The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center
Fall ’12
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The promise of medical hypnosis By Mary Brolley
in medical hypnosis to relax her enough to get through the MRI. She agreed. Lipski read the patient a short, standard script that asked for her cooperation and participation in a relaxation exercise, then guided her into it. Forty-five minutes later, she emerged from the procedure. “She was fine. She said she fell asleep,” Lipski says.
The patient was claustrophobic. Scheduled for an MRI to screen for cancer, she was afraid to have the procedure. But because she’d already had three primary cancers and was experiencing new symptoms, she needed it. Patients who can’t tolerate closed spaces aren’t unusual, according to Ian Lipski, M.D., clinical associate professor in the Department of Anesthesiology and Perioperative Medicine. “When we’re called to sedate patients, it’s usually for claustrophobia, anxiety and/or pain,” he says. But this patient had come in alone and had no one to drive her home. Giving her drugs was out of the question. Luckily, Lipski had another tool at his disposal. He asked the woman if she’d consider participating
New option gives patients more control Medical hypnosis is the use of hypnosis within the medical setting to help reduce anxiety, fear or pain, or help manage other symptoms. It’s gaining attention and racking up success stories as its use grows. Lipski was trained in the technique in 2010 at a three-day conference in Boston sponsored by the Society for Clinical and Experimental Hypnosis. Elvira Lang, M.D., an interventional radiologist who developed her own techniques in her practice, trained him and others. Lipski was hooked. Back at MD Anderson, he enlisted the support of Kenneth Sapire, M.D., professor, and Thomas Rahlfs, M.D., professor and chair of the continued on page 2
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The promise of medical hypnosis continued from page 1 department. Soon Lang was invited to the institution to train more than a dozen interested staff from anesthesiology, internal medicine, interventional radiology, proton therapy, thoracic surgery and pediatrics.
And it may reduce the amount of medication necessary to complete a procedure.
Since then, several anesthetic procedures have been performed at MD Anderson with medical hypnosis, either alone or as a complement to medication.
Hypnosis has also been used to reduce side effects like pain, anxiety, hot flashes and depression. It requires no prescription and has no side effects.
Crucial to its success, Lipski says, is establishing an instant rapport with patients. “We mirror body language. We tune in to preferences. For example, a patient might say, ‘I can’t see myself getting through this.’ “This can mean he’s a visual learner, so we help him visualize a peaceful or relaxing scene.” It’s important for practitioners to avoid negative suggestions, such as “This may hurt or cause discomfort.” Instead, the script emphasizes breathing exercises and progressive relaxation. These serve to focus attention on something pleasant, and the actual environment moves to the periphery.
What medical hypnosis isn’t It’s not magic, trickery or mind control. It’s an altered mental state, a state of focused attention, that’s entered willingly. It distracts a patient from pain or discomfort. It’s a complement to — not a substitute for — traditional anesthesia, Lipski says.
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“And procedures with less medication may be shorter,” Lipski adds.
“Of course, I’m not a trained psychotherapist,” Lipski says. “I’m interested in using this technique for procedural purposes in a rapid, fast-paced environment.” He sees great promise in the use of medical hypnosis at MD Anderson. He plans to work closely with Lorenzo Cohen, Ph.D., and Richard T. Lee, M.D., professor and assistant professor, respectively, in the Department of General Oncology and co-directors of the Integrative Medicine Program. “We’ll collaborate to develop a strategy to work medical hypnosis into our perioperative standards,” he says. “We want to deliver more compassionate care to patients while empowering them to participate,” he adds.
Scan this QR code to hear a Cancer Newsline podcast on medical hypnosis.
people profile Eva Vega: Spanish speaker a ‘walking advertisement’ for peer support By Erica Quiroz
Eva Vega has one mission: To educate as many Spanish speakers as she can about cancer. As the chair of Anderson Network’s 24th annual Cancer Survivorship Conference, held Sept. 14-15, her recruitment efforts were responsible for an impressive surge in Hispanic/ Latino attendees. There were more than 90 Spanish-speaking participants. “I tell people about Anderson Network and the conference because I want them to have the same support I’ve received,” she says. “Patients at MD Anderson aren’t always aware of the available programs.” Born in Mexico, Vega was diagnosed with breast cancer in 1999 and knows how overwhelming the disease can be. “I was very depressed after I received my diagnosis,” she says. “My doctor suggested that I go to a support group for Spanish speakers. I told him I would go, but kept putting it off.”
language,” Vega says. “Then we can go back to our families and share what we’ve learned.” A member of Anderson Network’s steering committee, Vega is a walking advertisement for Anderson Network, a program of the Department of Volunteer Services that delivers supportive programs to patients, survivors and caregivers. When it comes to their health, she advises patients to trust their instincts.
