Cancer patients suffer from psychosocial distress as soon as they are diagnosed with cancer before initiating the treatment approach. Increasing distress among cancer patients during and after the treatment has resulted in increased vulnerability in the patients’ cancer journey. The after-effects of the treatment, such as chemotherapy, surgery, and radiation in cancer treatment, have been a significant reason for deteriorating the mental health of cancer patients. Emotional distress depends entirely on the patient’s clinical condition, health, and prognosis. Therefore, the patients need to mitigate their emotional distress to improve their quality of life and increase their survival rate. Cancer patients are resilient, which does not mean they do not need any support, but they require emotional support from relatives, friends, and caregivers (Siedlecki et al., 2014).
Emotional wellness in cancer patients is promoted by helping them cope with their current situation by considering doctors, nurses, and allied health staff. The healthcare treatment team of the patient is one of the important sources of emotional support. The patients value the care they provide with empathy and as per their desire. Hence, the nurses and oncologists mitigate the psychosocial concerns of the patients, which will help improve the patient’s well-being.
The research has revealed that quality of life is improved by using emotional wellness programs that include stress management interventions. Some of the essential emotional wellness are discussed below:
Mind-body approaches: It aims to relax the mind and body using various techniques. It focuses on clarifying the mind, improving focus, enhancing decision-making capacity, managing stress or resolving conflict. It also helps reduce pain, fatigue, stress, anxiety, nausea and vomiting, depression, sleep disruption or other symptoms common in cancer and cancer treatments. Some of the techniques are:
Qigong: It is a system of coordinated body posture and movement, breathing, and meditation used for health, spirituality, and martial arts training.
Tai Chi: It is the art practised for defence training, health benefits, and meditation.
Yoga: It is the group of physical, mental, and spiritual practices or disciplines which originated in ancient India and aim to control (yoke) and still the mind and gain insights of peace within oneself.
Deep breathing: It is an easy way to relax and let all the worries go away. It requires only a few minutes to carry out this exercise.
Meditation: It is the practice of paying attention to the present moment with an accepting, nonjudgmental disposition.
Hypnosis: It is the human condition involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestions.
Music therapy: It is the clinical and evidence-based use of music interventions to accomplish individualised goals within a therapeutic relationship by a trained professional who has completed an approved music therapy program.
Guided Imagery: These practices help reduce cognitive, emotional stress, and fatigue among the cancer patients that is evolved due to the integration of various treatment approaches. It mainly includes motivating sentences, music, and breathing and relaxation training. It has helped the cancer patients relax and has been effective in relieving the adverse side effects of chemotherapy, such as nausea, vomiting, anxiety, and depression. It is effective in improving the overall care for patients.
Cognitive-behavioural therapy (CBT): It is a type of psychotherapy that aims to help patients change behaviour by changing thoughts and feelings. It shows efficacy in treating mental, emotional, personality and behavioural disorders such as insomnia and depression. CBT has also been used to treat anticipatory side effects such as nausea and vomiting during chemotherapy.
Mindfulness: It is the method of achieving a state of mind that is aware and in control. It helps reduce stress, improve physical health, and maintain harmony in life. It is considered an effective pain control method in cancer. Its practice has helped in reducing sleep disorders among cancer patients and survivors.
Art therapy: It uses the creative process of making art to improve cancer patients’ physical, mental and emotional well-being.
Biofeedback: It is concerned with electrical sensors or other instruments that report information about body status back to the patient. It aims to make the patient learn to respond to and act on any changes in the heart rate, blood pressure, breathing, muscle contraction, brain waves, sweat glands or skin temperature.
A) Zen Integrative Oncology Wellness Protocol
The emotional wellness provided by Zen Integrative Oncology Wellness Protocol is discussed below:
Zen Emotional Counselling Protocol: It is integrated for cancer patients and their loved ones. It is a significant step taken to improve the psychological distress of cancer patients. It shows efficacy in improving the quality of life of cancer patients. It reduces stress and promotes mind-body therapies in the form of effective supportive care strategies during and after cancer treatment. The Zen Emotional Counselling Protocol provides 15 sessions with expertise in mind-body medicine for dealing with the emotional distress that occured due to cancer diagnosis and treatment among cancer patients. The coaches focus on mind-body fitness and ensure that the patient and their families can set the best step forward. The program also includes a dedicated Cancer Coach for round the clock care.
B) Clinical evidence:
The clinical practice guidelines for emotional wellness have included integrating emotional wellness interventions to reduce anxiety, mood disturbance, and chronic pain and improve the quality of life in cancer patients. Clinical practices have shown the efficacy of emotional wellness among cancer patients in various studies. Some of them are discussed below:
- The incorporation of the mind-body approach has been effective among lung cancer patients in reducing the symptoms and side effects of treatment (Deng et al., 2013).
- Meditation, music therapy and yoga have shown efficacy in reducing chemotherapy-induced side effects such as nausea and vomiting among breast cancer patients (Greenlee et al., 2017).
- The integration of cognitive-behavioural therapy, mindfulness, relaxation or guided imagery has been effective in managing chronic pain among the survivors of adult cancers (Paice et al., 2016).
