Posted By SHL Librarian
Presented by: David Spiegel, MD
Willson Professor and Associate Chair, Department of Psychiatry and Behavioral Sciences
November 6, 2012
Watch the video
A diagnosis of breast cancer used to imply a terminal condition. But new understanding of the molecular and cellular processes behind the disease has led to more effective diagnostic tools and vast improvements in treatment. The result is that breast cancer now is considered more of a chronic condition rather than a terminal disease.
In the 1970s there were about 3 million cancer survivors in the United States; today those numbers have grown to more than 12 million. In fact, more than half of the women diagnosed with breast cancer tend to die of something else rather than the cancer.
?Survivorship is growing,? said David Spiegel, MD, associate chair of Stanford?s Department of Psychiatry and Behavioral Sciences, director of the Center on Stress and Health, and medical director of the Stanford Center for Integrative Medicine, who spoke at a presentation sponsored by Stanford Hospital Health Library. ?But that?s a good problem to have.?
But with these positive changes come some different challenges. How do you maintain a good quality of life while living with the uncertainty of a cancer diagnosis? How can survivors learn to deal with the stress associated with the disease and live well?
?It?s important to take care of your total health,? Dr. Spiegel said. ?Follow Grandma?s advice: Eat well, sleep well, and get plenty of exercise.?
Caring for Mind and Body
The psychosocial needs of cancer survivors should be an integral part of quality cancer care, he said. While conventional cancer therapy is increasingly effective, interventions such as surgery, chemotherapy, and radiation therapy can cause additional distress. Additional stress can come from dealing with pain and fear, diminished capabilities, changing family roles, a sense of mortality, and multiple other factors.
?For cancer survivors, it?s not a matter of just one source of stress, but a series of stressors. It?s an especially important time to explore your feelings and figure out ways to deal with them,? said Dr. Spiegel. ?The key is taking stressors one at a time and developing a plan for dealing with them. Feeling overwhelmed by stressors is yet another stressor.?
While sadness is a natural response to a cancer diagnosis, for some women these stresses can lead to depression?a long-term condition that affects a person?s physical and mental health and sense of worth. Sadness can easily morph into depression, which extends into hopelessness, helplessness, and worthlessness. While about 3 percent of the general population suffers from depression, more than 25 percent of cancer patients deal with the condition.
Depression, Dr. Spiegel said, is neither a normal nor acceptable part of cancer survivorship. It is a serious problem that has been shown to affect longevity?one study, published by Dr. Spiegel?s group in the Journal of Clinical Oncology, showed that breast cancer patients who reduced their depression increased their lives by an average of two years. Another study showed that long-term depression predicted mortality and that depressed cancer patients showed significantly higher mortality than non-depressed cancer patients.
Dealing with chronic stress creates changes in the brain?s neural pathways can be alleviated through a number of therapeutic approaches, including antidepressants, transcranial magnetic stimulation, hypnosis, and various types of psychotherapy. Proven techniques include individual sessions, peer counseling, and cognitive behavioral therapy.
Avoiding Depression
Dr. Spiegel?s expertise is in integrative medicine, which merges conventional and alternative therapies to address the complex and interconnected aspects of health and illness. His 30 years of working with breast cancer patients has shown that mind-body interventions can improve mood, quality of life, and coping skills.
He established a guideline that he calls FACES to help women deal with the stress of cancer survivorship while avoiding lapsing into depression:
- Facing issues?not fleeing from them
- Altering personal perceptions
- Cope actively?find some aspect of the situation that you can do something about
- Express emotions?acknowledge that something is amiss
- Social support?making connections is a critical aspect of mental well-being
Social connections appear to have an especially powerful influence on a person?s mental outlook. ?Loneliness is as bad as smoking is for your health, and it?s even worse when you have cancer,? he said. ?Social isolation is a key aspect of stress.?
Social Connections
In the 1970s Dr. Spiegel established support groups for women with metastatic breast cancer to create an opportunity for them to share and deal with their emotions. His landmark study found that the women involved in a support group, along with traditional medical care, experienced reduced anxiety, depression, and pain, and survived an average of 18 months longer than women who did not take part in a support group. More recent studies looking at both quantity and quality of life have found similar findings or no change in survival rates, but noted that participants showed less overall distress.
Participants were able to share their feelings about death and dying, express their emotions, build bonds, reorder their life priorities, manage symptoms, and clarify their roles.
?They could learn from other people?s perspectives, so they could understand their own ability to see that they did have some control over how they lived, which was very empowering,? he said. ?The goal of group therapy is to help manage their stressors. By changing depression into sadness and anxiety into fear, a person can begin to deal with their stress.?
Dr. Spiegel cited another study that found group therapy helped breast cancer survivors acknowledge their emotions: once they stopped trying to control their feelings, their stress levels dropped dramatically. Dealing with strong emotions allowed them make important decisions to make priorities and redefine their lives. This type of therapy also helped reduce depression and anxiety, and encouraged women to participate more actively in decisions related to their health.
?It?s healthy to feel anger or sadness,? said Dr. Spiegel. ?Women who check out by trying to constantly control their emotions are under more stress because they have difficulty figuring out what to do to reduce their distress.?
Self-hypnosis also has been shown to have a positive effect on managing symptoms because it can alter how pain is perceived and modulated. ?One study found that women in a support group using self-hypnosis reported half the pain levels as women not practicing self-hypnosis.
?Research has shown that women with advanced breast cancer involved in psychotherapy were less depressed and felt better about facing the possibility of death,? said Dr. Spiegel. ?It can help them deal with stress so that they feel better about life in general and also appears to improve survivorship. Stress management remains an important component of treating cancer. ?
About the Speaker
Dr. Spiegel, the Jack, Samuel and Lulu Willson Professor of Medicine and associate chair of the Department of Psychiatry and Behavioral Sciences, is internationally known for his research on the relationship between mental and physical health. He is also the medical director of the Center for Integrative Medicine at Stanford, which provides alternative and complementary services, such as meditation, acupuncture, and self-hypnosis, to help patients cope with cancer and other diseases. Dr. Spiegel has authored more than 475 research papers and chapters in scientific journals and 10 books on the mind-body connection. He is a member of the Institute of Medicine of the National Academies.
About the Series
The Ernest Rosenbaum Cancer Survivorship Lecture Series is named after the noted oncologist who established the cancer supportive care program at Stanford and the comprehensive cancer care program at UCSF?s Mount Zion Hospital. He wrote more than 25 books on cancer, most of them about living through treatments and life after cancer. The series is sponsored by the Stanford Supportive Care Program.
For More Information:
Stanford Health Library can do the searching for you. Send us your medical questions.
About Dr. Spiegel
http://stanfordhospital.org/profiles/frdActionServlet/David_Spiegel.profile?choiceId=printerprofile&&fid=3789&profileversion=full
Cancer Supportive Care
http://www.cancersupportivecare.com
Stanford Center for Integrative Medicine
http://www.stanfordhospital.com/clinicsmedServices/clinics/complementarymedicine
Source: http://www.shlnews.org/?p=697
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