Enhancing the Supportive Care of Cancer Patients using Integrative Mind and Body Practices - Moffitt Cancer Center Grand Rounds July 23, 2021 Lora ...
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Enhancing the Supportive Care of Cancer Patients using Integrative Mind and Body Practices Moffitt Cancer Center Grand Rounds July 23, 2021 Lora M.A. Thompson, Ph.D. Hannah Bromberg, D.O. Meghan Haas, D.O.
LEARNING OBJECTIVES
Summarize mind and body therapy services offered by Moffitt's
Summarize Integrative Medicine Service
Discuss benefits of massage, meditation and yoga for our Moffitt
Discuss patients
Describe Osteopathic Manipulation Therapy (OMT), a new
Describe Supportive Care Medicine service
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MIND AND BODY PRACTICES
• Falls within the field of integrative oncology (or more broadly, integrative
medicine)
• Patient-centered, evidence-informed techniques offered in conjunction with
conventional cancer treatments
• Goals
o “To optimize health, quality of life and clinical outcomes”
o “To empower people to prevent cancer and become active participants in
their care before, during and after cancer treatment”
• Types
o acupuncture, massage, meditation, exercise, movement (e.g., pilates),
relaxation techniques, guided imagery, spinal manipulation (e.g.,
chiropractic, osteopathic care), traditional Chinese medicine practices
(e.g., Tai chi, qi gong), Yoga, others (e.g., healing touch, hypnotherapy)
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Witt, Claudia M., et al. "A comprehensive definition for integrative oncology." JNCI Monographs 2017.52 (2017).
INTEGRATIVE ONCOLOGY GUIDELINES (2009)
• Mind and Body Practices
o recommended as part of multidisciplinary care to address mood
disturbance, anxiety, pain, and quality of life
o evidence insufficient but may also be considered for treatment related
nausea, fatigue, sleep difficulty
• Detailed summary including the strength of evidence and grade of
recommendation found at https://integrativeonc.org/practice-
guidelines/guidelines
• Mechanisms of action
o Direct: pressure to muscle/connective tissue, circulation, range of motion,
down regulation of HPA axis response and sympathetic nervous system,
strength, stamina, flexibility
o Indirect: attention, distraction, adaptive coping strategy
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Deng, et al, 2009; Sengupta, P. 2012; West, J et al., 2004; Kaliman et al., 2013;
Supportive Care Medicine Department Structure
Supportive Behavioral Integrative
Care Medicine Medicine Medicine
Palliative Care Psychiatry
Providers
Oncology Massage
Meditation
Doctor of Osteopathic Psychology:
Medicine: Yoga for Cancer
Guided Imagery
Osteopathic Relaxation Techniques Acupuncture
(independent contractor)
Manipulation Therapy Clinical Hypnosis (for
(OMT) symptom management)
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Sharen Lock, MS, C-IAYT Elaine Payne. LMT Elizabeth “Libby” Creagh, E-RYT-500 Jonatha “Jonny” Wright, LMT Liem Le-Lau, DAOM, L.Ac., Megan Marshall, LMT Dipl. OM
Moffitt.org/healingandwellness
Outpatient Clinic Inpatient Virtual
Self-refer or MD/APP MD or APP can order Register online, see
can order • Massage calendar of events
• MRC/MKC Massage • Yoga • Weekly group Yoga
($60/60 minutes) MD, APP, nurse, SW can series
• MRC Individual Yoga, order • Weekly group
Meditation • Meditation meditation
• Guided Imagery / Self-refer or MD/APP
Relaxation Training can order
• Individual Yoga,
Meditation, IM
consultation
Caregivers can participate with patients in outpatient or virtual services. For massage clinic, caregivers must
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be registered as Moffitt patient with medical record number.
ORDERS Search term: Integrative, massage, yoga, meditation, acupuncture “Appointment request” = outpatient “Consult” = inpatient MD/APP order “IM GI/Rx or IM Meditation” = inpatient nurse, SW order
CONTRAINDICATIONS
• Massage: bleeding/bruising, blood clots, lowered
immunity, open wounds, dermatitis, cellulitis,
tumor sites, enlarged lymph nodes,
surgical/radiation sites, medical device location,
sensory changes (e.g., neuropathy), risk of
fracture, increased pain
“Massage gave me
something to look
• Yoga: Bone metastases, fall risk, fracture risk, forward to, and I felt so
impaired lung function much better.”
• Oncology trained therapists skilled in assessment
and modification of therapy (e.g., pressure
adjustment, chair yoga) can treat high risk
patients
Corbin, L. Sa fe ty a nd e ffica cy of ma ssa ge the ra py for ca nce r pa tie nts. Ca nce r Control. 2005 ; 1 2 ( 3) : 1 5 8 - 1 6 4 .
J a ne e t a l., Syste ma tic re vie w of ma ssa ge inte rve ntio n for a dult pa tie nts w ith ca nce r. 2008 ; 31(6):E 2 4-E 3 5.
Rao, Raghavendra Mohan, et al. "Role of yoga in cancer patients: Expectations, benefits, and risks: A review." Indian journal of palliative
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care 23.3 (2017): 225.
Retrospective Study of Cancer
Patients receiving Integrative
Medicine Services
Please rate how you feel RIGHT NOW by circling one number for
each item.
10
1
Pain 2 3 4 5 6 7 8 9 As bad as it
No Problem
can be
How satisfied were you with this session?
