Long-term Care
In addition to being the world's greatest cause of mortality, cancer causes great stress for patients, families, and healthcare systems. The harsh therapies associated with cancer, such as radiation and chemotherapy, can cause a variety of psychological and physical side effects. These difficulties can have a significant impact on a patient's quality of life, underscoring the significance of providing care that goes beyond urgent medical attention.
In this regard, long-term care (LTC) services are essential for offering all-encompassing assistance, particularly to individuals coping with chronic conditions like cancer. LTC services are intended to address the various requirements of people who struggle to do everyday tasks on their own. These services improve a patient's overall health and quality of life by providing not just medical treatment but also personal aid and help with daily duties.
An increasing proportion of elderly residents in long-term care homes are affected by cancer as our population ages. Older people tend to have higher cancer incidence rates, and the normal aging process, with its attendant weakness and decreased physiological resilience, can leave elderly patients more susceptible to developing new health issues. This susceptibility may raise the likelihood of functional decline, increase care reliance, and in rare circumstances, even result in death.
Managing cancer in people 70 years of age and beyond is frequently made more difficult by the coexistence of several other medical disorders, with many having an average of three comorbidities. Due to these complications, cancer care must adopt a more complicated and sophisticated strategy that goes beyond the conventional emphasis on acute disease and treatment.
Months or even years after starting treatment, cancer survivors may face new or worsening symptoms, and research is showing that they have a higher long-term risk of acquiring other major health problems. For example, compared to their counterparts without cancer, those who have had breast, prostate, or colorectal cancer are more likely to acquire osteoporosis, diabetes, and heart failure.
It is becoming more and more crucial to identify and manage these possible side effects in order to give older persons with cancer complete, compassionate treatment. By making the management of these long-term consequences a top priority, elderly cancer patients can get the care and assistance they require to age as comfortably and with dignity as possible.
A broad range of social, medical, and personal services are included in long-term care, which is intended to assist people who are losing a considerable amount of their physical or mental capacity or who are at danger of doing so. The goal of this care is to respect their fundamental rights and human dignity while assisting them in maintaining their independence and standard of living.
Informal caregivers, who are members of the community, friends, or family, frequently offer long-term care for longer periods of time. Formal caregivers, who are professionals with training, are another option for providing it. Formal long-term care aims to stop, lessen, or restore a person's ability to decline. Depending on the needs of the patient, this care can be provided in a variety of locations, such as a hospital, residential facilities, the community, or the patient's home.
Executive Summary
Long-Term Cancer Care Long-term care for cancer patients is becoming increasingly important as more people survive cancer and live with its after-effects. This care extends beyond immediate treatment and focuses on managing ongoing symptoms, preventing recurrence, and improving quality of life. It encompasses physical, emotional, and social support, often involving a multidisciplinary team of healthcare professionals. As the population ages, the need for comprehensive long-term cancer care is growing, especially in residential care settings where many older cancer survivors reside.
Physical Challenges Cancer survivors often face a range of persistent physical challenges that can last for months or years after treatment. These may include chronic fatigue, pain, nausea, sleep disturbances, cognitive changes (often called "chemo brain"), and reduced physical function. The severity and type of these challenges can vary depending on the cancer type, treatment received, and individual factors. Managing these physical symptoms is a crucial part of long-term care and often requires ongoing medical attention, lifestyle adjustments, and sometimes specialized therapies.
Emotional and Psychological Impact The emotional toll of cancer can be profound and long-lasting. Many survivors experience anxiety, depression, fear of recurrence, and post-traumatic stress disorder (PTSD). These psychological challenges can persist long after physical treatment ends and may fluctuate over time. Addressing these emotional needs is essential for overall well-being and quality of life. Long-term care often includes access to mental health professionals, support groups, and counseling services to help survivors navigate these ongoing emotional challenges.
Social and Lifestyle Adjustments Cancer survivors often need to make significant adjustments to their daily lives and social relationships. This can include changes in work capacity, alterations in family dynamics, shifts in social circles, and adjustments to self-image and identity. Long-term care support in this area might involve occupational therapy, social work services, and guidance on returning to work or school. It may also include help in navigating changed relationships and developing new coping strategies for daily life.
Medical Monitoring and Check-ups Regular medical surveillance is crucial for cancer survivors to detect any recurrence early and manage ongoing health issues. This typically involves scheduled check-ups, imaging tests (such as CT scans, MRIs, or PET scans), blood work, and sometimes specialized tests depending on the type of cancer. The frequency and type of monitoring can change over time, usually becoming less intensive as years pass without recurrence. This ongoing monitoring also provides opportunities to address new health concerns and adjust long-term care plans as needed.
Managing Treatment Side Effects Many cancer treatments can have side effects that persist long after the treatment ends. These can include cardiovascular problems, bone density loss, hormonal imbalances, and changes in cognitive function. Long-term care focuses on monitoring and managing these side effects through various means, including medication, physical therapy, cognitive rehabilitation, and lifestyle modifications. The goal is to minimize the impact of these side effects on daily life and prevent them from developing into more serious health problems.
Mental Health Support Comprehensive mental health support is a critical component of long-term cancer care. This often involves access to psychologists, psychiatrists, and counselors who specialize in working with cancer survivors. Therapeutic approaches may include cognitive-behavioral therapy, mindfulness-based stress reduction, and sometimes medication for conditions like depression or anxiety. Support groups, both in-person and online, can also play a vital role in providing emotional support and a sense of community among survivors.
Complementary and Alternative Medicine Many cancer survivors explore complementary and alternative medicine (CAM) as part of their long-term care. This can include practices like acupuncture, massage therapy, meditation, yoga, and herbal supplements. While some of these practices can be beneficial for symptom management and overall well-being, it's crucial that their use is discussed with healthcare providers to ensure they don't interfere with ongoing treatments or follow-up care. Integrating CAM therapies into a comprehensive care plan requires careful consideration and often involves collaboration between conventional and alternative healthcare providers.
Nutrition and Physical Activity Proper nutrition and regular physical activity play vital roles in long-term cancer care. A healthy diet can help manage side effects, maintain a healthy weight, and potentially reduce the risk of recurrence. Physical activity can improve energy levels, reduce fatigue, enhance mood, and improve overall physical function. Long-term care often includes access to nutritionists and exercise specialists who can provide personalized advice tailored to the unique needs of cancer survivors. This may involve creating specific diet plans or exercise regimens that take into account any physical limitations or ongoing treatment effects.
Medication Management Cancer survivors often take multiple medications to manage ongoing symptoms, side effects, and other health conditions. This complex medication regimen can lead to potential drug interactions and side effects. Long-term care includes careful medication management, which involves regular medication reviews, monitoring for side effects, and adjusting prescriptions as needed. This often requires coordination between different healthcare providers to ensure all medications work together effectively and safely.
Spiritual and Existential Support A cancer diagnosis and survivorship journey often prompt deep existential and spiritual questions. Long-term care may include support for exploring these issues, which can be crucial for emotional well-being and finding meaning in the survivorship experience. This might involve access to chaplains or spiritual advisors, participation in support groups that address existential concerns, or engagement with therapies that focus on meaning-making and personal growth. For many survivors, addressing these spiritual and existential questions is an important part of processing their cancer experience and moving forward in life.
Future Planning and Advance Care Long-term cancer care often involves discussions and planning for future health scenarios. This includes creating advance directives, discussing preferences for future care, and planning for potential health changes or recurrence. It may also involve financial planning to manage ongoing healthcare costs and potential changes in work capacity. While these conversations can be challenging, they're an important part of comprehensive care, helping to ensure that future care aligns with the survivor's wishes and values. This planning can provide peace of mind for both survivors and their families, knowing that preparations are in place for various potential outcomes.
Physical, emotional, psychological, and social challenges faced by survivors
Physical challenges
Numerous issues pertaining to both bodily and emotional well-being can significantly lower their quality of life for cancer survivors. Mental health issues have frequently gotten less attention from healthcare professionals, who have historically concentrated on managing the physical symptoms of cancer and associated therapies. The range of physical symptoms that survivors may encounter varies based on the kind of cancer and the therapies they receive. Fatigue, sleep disruptions, discomfort, nausea, digestive disorders, skin ailments, neuropathy, weight loss, muscle and joint pain, lymphedema, sexual difficulties, and cognitive changes are some of the common complaints.
Many factors, such as the kind and stage of cancer at diagnosis, prognosis, therapy received, age, and other health issues existing before or after the cancer diagnosis, might influence how much these symptoms impair a survivor's quality of life. In addition, the efficiency of therapy and symptom management are significantly influenced by socioeconomic level and access to care.
Numerous physical symptoms might linger even after the first course of therapy is completed, according to recent research, which can negatively impact survivors' quality of life for years to come. The necessity of long-term monitoring and specialist care for cancer survivors is highlighted by the fact that certain problems, such as cardiotoxicity, may not manifest for ten or more years following treatment. Survivors of cancer are more likely than non-survivors to have persistent medical issues, poor health, difficulties in everyday living, and difficulties finding work even years after their diagnosis.
Emotional challenges
Being diagnosed with cancer is a transformative experience that can present serious emotional and psychological difficulties. A variety of mental health issues, such as depression, anxiety, adjustment disorders, panic disorders, and even post-traumatic stress disorder, can affect many people dealing with cancer. These difficulties can have a significant negative impact on one's general health, which can lower quality of life and make the process of receiving treatment and recovering more difficult.
These psychological difficulties may be considerably more severe for people who are dealing with the long-term impacts of cancer. Survivors frequently experience increased anguish, anxiety, and even physical symptoms that are related to their mental health. Depression can also be exacerbated by elements including a lack of intimate interactions, and the existence of late-stage symptoms.
Some cancer patients may experience emotions of shame, guilt, and stigma in addition to these emotional difficulties, especially if their disease is connected to certain activities like smoking. This can increase the emotional load they bear by causing them to feel guilty about themselves and like a burden to others.
Research has indicated that those with a history of cancer are less likely than those without to experience psychological discomfort. For instance, a study conducted in China discovered that a higher percentage of cancer patients experience psychological anguish than people in general. The fact that young cancer survivors are more likely to experience discomfort even years after their diagnosis emphasizes the potential long-term effects of cancer on mental health.
It's critical to acknowledge these emotional difficulties and address them with empathy and encouragement. Nobody should have to go through this road alone, and giving every patient and survivor the compassion and understanding they deserve requires an awareness of the psychological effects of cancer.
Psychological challenges
There is a higher likelihood of mental health difficulties for those who have chronic diseases, such as cancer. 10.1% of cancer survivors and 5.9% of persons without a history of cancer reported having mental health problems in the 2010 National Health Interview Survey. These findings demonstrate that those who have survived cancer are more likely to experience psychological problems; this risk increases when another chronic ailment is added to the list of concerns.
Cancer survivors may experience mental health issues due to certain reasons, which might complicate their path. In terms of mental health, being younger, less educated, managing several non-cancer-related medical issues, having a lower income, and being single or unmarried can all contribute to a worse quality of life.
It's not quite known how race or ethnicity affects the mental health of cancer survivors. Studies have revealed that, while some have not noted any appreciable variations across racial or ethnic groupings, African American breast cancer survivors, for instance, frequently report higher emotional well-being than their white counterparts. Findings have also indicated that survivors who identify as Hispanic, Asian American, or African American may have a worse quality of life in relation to mental health.
Ill mental health, especially depression, is associated with a number of hazards and difficulties. In the general population, depression might result in more medical services being required as well as trouble adhering to prescribed regimens. These difficulties also affect cancer survivors, whose sadness may lead to harmful habits and a lower chance of surviving at all. The lives of persons traversing the difficult path of cancer recovery can be greatly improved by identifying and addressing these concerns with empathy and support.
Psychosocial challenges
Deterioration of self-concept
A very personal and complex notion, self-concept includes many facets of our self-perception. Psycho-oncology research has examined important components of self-concept in relation to cancer, including self-worth, body image, self-dissatisfaction, and self-reflection.
Cancer and one's self-concept are correlated in both directions. On the one hand, the physical and psychological difficulties associated with cancer can have a significant effect on how patients view themselves. Because the illness is unpredictable and the treatments are frequently severe, people may be more susceptible to changes in how they see themselves. Conversely, a person's self-perception can also affect how well they manage their condition, how long their disease lasts, and how well their therapy works. For example, poor self-esteem can make it difficult to engage with others, which can lead to even more low self-esteem. Studies have indicated that patients who see their cancer as a chronic illness or who have more severe symptoms are more likely to suffer difficulties with self-discrepancies. On the other hand, those who have less self-discrepancies frequently have more rewarding relationships, a better feeling of purpose, and less depressive symptoms.
However, cancer may also cause a person's self-concept to be reconstructed in a number of ways. According to a research conducted on young cancer survivors, many of them thought that cancer was a part of their past. Some even believed that their identification as survivors had no bearing on how they constituted themselves in daily life. This emphasizes how crucial it is to acknowledge that every patient's and survivor's perspective of who they are is different and has to be treated with consideration and empathy in therapeutic settings.
Body image disturbance
Body image is a very personal assessment of one's own looks, and having a negative body image can negatively affect one's social and emotional wellbeing. Cancer patients may experience significant changes in the way their bodies look and feel as a result of chemotherapy, radiation, and surgery, among other therapies. These can be temporary or permanent changes, including hair loss, scars, and changes in body form, and dread of these changes typically starts even before treatment begins. A patient's quality of life may be significantly impacted by this body image worry, which can result in depressive, anxious, and emotionally distressing sensations.
