McGill Cancer Nutrition-Rehabilitation Program

1. McGill Cancer Nutrition-Rehabilitation Program McGill Cancer Nutrition-Rehabilitation Program Dr. Thomas Jagoe, Program Director; Dr. Martin Chasen, Clinical Director; Dr. Neil MacDonald, Founding Director Segal Cancer Centre Sir Mortimer B. Davis-Jewish General Hospital (SMBD-JGH) Dr. Thomas Jagoe, Pulmonologist Dr. Neil MacDonald, Oncologist, Palliative Care Physician Dr. Polymnia Galiatsatos, Gastroenterologist Dr. Maryse Duchesne, Psychologist Ms. Nelda Swinton, Dietitian Ms. Christina Van Der Borch, Dietitian Mr. Anh-Thi Tran, Physiotherapist Ms. Natasha Grant, Physiotherapist Ms. Louise Champagne, Infirmière Pivot Dr. Goulnar Kasymjanova, Research Associate Dr. Ravi Bhargava, Clinical Research Associate Ms. Cynthia Bromberg, Clinic Coordinator Dr. Rajesh Sharma, Data Manager McGill University Health Centre-Royal Victoria Hospital (MUHC-RVH) Dr. Martin Chasen, Oncologist, Palliative Care Physician Dr. Bruno Gagnon, Palliative Care Physician Dr. Pasqualina Di Dio, Psychologist Ms. Shafia Amdouni, Dietitian Ms. Marta Jelowicki, Physiotherapist Ms. Josée Lemoignan, Occupational Therapist Ms. Siobhan Carney, Infirmière Pivot Ms. Margaret Eades, Clinic Coordinator and Clinical Nurse Specialist Dr. Ravi Bhargava, Clinical Research Associate Ms. Sarah Schulman, Clinic Coordinator Dr. Rajesh Sharma, Data Manager Dr. Virginia Lee, Psychosocial Research McGill University, Department of Oncology Gerald Bronfman Centre Ms. Mary Jane MacDonald, Administration Dr. Gayle A. Shinder, Research Grants, Program Documents, Website Slide presentation:Content: Ms. Margaret Eades; Design and Editing: Dr. Gayle A. Shinder

2. McGill Cancer Nutrition-Rehabilitation Program Index To Slide Presentation Section Slides Introduction 3-7 About the McGill Cancer Nutrition-Rehabilitation Program 8-12 Cancer-Related Anxiety 13-24 Cancer-Related Fatigue 25-39 Nutrition 40-41 Complementary Therapies 42-54 A Final Note 55 McGill Cancer Nutrition-Rehabilitation Program Coordinates 56

3. McGill Cancer Nutrition-Rehabilitation Program INTRODUCTION

4. McGill Cancer Nutrition-Rehabilitation Program The Human Side of Cancer “This nonphysical side of cancer can be neglected in the crunch of the physical aspects of cancer but the feeling side of cancer is equally important and that the psychological, social and spiritual aspects must be given equal attention.” J.C. Holland & S. Lewis, 2000 The Human Side of Cancer: Living with Hope, Coping with Uncertainty

5. McGill Cancer Nutrition-Rehabilitation Program Cancer Survivors Tell Us ● A diagnosis of cancer has a huge impact on the person, family and close friends. ● A lot of learning and adjustment takes place during treatments and follow-up. ● That as much as possible they want to resume normal activities and a healthy lifestyle once treatments finish. ● Getting back to ‘normal’ is an important part of recovery and moving forward.

6. McGill Cancer Nutrition-Rehabilitation Program During Treatment Persons With a Diagnosis of Cancer May ● Feel weakened from: ●being less active than normal. ● resting in bed more. ● having cancer treatments. ● Need more assistance with everyday activities than before. ●Have more difficulties walking long distances or standing in lines. ●Feel they run out of energy more easily. ●Feel discouraged by these kinds of changes.

7. McGill Cancer Nutrition-Rehabilitation Program Living With Cancer Treatments ● Many new cancer treatment options have increased survival and quality of life for persons who have a cancer diagnosis. ● Over the years many survivors have intermittent periods when they require additional treatments. ● Like other chronic diseases, cancer requires medical follow-up and sometimes different treatments to prevent the disease from progressing. ● Learning how to incorporate treatments into an active life schedule is a challenge but many patients are very successful in this regard.

