Treatment Modalities of Cancer & Osteoporosis

Cancer
It is known medically as a malignant neoplasm, is a broad group of various diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body.

Conventional Management of Cancer

The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control) or relief of symptoms associated with the disease (palliation).

Multiple modalities are commonly used in cancer treatment

1. Surgery- surgical removal of the entire cancer, it remains the ideal and frequently used in treatment method.
Diagnostic surgery is the definitive method of identifying the cellular characteristics that influence all treatment decisions.

Biopsy- performed to obtain a tissue sample for analysis of cells suspected to be malignant.

2. Radiation therapy- ionizing radiation is used to interrupt cellular growth. Used to control malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is present.

Types of radiation: a. External Radiation- higher energy, deeper penetration into the body b. Internal Radiation- delivers high dose radiation to a localized area

Effects of Radiation:
a. Alterations of oral mucosa- xerostomia (dryness), stomatitis, loss of taste and decrease salivation b. Entire G.I mucosa may be involved and esophageal irritation with chest pain and dysphagia. Anorexia, nausea, vomiting and diarrhea may occur.

Effects of Radiation:
3. Bone marrow cells proliferate rapidly and if sites containing bone marrow included, anemia, leukopenia, thrombocytopenia may result. Fatigue and malaise may also occur.

Multiple modalities are commonly used in cancer treatmentcont

3. Chemotherapy- antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions, including replication. It is used primarily to treat systemic disease rather than localized lesions that are amenabler to surgery or radiation therapy or both to reduce size preoperatively.

Special problems with chemotherapy: a. Extravasation b. G.I- nausea and vomiting c. Hematopoietic systemmyelosuppression d. Renal system- increase urinary excretion of uric acids e. Cardiopulmonary system- irreversible cumulative cardiac toxicities f. Reproductive system- possible sterility

Complementary and Alternative Medicine for Cancer

Complementary and Alternative Medicine is a group of diverse medical and health care systems, practices, and products that are not generally considered as part of the conventional medicine.

Complementary approaches that may be used with cancer treatment

1. Acupuncture Acupuncture is a technique in which very thin needles are put into the body to treat a number of symptoms. It may help with mild pain and some types of nausea.

Acupuncture cont
Overview Although available evidence does not suggest acupuncture is effective as a treatment for cancer, clinical studies have found it may help treat nausea caused by chemotherapy and surgical anesthesia (the drugs used to make you sleep and not feel pain during surgery).

What does it involve? In traditional acupuncture (sometimes called acupuncture therapy), needles are inserted at specific locations called acupoints in order to restore balance and healthy energy flow to the body. Needles are put just deep enough into the skin to keep them from falling out and are usually left in place for a few minutes. Skilled acupuncturists cause virtually no pain. The acupuncturist may twirl the needles or apply heat or a weak electrical current to enhance the effects of the therapy

2. Aromatherapy Aromatherapy is the use of fragrant substances, called essential oils, that are distilled from plants to alter mood or improve symptoms such as stress or nausea.
Overview Available scientific evidence does not support claims that aromatherapy is effective in preventing or treating cancer, but its use may enhance quality of life. Early clinical trials suggest aromatherapy may have some benefit as a complementary treatment in reducing stress, pain, nausea, and depression.

Aromatherapy cont
What does it involve? Aromatherapy is either self-administered or administered by a practitioner. Many aromatherapists in the United States are trained as massage therapists, psychologists, social workers, or chiropractors and use the oils as part of their practices. The essential oils can be used individually or in combination and may be inhaled or applied to the skin. For inhalation, a few drops of the essential oil are placed in steaming water, atomizers, or humidifiers that are used to spread the water vapor and oil combination throughout the room. Sometimes the oils are placed in a heatproof dish over a candle or other flame to diffuse the scent.

3. Art therapy Art therapy is used to help people with physical and emotional problems by using creative activities to express emotions. This is done by mainstream therapists with specialized training.
Overview Many clinicians have observed and documented significant benefits among people who have used art therapy. Art therapy has not been studied scientifically to find out if it has value for people with cancer.

Art therapy cont..

