Tag Archive for: wellness

From Cancer Diagnosis to Healing: 21 Tips and Resources for Body, Mind, and Spirit

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Last month, I quietly marked a significant milestone—20 years since my breast cancer diagnosis. It’s a strange thing, this “20-year cancerversary”. It feels like a lifetime ago, yet it still feels raw and surprisingly recent. The shock of that day, hearing the words “you have cancer”, and the surreal weeks and months that followed, remain forever etched in my memory.

Looking back, I often think about the things I wish I had known back then—truths and lessons that could have eased the journey or offered comfort in moments of anxiety. That’s why I want to share some of those insights with you if you’re beginning your own cancer journey. I hope these tips will provide guidance, strength, and perhaps a little light to help you navigate the challenges ahead.

1. Become Your Own Best Advocate: Take charge of your healthcare journey. Ask questions, seek second opinions, and clearly communicate your needs and concerns to your medical team. Don’t hesitate to advocate for information that is tailored to your specific situation, age, and lifestyle.

Further Reading: Patient Advocacy: Understanding Your Illness – Patient Empowerment Network

2. Educate Yourself: Learn about your specific cancer type, treatment options, and the latest research. Knowledge is power and can help you make informed decisions. Use trusted sources like your medical team, cancer organizations, and support groups. Understand that the right information, provided at the right time, empowers you to make informed decisions.

Further Reading: How to Read and Understand a Scientific Paper – Patient Empowerment Network

3. Participate in Shared Decision-Making: Shared Decision Making (SDM) means you and your doctor work together to make choices about your healthcare. You’ll learn about the pros and cons of different treatments, how likely they are to work, and what side effects might happen. Don’t be afraid to ask lots of questions until you feel comfortable with the options presented to you.

Search here for articles on SDM.

4. Explore All Treatment Options: Discuss various treatment approaches with your doctor, including standard medical treatments, clinical trials, and complementary therapies like acupuncture or massage alongside your regular medical care.

Search here for articles on clinical trials.

5. Understand Cancer-Related Fatigue (CRF): Cancer-related fatigue is different from the tiredness you feel after a long day. It’s like having your battery completely drained, and no amount of sleep or rest seems to recharge it. This kind of fatigue can be overwhelming and make it difficult to do even simple everyday tasks. It’s important to talk to your doctor if you’re experiencing this, as there may be ways to manage it and improve your energy levels.

Read How To Cope With Cancer-Related Fatigue for more tips and information.

6. Be Aware of “Chemobrain”: Understand that cancer treatment can affect cognitive function. This is often called “chemobrain,” even if you didn’t have chemotherapy. It can feel like a mental fog, making it hard to remember things, focus, or think clearly. This can be frustrating, but it’s important to know that many people experience this. Staying mentally and physically active can help your brain recover. This could include things like puzzles, reading, socializing, and light exercise.

Further Reading: Is Chemobrain Real? Coping With Cancer-Related Cognitive Changes – Patient Empowerment Network

7. Manage Your Energy Bank: Be mindful of your energy levels. Think of your energy as a bank account – balance energy expenditure with rest and relaxation to avoid “overdrawing” your reserves. Prioritize tasks and schedule activities for times when you have more energy. Build in rest breaks throughout the day.

8. Engage in Light Exercise: Even though you may not feel like it, regular light exercise can help reduce fatigue and improve your mood. This doesn’t have to be anything strenuous – a short walk, some gentle stretching, or chair exercises can make a difference. Start small and gradually increase your activity level as you feel able. Listen to your body and don’t push yourself too hard. Even a little bit of movement can go a long way in improving your overall well-being.

Watch: What Role Does Exercise Play in Cancer Treatment? – Patient Empowerment Network

9. Eat a Healthy Diet: Nourish your body with a balanced diet that supports energy levels and avoid processed foods. Choose a variety of fruits, vegetables, whole grains, and lean proteins. Drink plenty of water throughout the day. Dehydration can worsen fatigue and other side effects. If you’re struggling with taste changes or nausea during treatment, consult an oncology dietitian for personalized advice and support. They can offer strategies to manage these side effects and maintain adequate nutrition.

Further Reading: Nourishing Your Body and Mind: Nutritional Advice For Cancer Survivors – Patient Empowerment Network

10. Prioritize Your Well-being: Facing cancer can be incredibly stressful, and it’s easy to get caught up in appointments, treatments, and worries. But taking care of your emotional and mental health is just as important as taking care of your physical health. Engage in activities that bring you peace and relaxation, such as meditation, spending time in nature, or pursuing hobbies. Even a few minutes of quiet reflection can help calm your mind and reduce anxiety. There are lots of apps and online resources to guide you.

11. Build a Support System: Connecting with others can make a huge difference in your emotional well-being and help you cope with the challenges of cancer. Support groups offer a safe space to connect with others who truly understand what you’re going through. If you’re not feeling up to in-person meetings, online forums and communities can be a great way to connect with others from the comfort of your home.

Check out this list of Online Cancer Support Groups and Organizations by Type of Cancer – Patient Empowerment Network

12. Allow Yourself to Feel Your Emotions Fully: It’s perfectly normal to have a rollercoaster of emotions when you’re dealing with cancer. You might feel scared, sad, angry or frustrated. Don’t judge yourself for having “negative” emotions. They are a natural part of the human experience, especially during difficult times. Allowing yourself to feel your emotions fully is an important part of processing what you’re going through.

13. Tune into Your Feelings: Taking time to check in with your emotions can help you understand your feelings with more awareness. Think of it like taking your emotional temperature. Set aside a few minutes each day when you can be still and undisturbed. Take a few deep breaths, inhaling slowly and exhaling fully. This helps to calm your mind and body. Ask yourself “What am I feeling right now?” Don’t overthink it, just notice the first emotion that comes to mind. Name the emotion without judgment. For example, “I’m feeling anxious,” or “I’m feeling sad.” Pay attention to any sensations in your body associated with the emotion. Is your chest tight? Are your shoulders tense? Do you feel a knot in your stomach? Don’t try to change the feeling or push it away. Simply acknowledge it and let it be.

Important Note: If the emotion intensifies or becomes overwhelming, stop the exercise and try again later. You can also seek support from a therapist or counselor if you’re struggling with difficult emotions.

14. Write Down Your Feelings: Sometimes, it’s easier to make sense of your emotions when you put them into words. Journaling can be a powerful tool for processing your experiences and navigating the emotional ups and downs of cancer. Looking back on your journal entries can also help you see how far you’ve come and recognize your own strength and resilience.

Further Reading: The Power of Journaling During Cancer Treatment – Patient Empowerment Network

15. Pay Attention to Grief Triggers: Anniversaries of your surgery, diagnosis, and other cancer-related milestones can reawaken difficult memories and emotions. Be mindful of these dates and plan ahead for ways to cope with potential emotional triggers. This might involve scheduling time for self-care, talking to a loved one, or engaging in a relaxing activity. You might also consider creating a meaningful ritual to acknowledge the anniversary or milestone such as lighting a candle or visiting a special place.

Further Reading: Grief, Loss, and the Cancer Experience – Patient Empowerment Network

16. Accept Anxiety as a Normal Response: Anxiety is a natural response to a challenging situation. It’s like an alarm system that gets triggered when your body perceives a threat. In this case, the threat is the cancer diagnosis and all the unknowns that come with it. When you acknowledge and accept your anxiety, you can start to develop healthy ways to manage it. There are many effective strategies for coping with anxiety, such as relaxation techniques, mindfulness practices, and exercise. However, if you find that your anxiety is overwhelming or interfering with your daily life, reach out for help and support.

Further Reading: Coping With Scanxiety: Practical Tips from Cancer Patients – Patient Empowerment Network

17. Identify Your Body’s Stress Response: Stress can manifest in many ways, and often, our bodies give us clues long before we consciously register feeling stressed. Learning to recognize your unique stress signals can help you manage anxiety and take steps to calm yourself down. For example, when you’re anxious, you might find yourself taking short, shallow breaths, or your heart might pound or feel like it’s skipping beats,  Once you’re aware of your physical stress response, you can take steps to interrupt it. This might involve deep breathing exercises, progressive muscle relaxation, or mindfulness techniques.

18. Acknowledge Emotional Trauma: Cancer is more than just a physical disease; it can be a deeply emotional and psychological experience. It can shake your sense of self, challenge your beliefs about the world, and bring up difficult emotions like fear, vulnerability, and grief. Recognizing the emotional trauma of cancer validates your experience and allows you to give yourself the compassion and care you deserve.

Further Reading: Cancer Trauma: How To Know If You’re At Risk and Key Strategies for Recovery – Patient Empowerment Network

19. Honor Your New Reality: For many of us cancer is a life-altering experience. It can shift your priorities, change your outlook on life, and even redefine who you are. It’s important to acknowledge and honor this new reality, even as you grieve for the life you had before. Even in the face of adversity, there is potential for growth and transformation. Cancer can teach you valuable lessons about resilience, gratitude, and the importance of living each day to the fullest.

