Cancer + Anxiety / Worry / Depression
Imaging-Guided Core-Needle Breast Biopsy: Impact of Meditation and Music Interventions on Patient Anxiety, Pain, and Fatigue
Mary Scott Soo, MD Jennifer A. Jarosz, MD Anava A. Wren, PhD Adrianne E. Soo, BS, Yvonne M. Mowery, MD, PhD ,
Karen S. Johnson, MD, Sora C. Yoon, MD, Connie Kim, MD , E. Shelley Hwang, MD, MPH,Francis J. Keefe, PhD, Rebecca A. Shelby, PhD
Purpose To evaluate the impact of guided meditation and music interventions on patient anxiety, pain, and fatigue during imaging-guided breast biopsy.
After giving informed consent, 121 women needing percutaneous imaging-guided breast biopsy were randomized into three groups: (1) guided meditation; (2) music; (3) standard-care control group. During biopsy, the meditation and music groups listened to an audio-recorded, guided, loving-kindness meditation and relaxing music, respectively; the standard-care control group received supportive dialogue from the biopsy team. Immediately before and after biopsy, participants completed questionnaires measuring anxiety (State-Trait Anxiety Inventory Scale), biopsy pain (Brief Pain Inventory), and fatigue (modified Functional Assessment of Chronic Illness Therapy-Fatigue). After biopsy, participants completed questionnaires assessing radiologist–patient communication (modified Questionnaire on the Quality of Physician–Patient Interaction), demographics, and medical history.
The meditation and music groups reported significantly greater anxiety reduction (P values < .05) and reduced fatigue after biopsy than the standard-care control group; the standard-care control group reported increased fatigue after biopsy. The meditation group additionally showed significantly lower pain during biopsy, compared with the music group (P = .03). No significant difference in patient-perceived quality of radiologist–patient communication was noted among groups.
Listening to guided meditation significantly lowered biopsy pain during imaging-guided breast biopsy; meditation and music reduced patient anxiety and fatigue without compromising radiologist–patient communication. These simple, inexpensive interventions could improve women’s experiences during core-needle breast biopsy.
Source : Journal of The American College of Radiology
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Laughter and Stress Relief in Cancer Patients: A Pilot Study
S. H. Kim,1 Y. H. Kim,1 and H. J. Kim2
1Department of Nursing, ASAN Medical Center, Seoul 138-736, Republic of Korea
2Department of Preventive Medicine, University of Ulsan College of Medicine, 43-Gil Olympic-ro, Songpa-gu, Seoul 138-736, Republic of Korea
The purpose of this study was to examine the effect of a therapeutic laughter program and the number of program sessions on anxiety, depression, and stress in breast cancer patients. A randomized controlled trial was conducted involving 31 patients who received four sessions of therapeutic laughter program comprised and 29 who were assigned to the no-program control group. Scores for anxiety, depression, and stress were measured using an 11-point numerical rating scale. While no change was detected in the control group, the program group reported reductions of 1.94, 1.84, and 2.06 points for anxiety, depression, and stress, respectively (p<0.01, p<0.01, and p<0.01). Scores decreased significantly after the first therapeutic laughter session (p<0.05, p<0.01, and p<0.01). As the therapeutic laughter program was effective after only a single session in reducing anxiety, depression, and stress in breast cancer patients, it could be recommended as a first-line complementary/alternative therapy.
Source : Evidence Based Complementary and Alternative Medicine
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Meditation Combined With Art Therapy Can Change Your Brain and Lower Anxiety
Cancer and stress go hand-in-hand, and high stress levels can lead to poorer health outcomes in cancer patients. The Jefferson-Myrna Brind Center of Integrative Medicine combined creative art therapy with a Mindfulness-based Stress Reduction (MBSR) program for women with breast cancer and showed changes in brain activity associated with lower stress and anxiety after the eight-week program. Their new study appears in the December issue of the journal Stress and Health.
Daniel Monti, MD, director of the Jefferson-Myrna Brind Center of Integrative Medicine and lead author on the study, and colleagues have previously published on the success of Mindfulness-based Art Therapy (MBAT) at helping cancer patients lower stress levels and improve quality of life.
"Our goal was to observe possible mechanisms for the observed psychosocial effects of MBAT by evaluating the cerebral blood flow (CBF) changes associated with an MBAT intervention in comparison with a control of equal time and attention," says Monti. "This type of expressive art and meditation program has never before been studied for physiological impact and the correlation of that impact to improvements in stress and anxiety."
Eighteen patients were randomly assigned to the MBAT program or an education program control group. All had received the diagnosis of breast cancer between six months and three years prior to enrollment and were not in active treatment. The MBAT group consisted of the MBSR curriculum (awareness of breathing, awareness of emotion, mindful yoga, walking, eating and listening), paired with expressive art tasks to provide opportunities for self-expression, facilitate coping strategies, improve self-regulation, and provide a way for participants to express emotional information in a personally meaningful manner.
Patient response to the MBAT program was measured using a 90-item symptom checklist, completed by each patient before and after the eight-week program. In addition, functional magnetic resonance imaging (fMRI) was used pre and post-program to evaluate cerebral blood flow, corresponding to changes in the brain's activity. Scans were performed at rest, during a "neutral task" (control), meditation task, stressor task and at rest again -- designed to evaluate the general as well as specific effects and provide a thorough analysis of the CBF changes between the pre and post-program scans.
