Guest Editor’s Note: Substantial evidence supports the value of practices that focus on the interactions among the mind, body, and behavior for promoting health and well-being. In this article, Kavita K. Mishra, MD, MPH, summarizes a clinical model for personalized mind-body medicine in cancer care along with practical tips for its effective application.

Kavita K. Mishra, MD, MPH

Overview

Mind-body medicine in cancer care is a diverse system of practices that focus on the interactions among the mind, body, and behavior to promote health and well-being. Mind-body medicine has shown beneficial short- and long-term impacts on physical, psychosocial/emotional, and interpersonal health.^1-6 Systematic reviews of randomized clinical trials and meta-analyses suggest that mind-body medicine practices are helpful for cancer-related symptoms, treatment-related side effects, during survivorship, and for end-of-life care.^7-13 Laboratory, imaging, and clinical data show mind-body medicine’s potential impact on chronic stress level and inflammatory markers, cortisol/hormone levels, structural and functional aspects of the nervous system, cognitive and emotional factors, immune function, cardiovascular parameters, telomere health, and epigenetics.^4,6,14-17

Mind-body medicine incorporates Eastern and Western models, traditional and modern approaches, psychological and physical components through an evidence-informed lens. Among these approaches are overlapping skills and methods, including meditation (ie, body/breath awareness, mindfulness, loving kindness and compassion-based training, transcendental); movement or energy-based therapies (ie, qi gong, Tai chi, and yoga); relaxation techniques (ie, diaphragmatic breathing, progressive muscle relaxation, guided imagery, autogenic training); and expressive and other practices (ie, nature, dance, art, writing, music therapy).²

Current Evidence and Guidelines for Use 

National practice guidelines by ASCO, the Society for Integrative Oncology (SIO), and the National Comprehensive Cancer Network (NCCN) now include mind-body medicine both during active cancer care and in survivorship.^3,7,18,19 Guidelines incorporate meditation, yoga, stress management, music therapy, as well as other integrative therapies (such as acupuncture, massage therapy, exercise, and nutrition). Mind-body medicine practices are recommended for cancer pain, fatigue, sleep disorders, anxiety, depression, fear of recurrence, cognitive dysfunction, sexual dysfunction, stress reduction, and quality of life.^3,18-22 For example, clinical options may include the following:

• Chronic pain—Use of mindfulness-based stress reduction/mindfulness-based cancer recovery/meditation, guided imagery, relaxation technique, breathwork
• Fatigue—Use of yoga, Tai chi, progressive muscle relaxation, meditation
• Loss of appetite/nausea—Use of mindful eating, yoga
• Weakness or neuropathy—Use of gentle movement chair yoga, nature/walking meditation, qi gong.^3,18-22

Mind-body medicine can be applied in the context of individual or group-based learning (ie, mindfulness-based stress reduction, mindfulness-based cancer recovery, Center for Mind-Body Medicine, stress management and resiliency training).^6,11,23,24 Further, virtual delivery of mind-body medicine via meditation/well-being mobile applications and online interventions allows potentially increased access and more equitable care.^25,26

Personalizing the Prescription

In the era of personalized medicine, oncology teams may tailor a mind-body medicine prescription for individuals with varied needs and circumstances. Though complicated, specific interventions may be applied by understanding the patients’ needs, preferences, and barriers for active participation in a longitudinal learning process.

Meditation models in the contemplative and neurosciences literature may serve as guideposts. One theoretical model defines families of meditation styles as “attentional,” “constructive,” and “deconstructive,” reflecting growth that may arise with various practices.^27-30 Attentional practices (“focused” or “open monitoring”) may strengthen stability of attention, awareness, and nonreactivity, facilitating a healthier state for the person along the cancer journey.²⁷ Constructive styles of practice (“loving kindness” and “compassion”) may encourage self-kindness, build prosocial behavior, and facilitate positive reappraisal and compassionate action.^4,27-30 The deconstructive family of mind-body medicine practices may elicit existential insight and generate knowledge through self-inquiry.

In “expressive” and “movement” meditation, one learns through an embodied experience to integrate physical movement, breathing, as well as emotion and somatic awareness. Such practices may be a way to increase accessibility to mind-body medicine in cancer care, especially if a seated/still practice is difficult because of pain, fatigue, traumatic reexperiencing, or rumination. In addition, the impact of group practices is important, with the growing understanding of social common therapeutic factors with instructor-led, group-based settings, such as a sense of belonging, validation, hopefulness, and alliance.³¹

Mind-body medicine for an oncology patient should be approached thoughtfully, especially in the context of trauma, mobility issues, energy implications, childhood adversity, and psychological underpinnings.^32-34 Meditation-related adverse events, such as anxiety, traumatic reexperiencing, and emotional sensitivity, have been noted. Interestingly, study participants with meditation-related adverse events have reported being equally glad to have practiced meditation as those not reporting such events.³² Risks may be reduced by identifying relevant factors, using trauma-informed care, and working with qualified experts. 

Practical Clinical Tips and ‘Mind-Body Medicine Snacks’

In clinical practice, the following steps may help in fostering a personalized mind-body medicine plan:

1) Develop ‘SMART’ goals (specific, measurable, achievable, relevant, and time-bound) and use local, online, and mobile resources as applicable.

2) Share clinical data, guidelines, and potential scientific mechanisms with patients and caregivers. Deliver information appropriately by cultural, language, educational, and other dimensions.

3) Have a provider team member practice with the patient in clinic (ie, 1 minute of deep diaphragmatic, box, or 4-7-8 breathwork). Share examples of use (ie, in a waiting room).

4) Use well-established resources, including mindfulness-based stress reduction and mindfulness-based cancer recovery. These programs typically run for 8 weeks with weekly group sessions and daily practice. Hybrid and shortened versions are under study, particularly for patients in active cancer care and those with limited ability, time, and resources.

5) Adapt a practice of “mind-body medicine snacks”—apply the concept of a nutritional snack, developing a short consistent practice, during 1- to 10-minute breaks in the day.

Guest Editor

Jun J. Mao, MD, MSCE

Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.

Guidelines Recommendations

The ASCO, SIO, and NCCN guidelines recommend specific mind-body medicine therapies for adult cancer pain, cancer-related fatigue, sleep disorders, anxiety, depression, fear of recurrence, cancer-associated cognitive dysfunction, sexual dysfunction, stress reduction, psychosocial adjustment, and improved quality of life. Provider teams can help patients with a mind-body prescription that is specific, realistic, and consistent. Resources including the local cancer center, community, mindfulness-based stress reduction/mindfulness-based cancer recovery/yoga/Tai chi and other courses, those available online, as well as mobile apps can be utilized for developing personalized mind-body medicine prescriptions. By applying personalized therapeutic approaches, mind-body medicine may support a healthy model for experiencing and coping with adversity during the cancer journey. 

Dr. Mishra is Professor, Department of Radiation Oncology, University of California San Francisco (UCSF), and Director of Clinical Programs, UCSF Osher Center for Integrative Health.

DISCLOSURE: Dr. Mishra reported no conflicts of interest.

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