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Title: Cancer treatments include:

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
Index To Slide Presentation
McGill Cancer Nutrition-Rehabilitation Program

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
The Human Side of Cancer
McGill Cancer Nutrition-Rehabilitation Program

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
Cancer Survivors Tell Us
McGill Cancer Nutrition-Rehabilitation Program

? 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
Living With Cancer Treatments
McGill Cancer Nutrition-Rehabilitation Program

? 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
Program Focus
McGill Cancer Nutrition-Rehabilitation Program

? Clinical Care
? Research
? Education

10
Mission
McGill Cancer Nutrition-Rehabilitation Program

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
Overall Goals
McGill Cancer Nutrition-Rehabilitation Program

? 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
Specific Goals
McGill Cancer Nutrition-Rehabilitation Program

? 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
CANCER-RELATED ANXIETY
McGill Cancer Nutrition-Rehabilitation Program
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
Cancer-Related Anxiety Can Increase
McGill Cancer Nutrition-Rehabilitation Program

? 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
Cancer-Related Anxiety Affects
McGill Cancer Nutrition-Rehabilitation Program

? 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
Anxiety
McGill Cancer Nutrition-Rehabilitation Program

? 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
Suggestions To Help Reduce Anxiety Levels
McGill Cancer Nutrition-Rehabilitation Program

? Talk to friends/family
? Listen to music
? Relaxation Exercises
? Meditation

20
Reduce Anxiety Good Sleep Preparation Habits
McGill Cancer Nutrition-Rehabilitation Program

? 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
Reduce Anxiety Activity
McGill Cancer Nutrition-Rehabilitation Program

? 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
Talk To Your Doctor/Nurse
McGill Cancer Nutrition-Rehabilitation Program

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
Tips To Caregivers To Manage Their Anxiety
McGill Cancer Nutrition-Rehabilitation Program

? 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
Tips To Caregivers To Manage Their Anxiety
McGill Cancer Nutrition-Rehabilitation Program

? Use available community resources.
? Dont 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
Cancer-Related Fatigue
McGill Cancer Nutrition-Rehabilitation Program
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
How frequent is fatigue ?
McGill Cancer Nutrition-Rehabilitation Program

? 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
Cancer-Related Fatigue
McGill Cancer Nutrition-Rehabilitation Program

? 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
Consequences Of Cancer-Related Fatigue
McGill Cancer Nutrition-Rehabilitation Program

? Feeling weary or exhausted (physically,
mentally and/or emotionally).
? Your body (arms and legs) feels heavy and achy.
? You dont feel like doing normal activities
(eg. eating, shopping).
? You may find it hard to concentrate and make
decisions.

30
What Are Things You Can Do To Help Reduce Your
Fatigue
McGill Cancer Nutrition-Rehabilitation Program

? Rest
? Activity
? Nutrition
? Energy Conservation
? Energy Restoration

31
Rest
McGill Cancer Nutrition-Rehabilitation Program

? Sleep and Rest are important.
? But dont over do it. Too much can decrease
your energy levels and reduce muscle function.
if you dont use it, youll lose it.
? If you have trouble sleeping tell your doctor.
? A Power Nap in the day is 1 hour or less.

32
Reduce Fatigue Good Sleep Preparation Habits
McGill Cancer Nutrition-Rehabilitation Program

? 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
Reduce Fatigue Activity
McGill Cancer Nutrition-Rehabilitation Program

? 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
Reduce Fatigue Nutrition
McGill Cancer Nutrition-Rehabilitation Program

? 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
Reduce Fatigue Energy Conservation
McGill Cancer Nutrition-Rehabilitation Program

? 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
Reduce Fatigue Energy Restoration
McGill Cancer Nutrition-Rehabilitation Program

? 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
Talk To Your Doctor/Nurse
McGill Cancer Nutrition-Rehabilitation Program

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
Tips To Caregivers To Manage Their Fatigue
McGill Cancer Nutrition-Rehabilitation Program

? 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
Tips To Caregivers To Manage Their Fatigue
McGill Cancer Nutrition-Rehabilitation Program

? Use available community resources.
? Dont 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
NUTRITION
McGill Cancer Nutrition-Rehabilitation Program
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
Complementary Therapies
McGill Cancer Nutrition-Rehabilitation Program
43
Complementary Therapies
McGill Cancer Nutrition-Rehabilitation Program

? 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
Alternative Therapies Are Different From
Complementary Therapies
McGill Cancer Nutrition-Rehabilitation Program

? 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
Most Often We Refer To These Therapies Together
As CAMs
McGill Cancer Nutrition-Rehabilitation Program

? 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
CAMs Are Available At Some Cancer Centres
McGill Cancer Nutrition-Rehabilitation Program

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
Nutritional Dietary CAMs
McGill Cancer Nutrition-Rehabilitation Program

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
Traditional and Folk Medicines
McGill Cancer Nutrition-Rehabilitation Program

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
Herbal Medicines
McGill Cancer Nutrition-Rehabilitation Program

Rationale Includes natural herbs or botanicals.
Examples Echinacea, Grape Seed, Green Tea, Aloe
Vera, Milk Thistle Chaparral,
Essiac,
Chamomile Ginger, Ginseng,
Kava-Kava.

51
Herbal Medicines
McGill Cancer Nutrition-Rehabilitation Program

? Clinical Trials in progress include
examinations of green tea, curcumin, flaxseed,
ginger, ginkgo, grape seed extract milk thistle
extract, mistletoe St Johns Wort (NIH, 2003).
? Botanicals can interact with one another and
with some medicines (chemotherapies) (Weiger et.
al, 2002).
Important to check with doctor

52
Mind-Body-Spirit Techniques
McGill Cancer Nutrition-Rehabilitation Program

Rationale Emotions may influence the course of
disease.
Objective Reduce stress through yoga,
biofeedback, group
support and/or music therapy.
Clinical trials (NIH, 2003) include music
therapy, massage, prayer and mindful-based art
therapy.

53
Manual Healing Physical Touch Methods
McGill Cancer Nutrition-Rehabilitation Program

Rationale Course of disease is influenced by
energies or forces that can be
manipulated.
Examples Range from acupuncture and chiropractic
to therapeutic touch
Clinical trials (NIH, 2003) are assessing
acupressure to control chemotherapy nausea and
acupuncture to control symptoms.

54
Breathing Exercise To Let Go Of
Tension
McGill Cancer Nutrition-Rehabilitation Program

1) Sit comfortably in a chair with feet flat on
the floor.
2) Breathe in deeply into your abdomen and say to
yourself Breathe in relaxation.
3) Breathe out from your abdomen and say to
yourself Breathe out tension.
4) Use each inhalation to become aware of any
tension in your body.
5) Use each exhalation to become aware of
letting go of tension.
6) Use your imagination to picture relaxation
entering your body and tension leaving your body.

55
A Final Note
McGill Cancer Nutrition-Rehabilitation Program