Further Reading: Finding Your New Normal: 7 Steps To Navigating Life After Cancer – Patient Empowerment Network

20. Find the Joy: Don’t let cancer overshadow the beauty and goodness in your life. Actively seek out experiences that bring you happiness and fill you with gratitude. Spend time outdoors, breathe in the fresh air, and appreciate the beauty of the natural world. Share laughter, stories, and hugs with the people who matter most to you.

Watch: Meditation on Joy – Patient Empowerment Network

21. Live with Purpose: A cancer diagnosis can be a profound wake-up call, prompting you to re-evaluate your priorities and consider what truly matters in life. This is an opportunity to connect with your deeper values and live each day with intention and purpose. Cancer may strip away the illusion of certainty, but it also illuminates what truly matters. Let this heightened awareness guide you as you rebuild your life, find hope in unexpected places, and honor the resilience you never knew you had. Rediscovering your dreams and identifying what you really want for your life can transform your loss into something new within yourself.

Wishing you strength and healing on your journey.

Navigating Supplements in Cancer Treatment: Insights from a Harvard Expert

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What should cancer patients know about supplement intake during treatment? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses advice about taking supplements during cancer treatment, communicating with healthcare providers, interactions with cancer medications, and improving the gut microbiome for optimal absorption. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

It’s essential to understand which supplements can support your health and which ones to avoid to maximize treatment effectiveness and overall well-being. With so much misinformation, are there evidence-based studies that can provide clarity? Find out next on this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, what are the essential guidelines for taking supplements during cancer treatment, and how can patients and their care partners select the right supplements without affecting treatment?

Dr. Jennifer Ligibel:

This is such a great question, Lisa, and one that my patients are asking me all the time. There is so much information and misinformation out there about supplements that it can make it really hard for people to know what they should be doing, to worry that they might be missing out on something important. And so, I think it’s really important to talk about supplements and how they factor into cancer treatment.

The first thing I will say is that if you are considering taking a supplement, please talk to your medical oncology providers about this. I think there have been studies that have shown that a lot of people who take supplements don’t talk to their oncology team about the supplements they’re taking. And this is so important, because there can be interactions that occur. I think it’s just so important that as an oncologist that I know the medicines that my patients are taking, whether they’re over-the-counter medicines or medicines that I or another physician prescribe.

I will be honest that most guidelines from groups like the American Cancer Society, the Oncology Nursing, the Oncology Nutrition Society really recommend that people get their nutrients from food. And the reason for this is that your body absorbs nutrition much better from food than it does from supplements. And it can be difficult to get to a dangerous level of a nutrient from food as opposed to from a supplement. Now this is for the average patient who has good nutrition and is able to eat.

The situation is quite different if people are not able to eat a balanced diet because of their cancer treatment or because of some kind of mechanical issue that’s related to the cancer or the surgery they’ve had. And in that situation, it is so critical that patients work with an oncology nutrition specialist, someone who really understands oncology treatment to make sure that they’re getting the nutrients that they need, because nutrition during cancer is such an important thing.

I think sometimes it is very tempting to want to take supplements as an alternative to treatment or an enhancement. And I think what’s very tricky about this is that supplements are not regulated as medicines in the United States. And so, that means that people can say things about supplements on their advertisements that may not be supported by the same kind of clinical trials that lead to the approval of a medicine, for example.

And so, that can make it really complicated for people to know what is really based on kind of fact and what may not be. I think another piece that’s so important is making sure if you’re somebody who’s actively receiving a cancer treatment, and this is especially true with a lot of the new targeted treatments, many of which are oral that if you are going to take a supplement that you make sure that it’s not going to interact with the cancer treatment that you’re taking.

A lot of supplements use the same cellular machinery to metabolize or break down the supplements that are used to metabolize cancer medicines. And so, what can happen is if you have two things that use some of the same machinery, sometimes you can end up with really high levels of a medication in your system or really low levels. So if you are interested in taking a supplement, it’s critical that you talk to your oncology team about it, so they can just make sure that it’s not going to impact the effectiveness of the cancer treatment.

There are also supplements that may have hormonal properties, things like an estrogen-like effect, and that can be of concern if you have breast cancer. So again, just really important to review all supplements with your oncology team. A lot of my patients take supplements and, you know, my perspective on all of this is that people are going to make their choices and do the things that feel best for them. My role as an oncologist is just making sure that things are safe and that I really want to have an open dialogue with my patients and just make sure they feel comfortable telling me about the medicines they’re taking so that I can make sure that they wouldn’t have any effect on the treatments that I was prescribing to the patient.

Lisa Hatfield:

Okay. Thank you. So, are there any supplements in particular that cancer patients should avoid or that they really need to be closely monitored?

Dr. Jennifer Ligibel:

So I am not an expert in different supplements, and this is a place where there is a growing workforce in oncology that focuses on integrative medicine. There are many places that have integrated medicine services or pharmacists within their cancer center where they could really answer that question much more concretely, because sometimes it depends on what medicines the patients are receiving. A lot of this is about interactions and changing the effectiveness of cancer treatment. For people that are not on therapy, I think that the concerns are generally much lower.

The other thing though that sometimes can happen, and that it really can be difficult, is that supplements and these more alternative treatments are not supported by insurance. And cancer itself has such financial toxicity that I do think that sometimes when people are worried about their outcome and their health, they can be more susceptible to, unfortunately, ending up spending thousands and thousands of dollars on these products.

And I do think, again, it’s just important to really look at the level of evidence when people are saying that this, whatever the supplement is, would maybe treat your cancer, to kind of think about sometimes if things sound too good to be true, they can be. So I just really also just want to make sure that people are aware of what the level of evidence is and the cost of many of these products.

Lisa Hatfield:

I appreciate you pointing that out, because I think sometimes us cancer patients feel desperate to take care of this cancer, and so we’ll go to great lengths to do that. So thank you for mentioning that. Always, always talk to your healthcare team for advice on supplements. 

Dr. Jennifer Ligibel:

There is a group called the Society for Integrative Oncology which is an international group that does a lot of research and work focused on integrative therapies and supplements in cancer. And that’s also a really nice resource for people looking for more information about supplements in cancer that’s evidence-informed. But I think really nicely balanced and recognizing the importance for people to feel autonomy in their health balanced with the safety and the financial pieces, so that’s a good resource for people.

Lisa Hatfield:

And I do have one last question. Hopefully, there’ll be a quick one for you. It’s regarding probiotics, because sometimes the chemotherapy or any medications we’re taking can wreak havoc on our system. I did consult with a local dietician she recommended, similar to you. She said, use whole foods to get those pro- and prebiotics, that was her suggestion. Unless she said, unless you have a vitamin D deficiency, then that’s an okay supplement.

But what are your thoughts on that, if a patient wants to take a probiotic or wants to improve their gut microbiome because of the side effects of treatment?

Dr. Jennifer Ligibel:

That is such a good question. And the microbiome is such a hot topic, and there’s just so much we don’t understand about the microbiome. You know, it’s interesting, there were studies, there have been studies that have actually shown that the composition and health of the microbiome is directly related to how well patients with some kinds of cancers respond to immunotherapy, which is kind of fascinating when you think about that connection with gut health and effectiveness of treatment.

But in that situation, people who took antibiotics and probiotics actually had less diversity of their gut microbiome, and that was related to not having as good of an outcome. Now that is a very small study, and I think there’s a lot that we don’t know, but I think what the dietician had suggested that your food is a better way to populate your microbiome, I think is important. And there are some foods that are very, very, very rich in active bacterial species. I mean, simple things like yogurt and then more complicated foods, things like kimchi really have some interesting impacts on your microbiome.

And consuming those types of foods I think really contribute to having a diverse bacterial kind of the…a lot of different species seems to be related to better outcomes in some cancers. And so, again, this is like really, really early. Some of it feels like science fiction where they’re taking someone’s gut microbiome and transplanting it into someone else. But I think this is a really interesting area. But again, as much as you can get your nutrition from food, I think the better for people’s overall health and their gut health. 

Lisa Hatfield:

You’ve heard it here straight from the expert. Thanks for joining us on this RESTORE program. I’m your host, Lisa Hatfield.

Lifestyle Interventions and Cancer Care Outcomes Research

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What’s important to know about lifestyle interventions and cancer care outcomes? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses lifestyle interventions of physical activity and weight loss on cancer outcomes, controversy about body weight, and exercise levels during cancer treatment that show cancer outcome benefits. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

How can lifestyle changes impact cancer care outcomes? The answer may be more crucial than you think. In this Patient Empowerment Network RESTORE program, we’ll connect with a respected expert on the ground floor of this research. 

Dr. Ligibel, your research highlights the impact of physical activity and body weight on cancer risk and outcomes. Can you explain how exercise and weight loss interventions influence biomarkers associated with cancer risk and outcomes?