What does it involve? People involved in art therapy are given the tools they need to produce paintings, drawings, sculptures, and many other types of artwork. Art therapists work with patients individually or in groups. The job of the art therapist is to help patients express themselves through their creations and to talk to patients about their emotions and concerns as they relate to their art.

4. Biofeedback

Biofeedback is a treatment method that uses monitoring devices to help people gain conscious control over physical processes that are usually controlled automatically, such as heart rate, blood pressure, temperature, sweating, and muscle tension.

Biofeedback cont..
Overview Biofeedback is one of several relaxation methods that was evaluated and found to be of possible benefit by an independent panel convened by the National Institutes of Health (NIH). What does it involve? Monitoring devices are used to amplify physical processes that are hard to detect without help. This information is then fed back in the form of a continuous signal (such as a tone or image readout). The person can adjust his or her thinking, emotional state, or other mental processes to focus on changing the signal and controlling his or her bodily functions.

5. Labyrinth walking Involves a meditative walk along a set circular pathway that goes to the center and comes back out. Labyrinths can also be walked online or on a grooved board following the curved path with a finger. 6. Massage therapy Massage involves manipulation, rubbing, and kneading of the bodys muscle and soft tissue. Some studies suggest massage can decrease stress, anxiety, depression, and pain and increase alertness.

Massage therapy cont..

Overview

Studies of massage for cancer patients suggest massage can decrease stress, anxiety, depression, pain, and fatigue. Many health care professionals recognize massage as a useful, noninvasive addition to standard medical treatment. Therapeutic massage is most often given by trained massage therapists. Caregivers can also be trained in safe massage techniques.

Massage cont
What does it involve? In all forms of massage, therapists use their hands (and sometimes forearms, elbows, and massage tools) to manipulate the body's soft tissue. Massage strokes can vary from light and shallow to firm and deep and from slow steady pressure to quick tapping. The type of massage stroke will depend on the health and needs of the individual and the training and style of the massage therapist. During active treatment for cancer, special considerations may apply.

7. Meditation

Meditation is a mind-body process in which a person uses concentration or reflection to relax the body and calm the mind. Overview Meditation is one of several relaxation methods evaluated and found to be of possible benefit by an independent panel convened by the National Institutes of Health (NIH). Some cancer treatment centers offer meditation or relaxation therapy with standard medical care. Available scientific evidence does not suggest that meditation is effective in treating cancer or any other disease; however, it may help to improve the quality of life for people with cancer.

Meditation cont..
What does it involve? There are different forms of meditation. Meditation may be done while sitting, but there are also moving forms of meditation, like tai chi, qigong, walking, and the Japanese martial art aikido. One commonly practiced type is Transcendental Meditation, which involves repeating a word or phrase, called a mantra, either silently or aloud. Another is mindfulness meditation, in which a person observes sensations, perceptions, and thoughts without judgment as they arise.

8. Music therapy Music therapy is offered by trained healthcare professionals who use music to promote healing and enhance quality of life.
Overview There is some evidence that, when used with conventional treatment, music therapy can help to reduce pain and relieve chemotherapyinduced nausea and vomiting. It may also relieve stress and provide an overall sense of well-being. Some studies have found that music therapy can lower heart rate, blood pressure, and breathing rate.

Music therapy cont

What does it involve?

Music therapists design music sessions for individuals and groups based on their needs and tastes. Some aspects of music therapy include making music, listening to music, writing songs, and talking about lyrics. Music therapy may also involve imagery and learning through music. It can be done in different places such as hospitals, cancer centers, hospices, at home, or anywhere people can benefit from its calming or stimulating effects. The patient does not need to have any musical ability to benefit from music therapy.

9. Prayer and spirituality Spirituality is generally described as an awareness of something greater than the individual self. Its often expressed through religion and/or prayer, but there are many other paths of spiritual pursuit and expression. Overview Studies have found spirituality and religion are very important to the quality of life for some people with cancer. Although available research has not supported claims that spirituality can cure cancer or any other disease, the psychological benefits of praying may include reduction of stress and anxiety, promotion of a more positive outlook, and the strengthening of the will to live.