While many cancer patients have body image issues, most study has focused on specific populations, mostly women with breast cancer and those with head and neck tumors. Research has indicated, for example, that women who lose their breasts go through a wide range of complicated emotions as they struggle to balance their sense of self, what society expects of them, and what it means to be a woman. These incidents highlight the need of sympathetic assistance and comprehension while patients work through these difficulties.
Maintaining social relationships
A cancer diagnosis can postpone the start of romantic relationships for young, unmarried people, adding yet another level of difficulty to an already difficult path. According to studies, these individuals typically marry at a lower rate than both the general population and their siblings. The effect of cancer on close relationships differs among married people. Compared to couples in good health, some couples with the diagnosis reported experiencing a stronger sense of love for one another. Both groups' marital struggles persisted, though, and some cancer-affected spouses felt less devoted to one another following their diagnosis.
According to other study, cancer may lead to marital discomfort and a general decline in the quality of the relationship. According to a poll, 13.1% of participants said that having cancer had made it harder for them to have successful marriages and sexual relationships.
The emotional and physical toll that cancer takes has a significant impact on family ties, especially between patients and their caregivers. According to a research looking at the dynamics in cancer patients' families, the disease frequently causes major changes in the way the family runs. Many cancer-affected families showed reduced emotional expressiveness; some were more aloof, while others became more supportive. Cancer patients and survivors may have social difficulties outside of the family, such as joblessness, social isolation, and the requirement for rehabilitation. These challenges might result in emotions of social restriction, where patients may experience avoidance or criticism, as well as a severe loneliness associated to cancer, when patients feel socially isolated as a result of their disease.
Other issues
Cancer patients and survivors may feel overwhelmed by the obstacles they confront outside of the hospital, in addition to the medical treatments. A major issue for many is the financial burden of paying for therapy while attempting to maintain a respectable standard of living. For instance, managing associated financial issues, such as figuring out insurance, can become quite difficult.
The distribution of healthcare access is unequal in many places of the world. Due to this imbalance, patients may have to travel across locations in order to get the best possible care, specialist treatments carried out by professionals, or the most up-to-date medical information. Organizing lodging and transportation in a distant place raises the stress level at an already challenging moment.
Many patients had important responsibilities in their families before receiving their diagnosis, such as taking care of small children or elderly relatives. It might be difficult for others to fill such duties after the diagnosis. Furthermore, a lot of patients were employed before their diagnosis, but the severity of cancer treatments might cause them to miss more time from work. It's not always simple for cancer patients to return to their employment, even if some feel capable of doing so do so. For example, a research revealed that 55.2% of patients who had cancer of the mouth and throat went back to work following treatment, which improved their prognosis. But they frequently encountered obstacles including inadequate assistance, inadequate communication, unfavorable work settings, prejudice, and false beliefs about their capacity for employment. These obstacles may make the path to recovery even more challenging.
In order to help cancer survivors overcome the social, psychological, emotional, and physical obstacles they encounter following treatment, caregivers are essential. They can offer emotional support and a listening ear in addition to helping with everyday tasks, promoting physical activity, and managing symptoms. In addition to encouraging healthy coping mechanisms and assisting in the availability of professional mental health care, caregivers should be alert to symptoms of anxiety or sadness. They may also assist in preserving the survivor's social networks and stand up for them in difficult situations, making sure they feel supported and not alone.
Physical Health Monitoring and Management
Regular Medical Check-ups:
The likelihood of identifying a cancer recurrence at an early stage, when it is most curable, improves with regular surveillance. Treatment results and survival rates can both be considerably increased by early intervention. Early detection of a recurrence lowers the risk of problems and the requirement for more intensive therapies by stopping the cancer from spreading to other body areas. More effective care may be provided by healthcare professionals who can customize treatment programs depending on the patient's present condition and the course of their cancer thanks to continuous monitoring. The treatment strategy can be swiftly modified if a recurrence is found, whether that entails starting new therapy, stopping old ones, or participating in research trials.
With regular monitoring and check-ups, survivors can feel more at ease knowing that any potential recurrence will be detected early. This comfort can greatly lessen worry and apprehension about the future. As survivors feel encouraged and secure in the knowledge that their health is being continuously monitored, continuous monitoring fosters trust between patients and their healthcare professionals. Monitoring guarantees that the survivor's general health is preserved and assists in treating any long-term negative effects of prior therapies. In addition to evaluating the likelihood of a cancer recurrence, routine follow-ups also evaluate the emotional, psychological, and social well-being of the survivor, all of which improve quality of life.
Imaging Tests
Computed Tomography
With the use of specialized x-ray equipment, computed tomography (CT) is a noninvasive imaging technique that produces finely detailed images, or scans, of internal body regions. Every image produced by a CT scan displays the bones, organs, and other tissues in a slender "slice" of the body. The set of images generated by CT may be compared to a loaf of sliced bread; you can see each slice separately, creating two-dimensional photographs, or you can view the entire loaf, creating three-dimensional views. Both kinds of images are produced by computer programs.
Unlike the early CT scanners, which took a sequence of photographs of different body slices, modern CT machines capture continuous pictures in a helical (or spiral) pattern. Compared to prior CT methods, helical CT, also known as spiral CT, is quicker and generates higher-quality 3-D images of internal body regions, which may help detect minute abnormalities.
There are several applications for CT in the detection, management, and surveillance of cancer:
cancer screening
assisting in the tumor's diagnosis supplying details regarding the cancer's stage precisely deciding where to conduct (i.e., guide) a biopsy
supporting the proposal surgical procedures
external beam radiation therapy
monitoring tumor recurrence
assessing how well a malignancy is responding to treatment
With a whole-body CT scan, almost every part of the body may be seen, from the chin to the area just below the hips. This treatment may be used to individuals without any sickness symptoms as well; it is commonly utilized on cancer patients. Furthermore, ionizing radiation exposure from whole-body CT scans may be rather high—an effective dosage of around 10 to 20 mSv, or more than three times the estimated average yearly dose from natural sources of radiation.
Whole-body CT is generally not advised for patients who do not exhibit any disease-related signs or symptoms.
Those who are thinking of getting CT should discuss the dangers and advantages of the process with their doctors, as well as if it is essential for them. It is advised by several groups that individuals maintain a record of the imaging tests they have had in case their doctors do not have access to all of their medical information. The American College of Radiology, the Radiological Society of North America, and the U.S. Food and Drug Administration created an example form called My Medical Imaging History Exit Disclaimer. It contains questions to put to the doctor before having any therapy or x-ray done.
Nuclear Medicine Scan
As opposed to conventional imaging procedures, which create images based on physical shapes and forms, nuclear scans create images based on the body's chemistry, such as metabolism. Liquids with low radiation release known as radionuclides—also referred to as tracers or radiopharmaceuticals—are used in these examinations.
Certain disorders, including cancer, might cause body tissues to absorb different amounts of the tracer than healthy ones. Utilizing specialized cameras, images illustrating the trajectory and accumulation sites of the tracer are produced.
If cancer is present, the tumor may appear as a "hot spot" on the image, which is an area with elevated tracer uptake and cell activity. The tumor may alternatively be a "cold spot," or a location of less uptake (and less cell activity), depending on the sort of scan that was performed.
Small tumors may not be detected by nuclear scans, and the presence of malignancy in a tumor cannot always be determined. Although these scans don't provide highly detailed images on their own, they can reveal some interior organ and tissue issues more clearly than other imaging procedures. They are therefore frequently used in conjunction with other imaging tests to provide a more comprehensive view of the situation.
For cancer, these nuclear medicine scans are frequently used:
Bone scans: Bone scans search for malignancies that may have metastasized, or moved from other parts of the body to the bones. They frequently detect abnormalities in the bone far sooner than standard x-rays. After a few hours, the tracer accumulates within the bone, and the scans are completed.
PET scans: A kind of radioactive sugar is typically used for PET scans, which employ particle emission tomography. The quantity of sugar absorbed by body cells varies based on their rate of growth. Rapidly expanding cancer cells are more prone than healthy cells to absorb more sugar. It is required of you to abstain from sugar-filled beverages for a few hours before to the exam.
PET/CT scans: Medical professionals frequently employ devices that combine a PET scan with a CT scan. PET/CT scanners provide details on any regions with elevated cell activity as well as enhanced detail in these regions. This assists physicians in identifying malignancies. However, they also increase the patient's radiation exposure.
Radioactive iodine (iodine-123 or iodine-131) is ingested during thyroid scans. After entering the bloodstream, it gathers in the thyroid gland. Thyroid malignancies can be detected using this scan. Thyroid cancer can also be treated with radioactive iodine. If you consume anything that contains iodine, this test might not function as intended. Make sure your doctor is aware of any iodine or shellfish sensitivities you may have.
MUGA scans: This type of scan examines cardiac function. It can be used to monitor heart health prior to, during, and following a particular kind of chemotherapy. The tracer sticks to red blood cells in your blood, and the scanner displays how your heart pumps blood throughout your body. Your ejection fraction, or the volume of blood your heart pumps out, is determined by the test. 50% or more is considered typical. Your doctor may decide to switch you to a different type of treatment if the results are abnormal. Before the test, you could be requested to abstain from caffeine and tobacco usage for 24 hours.
Gallium scans: This test uses the tracer gallium-67 to check for cancer in specific organs. Another application for it is a full body scan. The scanner searches the body for areas where gallium has accumulated. These might be cancerous, inflammatory, or infected regions.
Positron Emission Tomography (PET)
One kind of nuclear medicine technique called PET scans is used to monitor the metabolic activity of bodily tissues' cells. In reality, PET combines nuclear medicine with biochemical analysis. PET is mostly used in patients with cancer, heart disease, or brain disorders. It makes it easier to see the biochemical changes occurring in the body, such as the heart muscle's metabolism—the process by which cells convert food into energy after it has been broken down and taken into the circulation.
PET is distinct from other nuclear medicine tests in that it measures metabolism inside bodily tissues, whereas other nuclear medicine tests measure the quantity of a radioactive material accumulated in bodily tissue at a specific site in order to assess the function of the tissue.
Because PET is a form of nuclear medicine treatment, a small quantity of a radioactive material known as a radiopharmaceutical—also known as a radionuclide or radioactive tracer—is used to help examine the tissue being studied. PET investigations specifically assess the metabolism of a given organ or tissue, providing insights into the structure, physiology, and biochemical characteristics of the organ or tissue. Therefore, before morphological changes associated with a disease may be observed using other imaging techniques like computed tomography (CT) or magnetic resonance imaging (MRI), PET may be able to detect metabolic changes in an organ or tissue that can indicate the start of a disease process.
Mammography
An X-ray examination of the breast is called a mammogram. It is used to identify and diagnose breast illness in both individuals with and without breast complaints, including those who have breast issues such as a lump, discomfort, or nipple discharge. Through this process, benign tumors, breast malignancies, and cysts can be found before they can be felt or palpated.
Although a mammogram cannot confirm that an abnormal spot is cancer, tissue will be retrieved for a biopsy if there is a strong suspicion of malignancy. To find out if tissue is cancerous, it can be removed surgically or with a needle biopsy and inspected under a microscope.
Mammography can be used for diagnosis or for screening. If a woman over 30 has any symptoms—such as a palpable lump, thickening or indentation of the breast skin, discharge or retraction of the nipple, erosive sore of the nipple, or breast pain—she should get a diagnostic mammography.
Breast discomfort may be assessed using a mammography if the results of a physical examination and history are inconclusive. Mammograms may be used to screen women whose breasts are thick, "lumpy," or very big since physical examinations may be challenging in these cases. Mammograms may be performed on women who have a history of breast cancer or who are at high risk for the disease.
It could be a good idea to inquire with your healthcare professional about the dangers associated with the operation and the quantity of radiation utilized. Keeping a record of your prior radiation exposure is a good idea so you can tell your physician about it. Radiation exposure risks may be correlated with the total number of X-ray exams and/or treatments received over an extended period of time.
You should let your healthcare practitioner know if you are pregnant or think you might be. Pregnancy-related radiation exposure has been linked to birth abnormalities. Should a mammography be required, extra care will be taken to reduce the radiation exposure to the developing foetus.
The same x-ray technology is employed in digital mammograms as in traditional mammograms, but solid-state detectors are used to record the x-ray pattern traveling through the breast rather using film. The x-rays that go through these detectors are transformed into electrical impulses and routed to a computer. These electrical impulses are subsequently transformed by the computer into visuals that may be seen on a monitor and saved for later use. Digital mammography has a number of benefits over film mammography, such as the capacity to adjust contrast levels for improved clarity, computer-assisted anomaly identification, and simple digital file transfer to other specialists for a second assessment.
Additionally, fewer retakes—which are frequently required for film mammograms owing to improper exposure procedures or issues with film development—may be required with digital mammograms. Digital mammography can therefore result in reduced x-ray exposures. Although there is currently no proof that digital mammography lowers a woman's chance of dying from breast cancer better than film mammography, digital screening may be more accurate in detecting malignancies in younger or denser women.
Digital Breast Tomosynthesis, also referred to as 3D mammography, is an FDA-approved technique for screening for breast cancer that creates thin cross-sections by taking images of the breast at various angles. The three-dimensional picture of the breast produced by normal CT technology is comparable to that of the object. In comparison to CT technology, tomosynthesis produces far fewer x-ray beams through the breast and greatly lessens the amount of radiation that is exposed to the rest of the chest. As a result, the radiation exposure from tomosynthesis to the breast is comparable to that from 2D mammography. Despite using extremely low-dose x-rays, tomosynthesis is presently most frequently combined with 2D mammography, resulting in a greater overall radiation dosage compared with regular mammography.