Dr. Jennifer Ligibel:

Absolutely. So this research is, I think, both really, really exciting and empowering for patients, because exercise and nutritional change are things that people can do themselves that don’t involve a prescription. But they can also be kind of confusing and leave people sometimes feeling like they’re not sure what the right thing to be doing is to support their long-term cancer outcomes. The truth is we do know that there are patterns that we see in society.

Like if you ask a lot of cancer patients, how much do you exercise and you track their weight. We see that people who exercise tend to have better cancer outcomes. So they tend to have a lower risk of cancer returning and a higher likelihood of surviving their cancer. For common cancers like breast cancer, colon cancer, prostate cancer, not as much evidence in some other cancers. We also know that people who keep their weight in a healthy range are less likely to develop cancer in the first place, and they’re less likely in some cancers, mostly the ones we talked about, breast, prostate, and colon to have their cancer return or die from cancer.

But what we don’t know is what aspect of lifestyle really drives these relationships, because the thing that’s complicated is that somebody who exercises more tends to have a little bit of a different dietary pattern than somebody who doesn’t. It’s not true for every single person. I’ve known marathon runners that live on Twinkies. But for the most part, people that exercise more are thinking more about their diets. They tend to weigh a little bit less, they smoke less. They may be going to do their screening mammograms and colonoscopies more often.

So it can be really tricky when you look at a large group of people and you just ask them what they’re doing and following them to make direct cause and effect relationships between one particular thing, like exercise or eating a particular food and their cancer outcomes. And this is one reason why my group at Dana-Farber, the research that we do really seeks to put people into interventions where we take a group of people that maybe aren’t exercising or they have a body weight that’s kind of above the ideal, and we help them to lose weight or to exercise more.

And we compare two groups of people that were the same at the beginning. One group took part in our program, the other didn’t. And then we’re able to kind of look more directly at whether these types of things affect their cancer outcomes, kind of what happens after their cancer is diagnosed. So we have some ongoing studies that are testing the effect of weight loss programs on cancer recurrence and breast cancer. We have some smaller studies looking at exercise and how that affects cancer. But the truth is we don’t a hundred percent know yet.

If we take a patient who’s not exercising or has weight in a certain range and we change that, is that going to have a direct effect on their cancer? We hope so, but that’s still something that we’re really studying. At this point, what we do know is that healthy lifestyle seems to be linked to lower cancer risk and better outcomes for people who’ve had cancer.

And I think the other thing that is really promising and hopeful is that there’s evidence that shows that even people that maybe didn’t have the healthiest lifestyle before being diagnosed with cancer, if they make some changes, they may have better long-term outcomes. So it kind of shows us that it’s not too late after cancer is diagnosed, but I think we’re still trying to really learn what are the particular factors for an individual person that are going to be most impactful to improve their cancer outcomes?

Lisa Hatfield:

Okay. Thank you. That gives cancer patients a lot of hope too, to know that going forward I can make some changes. In your randomized trials, how have you measured the effects of exercise and weight loss on cardio, respiratory fitness, and body composition in cancer patients? And what have been the key findings in their implications for patient care?

Dr. Jennifer Ligibel:

Absolutely. So we’ve done a lot of work in taking people who’ve been diagnosed with cancer and perhaps aren’t exercising regularly, or their diet is not as healthy as it could be, or their body weight is higher than the kind of there’s…a lot of controversy about the best body weight. But we, we kind of look at different levels of overweight and obesity and how they relate to health outcomes.

So we’ve looked at many different studies where we take people who might not have the healthiest lifestyle, and then we help them exercise more. We work, have them work with a coach or take part in a structured program. The first studies that we did really looked at, just how do you get people to make these changes when they’re going through cancer treatment or afterwards? Because there are a lot of extra barriers. We all know it’s not so easy to eat well or to lose weight or to exercise regularly at any point, but then you add cancer treatment to that, and it becomes more complicated.

So our first studies really just looked at how do you get people to do it? Is it safe? And we found indeed it was safe and that we could get large groups of people to engage in these programs. Not just people we enrolled at Dana-Farber, but people from all over the country. And that was really good to see that we could scale things that way.

Then we were interested in looking at some of the biomarkers you talked about, like what happens when somebody who hasn’t been exercising starts to exercise, or somebody whose body mass index is 27 or 30 or kind of in the higher levels showing that they have excess adiposity. What if they lose weight? What changes? So we’ve been able to show that people who exercise or lose weight have favorable changes in their metabolic hormones, favorable in changes in inflammation, which we know is something that relates to cancer risk.

And most recently, we’ve been able to show that exercise in particular has an effect on the immune system, both throughout the whole body and at the level where breast tumors form. So that’s been really interesting and helps to perhaps show us how is it that exercise could lower someone’s risk of cancer and really seeing how it activates the immune system. We’re also doing studies that then look at really big long-term outcomes, like whose cancer comes back and whose doesn’t. Those studies are really, really complicated to do. They involve enrolling thousands of patients, and they take 10 years to get the results.

And so, we’re still waiting for some of the outcomes of those studies. But the work that we’ve done so far shows that it’s safe for people to exercise and lose weight throughout their whole cancer journey, that it is also very scalable, not just to small groups of patients, but we can do this more broadly across thousands of patients. We’ve shown that when you make these types of changes, your metabolism improves, your risk of cardiovascular disease potentially decreases, then people feel better. We’ve done a lot of work with quality of life and fatigue and other side effects, and showing that when you make these types of changes the side effects of cancer therapy are often lessened.

Lisa Hatfield:

Okay, thank you. One quick follow-up question also as a patient. If you were telling me about exercise and how it might reduce inflammation, is that cardio or strength training or a combination of both? Do you have a recommendation on that for patients?

Dr. Jennifer Ligibel:

So, that is a great question and something that has been studied looking at different kinds of exercise. So there’s definitely value to both cardiovascular exercise, things like walking and running or swimming and to strength training. And that can be done using body weight. Things like squats and lunges, using weights, using machines. Strength training exercise is really important for maintaining muscle, and we know that a lot of cancer patients lose muscle, and that losing muscle is associated with losing function. So, doing strength training exercise is so important for maintaining your muscles.

A lot of the studies that have looked at how exercise relates to long-term cancer outcomes have primarily studied aerobic exercise, and that literature is really strong, that as little as walking three times a week can have benefits, long-term benefits in terms of cardiorespiratory health and perhaps even cancer-related outcomes. There’s an important place for both cardiovascular and aerobic exercise.

here’s a group, the American College of Sports Medicine, who tried to bring together all of the research from intervention studies. So studies where they took people and they put them on exercise programs to look at, well, what changes when you’re on an exercise program? And they looked at all these studies and tried to develop what’s called a fit prescription. So frequency, intensity, time, and type of exercise.

So to be able to tell people, “All right, what you need to do is 30 minutes of cardio three times a week, and that’s what’s going to help you feel better from a fatigue standpoint.” And so, they’ve worked out a couple of prescriptions for things like anxiety and fatigue that really are helpful in thinking about, well, how much do you really need to do to start to see a benefit? And in most of these studies, it was at least 90 minutes of aerobic exercise and a couple of strength training each week were kind of the minimal level of exercise where people really started to have benefit.

Lisa Hatfield:

Okay. That’s really helpful. Thank you.

Dr. Jennifer Ligibel:

Sure.

Lisa Hatfield:

Dr. Libel, how do you integrate quality of life assessments into your research on energy balance factors? And what role do these assessments play in evaluating the effectiveness of lifestyle interventions for cancer patients and survivors?

Dr. Jennifer Ligibel:

This is really important, because supportive care is designed to help people feel better. And if we are making people more active or changing their lifestyle in a way that doesn’t help them feel better, then we’re really not satisfying kind of the primary goal of supportive care interventions. And so, this is why we really make sure that we measure what are called patient-reported outcomes. So how does the patient feel as an integral part of the work that we do.

And so, most of the time these types of measurements are done through questionnaires where you ask people, how do you feel? How much does this side effect affect you? How much does fatigue impact your daily life? What about nerve-induced, what’s called chemotherapy-induced peripheral neuropathy? How much does that affect you? How much does that stop you from doing the things that you want to do? So we generally evaluate like, is the symptom present? And if it is, how much does it impact your ability to do the things you want to do? And I think that, when we see that people feel better that these side effects lessen as a result of interventions, that’s really what leads us to want to take things from being part of a research study to part of the standard care that we provide to our patients.

Lisa Hatfield:

That’s great. Thank you. You heard it here from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

How Does Nutritional Screening and Assessment Impact Cancer Care?

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What impact can nutritional screening have on cancer care? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses key pieces of the nutrition puzzle for cancer patients and advice for boosting calorie intake and nutrition during the cancer journey. 