8. McGill Cancer Nutrition-Rehabilitation Program About the McGill Cancer Nutrition-Rehabilitation Program

9. McGill Cancer Nutrition-Rehabilitation Program Program Focus  Clinical Care  Research  Education

10. McGill Cancer Nutrition-Rehabilitation Program Mission 1. Develop and administer nutritional and rehabilitation programs for cancer patients who are suffering from poor appetite, malnutrition, weight loss, fatigue and loss of function. 2. Conduct research aimed at understanding the underlying biological reasons why some cancer patients suffer from the above symptoms. 3. Educate patients, family caregivers and health professionals in new ways to manage the above symptoms.

11. McGill Cancer Nutrition-Rehabilitation Program Overall Goals ● Enhance patient quality of life. ● Sustain patient function allowing them to remain at home caring for themselves for prolonged periods of time. ● Reduce the burden, both physical and psychological, on family and caregivers. ● Reduce the adverse effects of anti-cancer therapies.

12. McGill Cancer Nutrition-Rehabilitation Program Specific Goals ●To maximize your physical functioning, safe activity levels and exercise tolerance. ● To optimize your nutritional intake for healing, building and keeping muscles and to provide adequate daily energy sources. ● To assure you have what you need for optimal symptom control and management. ● To help you learn strategies and have information to continue with your own program of rehabilitation.

13. McGill Cancer Nutrition-Rehabilitation Program CANCER-RELATEDANXIETY

14. McGill Cancer Nutrition-Rehabilitation Program ● Most people with cancer, and their family members, experience anxiety. ● Uncertainty, particularly during treatment, is normal and makes planning for tomorrow or next week unpredictable and frequently difficult. ● A person with a cancer diagnosis often describes feeling uneasy or apprehensive. ● The feeling of uncertainty can interfere with the ability to do normal everyday activities.

15. McGill Cancer Nutrition-Rehabilitation Program Cancer-Related Anxiety Can Increase ● When the Doctor tells you the diagnosis. ● When undergoing treatments. ● When anticipating a cancer recurrence. ● During screening tests or waiting for test results. ● When you have pain, poor sleep or feel unwell.

16. McGill Cancer Nutrition-Rehabilitation Program Cancer-Related Anxiety Affects ● What you feel you can do (physically, mentally and/or emotionally) ● Symptoms of pain, fatigue etc. by making them worse or more difficult to control. ● Your thoughts and beliefs about your well-being. ● Your readiness to do normal daily activities (eg. eating, shopping). ● Your ability to fall asleep or stay asleep.

17. McGill Cancer Nutrition-Rehabilitation Program Anxiety ● Gets our attention or makes us pay attention and be vigilant. ● Gives us feedback in response to risky situations. ● Can help you move toward making choices to reduce or eliminate the anxiety. ● Can encourage assessment, problem solving and re-evaluation of a situation

18. McGill Cancer Nutrition-Rehabilitation Program When you identify triggers make note of what they are. Knowing is the first step to managing them better.

19. McGill Cancer Nutrition-Rehabilitation Program Suggestions To Help Reduce Anxiety Levels  Talk to friends/family  Listen to music  Relaxation Exercises  Meditation

20. McGill Cancer Nutrition-Rehabilitation Program Reduce Anxiety: Good Sleep Preparation Habits ● Drink warm liquids (caffeine-free) or milk. ● Do something relaxing (eg. read a book, listen to music) before going to bed. ● Go to bed at the usual time. ● If you are unable to fall asleep, get up and do something relaxing (eg. read a book, listen to music).

21. McGill Cancer Nutrition-Rehabilitation Program Reduce Anxiety: Activity ● Keep as active as you can during the day. ● Do regular exercise (3-5 times per wk). ● Set short term goals and gradually increase amount or duration of activity. ● Celebrate your gradual progress and achievements.

22. McGill Cancer Nutrition-Rehabilitation Program Talk To Your Doctor/Nurse If You Feel:  More anxious than what you normally feel.  You have more problems concentrating.  Too tired to get out of bed for more than 12 hrs.  If you have pain, nausea, constipation/diarrhea or other discomforts.

23. McGill Cancer Nutrition-Rehabilitation Program Tips To Caregivers To Manage Their Anxiety  Maintaining your own health and wellbeing is important to be able to provide the best care possible.  Take time for yourself (a day off or quiet time).  Watch for signs of your stress build-up (impatience, loss of appetite, difficulty sleeping).  Be open to accepting offers of help.  Educate yourself about the disease, symptoms and care.