While large-scale, randomized trials comparing tomosynthesis and 2D mammography are ongoing, preliminary reviews of 3D mammography point to a better identification of breast cancers than 2D mammography. Consequently, it is unclear to researchers to what extent 3D mammography differs from traditional mammography in terms of preventing false-positive findings and detecting early malignancies in all patient types.
X-ray
An x-ray is a diagnostic procedure that creates images of your inside organs using tiny quantities of radiation. They can reveal changes brought on by cancer or other medical disorders and are a useful tool for examining bones. Changes in other organs, including the lungs, can also be shown on X-rays. Doctors use radiography examinations, such as X-rays and radiographs, roentgenograms, and contrast studies, to detect cancer in several bodily areas, including the kidneys, stomach, and bones. X-rays are usually quick, painless, and don't require any additional preparation.
Specific x-ray procedures known as contrast tests combine radiography with iodine-based dyes or contrast agents, such as barium, to enhance image quality and highlight internal organs. For example, following the bowel's filling with barium sulfate, an x-ray is taken during a lower gastrointestinal (GI) series, often known as a barium enema exam. An intravenous pyelogram (IVP), a different type of contrast examination, examines the anatomy and physiology of the urinary system (ureters, bladder, and kidneys) using a particular dye.
Fluoroscopy/X-ray with contrast
Barium Swallow/Enema:
Barium is a radiopaque, thick, white material that is either ingested (for upper gastrointestinal examinations) or administered by enema (for lower GI studies). It covers the lining of the stomach, intestines, or esophagus, making these organs distinctly apparent on X-rays. used to identify diseases such as stomach anomalies, tumors, obstructions, and ulcers. On X-rays, barium produces a sharp contrast that draws attention to any anomalies or structural alterations.
Intravenous pyelogram (IVP)
A contrast agent is injected into a vein during an intravenous pyelogram (IVP), and it passes via the circulation to the kidneys, ureters, and bladder. After that, X-rays are obtained periodically to monitor the contrast's passage through the urinary system. It increases the kidney, ureters, and bladder's visibility on X-rays, which aids in the diagnosis of kidney stones, tumors, or anomalies in the urinary tract.
Contrast-enhanced CT scans
Iodine-Based Contrast
Usually injected into a vein, iodine-based contrast agents travel throughout the bloodstream. They improve the contrast of organs and blood arteries, which increases their visibility on CT scans. Through the visualization of blood flow, organ structure, and the presence of any abnormal growths or blockages, it may be utilized to diagnose cancers, blood vessel abnormalities, infections, and other disorders.
Oral/Rectal Contrast
Depending on the location being examined, the contrast agent is either ingested or given rectally. It covers the gastrointestinal system, making the colon, intestines, and stomach easier to see on CT scans. frequently used to make the gastrointestinal system stand up against other tissues so that it may be examined for problems such as tumors, obstructions, or inflammatory disorders.
MRI with Contrast
Contrast Based on Gadolinium
When injected into the body, gadolinium is a paramagnetic material that changes the magnetic characteristics of adjacent water molecules. This alteration improves the contrast on MRI images between various tissues. Gadolinium contrast is very helpful for imaging soft tissues, such the brain, spinal cord, and joints. It makes lesions from multiple sclerosis, inflammation, blood vessel irregularities, and malignancies show up more during imaging.
Contrast ultrasound
Agents for microbubble contrast
A gas-filled microbubble is injected into the circulation. The vivid echoes produced by these bubbles, which reflect ultrasonic waves far more efficiently than blood or tissues, improve the visibility of organ architecture and blood flow. Its uses include assessing vascularity in tumours and detecting abnormalities in the liver and heart, among other organs. The pictures are clearer because of the contrast, especially in regions where blood flow is significant.
Angiography
Contrast Based on Iodine
Using a catheter inserted into an artery or vein, a contrast agent is directly administered into the circulation. The blood vessels are then imaged using CT/MRI scans or X-rays. By contrasting the blood vessels with the surrounding tissues, angiography, which is used to see blood vessels throughout the body, aids in the diagnosis of blockages, aneurysms, and other vascular disorders.
Nuclear Medicine Scans with Radiotracers
Technetium-99m, Iodine-131, etc.
Radioactive compounds known as radiotracers are injected or taken orally into the body. These tracers release gamma rays, which are then photographed by specialized equipment to provide pictures of tissues or organs. By displaying how the radiotracer is absorbed by various tissues, this technology is used in procedures such as PET scans, thyroid scans, and bone scans to identify anomalies like cancer, bone problems, or thyroid malfunction.
Technology advancements have led to the replacement of many contrast tests by alternative scans, such as CT or MRI scans. For example, angiography used to be a common tool for determining the stage or extent of cancer, but these days, CT and MRI scans are the most common ways to find out. Nevertheless, angiography can occasionally be utilized to see the blood veins next to a malignancy, allowing for the planning of surgery that minimizes blood loss. Additionally, blood vessel disorders other than cancer can be diagnosed with angiograms.
Magnetic Resonance Imaging (MRI)
A non-invasive imaging method that creates three-dimensional, finely detailed anatomical pictures is called magnetic resonance imaging (MRI). It is frequently employed in the diagnosis, monitoring, and detection of diseases. It works by stimulating and detecting the shift in the direction of the protons' rotating axis, which is present in the water that constitutes living tissues, using advanced technology.
Planning a course of treatment and staging for cancer are made easier with the use of MRI scanners. It could be possible to differentiate between abnormalities and normal tissue using the finely detailed pictures produced by an MRI machine. This makes it easier for the radiology team to determine exactly where malignant cells have spread throughout the body. Additionally, it could be helpful in identifying metastases, or cancer that has migrated to another area of the body. A computed tomography (CT) scan is less contrasted than an MRI when it comes to the body's soft tissues. Thus, the device is frequently used by radiologists for medical imaging of the brain, spinal cord, muscles, ligaments, blood vessels, and internal structures of bones.
MRI scanners are very useful for imaging the body's soft tissues and non-bony sections. They are different from computed tomography (CT) in that they don't utilise x-rays' harmful ionising radiation. Because MRI images the brain, spinal cord, and nerves as well as muscles, ligaments, and tendons far more clearly than standard x-rays and CT images do, MRI is frequently used to picture the knee and shoulder in injuries.
Aneurysms and tumors can be diagnosed via MRI, which can also distinguish between white and grey matter in the brain. When repeated imaging is needed for diagnosis or treatment, especially in the brain, magnetic resonance imaging (MRI) is the preferred imaging modality as it doesn't involve radiation or x-rays. MRIs cost more than CT scans or x-ray imaging, though.
Functional Magnetic Resonance Imaging is one type of specialized MRI (fMRI). This is done in order to study the architecture of the brain and ascertain which regions "activate"—that is, require more oxygen—when doing different kinds of cognitive activities. It contributes to our understanding of how the brain is organized and may establish a new benchmark for determining neurosurgical risk and neurological state.
Managing Long-term Side Effects of Treatment
Cancer-Related Fatigue and Nausea
Patients should talk to their physician or nurse about their symptoms and/or signals. A patient might be experiencing:
Having trouble going up stairs or short distances
Weakened muscles
Breathing difficulties
Gaining or losing weight
Intolerance to cold
Low thyroid function test findings or anemia
Dry skin or hair loss
Issues with sleep
Moodiness and/or anxiety
Absence of drive
negative mindset
Intolerance
Unable to focus
Memory loss or diminished mental acuity
Absence from previously loved activities
Unusual tension in partnerships
Because fatigue cannot be objectively measured, it might be challenging to evaluate. Finding and treating any underlying physical issues is the first step in evaluating CRF. These underlying problems that might be causing your weariness could include anemia, an infection, or adverse effects from your medication. Your doctor or nurse practitioner may choose to request one or more of the following tests to help identify probable reasons, even though there isn't a blood test that screens for CRF:
Complete blood count (CBC)
Peripheral blood smear
Serum iron level
Transferrin level (protein that transports iron throughout the body)
Total iron-binding capacity (TiBC)
Ferritin level (protein in cells that stores iron)
Folate level (also known as folic acid or Vitamin B₉)
Vitamin B12 level
Erythropoietin level (a hormone that increases the number of red blood cells)
Thyroid function
Adrenocorticotropic hormone (ACTH) level (also known as cosyntropin stimulation test)
Antiemetics, often known as antinausea medications, are effective in both preventing and treating nausea and vomiting in cancer patients. Depending on the intensity of your nausea and vomiting, your doctor may give you a combination of antiemetics. Additionally, your physician will advise you on the best times to take the antiemetics, such as right before or right after chemotherapy sessions or a certain window of time before meals.
There are several different kinds of antiemetics that might stop or lessen nausea and vomiting; you might be prescribed any of the following:
medications that inhibit serotonin, a neurotransmitter that can cause nausea and vomiting, including palonosetron (Aloxi), dolasetron (Anzemet), granisetron (Kytril), and ondansetron (Zofran).
medications that inhibit the brain chemical dopamine, which can cause nausea and vomiting: metoclopramide (Reglan), prochlorperazine (Compazine), promethazine (Phenergan), and chlorpromazine.
medications that block the brain protein NK-1 receptor, which can cause nausea and vomiting: Precipitant or fosaprepitant (Emend)
steroids: dexamethasone (Decadron), methylprednisolone (Medrol)
benzodiazepines: alprazolam (Xanax), lorazepam (Ativan)
antipsychotics: olanzapine (Zyprexa) cannabinoids: dronabinol (Marinol)
cannabinoids, which contain THC and can alleviate nausea and vomiting related to anxiety
Track nausea to identify patterns and causes.
Chemotherapy may be the direct cause of some nausea. Knowing when nausea starts following treatment is helpful. Sometimes it starts right away, and other times it takes longer. Monitoring might assist in determining other reasons or triggers for nausea. Mobile applications have been an invaluable resource in recent years, providing patients with individualized tools and assistance to monitor, manage, and reduce nausea and vomiting. These applications track symptoms, give nutritional recommendations, help with prescription scheduling, and even contain relaxation methods to ease pain. Cancer patients can now manage these difficult side effects more proactively because to the ease of mobile technology.
Reducing odours can be helpful.
It is preferable to pick meals with little to no odor, such as oatmeal, cereals, canned fruit, drinks, and smoothies, as odors might cause nausea. When cooking at home, choose dishes like pancakes, scrambled eggs, reheated soup, or other prepared items that just need to be warmed through. These have quick cooking periods and produce little to no smell. Foods that are cold or room temperature often smell less than those that are heated.
Steer clear of preparing meats, casseroles, and slow-cooked dishes because they require lengthy cooking times. Request that friends or relatives prepare these foods in a different kitchen, such as a neighbor's.
Consume a few number meals or snacks.
Having five to six little meals or snacks throughout the day as opposed to two or three bigger meals may help reduce nausea. This avoids both excessive stomach acid production and the stomach being excessively empty. Chew everything thoroughly. The mouth is where the digestive process starts. Stock up on flavorless, tasteless snacks for quick meals and munching. Crackers, cheese, yogurt, canned fruit, potatoes, rice, and pasta are a few examples.
Light, temperature, and other environmental signals can exacerbate nausea. Lower temperatures and dim lighting are often more conducive to managing nausea. Using a ceiling fan or fan may also have an impact. When trying to enjoy a meal or snack, it's critical to avoid environments that exacerbate anxiety (such as loud voices, arguments, loud music, or unsettling television shows).
It can be ideal to have meals and snacks in a cool, dark room with soft, peaceful music playing or a relaxing television show or activity. Get some rest after eating but avoid lying down flat since this might make you nauseous. Since each person is unique, not every food will help someone who is experiencing nausea. Try to be patient and try out various cuisines. Introduce foods one at a time, starting with simple, low-odor options.
For unknown reasons, some meals make you feel queasy. It's possible that some of these causes are psychological. For optimum nutrition, steer clear of these foods. The body loses out on nourishing food throughout the period it takes to heal after an incident. Foods that are more difficult to digest and remain in the stomach for a longer period of time might cause nausea. Typically, these items are heavier in fat, including fried dishes and foods made with a lot of butter or oil. Most people don't tolerate spicy foods well. Smoking and caffeine both increase nausea. Refrain from smoking and stick to drinking only decaffeinated drinks.
One spice that has shown some efficacy in treating nausea is ginger. Ginger tea, ginger snaps, ginger ale, or ginger gum are some possible remedies for nausea. Certain Asian dishes also frequently call for ginger. There are supplements made of ginger. Prior to using a ginger supplement, see your physician.
Chemobrain
Cognitive (mental) processes including focus, memory, and multitasking might be affected by chemotherapy and radiation therapy. Although doctors are unable to anticipate who could be impacted, most chemotherapy patients have these side effects, frequently referred to as "chemobrain" or brain fog, to some degree. For some people, chemotherapy has long-lasting impacts on cognition. It is rare for people to experience long-term side effects from chemotherapy that are referred to as "chemotherapy-induced cognitive impairment."
Behavioral Strategies
A clinic-based treatment program called cognitive rehabilitation aims to enhance an individual's functional ability, real-world skills, cognitive talents, and/or internal metacognitive strategies (i.e., internal plans of action for accomplishing cognitive tasks). Patients in these programs meet with a professional clinician (usually an occupational therapist, neuropsychologist, psychologist, or speech and language pathologist) on an individual or group basis. Programs can be inpatient or outpatient. Although there have only been a few research on cognitive rehabilitation following breast cancer, most of them have shown a considerable increase in quality of life as well as objective and subjective cognitive function.