Download Resource Guide

See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

How can nutrition help during the cancer journey? So many questions, and fortunately I’ve connected with a respected Harvard expert to get some answers on this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, what are the key components of nutrition that patients should be thinking of during their cancer treatment?

Dr. Jennifer Ligibel:

This is such a good question and honestly, something I get asked every day that I’m in clinic, “What should I eat?” I think it’s such an important part of our health more broadly. What we eat is related to our weight. It’s related to often, our mood. It has such an impact on so many elements of our lives. And for a cancer patient, there is I think a really complicated relationship often with food for people as they’re going through treatment, things that they once really loved to eat are no longer palatable.

Sometimes people also really feel worried about will what I eat make my cancer worse or make it come back? And I think there’s a lot of myths out there about the relationship between food and cancer. We do know that, historically, if you look across large groups of people, that people who eat healthier diets have a lower risk of developing many kinds of cancer.

But I think what’s confusing sometimes is what healthy is. Sometimes changes, and you only have to look back in history to see, there was a time when we thought all fat was bad, and low fat products were the way that everybody should be eating. And then people realized, “Oh wait, if we take all the fat out, that means we added a lot of sugar.” And so I think that there can be a lot of confusion about diet at times.

One of the things that we do know though, that eating whole foods, so things that come from a plant or from an animal that are not ultra-processed generally tend to be healthier for people. Balanced diets are really important, although there’s a lot of interest in sort of these extreme diets where you cut out all the fat or all the carbs really for long-term health. Most studies suggest a balanced diet is more healthful, that really relies on fruits and vegetables and lean meats and more complicated grains.

So these are kind of really healthful eating patterns more broadly. But what about for somebody with cancer? And the reality is that we don’t have perfect evidence about what the best diet for someone to be eating is. And that can be really frustrating, because I know people often want to be told, “What you need to do is eat a lot of broccoli, or as long as you never have X food again, you’re going to be fine”.

Unfortunately, the research that we have doesn’t give us such clear-cut guidance about what the best diet is or if there are foods that people should avoid at all costs or something that you should eat every day. We do know as well that there are kinds of different dietary considerations for different phases of the cancer journey as well. One thing that is important when you’re getting treatment, especially chemotherapy treatment, is to make sure that you have enough protein in your diet. We know that people tend to lose muscle mass during chemotherapy treatment, and not having adequate protein is one of the factors that contributes to that, as well as not exercising as much.

We know that after cancer treatment, making sure that your diet is balanced, that it keeps your weight in a good range, is really important. But there’s a lot that we don’t know about diet, and I think this is something that’s really important to acknowledge and to study. But I think it also means that people shouldn’t beat themselves up if they’re not able to adhere to a very strict or a particular dietary plan. There’s a lot we need to still learn about food. But I think that people can really be aware that trying to eat a healthy balanced diet is something that is a long-term goal and not something that if you have one bad day that it’s going to have an impact on you or your cancer.

Lisa Hatfield:

Okay. Thank you. I appreciate that. And I know we hear a lot as cancer patients, there’s a lot of information thrown at us to not eat sugar, cut out all sugar, sugar feeds cancer. I know that we could have a two-hour-long discussion, at least, about that. But it’s nice to hear that we don’t need to beat it, if we have one little piece of dark chocolate, because it just feels good after our chemo, that’s probably okay. If we want to do that. So that’s nice to hear. So thank you.

Dr. Jennifer Ligibel:

Absolutely.

Lisa Hatfield:  

You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

What Supportive Care Treatments Are Available to Patients?

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What options do cancer patients have for supportive care treatments? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses side effect management, exercise, nutrition, and integrative therapy for patient care. 

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See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

 How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

Managing the side effects of cancer treatment can be just as crucial as the treatment itself. But how does supportive care fit into the equation? I’m getting some clear answers from a respected expert in this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, could you speak to some available supportive care options, and how can patients work with their healthcare team to effectively incorporate supportive care into their treatment plans to manage side effects?

Dr. Jennifer Ligibel:

Absolutely. And this is such an important topic. I think sometimes people want to downplay the symptoms that they’re experiencing. And so, they don’t tell their healthcare team when they’re experiencing nausea or fatigue, or they’re just feeling really down because of the effects of their cancer treatment. And these are all areas that supportive care treatment modalities can really help people feel better during their cancer treatment if they talk to their oncology teams about the symptoms they’re experiencing, because there are so many supportive care options that are available now.

These options really run the gamut. So there are supportive care medications. We know that there are really effective medicines for nausea, for example, and sometimes people need different nausea medicines than what was initially prescribed. So really important if you’re experiencing nausea despite the medicines that you’re taking to talk to your care team about that.

here are medications additionally for pain when people develop nerve damage from treatment. Those are other things that there are supportive care medicines that can be really important and really help people feel better. Then there are other types of modalities that people may seek out themselves, things like exercise or changes in nutrition. I always recommend that people talk to their healthcare teams before incorporating any kind of supportive care into their treatment protocol, especially if they’re currently receiving treatment for cancer.

But there are many different ways that people can help themselves feel better by being more active and by making sure that they’re consuming enough calories, making sure that they have enough protein in their diets to really support themselves through treatment. Then there are supportive care modalities that are directed toward particular symptoms. And there are what are often called integrative therapies.

And integrative therapy is a type of treatment modality that really takes the best of both Western medicine and Eastern medicine to try to help support people during their cancer treatment. Integrative modalities often include things like yoga and acupuncture and massage, and there’s a growing literature showing that these types of interventions can also really help support patients during cancer treatment.

There’s also meditation and mindfulness, because we know that cancer and cancer treatment has such an effect, not just physically on people, but also emotionally, and really managing the emotional effects of cancer treatment is incredibly important to feeling better. And so, this is an area where there’s a lot of active research, so many more ways that we know now can help people feel better during treatment than even five years ago. And so, it’s important to talk to your care team about the side effects that you’re experiencing and really to be open to different types of supportive care options to help you feel better.

Lisa Hatfield:

Okay. Thank you. Dr. Ligibel, what factors should patients consider when discussing supportive care options with their providers? And how can these therapies help enhance their overall treatment experience?

Dr. Jennifer Ligibel: 

Absolutely. And I think one of the things that we’ve come to recognize is that it’s often easier to prevent side effects than it is to treat them once they’ve already occurred. And so, I think it’s really important for people to be proactive and talk to their oncology care providers from the very beginning about what kinds of side effects they may experience as a result of treatment. And thinking about preventative strategies as early as possible.

We were reviewing all of the evidence, looking at exercise, nutrition, and weight management programs for people currently receiving chemotherapy as part of a project through the American Society of Clinical Oncology and saw really consistent evidence that for people who started exercising even before their cancer treatment started, they were much less likely to experience things like fatigue. They were much less likely to lose strength or mobility. They were less likely to suffer from anxiety or depression, and they had a better quality of life.

So really starting that type of program as early as possible is definitely something that we recommend, but it doesn’t mean that those types of changes couldn’t have value no matter where you are in your cancer trajectory. And there have also been studies that have shown that exercise can help treat fatigue once it’s developed, can help people regain strength. So it’s never too late. But I think that for many supportive care options, the earlier that you start them, the more benefit you may derive.

Lisa Hatfield:

Okay. Thank you. You heard it here directly from Dr. Jennifer Ligibel. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

What Is Supportive Care Therapy in Cancer Care?

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In cancer care, what is supportive care therapy exactly? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses the concept of supportive care and a variety of supportive care methods of nutrition, exercise, behavioral therapy, and side effect management.

Download Resource Guide

See More from RESTORE

Related Resources:

Lifestyle Interventions and Cancer Care Outcomes Research

Lifestyle Interventions and Cancer Care Outcomes Research

 How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

Transcript:

Lisa Hatfield:

The term supportive care may be an unfamiliar term to many patients. So what is it and what are the key components of supportive care? I’m diving deep into this topic, with the Harvard expert on this Patient Empowerment Network RESTORE program. 

Dr. Ligibel, there are so many variations of this term, and it may mean different things for different patients. Can you give us a baseline by explaining what supportive care in today’s cancer care landscape is?

Dr. Jennifer Ligibel:

Absolutely. So when we think about supportive care, we think about all of the things that we do to help our patients feel better after a cancer diagnosis through their cancer treatment, and beyond that can be things that help support people’s quality of life, decrease their side effects, support their mood. There are many, many different aspects of supportive care, but it’s all about trying to help people feel as good as they can throughout the cancer journey.

Lisa Hatfield:

Okay, thank you. Dr. Ligibel, how can patients maximize the benefits of supportive care, such as nutritional counseling and psycho-oncology to manage side effects and maintain their overall well-being during treatment?

Dr. Jennifer Ligibel:

This is a great question and this really does vary by the patient, by the stage of their disease, by the type of treatment that they’re getting. So there are a lot of different elements of supportive care, and some of them may be more useful at some points during the cancer trajectory than others. I think that speaking with their oncology team is a good first step, really being clear about the side effects they’re experiencing as a result of their treatment or after their treatment has been completed. Because there’s a lot of research that’s going on now, trying to figure out what type of supportive care can be the most beneficial for a particular side effect.