After rebuffing his suggestion several times, Vega finally went to a support group at The Rose (a non-profit breast cancer organization) and was amazed at the amount of information she received.
“We’re the ones who know our bodies. If there’s anything unusual, people need to see a doctor,” she says. “I caught my cancer very early, and I want people to know all the options they have to prevent cancer.”
“Meeting women who were going through the same thing gave me a lot of confidence,” she says. “And that’s when I heard about the conference for the first time.”
Vega speaks to people she meets throughout the year in Houston, at her church, The Rose, Ben Taub General Hospital, Lyndon B. Johnson General Hospital — even at the grocery store.
Making a difference
“I know that Spanish speakers don’t go to events like this for many reasons, so my main goal is to make them aware of this resource and increase their attendance,” she says.
With her newfound support system, Vega and friends from her support group jumped at the chance to attend their first conference in 2004. They’ve attended every year since. With more Hispanics/Latinos attending, breakout sessions in Spanish were added to the conference in 2008. Vega says these sessions have benefited her group and other Spanish speakers enormously.
“We hear about cancer research and prevention in our own
“Growing up in Mexico, I never thought I’d face this disease, but it’s given me so much. I’ve met a lot of people, I’ve grown as a person and I’ve been able to help other women.”
To learn more about Anderson Network, call 713-792-2553 or 800-345-6324 or click on www.mdanderson.org/andersonnetwork. 3
doctor, doctor
Focus on the cardiac catheterization lab We asked Jean-Bernard Durand, M.D., associate professor in the Department of Cardiology, to tell us about MD Anderson’s state-of-the-art cardiac catheterization lab. What is a cardiac catheterization lab? It’s a diagnostic and interventional suite where we perform tests to discover any abnormalities of the heart prior to, during or after exposure to cancer treatment.
Why is it important for MD Anderson to have one? The number one cause of death after surviving cancer is heart disease. MD Anderson is the world leader in treating complications that have developed from cancer-related treatment. This experience helps us identify and treat heart disease early so patients can continue to have a wonderful life after cancer treatment. We also want to assure a continuum of care to our patients, many of whom are too ill to have these serious heart complications treated elsewhere.
What’s one example of a problem that your cath lab is especially equipped to deal with? One-quarter of our patients have low platelets, which can cause prolonged bleeding times. Most labs wouldn’t consider performing catheterizations on such patients, but we’re treating them safely and effectively. Our experience and published data suggest that these are very high-risk patients who need to be evaluated in a center staffed by cardiologists with substantial knowledge of the interaction between cancer and heart disease.
How does cancer or its treatment affect patients’ cardiac health? Cancer can develop within the heart, or some cancers, such as breast, lymphoma or sarcoma, may travel to the heart and cause symptoms. Many cancer therapies affect the heart muscle. Also, radiation can injure all structures of the heart: its muscle, valves, coronaries and electrical system.
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Jean-Bernard Durand, M.D.
How does the team’s work in the lab improve patient outcomes? Early identification and diagnosis of heart disease allows us to intervene early and minimize side effects during and after chemotherapy. Members of the cath lab team have extensive experience in cardiovascular disease.
What kinds of research are going on in the lab? We’re investigating all aspects of how the heart is injured and its ability to protect itself from further injury. We have extensive protocols that evaluate blood flow through the coronaries and determine the need for treatment with a stent (metal coil) to prevent a heart attack during chemotherapy or surgery. We’re also studying the microscopic changes that occur from chemotherapy and how that may predict the heart’s ability to repair itself.
Your small but experienced team has treated more than 1,000 patients. What do you see for the future of the lab? We have plans to pursue treatment of cardiac tumors with minimally invasive strategies and also to develop methods to identify early injury to the heart. We have a new cardiologist trained in electrophysiology who’ll introduce new therapies to prevent sudden cardiac death, treatment of heart failure and electrical rhythms. Also, MD Anderson is well prepared to introduce stem cell therapy to repair heart tissue.
