A breast cancer diagnosis is more than just terrible medical news; it’s also a shock to the system. We discussed balancing the physical, psychological, and spiritual effects of cancer with Nancy H. Dahm, RN, author of “Mind Body and Soul: A Guide to Living With Cancer.”
The opinions expressed herein are the guest’s alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live, Nancy. You take a holistic approach to living with cancer. Tell us about that.
Dahm: Yes, I do take a holistic approach to cancer. Cancer has to do with balancing the physical, psychological, and spiritual effects of the disease. We must look at the whole person because it is the whole person who is going through the cancer experience.
The physical is the disease itself, the physiological response to the disease.
The psychological is how your mind interprets the threat of the disease, which is manifested in fear, stress, anger, and depression.
The spiritual is your belief and practices, your personal connection to God or universal order.
There is a mind, body, and soul connection. Science has shown this, but it is not fully understood. We have now begun to integrate the mind-body-soul medicine into mainstream medicine.
Member question: What is your approach to pain management for the cancer patient?
Dahm: My approach is to assess the patient’s pain by eliciting a scale rating of their pain on a zero to 10 scale. The pain is always subjective. It is what the patient says it is. My approach is to use my own theory, called “The Continuum of Pain, The Continuum of Pain Control.” Pain medication is only a small part of pain management. I look at the variables, or factors, and there are 18 of them, that contribute to a patient’s pain and see if they are interfering with the pain control of the patient.
For example, I look at the medication that’s prescribed from the patient’s point of view. I look at fear of addiction and fear of side effects. Is the patient reluctant to take medication? Is the physician prescribing an adequate amount of medication for the patient? Is the physician knowledgeable in using the protocols in prescribing the pain medications?
Regarding the family, is the family supporting the patient? Does the family have a fear of addiction, as well? And is the family preventing the patient from taking the pain medication?
Of those 18 factors I mentioned, 11 are general factors that contribute to the existence of pain, but there are seven absolute factors that are critical to a patient receiving pain control. So if there is an absolute factor, like not taking the medication, or not prescribing the medication, or the family’s failure to give the medication, then it will be an absolute that the patient will remain in pain. I was able to keep most of my patients pain-free by aggressively managing these factors and then interceding where I needed to, to change the negative factor into a positive one.
Pain management is very doable on a personal level, in terms of the patient and the family. They just need to know the basics of what is used when it is used, and if they follow the factors that I’ve mentioned, they can, indeed, keep themselves pain-free.
Moderator: Integration of body and mind is evident in the effect fear and stress have on pain. How do you address the fear and stress?
Dahm: That is very interesting. Fear and stress are a major blocks to pain control. The fear of addiction prevents taking the medication. The fear of being overmedicated affects the patient’s decision to take the medication, and stress heightens the perception of pain. So it is crucial that we work on fear and stress, not only in terms of pain management but also in terms of the effects throughout the whole cancer experience.
Regarding pain medication, we always start at the lowest levels. And we don’t always start with narcotics. We start with the simplest form of medication for pain. We titrate up in the class of drug and the dosage according to the need of the patient. Now, addiction is very, very rare. It is so rare that it should never be a concern. There was a study done in 1990 where 24,000 patients were studied, and out of those 24,000 people receiving a narcotic, only seven developed an addiction as a result of the narcotic for pain relief. So we must educate people that addiction is so rare that it should not ever be a consideration, in terms of treating cancer pain.
Member question: Do you think most oncologists are good pain managers? Or are they more focused on dealing with the disease than our comfort?
Dahm: That’s a good question. Oncologists are experts on pain management. They are also experts on comfort-care management. They are the ones whom people should turn to, as well as anesthesiologists, and there are many internists who are very good at pain management. But this is what the oncologists do every day. Also, palliative care expert physicians; this is their specialty as well.
In cancer care, we can’t look at one aspect as being problematic, like pain. It is the whole of the person, their physical, their mental, their stress, their fears, their perception of what cancer is to them; this can all be very problematic and all has a relationship to how they are going to go through this cancer experience. Pain is just one segment of an issue. And so we have to be aggressive in looking at all of it and giving the patients what they need in an aggressive manner.
Moderator: What other kinds of mind/body connections can a patient make to help deal with the disease?
Dahm: I like to use philosophy and spirituality together to help the patient promote their own sense of well-being. Cancer has a way of leading people toward a search for meaning. Their spirituality or development of a spirituality, which does not necessarily mean religion, and their quest to find answers, can also come from philosophy. Questions like, ‘Who am I? Why am I here? And, Is there a purpose in my life?’
Socrates answers these questions for us in a very profound way. We find an enlightening and empowering view of life through what he has said. In essence he says that the whole of creation has purpose, meaning, and destiny. He talks about the permanence of the soul. And he talks about specifically the fear of death and that there is no death. We do go on in a different form through the existence of our soul or our spirit, which is never destroyed.
Spirituality and philosophy give us the kind of comfort that we desperately seek during these stressful times of questioning our own mortality. It is very soothing to the soul and it does help us cope.
