New hope for breast cancer – with implications for prevention as well as survival

Breakthrough research demonstrates mindfulness and emotional expression maintain telomeres and offers new hope to women affected by breast cancer.

Speaking generally, people diagnosed with cancer who have shorter telomeres are more likely to die of that cancer than those with longer telomeres. Theoretically, anything that preserves telomeres, or better still, lengthens them could well lead to higher rates of survival, even recovery.

Considering breast cancer specifically, telomere length (TL) has been associated with prognosis. Again, the longer the telomeres, the longer the survival.

So this week, we report on a landmark study that shows learning mindfulness and emotional expression in a group setting offers new hope to women affected by breast cancer, but first

           Thought for the day

                   Meditation is acceptance. 
                   It is the acceptance of life 
                  Within us, 
                  Without us, 
                  And all around us. 

                  Acceptance of life 
                 Is the beginning of human satisfaction.

                                       Sri Chinmoy


Previous research has shown that group psychosocial interventions including mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET) can help breast cancer survivors decrease distress and influence cortisol levels.

This is the first randomized controlled trial to examine how mindfulness and emotional expression impact on telomere length (TL) in women affected by breast cancer.

Eighty-eight distressed breast cancer survivors with a diagnosis of stage I to III cancer who had completed treatment at least 3 months prior participated.

They were separated into three groups  - one was asked to attend eight weekly, 90-minute group sessions that provided instructions on mindfulness meditation and gentle yoga. These participants were asked to practice meditation and yoga at home for 45 minutes daily.
The second group met up for 90 minutes each week for the three months and supported and guided by well-trained group leaders were encouraged to talk openly about their concerns and feelings.

The third control group simply attended a one day, six hour stress management seminar.
Before and after the study, all participants had their blood analysed and their telomere length measured.



Both groups who attended the support groups maintained their telomere length over the three-month period, while the telomeres of the control group had shortened.

The two groups who attended the therapeutic group sessions also reported lower stress levels and better moods.



RESULTS
Very interesting. MBRC and SET had almost the same positive effect on telomere length when compared to the control group. In both the MCBR and SET groups, telomere length was maintained, whereas it was found to decrease for those in the control group. It seems either MBRC or SET led to about the same benefit.

COMMENT
Curiously, there were no associations noted between changes in TL and changes in mood or stress scores over time.

Curiously, because previous studies that have examined the impact of group therapies on survival times for people affected by cancer have indeed demonstrated a strong correlation between state of mind and outcome.



To summarise, those groups studied that led to measurable improvements in  “quality of life" - (in inverted commas because quality of life is a broad term), generally were associated with increased survival times for the participants.



Where there was no improvement in quality of life following participation in a group, generally there was no increase in survival times.



The conclusion many reached based on these observations has been that a well run group will lead to improvements in quality of life for its participants, and that translates into or has a correlation with longer survival times. There is a certain logic to this.

Curious then that in this study, no association was found between telomere lengths and mood or stress levels. The researchers postulated on a number of reasons for this, but hopefully, it will not be long before more research groups look into the intriguing relationships between cancer, telomeres and the mind studied in this important piece of research and we will come to learn more of the science in this fascinating and important area..

CONCLUSIONS
Although this research is pretty exciting, it is still not known if these benefits will be long-term or what is causing this biological effect. But for now, we can take heart. This study does suggest that telomeres can be preserved. It is reasonable to suppose that if telomeres remain longer, then survival times may well go up.

Hopefully, this study will be followed up so that the effect of learning and practising mindfulness and emotional expression in a group setting on survival times for women with breast cancer will be reported. Many would anticipate from personal experience that those findings also will be positive.

This study has made the important contribution of demonstrating that a psychosocial intervention that lasted only 3 months and that taught and supported either mindfulness-based stress reduction or emotional support resulted in telomere length stabilisation in distressed breast cancer survivors, compared with decreases in those offered usual care.

Speaking more generally, these results provide provocative new data that suggest it is possible to influence telomere length in cancer survivors through the use of psychosocial interventions involving group support, emotional expression, stress reduction, and mindfulness meditation. By implication, the findings are of great interest for the prevention of breast cancer.

More research please.