For more information about the Cardiac Catheterization Lab, call 713-792-4015 or call askMDAnderson at 1-877-632-6789. Appointments require a physician’s referral.
research briefs Predictive value of circulating tumor cells Circulating tumor cells — established in metastatic breast cancer for predicting a woman’s chance of recurrence and survival — have now shown similar value in early stage breast cancer. As one of the first studies and the largest to show this new predictive value, its findings may help determine which earlier stage breast cancer patients need additional treatment and intervention in the adjuvant setting. Lead author and principal investigator: Anthony Lucci, M.D., professor in MD Anderson’s Department of Surgical Oncology. Reported in the July 2012 edition of Lancet Oncology.
Genetic change caused by sun damage It’s been a burning question in melanoma research: Tumor cells are full of ultraviolet (UV)-induced genetic damage caused by sunlight exposure, but which mutations drive this cancer? The sheer abundance of these passenger mutations has obscured the search for genetic driver mutations that actually matter in melanoma development and progression. Researchers, however, have now identified six genes with driving mutations in melanoma, three of which have recurrent “hotspot” mutations as a result of damage inflicted by UV light. Co-senior author: Lynda Chin, M.D., professor and chair of MD Anderson’s Department of Genomic Medicine; in collaboration with scientists at the Broad Institute of MIT and Harvard, and the Dana-Farber Cancer Institute. Reported in the July 20, 2012, issue of the journal Cell. .
Clinical tool indicates radiation benefit A new nomogram, or clinical model, demonstrates accuracy in predicting the benefit of radiation therapy in older women — ages 66-79 — with breast cancer. The study may offer clinical guidance to physicians, so they can help determine which patients in this age group will likely benefit from radiation therapy. As the U.S. population ages, it is critical to establish indications for radiation therapy. A 57% increase in breast cancer diagnoses in older women is projected during the next two decades. Lead author: Benjamin Smith, M.D., assistant professor in MD Anderson’s Department of Radiation Oncology. Reported in the Aug. 10, 2012, edition of the Journal of Clinical Oncology.
Therapies for rheumatoid arthritis do not increase cancer risk Biologic therapies developed for patients with rheumatoid arthritis during the last decade have caused concern about possible links to cancer. However, results from the largest systematic review of these drugs — including 29,423 adult patients from 63 randomized, controlled trials — showed no statistically significant increased risk of any type of cancer in patients treated with these biologic response modifiers (BRMs), compared to other medications. Rheumatoid arthritis affects approximately 1% of the population and can lead to significant morbidity, joint deformity and impaired quality of life. Researchers compared the safety of all nine BRMs currently approved by the U.S. Food and Drug Administration against a placebo or traditional disease-modifying, anti-rheumatic drug. They worked with the Cochrane Collaboration, an independent, non-profit organization that houses the largest collection of records of randomized, controlled trials in the world. Senior author: Maria Suarez-Almazor, M.D., professor in the Department of General Internal Medicine. Reported in the Sept. 5, 2012, issue of the Journal of the American Medical Association.
To learn more about MD Anderson research, visit www.mdanderson.org/newsroom or the Cancer Frontline blog at www2.mdanderson. org/cancerfrontline. 5
Bedside manners: Can
empathic communication be taught? By Mary Brolley Walter Baile, M.D.
Walter Baile, M.D., remembers the moment he discovered his passion. “A patient with metastatic breast cancer came to my clinic for counseling. She’d recently been told by her physician that her cancer had recurred. When she got this news, she was understandably upset and began to cry. “She said he told her that if she didn’t stop crying, he’d leave the room,” Baile, professor in the Department of Behavioral Science, recalls with amazement. As a psychiatrist treating cancer patients, he’d heard many stories from distraught patients about physicians who’d told them in blunt terms that further treatment would be futile. “Some just told them it was the end of the line, or to get their affairs in order. One doctor told a patient that he wouldn’t touch his case ‘with a 10-foot pole.’” So Baile decided to do something about it. He began to design a training course for physicians and health care professionals to help them communicate more compassionately and effectively with patients.
‘A different set of skills’ Called Interpersonal Communication and Relationship Enhancement — I*CARE for short — the program provides guidelines and video demonstrations for medical professionals on how to empathize with patients and caregivers and communicate with honesty and concern.