Executive functioning, working memory, attention, memory, processing speed, and visual-spatial abilities are among the cognitive domains where intervention benefits are evident. The intervention method of four 30-to-50-minute individual office visits held every two weeks, interspersed with phone calls. In addition to training in self-awareness, self-regulation, and cognitive compensatory methods, intervention participants received psychoeducation about memory and attention. The intervention group showed considerably better memory performance and self-reported quality of life as compared to the waiting control group. The intervention was most helpful to participants in compensating for their everyday memory problems.
Enhancing real-world goal attainment and controlling psychological comorbidities, like the anxiety and sadness that the patient mentioned above was experiencing, can both benefit from cognitive rehabilitation. It is thought that a large portion of the approach's social components—such as the group members' therapeutic connection with the clinician—contribute considerably to its cognitive and psychological impacts. Unfortunately, because cognitive rehabilitation needs several in-person sessions and is administered by qualified professional providers, it is not always practical. Furthermore, there is a lack of accessibility to cognitive rehabilitation and a history of inconsistent health insurance coverage. Nonetheless, a manualized therapy strategy is used in many studies of cognitive rehabilitation in breast cancer survivors, which enhances the practicality of distribution and standardization of interventions.
Through dispersed, adaptive practice of certain cognitive areas, cognitive training seeks to enhance and preserve cognitive abilities. In contrast to cognitive rehabilitation, cognitive training often makes extensive use of computerized activities and focuses on practicing cognitive abilities independently, without the need for compensatory or metacognitive techniques. Since most games need some level of active problem solving and decision making to advance, these activities are usually game-based. Algorithmic control of the degree of difficulty is another feature of the exercises that optimizes the ratio of challenge to incentive. Even while research on cognitive training for CRCI following breast cancer is still in its early stages, it appears that as few as 10 hours of dispersed training will enhance executive function, memory, processing speed, self-rated cognition, anxiety, and sadness.
Physical Activity
Research on both humans and animals has shown that physical activity (PA) improves cognitive performance. While gains in memory and other cognitive abilities have not been as constant as they could be, executive functions in healthy people exhibit the highest and most consistent increases in response to exercise. In addition to increasing neurogenesis, neurotransmitter and neurotrophin levels, and favorable alterations in brain vasculature, PA also lowers inflammation. Reducing psychiatric disorders and long-term medical diseases linked to PA (such as depression, insomnia, diabetes, and obesity) may also tangentially enhance cognitive performance. Moreover, PA is thought to modulate the signaling pathways related to neuroprotection, including upregulating the expression of genes that promote neuroprotection. Significantly, research on animals indicates that PA may enhance cognitive performance during breast cancer therapy.
In human research, Hatha, Iyengar, Qigong, and Tai Chi have been used as an intervention for Chemotherapy-related cognitive impairment (CRCI) in breast cancer. Processing speed, memory, executive function, and quality of life all showed improvements. After as little as one month of PA intervention, cognitive effects were shown in one study, which is in line with findings from earlier research in healthy people. Janelsins et al. specifically randomized cancer survivors (of which 75% were breast cancer) to either a yoga intervention or no therapy. During the course of four weeks, the intervention included breathing techniques, mild Hatha and Restorative yoga poses, and twice-weekly 75-minute meditation sessions. The intervention group showed much better subjective memory performance, reduced tiredness, and increased quality of life.
There is a reciprocal link between PA and cognitive function, particularly executive function. It has been demonstrated that executive function in healthy persons moderates PA adherence. Furthermore, in healthy people, a lower level of prefrontal brain activity has been linked to a lower level of self-regulation of PA behavior. This is not unexpected as effective self-regulation is thought to depend on key executive processes including working memory, inhibition, and task switching. Cognitive impairment can be a barrier to PA involvement following cancer, and individuals with executive dysfunction frequently struggle to modify their beliefs or habits. Accordingly, for certain cancer survivors—especially those with substantial CRCI—the combination of PA with cognitive therapies may prove to be more beneficial.
Neuromodulation Strategies
New, noninvasive methods for treating cognitive impairment are provided by interventional research grounded on cognitive neuroscience. By giving a participant feedback on her brain activity, a technique known as neurofeedback teaches her to use metacognitive tactics to regulate her brain activity's up- and down-regulation. Targeting the right brain areas may help lessen a variety of cognitive-behavioral problems. Real-time functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (NIRS), or electroencephalogram (EEG) are the methods used to offer neurofeedback. Studies on neurofeedback in non-cancer populations show that individuals may learn to regulate the activity of brain areas linked to emotion regulation, motor function, attention, and pain response, among other functions. Similar neurofeedback approaches may be useful, as evidenced by a research including breast cancer survivors that used EEG neurofeedback to show favorable benefits on subjective cognitive performance.
Magnetic fields are used in repetitive transcranial magnetic stimulation (rTMS) to alter neuronal excitability. A TMS coil is used to apply brief electromagnetic pulses across a particular region of the skull throughout the process. The US Food and Drug Administration has authorized the approach for the treatment of depression at this time; however, it is also being researched as a potential strategy to enhance cognitive function. Although rTMS has not yet been studied for CRCI, investigations on other populations have shown that it has good benefits on memory and attention impairments, making it a viable prospective intervention for further research.
Pharmacotherapy
Few psychopharmacologic treatments have been shown to be successful in avoiding or lessening cognitive impairment in people with cancers other than CNS cancers. Psychostimulants such as modafinil, dexmethylphenidate, and methylphenidate have had inconsistent outcomes, and it is still unclear how helpful these medications are. An further example of a medication that attracted interest following preliminary preclinical results is the acetylcholinesterase inhibitor donepezil.
Determining the specific processes behind CRCI might make it easier to find innovative pharmacologic treatment approaches. Promising treatments include preventing oxidative stress associated with chemotherapy with N-acetylcysteine, melatonin, or 2-Mercaptoethane sulfonate; stimulating neurogenesis with fluoxetine, glucose, or insulin-like growth factor-1; and treating chemotherapy-induced CRCI with glutamate receptor antagonists like dextromethorphan or memantine. These interventions have been suggested by a number of animal studies that focus on the effects of chemotherapy on cognition. More preclinical research will be required to comprehend and maybe reduce the negative side effects on cognition associated with the introduction of novel targeted medicines and immunotherapies that may affect cognition, either independently or in conjunction with established anticancer drugs.
Mental and Emotional Well-being
Dealing with Anxiety, Depression, and PTSD:
No matter the stage of the disease, the primary cancer site, or the stage of treatment, anxiety and depression are the most common psychological symptoms in cancer patients. Symptoms can range from nonpathological states like worries, anxiety, sadness, and increased hopelessness to specific psychiatric syndromes like anxiety and depressive disorders, which are linked to significant distress and marked disability, poor quality of life (QoL), increased physical symptoms like pain or nausea, poor treatment adherence, increased risk of suicide (in people with depression), poorer prognosis, and higher mortality.
In the general population, anxiety and depressive disorders are quite common. In 2015, it was estimated that 322 million individuals (4.4% of the world's population) and 264 million people (3.6% of the world's population) respectively suffered from anxiety and depression. When compared to pre-coronavirus disease (COVID)-19 pandemic levels, there will likely be 53.2 million more instances of major depressive disorder and 76.2 million cases of anxiety disorder worldwide. This represents a substantial increase in both the incidence and prevalence of both illnesses in recent years. The cost of chronic illnesses is growing in importance as a global issue. Significant depression, or depression on its own, is thought to be the leading cause of disability, surpassing both cancer and cardiovascular illnesses.
Psychotherapeutic modalities
There is strong evidence that psychoeducation, MBT (including MBSR and MBCT), CBT, supportive therapy, and blended modalities (e.g., web-based, online, and in-person) are effective treatments for anxiety disorders at all stages of the cancer trajectory. In contrast to traditional CBT, modern CBT has been shown to provide notable advantages in terms of altering the way patients relate to their inner experiences by emphasizing cognitive processing and meta-cognitions in fear of cancer recurrence (FCR).
Both psychopharmacological and psychotherapeutic modalities are beneficial; however, for individuals with mild to moderate symptoms, psychotherapy alone may be more beneficial than pharmacotherapy for anxiety or depression. The main techniques used in psychotherapy are cognitive behavioural therapy (CBT), problem-solving therapy, interpersonal therapy (IPT), relaxation training, mindfulness-based therapy (MBT) (which includes mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT)), and psychoeducation. The following are examples of crucial first-line therapies for patients with advanced cancer and anxiety or depression: dignity therapy, meaning-centred therapy, supportive-expressive group psychotherapy, and Managing Cancer and Living Meaningfully (CALM) therapy. Data for these therapies are available from randomized controlled trials (RCTs).
Support Systems
The relatives and friends of cancer patients are under a great deal of stress due to the healthcare system's growing overload. Indeed, the weight of treatment has moved from hospitals to homes, and in certain situations, to ambulatory facilities, as a result of recent developments in the medical business. Family and friends may not always be able to do such a wide range of responsibilities, some of which call for specific training and expertise. To establish a strong support system, they should be ready to collaborate with the patient's physician, surgeon, nurses, and other medical professionals.
Unfortunately, the emotional toll that cancer exacts makes it difficult to provide both physical and emotional assistance to patients. This is due to the fact that receiving a cancer diagnosis always causes anxiety and distress for the patient as well as for close friends and family.
According to some estimates, after receiving a diagnosis, a complete 20 to 30% of spouses or partners have mood disorders or even psychological damage.Family members who don't exhibit the outward signs of emotional or psychological harm still endure a great deal of stress because of the illness.
Social ties can offer emotional support, safety, comfort, and direction. Others may provide us company, support, common interests and ideals, and the chance to give back with love, care, and nurturing. People who have assistance report higher wellbeing and a higher quality of life. Having supportive friends and family will provide you the "resources" you need to deal with the stress and emotional upheaval that come with undergoing cancer treatment and the protracted recovery that follows.
When someone is in a relationship, that person is frequently the center of attention for their social network. Among all relationships, the supporting spouse has the biggest influence on one's mental and physical health, as opposed to the negative or even the "present" partner. In actuality, having a supportive partner might be even more advantageous than having a support person who is not your spouse. How come this might be the case?
To put it simply, having a partner increases your access to assistance, especially when they inquire about your wellness and the best ways to assist you or communicate honestly with you. However, some spouses take on the role of protector, hoping to eliminate any possible causes of stress. A spouse could, for instance, hide their own concerns, downplay any suggestion of conflict, or "hover," limiting your engagement in important or mundane tasks. Even with the best of intentions, these kinds of behaviors could not be beneficial.
Counseling and Therapy:
An essential component of cancer therapy is psychological support. It offers education, counseling, and other services. It might be a mistake for many cancer patients not to seek out psychological care. This may be particularly true for residents in rural locations, where mental health professionals with competence in oncology are few. Many cancer patients find that counseling is beneficial, but it may also be a very difficult procedure. It's crucial to locate a qualified counselor who can assist you in comprehending your emotions and maximizing the benefits of treatment. A competent counselor may offer helpful strategies for symptom management and general quality of life enhancement, as well as assist you in coping with the psychological ramifications of your diagnosis and treatment.
Overview of different types of therapy (CBT, MBCT, ACT).
Patients undergoing long-term cancer therapy may have severe physical and psychological side effects. Survivors may have symptoms associated with cancer therapy, such as fatigue, sleeplessness, obesity, and fear of cancer recurrence, for months or years. These symptoms can have a negative impact on survivors' quality of life. Consequently, during the protracted course of cancer therapy, it is extremely important to keep an eye on and mitigate the negative effects of cancer treatment. The goal of cognitive behavioral therapy (CBT) is to change a patient's dysfunction through behavioral and psychological treatments. Research indicates that cognitive behavioral therapy (CBT) is the most successful psychological strategy for reducing fatigue brought on by cancer treatment and can enhance the quality of life for cancer survivors.
CBT is a problem-focused psychotherapy intervention. It is a combination of behavioral therapies like exposure therapy, behavioral stimulation, emotion management, and relaxation training. Over the course of more than 60 years, it has changed from traditional in-person therapy to a wide variety of therapies, including online cognitive behavioral interventions. CBT is an evidence-based therapy approach that has been shown to be effective in treating a range of psychiatric conditions, including schizophrenia, anxiety disorders, depression, and personality disorders. One of the upcoming paths for study and therapy will be the combination of CBT and medicine, which is becoming more prevalent in clinical practice and achieving increasing success.
Recently, there has been substantial data supporting the use of mindfulness-based techniques in cancer care. Through meditation, yoga, group discussions, and regular contemplative practices, mindfulness-based therapies (MBIs) help patients develop compassionate attitudes, increase their awareness, and stay focused in the present moment. Better control over their emotions, thoughts, and behavior results from these processes, which eventually contribute to mental stability. Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) are the two MBIs that are most often utilized. While the two programs' structures are similar, MBCT employs a cognitive treatment approach and offers more detailed psychoeducation about the connection between mood, cognition, and functioning than MBSR.
Notably, MBCT helped patients feel less exhausted. One of the two most prevalent complaints among cancer survivors is fatigue, which considerably lowers the quality of life for cancer patients. Exercise and sleep hygiene have been shown to be beneficial, although their effects are not very large. Moreover, it might be challenging for medical professionals to encourage tired cancer survivors to engage in physical activity.
