Mind-Body Medicine and Cancer Prevention and Treatment

The Role of Emotions, Stress and How to Utilize the Mind-Body Connection

Integration of Mind-Body Medicine

• Body – Physical• Speech – Sound• Mind – Thought Patterns

Mind-Body Relationships and Risks

• Chronic Stress

• Pessimism

• Sedentary lifestyle

Linked to:

• Cancer risk

• Tumorigenesis

• Metastasis

• Cancer mortality

Mind-Body Relationships and Risks

Many cancer patients experience:

• Chronic stress• Anxiety• Depression • Pessimism

(Pre and Post Dx)

Mind-Body Relationships and Risks

Chronic Stress Correlates with:

• Immune suppression• Upregulated tumorigenic signaling

pathways• Chromosomal instability & DNA

damage

Chronic Stress is an Immunosuppressant

Chronic stress maintains elevated levels of stress hormones (Catecholamins and Glucocortisoids) which:

• Enhance T-2 immunity, allowing cancer cells to avoid immune surveillance

• Increase suppressor T-Cells in tumor and surrounding site

• Causes lymphocyte apoptosis through upregulation of “death ligand” FAS.

Chronic Stress in Cancer Immunity

• Self-reported chronic stress correlated with low cytotoxicity of NK cells against ovarian cancer cells

• Stress-mitigation factors such as social support, spirituality and humor correlate with increased levels of NK cell cytotoxicity in breast and ovarian cancer patients

Chronic Depression &NK cell Activity

• Chronic depression in ovarian cancer patients correlated with decreased NK cell activity in tumor infiltrating lymphocytes, vs. non-depressed patients

Chronic Depression &NK cell Activity

• Chronically depressed patients with GI tract cancer showed significantly fewer NK cells and total lymphocytes than non-depressed patients

Chronic Stress & Cancer Risk

• Breast cancer risk doubled after disruption of marriage from divorce, separation or spouse death

• Severe distress with minimal social support increased breast cancer occurrence 9 fold

• Cancer risk higher after 6 + years of chronic depression

Chronic Stress Promotes Cancer Progression

• Increases growth, proliferation and metastasis of tumors

• Reduces host resistance to recurrence

• Increases tumor vascularization and vascular endothelial growth factor levels (VEGF)

Stress Factors on Tumor Biology: Pathways and Mechanisms

Stress Pathways and Key Influences on Tumorigenesis

• CRP• Cortisol• Epinephrine• Norepinephrine• IL-6• Galectin-3

Stress, DNA Damage and Tumor Development

• Lowered DNA repair capacity• Reduced levels of DNA repair enzymes• Increased DNA susceptibility to

mutation• Increased rate of DNA mutation

occurrence• Increased tumor incidence, growth,

size & malignancy

Stress and breast cancer: from epidemiology to molecular biologyAntonova L, et al. Stress and breast cancer: from epidemiology to molecular biology. Breast Cancer Research 2011. Center for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada; Queen's Cancer Research Institute, Kingston, ON, Canada

Abstract

Stress exposure has been proposed to contribute to the etiology of breast cancer. However, the validity of this assertion and the possible mechanisms involved are not well established. Epidemiologic studies differ in their assessment of the relative contribution of stress to breast cancer risk, while physiological studies propose a clear connection but lack the knowledge of intracellular pathways involved. The present review aims to consolidate the findings from different fields of research (including epidemiology, physiology, and molecular biology) in order to present a comprehensive picture of what we know to date about the role of stress in breast cancer development.

Impact of Stress on Cancer Metastasis

• Psychosocial risk factors for cancer progression/metastasis: chronic stress, depression, & isolation

• Chronic pessimism/depression demonstrates stronger correlation to negative outcome than isolated stressful events

Impact of Stress on Cancer Metastasis

• Suggests that sustained activation of stress pathways is strongest psychosocial risk factor in cancer progression

Pessimism and Cancer Risk/Mortality

• 238 cancer patients undergoing palliative radiation therapy followed for 8 mos.; 70 died by end of study

• Controlling for cancer site and symptomology, results showed pessimistic orientation to be a critical risk factor for mortality among younger patients age 30-59

Pessimism Shortens Telomeres and Increases Inflammation

• Chronic pessimism demonstrates a link to shortened DNA telomeres

• Chronic pessimism correlates with increases in IL-6, indicating increased systemic inflammation and oxidative stress

AbstractCancer patients (N = 238) receiving palliative radiation treatment were followed for 8 months; 70 patients had died by the 8-month follow-up. Controlling for site of cancer and level of symptomatology at baseline, the authors studied the independent effects on mortality of pessimism, optimism, and depression. The findings show that the endorsement of a pessimistic life orientation is an important risk factor for mortality, but only among younger patients (ages 30-59). Attempts to replicate this finding with conceptually related constructs such as depression or optimism did not yield significant associations for either younger or older patients, suggesting that negative expectations about the future may contribute to mortality in unique ways. The authors conclude that attempts to link psychosocial factors to mortality should focus on specific psychological constructs instead of diffuse, global measures that cover many psychological phenomena and that the role of psychological processes in mortality may vary dramatically depending on age.