- Improvement in the immune parameters among women with stage 1 breast cancer has been observed when the patient has incorporated relaxation, guided imagery, and biofeedback (Gruber et al., 1993).
- CBT effectively reduces anxiety, mood disturbance, and chronic pain and improves the quality of life among cancer patients (Deng et al., 2009).
- The combination of CBT and hypnosis has effectively reduced the emotional distress among women with breast cancer who have undergone radiotherapy (Montgomery et al., 2017).
B) Other cancer types:
Lung cancer: The emotional wellness in lung cancer patients improves the quality of life and survival rates by adopting to following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Tai Chi, Qigong, and Cognitive Behaviour Therapy (CBT) stress management.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture and Massage.
Skin cancer: The emotional wellness in skin cancer patients improves the quality of life and survival rates by adopting to following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Walking, Relaxation techniques, and Cognitive Behaviour Therapy (CBT) stress management
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, Acupressure, and Massage
- Blood cancer: The emotional wellness in blood cancer patients improves the quality of life and survival rates by adopting to following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Hypnosis, Music therapy, Guided imagery, and Tai chi.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, Aromatherapy, and Massage.
- Energy therapy: It includes a healing touch.
- Head & neck cancer: The emotional wellness for the patients with head and neck cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Behavioral Therapy, Music therapy, Guided imagery, Tai Chi, and Qigong that help in reducing the side effects and stress of treatment outcomes.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, Acupressure, Aromatherapy, and Massage.
- Energy therapy: It includes Reiki.
Liver cancer: The emotional wellness for the patients with liver cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Behavioral Therapy, Guided imagery, Tai Chi, and Qigong that help in reducing the side effects and stress of treatment outcomes.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, Acupressure, and Massage.
- Pancreatic cancer: The emotional wellness for the patients with pancreas cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Relaxation therapy, Hypnosis, Biofeedback, and Art therapy that help in reducing the side effects and stress of treatment outcomes.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, and Massage.
Brain cancer: The emotional wellness for the patients with brain cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Relaxation therapy, Hypnosis, Qigong, Cognitive Behavior Therapy (CBT) stress management, and Cognitive Behavioral Therapy for Insomnia (CBT‐I) that help in reducing the side effects and stress of treatment outcomes.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, and Acupressure.
- Energy therapies: It involves Touch Therapy.
- Bioelectromagnetic based therapies: It includes Optune.
- Kidney cancer: The emotional wellness for the patients with kidney cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Relaxation therapy, Hypnosis, Music therapy, Art therapy, Aromatherapy, Hyperthermia and Tai Chi that help in reducing the side effects and stress of treatment outcomes.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture, and Massage.
Breast cancer: The emotional wellness for the patients with breast cancer involves the following approaches:
- Mind‐body approaches: It includes Music therapy, Hypnosis, Expressive art techniques, Cognitive Behavioral Stress Management (CBSM), Relaxation techniques, Cognitive Behavioral Therapy for Insomnia (CBT‐I), Mindfulness meditation, Taichi, Qigong, Stress reduction practices, Yoga meditation, and Yoga that help in reducing the side effects and stress of treatment outcomes.
- Body‐manipulative therapies: It is effective in managing side effects involving Acupuncture.
- Colorectal cancer: The emotional wellness for the patients with colorectal cancer involves the following approaches:
- Mind‐body approaches: It includes guided imagery which reduces anxiety, pain and narcotic effects after colorectal surgery.
Ovarian cancer: The emotional wellness for the patients with ovarian cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Taichi, Music therapy, Relaxation techniques, Hypnosis, Cognitive-behavioral therapy, and Acceptance and Commitment Therapy (ACT).
- Body‐manipulative therapies: It is effective in the management of side effects involving Acupuncture, and Massage.
- Prostate cancer: The emotional wellness for the patients with prostate cancer involves the following approaches:
- Mind‐body approaches: It includes Meditation, Yoga, Taichi, Music therapy, Relaxation techniques, Hypnosis, Tai chi, Expressive art techniques, and Cognitive Behavior Therapy (CBT) stress management.
- Body‐manipulative therapies: It is effective in the management of side effects involving Acupuncture.
- Energy therapies: It includes Reiki.
- Bioelectromagnetic based therapies: These include transcutaneous electrical nerve stimulation (TENS).
References
- Siedlecki KL, Salthouse TA, Oishi S, Jeswani S. The relationship between social support and subjective well-being across age. Soc Indic Res. 2014;117(2):561–576. https://doi.org/10.1007/s11205-013-0361-4
- Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S. https://doi.org/10.1378/chest.12-2364
- Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232. https://doi.org/10.3322/caac.21397
- Paice JA, Portenoy R et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology. 2016 Sep 20;34(27):3325-45. https://doi.org/10.1200/jco.2016.68.5206
- Gruber BL, Hersh SP et al. Immunological responses of breast cancer patients to behavioral interventions. Biofeedback and Self-Regulation. 1993 Mar;18(1):1-22. https://doi.org/10.1007/bf00999510
Montgomery GH, Sucala M, Dillon MJ, Schnur JB. Cognitive-behavioral therapy plus hypnosis for distress during breast radiotherapy: a randomized trial. American Journal of Clinical Hypnosis. 2017. https://doi.org/10.1080/00029157.2017.1335635