REFERENCE
Carlson, L. E. et al. (Feb 2015), Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer, 121: 476–484. doi: 10.1002/cncr.29063

RELATED BLOG
Service your car? Of course! Service your telomeres? What? – Examines how everyone can support their telomeres – and what the benefits are.

Is this the elixir of youth? – More on telomeres including another landmark study, this time from Dean Ornish, that showed a lifestyle-based group intervention increased telomerase levels in men affected by prostate cancer, and that this translated into longer telomeres after 5 years.

RESOURCES

Product B - Herbal telomere support approved by the Australian TGA: CLICK HERE


NOTICEBOARD
MEDITATION POSSIBILITIES IN QUEENSLAND 
– Coming soon

Brisbane day workshop - Sunday, June 14th, 2015

A Relaxing, Regenerative Meditation Intensive 

Designed for experienced meditators, but definitely open to those newer to meditation

Date        Sunday, June 14th, 2015 from 10am (arrive 9.30) to 5pm
Venue     The Relaxation Centre, 15 South Pine Rd, Alderley, Brisbane
Enquiries and Bookings    The Relaxation Centre        Telephone: 07 3856 3733
                                                                                       
www.relaxationcentreqld.com.au

Cairns Weekend Meditation Intensive 
June 20 and 21 – Non-residential

Meditation is the greatest gift you can give to yourself, or someone you care for

Date              Saturday, Sunday 20th and 21st June. Starts 10am (arrive 9.30) to 5pm
Venue           Khacho Yulo Ling Buddhist Centre, 348 Severin Street, Cairns
Enquiries      Call  07 4041 5556    or email   info@yuloling.com
Bookings      Online, go to :  www.yuloling.com     or call Rinchen    07 4041 5556


Medicine of the Mind  
Cairns Evening Public Lecture – June 23

For everyone interested in the power within 

Date                Tuesday 23rd June, 2015      Starts 7pm (arrive 6.30) to 10pm
Venue             Khacho Yulo Ling Buddhist Centre, 348 Severin St
Enquiries        Call  07 4041 5556    or email   info@yuloling.com
Bookings        Online, go to :  www.yuloling.com     or call Rinchen    07 4041 5556

Compelling cancer research

Lets be really clear about this. What someone with cancer does to help themselves is therapeutic. It makes a difference to their disease as well as to how they feel. People with cancer who are not encouraged and helped to help themselves may well be shortening their lives.

A really effective self-help program is not just designed to help people to feel better, although it is highly likely to do this and of itself, this outcome is very worthwhile. But there is more to it. A really effective self-help program is also designed to improve survival. As such, an effective self-help program is as important in cancer medicine as surgery. Or chemotherapy. Or radiotherapy. Or any natural therapy.

In some situations what a person with cancer does to help themselves is actually even more therapeutic than these other treatments. Just as one example, the evidence shows that for a woman with early breast cancer, regular exercise increases her chances of long-term survival twice as much as chemotherapy.

This week, as Ruth and I have just completed the most recent of the series of follow-up programs called Cancer and Beyond that we present regularly, let us go Out on a Limb once again and examine findings from a major, systematic review of 4,900 published research articles. The researchers went on to identify and analyse 203 randomised controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment.

Given there still seem to be people claiming there is little or no research validation for the self-help interventions covered below, this is information that warrants being widely shared, but first,



    
   Thought for the day

Ten thousand flowers in spring, 
The moon in autumn, 

A cool breeze in summer, 
Snow in winter.


If your mind isn't clouded by unnecessary things,

This is the best season of your life.


   Wu-men - Zen master of the 12th/13th century




Nice title this one: The Society for Integrative Oncology Guidelines Working Group. They commissioned the development of Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer.

Practice guidelines are intended to inform clinicians and patients about safe and effective therapies.

These specific breast cancer guidelines have been developed in response to the well know fact that the majority of women affected by breast cancer do use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life.

The guidelines are based on the results of a literature search that reviewed relevant published data from January 1, 1990 to December 31, 2013. This search identified 4900 articles, of which 203 were eligible for analysis.

WHAT DID THE RESEARCH REVEAL?
In short, the conclusion reached was that “specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment”.

BROADLY, WHAT LIFESTYLE THERAPIES ARE RECOMMENDED?
Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A)   A – is the highest level of evidence-based recommendation, and reducing through B, C and so on.

Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B).

Many interventions, 32 in all, had weaker evidence of benefit (Grade C).

