mcgill cancer nutrition-rehabilitation program dr. thomas jagoe, program director; dr. martin...

McGill Cancer Nutrition-Rehabilitation Program

McGill Cancer Nutrition-Rehabilitation ProgramMcGill Cancer Nutrition-Rehabilitation ProgramDr. Thomas Jagoe, Program Director; Dr. Martin Chasen, Clinical Director; Dr. Neil MacDonald, Founding Director

McGill University, Department of OncologyGerald Bronfman Centre

Ms. Mary Jane MacDonald, AdministrationDr. Gayle A. Shinder, Research Grants, Program Documents, Website

Slide presentation: Content: Ms. Margaret Eades; Design and Editing: Dr. Gayle A. Shinder

Segal Cancer CentreSir Mortimer B. Davis-Jewish General Hospital (SMBD-JGH)Dr. Thomas Jagoe, PulmonologistDr. Neil MacDonald, Oncologist, Palliative Care

PhysicianDr. Polymnia Galiatsatos, GastroenterologistDr. Maryse Duchesne, PsychologistMs. Nelda Swinton, DietitianMs. Christina Van Der Borch, DietitianMr. Anh-Thi Tran, PhysiotherapistMs. Natasha Grant, PhysiotherapistMs. Louise Champagne, Infirmière PivotDr. Goulnar Kasymjanova, Research AssociateDr. Ravi Bhargava, Clinical Research AssociateMs. Cynthia Bromberg, Clinic CoordinatorDr. Rajesh Sharma, Data Manager

McGill University Health Centre-Royal Victoria Hospital (MUHC-RVH)

Dr. Martin Chasen, Oncologist, Palliative Care Physician

Dr. Bruno Gagnon, Palliative Care PhysicianDr. Pasqualina Di Dio, PsychologistMs. Shafia Amdouni, DietitianMs. Marta Jelowicki, PhysiotherapistMs. Josée Lemoignan, Occupational TherapistMs. Siobhan Carney, Infirmière Pivot Ms. Margaret Eades, Clinic Coordinator

and Clinical Nurse Specialist

Dr. Ravi Bhargava, Clinical Research AssociateMs. Sarah Schulman, Clinic CoordinatorDr. Rajesh Sharma, Data ManagerDr. Virginia Lee, Psychosocial Research

Index To Slide PresentationIndex To Slide PresentationSection SlidesIntroduction 3-7About the McGill Cancer Nutrition-Rehabilitation Program 8-12Cancer-Related Anxiety 13-24

Cancer-Related Fatigue 25-39Nutrition 40-41Complementary Therapies 42-54A Final Note 55McGill Cancer Nutrition-Rehabilitation Program Coordinates 56


INTRODUCTION


The Human Side of CancerThe Human Side of Cancer

“This nonphysical side of cancer can be neglected in the crunch of the physical aspects of cancer but the feeling side of cancer is equally important and that the psychological, social and spiritual aspects must be given equal attention.”

J.C. Holland & S. Lewis, 2000 The Human Side of Cancer: Living with Hope, Coping

with Uncertainty


Cancer Survivors Tell UsCancer Survivors Tell Us● A diagnosis of cancer has a huge impact on the

person, family and close friends. ● A lot of learning and adjustment takes place during

treatments and follow-up.● That as much as possible they want to resume normal

activities and a healthy lifestyle once treatments finish.

● Getting back to ‘normal’ is an important part of recovery and moving forward.


During Treatment Persons With a Diagnosis of Cancer May

● Feel weakened from:●being less active than normal. ● resting in bed more. ● having cancer treatments.

● Need more assistance with everyday activities than before.

● Have more difficulties walking long distances or standing in lines.

● Feel they run out of energy more easily.● Feel discouraged by these kinds of

changes.


Living With Cancer TreatmentsLiving With Cancer Treatments ● Many new cancer treatment options have increased

survival and quality of life for persons who have a cancer diagnosis.

● Over the years many survivors have intermittent periods when they require additional treatments.

● Like other chronic diseases, cancer requires medical follow-up and sometimes different treatments to prevent the disease from progressing.

● Learning how to incorporate treatments into an active life schedule is a challenge but many patients are very successful in this regard.


About the McGill Cancer Nutrition-Rehabilitation

Program


Program FocusProgram Focus

Clinical Care

Research

Education


MissionMission1. Develop and administer nutritional and rehabilitation programs for cancer patients who are suffering from poor appetite, malnutrition, weight loss, fatigue and loss of function.2. Conduct research aimed at understanding the underlying biological reasons why some cancer patients suffer from the above symptoms.3. Educate patients, family caregivers and health professionals in new ways to manage the above symptoms.


