Ting Bao, MD, DABMA, MS
Jun J. Mao, MD, MSCE
The spread of COVID-19 continues to have a dramatic impact around the world, disrupting social lives and the delivery of oncologic treatments to patients with cancer. Even under “normal” circumstances, health-care professionals, including those in oncology, are prone to occupational stress. Excessive stress is associated with depression, anxiety, compassion fatigue, and burnout—a condition comprising emotional exhaustion, depersonalization, and low personal accomplishment.1-3
This outbreak can further heighten psychological distress as oncologists, nurses, and other health-care workers are overwhelmed by the escalating workload; are frustrated by the inability to continue delivering care for their patients; have personal fears about putting themselves at risk due to shortages in personal protective equipment; and are experiencing challenges associated with balancing the care of their own family members. In the midst of these competing priorities, it is crucial that health-care professionals follow a self-care routine to manage stress and anxiety, to ensure continued care for their patients.
Mind-body therapies are safe, noninvasive techniques that have been shown to reduce stress and anxiety in both oncology4 and nononcology populations.5,6 Furthermore, they have demonstrated preliminary effects in improving psychological outcomes in physicians and health-care providers.7,8 Mind-body therapies include meditation, yoga, and tai chi, which share common goals of stress reduction, physical relaxation, psychological well-being, and improved vitality and coping.
The Integrative Medicine Service at Memorial Sloan Kettering Cancer Center (MSK) offers a variety of online mind-body tools for managing anxiety and stress during this challenging time. These audio and video recordings are available to anyone with an Internet-connected computer, tablet, or mobile device. They provide opportunities for health-care providers on the front lines to take brief pauses throughout the day to relax, breathe with awareness, and practice mindfulness to manage stress and anxiety.
At the end of the day, whole-body, focused relaxation practices, such as guided imagery or yoga nidra, can help promote deep, restful sleep. More crucial now than ever before, regular practice of mind-body therapies can positively impact the psychological and physical well-being of health-care professionals.
Meditation
Meditation practices are effective for improving anxiety and depression,5 calming the mind, and improving vitality and coping. The following video series offers simple guided meditations for anxiety and stress relief, as well as improved sleep: https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/multimedia/meditations.
Exercise
Exercise can improve mood,9,10 energy levels, and physical functioning. The following videos demonstrate simple exercises that focus on the importance of exercise during and after cancer treatment, but are also relevant for noncancer audiences: https://www.mskcc.org/videos/exercise and https://www.youtube.com/user/mskcc. (Press playlist, Exercise With MSK.)
Tai Chi
Tai chi helps reduce stress,11,12 improve sleep,13 and enhance balance, muscle strength, flexibility, stamina, and mental outlook. This video series has instructions for individuals to practice tai chi from home.
Over the coming days and weeks, MSK’s Integrative Medicine Service will continue to develop online mind-body resources to support health-care workers, patients, and their families and loved ones in this rapidly changing landscape. Stay up to date on the latest offerings by following @MSK_IntegrativeMedicine and #CalmCOVID19 on Twitter.
Dr. Bao is the Director of Integrative Breast Oncology in the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York. Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and the Chief of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
DISCLOSURE: Dr. Bao has served as a consultant or advisor to Eisai. Dr. Mao has received institutional research funding from Tibet Cheezheng Tibetan Medicine and Zhongke Health International.
REFERENCES
1. Pereira SM, Fonseca AM, Carvalho AS: Burnout in palliative care: A systematic review. Nurs Ethics 18:317-326, 2011.
2. Trufelli DC, Bensi CG, Garcia JB, et al: Burnout in cancer professionals: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 17:524-531, 2008.
3. Bride BE, Radey M, Figley CR: Measuring compassion fatigue. Clin Soc Work J 35:155-163, 2007.
4. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al: Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 67:194-232, 2017.
5. Goyal M, Singh S, Sibinga EMS, et al: Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Intern Med 174:357-368, 2014.
6. Tarsha MS, Park S, Tortora S: Body-centered interventions for psychopathological conditions: A review. Front Psychol 10:2907, 2020.
7. Lebares CC, Hershberger AO, Guvva EV, et al: Feasibility of formal mindfulness-based stress-resilience training among surgery interns: A randomized clinical trial. JAMA Surg 153:e182734, 2018.
8. Krasner MS, Epstein RM, Beckman H, et al: Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 302:1284-1293, 2009.
9. Wegner M, Helmich I, Machado S, et al: Effects of exercise on anxiety and depression disorders: Review of meta-analyses and neurobiological mechanisms. CNS Neurol Disord Drug Targets 13:1002-1014, 2014.
10. Stubbs B, Vancampfort D, Rosenbaum S, et al: An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Res 249:102-108, 2017.
11. Cocchiara RA, Dorelli B, Gholamalishahi S, et al: Tai Chi and workplace wellness for health care workers: A systematic review. Int J Environ Res Public Health 17, 2020.
12. Wang F, Lee E-KO, Wu T, et al: The effects of tai chi on depression, anxiety, and psychological well-being: A systematic review and meta-analysis. Int J Behav Med 21:605-617, 2014.
13. Irwin MR, Olmstead R, Carrillo C, et al: Tai Chi Chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: A randomized, partially blinded, noninferiority trial. J Clin Oncol 35:2656-2665, 2017.