Seven interventions were deemed unlikely to provide any benefit (Grade D).

WHAT ABOUT SIDE-EFFECTS?
Notably, from all these studies examining a wide range of lifestyle/integrative interventions, only one, acetyl-L-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy.

Wouldn’t you love it if the side-effect profile of chemotherapy or radiotherapy was this small?

WHAT ABOUT SYNERGY?

Sadly, combined self-help programs like the ones we present, are not well researched as yet. Given that there are more variables to take into account – like the combined benefits of exercise, and meditation, and exercise, and… and… ; that type of research is far more complex and far more expensive to conduct, so we will need to wait for that data.

At present, all that can be said is that the majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).

WHAT ABOUT SPECIFIC RECOMMENDATIONS? Here are some details…

Meditation [Grade B evidence found] including mindfulness-based stress reduction, yoga [Grade B], and stress management programs [Grade B] are recommended to reduce longer term anxiety both during and after treatment.


Longer stress management groups are likely more effective than short home study programs.


Meditation [Grade A) particularly mindfulness-based stress reduction, is recommended for improving mood and depression during radiation therapy and post treatment.

Yoga alone [Grade A)and relaxation [Grade A) are also recommended for improving mood and depressive symptoms during radiation therapy and chemotherapy and in the presence of fatigue.


Massage [Grade B) is recommended for improving mood disturbance in post treatment survivors.

Healing touch [Grade C) can be considered for improving mood in patients undergoing chemotherapy.

Meditation [Grade A) is recommended for improving quality of life, while relaxation and guided imagery [Grade C), qigong [Grade C], reflexology [Grade C], stress management [Grade C], and yoga [Grade C] can also be considered.

LIMITATIONS
There are insufficient data from existing trials to make guideline-level recommendations on interventions to prevent and/or treat side effects and symptoms related to cognition, anaemia, neutropenia/leukopenia, alopecia, cardiomyopathy and adherence to standard treatment.

Many trials available for review shared common limitations, including small study sizes, poorly reported or unstated delineation of outcomes (ie primary, secondary, or exploratory outcomes), lack of standardised outcome measures, use of surrogate measures with limited clinical relevance, omission of toxicity and adverse event data, inadequate statistical methods, and lack of blinding and/or appropriate control groups.

THE FUTURE
The researchers commented that to improve the validity of future studies, it is critical that trials measure clinically relevant and standardised outcomes using validated tools and that they are analysed with accepted and appropriately chosen statistical methods to better allow for pooled analyses.

THIS AUTHOR’S CONCLUSION
This major review investigated the role Integrative Therapies play in supportive care for people affected by cancer. In the result there is very useful information that clearly validates that the self-help approach makes a significant contribution to quality of life and general care of women affected by breast cancer. On e could imagine that the evidence for that is strong enough to suggest that a well run program teaching and supporting these modalities needs to be a part of standard care..

Notably, most of the modalities recommended come under the banner of what we would call Lifestyle Medicine.

Meditation has the best level of evidence for the widest number of benefits.

Take up on these self-help principles generally and you are highly likely to have a better experience when diagnosed, treated and recovering from cancer.

What we need urgently now is for the focus of future research to hone in on the potential benefits Lifestyle Medicine offers to actual recovery. There is already a good body of evidence for the therapeutic benefits of some Lifestyle – based therapies such as nutrition and exercise, but it would be good to see all of that evidence collated and evaluated clearly.

And equally as clearly, more research is needed.

WHERE ARE THE STUDIES ON THE THERAPEUTIC BENEFITS OF MEDITATION? 

But the big question remains.

With so many people affected by cancer meditating, why no outcome studies?

Come on Cancer Council.
Breast Cancer Network.
You have the research funds. Lets find out just how beneficial to survival meditation may be ….

Many, many people would welcome and support that research.

REFERENCE

Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer , Greenlee H et al. J Natl Cancer Inst Monogr 2014 (50): 346-358.

To read the full reference CLICK HERE

RELATED BLOG
The Cancer Council, the survivors and the book

NEWS


We head to New Zealand again this week to present the 8 day cancer self-help program Cancer, Healing and Wellbeing in the beautiful southern island town of Wanaka.


What an environment for healing!


For the next post, that will come in 10 days, I will report on this program and the one we have just completed at the Foundation, Cancer and Beyond.