For example, there are studies that have gone on looking at treatment of things like nausea, and we know that there are a lot of anti-nausea medications that are in a really important part of the supportive care for patients receiving therapy that help mitigate nausea. But there are other strategies that may also be beneficial, things like acupuncture or altering diet. And so, I think the first step really is talking to the oncology care team about the side effects that are present to start thinking about what types of supportive care modalities can be most beneficial.

Lisa Hatfield:

Okay, thank you. And two of the things that seem to come up a lot with cancer patients, myself included, during treatment and ongoing treatment, are fatigue and then just the mental gymnastics of dealing with cancer. Do you have any suggestions on types of supportive care for those two symptoms or side effects in particular?

Dr. Jennifer Ligibel:

Absolutely. And honestly, we could talk for hours about the best ways of managing those types of issues, because they’re so common for people, and the causes of fatigue in particular can really be multifactorial. Some patients may have a low red blood cell count or be anemic. Other patients, it may be a direct effect of the treatment itself, or the treatment may be causing them to not have an appetite, and so their nutrition is not sufficient during treatment.

So I think the first step in really helping to minimize a side effect like fatigue is trying to look at, well, what are the causes? Is there something else going on that may be contributing to fatigue? Most of the time, honestly, it’s the effect of the cancer or the cancer treatment itself. And in that case, there’s been a lot of work that’s been done to look at, well, what types of supportive care modalities are beneficial, actually, and this often is counterintuitive to many people, the best medicine for fatigue is exercise.

I know it seems crazy in some ways that when you’re already feeling tired, the thought of getting out there and exercising may seem insurmountable. But there have been hundreds of studies that have looked at exercise programs as a way of mitigating fatigue. Most of the time, these programs start really slowly. They involve things like walking, doing kind of low intensity strength training, but the evidence is really consistent that exercise is incredibly beneficial to both prevent fatigue and to treat it once it develops. Another really effective strategy for both preventing and treating fatigue is cognitive behavioral therapy.

And so, this involves really thinking about your energy levels and when your energy levels are higher and matching your activity to the times of day when you have the most energy. There are many other strategies for fatigue that have been explored. Things like mindfulness and meditation. The thing that hasn’t been shown to be that beneficial in most settings for fatigue is medications, unfortunately. And I think that’s something that many of us reach when we’re experiencing any kind of a side effect is for a medication, and in this time period, unfortunately, medications haven’t been shown to be as effective.

Lisa Hatfield:

You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

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How can diet and lifestyle changes impact cancer care and recovery? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses diet and exercise, comorbidities, self-regulation methods, and oncology dietitian support. 

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Transcript:

Lisa Hatfield:

How do patients optimize nutrition during cancer treatment? What are some actionable steps towards supporting behavior change during this critical time? I’m connecting with a respected expert to learn more on this Patient Empowerment Network RESTORE program. 

Dr. Thomson, how can changes in daily habits like diet and exercise really impact cancer care and recovery, and why is this something that patients and care partners should pay attention to? 

Dr. Cynthia Thomson:

Well, importantly, we move every day and we eat every day. And we can make decisions about what we eat and how we move that really can optimize not just our response to cancer treatment, but also our longer-term health, right? And keep that cancer at bay as well as reduce comorbidities, things like diabetes or hypertension that might sneak up on us as we age. And so it really is important to make healthy decisions about what we’re eating and how active we are as cancer patients, but also in general, everyone needs to think about these things.

Lisa Hatfield:

Okay, thank you. And Dr. Thomson, in your study, self-regulation was strongly associated with meeting nutritional and physical activity recommendations. What strategies could be employed to enhance self-regulation in cancer survivors, particularly through mobile app interventions? 

Dr. Cynthia Thomson:

Yeah, so, self-regulation is always a bit of a challenge for each of us, but it’s so important, right? And it starts really with mindfulness and really thinking about the connection between what we eat, how active we are, and how it affects our health. And believe it or not, a lot of people really haven’t given a lot of thought to that. And it’s amazing to me because as I work with patients, what I realize is when they make that connection, when they realize how much better they feel, it makes them kind of self-motivated to continue to self-regulate.

Now there are a lot of different ways you can self-regulate, and one is self-monitoring. And I think that’s probably the most common. Many of us have our watches, right? We have our little devices on our wrist that we use to monitor our activity and perhaps our sleep and maybe even some health outcomes. But in addition, you can do things like think about how you walk through the grocery store. You start in the produce section, right? Instead of going to the cookie aisle. You can think about where you park your car and are you allowing yourself to park further away so that you can walk. So setting some of those self-regulatory behaviors can really help.

You can, in terms of eating, write down what you eat. There are literally hundreds of apps where you can download information about what’s in the food you eat and guide yourself to make better choices. Most people will get tired of writing down what they eat. And so usually if people want to do kind of the written or the app approach, I’ll recommend that they pick a few days of a week or maybe the first week of the month and not burden themselves with doing this day in and day out because over time it begins to lose its excitement. The feedback that you’re getting is not quite as enticing and you begin to feel burdened and you may even change your habits for a lower quality diet simply because you’ve kind of had it with the app.

Lisa Hatfield:

Okay, thank you. Now for patients who are trying to monitor what their intake is and what their diet looks like and maybe they do have access to an app but maybe they don’t, do most cancer centers have a dietitian that a cancer patient can work with on nutritional information surrounding their cancer diagnosis? 

Dr. Cynthia Thomson:

Well, Lisa, I wish they did. But the data that we have suggests there is one dietitian for about every 1,208 patients, which is just dismal. So I do think it’s really important when you’re in care to ask for that referral and try to get in with an oncology dietitian. There are dietitians who practice outside of oncology that certainly can be helpful, but they’re not going to have the insights that you’re going to get from an oncology dietitian. You may have to go to a larger kind of academic or what we call comprehensive cancer center in order to locate a dietitian with this expertise. But I think it’s important to speak up and maybe we’ll get more dietitians on staff if patients advocate for this important information and support during their care.

Lisa Hatfield:

Okay, thank you. Dr. Thomson, how do you think self-efficacy and self-regulation can be effectively promoted in cancer survivorship programs, especially among populations with lower initial adherence to health behaviors? 

Dr. Cynthia Thomson:

Well, I think there’s a number of different ways that we can help people to self-regulate. I think the important thing is to meet people where they are. I think a lot of times as professionals, we’re really quick on giving advice that comes from our own context and our own set of values and beliefs. And most times when we’re asking people to do things that align with our values and beliefs, it doesn’t always work.

And so many times they say it’s really about listening. It’s about hearing the patient and really having patients share what is it that, why are you coming to see a dietitian or why are you interested in nutrition? What motivated you to come here today? What are you expecting to get out of these counseling sessions? And really focusing on having people understand where the gains are for them. I would say that many times it’s important to think about knowledge, right? Because a lot of times people will not have the foundational knowledge to make the right choices.

And certainly we need to support knowledge, but it really is much bigger than that. We have to support self-efficacy. We have to help them build belief in themselves that they can adapt a whole new dietary plan if that’s what is necessary. And so I think it’s really important for us to reward good behavior, support them in any way with information or advisement when they ask for it. And then also to really make sure that we repeat, repeat, repeat. Because I think a lot of times, especially patients in cancer therapy are dealing with a lot. And if you’re trying to work on changing your diet on top of everything else, sometimes it goes in and out and you have to kind of be there to repeat the messaging and support all along the way.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

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What are nutrition and intervention strategies for age-inclusive cancer survivorship? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses cancer research studies on diet and exercise behaviors, strategies to make studies more age-inclusive, and ways to increase self-determination in cancer survivorship.

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

Navigating cancer treatment is challenging at any age. How can age-specific strategies support better outcomes for cancer patients? I’m getting insightful answers from a leading expert in this edition of the Patient Empowerment Network RESTORE program. 

Dr. Thomson, your study suggests that age at diagnosis was not a significant effect modifier. What implications does this have for designing interventions that address diet and physical activity behaviors across different age groups? 

Dr. Cynthia Thomson:

Yes, I think it’s really important when we think about designing studies that we think about what is best for the individual patient, right? And, unfortunately, when we’re designing trials and we’re trying to evaluate diet and physical activity, we have to keep what’s called treatment fidelity. We have to kind of give everyone the same package, right? Because we want to know if this package works.

On the other hand, we know that patients do best when we individualize that care. And so it’s kind of a dance that we do as researchers to make sure patients get what they need, but also are relatively adherent to a plan that we’re testing with hypotheses. And so I would say that in some of my research, age has not been an effect modifier. In others, it has. And it really comes down to two things, I think. One is in individual studies, the age range may be very narrow, right? A lot of times when we go to do exercise and diet studies, we focus on, oh, we don’t want anyone who has heart disease, or we don’t want anyone who might fall, or we don’t want anyone who’s, we’re going to drive up their blood pressure.