24. McGill Cancer Nutrition-Rehabilitation Program Tips To Caregivers To Manage Their Anxiety  Use available community resources.  Don’t be afraid to talk about your concerns and feelings with friends and family.  Give yourself credit. The care you give makes an important difference.  When you have questions, ask the treatment team members.

25. McGill Cancer Nutrition-Rehabilitation Program Cancer-Related Fatigue

26. McGill Cancer Nutrition-Rehabilitation Program Cancer-related fatigue: …”unpleasant debilitating feeling of tiredness to exhaustion.” “It can keep you from doing the things you would do ordinarily or would like to do” “It often interferes with your ability to function normally (day to day).”

27. McGill Cancer Nutrition-Rehabilitation Program How frequent is fatigue ? ● In general population: 23-30% of women. 13-20% of men. ● Most people complain of fatigue for several weeks after surgery. ● Most people with cancer, and those having treatments such as chemotherapy and radiotherapy (75-96% describe cancer fatigue).

28. McGill Cancer Nutrition-Rehabilitation Program Cancer-Related Fatigue ● Patients tell us it is different from the fatigue experienced after hard work or exercise. ● They say it is often unpredictable. ● The amount of fatigue and how much it limits their loved one is a source of worry for family members.

29. McGill Cancer Nutrition-Rehabilitation Program Consequences Of Cancer-Related Fatigue ● Feeling weary or exhausted (physically, mentally and/or emotionally). ● Your body (arms and legs) feels heavy and achy. ● You don’t feel like doing normal activities (eg. eating, shopping). ● You may find it hard to concentrate and make decisions.

30. McGill Cancer Nutrition-Rehabilitation Program What Are Things You Can Do To Help Reduce Your Fatigue ● Rest ● Activity ● Nutrition ● Energy Conservation ● Energy Restoration

31. McGill Cancer Nutrition-Rehabilitation Program Rest ●Sleep and Rest are important. ● But don’t over do it. Too much can decrease your energy levels and reduce muscle function. “if you don’t use it, you’ll lose it.” ● If you have trouble sleeping tell your doctor. ● A “Power Nap” in the day is 1 hour or less.

32. McGill Cancer Nutrition-Rehabilitation Program Reduce Fatigue: Good Sleep Preparation Habits ●Drink warm liquids (caffeine-free) or milk. ● Do something relaxing (eg. read a book, listen to music) before going to bed. ● Go to bed at the usual time. ● If you are unable to fall asleep, get up and do something relaxing (eg. read a book, listen to music).

33. McGill Cancer Nutrition-Rehabilitation Program Reduce Fatigue: Activity ● Keep as active as you can during the day. ● Do regular exercise (3-5 times per wk). ● Set short term goals and gradually increase amount or duration of activity. ● Celebrate your gradual progress and achievements.

34. McGill Cancer Nutrition-Rehabilitation Program Reduce Fatigue: Nutrition ● Drink plenty of fluids early in the day. ● Eat as well as you can: select nutritious choices. ● Carbohydrates are good sources of energy. ● Small meals of cool foods can refresh and make eating easier. Nutrition Guide: http://www.mcgill.ca/cnr/guide/

35. McGill Cancer Nutrition-Rehabilitation Program Reduce Fatigue: Energy Conservation ● Select activities according to your priorities. ● Plan breaks and rest periods in between. ● Let friends and family members help with meal preparation, errands and housework. ● Pace yourself and delegate to decrease energy depletion. ● Do some activities seated.

36. McGill Cancer Nutrition-Rehabilitation Program Reduce Fatigue: Energy Restoration ● Do activities you enjoy and that make you feel good. ● Do outdoor activities that you enjoy (eg. gardening, bird watching, walking the dog) ● Listen to music, massage therapy, reflexology, aroma therapy. ● Visit with friends and family.

37. McGill Cancer Nutrition-Rehabilitation Program Talk To Your Doctor/Nurse If You Feel: ● More fatigued than normal. ● You have more problems concentrating. ● Too tired to get out of bed for more than 12 hrs.