Additionally, MBCT therapies significantly enhance patients' spiritual and quality of life. It is noteworthy that MBCT enhanced positive features of cancer patients' everyday life while simultaneously reducing unfavorable psychological aspects. Spiritual health acts as a buffer against clinically significant problems including pain, exhaustion, sadness, and a desire for an early death.
Notably, MBCT helped patients feel less exhausted. One of the two most prevalent complaints among cancer survivors is fatigue, which considerably lowers the quality of life for cancer patients. Pharmacotherapy has not been proven to be effective. Exercise and sleep hygiene have been shown to be beneficial, although their effects are not very large. Moreover, it might be challenging for medical professionals to encourage tired cancer survivors to engage in physical activity.
Additionally, MBCT therapies significantly enhance patients' spiritual and quality of life. It is noteworthy that MBCT enhanced positive features of cancer patients' everyday life while simultaneously reducing unfavorable psychological aspects. Spiritual health acts as a buffer against clinically significant problems including pain, exhaustion, sadness, and a desire for an early death.
The practice of mindfulness, which fosters a sense of internal harmony and completeness, may help cancer patients better understand their own meaning in life—even in the face of a terminal diagnosis.
It is commonly acknowledged that the most effective psychotherapy intervention for treating a variety of mental illnesses, such as anxiety, depression, and schizophrenia, is cognitive-behavioral therapy, or CBT. But the first two generations of CBT—traditional behavior therapy and cognitive-behavioral therapy—have shown to have drawbacks, including a weak connection between fundamental ideas and established clinical traditions, imprecise definitions of interventions, and scant data indicating their effectiveness. As a result, these therapies are comparatively mechanistic and unreliable. The third wave of CBT, which includes dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT), and metacognitive techniques, appears to be continuing the CBT tradition into new frontiers. This wave is built on the first and second waves of CBT.
Rather than attempting to suppress or eradicate particular psychological issues or radically alter control behavior and cognition, they would much rather structure adaptable and powerful repertoires like acceptance, mindfulness, or cognitive defusion to change the way an individual interacts with these issues.
With an influence on six key processes, ACT primarily aims to develop greater psychological flexibility to help people productively adapt to these challenges, rather than being committed to counterproductive attempts to control or eliminate undesirable thoughts, feelings, and experiences like pain, anxiety, or fear. Acceptance, cognitive defusion, being present, the self as context, values, and committed action are the six processes. Anxiety and depression are examples of extremely stressful events that arise during cancer diagnosis and treatment. These events have a significant impact on quality of life (QoL), accelerate the course of cancer, and are strongly linked to both cancer-specific and all-cause death.
Psychological distress and conditions like financial toxicity and post-traumatic stress disorder (PTSD) are causally related in a reciprocal manner. Symptoms like exhaustion, functional limits, pain, sleep issues, and melancholy are examples of these relationships. Patients with cancer are guided to actively and nonjudgmentally experience (not just tolerate) the cancer conditions here and now as they are, explore and clarify values, identify achievable goals, and commit concrete actions to overcome the specific barriers impeding the steps toward the value ends through the application of acceptance, mindfulness, and value-based living and commitment processes in ACT. This creates psychological flexibility for patients with cancer.
Based on the idea that pain, suffering, and disease are inevitable aspects of life, ACT views the discomfort experienced by cancer patients as a typical reaction to the difficult experience of a serious illness. Primary suffering (e.g., typical levels of worry of cancer progression or recurrence, grieving at loss of functional capacity) is the classification given to this anguish. On the other hand, maladaptive coping mechanisms like experiencing avoidance or control techniques (such dwelling on events connected to the illness or engaging in "positive thinking") lead to secondary suffering. These attempts to regulate or change the nature, frequency, or sensitivity of personal experiences in cancer patients are frequently linked to dysfunctional behaviors, such as overusing or underusing the healthcare system to allay worries about their health or failing to start and/or continue disease self-management practices.
Based on the concept that pain, suffering, and disease are inevitable aspects of life, ACT views the discomfort experienced by cancer patients as a typical reaction to the difficult experience of a serious illness. Primary suffering (e.g., typical levels of worry of cancer progression or recurrence, grieving at loss of functional capacity) is the classification given to this anguish. On the other hand, maladaptive coping mechanisms like experiencing avoidance or control techniques (such dwelling on events connected to the illness or engaging in "positive thinking") lead to secondary suffering. These attempts to regulate or change the nature, frequency, or sensitivity of personal experiences in cancer patients are frequently linked to dysfunctional behaviors, such as overusing or underusing the healthcare system to allay worries about their health or failing to start and/or continue disease self-management practices.
Attempts at control can also show themselves as an excessive concentration on one value (health, for example) at the expense of other values (social interactions, for example). When it comes to treating disordered ideas and feelings, ACT provides a radically different approach than typical CBT techniques (such as Beckian therapy). Instead than altering thoughts and feelings by cognitive reconstruction, it is typified by an acceptance- and value-based approach to original suffering (e.g., unpleasant experiences and emotions), decreasing or even preventing subsequent suffering. In order to reduce secondary suffering, ACT therapists employ six fundamental processes with their cancer patients. These processes make up the Hexaflex of psychological flexibility.
"Contact with the present moment" refers to the non-judgmental focus on the "here-and-now," which can be shaped, in contrast to an uncertain future. "Diffusion" refers to the de-literalization of thoughts, such as "The pain is certainly a sign of cancer progression." "Contact with the unchangeable "self-as-context" refers to the willingness to bear unpleasant emotions and experiences, such as grief over functional restrictions, fear of progression, pain, and fatigue. "Value-based living" is encouraged and actively engaged in during cancer patients. A cancer diagnosis, for example, may cause values to be rearranged in order of importance. ACT's values-based methodology can assist in making these ideals more clear.
With the overarching objective of helping cancer patients cope with the aforementioned significant physical, psychological, and social changes, all of these hexaflex processes are addressed in ACT therapy. ACT therapy protocols emphasize not just psychological flexibility but also larger ACT-consistent processes such as emotional approach coping and self-compassion, which include actively noticing, processing, and expressing one's feelings in order to cope with stresses.
Role of psycho-oncology
A subspecialty of cancer called psychosocial oncology deals with the range of psychological, behavioral, emotional, and social problems that affect cancer patients and their families. Patients and their families may experience severe suffering as a result of cancer. Depending on what each person and family experiences, there are many types of anguish. Numerous things might have an impact on it, such as the kind of cancer, the stage of life at which the patient is in, and the way in which they typically handle difficult circumstances. In the widest sense, cancer has two psychological aspects. The first is the emotional reaction that cancer has on sufferers and their relatives. The second factor that affects living with cancer is the emotional, behavioral, and psychological challenges. Psychosocial oncology deals with each of these aspects.
Management of pain and fatigue
Pain is one of the main reasons cancer patients experience physical misery. The majority of the time, the invasive development of the tumor generates the pain sensations; nevertheless, they can also be brought on by treatment measures (chemotherapy, radiation, surgery), immobilization, or factors unrelated to cancer.
Excellent randomized controlled trials (RCTs) and several meta-analyses have demonstrated the ability of psychological and cognitive behavioral therapies to lessen the intensity of pain and interfere with function. At various phases of the condition, cognitive behavioral therapy, psychoeducation, hypnosis, yoga, and exercise have all been shown to be beneficial. These treatments seek to enhance self-efficacy, reframe catastrophic thoughts, modify activities, improve coping and acceptance of pain, and change the focus of attention. Patients who get educational interventions are also assisted in communicating with healthcare practitioners and utilizing available therapy alternatives.
Energy expenditure interventions aim to regulate patients' activity levels according to their individual possibility and needs. They include delegation, educational intervention, energy expenditure planning, and physical exercise. In addition, energy levels can be restored by ensuring rest, reducing stress, learning relaxation techniques, and engaging in enjoyable activities. Psychotherapeutic interventions may also aim to reduce negative or catastrophizing thought, create acceptance strategies, and refocus attentional processes. Numerous clinical trials have demonstrated that aerobic training and, in some cases, resistance or strength training will reduce fatigue.
Sexuality and reproduction in cancer disease
There are several direct and indirect ways that cancer can impact sexuality. Cancer itself, and particularly malignancies related to the testicles, prostate, penile, bladder, or gynecology, can damage the anatomical components required for sexual function. Sexual function is disrupted by hormonal changes brought on by diseases or by hormonal changes brought on by chemotherapeutic, hormonal, or surgical treatments. A significant influence is also played by changes in body image and self-esteem, exhaustion brought on by cancer, pain or emotional issues, or stress in the connection with a sexual partner. It has been demonstrated that sexual dysfunction significantly lowers quality of life.
Certain cancers can affect reproductive function, although the majority of the time, fertility is threatened by chemotherapy and radiation treatment. While storing sperm can help men maintain their fertility, it might be more difficult for women to do the same. Although these are well-established techniques, ovarian translocation prior to pelvic radiotherapy and the cryopreservation of fertilized eggs may only be beneficial in specific situations. Ovarian tissue or unfertilized eggs can be cryopreserved as alternative, less researched options. All these techniques are, however, rather intrusive. Making decisions on fertility preservation frequently involves working under time constraints, going through a trying time, and juggling the emotional weight of dealing with the diagnosis and associated treatment options.
Patients require assistance in coping with these choices, concerns about reproduction, or the loss of reproductive function when it may not be preserved. Prospective parents are also frequently worried about the cancer's potential heritability, genetic damage from chemotherapy or radiation therapy, or the potential impact of pregnancy on the risk of recurrence (for example, in hormone-receptor-positive breast cancer). In these situations, comprehensive information and cooperation with reproductive medicine are necessary.
Treatment of psychiatric comorbidities and fear of recurrence
In addition to significantly lowering quality of life, psychiatric comorbidities are linked to worse prognosis in cancer patients. The management of depressive episodes in cancer patients is outlined in several guidelines and does not differ greatly from that of non-cancer patients. But because depression and cancer symptoms sometimes coexist, the diagnosis procedure requires extra attention. Special attention must also be paid to the negative effects and interactions of antidepressant medication (e.g., the interactions between certain antidepressants and tamoxifen). Numerous studies have demonstrated that psychotherapy interventions help cancer patients with their depression symptoms at various phases of the illness.
Research has been done on traditional therapeutic modalities such cognitive behavioral therapy, and more recently, specialized treatment plans have been created. When receiving psychotherapy, considerations such as the particular treatment environment, illness stage, bodily indications of distress, and existential danger must be made. Similar, if less fully explored, concepts also apply to anxiety disorders, where the recommendations for treatment in non-cancer patients are mostly followed by psychopharmacological and psychotherapy approaches.
In cancer therapy, fear of recurrence (or fear of advancement) is a separate phenomenon. It is one of the most often mentioned worries of cancer survivors and is characterized as "fear, worry, or concern about cancer returning or progressing." Progression anxiety has been addressed using a number of treatment ideas. on a (partially) RCT, group therapy grounded on cognitive behavioral principles was found to reduce fear of progression in an inpatient rehabilitation setting. A pilot phase of the program also revealed some encouraging results, albeit with some changes, for an outpatient setting. Self-observation, exposure-based methods, abstaining strategies, and putting new behavioral patterns into practice are crucial components.
Social and Lifestyle Adjustments
Throughout the whole cancer continuum, including the etiology, treatment effectiveness, toxicity, rehabilitation, risk of recurrence, cancer-specific outcomes, and overall survival, lifestyle plays a critical role. Numerous observational studies have demonstrated the significance of lifestyle elements for survival and recurrence following cancer therapy, such as regular exercise and a nutritious diet. There is evidence from a number of studies that physical exercise following a cancer diagnosis is linked to improved overall and cancer-specific survival for patients with prostate, colorectal, or breast cancer.
A typical side effect of cancer treatment is an elevated risk of cardiovascular disease (CVD) and type 2 diabetes mellitus, but one that varies depending on the treatment modality. Testicular cancer survivors often develop cardiovascular disease (CVD) risk factors, such as overweight, hypertension, and hypercholesterolemia, during the first five years of follow-up following platinum-based chemotherapy. Over ten years after chemotherapy, these patients have an increased risk of myocardial infarction in comparison to men in the general population. Breast cancer survivors who get adjuvant chemotherapy including anthracycline had a higher chance of heart failure and weight gain following treatment. In a cross-sectional investigation, the prevalence of CVD risk factors was shown to be either equal to or greater in survivors of gynecologic, colorectal, and prostate malignancies than in the overall adult population.
Guidelines for physical exercise and diet have been created specifically for cancer patients, based on emerging knowledge about healthy behaviors and the toxicity associated with cancer treatments. According to these recommendations, consuming unprocessed, high-fiber meals, abstaining from alcohol (or reducing consumption to one drink per day), and engaging in at least 150 minutes of physical activity each week are the keys to reaching and maintaining a healthy weight.
While oncologists agree that it is important to counsel patients on leading healthy lifestyles, they don't always follow through on this obligation and may lack the necessary skills to do so. They face obstacles when trying to offer lifestyle advice, such time constraints, a lack of standards, or hesitations stemming from a concern of losing patient relationships when discussing health-related activities. Still, the great majority of cancer patients and their social network consider dietary, weight, and exercise recommendations to be helpful. Few believe that this counsel would be callous or place the responsibility on the patient; they also believe that their doctor is the best person to give them this. The patients also stated that they were aware of the advantages of maintaining a healthy diet and were eager to learn more, but that they had not received guidance from a professional in this area.
