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
McGill University Health Centre-Royal Victoria
Segal Cancer Centre
Hospital (MUHC-RVH)
Sir Mortimer B. Davis-Jewish General Hospital
(SMBD-JGH)
Dr. Martin Chasen, Oncologist, Palliative Care
Dr. Thomas Jagoe, Pulmonologist
Physician
Dr. Neil MacDonald, Oncologist, Palliative Care
Dr. Bruno Gagnon, Palliative Care Physician
Physician
Dr. Pasqualina Di Dio, Psychologist
Dr. Polymnia Galiatsatos, Gastroenterologist
Ms. Shafia Amdouni, Dietitian
Dr. Maryse Duchesne, Psychologist
Ms. Marta Jelowicki, Physiotherapist
Ms. Nelda Swinton, Dietitian
Ms. Josée Lemoignan, Occupational
Ms. Christina Van Der Borch, Dietitian
Therapist
Mr. Anh-Thi Tran, Physiotherapist
Ms. Siobhan Carney, Infirmière Pivot
Ms. Natasha Grant, Physiotherapist
Ms. Margaret Eades, Clinic Coordinator
Ms. Louise Champagne, Infirmière Pivot
and Clinical Nurse
Dr. Goulnar Kasymjanova, Research Associate
Specialist
Dr. Ravi Bhargava, Clinical Research Associate Dr. Ravi Bhargava, Clinical Research Associate
Ms. Cynthia Bromberg, Clinic Coordinator
Ms. Sarah Schulman, Clinic Coordinator
Dr. Rajesh Sharma, Data Manager
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
McGill Cancer Nutrition-Rehabilitation Program
Index To Slide Presentation
Section
Introduction
About the McGill Cancer Nutrition-Rehabilitation Program
Cancer-Related Anxiety
Cancer-Related Fatigue
Nutrition
Complementary Therapies
A Final Note
McGill Cancer Nutrition-Rehabilitation Program Coordinates
Slides
3-7
8-12
13-24
25-39
40-41
42-54
55
56
McGill Cancer Nutrition-Rehabilitation Program
INTRODUCTION
McGill Cancer Nutrition-Rehabilitation Program
The Human Side of Cancer
“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
McGill Cancer Nutrition-Rehabilitation Program
Cancer Survivors Tell Us
● 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.
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.
McGill Cancer Nutrition-Rehabilitation Program
Living With Cancer Treatments
● 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.
McGill Cancer Nutrition-Rehabilitation Program
About the McGill Cancer
Nutrition-Rehabilitation
Program
McGill Cancer Nutrition-Rehabilitation Program
Program Focus
 Clinical Care
 Research
 Education
McGill Cancer Nutrition-Rehabilitation Program
Mission
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.
McGill Cancer Nutrition-Rehabilitation Program
Overall Goals
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Specific Goals
● 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.
McGill Cancer Nutrition-Rehabilitation Program
CANCER-RELATED ANXIETY
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.
McGill Cancer Nutrition-Rehabilitation Program
Cancer-Related Anxiety Can
Increase
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Cancer-Related Anxiety Affects
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Anxiety
● 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 reevaluation of a situation
McGill Cancer Nutrition-Rehabilitation Program
When you identify triggers make note
of what they are.
Knowing is the first step to managing
them better.
McGill Cancer Nutrition-Rehabilitation Program
Suggestions To Help Reduce
Anxiety Levels
 Talk to friends/family
 Listen to music
 Relaxation Exercises
 Meditation
McGill Cancer Nutrition-Rehabilitation Program
Reduce Anxiety: Good Sleep
Preparation Habits
● 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).
McGill Cancer Nutrition-Rehabilitation Program
Reduce Anxiety: Activity
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Talk To Your Doctor/Nurse
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.
McGill Cancer Nutrition-Rehabilitation Program
Tips To Caregivers To Manage
Their Anxiety
 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.
McGill Cancer Nutrition-Rehabilitation Program
Tips To Caregivers To Manage
Their Anxiety
 Use available community resources.
 Don’t 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.
McGill Cancer Nutrition-Rehabilitation Program
Cancer-Related Fatigue
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).”
McGill Cancer Nutrition-Rehabilitation Program
How frequent is fatigue ?
● 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).
McGill Cancer Nutrition-Rehabilitation Program
Cancer-Related Fatigue
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Consequences Of Cancer-Related
Fatigue
● Feeling weary or exhausted (physically, mentally and/or
emotionally).