Overall GoalsOverall Goals● Enhance patient quality of life.

● Sustain patient function allowing them to remain at home caring for themselves for prolonged periods of time.

● Reduce the burden, both physical and psychological, on family and caregivers.

● Reduce the adverse effects of anti-cancer therapies.


Specific GoalsSpecific Goals

● To maximize your physical functioning, safe activity levels and exercise tolerance.

● To optimize your nutritional intake for healing, building and keeping muscles and to provide adequate daily energy sources.

● To assure you have what you need for optimal symptom control and management.

● To help you learn strategies and have information to continue with your own program of rehabilitation.


CANCER-RELATEDCANCER-RELATED ANXIETYANXIETY


● Most people with cancer, and their family members, experience anxiety.

● Uncertainty, particularly during treatment, is normal and makes planning for tomorrow or next week unpredictable and frequently difficult.

● A person with a cancer diagnosis often describes feeling uneasy or apprehensive.

● The feeling of uncertainty can interfere with the ability to do normal everyday activities.


Cancer-Related Anxiety Can Cancer-Related Anxiety Can IncreaseIncrease

● When the Doctor tells you the diagnosis.

● When undergoing treatments.

● When anticipating a cancer recurrence.

● During screening tests or waiting for test results.

● When you have pain, poor sleep or feel unwell.


Cancer-Related Anxiety AffectsCancer-Related Anxiety Affects● What you feel you can do (physically, mentally and/or

emotionally)● Symptoms of pain, fatigue etc. by making them worse

or more difficult to control. ● Your thoughts and beliefs about your well-being.● Your readiness to do normal daily activities (eg.

eating, shopping).● Your ability to fall asleep or stay asleep.


AnxietyAnxiety● Gets our attention or makes us pay attention and be

vigilant.● Gives us feedback in response to risky situations.● Can help you move toward making choices to reduce or

eliminate the anxiety.● Can encourage assessment, problem solving and re-

evaluation of a situation


When you identify triggers make note of what they are.

Knowing is the first step to managing them better.


Suggestions To Help Reduce Suggestions To Help Reduce Anxiety LevelsAnxiety Levels

Talk to friends/family

Listen to music

Relaxation Exercises

Meditation


Reduce Anxiety: Good Sleep Reduce Anxiety: Good Sleep Preparation HabitsPreparation Habits

● Drink warm liquids (caffeine-free) or milk.

● Do something relaxing (eg. read a book, listen to music) before going to bed.

● Go to bed at the usual time.

● If you are unable to fall asleep, get up and do something relaxing (eg. read a book, listen to music).


Reduce Anxiety: Reduce Anxiety: ActivityActivity● Keep as active as you can during the day.

● Do regular exercise (3-5 times per wk).

● Set short term goals and gradually increase amount or duration of activity.

● Celebrate your gradual progress and achievements.


Talk To Your Doctor/NurseTalk To Your Doctor/Nurse

If You Feel:

More anxious than what you normally feel.

You have more problems concentrating.

Too tired to get out of bed for more than 12 hrs.

If you have pain, nausea, constipation/diarrhea or other discomforts.


Tips To Caregivers To Manage Tips To Caregivers To Manage Their AnxietyTheir Anxiety

Maintaining your own health and wellbeing is important to be able to provide the best care possible.

Take time for yourself (a day off or quiet time). Watch for signs of your stress build-up (impatience, loss of

appetite, difficulty sleeping). Be open to accepting offers of help. Educate yourself about the disease, symptoms and care.


Tips To Caregivers To Manage Tips To Caregivers To Manage Their AnxietyTheir Anxiety

Use available community resources.

Don’t be afraid to talk about your concerns and feelings with friends and family.

Give yourself credit. The care you give makes an important difference.

When you have questions, ask the treatment team members.


Cancer-Related FatigueCancer-Related Fatigue


Cancer-related fatigue:

…”unpleasant debilitating feeling of tiredness to exhaustion.”

“It can keep you from doing the things you would do ordinarily or would like to do”

“It often interferes with your ability to function normally (day to day).”


How frequent is fatigue ?How frequent is fatigue ?● In general population:

23-30% of women.

13-20% of men.

● Most people complain of fatigue for several weeks after surgery.

● Most people with cancer, and those having treatments such as chemotherapy and radiotherapy (75-96% describe cancer fatigue).


Cancer-Related FatigueCancer-Related Fatigue

● Patients tell us it is different from the fatigue experienced after hard work or exercise.