Prior research on cancer survivors has shown that, while being more vulnerable to long-term health issues, their rates of poor lifestyle choices are comparable to those of the general population. Worse health habits were also noted in young adult cancer patients: males ate less fruit and vegetables and women smoked more frequently than their counterparts. Moreover, cancer survivors need more than just a diagnosis to be inspired to make long-lasting, positive changes in their health behaviors. Supportive environments are necessary for cancer patients to really initiate lifestyle changes. A cancer patient's motivation and capacity to alter their lifestyle may be significantly impacted by social support, particularly support from their spouse or partner.
For instance, if a partner is encouraging or exhibits the same behavior, attempts to boost the amount of exercise or quit smoking may be more successful and long-lasting. An interested and encouraging spouse can help improve adherence to a pelvic floor exercise regimen after prostate cancer. Additionally, it was shown that the health behaviors of cancer patients and their partners were quite similar in terms of consuming fruits and vegetables and exercising. Patients reported higher levels of relationship satisfaction and felt their spouse was more supportive when they both adopted more equitable health practices.
Partners must live a healthy lifestyle in order to positively impact the patients' health-related habits. But much like with patients, spouses may find that receiving a cancer diagnosis is insufficient to permanently alter their health-related behaviors. The experience of living with cancer made family members of cancer patients who were nearing the end of their treatment more conscious of the value of leading a healthy lifestyle, but they also showed less desire to actually make changes. A review of studies on health behavior change among cancer patients' caregivers found conflicting findings; while some studies shown improvements in health habits, others indicated declines.
A research conducted among Danish partners of cancer patients revealed the same thing. Couples did modify their way of life, but only in cases where the patient's prognosis was favorable and they were still living. In summary, individuals with cancer should get guidance on maintaining a healthy lifestyle after their diagnosis, although they appear to follow comparable lifestyle habits to those without a history of cancer. Furthermore, it appears that partners' and patients' health behaviors are associated. While having a supportive spouse makes it easier to adopt a healthy lifestyle, partners find it difficult to change their own behavior. Therefore, further research is required to understand how to encourage healthy behavior following a cancer diagnosis as well as the obstacles and enablers of a healthy lifestyle in patients and their partners.
According to a different study, virtually all of the participants changed their health-related habits after receiving treatment for either breast or testicular cancer. This was because the experience of having cancer affected their perspective on leading a healthy lifestyle. Most typically, patients and their partners changed their diets, then cut back on or stopped smoking. Although 41% of spouses and over half of patients recalled receiving some guidance on leading a healthy lifestyle while in the hospital, the advice did not feel personalized or detailed enough, and it was not repeated during survival.
Although survivorship did not repeat the advise on leading a healthy lifestyle, patients and couples did recall receiving it, feeling that it was impersonal. It is imperative that lifestyle counseling be incorporated into the care route and that survival phase follow-up be extensive. Although early lifestyle modification—sometimes even before to surgery—is proven to be advantageous, interview studies also reveal obstacles to change during the initial stages of treatment and aftercare. For instance, the smoking research showed that family members would not have been willing to give up the habit if therapy had recommended it, as they also had to deal with stress and relied on smoking as a coping mechanism. Therefore, it is preferable to continue discussions about changing one's lifestyle and give guidance or support during follow-up treatment in order to accommodate the patient's and partner's willingness and capacity for change.
Returning to work or school post-treatment
Worldwide, 49–91% of cancer patients return to work after a year, despite variations in disease kinds and the social assistance system. However, a review of national health insurance data indicates that just 40 percent of working cancer patients find new employment after obtaining a cancer diagnosis, with approximately half of them losing their jobs after being diagnosed. There are a number of possible explanations for this, but it appears that comorbidities, age, gender, kind of profession, economic level, and medical conditions—including chemotherapy—are the main ones. Moreover, it has been proposed that a patient's decision-making about their employment may also be influenced by the degree of understanding from colleagues, the patient's social support network, information sharing, the prevalent stigma, and the existence or non-existence of discrimination against cancer patients.
Physical fitness
Examining physical capacity is typically necessary while returning to work or school after cancer treatment since therapies like radiation, chemotherapy, and surgery can have long-term impacts.
Energy Levels and Fatigue Management: Fatigue may last for several months or even longer even after therapy is completed. Motivate people to:
Track Energy: To identify trends, advise maintaining a daily energy journal. This can aid in scheduling events for when people are most energetic and when they need to relax.
Small, Regular Breaks: To prevent burnout, divide work into manageable chunks and plan regular pause times.
Sleep hygiene: Advocate for having a peaceful sleeping environment, avoiding electronics just before bed, and using relaxation techniques to treat insomnia.
Nutrition and Hydration: Recuperation can be aided by drinking plenty of water and eating a balanced diet rich in foods that provide energy, such as lean proteins and whole grains.
Phased Schedules and Gradual Return.
It may seem daunting at first to return full-time, so provide alternatives like:
Phased Return Plans: Increase progressively over weeks or months, starting with fewer courses or part-time hours. This gives the body enough time to adapt.
Flexible Hours: Starting later in the day or working/studying remotely on certain days may be beneficial to individuals.
Modified Responsibilities: If the work requires physical labor, modifications such as fewer demanding tasks, frequent sitting, or less heavy lifting may be beneficial.
Mental and Emotional Well-Being
Survivors frequently navigate a challenging emotional terrain. Treatment may have just as big of an impact on the mind as it does the body.
Anxiety and Stress Management: Thinking about getting back to "normal" can be stressful, especially if you're worried about a recurrence or have to catch up in your studies or career.
Meditation and mindfulness: To aid with anxiety management, use mindfulness techniques like guided meditations. When feeling overwhelmed, doing breathing exercises can also help reduce stress.
Counseling or Support Groups: Cognitive-behavioral therapy (CBT), in particular, is a useful therapeutic approach for managing anxiety and anxieties. Promote involvement in cancer survivor support groups, as the shared experiences among members helps alleviate feelings of loneliness.
Establishing a "New Normal": Assist patients with redefining "normal" in the wake of therapy. It's critical to have reasonable expectations and realize that things don't have to go back to how they were when you return to work or school.
Handling Concentration and Memory Problems (Chemo Brain):
Organizational Tools: To make up for memory gaps, promote the use of apps, calendars, and note-taking tools. Having a well-organized to-do list helps facilitate daily planning.
One Job at a Time: It is advised to concentrate on one work at a time since multitasking might aggravate chemotherapy brain.
Practice and Patience: Puzzles and brain training applications are examples of cognitive activities that could be beneficial. It's also critical to notice your improvement over time and engage in self-compassion practices.
Social Reintegration:
Returning to a social setting might be like traveling to a foreign land. Many times, patients are unsure about how to discuss their experiences.
Managing Inquiries: Give instances of how to reply to questions concerning their care. If they feel like doing so, they can go into further information or just say something like, "I'm doing better, thanks for asking!" Here, boundaries are crucial.
Encourage survivors to practice self-affirming statements, such as "I've overcome a lot, and I'm capable of handling this," in order to boost their confidence.
Policies at Work or School
A seamless transition depends on knowing your legal rights and how to interact with employers and school officials.
Legal Defenses:
Laws pertaining to disabilities: A lot of nations have laws protecting workers or students who are recovering from illness. For instance, the Americans with Disabilities Act (ADA) prohibits discrimination against workers because of a medical condition. They could be entitled to reasonable modifications, such as altered schedules or physical accommodations.
Health Insurance: In order to pay for continued care or follow-ups, survivors may need to keep their health insurance. Inform them of their choices, such as COBRA insurance continuance or disability leave.
Employer/School Communication:
Disclosure of Condition: People are free to reveal their history of cancer or not. Suggest scheduling a meeting with HR or a counselor to go over the necessary adjustments, the amount of information to disclose, and the legal requirements.
Workplace Perquisites: Suggest talking about the possibilities for Modified work schedule, adjustable work-from-home schedules, and/or less work or more frequent breaks.
Accommodations for Students: Accommodations for education might be in the form of extended deadlines, flexible exam scheduling, or tutoring.
Prolonged Recuperation and Equilibrium
Many people find that their rehabilitation continues after therapy is completed, juggling continued healing with obligations to their jobs or studies.
Continued Care or Monitoring: Those who have survived may need to go for scans, follow-up consultations, or continuous care. Assist them in devising a plan to reconcile these obligations with their job or academic duties.
Time management: Give them advice on how to fit work and school around their medical visits by scheduling time in their calendars.
Communicating Ongoing Needs: It's important to be upfront with employers or school officials if they require more flexibility because of long-term therapy side effects.
Immunizations and Preventive Care:
Cancer patients frequently have compromised immune systems due to a variety of factors, such as chronic inflammation, impaired and/or decreased function of elements of the hematopoietic lineage, and immune-compromising treatments. As a result, patients with cancer are more likely to become infected, which can occur after receiving cancer treatment. This emphasizes the need for oncologists to collaborate with primary care providers to obtain a current vaccination history as part of the standard oncologic evaluation and to address vaccine-preventable diseases.
The effectiveness of vaccines against infection in cancer patients is related to the type and degree of immunosuppression and/or severity of underlying malignancy. Vaccination is intended to protect against infection and to lessen the severity of disease in cases where infection cannot be fully prevented.
The necessity for a vaccination strategy that is appropriate for health care teams treating patients with medically difficult oncology cases is reinforced by inherent diversity in clinical practice, which includes the absence of primary care physicians for certain cancer patients. Vaccinations containing live viruses are generally not recommended for those whose immune systems are seriously impaired. On the other hand, nonlive vaccinations are usually regarded as safe; nonetheless, their capacity to elicit an immune response varies according on the overall level of immunosuppression. The suggested immunization schedule for cancer patients is arranged in this ASCO recommendation, which also specifies the specific circumstances that call for revaccination and when it should occur.
Recommended Immunizations for Adults With Cancer
| Vaccine | Recommended Age | Schedule |
|---|---|---|
| Influenza * | All ages | Annually |
| RSV | 60 years and older | Once |
| COVID-19 | All ages | As per the latest CDC schedule for immunocompromised * |
| Tdap or Td * | 19 years and older | One dose of Tdap, followed by Td or Tdap booster every 10 years |
| Hepatitis B | 19-59 years: eligible, 60 years and older: immunize those with other risk factors * | For adults 20 years and older, use high antigen (40 µg) and administer as a three-dose Recombivax HB series (0, 1, 6 months) or four-dose Engerix-B series (0, 1, 2, 6 months) * |
| Recombinant zoster vaccine | 19 years and older | Two doses at least 4 weeks apart |
| Pneumococcal vaccine | 19 years and older | One dose PCV15 followed by PPSV23 8 weeks later OR One dose PCV20 * |
| HPV | 19-26 years: eligible, 27-45 years: shared decision making | Three doses, 0, 1–2, 6-months |
Recommendations for Other Vaccines That May be Indicated for Adults With Cancer and Coexisting Health Conditions
| Vaccine | HType | Other Risk Factor | Recommendation |
|---|---|---|---|
| Haemophilus influenzae type b vaccination (Hib) | Nonlive | Anatomic asplenia | For elective splenectomy: one dose at least 14 days before splenectomy (preferred) |
| Functional asplenia | One dose if previously did not receive Hib | ||
| Hepatitis A vaccination | Nonlive | Chronic liver disease, HIV, MSM, homelessness, injection or noninjection drug use, occupational exposure, travel | Two-dose series HepA or three-dose series HepA-HepB |
| Meningococcal vaccination * | Men ACWY (nonlive) | Anatomic or functional asplenia, complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab), Travel, Occupational, Military recruits, Residential living for college students | FTwo-dose series MenACWY-D. Frequency: 8 weeks apart. Revaccinate every 5 years if risk remains |
| Men B (nonlive) | Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use, occupational (microbiologists), pregnancy, MSM outbreak setting | Two-dose primary series MenB-4C at least 1 month apart. Or three-dose primary series MenB-FHbp at 0, 1-2, 6 months. Revaccinate every 2-3 years if risk remains | |
| IPV | Nonlive | Travel. Community risk (eg, wastewater detection of vDPV) | Single booster |
| MMR | Live | No evidence of immunity: HIV (CD4 >200 for 6 months), HCP, outbreak setting, travel | Contraindicated with cancer treatment and other immunocompromising conditions |
| Varicella | Live | Postexposure | Contraindicated with cancer treatment and other immunocompromising conditions |
| MVA (Monkeypox) | Live (replication-deficient) | Postexposure, Occupational exposure (laboratory worker), high risk | Safe to administer in persons with HIV or those on immunosuppressive therapies |
| Monkeypox and smallpox (ACAM2000) | Live | Contraindicated with cancer treatment and other immunocompromising conditions |
Other Vaccine Recommendations for Previously Unimmunized Adults With Cancer
| Vaccine | Recommended doses |
|---|---|
| IPV | Complete three-dose series |
| Tdap | One dose of Tdap followed by one dose of Td or Tdap at least 4 weeks later, and a third dose of Td or Tdap 6-12 months later |
| Hepatitis A | Perform serologic assessment for past infection. If negative, vaccinate as per Table 3 |
| Hepatitis B | Perform serologic assessment for past infection. If HBsAg is negative, vaccinate as per Table 2 |
| Varicella | Cannot be given to immunocompromised patients. Patients with solid tumors receiving chemotherapy, immunotherapy, or radiation should be assumed to be immunocompromised. For solid tumors, vaccines may be considered at least 4 weeks before cancer treatment initiation and wait at least 3 months after completion |
Navigating Drug Interactions and Polypharmacy
Among older persons with cancer, polypharmacy—the use of many drugs concurrently—is a serious and expanding public health concern. A patient's age, comorbidities, and disability are examples of risk factors for polypharmacy. System-level variables that increase the likelihood of polypharmacy include fragmented care, poor care transitions, using numerous pharmacies, and prescription cascades. In the literature, the phrase "excessive polypharmacy" usually refers to the usage of more than ten drugs. The most prevalent definition of polypharmacy is five or more medications.