Participants in the MBAT group demonstrated significant effects on cerebral blood flow compared with the control group. The MBAT group showed increases in the emotional centers of the brain including the left insula which helps us to perceive our emotions, the amygdala which helps us experience stress, the hippocampus that regulates stress responses, and the caudate nucleus that is part of our brain's reward system. These increases correlated significantly with a lowering of stress and anxiety, as also reflected in the results of the pre and post-program anxiety scores among the MBAT intervention group.
The observed psychological and neuropsychological changes are consistent with current literature that states that MBSR interventions have shown to reduce anxiety, depression and psychological distress in a variety of populations. These have been associated with improved immune function, quality of life and coping effectiveness in women with breast cancer.
Given the improvements in anxiety levels and observed changes in CBF in the MBAT participants, these findings suggest that the MBAT program helps mediate emotional responses in women with breast cancer. "With the sample size enlarged, perhaps we can extrapolate these results to other disease populations and gain a fuller understanding of the physiological mechanisms by which mindfulness practices confer psychological benefits," says Monti.
Source : Science Daily
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Anxiety Increases Cancer Severity in Mice, Study Shows
Worrywarts, fidgety folk and the naturally nervy may have a real cause for concern: accelerated cancer. In a new study led by researchers at the Stanford University School of Medicine, anxiety-prone mice developed more severe cancer then their calm counterparts.
The study, published online April 25 in PLoS ONE, found that after hairless mice were dosed with ultraviolet rays, the nervous ones -- with a penchant for reticence and risk aversion -- developed more tumors and invasive cancer. Consistent anxiety also came with sensitivity to chronic stress and a dampened immune system. Though other researchers have already linked chronic stress to higher risks for cancer and other maladies, the study is the first to biologically connect the personality trait of high anxiety to greater cancer threats.
"Anxiety may be defined as increased sensitivity to physically existent, or non-existent but perceived or anticipated, stressors," said stress expert and immunologist Firdaus Dhabhar, PhD, first author of the study.
Dhabhar's previous work has investigated the balance of "good" and "bad" stress. Short-lived stressors -- like being chased by a lion, or giving a weighty presentation to your boss -- can actually boost your immune system by preparing your body for battle. But constant stress, such as caring for a disabled loved one, breaks down the body's ability to fight off disease over time, he said.
The question is: How much stress is too much? Because stress responses vary between individuals, Dhabhar turned to understanding the link between base-level anxiety and actual stress.
For mice, stress comes from striking a balance between exploring to find food and mates, and protecting themselves from danger. Highly anxious mice, Dhabhar hypothesized, would err on the side of avoiding danger. He and his research team placed hairless mice on a raised, cross-shaped track, which had one walkway enclosed by walls and the other open. Then they measured how often each mouse ventured to the open arms. Likewise, he placed them in a large box, half lit and half dark, and noted those that spent the most time in the dark side.
"It's similar to the idea that if someone is very anxious they may be more worried about, and less likely to, walk down a dark alley," said Dhabar, an associate professor of psychiatry and behavioral sciences and a member of the Stanford Cancer Institute and the Stanford Institute for Immunity, Transplantation and Infection.
With their evaluation of anxiety complete, the researchers exposed all the hairless mice to UV rays for 10-minute bouts, three times a week, for 10 weeks -- exposure similar to that of humans who spend too much time in the sun. Tumors cropped up a few months afterward. "This skin cancer model is really valuable," Dhabhar said, "because it closely mimics human skin cancer."
Additionally, these types of tumors are vulnerable to an immune system attack. In some cases, the immune system could destroy them, he said.
Though all the mice eventually developed skin cancer, the anxious mice had more tumors and were the only ones to develop invasive forms of cancer.
When he and his team compared the immune responses of the low- and high-anxiety mice, they found that nervous mice had higher levels of immune-suppressing cells called regulatory T cells, which normally thwart overzealous responses. The high-strung mice were also making fewer of the chemical signals that fire up an immune attack on the tumors.
Lastly, the researchers looked at the hormone corticosterone. In mice and other animals, the adrenal system -- the "fight or flight" controller of the body -- secretes corticosterone in response to disease and stress. The levels of this hormone were cranked up in anxious mice, suggesting that they have more sensitive stress sensors and, perhaps, a lower threshold for feeling under the gun.
"Identifying a psychological trait right at the beginning -- before any experimental manipulation -- and seeing that it can be associated with increased tumors months later, and with biology that can begin to explain mechanisms, was a rewarding surprise," Dhabhar said.
This hasn't been tested in humans yet, and that needs to be done, Dhabhar said.
"It's bad enough that cancer diagnosis and treatment generates stress and anxiety, but this study shows that anxiety and stress can accelerate cancer progression, thus perpetuating a vicious cycle," Dhabhar said. "The goal is to ameliorate or eliminate the effects of anxiety and chronic stress, at least at the time of cancer diagnosis and during treatment."
The team's next step will be examining whether knocking down the negative effects of anxiety and stress can increase the benefits of cancer treatment. A shot of anxiety medication, such as Valium, for limited periods of time may be helpful, Dhabhar said. There may also be combinations of drugs and behavioral changes that could be most effective in the long run. "Ultimately," he said, "we really want to harness the patient's mind and body while doing everything that medicine can from the outside to maximize treatment success."
Source : Science Daily
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