● They say it is often unpredictable.

● The amount of fatigue and how much it limits their loved one is a source of worry for family members.


Consequences Of Cancer-Related Consequences Of Cancer-Related FatigueFatigue

● Feeling weary or exhausted (physically, mentally and/or emotionally).

● Your body (arms and legs) feels heavy and achy.● You don’t feel like doing normal activities (eg. eating,

shopping). ● You may find it hard to concentrate and make decisions.


What Are Things You Can Do What Are Things You Can Do To Help Reduce Your FatigueTo Help Reduce Your Fatigue

● Rest

● Activity

● Nutrition

● Energy Conservation

● Energy Restoration


RestRest● Sleep and Rest are important. ● But don’t over do it. Too much can decrease your

energy levels and reduce muscle function. “if you don’t use it, you’ll lose it.”

● If you have trouble sleeping tell your doctor.● A “Power Nap” in the day is 1 hour or less.


Reduce Fatigue: Good Sleep Reduce Fatigue: Good Sleep Preparation HabitsPreparation Habits

● Drink warm liquids (caffeine-free) or milk.

● Do something relaxing (eg. read a book, listen to music) before going to bed.

● Go to bed at the usual time.

● If you are unable to fall asleep, get up and do something relaxing (eg. read a book, listen to music).


Reduce Fatigue: ActivityReduce Fatigue: Activity● Keep as active as you can during the day.

● Do regular exercise (3-5 times per wk).

● Set short term goals and gradually increase amount or duration of activity.

● Celebrate your gradual progress and achievements.


Reduce Fatigue: NutritionReduce Fatigue: Nutrition

● Drink plenty of fluids early in the day.● Eat as well as you can: select nutritious choices.● Carbohydrates are good sources of energy. ● Small meals of cool foods can refresh and make

eating easier.

Nutrition Guide: http://www.mcgill.ca/cnr/guide/


Reduce Fatigue: Energy Reduce Fatigue: Energy ConservationConservation

● Select activities according to your priorities.● Plan breaks and rest periods in between. ● Let friends and family members help with meal

preparation, errands and housework. ● Pace yourself and delegate to decrease energy

depletion.● Do some activities seated.


Reduce Fatigue: Energy Reduce Fatigue: Energy RestorationRestoration

● Do activities you enjoy and that make you feel good.● Do outdoor activities that you enjoy (eg. gardening,

bird watching, walking the dog)● Listen to music, massage therapy, reflexology, aroma

therapy.● Visit with friends and family.


Talk To Your Doctor/NurseTalk To Your Doctor/NurseIf You Feel:

● More fatigued than normal.

● You have more problems concentrating.

● Too tired to get out of bed for more than 12 hrs.


Tips To Caregivers To Manage Tips To Caregivers To Manage Their FatigueTheir Fatigue

Maintaining your own health and wellbeing is important to be able to provide the best care possible.

Take time for yourself (a day off or quiet time). Watch for signs of your stress build-up (impatience, loss of

appetite, difficulty sleeping). Be open to accepting offers of help. Educate yourself about the disease, symptoms and care.


Tips To Caregivers To Manage Tips To Caregivers To Manage Their FatigueTheir Fatigue

Use available community resources.

Don’t be afraid to talk about your concerns and feelings with friends and family.

Give yourself credit. The care you give makes an important difference.

When you have questions, ask the treatment team members.


NUTRITIONNUTRITION

A NUTRITION GUIDE FOR PATIENTS, FAMILIES, AND FRIENDSMCGILL CANCER NUTRITION REHABILITATION PROGRAM

Authors: Nelda Swinton and Neil MacDonaldGraphic design: Linda Van Inwegen

http://www.mcgill.ca/cnr/guide/


Complementary TherapiesComplementary Therapies


Complementary TherapiesComplementary Therapies

● Non-drug treatments that add to or enhance medical treatments.

● Usually seen as effective, safe, “natural,” non-toxic and supportive treatments that relieve the ill effects of medical treatments or the illness itself.

● Therapies that give the person an improved sense of well-being.

● Examples are: Relaxation, Yoga, Reiki, Shiatsu, Therapeutic Touch, Reflexology and Massage.


Alternative Therapies Are Alternative Therapies Are Different Different

From Complementary TherapiesFrom Complementary Therapies● Alternative therapies have been used instead of

conventional treatments by some people who see them as superior to and preferred over medical treatments (familiarity, cultural, traditional).

● How they are used can be different too: possibly alone, one after another or together with other treatments.