According to studies, up to 80% of these individuals take five or more drugs, and up to 40% take ten or more. These percentages are much higher than those usually found in older community-dwelling cancer patients. In older persons, the chance of taking one or more potentially inappropriate drugs (PIMs) is increased by polypharmacy, with a greater risk than benefit. Furthermore, there is a considerable rise in the likelihood of clinically significant potential drug-drug interactions (PDIs) in cases with preexisting polypharmacy. Adverse drug reactions (PDIs) might result in unanticipated hospital stays and fatalities.
Strategies for Managing Polypharmacy and Drug Interactions
Medication Reconciliation
At every stage of a patient's treatment, including hospital admissions, clinic visits, and follow-up appointments, medication reconciliation is a systematic procedure carried out by healthcare professionals to examine and confirm the patient's whole drug list. This guarantees that every medication—prescription, over-the-counter (OTC), and supplement—is tracked down. In order to find any possible interactions, providers keep track of every medicine the patient is presently taking and cross-reference it with any new prescriptions. This is particularly important for cancer patients who see several experts who may recommend more therapies, or who are being released from the hospital.
Receiving several prescriptions for medications with identical active components or comparable therapeutic effects raises the possibility of overdosing or experiencing adverse consequences. Regular updates to the prescription list are necessary, especially if the patient's cancer treatment plan or other health circumstances change.
Clinical Pharmacist Involvement
Experts in overseeing intricate treatment schedules, oncology pharmacists can be vital in averting drug interactions. To maximize the utilization of medications, they work in conjunction with primary care doctors, oncologists, and other specialists. Pharmacists assess possible interactions between cancer therapies and other drugs using sophisticated drug interaction databases and algorithms. Pharmacists can determine the effects of one medicine on another by using resources like Lexicomp, Micromedex, or the medicine Interaction Resource from the Oncology Nursing Society.
When interactions are inevitable, pharmacists could suggest lowering the dosage of one or more medications to reduce risk. For instance, lowering the dosage of a painkiller in order to avoid overdosing on sedatives while taking them with medications that reduce anxiety. Pharmacists can suggest safer treatment options if a medication interaction is found. For example, they might recommend changing to an antifungal that does not interfere with the metabolism of chemotherapy drugs instead of one that could interact with it. Pharmacists can ensure that side effects are effectively handled by monitoring for indicators of adverse drug reactions (ADRs) and adjusting prescriptions accordingly.
Deprescribing
The methodical process of reducing, stopping, or switching out drugs that could no longer be helpful or potentially present dangers because of combinations with cancer therapies is known as deprescribing. This is especially crucial for older cancer patients who are more susceptible to polypharmacy as they frequently take several drugs for ongoing illnesses. Healthcare professionals assess each medication's need. For example, terminally sick cancer patients may not gain as much right away from certain long-term treatments (e.g., statins for cholesterol).
The main goals of cancer care are symptom management and cancer treatment. Drugs that don't immediately help achieve these objectives could be better off being stopped. To prevent withdrawal symptoms, some medications, particularly those that impact the neurological system (such as sedatives or antidepressants), must be tapered down gradually. Deprescribing may include switching to a safer medication when a prescribed one is required but has interaction concerns. One possible substitute for a blood pressure medicine that interferes with chemotherapy is an alternative class of antihypertensive.
Patient and Caregiver Education
Reducing drug interactions and increasing adherence to treatment programs require teaching patients and their caregivers the value of managing drugs. All medications, including prescription prescriptions, over-the-counter medications, vitamins, and herbal supplements, should be kept in a written or digital record by patients and caregivers. Symptoms of medication interactions that are frequently seen by caregivers include disorientation, lightheadedness, inexplicable weariness, and gastrointestinal problems. If they have these symptoms, they should notify the healthcare professional right away.
It is important to urge patients to disclose to their medical team all of the drugs they use, including over-the-counter vitamins and over-the-counter treatments. Preventing drug interactions requires knowing when and how to take each prescription. For instance, although certain prescriptions should be taken on an empty stomach, others may need to be taken with meals.
Simplifying Medication Regimens
The possibility of forgotten dosages, pharmaceutical mistakes, and dangerous interactions can be decreased by streamlining prescription schedules. Patients who are elderly or have cognitive problems, who may find it difficult to manage complicated schedules, should pay special attention to this method. Healthcare professionals may prescribe combination medications, which address several illnesses with a single tablet, if at all possible. Taking one drug, for instance, to treat high blood pressure and cholesterol.
Adherence can be increased by coordinating medication regimens so that individuals take their medications fewer times each day. One possible solution may be to arrange for all daily drugs to be given in the morning and evening, as opposed to sporadically throughout the day. Digital applications or pill organizers are examples of tools that might assist people manage their prescriptions and minimize uncertainty about what pills to take when.
Using Drug Interaction Tools
Advanced techniques and databases are utilized by healthcare practitioners to detect and handle possible medication interactions. Safer prescription procedures are made possible by the real-time information and suggestions these systems give.
Some tools include:
Lexicomp: A thorough resource on medication interactions that offers thorough details on interactions between pharmaceuticals and recommends safer substitutes.
Micromedex: It is another well-known tool that doctors use to look for interactions, side effects, and necessary dosage modifications.
Electronic Health Records (EHRs) systems: Drug interaction warnings are a feature of many EHR systems that automatically identify possible problems when a new medication is administered.
With the use of these technologies, medical professionals may promptly recognize hazardous combinations and recommend changes prior to prescriptions being completed. Some technologies are quite beneficial in this context since they are particularly made for oncology and take into consideration the intricacies of cancer therapies
Regular Monitoring and Follow-Up
Patients receiving cancer therapy require close and ongoing care, especially those who are polypharmacically at risk of medication interactions. Regular blood testing is necessary for certain cancer medicines and supportive medications to screen for possible drug interactions that might impair liver, kidney, or heart function. For example, patients receiving chemotherapy and blood thinners require routine monitoring to make sure their blood coagulation is stable.
Healthcare professionals should routinely evaluate the patient's general health, closely monitoring any new or worsening symptoms that could point to a side effect or medication interaction. Healthcare professionals may need to change medications, change dosages, or stop using medications that are producing problems in light of test results and patient input.
Holistic and Integrative Care Approaches
Complementary and Alternative Medicine (CAM):
Complementary and alternative medicine (CAM) is reported to have been used at some stage before to, during, or following cancer treatment by about two thirds of cancer patients. The National Center for Complementary and Alternative Medicine defines complementary and alternative medicine (CAM) as a broad category of medical and healthcare systems, procedures, and goods that may not have found their way into mainstream practice.
The following categories can be used to classify the various therapies or treatments that fall under the umbrella of complementary and alternative medicine (CAM): natural products (herbs, vitamins, minerals); mind/body medicine (yoga, meditation); body-based approaches (chiropractic, massage); whole medical systems (acupuncture, Ayurveda, traditional Chinese medicine, homeopathy); and energy healing (reiki). Patients are showing a rising interest in complete, integrated cancer care that takes into account their physical, psychological, and spiritual well-being, as the scientific foundation for certain complementary and alternative medicine therapies has grown.
Research has shown that complementary and alternative medicine (CAM) is being used increasingly often in conjunction with mainstream care, despite the misconception that it was exclusively utilized by those who were unhappy with traditional cancer therapies. The promotion of wellbeing, illness prevention, and symptom management (hot flashes, discomfort, sleeplessness, etc.) are the common justifications for using complementary and alternative medicine (CAM). Researchers have recently focused on the spiritual and psychological factors that influence CAM choice. After chemotherapy or radiation therapy, there seems to be a greater urge to reduce feelings of hopelessness and to "do something" in order to better manage lingering symptoms or maybe lower the chance of developing cancer in the future. Behavioral or psychological attempts to alter the thoughts or sensations connected to the stressful experience are examples of active coping methods.
Active coping in the context of cancer often entails learning stress-reduction strategies, modifying one's food and lifestyle, expanding one's social network, and obtaining knowledge. Active coping tactics are reported to promote both physical and mental well-being in cancer patients. CAM usage has been repeatedly associated with a desire for more control and a preference for a more active and collaborative participation in treatment decisions. This makes using complementary and alternative medicine (CAM) a type of active coping.
Data indicates that there may be a disconnect between patients' expectations and what they really get from healthcare providers because of the alleged lack of communication on complementary and alternative medicine. This study indicates that at least one-third of patients utilize complementary and alternative medicine (CAM), and most of these patients report not talking to medical professionals about CAM. It's also crucial to remember that 30% of CAM users reported having conversations with medical practitioners about CAM usage, compared to 15% of all respondents. Family, the media, and the Internet were the most popular sources of information regarding CAM in such cohorts.
Since we know that certain herbs can affect drug uptake (e.g., echinacea may reduce the effects of immunosuppressants), these findings suggest a significant potential risk of interactions between CAM interventions and cancer treatments. Several studies have noted that patients had no discussion regarding CAM use with healthcare providers.
The advantages of CAM use that have been identified align with the most prevalent motivations for using it: better mental and physical health. The reported advantages of other popular causes, such as "to improve body's ability to fight cancer" (9.9% and 26%, respectively), did not align as well with their perceived benefits.
Integrating CAM with conventional care
Increased treatment options, higher levels of satisfaction for both patients and providers, and better therapeutic results are just a few of the benefits that might result from the integration of complementary and alternative medicine (CAM) techniques, therapies, and beliefs with traditional medical methods. Along with these advantages come a number of difficulties. The effective integration of conventional and non-conventional methods will need practitioners to address several critical concerns, such as disparities in practice cultures, qualifications and training, financing and research, quality assurance, and so on.
Integrative treatment may be able to better balance the shortcomings of conventional medicine while also boosting its positive aspects. These include the high prices and depersonalizing character of technology solutions, the possibility of adverse side effects from particular pharmaceutical agents and polypharmacy, and the suppression of symptoms without fostering total recovery.
In addition to curing sickness, the aim of medicine is to alleviate suffering, which affects not only the biology but also the complex social and psychological nature of the human person. Modern medicine moves at such a fast speed that it occasionally forgets to consider the requirements of the complete individual, leading to technically sound but insufficient medical intervention. The bio-psycho-sociospiritual aim of curing the complete person may become ingrained in medical practice when CAM ideas collide with traditional treatment.
An integrated clinical practice offers a wider range of healthcare alternatives by definition. Conventional therapy, like prescription medications, may be useful in treating a certain ailment, but not every person will react favorably to a particular procedure. For example, the acute management of migraines has been transformed by the introduction of triptans. Nevertheless, more than 25% of patients have no response to triptans, and of those who do, only 75% of headaches may be effectively treated. Incorporating alternative treatments for acute headache—such as self-hypnosis, aromatherapy, and acupressure—provides patients with beneficial choices that lead to pain reduction and decreased cost.
Mind-Body Techniques:
Living a balanced and contented existence is contingent upon having good psychological functioning, which is a condition of emotional health. Emotionally healthy people have self-control over their emotions and behavior, which enables them to overcome obstacles in their lives, such as conflict in their families or in their careers. Nonetheless, a lot of people have dealt with emotional problems and disruptions at some point in their lives. Due to rising healthcare expenditures, emotional problems are closely linked to heart disease and stroke, two major causes of sickness and disability that place a heavy burden on families and society. Therefore, promoting additional research in the field of mental health is crucial for public health.
What are mind-body techniques?
Activities that emphasize the connections between the brain/mind, body, and behavior are known as mind-body practices. They may also have positive effects on one's quality of life and general well-being. Certain practices use regulated breathing (as in yoga, meditation, or pilates), therapeutic touch, and/or bodily movements (like in dance therapy, tai chi, yoga, or pilates).
Working with the brain's and mind's capacity to modify physical functioning or physiological perceptions and advance improved health is a similarity across these techniques. A trance state, for example, can be experienced during some of these activities. Depending on the technique, this state may be a direct result of the intervention (hypnosis, meditation), or it may be a byproduct that the therapist chooses to employ or not (art therapy, guided imagery, yoga). These techniques are usually given or taught by a qualified professional, and practicing them on one's own is encouraged since they can expand one's toolkit of symptom management and self-care techniques.
It is commonly known that mind-body techniques may effectively treat anxiety, depression, and other psychopathologies as an adjunctive and alternative therapy. Much attention has recently been focused on the topic of mind-body training-induced emotional effects in order to understand the role that complementary and alternative therapies play in the prevention and treatment of emotional illnesses and disturbances. These mind-body techniques include Qigong, Baduanjin, yoga, and Tai Chi Chuan. Applying regimens with scientific data has the ability to prevent and manage mental health illnesses, as mind-body activities are accessible to people of all ages. At the moment, individuals with emotional illnesses as well as the general healthy population have been treated with mind-body integrative therapies.
Mechanisms of Action of Mind-Body Practices
There are two primary methods for determining how mind-body techniques for pain management work. The first focuses on the processes that the mind-body intervention itself engages in and seeks to offer a more comprehensive conceptual framework to explain how the intervention may result in a range of benefits, including reductions in pain. In order to evaluate criterion validity beyond self-reports of pain alleviation, the second is focused on the desired pain outcomes and provides supplementary measures relevant to the underlying pain-related processes (e.g., nociceptive physiological activity, inflammation). Though research on the processes behind the impact of mind-body activities is still in its infancy, significant progress has been achieved in a number of areas.