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In medical school, physicians are taught a set of specialized skills focused on treating the disease, Baile says. “But, today more than ever, a different set of skills is required. Physicians need to know how to get into the shoes of the patient. Because so many cancers are treatable, patients have many other concerns than dying.” Some of these are side effects, the impact of the cancer on the family, the ability (or inability) to work and the fear of recurrence. “When doctors need to deliver bad news, it’s important for patients to feel supported. Physicians must acknowledge the feelings the patient is experiencing, and listening is an important first step,” Baile says. A fundamental goal of the program is to strengthen relationships between patients and physicians. Establishing trust early by listening and conveying empathy is essential and will sustain the patient and family when things aren’t going well — for example, the disease has recurred or progressed, side effects are worsening, or chemotherapy or targeted therapies aren’t working.
A resource for medical staff, volunteers, patients The I*CARE team has conducted workshops for more than 1,000 oncology care providers at MD Anderson and beyond. It breaks down communication into specific skills applicable to physicians, physician assistants, nurses, patient advocates, chaplains, patient volunteers and others. Today, the program’s website is a rich resource for clinicians all over the world. A video series called the MD Anderson Library of Clinical Communications Skills covers the fundamental principles of communication and such topics as acknowledging emotions, breaking bad news,
transition to palliative care, end-of-life care, disclosing medical errors and additional difficult conversations that occur when someone has a life-threatening illness. The videos feature experts from universities and medical schools all over the United States and in several other countries. However, while videos and explanations can provide guidelines, hands-on instruction through interactive workshops can lead to more sustainable acquisition of these skills. So the I*CARE team provides custom workshops for internal and external audiences, such as the one Baile’s team developed for MD Anderson’s Department of Volunteer Services. It trains volunteers and the supervisors who manage them, says Mary Donnelly Jackson, program manager in the department. Baile worked with Jackson and Jacquié Frelow, volunteer coordinator, to create a workshop for volunteers who interact with patients and families going through emotional crises. Jackson also uses the I*CARE videos as continuing education tools for volunteers who must complete annual training modules. The videos have helped them sharpen crucial skills in assisting patients in distress without overstepping boundaries.
“Working with Dr. Baile and the I*CARE team has been a great experience,” Jackson says. “The response from volunteers is so positive. They’re so impressed with the quality of the videos that we’re offering them year-round now.” Baile says it’s been heartening to see the program’s growth and success. “I’ve taught courses in Italy, Germany, Japan and Portugal,” he says. “Except for some cultural differences, health care professionals around the globe face similar communication challenges. “At one time we withheld the truth about the disease from cancer patients. Now, however, the question has become not ‘whether to tell,’ but ‘how to tell and support the patient and family.’”
I*CARE has resources for patients, survivors and caregivers. “Talking About the Side Effects of Cancer” offers an expert perspective on why it’s important to report side effects and how best to discuss them with your doctor. To find it, go to Network online at www.mdanderson.org/network.
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network The Anderson Network is a program of Volunteer Services at MD Anderson Cancer Center. Address changes should be sent to: Mary Brolley The University of Texas MD Anderson Cancer Center Communications Office – Unit 700 6900 Fannin St. Houston, TX 77030-3800 Phone: 713-792-0658 Fax: 713-563-9735 Email: mbrolley@mdanderson.org Articles and photos may be reprinted with permission. Susan French, Executive Director, Volunteer Services Debbie Schultz, Assistant Director, Volunteer Services/ Anderson Network Sara McIntosh, Chair, Anderson Network Mary Brolley, Writer/Editor, Network Scott Merville, Erica Quiroz, Contributing Writers Gini Reed, Graphic Design © 2012 The University of Texas MD Anderson Cancer Center
Moon Shots Program ‘a giant leap’ for patients MD Anderson is launching an unprecedented effort to dramatically accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths. President Ronald DePinho, M.D., says that the success of the new Moon Shots Program will be measured by reduced patient mortality and nothing less. The program brings together sizable multidisciplinary groups of researchers and clinicians to mount comprehensive attacks on eight cancers initially. They’ll work as part of six moon shot teams: acute myeloid leukemia and myelodysplastic syndrome, chronic lymphocytic leukemia, melanoma, lung cancer, prostate cancer, and triple-negative breast and high-grade serous ovarian cancers, which are linked at the molecular level. One of the moon shot leaders, Gordon Mills, M.D., Ph.D., chair and professor in the Department of Systems Biology, says it’s patients who remind MD Anderson why this effort can’t wait. “We’re no longer talking about it. We’re no longer thinking about it. We’re no longer promising it for the future. We’re doing it today,” he says.
Find out the results of Network’s readership survey at www.mdanderson.org/network 8
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