Lessen the stress: A comprehensive, holistic approach to care helps improve cancer outcomes, doctors say – Steamboat Pilot & Today
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Editor’s note: This is the third article in a four-part series titled “Peaks, Valleys of High Country cancer.” View all installments here.
Ira Bornstein has two mantras he lives by: never stop moving and have no regrets.
Even before his diagnosis, Ira and his wife Sandra prioritized exercise and were active skiers and hikers, but it became all that more important after he was diagnosed with glioblastoma, a rare cancer that affects the brain and spinal cord, in 2020.
Despite doctors telling the Bornsteins that his case is incurable and terminal, they go about their lives living in the present moment, not ruminating on the past or what is yet to come. They take each day fresh, and they enjoy each moment they share.
A lawyer by trade, Ira is used to dealing with stress. He tends to his yard meticulously as a way to decompress, always taking any opportunity he gets to enjoy nature and spend as much time as he can outside.
Sandra and Ira make a point to understand the gravity of Ira’s condition, but they place even more importance on reducing his stress in any way possible.
He’s undergone brain surgery, radiation and chemotherapy — all clinical efforts to extend his life, but Sandra and Ira say their positive mindset and holistic approach to reducing stressors in his life have played a large role in his success.
Since his diagnosis and throughout his treatment, the Bornsteins have traveled the world, knocking off bucket-list items as they ski, hike and try new things while at their home in Summit County and abroad.
In addition to being active, the Bornsteins completely changed their diets to get rid of any processed foods, which plays a part in reducing stress on his body, they said. Even though Ira loves ice cream, the processed and refined sugar in his favorite treat was identified as something he should avoid, so he replaced his cravings with healthy alternatives.
Treatments such as chemotherapy and some forms of radiation therapy can cause impacts on diet and appetite. Here’s a list of recommended foods from doctors at Johns Hopkins Medicine.
Plant-based proteins offer the highest levels of vitamins and minerals. This means eating lots of vegetables as well as beans, legumes, nuts and seeds. If you do eat animal proteins, doctors encourage lean options like chicken or fish.
Unsaturated fats also have health benefits. Avocados, olive oil, grape seed oil and walnuts are all high in omega-3 fatty acids, which help combat inflammation and improve cardiovascular health.
This includes grains like whole wheat, bran and oats. These have soluble fiber, which helps maintain good gut bacteria. Soluble fiber also promotes the production of short-chain fatty acids, which can help processes like metabolism and cellular repair.
For people with cancer and the professionals who provide treatment, creating a full-body strategy for cancer care is key to a smooth recovery.
Lindy Owens, a nurse navigator with Vail Health’s Shaw Cancer Center, is an advocate for patients during care — from the initial consultation and onward. It’s her job to help lessen the stress patients encounter as they process and navigate their diagnosis and treatment.
“I think we need a navigator for anybody who’s diagnosed with cancer because I think that there are so many unknowns when we’re initially diagnosed,” Owens said. “I think it does help to alleviate some of the anxiety once you hear the word cancer.”
Though a radiologist, oncologist or other cancer specialist likely shared the treatment plan with the patient, Owens added, “I can promise you a patient does not remember that.”
It’s her job to help them process the situation and move forward with taking action, connecting them with the oncology department’s comprehensive care team.
As cancer treatments like chemotherapy and radiation have evolved over time, so have strategies to relieve stress for patients as they navigate their diagnoses and the care surrounding them. Now, many patients receive integrative care that coincides with their cancer treatments, and they use resources to go beyond chemotherapy, radiation and surgical methods of intervention.
According to the American Cancer Society, “integrative” or “complementary” medicine is often used to describe products and practices used along with standard medical care to help manage symptoms and side effects from cancer and its treatment.
To accomplish this type of medicine for patients, social workers, dietitians, nurse navigators and other staff work together to create a holistic plan with patients to complement their chemotherapy or radiation treatments. This can include tailoring exercise routines for patients to follow, providing support group resources or other behavioral health care and working on diet plans to support each patient’s individual needs.
Complementary care includes physical and emotional health support for patients throughout care, including:
“It’s important to treat the whole body rather than just the physical aspect of, ‘Oh, we have to put chemotherapy in you,’” Owens said. “’But what about all the extra curricular things that you have going on in your life? How can we help manage that? What about your previous back pain that you’ve had for 42 years? What about your anxiety? What about your relationship with your significant other?’ I mean it is truly comprehensive.”
Sarah Roberts is a social worker based at the Dillon Health Center and a member of the Spirit of Survival team, a survivorship program that addresses the physical and emotional effects of cancer, long-term health goals and the impact of cancer on day-to-day life.
Roberts said that stress causes the body to produce more cortisol, a stress hormone, and that can lower how well the immune system functions against threats. Roberts said that this makes it harder for your body to fight anything — even just the common cold — so minimizing stress is a crucial part of any care plan for patients.
“Minimizing stress is super important for any health outcome,” Roberts said. “It’s the same mentally, too. When you are stressed out, it’s harder to manage your emotions. Your brain is in multiple different places. Creating more of a parasympathetic response in the body and helping our bodies and our minds to be calm — because they work together — are just so much more (effective) for health outcomes across the board.”