There is unlikely to be a single, comprehensive scientific explanation that can explain every potential impact on health due to the multiplicity of mind-body activities. Numerous methods entail paying close attention to bodily sensations or movements, such as breathing, activating the executive functions of the brain that underlie meta-awareness of mental contents, and developing the non-judgmental attitude that characterizes mindfulness-based methods or other contemplative practices.
With changes in brain morphology and function observed with intensive or long-term practice, there is mounting evidence that these practices may improve immune, inflammatory, and telomerase regulation, as well as the autonomic and hormonal stress responses. The evidence at hand offers a tenable theoretical framework that supports evaluating their effectiveness in the treatment of pain.
Hypnosis is one method that has been studied in greater detail over a number of decades. Experiments investigating the underlying processes have supported the adaptation of specific approaches for pain management. Strong evidence that hypnosis lessens acute pain perception and the physiological reactions brought on by nociceptive stimuli has been found by meta-analysis.
According to research on functional imaging, hypnosis can alter how the brain reacts to painful stimuli and activates areas of the brain that support executive control systems. Although there have been less mechanistic research on people with chronic pain, the data that is now available shows intriguing modulatory effects in the corticolimbic network, a functional system linked to the motivational and affective elements of pain as well as factors that contribute to the chronicity of pain. These experiments offer tenable mechanistic proof that mind-body techniques—hypnosis in particular—may enhance the management of chronic pain.
It is important to carefully weigh the risks and benefits of integrating mind-body practices into an integrated care approach for managing chronic pain, as well as the patient's needs and preferences (which are connected to their views and beliefs regarding chronic pain and its treatment). Debating these techniques with patients and/or their families and failing to fully disclose the advantages and disadvantages might harm the therapeutic alliance and treatment results. As a result, it is critical that the patient participate in the decision-making process within the team.
In order to create new, better judgments that will assist the patient reach their goals, it is also critical to provide the patient the freedom to make decisions and to report on the outcomes—both good and bad—of these activities.
Despite the fact that mind-body techniques have been around and extensively utilized in healthcare for many years, there is still much work to be done in fully integrating them into pain treatment, particularly in basic care. It is necessary to provide healthcare workers with more knowledge and training so they can communicate and collaborate with other experts in an interprofessional network. Furthermore, methodical adjustments to ease the burden on clinic staff and streamline reimbursement procedures may also aid in removing obstacles and speeding the incorporation of scientifically proven mind-body treatments into medical care.
Integration between practices and practitioners may also be facilitated by integrative primary care practices or pain clinics that offer mind-body therapies like chi gong courses, mindfulness groups, or hypnotherapy for certain EBM-supported pain treatment purposes.
Alexander Technique
The actor Frederick Matthias Alexander (1869–1955) created this technique initially as a self-help remedy for his vocal struggles on stage. This method lays a strong focus on maintaining proper anatomical posture for motions as well as the spine. In addition to teacher-directed movements, it employs mental instructions or self-suggestions (e.g., "my neck is wide and free") to raise awareness of undesirable movement and posture patterns and ultimately help modify them.
It is recommended as a useful method for any anatomy-related pain issues, including persistent back pain, discomfort in the neck and shoulders, and speech difficulties. In order to integrate new movements and relearn old postures and movement patterns, the Alexander Technique (AT) often requires a series of one-on-one sessions. Subsequent booster sessions are expected to be advantageous. With the exception of the self-hypnotic instructions that are meant to be included into regular motions, AT is often not practicable on its own.
Qi Gong/Tai Chi
Although the majority of these Chinese movement meditations have just recently been recorded, it is believed that they originated from ancient martial arts training. They are predicated on the idea that Chi, which is thought of as the universal life force or energy, must be balanced between two opposing polar sides and is constantly utilized and renewed by the body. Chi may be replenished by movement and breathing. As a result, certain sets of exercises are performed to replenish and harmonize Chi in the body. It may be highly hard on the muscular system to practice Qi Gong, which employs slow, repeating patterns of motions with precise breathing and movement synchronization. Various exercises are tailored to certain purposes.
Tai Chi involves a set of figures that move in unison with one another. These exercises vary slightly in kind and school, and they are performed at different speeds. Exercises with Qi Gong may be done alone or combined into a daily routine that takes only a few minutes. Programs for tai chi are often lengthier, lasting at least 15 to 30 minutes. Both methods require skilled and experienced teachers at first, with close monitoring of proper movements, because to their complex patterns and reliance on right motions. This is necessary until pupils gain some competency and are able to profit from their own training. While Qi Gong may be performed for a shorter amount of time, both should be done every day for at least fifteen minutes.
Tai Chi and Qi Gong, though ancient by today's standards and widely acknowledged as all-around health enhancing, calming, and integrating practices, have not received much scientific investigation. According to a comprehensive study, there is insufficient data to support the usefulness of Tai Chi in treating rheumatoid arthritis patients. A different study found that Tai Chi programs conducted in the community helped lessen seniors' anxiety about falling while living in communal housing. When added to current exercise interventions, tai chi can benefit cancer patients as well as low- and intermediate-risk cardiac rehabilitation patients.
Yoga Interventions
Yoga literally translates to "union." While some yoga programs concentrate more on physical training, others are more like TM or mindfulness meditation programs, since they primarily develop attention and awareness. The TM program might be perceived as a modification and enhancement of an ancient Vedic Yogic meditation method to suit contemporary needs. For instance, Kundalini Yoga is a particular kind of yoga practice that stresses the rising and awakening of the Kundalini power, which is represented as an enrolled snake at the base of the spine. But in the West, yoga is mostly connected with Hatha yoga, which stresses transcending physical constraints as a window to the mind.
The unification of body and mind is to be attained by frequent practice of asanas (body poses of stretching and holding), breathing exercises, attentional concentration, and meditation. The theory is that this union will have mental relaxation, therapeutic, and preventative benefits.
Numerous studies reveal that yogic meditation has distinct effects on the brain, as seen by the EEG. These effects are mostly related to an increase in the strength of lower frequencies (alpha, delta, and theta) and the coherence of resonators throughout the brain. Although most of the studies had methodological flaws, a comprehensive review reveals that yoga may lower insulin-resistant syndrome risk factors for cardiovascular disease.
There is evidence that some meditation practices, including as yoga, relaxation response, meditation, and contemplative prayer, may be beneficial to one's health, although there aren't many reliable methodological research on the subject. With the exception of those measuring physical fitness, a recent evaluation comprising over 80 research discovered that yoga treatments appeared to be on par with or better than exercise in the majority of outcome criteria. Two recent studies demonstrated the effectiveness of yoga in treating low back pain.
Transcendental Meditation
Transcendental Meditation is perhaps the mind-body intervention with the most study. The late Maharishi Mahesh Yogi (1918–2008) brought this Yogic–Vedic meditation practice to the West. While not absolutely dependent on this individual, a sizable community and organization have developed around this guru and his methodology, which also served as the impetus for the research. The central idea of the TM program is a mantra that is only said to be personally selected and given out during sessions under close supervision. During the meditation practice, this mantra—which consists of a few Sanskrit words—is utilized to focus attention. It is hypothesized that this phrase serves as a subtle spiritual aid in addition to helping the meditater stay focused.
The meditator can achieve a state of transcendence of normal consciousness into a blissful state of pure consciousness after some training, which is supposed to consist of two sessions of 20 minutes daily training over a period of 10–16 weeks. This state is thought to be both psychologically desirable and physically healthy.
TM seems to be helpful in reducing stress, and it may also help prevent coronary artery disease and, while this has been questioned, reduce blood pressure. Numerous encouraging single studies have demonstrated how TM affects cardiovascular risk variables and blood pressure. This is corroborated by certain publications, and one review published recently indicated that TM could be able to lower blood pressure in a clinically significant way, both systolic and diastolic.
The meditator can achieve a state of transcendence of normal consciousness into a blissful state of pure consciousness after some training, which is supposed to consist of two sessions of 20 minutes daily training over a period of 10–16 weeks. This state is thought to be both psychologically desirable and physically healthy.
TM seems to be helpful in reducing stress, and it may also help prevent coronary artery disease and, while this has been questioned, reduce blood pressure. Numerous encouraging single studies have demonstrated how TM affects cardiovascular risk variables and blood pressure. This is corroborated by certain publications, and one review published recently indicated that TM could be able to lower blood pressure in a clinically significant way, both systolic and diastolic.
Mindfulness Meditation
Being mindful Since the historical Buddha is credited with creating meditation, it is likely among the first forms of meditation. It involves paying attention to the breath and everything in the mind, both inside and outside of the practice. In the long run, it should also result in a non-judgmental attitude toward one's own thoughts and the behaviors of others, as well as a conscious awareness of one's own mental activity. In these and other ways, mindfulness is dialectical since it is both active (actively observing) and passive (not reacting to what is perceived). While it is obvious that the original practice had a religious purpose—to achieve enlightenment and so be free from suffering—modern adoptions of the practice frequently only employ the technique itself, omitting the philosophical and theological context.
One of the most widely used programs is Mindfulness Based Stress Reduction (MBSR). Two other innovations are Mindfulness Based Cognitive Therapy (MBCT), a program for treating depression relapses, and Dialectical Behavior Therapy, which incorporates mindfulness principles into a specific therapy program for patients with borderline personality disorder. These programs all involve formal mindfulness meditation instruction and incorporate mindfulness principles. Patients are encouraged to practice mindfulness on a daily basis for the duration of the eight-week program.
Similarly, controlled studies have shown that MBCT can effectively prevent relapse in patients with recurrent depression; nevertheless, due to conflicting study results, some do not now view MBCT as a totally dependable therapeutic. Those who suffer from pain appear to benefit most from mindfulness, though not from pain relief per se. However, mindfulness appears to establish a cognitive gap between the perception of pain and the mental response to it.
Spirituality and Meaning-making:
Two approaches to creating meaning that affect a person's capacity to deal with, endure, and accept illness and suffering are religion and spirituality. The human spirit's need to create meaning is taken into account by the biopsychosocial-spiritual model, which also takes into account personality, mental health, age, sex, social interactions, and stress-related behaviors. Studies on the impact of spirituality and religion on pain in connection to physical and mental health, spiritual activities, and the placebo effect are reviewed in this study. The results indicate that individuals with higher levels of self-efficacy and greater religious and spiritual openness to exploring a connection to the transcendent or meaningful spiritual practices are better able to endure pain.
Participation in religion is positively correlated with health and quality of life, according to numerous studies. According to a different study, out of the 27 studies he looked at, 22 of them demonstrated a strong favorable correlation between religious participation and health, with the quality of the studies growing over time. Engagement in religious pursuits, especially church attendance, is linked to improved psychological health and relationships, a greater sense of life satisfaction, and a reduced and improved pain threshold.
According to a different study, those who regularly attend religious services may have lower levels of inflammatory cells and proteins as a result of reducing stress. Reduced pain levels are correlated with reduced inflammation. Moreover, it seems that engaging in religious and spiritual meaning-seeking behaviors provides the chance to access a higher level of pleasant emotions and power from an infinite transcendent source. It was also mentioned that spirituality is the knowledge of something shared and visible that is sacred beyond the material world.
According to studies, people can withstand pain better when they have a meaningful source of support, affection, and caring. One study looked at the brain as an active system that modifies, filters, and chooses inputs; another study found precise cellular and molecular mechanisms that activate the opioid system. When a spiritual or religious seeker connects with meaning and/or the transcendent, technology has provided a window into the workings of the brain and body. What it is about religion that enables people to cope with pain more psychologically has been the subject of several studies. Perhaps the answer can be found in the search of understanding, purpose, strength, and transcendence, the yearning to move beyond.
We interpret the constant barrage of data coming from our bodies and surroundings because of the brain's innate need to find a reason for everything. Our preferred systems for bringing order and purpose are science and religious and spiritual belief systems. Religious and spiritual belief systems encourage introspection, awareness of one's influence on others, seeking strength from a higher power, conquering challenges, and letting go of negative things. They promote putting other people's wants and feelings above one's own. Beliefs in religion and spirituality can give one courage, hope, and perseverance. Thoughts, both positive and negative, set off a chain reaction in the brain. Any event's significance has a significant impact on how the body functions both emotionally and physically.
Every person will experience pain at some point in their lifetime. Pain reactions that are either maladaptive or adaptive may have their roots in inner convictions. Thoughts, phrases, and visuals that arouse feelings of love, support, and comfort seem to lessen stress and have a positive impact on particular bodily systems. People may turn more and more to the behaviors that religious and spiritual institutions promote in order to find strength and comfort from their pain, incapacity, and loneliness. People who seek or believe in a loving cosmos or God do not experience pain from religion or spirituality, nor does it intensify it. On the other hand, those who are scared or pessimistic and believe in a punishing or vengeful God or cosmos may find that their suffering gets worse. The impact of religious and/or spiritual meaning-making practices on pain tolerance and/or severity requires more investigation.
Conclusion
The process of obtaining long-term care can be difficult for individuals and their families, but it is also essential to maintaining dignity and quality of life. Through comprehension of the available alternatives, proactive preparation, and utilization of resources, individuals receiving care and those providing it can approach the future with compassion and assurance. Long-term care, whether provided at home or in a facility, should be customized to meet each person's specific needs and provide an atmosphere that supports their physical, emotional, and social well-being. In the end, considerate, organized care can significantly improve the quality of life for all parties concerned.