And so in order to keep things safe, we may develop an age range for enrollment in our trial that kind of excludes people at either end. And so that lack of significance as an effect modifier may just reflect that it was a pretty narrow age range. The other thing is I always tell people when I hang up my flyer and say, come join my diet and physical activity study, cancer survivor, we need you. It attracts the people who are already walking, the people who go, well, I’m a vegetarian, I’d be great for this study. And so one of the things that we really need to do in research is to be more inclusive and to get those different age groups into different studies. And we are starting to do that. I think there are more and more studies that are reaching higher and higher age groups, younger age groups, trying to be more inclusive.

Lisa Hatfield:

Okay, thank you. And then considering that health behaviors and beliefs among adolescent and young adults and adults or older cancer survivors were found to be similar, how should this influence the way that we approach the development of age-inclusive survivorship care plans? 

Dr. Cynthia Thomson:

Yeah, so care plans I think are imperative to really help people kind of have that self-determination about where they’re going during and after their cancer journey. And I think it’s important to think about age. I think it’s also important to think about race, ethnicity, resources that individuals have. We need to think about the individual overall and adapt our care plans to meet individual goals and individual needs. Even things like language, preferable language, many times are not addressed during cancer care or survivorship. And so we really have to get back to that and make sure that we’re meeting all of those needs across the spectrum of cancer survivors that we treat.

Lisa Hatfield:

Okay, thank you. And I just want to clarify a little bit the word or the term survivorship care plan. What exactly is that and what would that include for people who are wondering, hmm, I don’t have, I’m a cancer patient, but I don’t have a survivorship care plan. What might you tell them about that? 

Dr. Cynthia Thomson:

Usually it’s the nurses that really take charge of helping patients develop their survivorship care plan. And really, this is a written plan that goes within your medical record that really details, what your current health status is, what your goals are as a cancer survivor. It may even detail different resources, different providers you need to meet with, the frequency that you need to follow up on your survivorship care. And so diet and physical activity should be part of that survivorship care plan, but those plans are much broader. They’re really addressing all of the healthcare needs that a cancer patient will need to tap into both immediately and long-term.

Lisa Hatfield: Okay, thank you for explaining that. You heard it here directly from Dr. Cynthia Thompson. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Does Diet Adjustment Impact Cancer Care?

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How is cancer care impacted by diet adjustments? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses potential impacts of strategies for symptom management, immune response, nutrient deficiencies, inflammation, and diet patterns. 

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

How can adjusting your diet support you through your cancer journey? I’m excited to connect with a top expert to help us find the answers on this Patient Empowerment Network RESTORE program.  

Dr. Thomson, what are the key components of nutrition that patients should be thinking during their cancer treatment? 

Dr. Cynthia Thomson:

I think to start with, people need to think about what kind of symptoms they might be having during treatment and how can nutrition help them manage symptoms because I think symptom management is probably the most central nutritional issue in terms of making sure people can get through their cancer treatment in a timely manner that aligns with the prescription and optimizes their outcome after treatment. So I think managing those symptoms is one of the key components.

The second is to really do an assessment of what you’re eating and the quality of that diet. Are there nutrient deficiencies that need to be addressed and really honing in on specific nutrients or eating patterns that need to be evaluated and addressed. And then I think the third is really to move towards that long-term cancer survivorship eating plan. Where we’re really promoting a diet that’s more plant-based, a diet that is going to help reduce comorbidities, a diet that’s going to help you have the highest level of vigor and vitality after treatment. And so it’s kind of a continuum from symptom management, address those deficiencies and inadequacies in the diet, and then let’s go after optimization to reduce any risk of cancer recurrence as well as keep us healthy overall.

Lisa Hatfield:

Okay, thank you. And, Dr. Thomson, can you speak to the connection, if there is one, between the immune system and blood type and its impact on diet for cancer patients? And is this a consideration during care for you and your colleagues while supporting patients through their cancer journey? 

Dr. Cynthia Thomson:

Yeah, so I do think there are a number of different, what we call fad diets, like the blood type diet, that are intriguing. Could our blood type actually dictate what diet we should be on and what diet is optimal for our health? I would say that there’s just a total lack of evidence for the blood type specifically. And so will research evolve in the future? I don’t know. I think right now we need a lot more preliminary evidence that this matters, and this is an important factor before we would move forward.

In terms of the immune system, I think this is where diet is critical, as well as physical activity. There is a lot of evidence that when we get active and when we eat certain foods, we can modulate how our immune system responds. And in fact, our immune system is the checkpoint, to make sure cancer does not develop in our bodies or that when it does develop, we can counter it.

I think it’s really important to think about what we eat and our physical activity to enhance our immune system. And I’ll give you, One of the more common examples is adequacy of vitamin C and making sure that we have adequate vitamin C for our immune system to respond. We also know that people who are deficient in vitamin D can have lower immune response. It can happen with other nutrients as well, but on the other side, we have things like inflammation, which is a hallmark of cancer. And so If we can select dietary components that are anti-inflammatory that reduce the inflammatory response within our bodies, then that also can help to modulate our cancer risk. So I think this connection between lifestyle behaviors and the immune system is critical. It is the primary mechanism by which these health behaviors protect us and keep us healthy.

Lisa Hatfield:

Okay, thank you. I do have a follow-up question. As a cancer patient myself, and I know you’re a cancer survivor also, so we hear a lot about different diets, the blood type diet we just talked about, and then things like the keto diet, eat more protein, eat less protein, eat plant-based, importance of the health of the gut microbiome. Is there any evidence that any one type of diet works better than another when it comes to not just cancer prevention, but maintaining where we’re at with our cancer, whether it’s curing it or maintaining, stabilizing the cancer when it’s not curable? Do you have any comments on that? 

Dr. Cynthia Thomson:

Yeah, I mean, I think, first of all, there is a lack of randomized controlled trials, what we consider the gold standard, right? So, in terms of, can I say to you, we have 18 studies that say, the Mediterranean diet is the way to go. We don’t have that. What we do have is a lot of what we call epidemiological data.

So when we look at the diets of individuals who are either prior to their diagnosis of cancer, during their treatment, or after their treatment, we have increasing evidence that people who eat certain diet patterns, like a Mediterranean diet, like an anti-inflammatory diet, or score high on what we call the healthy eating index, where the quality of the diet is very plant-based, lower in fat, lower in processed foods, particularly processed meats. When those patterns are followed, we see better outcomes in terms of survival, but we also see that we can modulate certain inflammatory responses, oxidative stress, et cetera, that lead to cancer. So the mechanisms are there as well.

Lisa Hatfield:

Is there any evidence that there are cancer superfoods that might help stop the cancer or prevent cancer? I hear about blueberries being a superfood. Can you name any superfoods, or is there evidence to support that? 

Dr. Cynthia Thomson:

Well, I think we all have our own superfoods, right? Broccoli, because it’s a cruciferous vegetable, or garlic and onion, which are known to enhance immune response against viral infections, or, on and on and on omega-3 fatty acids. And it could go on and on. So I always hate to say that any one food is going to prevent cancer. That is so unlikely. If there is one, it must be hidden somewhere. I just can’t imagine and so it really and increasingly we know this.

It’s a diet pattern, right? Like if you are, Lisa, putting blueberries on your cereal every morning, but that cereal is Cap’n Crunch or some other sugared cereal versus something that’s higher in fiber, like steel-cut oats or, you know. So I feel like we cannot look at foods in isolation because while one food may have a beneficial effect, we can easily counter that by making other choices that are not so healthy. And so we can eat this anti-inflammatory food and then counter it with a pro-inflammatory food. So it’s really the pattern of eating that we need to think about.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

What Is an Oncology Dietitian vs. a Nutritionist?

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Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses the differences in education levels, training, and continuing education for dietitians versus nutritionists and the meaning of registered dietitians and registered dietitian nutritionists.

Download Resource Guide

See More from RESTORE

Related Resources:

Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 
 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

Dr. Thomson, can you explain the difference between a dietitian and a nutritionist, and why it’s important for patients to seek out the appropriate person, maybe in their cancer center and oncology dietitian when receiving care for cancer? 

Dr. Cynthia Thomson:

Yeah. Definitely. So a registered dietitian, or what we call an RD, similar to a registered nurse, RN, right, they have had a four-year undergraduate degree that is extremely heavy in the sciences, chemistry, biochemistry, physiology. They understand how nutrients are metabolized and how the body processes nutrients to optimize health. In addition, after all of that four-year degree, which is pretty much equivalent to a pre-med degree, they will then go through an internship where they’re supervised by professionals in the field and spend quite a bit of time in the clinics with patients, learning the day-to-day application of all that knowledge that they’ve learned. It’s a five-year commitment for most individuals.