Most Often We Refer To These Most Often We Refer To These Therapies Together As CAMsTherapies Together As CAMs

● Complementary and alternative medicine taken together describes the whole domain.

● 50-70% of patients use CAMs.● A major worry is that there are few studies that have

evaluated the usefulness, effectiveness and safety of some of the CAM treatments.

● CAMs are mostly unregulated. They are easily accessible and based on client-directed and client-defined benefits.


CAMs Are Available At Some CAMs Are Available At Some Cancer CentresCancer Centres

Memorial Sloan-Kettering

Duke & Stanford

CAM departments which study and offer a variety of modalities: music therapy, healing touch, medical Qigong, energy healing.


● CAMs are consumer driven: marketing is both cause and effect of the popularity of many CAMs.

● Third party payers or insurance companies are reimbursing for a growing number of CAM therapies.

● Important to have more attention to public policy and client safeguards.

● Clinical trials are studying whether there is scientific evidence of health effects of particular CAMs.

● Public policy is being developed to regulate usage in some cases.


NutritionalNutritional & Dietary CAMs & Dietary CAMsRationale: If diet can prevent cancer it may also cure

● Some dietary elements may function as antioxidants.

● Melatonin, Selenium, mega-vitamin therapy (A, E, C), low-fat diets, Omega 3 fatty acids, macrobiotics and soy are other examples of CAM nutritional and dietary regimens.

● Clinical trials (NIH, 2003) include low fat diet, macrobiotics, vitamin E and soy.

Deterrents: Antioxidants may interfere with radiation therapy and some chemotherapy. Some dietary CAMs have anticoagulant effects and could compromise diagnostic tests.

Discuss questions pertaining to nutritional and dietary CAMs with a nutritionist.


Traditional and Folk MedicinesTraditional and Folk Medicines

Rationale: There are accepted understandings of the development of disease and physiology that differ from conventional Western medical thinking and are time honoured. (Ross,

2000)

Example: Traditional Chinese Medicine (TCM) Clinical Trials of some TCM are in

progress.


Herbal MedicinesHerbal MedicinesRationale: Includes natural herbs or botanicals.

Examples: Echinacea, Grape Seed, Green Tea, Aloe Vera, Milk Thistle & Chaparral, Essiac, Chamomile & Ginger, Ginseng, Kava-Kava.


Herbal MedicinesHerbal Medicines● Clinical Trials in progress include examinations of green

tea, curcumin, flaxseed, ginger, ginkgo, grape seed extract & milk thistle extract, mistletoe & St John’s Wort (NIH, 2003).

● Botanicals can interact with one another and with some medicines (chemotherapies) (Weiger et. al, 2002).

Important to check with doctor


Mind-Body-Spirit TechniquesMind-Body-Spirit Techniques

Rationale: Emotions may influence the course of disease.

Objective: Reduce stress through yoga, biofeedback, group support and/or music therapy.

Clinical trials (NIH, 2003) include music therapy, massage, prayer and mindful-based art therapy.


Manual Healing & Physical Manual Healing & Physical Touch MethodsTouch Methods

Rationale: Course of disease is influenced by energies or forces that can be manipulated.

Examples: Range from acupuncture and chiropractic to therapeutic touch

Clinical trials (NIH, 2003) are assessing acupressure to control chemotherapy nausea and acupuncture to control symptoms.


Breathing Exercise To Breathing Exercise To Let Go Of TensionLet Go Of Tension

1) Sit comfortably in a chair with feet flat on the floor.2) Breathe in deeply into your abdomen and say to

yourself “Breathe in relaxation”.3) Breathe out from your abdomen and say to yourself

“Breathe out tension”.4) Use each inhalation to become aware of any tension

in your body.5) Use each exhalation to become aware of letting go

of tension.6) Use your imagination to picture relaxation entering

your body and tension leaving your body.


A Final NoteA Final Note

Remember to indulge in activities that give you pleasure….activities that you always enjoyed doing, or perhaps even something new.


McGill Cancer Nutrition-Rehabilitation Program www.mcgill.ca/cnr

Dr. R. Thomas Jagoe, Program DirectorDr. Martin R. Chasen, Clinical DirectorDr. Neil MacDonald, Founding Director

546 Avenue des Pins OuestMontreal, Quebec

H2W 1S6Tel: (514) 398-8988Fax: (514) 398-5111


mcgill cancer nutrition-rehabilitation program dr. thomas jagoe, program director; dr. martin...

Documents

cancer treatments

diagnosis of cancer

cancer survivors

physical aspects of

cancerrelated anxiety

cancerrelated fatigue

program director

program documents