Member question: It’s hard to ask for help sometimes, with pain or with psychological effects. There’s a guilt there that says, “Stop whining, at least you’re alive.” How to get past that?
There are some things people need to do when they’re diagnosed with cancer:
They need to make their life simple.
They need to get help with household chores during treatment.
They should make to-do lists to delegate responsibilities.
They should let their friends help.
It’s OK to say I can use some help with meals.
Do something positive for yourself every day.
Accept that these are temporary limitations and there should be no room for guilt.
All these things impact on your sense of empowerment. When you have guilt, you’re not empowered. When you have the courage to ask for help, you are empowering yourself to act on your behalf. This will be your greatest advantage. So get rid of the guilt and get empowered.
Member question: What is your advice for getting past the “Why me?” shock of a diagnosis?
Dahm: First, you need time to process what has just happened. This may take a week; it may take several weeks. There will be a grieving period. But after the shock must come the empowerment phase, and that is where you sit down and make a plan.
You must have information about the kind of cancer you have, the treatment options that are given to you, and elicit help from support organizations and from your doctor. Go online and get a plethora of information about treatments and support. Join a support group online if you don’t want to go in person, but do not try to handle this on your own. You will do much better with the help of other people.
People can always write to me at www.cancerbook.com and I will always help give them the information they need. At least that way we can work that way together. By you taking actions you will decrease the perception of the shock.
Moderator: And of course, we have support groups and lots of information available to you on WebMD. Check our message boards for a good jumping off point.
Member question: What is the best thing that family members can do in the diagnosis stage?
Dahm: The best thing a family can do to help is to hold a family meeting with the loved one who is diagnosed. The best plan is a plan that you come up with together. Delegate responsibilities to different family members. Express your feelings and concerns with your family. Get help with household chores. Prioritize your needs. Simplify your lives as much as possible. Because you can’t cope with the stress and at the same time expected to do the things that you’ve always done before. So you have to limit your involvement with work and things that are stressful to you during this period.
Member question: What role do you see for education in dealing with cancer? I want to know all about breast cancer and I don’t want to know all about breast cancer.
Dahm: My best advice is to learn everything about it that you can, because knowledge is power. Fear of knowing can be far worse as far as how you deal with the cancer.
Member question: What nonmedicinal pain management techniques do you recommend? Yoga? Meditation? Acupuncture?
Dahm: I recommend many nonmedicinal therapies for stress, for pain management:
Acupuncture, which is good for many things: pain; stress; anxiety
Massage therapy
Music therapy
Humor is also very important. Countless people have used humor to control pain, to relieve depression, and to fight infection, and it’s been proven that a therapy of humor can help heal the body in terms of how the immune system functions. It is greatly affected by using humor.
Biofeedback
Meditation
Mental imagery or positive thoughts
The whole goal of all these methods is to maintain your body and your mind in a state of equilibrium, a balance.
Moderator: For those interested in humor, please check out “Not Now...I’m Having a No Hair Day,” by Christine Clifford. She’s a cancer survivor who has published several books dealing humorously with her cancer experience.
Moderator: Judging from your book, you are clearly a religious person. For those who are, what role do you see for religious institutions to assist someone living with cancer?
Dahm: Although I am a religious person, inwardly I believe in all religions. I believe in philosophy, I believe in all religions, because each has something to offer. As far as religious institutions assisting people with their need for spirituality, this is a very important thing, in that they should be assisting people with whatever the patient’s belief systems are. If you’re in a Catholic hospital, there should be a rabbi, a minister, a priest, a representative from different religious beliefs assisting the patients and families with their own religious beliefs.
I wrote an article called “Spirituality and Cancer,” that is on my web site at www.cancerbook.com. It addresses spirituality as a connection to and reverence for all that is universal, and what it can do for us in terms of why we’re here and our own mortality issues. It is not about religion. It is about developing a sense of spirituality that is different from religion, and institutions should be incorporating this into their care of patients.
Member question: Do you see a difference in patients who have a religious base to work from and those that don’t?
Dahm: Yes, I do. Those who have a religious base to draw from are usually people who present themselves as calmer in dealing with cancer. There’s a sense of internal comfort that they have, and less fear. Those without a religious base have a bit more of a difficult time dealing with stress and anxiety and fear.
However, those who do not have a religious base can help themselves by using the methods that we talked about earlier, like the massage. In other words, learn self-love. People need to go into themselves more and find out who they are and learn to love who they are. That will give them a greater sense of calm and dignity. They have to work at it, and they need help in doing that, but there are endless possibilities for improving your own sense of comfort and empowerment.
Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us, Nancy?
Dahm: Taking care of yourself — mind, body, and soul — can mean the difference between being a victim and being in control and able to fight — not with anger, but with love, understanding, and determination.
Visit my web site at www.cancerbook.com for my articles and resources.
Moderator: Thanks to Nancy Hassett Dahm, RN, for sharing her expertise with us today. For more information, please read her book “Mind, Body, and Soul: A Guide to Living with Cancer.” And please explore our several message boards devoted to breast cancer and cancer in general, as well our many articles and archived Live Events.
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