The environment plays a vital role in healing the patient from any disease. Cancer causes psychological distress among patients due to its complexities of life-threatening conditions and other adverse events. Hence, there is a need to develop a person-centred healthcare environment for supporting the patients in building their physical and psychological well-being. A healing environment is related to the healthcare environment for cancer patients that helps establish therapeutic relationships between professionals and patients depending upon mutual trust, dignity, understanding, and sharing of human experiences. These factors will help promote a healing environment that involves care, and a degree of patient and family participation, thus enabling satisfaction levels among patients and the healthcare team.
Some exposures provide efficacy in improving the patients’ health and wellness. These exposures mainly include nature, clean air and water, bright light in the morning and darkness at night. Also, different chemicals and physical agents that may be natural or human-made are responsible for damaging the DNA and affecting the individuals’ health. These harmful exposures mainly involve air pollution, chemicals, and several forms of radiation.
Undergoing any cancer diagnosis does not imply that it is late to remove the harmful substances and exposures from the surrounding environment. This enhances the body’s natural healing capability by removing the toxic exposure that may disrupt the hormone functioning, trigger the immune system, increase stress response, interfere with sleep, and contribute to symptoms. The directions responsible for increasing the chances of cancer include air pollution, Bisphenol A (BPA), flame retardants, pesticides, plastic, solvents and alcohol, and radiation exposure such as ionising radiations, electromagnetic radiation, and other vulnerabilities.
Some of the exposures that are health-promoting and improve the body functioning for healing include:
- Clean food, water and air
The ways of increasing exposure to clean food, water and air include:
- Avoiding the consumption of processed, charred and well-done meats that increases the risk of cancer.
- Use of water filters.
- Use of glass containers to store water or food
- Providing ventilation to the indoor spaces
- Using HEPA filters in the environment to filter any source of contamination
The ways of increasing the exposure to light with natural cycles include:
- Allowing a 30-minute or longer transition from screen time to bedtime.
- A good sleep during the night with a dark mode of light is provided while sleeping.
- Use LED circadian light bulbs, mainly in the places that occupy the last 30 minutes before going to bed..
A) Different segments of the healing environment:
- Toxins and Chemicals: Toxins are substances that are poisonous to the body tissues and capable of causing diseases. It causes acute (short but severe) and chronic (persist for longer duration) responses. It causes an inflammatory response in the body and deteriorates the functioning of the immune system. The toxins mainly include allergens, mutagens, neurotoxins, teratogens and endocrine disruptors. The most common chemicals found in an environment that increases the chances of cancer development include PFAs, PBDEs, radon, heavy metals, pesticides, plastics, harsh cleaners, PERC, PVC, formaldehyde, VOCs and EDCs. Therefore, all these toxins and chemicals should be avoided to develop a healing environment.
- Identification of safe personal care products: The common personal care products used in daily life includes hair gels, shampoos, toothpaste, aftershave, deodorant and lotions that consist of almost 126 unique ingredients. Unfortunately, a major population comes in contact with such chemicals. Most cosmetic products contain various synthetic chemicals that can be potentially toxic. Hence, these chemicals and toxins need to be avoided by figuring out the toxic and harmful chemical content in the products being used. Hence, while purchasing the products following things should be considered:
- FDA does not regulate the term natural, so such products are avoided.
- The list of ingredients used in the products is mentioned on the back side, which needs to be read by the purchaser. These ingredients tell us about the chemicals and toxins present in the product.
- Food and cookware storage: Plastic containers have several health risks, so their use should be avoided. The chemicals used in manufacturing plastic containers leach into foods and beverages. The food stored in plastics causes exposure to toxins. Hence, no plastic containers should be used for food and cookware storage.
- Electromagnetic fields and radio frequencies: Safe use of cell phones are recommended. The cell phones should have specific absorption rate values, known to be the measurement of radio frequencies. The use of cell phones directly against the head is not recommended. The duration of calls should be reduced to a minimum. Protective shields should be used for cell phones, laptops and tablets that can block 90% of the electromagnetic fields.
- Household pesticides and other carcinogens: Household pesticides are intended to kill unwanted pests, but their toxicity can also be harmful to humans. Many individual pesticides and specific classes of pesticides have been found to have a wide range of harmful effects on human health. Many commercial pesticides combine active ingredients as they risk creating carcinogens that show synergistic effects in humans.
B) Clinical Evidence:
Creating a healing environment has shown efficacy in working against cancer growth or spread, improving survival, or working with other treatments or therapies to enhance patients’ health and healing capability. Some of the positive outcomes of the healing environment have been listed below:
- One study has shown to reduce the anxiety, pain, and agitation among critically ill adults with nature-based sounds in the environment where the patient is dwelling (Thrane et al., 2019).
- A reduction in the anxiety levels among adults suffering from pre-hypertension or hypertension has been observed (Yau & Loke, 2020).
- Lower scores on the Profile of Mood States (POMS) test for anxiety, depression, anger, fatigue and confusion and higher scores for Vigo have been reported in cancer patients (Park et al., 2010).
- Bright light therapy in the morning can improve sleep in cancer patients (Wu et al., 2018).