● Your body (arms and legs) feels heavy and achy.
● You don’t feel like doing normal activities (eg. eating,
shopping).
● You may find it hard to concentrate and make decisions.
McGill Cancer Nutrition-Rehabilitation Program
What Are Things You Can Do
To Help Reduce Your Fatigue
● Rest
● Activity
● Nutrition
● Energy Conservation
● Energy Restoration
McGill Cancer Nutrition-Rehabilitation Program
Rest
● Sleep and Rest are important.
● But don’t over do it. Too much can decrease your
energy levels and reduce muscle function. “if you
don’t use it, you’ll lose it.”
● If you have trouble sleeping tell your doctor.
● A “Power Nap” in the day is 1 hour or less.
McGill Cancer Nutrition-Rehabilitation Program
Reduce Fatigue: Good Sleep
Preparation Habits
● 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).
McGill Cancer Nutrition-Rehabilitation Program
Reduce Fatigue: Activity
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Reduce Fatigue: Nutrition
● 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/
McGill Cancer Nutrition-Rehabilitation Program
Reduce Fatigue: Energy
Conservation
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Reduce Fatigue: Energy
Restoration
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Talk To Your Doctor/Nurse
If You Feel:
● More fatigued than normal.
● You have more problems concentrating.
● Too tired to get out of bed for more than 12 hrs.
McGill Cancer Nutrition-Rehabilitation Program
Tips To Caregivers To Manage
Their Fatigue
 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.
McGill Cancer Nutrition-Rehabilitation Program
Tips To Caregivers To Manage
Their Fatigue
 Use available community resources.
 Don’t 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.
McGill Cancer Nutrition-Rehabilitation Program
NUTRITION
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/
McGill Cancer Nutrition-Rehabilitation Program
McGill Cancer Nutrition-Rehabilitation Program
Complementary Therapies
McGill Cancer Nutrition-Rehabilitation Program
Complementary Therapies
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Alternative Therapies Are
Different
From Complementary Therapies
● 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.
McGill Cancer Nutrition-Rehabilitation Program
Most Often We Refer To These
Therapies Together As CAMs
● 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.
McGill Cancer Nutrition-Rehabilitation Program
CAMs Are Available At Some
Cancer Centres
Memorial Sloan-Kettering
Duke & Stanford
CAM departments which study and offer a variety of
modalities: music therapy, healing touch, medical
Qigong, energy healing.
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.
McGill Cancer Nutrition-Rehabilitation Program
Nutritional & Dietary CAMs
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.
McGill Cancer Nutrition-Rehabilitation Program
Traditional and Folk Medicines
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.
McGill Cancer Nutrition-Rehabilitation Program
Herbal Medicines
Rationale: Includes natural herbs or botanicals.
Examples: Echinacea, Grape Seed, Green Tea, Aloe
Vera, Milk Thistle & Chaparral, Essiac,
Chamomile & Ginger, Ginseng, Kava-Kava.
McGill Cancer Nutrition-Rehabilitation Program
Herbal Medicines
● Clinical Trials in progress include examinations of green
tea, curcumin, flaxseed, ginger, ginkgo, grape seed
extract & milk thistle extract, mistletoe & St John’s Wort
(NIH, 2003).
● Botanicals can interact with one another and with some
medicines (chemotherapies) (Weiger et. al, 2002).
Important to check with doctor
McGill Cancer Nutrition-Rehabilitation Program
Mind-Body-Spirit Techniques
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.
McGill Cancer Nutrition-Rehabilitation Program
Manual Healing & Physical
Touch Methods
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.
McGill Cancer Nutrition-Rehabilitation Program
Breathing Exercise To
Let Go Of Tension
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.
McGill Cancer Nutrition-Rehabilitation Program
A Final Note
Remember to indulge in activities that
give you pleasure….activities that you
always enjoyed doing, or perhaps even
something new.
McGill Cancer Nutrition-Rehabilitation Program
McGill Cancer Nutrition-Rehabilitation Program
www.mcgill.ca/cnr
Dr. R. Thomas Jagoe, Program Director
Dr. Martin R. Chasen, Clinical Director
Dr. Neil MacDonald, Founding Director
546 Avenue des Pins Ouest
Montreal, Quebec
H2W 1S6
Tel: (514) 398-8988
Fax: (514) 398-5111