COMING EVENTS with RUTH and MYSELF

MEDITATION RETREAT

Meditation and the Inner Journey        8th  – 12th  June     Yarra Valley

This retreat brings together 2 powerful experiences - the deep natural peace of meditation, and a gentle process of introspection that will help you reconnect with your own inner wisdom.

For thousands of years, people have removed themselves from the busyness of daily life and entered into a retreat situation to meditate. Come, join like-minded people, be inspired, be renewed. Immerse yourself in meditation.

Be guided, be nurtured. Take the opportunity to reconnect with your own inner wisdom and natural great peace.

FULL DETAILS  -  Click here

How to avoid a disaster

Have you ever had a special night out spoiled by poor service, poor staff? Lets go Out on a Limb once more and investigate how to avoid such a disaster in the future, plus details of a major new research review from the National Cancer Institute in the USA that recommends meditation for women with breast cancer, and news of the next Happiness and its Causes Conference (that will feature HH the Dalai Lama!) with a special offer to you the reader of a big discount, but first





               Thought for the day

  We can never obtain peace in the outer world 
  Until we make peace with ourselves


                     HH The Dalai Lama 








Imagine this. You have a special occasion to celebrate. Maybe a special birthday, an anniversary. Completion of a challenging piece of work, a loan paid off, a sporting triumph….  All sorts of possibilities, but definitely time for a big celebration.

So you gather the family, maybe some friends; and decide it will be your shout, no expenses spared, and you book into a fancy restaurant.

The evening arrives. Some anticipation. You head into the restaurant, the manager’s greeting is a touch cool, but then this is a classy place, maybe that is how things are done here?

But then the waitress. Definitely cool. Even remote. Hardly much of a welcome at all.

She tells you of the specials for the evening. Almost disinterest. No verve, no enthusiasm. You start to wonder??? This is not how it I imagined it would be. Fancy restaurant. I expected better service than this. The place must have a management problem. They should be employing better staff than this. Or supervising them better; making sure they are doing their job.




You order.



Everyone else seems happy enough.



Maybe it is OK after all.





But your soup arrives and THAT waitress manages to actually spill a little on your lap! Spilled the soup. Good grief! Everyone apologizes profusely, but your worst fears are confirmed. The night is gone for you.

Things go from bad to worse. An error in the mains that arrive, very expensive wine tastes ordinary, dessert not what you hoped for. Big bill. No tip. You try to put on a brave face for your guests, but you leave feeling miserable, swearing you will never go back to that place again.

An unmitigated disaster.

Now, imagine re-running the same scenario - up until the time you arrive at the restaurant. This time, the manager greets you, welcomes you with some reserve and what seems like a little trepidation, then explains.

It seems one of his waitresses had her own disaster just 6 weeks ago. Her husband was killed in a car accident and she has 3 young children to support. She need to work. This is actually her first night back. Everyone is unsure of how she will go, but he asks for your patience and understanding.

So knowing this, how differently things unfold. You welcome her warmly, understand the lack of verve. Laugh off the spilled soup, make good everything else that could have gone “wrong”. The wine tastes sweet; the dessert spectacular. You have a great night. Maybe even make a new friend.

So how much of an explanation in day-to-day events do we need to display compassionate awareness? How often do we stumble into mindless intolerance?

It would seem that compassionate awareness is a big part of Emotional Intelligence, and requires quite some work on our part to over-ride what is often an immediate, unaware, instinctual reaction.

Next time you are at a restaurant, maybe pause for a moment to wonder what sort of day those who are serving you have had.

And smile.

RELATED BLOG
Finding our true identity

NEWS
1. Meditation recommended for women with breast cancer
A major new review article has recommended the use of meditation and some other complementary and/or integrative therapies for a range of conditions affecting women with breast cancer. This is such an important piece hat the entire abstract is offered here. The full article can be read by following the link below.

Abstract

Background The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies.

Methods Following the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system.

Results The search (January 1, 1990–December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).

Conclusions Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.

REFERENCE: Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer. Greenlee H et al; J Natl Cancer Inst Monogr 2014 (50): 346-358.   LINK HERE

2. Happiness and its Causes 2015 with HH the Dalai Lama

Special discount to readers of Out on a Limb

REGISTER HERE