38. McGill Cancer Nutrition-Rehabilitation Program Tips To Caregivers To Manage Their Fatigue  Maintaining your own health and wellbeing is important to be able to provide the best care possible.  Take time for yourself (a day off or quiet time).  Watch for signs of your stress build-up (impatience, loss of appetite, difficulty sleeping).  Be open to accepting offers of help.  Educate yourself about the disease, symptoms and care.

39. McGill Cancer Nutrition-Rehabilitation Program Tips To Caregivers To Manage Their Fatigue  Use available community resources.  Don’t be afraid to talk about your concerns and feelings with friends and family.  Give yourself credit. The care you give makes an important difference.  When you have questions, ask the treatment team members.

40. McGill Cancer Nutrition-Rehabilitation Program NUTRITION A NUTRITION GUIDE FOR PATIENTS, FAMILIES, AND FRIENDS MCGILL CANCER NUTRITION REHABILITATION PROGRAM Authors: Nelda Swinton and Neil MacDonald Graphic design: Linda Van Inwegen http://www.mcgill.ca/cnr/guide/

41. McGill Cancer Nutrition-Rehabilitation Program

42. McGill Cancer Nutrition-Rehabilitation Program Complementary Therapies

43. McGill Cancer Nutrition-Rehabilitation Program Complementary Therapies ● Non-drug treatments that add to or enhance medical treatments. ● Usually seen as effective, safe, “natural,” non-toxic and supportive treatments that relieve the ill effects of medical treatments or the illness itself. ● Therapies that give the person an improved sense of well-being. ● Examples are: Relaxation, Yoga, Reiki, Shiatsu, Therapeutic Touch, Reflexology and Massage.

44. McGill Cancer Nutrition-Rehabilitation Program Alternative Therapies Are Different From Complementary Therapies ● Alternative therapies have been used instead of conventional treatments by some people who see them as superior to and preferred over medical treatments (familiarity, cultural, traditional). ● How they are used can be different too: possibly alone, one after another or together with other treatments.

45. McGill Cancer Nutrition-Rehabilitation Program Most Often We Refer To These Therapies Together As CAMs ● Complementary and alternative medicine taken together describes the whole domain. ● 50-70% of patients use CAMs. ● A major worry is that there are few studies that have evaluated the usefulness, effectiveness and safety of some of the CAM treatments. ● CAMs are mostly unregulated. They are easily accessible and based on client-directed and client-defined benefits.

46. McGill Cancer Nutrition-Rehabilitation Program CAMs Are Available At Some Cancer Centres Memorial Sloan-Kettering Duke & Stanford CAM departments which study and offer a variety of modalities: music therapy, healing touch, medical Qigong, energy healing.

47. McGill Cancer Nutrition-Rehabilitation Program ● CAMs are consumer driven: marketing is both cause and effect of the popularity of many CAMs. ● Third party payers or insurance companies are reimbursing for a growing number of CAM therapies. ● Important to have more attention to public policy and client safeguards. ● Clinical trials are studying whether there is scientific evidence of health effects of particular CAMs. ● Public policy is being developed to regulate usage in some cases.

48. McGill Cancer Nutrition-Rehabilitation Program Nutritional & Dietary CAMs Rationale: If diet can prevent cancer it may also cure ● Some dietary elements may function as antioxidants. ● Melatonin, Selenium, mega-vitamin therapy (A, E, C), low-fat diets, Omega 3 fatty acids, macrobiotics and soy are other examples of CAM nutritional and dietary regimens. ● Clinical trials (NIH, 2003) include low fat diet, macrobiotics, vitamin E and soy. Deterrents: Antioxidants may interfere with radiation therapy and some chemotherapy. Some dietary CAMs have anticoagulant effects and could compromise diagnostic tests. Discuss questions pertaining to nutritional and dietary CAMs with a nutritionist.

49. McGill Cancer Nutrition-Rehabilitation Program Traditional and Folk Medicines Rationale: There are accepted understandings of the development of disease and physiology that differ from conventional Western medical thinking and are time honoured. (Ross, 2000) Example: Traditional Chinese Medicine (TCM) Clinical Trials of some TCM are in progress.

50. McGill Cancer Nutrition-Rehabilitation Program Herbal Medicines Rationale: Includes natural herbs or botanicals. Examples: Echinacea, Grape Seed, Green Tea, Aloe Vera, Milk Thistle & Chaparral, Essiac, Chamomile & Ginger, Ginseng, Kava-Kava.