And then they have to pass a registration exam. And then on top of that, they have to stay up-to-date in terms of continuing education, right? They can’t just walk away and then for the next 30 years practice nutrition without being up-to-date. And so it’s a pretty intensive process and a lifelong learning process. In contrast, the nutritionist could be anybody. Lisa, you could decide today, you’re a nutritionist. Technically, in many states, you could hang up a shingle and say, come see me, I’m a nutritionist. And so it gets a little confusing, because people assume that people who say they’re a nutritionist know nutrition.

And, unfortunately, over the years, it has been very difficult to convince people or even educate them on what a registered dietitian is. So about a decade ago, the Academy of Nutrition and Dietetics, which is the professional organization that registered dietitians belong to, decided maybe we should opt to call ourselves registered dietitian nutritionists RDN, because then people would start to put it together that there are different kinds of nutritionists. And so many dietitians have moved to the title of RDN, others who’ve been in the field longer may have chosen to stick with the RD only. And so really look for an RDA or an RD when you’re looking for professional help, because you know you have a highly qualified individual.

When I became an oncology dietitian, my whole day was about taking care of cancer patients. I wasn’t seeing one cancer patient and five heart patients and two pediatric patients. I was seeing oncology patients, inpatient, outpatient, all different cancers at all levels of care. And so I really understood the disease process and how it affected the nutritional status of my patients. And so it’s just a matter of an oncology dietitian is really going to have that certification above and beyond the RDN that says, I know my stuff, and I’ll share it with you. And they also have to go through an exam, a special exam to be an oncology dietitian, and they have to repeat that exam every five years, so very intense. You get what you pay for, and the dietitians who put them through, themselves through all that training do so because they know that’s what’s best to meet the needs of their patients.

Lisa Hatfield:

You’ve heard it straight from Dr. Cynthia Thomson. Thanks for joining us on this RESTORE program. I’m your host, Lisa Hatfield. 

What Is Whole Person Care Exactly?

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Whole person care is a key part of cancer treatment, but what does it mean exactly? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the meaning, aspects, and benefits of whole person care for cancer patients.

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Transcript:

Lisa Hatfield:

We hear about the importance of wellness during and after cancer treatment. Some refer to it as whole person care or lifestyle medicine, but what is it really? I’m getting to the bottom of it in this Patient Empowerment Network RESTORE Program. 

Dr. Comander, can you explain the concept of whole person care in the context of cancer treatment, and why are these concepts or strategies important for patients and care partners to understand?

Dr. Amy Comander:

Thank you for that excellent question. As an oncologist, I really focus on providing care for the whole patient or really taking what we also refer to as a patient-centered approach, certainly taking into account my patient’s diagnosis, the stage of the cancer, and the appropriate treatments, but also how can I best address all the other needs my patient is facing, whether that’s transportation to appointments, her goals when it comes to her treatment plan, her neighborhood she lives in and how easy it is for her to get to appointments and get outside to get exercise, and really thinking about all of these needs and integrating them as I formulate a treatment plan and also bringing in other members of our team to address the needs that my patient may face so we can really take care of the whole patient. So I’m so glad that you asked about that.

Lisa Hatfield:

Thank you. Nicole, can you share what the meaning of a whole person care is for you as a social worker? As you interact with patients, how do you explain it to them?

Nicole Normandin Rueda:

Sure. So whole person care means you’re addressing not just the physical aspects of cancer, but also the emotional, social, psychological, and spiritual dimensions of the patient’s experience. 

The approach recognizes that cancer affects every aspect of a patient’s life and that effective care must go beyond just the traditional medical treatments. It also includes everything from nutrition, physical activity, counseling. It’s very personalized to the patient, meaning we take the time to get to know the patient, figure out how we can help tailor the interventions that we’re going to suggest to their specific needs, including everything that we need to consider, such as their personal, cultural, or social context. And finally, it’s holistic. So we’re addressing emotional, psychological, social challenges that may arise.

In addition to just being diagnosed with cancer, everything else that’s compounded whenever that happens to somebody, we want to make sure that we are addressing as much of that as possible. So whenever I’m interacting with patients, I’m the social worker that comes in and really just gets to explain all of this from A to Z, that we are, as a team, we’re going to take a comprehensive approach that treats them as individuals, rather as just focusing on treating the disease.

I emphasize that we’re looking at their overall well-being, helping them manage their day-to-day life, as well as everything else that comes with a cancer diagnosis, their side effects, the emotional stress, the financial issues that may come about, the change in roles, the cultural things that may come up. All of these things will be addressed in some way or another, depending on what the needs of the patient are.

Lisa Hatfield:

You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Dr. Krisstina Gowin: Why Is It Important for You to Empower MPN Patients?

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Dr. Krisstina Gowin: Why Is It Important for You to Empower MPN Patients? from Patient Empowerment Network on Vimeo.

Empowerment for myeloproliferative neoplasm (MPN) patients is a vital part of their care, but how can providers help with this? Dr. Krisstina Gowin from the University of Arizona shares key ways that she helps empower her patients and explains some reasons why patient empowerment is important in their care.

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Transcript:

Dr. Krisstina Gowin: 

I think the first key to empowerment is education. And so anytime I meet a patient, I spend a significant amount of time really making sure they understand their disease and what are the treatment goals, and how do we best achieve those together? And I think for MPNs in particular, that I want them to understand that, yes, we want hematologic response, we want to control your blood counts and your numbers, we want to reduce those thrombotic complications, we want to control your symptom burden, so so important, your quality of life and symptom burden is part of the disease management.

And so I want them to understand what is symptom burden, and how is it measured, and how do we best achieve chronologic measurements? Do they do that at home? Is it best in clinic, are they going to be journaling? So symptom burden and measuring, and then the other is wellness and the management of cardiovascular risk factors, and so education around all of those for my MPN patients.

And then why is it important while it’s important because we want our patients to feel empowered, we want to feel like they are driving the bus and contributing to their own survivorship and wellness, and so how do they best do that is through education and then again, getting the tools they need to really navigate their journey in the most precision and personal, personalized way as possible, and so that’s really my strategy is education and empowerment.

What Are Potential Telemedicine Risks for Myeloproliferative Neoplasm Patients?

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What Are Potential Telemedicine Risks for Myeloproliferative Neoplasm Patients? from Patient Empowerment Network on Vimeo.

What risks should myeloproliferative neoplasm (MPN) patients be aware of with telemedicine? Experts Dr. AnaMaria Lopez from Sidney Kimmel Cancer Center, Dr. Krisstina Gowin from University of Arizona Cancer Center, and patient Lisa Hatfield share their perspectives and advice. Watch as they discuss potential risks in MPN patient care, how to advocate for the continuation of telemedicine, and advice for patients to work toward optimal wellness.

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Transcript:

Lisa Hatfield: 

Are there any risks or drawbacks that you see to telehealth or telemedicine for digital health?

Dr. AnaMaria Lopez: 

The most important thing is to remember that the technology is a tool, and if the person feels that there’s a limitation, so, for example, if the patient is seen and they say their heart is racing or skipping beats or something, now, there are ways, there are electronic stethoscope, so you can really do a full exam except for palpation through telemedicine. But not everybody has that even in a clinic, but certainly in our own home, we don’t have that technology. So if a patient is expressing a concern for which the clinician really feels that needs a closer evaluation, then that’s the right next step, so we’re not…the technology is a tool to help us care for people, and if it’s not all available right there, then we need to see the patient in person. So I think that’s the risk is just sometimes people may feel limited like, “Oh, well, I’m not really sure It’s okay, I’m not really sure I need to see you, or you need to go here or go there for the care.”

And the other, which is a really big threat, is that part of the reason we did 70 years work in a couple months is because it was reimbursed, and we’re reaching the end of the pandemic, the federal…and with that, the payers may go backwards. We all know that if that happens, we will go backwards in telemedicine. [chuckle] There will just be decreased, decreased use. And it may lead to people then going back to traveling for four hours, waiting, only to be told, “Oh, you know what? There’s not this. This clinical trial doesn’t work for you.” So we don’t want to lose ground. And part of not losing ground is that we really need to continue to have advocacy around reimbursement.

Lisa Hatfield: 

Thank you, Dr. Lopez. And I feel compelled, just to follow up with one more question regarding that, because I’m very passionate about this. With some of these rules and guidelines coming to an end, I know in my particular state that I will no longer be able to access my specialist. I see a myeloma specialist. We do not have any here locally. I can access a specialist via telemedicine. I will not have that opportunity. So as all of us know, there are disparities and there are financial disparities in cancer patients. There are racial disparities in cancer patients, there are socioeconomic disparities. Telemedicine has been a tremendous…has had a tremendous impact on the care and the outcomes and the quality of life of so many patients. So as a patient and as an advocate, do you have any recommendations? Do I go to my doctor and say, “Okay, how can I move forward and still talk to my specialist, who’s out of state? Do I go to my state legislature? Do I talk to my insurance company? How can we get this to continue?” Because this has had such a significant impact on the quality of life and on the outcomes for patients, who otherwise, would not have been able to access that care.