Other approaches can include adding more stress-relieving techniques like yoga, acupuncture or massage. The Bornsteins said that while traveling and at home, they like to try off-the-wall activities in addition to their usual walks, such as aerial yoga.
“We were on these small trampolines at the last wellness place we went to in Utah, and we experimented with these like vibration balls and different things,” Sandra Bornstein added. “We try different things because I think it’s always good for the brain and the mind to be processing different experiences.”
It’s not just physical health that’s affected by a cancer diagnosis and treatment. According to a June report from the National Cancer Institute, about 25% of cancer survivors have persistent problems with their mental health post-treatment, including anxiety, depression and other psychological and social distress.
For many patients with cancer (up to 75% of breast cancer patients, according to the National Cancer Institute), chemotherapy and radiation can cause “chemobrain” or “chemofog,” a cognitive impairment with symptoms like confusion, memory loss, difficulty concentrating and a shortened attention span. According to a study published in August 2021 by the Journal of Clinical Oncology, research suggested that physical activity may help people with breast cancer avoid some of these problems.
Patients who were more active before starting chemotherapy performed better on cognitive tests immediately and six months after completing chemotherapy than patients who were less active before starting chemotherapy, the researchers reported. Patients who continued to meet physical activity guidelines before and after chemotherapy had the best cognitive performance across the treatment period. Patients who never met the physical activity guidelines reported worse cognitive performance before and after chemotherapy. In addition to effects from chemotherapy, studies show that physical activity can reduce the risk of death from breast, colorectal and prostate cancer survivors.
“I worked out before this, and I continued,” Ira Bornstein said. “The difference is that I didn’t stop. I work out every other day for about an hour and three-quarters, and I did that throughout radiation and chemo in order to help offset the effects of especially the chemo, which degrades your body — especially your muscles.”
Kristi Grems, a licensed professional counselor who works with patients on their emotional needs and resources, said that approaching how a patient adjusts to their diagnosis means addressing impacts to pretty much all aspects of their lives. Staff members address concerns such as financial distress, transportation to and from appointments and child care for parents who need it. She added that there is often a lot of processing with how their bodies and lives change throughout treatment.
“People think it’s like, ‘Oh, I got a diagnosis. I have treatment, and now I’m better.’ A lot of times, you aren’t the same after mentally or physically. It’s processing what that looks like,” Grems said. “A lot of people hear, ‘Oh, this is your new normal,’ and I hear a lot of ‘I don’t want this to be my new normal. I don’t want to have to accept that.’ We help people just evaluate what their life looks like now and give them back that autonomy and control to say this is what I want my life to look like in spite of what just happened.”
Erin Perejda, the supportive care services manager and licensed clinical social worker at the Shaw Cancer Center, said she has observed the benefits of integrative care throughout her career. She said the change from being diagnosed to post-treatment can be “remarkable.”
For some patients, survivorship programs like the Spirit of Survival program can build a sense of community that can improve their stress levels throughout their care.
This year, approximately 1.9 million people in the U.S. are expected to be diagnosed with some form of cancer, according to estimates from the National Cancer Institute. Perejda said that providing peer-support in addition to medical care gives patients a community of others who face similar obstacles during treatment.
“I think every patient who walks in at first is all consumed with the diagnosis. It penetrates every minute of their day,” she said. “It can be the first thing they think of and the last thing they think of. I think naturally through the process of coming to terms with the diagnosis, learning their resources, learning their tools, their support team, their network and then getting involved in the activities — the community and the camaraderie — they learn they’re not alone. They have safe places to turn to to alleviate that stress and to normalize that experience.”
Perejda said that survivorship programs and holistic care does not have to necessarily stop with the patient, and resources are available to family members and significant others of patients.
She said that there have been families where the patient does not feel like they need certain resources like mental health services but their spouse does or their children do. She said that this can provide a much-needed personalization of care, since every patient navigates it differently.
“(Support groups) are a great, great thing for people who really find that environment valuable and walk away with something,” she said. “But not everybody finds them a benefit, so that’s why we’re then able to offer one-on-one counseling and family counseling.”
Ira Bornstein said that staying positive has been a key to survivorship.
He added that though he has been diagnosed with an aggressive illness, that does that mean that his life has already ended. He wants to do everything he can to help his body and mind during his treatment.
Sandra said the way Ira approaches his terminal illness is different than what she’s seen in chat rooms and support groups for people diagnosed with glioblastoma since the brain tumors associated with this form of cancer often lead to chronic vomiting, nausea, headaches and seizures along with deteriorating neurological functions like memory loss, speech issues and changes to vision, according to the Mayo Clinic.
She’s seen people terrified about their terminal illness, but Ira remains “chill,” taking each challenge as it comes but not ruminating on what might lie ahead.
While there is no way to clinically tell if his positive approach to the situation has extended his life, the Bornsteins are sure that it’s having a positive impact.
He lives a fairly normal life, free of severe symptoms and complications brought on by the cancer.
Ira and Sandra understand the chances aren’t great, but they do everything they can — from their daily walks to enjoying vegetable-heavy meals together — to take action so they can continue to collect fond memories.
“If we have the choice of extending your life, we’re going to take whatever measures we can,” Sandra Bornstein said. “And right now it’s working.”
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