional Chinese Medicine
Andrew Weil says that traditional Chinese medicine is all about expelling evil and supporting good. And he says modern Western medicine focuses on expelling evil.
Coming to see me as an integrative oncologist, I try to support good. But when you go to traditional Chinese medicine, they do both at the same time, but from a different angle.
They won’t say you have diffuse large B-cell lymphoma. They’re going to say you have decreased spleen chi and decreased kidney yang, and they’ll treat that.
How diagnoses are made
Chinese medicine practitioners make a diagnosis, not using real physical exams or X-rays and blood tests. They look at your tongue and they take the pulse on four sides of the wrist using three fingers, and that gives them their unique diagnosis.
Chinese medicine believes that disease arises from an imbalance of opposing forces, particularly yin and yang and unbalanced chi, which is your energy.
In that practice, the organs project onto the skin in the lines or meridians that have points in which needles are placed to help move the chi and bring balance back.
Acupuncture
Acupuncture is just one of the modalities of traditional Chinese medicine. They also have a nutrition massage called tui na, and certainly, Chinese herbs are widely used as well.
I find that my patients undergoing chemotherapy do much better if they’re getting acupuncture.
The National Institutes of Health in 1997 had a consensus conference that concluded that acupuncture was effective for chemotherapy-induced nausea and vomiting. I find it useful for fatigue associated with cancer peripheral neuropathy secondary to chemotherapy.
Patients who are getting head and neck radiation get much less problem with persistent dry mouth if they’ve had acupuncture while they’re getting their radiation. Patients on hormonal therapies who get hot flashes both men and women experience reduced hot flashes if they’re getting concurrent acupuncture.
One thing that I’ve always perceived that now has been verified in a clinical manuscript1 published recently was that patients getting acupuncture keep their blood counts higher while they’re getting chemotherapy so that they can get more chemo with fewer delays or dose reductions.
I’m a big fan of acupuncture. I really believe that patients who participate with a traditional Chinese medicine practitioner while they’re getting their chemo and radiation just do much better.
How do you find a good acupuncturist?
We have a lot of acupuncturists at the Center for Integrative Medicine. There are probably have long wait times. That’s why we keep hiring more acupuncturists.
But I’ve asked patients that come to see me that live in Santa Cruz or Fresno or Modesto or Marin if they have an acupuncturist that they like. I have a list that I can share with patients and I tell them people that I don’t know personally but have been recommended by another person.
Meditation and Mindfulness
What are the benefits?
For patients who are stressed, I ask them to tell me their story about their cancer. They often weave stories of stress-caused cancer.
Stress in and of itself doesn’t cause cancer. But stresses adrenaline or epinephrine kills your lymphocytes, the building block cells of the immune system, and stresses cortisol, a steroid hormone that is an immune suppressant.
So decreasing stress is important, and there are many ways to do it.
I like yoga or physical activity. Guided imagery is good, so is massage, but a lot of people like to have a mind-body intervention that they can do whenever they want.
Mindfulness-based stress reduction (MBSR)
Mindfulness-based stress reduction is an eight-week course that we offer at the Osher Center, and it’s offered elsewhere as well where you learn how to be here now—live in the moment, not in the past, not in the future.
It also teaches how to not be judgmental about the thoughts that come in and out of your mind, but just to accept them. It’s also combined with some movement or yoga poses and ends with a full-day silent retreat again.
Now that everything is virtual, I’m not sure exactly how the programs are working, but many of my patients like to do the mindfulness-based stress reduction program. It helps them cope with their stress, either of their diagnosis or their survivorship, which can also be stressful.
For people that don’t want to do the eight-week course, there are many apps that people get now on their phones like calm and insight timer. Those are two that have been recommended to me by patients.
I’m not a big meditator, so I don’t have much experience. The mindfulness-based stress reduction is one of the few things that I recommend to people that I’ve never experienced myself.
Maybe I should especially that it’s virtual because at least I could be still traveling if I need to be and participate in the eight weekly sessions. But I have to confess, I haven’t done it yet.