Neither
Very
Satisfied Satisfied Dissatisfied Very Dissatisfied
Satisfied
Nor DissatisfiedMeditation Class – Clinically Significant (CS) Improvement
94.44
87.5
57.14
47.22
38.89 38.71
34.48 35.29
32.26
25.81 25.81 25.71
19.35
15.15
3.23 0
NAUSEA FATIGUE PAIN ANXIETY EMOTIONAL PHYSICAL QUALITY OF VERY SATISFIED
DISTRESS DISTRESS LIFE
Patients (N=32) Caregivers (N=36)
Percentage reporting > 2 point* change in symptom ratings from pre to post class
*clinically significant; Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole M. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94: 149e158.Patient Perspective I think the first time I did go to yoga, I told [provider]… I told her uh that I don’t believe it is going to do anything for me because I am not the meditation type . And when she… at the end of the session you are supposed to think of something good or wish for something good and I thought that was nonsense. It changed me a little bit. I saw… I started feeling wow uh the hour that I get rid of everything in my mind and I just concentrate on me and myself and my well-being. Uh just uh like one hour of watching a beautiful sunset. It makes a difference. It makes a very big difference...it makes me feel good. It makes me feel alive . Bockover, S. (2018) (Unpublished master’s thesis)
Yoga Class (N > 2200) – CS and Any Improvement
96.36
53.66 51.89
50.95 50.35 50.68
44.29
22.65 23.76 22.66
16.04 17.86
14.33
9.8
0.08 2.93 0.33 0.33 0.26 0.08 0.25 0.46
NAUSEA FATIGUE PAIN ANXIETY EMOTIONAL PHYSICAL QUALITY OF VERY SATISFIED
DISTRESS DISTRESS LIFE
CS Worse Any change CS Improved
Percentage reporting change in symptom ratings from pre to post classYoga Inpatient Unit (N = 60 to 62) – CS and Any Improvement
89.66
79.03
73.77 73.77
70
62.3
59.02
50
47.54
45.16 43.55
32.79 34.43
19.35
13.11
1.64 0 0 0 0 0 1.64 0
NAUSEA FATIGUE PAIN ANXIETY EMOTIONAL PHYSICAL QUALITY OF VERY SATISFIED
DISTRESS DISTRESS LIFE
CS Worse Any change CS Improved
Percentage reporting change in symptom ratings from pre to post individual sessionYoga Transplant Unit (N = 178)
90.23
69.1
64.41 66.1
58.62
54.65
43.26
40.56
38.2 36.72
35.06
32.77
26.74
20.79 18.89
0.56 1.69 1.11 0.57 0.56 1.13 0.58
NAUSEA FATIGUE PAIN ANXIETY EMOTIONAL PHYSICAL QUALITY OF VERY SATISFIED
DISTRESS DISTRESS LIFE
CS Worse Any change CS Improved
Percentage reporting change in symptom ratings from pre to post individual sessionRobin Hesselink’s Story
Massage Inpatient Unit (N > 600)
82.4
73.06
67.74 67.1
63.32
59.14
54.8
51.51
48.45
44.57 45.1 43.69
35.79
27.42
12.81
0.99 0.99 0.32 0.66 1.31 0.55 2.51 9
NAUSEA FATIGUE PAIN ANXIETY EMOTIONAL PHYSICAL QUALITY OF VERY SATISFIED
DISTRESS DISTRESS LIFE
CS Worse Any change CS Improved
Percentage reporting change in symptom ratings from pre to post individual sessionMassage Transplant Unit (N > 450)
76.42
64.86 66.52
60.45
52.24 52.78
46.79
42.24
40.04
35.78
33.64 32.28 30.71
26.23
15.33
12.5
0.75 0.37 0.37 0.19 0.75 0.44 1.51
NAUSEA FATIGUE PAIN ANXIETY EMOTIONAL PHYSICAL QUALITY OF VERY SATISFIED
DISTRESS DISTRESS LIFE
CS Worse Any change CS Improved
Percentage reporting change in symptom ratings from pre to post individual sessionInterview with Megan Marshall, LMT and Megan Peeler, Artist in Residence, Arts in Medicine
Osteopathic Manipulative Treatment (OMT)
• A gentle, holistic and hands-on approach to
help improve function and reduce
discomfort throughout the body
• Can be used together with medications,
surgery and other medical treatments
• Indications: pain of muscles and joints,
nausea, constipation, hiccups, sinus
congestion/lymphatic drainage, headaches
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0BENEFITS FOR INDIVIDUAL WITH CANCER
• Muscle energy
o Involves active use of muscles against a
counterforce in a specific position and
direction to improve muscle tension or
strain
• Counter strain
o An indirect technique used to treat a
tender point
• Myofascial release
o Helps to stretch and free limitations in
muscle and fascia
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1FOR MORE INFORMATION
moffitt.org/healingandwellness; moffitt.org/yoga;
Integrative Medicine
moffitt.org/massage; moffitt.org/meditation;
“Healing and Wellness moffitt.org/acupuncture
Services”
Email: patientwellness@moffitt.org
Outpatient scheduling: 813-745-4630
Program administration: 813-745-6052
Patient education A to Z tools:
intranet.moffitt.org/display/NUR/Patient+Education
OMT
Contact Dr. Bromberg or Dr. Haas
Full presentation on OMT this Fall
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