Pessimism, age, and cancer mortalityShultz R, et al. Psychol. Aging. 1996 Jun;11(2) 304-9. Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA

Shortened Telomeres, Chromosomal Instability & Cancer

• Shortened telomeres with chromosomal instability promote malignant cell mutation

• 787 patients without cancer followed 10 yrs. - Baseline telomere length significantly shorter in patients

who later developed cancer than those who remained cancer free

• Aggressive tumors demonstrated stronger link to shortened telomere length

Mind-Body Interventions

Body-Speech-Mind:Solutions to improve health

and quality of life

Mindful Meditation

Mindful Meditation is a common term used to describe mindfulness-based meditation practices such as:

• Shamatha (“Calm Abiding”) meditation• Vipassana (“Insight”) meditation• Zen meditation• Yoga and Qi Gong

Benefits of Mindfulness Based Stress Reduction (MBSR) Methods

Reduces:• Cortisol • IL-6 and pro-inflammatory cytokines• Systolic blood pressure• Anxiety, depression and stress

Benefits of Mindfulness Based Stress Reduction (MBSR) Methods

Improves:• NK cell activity• Antioxidant activity• Brain function• Quality of life

Mindfulness-based stress reduction and cancer: a meta-analysisLedesma D and Kumahano H. Psychooncology 2009;18:571. Department of Stress Science and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan

AbstractObjective: This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients.Methods: Ten studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen's effect size d was computed for each category.Results: MBSR may indeed be helpful for the mental health of cancer patients (Cohen's effect size d=0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen's effect size d=0.18).Conclusion: The results suggest that MBSR may improve cancer patients' psychosocial adjustment to their disease.

Meditation and Yoga Improve Telomere Function

• Positive psychosocial effects of meditation and yoga can increase neuroendocrine factors which promote healthy telomere function

• Regular practice decreases stress-induced cellular dysfunction, via increased telomerase activity

Intensive meditation training, immune celltelomerase activity, and psychological mediators Jacobs TL, et al. Psychoneruoendocrinology 2011;36(5):664-81. UC Davis Center for Mind and Brain, Davis, CA, USA; UC San Francisco Department of Psychiatry, San Francisco, CA, USA; UC San Francisco Department of Biochemistry and Biophysics, San Francisco, CA, USA; UC Irvine Department of Cognitive Science, Irvine, CA, USA; UC Davis Department of Psychology, Davis, CA, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Santa Barbara Institute for Consciousness Studies, Santa Barbara, CA, USA; UC Davis Medical Center M.I.N.D. Institute, Sacramento, CA, USA

Abstract

Results: Telomerase activity was significantly greater in retreat participants than in controls atthe end of the retreat ( p < 0.05). Increases in Perceived Control, decreases in Neuroticism,increases in both Mindfulness and Purpose in Life were greater in the retreat group ( p < 0.01).Mediation analyses indicated that the effect of the retreat on telomerase was mediated byincreased Perceived Control and decreased Neuroticism. In turn, changes in Perceived Control

and Neuroticism were both partially mediated by increased Mindfulness and Purpose in Life.

Conclusions: This is the first study to link meditation and positive psychological change withtelomerase activity. Although we did not measure baseline telomerase activity, the data

suggestthat increases in perceived control and decreases in negative affectivity contributed to anincrease in telomerase activity, with implications for telomere length and immune cell longevity.Further, Purpose in Life is influenced by meditative practice and directly affects both perceivedcontrol and negative emotionality, affecting telomerase activity directly as well as indirectly

Healing Body

Mind-Body exercises improve physical, mental & emotional

health

Benefits of Yoga

Shown to:• Reduce chemo-related nausea and emesis• Decrease plasma TNF alpha levels following

cancer surgery• Improve cardio-performance/vitality• Improve physiological functioning• Reduce cortisol• Increase melatonin production• Improve psycho-spiritual well-being &

quality of life

Benefits of Qi Gong

Medical Qi Gong shown to:

• Reduce inflammation• Reduce cortisol• Reduce pain• Lower anxiety and stress• Improve emotional well being and

quality of life

Physical Activity &Cancer Risk/Progression

Moderate, regular exercise:

• Critical in cancer prevention and risk reduction

• Important and now widely recommended in cancer treatment

Healing Speech

Mind-body benefits of breath-work, chant and sound

Benefits of Meditative Breathing, Chant, Mantras

Increases:• Parasympathetic activity• Cerebral blood flow to right temporal

lobe

Decreases:• Pulse rate• Respiratory rate • Blood pressure• Limbic brain activity

Healing Mind

Meditation & Neuroplasticity Effect

Long-term Meditation Practitioners Show:

• Larger hippocampal and frontal volumes of gray matter

• Increased cortical gyrification

Correlates with:

• Positive emotional regulation/response control

• Positive mental state• Increased introspection • Heightened awareness• Increased compassion

Healing Qualities of Mind

• Focused and calm• Spacious and insightful

Connect with Our Heart

• Love and Compassion

Tonglin

• Taking others suffering on the path

• Exchanging suffering with love and compassion

-Essence --Expression-

-Manifestation-

The Unfolding of our Being:Physiological Perspective

The healing power of the mind

• In diagnosis• In treatment

Integrative Approaches to Cancer Care Summary

• Key Principles– Integrate patient wellness with fighting

& preventing cancer

– Keep treatment dynamic & changing

– Incorporate Mind-Body methods & approaches

Thank you!

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