Dr. AnaMaria Lopez: 

Yeah, I mean, I think all of the above. Partnering with other advocates, the American Telemedicine Association has a map that kind of says where are all the shifting sands regarding the different rules and legislative changes. But I think it’s led us to a place, where we are all advocates and where physicians, nurses, patients, pharmacists, everybody in the same way that we do team-based care, that we do team-based advocacy and it’s all for our patients.

Lisa Hatfield: 

Great. Thank you for that. Dr. Gowin, any last words that you may have about accessing specialists or telemedicine options?

Dr. Krisstina Gowin: 

Well, I think we covered the basics, but I just want to end with just how empowering the access to digital health interventions really is. And so I don’t think there is a one-size-fits-all approach to every patient. So what I would encourage patients to do is just to really think, “How do I compliment my care? What am I missing? How do I achieve my best wellness? And how do I get those resources in my home to make them more convenient for me?” And to start doing some research and self-advocacy to really get those resources because they are out there and in almost…in every domain, there is now a digital version that is accessible to you now.

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How Is Telemedicine Influencing Personalized Medicine for MPN Patients?

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How Is Telemedicine Influencing Personalized Medicine for MPN Patients? from Patient Empowerment Network on Vimeo.

How can myeloproliferative neoplasm (MPN) personalized medicine be influenced by telemedicine? Expert Dr. Krisstina Gowin from University of Arizona Cancer Center explains how telemedicine helps create a more personalized and precision-based approach for optimal MPN patient wellness.

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Transcript:

Lisa Hatfield: 

Dr. Gowin, can you provide or share some examples of how telemedicine is influencing personalized medicine and MPN care, and how can MPN patients best advocate for themselves to get the latest in MPN care?

Dr. Krisstina Gowin: 

Well, I think it’s going back to some of the conversations we’ve already had, is that now with telemedicine, you can really access academic centers no matter where you are. And so rural areas now can go to academic centers, very accessible without travel, and so what that lends to is more access to precision-based clinical trials, and very often now we’re doing next-generation sequencing panels for patients with MPN. We’re looking at what are the genetic features of the disease and we may be accruing trials based on those genetic features. And so that kind of conversation really only happens at academic centers, and so I think it’s really allowing those that live far away, a few hours away, to really have those personalized and precision-based conversations. And then tying in again the aspect of integrative medicine. And then what is integrative medicine all about is personalizing your treatment plan, asking what are your goals, what is your lifestyle, what is your culture, and how do we really get you on a plan that makes sense for you, that is local for you and sustainable for you to really achieve your optimum wellness?

And so if I were counseling patients listening to this, I would say, start with the in-state academic centers and say, “What are the telemedicine services there? Is there an integrative medicine department there”? And then get a quarterback within that department and say, “Okay, this is the plan,” and then that quarterback can say, “Well, now let’s look local. What do you have? What are your resources there? Let me do some homework with you and hook you up with really evidence-based high quality providers to achieve your personalized needs in your local community.” And I think that’s how we’re really going to get all of our patients in a precision and personalized approach no matter where they live, and that’s again, the beauty of telemedicine and digital health. 

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How Can Myeloproliferative Neoplasm Patients Use Integrative Health?

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How Can Myeloproliferative Neoplasm Patients Use Integrative Health? from Patient Empowerment Network on Vimeo.

How can myeloproliferative neoplasm (MPN) patients benefit from integrative health? Experts Dr. Krisstina Gowin, Dr. AnaMaria Lopez, and patient Lisa Hatfield discuss common symptoms of MPN patients, integrative health techniques, and benefits of including integrative medicine.

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Transcript:

Lisa Hatfield: 

So I have multiple myeloma, and, of course, that comes with side effects from the different therapies and symptoms of their own. We have a great integrative health center at our cancer center here locally where I live, and I’ve used it for acupuncture for some of my symptom management. I’ve also watched you on different platforms, through webinars and patient support groups where you describe different integrative health techniques and that type of thing. So I’m wondering…two questions. The first part is, what symptoms do MPN patients face the most? And then how can they use integrative health to do that, particularly as it relates to telemedicine? Are there telemedicine options for integrative health? I suppose things like acupuncture, maybe not, but other types of, of integrative health, and can they get a consult for integrative health? Can they even go as far as getting a consult? So if you can answer those questions, the symptoms they face, how to use integrative health, and if they can get a consult for integrative health, that would be great. We’d appreciate that.

Dr. Krisstina Gowin: 

Yeah. Well, Lisa, I want to take a moment just to validate your journey that you’re going through and to congratulate you for your self-advocacy to go look for those integrative therapies to support yourself. And for MPN patients, I will say that it’s a really unique group, and so all cancer patients experience symptoms. But in myeloproliferative neoplasms, it’s really kind of this heterogeneous what we call a symptom burden. And so most patients will experience fatigue about 80 percent of MPN patients. But then beyond that, there’s really a whole slew of different sequelae that can be associated with the disease, which you may or may not think about when you’re thinking about MPNs, such as psychosocial issues, sleep issues, sexual issues.

And then we have kind of the classical issues that happen with MPNs, such as dizziness, but we talked about the fatigue, bone pain, itching, abdominal discomfort from an enlarged spleen and early satiety, or feeling full quickly. It’s really a huge symptom complex, if you will. And we now have validated measurement tools to better understand those. It’s the MPN symptom assessment form, which has really, I think, revolutionized how we look at MPN. It’s no longer just treating the blood counts. We’re treating the patient as a whole, and even within our NCCN guidelines, kind of how we as oncologists go through the algorithms of how to change therapy and how we look at patients. We now have symptoms in there. So even if blood counts are controlled, we may change therapies or even do a bone marrow based on symptoms alone. So symptoms are a huge thing in MPN. So getting to your second question for integrative health.

So I think that MPN…the patients in the community are really early adopters for digital engagement, which is fantastic. Everyone’s very engaged, and I’ve had the opportunity to work on meditation apps, yoga apps, a wellness-based app here from the University of Arizona, and patients just really accrue fast. Everyone’s so excited. And most of these, though, were very small kind of pilot trials, looking at feasibility, can’t we really do these things? But most of them as well are showing some impacts on depression, anxiety, sleep, and total symptom burden. So I do think that these modalities through digital platforms certainly can make a difference on the symptoms. And we’ve seen that with meditation. We’ve seen it with yoga, and we’ve seen it with a seven domain wellness app. And is it the digital engagement? I don’t think so.

I think it’s likely the integrative therapies that they’re receiving through that platform, right? We know meditation works, we know yoga works, perhaps not so well in MPNs. We need to build that evidence base, but other solid cancers, we know those interventions really work. But it’s wonderful to get that kind of early data, say it not only works, but it also works when you’re doing it at home, when you’re doing it on a digital platform. And so I would encourage all patients listening to this to, yes, look at what’s around you, what are the resources, what are the clinical trials? Looking at these different digital modalities for integrative medicine, but also to go get an integrative consultation.

And as Dr. Lopez already had mentioned, she does all of her integrative medicine via telemedicine now, which is fantastic. And so you, it’s really, it’s that, you know, your fingertips. You now have access to wonderful oncologists like Dr. Lopez to guide you in this journey. And the journey is not only allopathic Western medicine, but it’s treating you as a person, you as a whole symptom complex. And that’s really what integrative medicine aims to support you through. 

Lisa Hatfield: 

And you mentioned that Dr. Lopez also does her integrative health via telemedicine. So I’m going to ask, Dr. Lopez, can you speak to that a little bit more? How do you do that with patients? Do they just contact you and set up an appointment for an integrative health consult or appointment? And do you conduct some of that yourself, or do you send them to particular resources in the community?

Dr. AnaMaria Lopez: 

Sure. So, yes, patients can make an integrative oncology appointment directly. I really like to do the consults through tele simply because I can…as I was mentioning, it’s like a virtual house call to really get a sense of the patient. Often a partner, significant other, caregiver might be present as well, and as we know there’s the survivor and there’s the co-survivor. So including both can be very helpful to some people, and I think the initial intake…again, as Dr. Gowin was saying, it depends so much on what the person wants to do. So the first opportunity for coming together is simply, “Where are you? What are your goals? What’s important to you? And of the panoply of options, which might be the easiest or the one that you are most interested in?”

And so depending on what it is, we might work together, we might also bring in others if the person is really interested in making lifestyle changes, let’s say related to nutrition. The person might work closely with a nutritionist for some period of time and then come back, and we’d come together and reassess. You mentioned the acupuncture, and you can’t do acupuncture at a distance, but you can certainly teach people about the points and consider acupressure for certain points. So there are so many ways to engage and interact, but yes, I think like a lot of medicine, it’s a team-based approach.

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