Nurses Discuss Mindfulness: 7 Complementary Therapies in Cancer Care

Heidi Lowitzer, RN, CCRN

Heidi Lowitzer, RN, CCRN

Have you ever arrived at work and then wondered how you got there, since you couldn’t remember one minute of your drive? If you have, and especially if you spent your drive time ruminating, you may be overlooking an important method for making your life happier: mindfulness.

“Mindfulness is the quality or state of being conscious or aware of something,” says Heidi Lowitzer, RN, CCRN, a critical care nurse at Buffalo General Medical Center, in New York, who discussed the therapeutic technique during the Cholangiocarcinoma Foundation Annual Conference in Utah on February 1. “It’s a mental state achieved by focusing awareness on the present moment and calmly accepting our thoughts, feelings and bodily sensations. Mindfulness is a coping mechanism that will help bring beauty and peace and joy into our lives, no matter what the situation.”

Lowitzer shared tips about the technique with patients and their loved ones during a talk about complementary and integrative medicine during the conference. Having lost her husband to intrahepatic cholangiocarcinoma in November 2012, Lowitzer has since been volunteering with the Cholangiocarcinoma Foundation and serving on its Nursing Advisory Board. In giving the talk, she was joined by Monica Del Rosso, RN, BSN, OCN, an oncology nurse at Orange Regional Medical Center, in New York — and also a practitioner of reiki, a therapy that uses light touch to achieve relaxation — who gave an overview of integrative therapies including yoga and acupuncture.

About 8,000 people are diagnosed with cholangiocarcinoma, bile duct cancer, each year in the United States. The relative 5-year survival rate for people with the disease is 15% if the cancer is localized at diagnosis, 6% if the cancer has spread regionally prior to diagnosis and 2% if it has metastasized to distant locations within the body.

Mainly, the disease is treated with surgery, radiation and/or chemotherapy.

Palliative treatments are also prescribed by doctors, and adding integrative therapies may further help to increase quality of life.

Integrative Therapies

Integrative therapies can complement the conventional therapies prescribed to patients with various types of cancer, such as chemotherapy, immunotherapy, targeted or hormonal drugs, radiation, surgery and stem cell transplants. These supportive therapies, Del Rosso says, may help ease the side effects of the conventional treatments, which can include nausea, vomiting, fatigue, pain, neuropathy, anorexia and emotional issues including anxiety, fear, sadness, grief, depression and concern over the loss of physical attractiveness.

Integrative therapies include those that can be self-taught, perhaps with help from books, Internet articles or YouTube; these include meditation, prayer, guided imagery and acupressure. Other techniques require guidance from someone with training, such as qigong (an exercise form that incorporates physical postures, breathing and focused intention), yoga, dance, music, art and aromatherapy. Then, there are some that must be administered by an expert, such as reiki, massage and acupuncture.

Del Rosso discussed some specific techniques:

• Meditation: Finding a moment in the day to turn off digital devices and get comfortable in an environment you like will help you stay in the present moment, Del Rosso suggests. “Take some nice breaths and find out how that breathing affects your body. Try to clear your mind; focus on one picture or object,” she says.
• Guided imagery: Visualize a place that has made you happy in the past and use all of your senses to recall its details — for instance, hearing the crash of ocean waves, feeling the warmth of the sun and smelling salty air. “Not only can you use this during chemotherapy or radiation, but I’ve used it at dental appointments,” Del Rosso says.
• Yoga, qi gong, tai chi and dance therapy: Beyond improving your muscle strength and tone, these techniques combine meditation and body movement, encouraging you to focus on the activity at hand, rather than on daily concerns. Check with your doctor before starting.
• Aromatherapy with essential oils: Scented oils can bring back happy feelings from another time and can also be used in massage. Some oils may help ease symptoms, such as peppermint for nausea or lavender to induce sleep. Ensure that you’re not allergic to ingredients in the oils before using them. Those with asthma or other respiratory issues may not want to try this technique; check with a doctor first.
• Reiki and acupuncture: These techniques endeavor to improve the body’s inner energy flow. Reiki can aid in relaxation, in part because the treatment is one-on-one in a quiet place. Acupuncture uses thin needles to foster relaxation and other beneficial effects, and while infection is one risk, this should not occur with a good clinician, so check certifications, Del Rosso says. Don’t try acupuncture if you take blood thinners, are pregnant or have a pacemaker or palpable tumor.
• Massage: This can help relieve pain and stress, although it can cause temporary muscle soreness. Practitioners should not massage over palpable masses or tumors, and should not treat patients who have spinal or bone metastases or spinal cord compression. The patient’s oncologist should be consulted before treatment.
• Humor: “Don’t ever forget that watching something funny, listening to a funny story or laughing with friends is really good medicine,” Del Rosso says. “Other good techniques are singing in a group choir or alone, dancing, exercise, meditation, eating chocolate and engaging in sex.”

“The key takeaways about complementary and alternative medicine are that many of them don’t have any side effects,” she continues. “They can all be used together, and they don’t cost too much. The initial investment is all it costs — for instance, if you go to yoga class to learn it and then can do it in your own home.”

To get started with methods that require guidance, patients can look for certified therapists or programs at hospitals, YMCAs or municipal recreation programs; or, they can ask around at support groups or among coworkers or family members. For methods people can learn on their own, patients can seek out books and online tutorials.

Insurance may cover some of these treatments, but patients need to check.

Learning to be Mindful

Mindfulness, on the other hand, is free and can be done anywhere, anytime, Lowitzer points out.

“We need coping skills to stay calm and relieve our stress and anxiety,” she says, “especially during the treatment of cancer or any huge crisis in our lives.”

If your furnace blows up or your children are having problems in school, and these events don’t give you a clear enough signal that you’re under stress, your body may offer you other signs, such as bowel irregularities, headaches or fatigue, or you may find yourself irritable, moody or even turning to drugs or alcohol, Lowitzer says. These are the times to introduce mindfulness, she says, since studies have shown it can ease pain, stress and fatigue.

Worrying about our problems is a way of life for most of us. Unfortunately, Lowitzer says, “worrying doesn’t take away tomorrow’s problems but today’s peace. It’s like a rocking chair — it gives you something to do, but it doesn’t get you anywhere. Mindfulness gives us a break from that worry and stress so we can appreciate the good things in front of us that we miss when we’re on that drive and don’t remember it.”

Listen to your child singing in the bathtub, admire the vibrancy of your garden or enjoy your pet sitting in your lap, she says, and you’ll find that “lots of little good things add up to a good life. Your attitude forms your outlook and how you view your life, whether it’s bad, stressful or has a lot of good in it.”

Lowitzer and her late husband used to enjoy sitting by Lake Erie and watching the sun set; they would spend an hour there and talk about every level of what was happening in the sky. “Those little moments are what we need to cherish to make our lives happier and better,” she says.

But what if this kind of behavior is not in your nature? A clinical trial conducted at Indiana University enrolled patients and taught them to “mindfully optimize the delivery of end-of-life care,” Lowitzer says. Results were reported in 2016. “They trained the patients to be mindful and sent them out to practice. These patients found it made a huge effect for them. They were happier, and their lives were richer and fuller, even if their prognosis wasn’t good.”

That practice certainly made a difference for Lowitzer and her husband.

“In the end, I may not have gotten my husband into a pair of yoga pants, but watching the sunset wasn’t just a romantic moment — it was our form of meditation, even though we didn’t realize it in the moment,” she says. “It helped us live better, happier lives when we were together, and I wouldn’t trade that for all the tea in China.”