Page 2532 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 156 Integrative Therapies in Patients With Hematologic Diseases 2255

TABLE Herbs and Botanicals: Educational Websites TABLE Mind–Body Therapies
156.2 156.3
• Memorial Sloan-Kettering Cancer Center: https://www.mskcc.org/ • Relaxation response
cancer-care/treatments/symptom-management/integrative-medicine/ Biofeedback
herbs (accessed 8/31/16) • Mindfulness meditation
• The University of Texas MD Anderson Cancer Center: http:// Progressive muscle relaxation
www.mdanderson.org/ (accessed 8/31/16) Deep breathing exercise
• American Cancer Society: http://www.cancer.org (accessed 8/31/16) Prayer
• National Center for Complementary and Integrative Health (https:// • Guided imagery
nccih.nih.gov/) • Self-hypnosis
• National Cancer Institute’s Office of Cancer Complementary and • Self-expression in words
Alternative Medicine: https://cam.cancer.gov/ (accessed 8/31/16) • Music therapy
• Natural Medicines Comprehensive Database: http:// • Expressive arts therapy
www.naturaldatabase.com (accessed 8/31/16) • Dance
• Natural Standard: https://naturalmedicines.therapeuticresearch.com/ • Yoga
(accessed 8/31/16) • Tai chi
• Qigong
• Support groups
INDIVIDUAL INTEGRATIVE THERAPY MODALITIES

Mind–Body Therapies body programs. There are several common forms of meditation:
(1) concentrative meditation, which focuses on a phrase or a visual
Mind–body therapies are frequently studied interventions in patients image such as the relaxation response; (2) mindfulness meditation or
17
with chronic diseases such as hematologic malignancies. Mind–body awareness, in which the client becomes aware of his or her thoughts
therapies focus on the interactions between the brain, mind, body, and feelings and focuses on those issues; and (3) expressive meditation
and behaviors and on the ways in which emotional, mental, social, used in tribal societies consisting of fast deep breathing, shaking,
spiritual, and behavioral factors can directly affect health. Mind–body whirling, and dancing. 17
therapies are used throughout the world in treatment, disease preven- Mind–body interventions are often self-taught or presented by a
tion, and health promotion. professional. Double-blinded trials are difficult to conduct partly
A diagnosis of a hematologic malignancy can be very stressful. because the presence of an empathetic professional giving the thera-
Stress is part of normal physiologic body functioning and can be peutic modality may be considered a placebo effect. Mind–body
divided into good stress and bad stress. Chronic stress can be caused interventions are often accompanied by other integrative therapy
by an unexpected situation such as experiencing a new diagnosis (e.g., interventions, making pure studies unevaluable; however, random-
leukemia), an uncomfortable interaction with a colleague, painful ized clinical trials have demonstrated that relaxation training and
treatments, loss of a loved one or a job, or just the pressures of modern guided imagery significantly reduce nausea and anxiety. 20
life. Chronic stress has been shown to decrease immune functioning Compared with medication, relaxation therapy showed similar
by inhibiting the body’s ability to make T cells, B cells, macrophage decreases in anxiety and depression, although medication might have
cells, and interferon—four major components of the immune system. been slightly faster in its effect. Other randomized trials have shown
Research in the field of psychoneuroimmunology has shown that decreases in tension, depression, anger, and fatigue during relaxation
decreasing stress can actually boost immune function. Prolonged training or imagery. In children, hypnosis has been found to be
or severe stress not only weakens the immune system, it strains the especially effective. In a randomized clinical trial comparing hypnosis
heart, damages memory cells, and deposits fat at the waist rather or nonhypnotic distraction such as the relaxation techniques versus
than at the hips and buttocks (a risk factor for heart disease, cancer, joining a placebo attention-control group, the children in the hyp-
and other illnesses). When stress persists for too long or becomes too nosis group reported significant reduction in anticipatory nausea and
severe, the normally protective mechanisms become overburdened, a CINV.
condition that Bruce McEwen, at Rockefeller University, refers to as Mind–body therapies have also been used to alleviate pain. In a
“allostatic load.” study of children undergoing bone marrow or lumbar puncture
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Stress has even been shown to take a toll on gene expression. procedures, hypnosis significantly reduced the pain as well as anxiety.
Investigations into mind–body therapies using functional genomics A recent study has shown that a relaxation response training reduced
20a
have revolutionized the understanding of mind–body therapy mecha- anxiety in women undergoing breast biopsies. Also a study of
nisms and their effects on human physiology. Existing trials focusing mind–body therapies for men just diagnosed with prostate cancer,
on gene expression changes brought about by mind–body therapies preparing to go through radiation treatments, found that mind–body
have revealed intriguing connections to the immune system. 19 therapies reduced anxiety, improved sleep, reduced fatigue, and
Mental health professionals have significantly underestimated the improved concentration in all of the participants. 20b
importance of lifestyle factors as contributors to physical, emotional, Expressive arts therapy and music therapy as well as repetitive
behavioral, and spiritual pathologies. Mind–body therapies have been exercise, yoga, tai chi, qigong, and Pilates also can reduce stress and
underused in health care. anxiety. Music therapy is considered a mind–body therapy that
In the 1970s Dr. Herbert Benson popularized the “relaxation reduces stress and anxiety because it uses a variety of active and passive
response,” the performance of “a time out” in normal daily functions. music experiences, live or recorded. This technique can be used either
Benson coined this term after observing that when monks meditated, independently or with a music therapist. Randomized trials have
they experienced decreases in their pulse, blood pressure, and respira- shown statistically significant improvements in mood and physical
tions. Although there are now known genetic, environmental, and discomfort. In patients with hematologic malignancies admitted for
dietary factors that play a significant role in causation of chronic autologous stem cell transplantations, patients receiving an individu-
disease, stress may be a lesser but significant factor. Mind–body alized program of live music therapy had a significant improvement
techniques (Table 156.3) include transcendental meditation or the in mood or what is referred to as “courageous coping.” Music therapy
relaxation response, mindfulness meditation, biofeedback, guided has also been shown to be an effective adjunct to antiemetic therapy.
imagery, and hypnosis. In addition, music therapy, and modified Studies of immune function have yet to show any statistically signifi-
physical activities such as yoga, tai chi, and qigong also are mind– cant improvement in immune function.