- Bright daytime light enhances mood as observed among women with mild to moderate depressive symptoms resulting in scoring better in the measures of depression.
C) Other cancer types:
Lung cancer: Creating a healing environment involves the following approaches for better health outcomes for the patients with lung cancer:
- Eliminating and reducing physical, chemical and biological exposures to known carcinogens of lung cancer.
- Avoid exposure to asbestos, ionizing radiations, vinyl chloride, air pollutants, secondhand smoke, and household combustion.
- Implementing environmental interventions in home and work settings.
- Maintaining clean air and better environmental quality.
Skin cancer: Recommendations for creating a healing environment for skin cancer (melanoma) patients include:
- Avoid using solariums.
- Avoid getting sunburnt, especially to the point of blistering and skin peeling, because multiple episodes have increased the risk of developing melanoma.
- Protecting skin from the sun during sun protection times (UV rays) using a combination of long-sleeved clothing, broad-brimmed hats, broad-spectrum sunscreens with an SPF of 30 or higher, sunglasses, and seeking out shade.
Blood cancer: Recommendations for creating a healing environment for blood cancer (leukemia) patients include:
Washing of hands thoroughly to avoid any infection.
Avoiding exposure to chemicals such as benzene, Agent Orange, etc.
Avoid exposure to ionizing rays.
Head & neck cancer: Recommendations for creating a healing environment for head and neck cancer patients include:
- Avoiding exposure to tobacco smoke and environmental carcinogenic agents such as asbestos, wood dust, paint fumes, and certain other chemicals.
- Avoiding exposure to ionizing radiations.
- Maintaining good oral hygiene.
- Using sunscreen and lip balm.
Liver cancer: Recommendations for creating a healing environment for liver cancer patients include:
- Avoiding exposure to aflatoxins
- Avoiding excessive alcohol consumption
Pancreatic cancer: Creating a healing environment involves the following approaches for better health outcomes for patients with pancreatic cancer:
- Avoiding tobacco smoke.
- Avoid occupational exposure to CHC solvents and related compounds.
- Reducing the exposure to chromium, nickel, organochlorine insecticides, silica dust, and aliphatic and alicyclic hydrocarbon solvents.
- Maintaining good oral hygiene.
Brain cancer: Creating a healing environment involves the following approaches for better health outcomes for patients with brain cancer:
- Avoiding exposure to heavy metals, pesticides, and contaminants in tap or healthy water and air pollution.
- Avoid exposure to non-ionizing radiations.
- Reducing the exposure to cadmium, diesel particulate matter, and polycyclic aromatic hydrocarbons.
- Maintaining a clean and pollution-free environment.
- Dark nights
- Bright mornings
Kidney cancer: Creating a healing environment involves the following approaches for better health outcomes for patients with kidney cancer:
- Avoiding exposure to certain chemicals in the environment, at home, and work.
- Reducing the exposure to benzene, asbestos, vinyl chloride, radon, and arsenic.
- Avoid exposure to carcinogens in the air and water.
- Maintaining a clean and pollution-free environment.
Breast cancer: Developing a healing environment is essential as most of the living environment of breast cancer patients deals with exposure to toxic chemicals, light at night, radiation and electromagnetic fields. Hence, this needs to be mitigated by creating a healing environment such as:
- Dark nights
- Bright mornings
- Limiting the chemical and radiation exposures
Colorectal cancer: Creating a healing environment involves the avoidance of following components:
- Aromatic amines
- Chlorination byproducts
- Ionizing radiation
- Working in night-shift
- Water containing nitrates
Ovarian cancer: Creating a healing environment involves avoiding the following components:
- Limiting chemical and radiation exposures.
- Talcum powder
- Endocrine‐disrupting chemicals (EDCs), including bisphenol‐A, hormone residues in meat, poultry and dairy products and some pesticides, such as organophosphates
- Ionizing radiation such as x‐rays
Prostate cancer: Creating a healing environment involves the following approaches for better health outcomes for patients with prostate cancer:
- Increasing exposures to green natural areas and sunlight (mindful of skin cancer risks).
- Reducing the exposure to chemicals including pesticides, dioxins, PAHs and solvents.
- Thrane SE, Hsieh K et al. Could complementary health approaches improve the symptom experience and outcomes of critically ill adults? A systematic review of randomized controlled trials. Complementary Therapies in Medicine. 2019 Dec;47:102166. https://doi.org/10.1016/j.ctim.2019.07.025
- Yau KK, Loke AY. Effects of forest bathing on pre-hypertensive and hypertensive adults: a review of the literature. Environmental Health and Preventive Medicine. 2020 Jun 22;25(1):23. https://doi.org/10.1186/s12199-020-00856-7
- Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Environmental Health and Preventive Medicine. 2010;15(1):18‐26. https://doi.org/10.1007/s12199-009-0086-9
Wu LM, Amidi A et al. The effect of systematic light exposure on sleep in a mixed group of fatigued cancer survivors. Journal of Clinical Sleep Medicine. 2018 Jan 15;14(1):31-39. https://doi.org/10.5664/jcsm.6874