Mindfulness Tools… An introduction to practices and

scientific evidence18th Annual Women’s Health & Breast Cancer Conference Expanding the Horizons of Breast & Women’s HealthSheraton Hotel and Conference Center, Burlington, VermontOctober 2, 2015

Roz Grossman, MAThe Neshamah Center Burlington, VT 05401roz@mindfulstressrelief.netwww.mindfulstressrelief.net(802) 233-2461

Yu–Jing Sun, PhDYujing.sun@yahoo.comwww.sunnyinvitation.com(802) 922-0645(C)Vermont Cancer CenterYujing.sun@med.uvm.edu(802) 656-3655(O)

Mindfulness Tools

Interests to Disclose/All Potential Conflicts of Interest have been Resolved: Roz Grossman, Owner of the Neshamah Center

Workshop Intentions

• Explore and describe the benefits of mindfulness practices known to help reduce stress and promote wellness for cancer patients

• Review mindfulness research studies from peer-reviewed journals with a highlight on cancer– Impact on psychological stages, physiological and

immunological functions– Impact on breast cancer population– Research opportunities at Vermont Cancer Center

MINDFULNESS

MBSR

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“Mindfulness” in the media

Awareness of Breath

The Breath Can Be Used

as An Anchor

Between the Mind and the Body

to help us FocusWe aren’t trying to

make things different

Awareness of Body

Body Scan Yoga/Gentle Stretching

Paying attention

to sensations in the body

can help us to make

healthy choices

Stress and Mindfulness Reduction

Sympathetic Parasympathetic Activity Rest phase Fight or Flight Relaxation

Studies with Nurses & Physicians

MBSR for Nurses

• Improvements in– Stress, burnout and anxiety– Increased focus & self-care– Improvement in mood and

decrease in depression• Potential to improve patient

satisfaction & turnover

Mindfulness for Physicians

• Use of Appreciative Inquiry - reinforcement of positive experiences more likely to change behavior in positive directions

• May result in improvement in well being, burnout, mood, empathy and psychosocial beliefs

Smith, S. (2014) Mindfulness-Based Stress Reduction: An Intervention to Enhance the Effectiveness of Nurses’ Coping with Work-Related Stress International Journal of Nursing Knowledge, 25, No 2119-130

Krasner, M. S., et al. (2009) Association of anEducation Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. JAMA 302, 12 1285-1293

It’s not the stressors in our lives but how we respond to them

Mindfulness Science Research

How to study ?

What has been found? Why to study?

Neuroendocrine Immunology

Stress has significant adverse effects on health and is a risk factor for many illnesses.

From: Sternberg EM. Neural regulation of innate immunity: a coordinated nonspecific host response to pathogens. Nat Rev Immunol. 2006 Apr;6(4):318-28. Review. PubMed PMID: 16557263.

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Psychological and behavior measurement

Physical assessment

Endocrine and Immune function

Demographics and Medical History FormHealth Behaviors FormCancer Quality of Life Questionnaire (QLQ-C30)Profile of Mood States (POMS)Symptoms of Stress Inventory (SOSI)Sleep quality

Characterization of Leukocytes Subclasses Intracellular Cytokine DeterminationNatural killer (NK) Cell Function Assay Hormone Assays (Cortisol, DHEAS, melatonin)Gene and Protein Expression

Blood pressureHeart rate

Assessments used pre- and post-intervention and follow-up

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160,000 Cancer ar-

ticles 549

Mindfulness articles

Cancer Research articles published in year 2013

Cancer Literature Mindfulness Literature

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• Reduce stress (Carlson, 2003, 2007, 2013, Zainal 2013)

• Increase quality of life (Carlson, 2007, Witek-Janusek, 2008)

• Increase sleep quality (Carlson 2004, Lengacher 2014)

• Decrease cortisol level and positive change on cortisol pattern. (Carlson

2004, 2007, 2013, Matchim 2011)

• Improve immune profile (Carlson 2003, 2007, Lengacher 2013)

• Decrease blood pressure (Carlson 2007, Matchim 2011)

• Increase cell telomerase function (Lengacher 2014)

Mindfulness Intervention for Cancer patients can :

MBSR intervention reduce stress and cortisol level in breast and prostate cancer patients

Data on 49 BC and 10 PC patients showed significant improvements in overall symptoms of stress in MBSR participants which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up.

Carlson L, 2007, Brain, Behavior and Immunity.

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MBSR intervention re-establish breast cancer patients immune function

Natural Killing cells activity(NKCA)

Interferon Gamma production levels

Witek-Jnausek, 2008, Brain, Behavior and Immunity.

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PBMC TA increased steadily over 12 weeks in the MBSR(BC) group (approximately 17%) compared to essentially no increase in the control group (approximately 3%, p < .01).

MBSR intervention increase telomerase activity(TA) in breast cancer patients

Lengacher, 2014, Bio Res Nurs

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• 271 breast cancer patients(stage 0-III),

• Randomized controlled design into MBCR, SET and control• MBCR group improved more over time on stress symptoms compared with women in

both the SET (P = .009) and control (P = .024) groups. • MBCR group showed greater improvements in the MBCR group in quality of life

compared with the control group (P = .005) and in social support compared with the SET group (P = .012).

Clinical Practice Guidelines of Integrative Therapies in Breast Cancer Patients

Society for Integrative Oncology Guidelines Working Group

Greenlee et al, J Natl Cancer Inst Monogr. 2014 Nov;2014(50):346-58.

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Potential research opportunity in Fletcher Allen Hospital

1 Psychological outcome and relationship with medication usage in cancer patients taking 8 week MBSR participants.

2 Application for grant to study how MBSR can improve cancer patients physical, immunological and neurological condition, like “Chemobrain”.

Note: Dr. Yujing Sun’s slides can be found on www.sunnyinvitation.com/MBSR program

Mindfulness helps us to

Handouts• Re-minders• Upcoming

Mindfulness Classes with Roz and Sunny

• Contact Information

• Slideshow found on websites

Thank You!

…Meanwhile the wild geese, high in the clean blue air are heading home again. Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting-over and over announcing your place in the family of things.

Wild Geese By Mary Oliver