Prayer and spirituality cont..

What does it involve? Spirituality has many forms and can be practiced in many ways. Prayer, for example, may be silent or spoken out loud and can be done alone in any setting or in groups, as in a church or temple. Regular attendance at a church, temple, or mosque may involve prayer that focuses on one's self (called supplication) or on others (called intercessory prayer). In this type of setting, the entire congregation may be asked to pray for a sick person or the persons family.

10. Tai chi: Tai chi is an ancient Chinese martial art. Its a mind-body system that uses movement, meditation, and breathing to improve health and well being. It has been shown to improve strength and balance in some people. 11. Yoga: Yoga is a form of nonaerobic exercise that involves a program of precise posture and breathing activities

Yoga cont
Overview Yoga can be a useful method to help relieve some symptoms of chronic diseases such as cancer, arthritis, and heart disease and can lead to increased relaxation and physical fitness. Available scientific evidence does not support yoga as an effective treatment for cancer or any other disease; however, it may enhance quality of life. Some cancer treatment centers even offer yoga in addition to standard medical treatment.

Yoga cont
What does it involve? There are more than a hundred different types of yoga practiced in the United States today. Most of them are based on hatha yoga, which uses movement, breathing exercises, and meditation to achieve a connection between mind, body, and spirit.

Osteoporosis
Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones. Osteopenia is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis.

Osteoporosis cont..
Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.

Pharmacologic Therapy
Pharmacologic management of OA is directed toward symptom management and pain control. In most patients, the initial analgesic therapy is acetaminophen. Other medications considered are opioids and intra-articular corticosteroids.

Surgical care includes vertebroplasty and kyphoplasty. Vertebroplasty and kyphoplasty are minimally invasive spine procedures used for the management of painful osteoporotic vertebral compression fractures.
Pain-relieving modalities such as moist hot packs and transcutaneous electrical nerve stimulation should also be considered.

Complementary and Alternative Medicine for Osteoporosis

Osteoporosis Treatment: The CAM Approach The body's bone modeling is based on two functions: osteoblasts, which build bone, and osteoclasts, which break down bone. The balance between these two processes is what helps to maintain healthy bones. The underpinning of osteoporosis therapies is all about affecting the behavior of one or both of those, explains Joyce Frye, MD, of the University of Maryland Center for Integrative Medicine. For example, Frye emphasizes the role of exercise in any therapeutic approach to osteoporosis. Exercise is the primary stimulator of osteoblast activity. Anything that can get people moving is the most important thing that they can do throughout their lives to maintain bone health.

Some CAM therapies that have a place in osteoporosis treatment include:

1. Acupuncture Acupuncture can increase energy, improve mood, and reduce pain, making it possible to get back into motion and therefore indirectly help to protect your bones. Biofeedback and relaxation techniques, such as meditation, can also achieve these results by reducing stress, which may enable you to participate in more physical activity.

2. Diet Eating an osteoporosis-friendly diet is recommended as part of an osteoporosis management plan. In addition to reviewing your intake of calcium, vitamin D, and other vitamins and minerals, a CAM physician will make recommendations about other elements of your diet and may suggest specific foods to incorporate. As an example, one review of existing data from 17 clinical trials concluded that isoflavones from soy or red clover may help strengthen women's bones after menopause.

3. Herbs Traditional Chinese herbal practitioners may suggest herbal teas, soups, and other therapies that can affect calcium use by your body. For your own safety, just be sure to work with a Chinese herbal practitioner who is certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

4. Nutritional supplements Consider using a bone-building supplement that includes calcium, zinc, magnesium, boron, and the other vitamins and minerals necessary for healthy bones.

Thank you for listening!

Sources: Smeltzer, S. & et. al. (2008). Textbook of medical-surgical nursing. 11th ed. USA: :Lippincott- Raven Publishers. ]

http://www.cancer.org/Treatment/TreatmentsandSideEffects/Comple mentaryandAlternativeMedicine/complementary-and-alternativemethods-for-cancer-management

http://www.everydayhealth.com/osteoporosis/alternativeosteoporosis-treatment.aspx