1. Mindfulness Tools… An introduction to practices and scientific evidence
18th Annual Women’s Health & Breast Cancer Conference
Expanding the Horizons of Breast & Women’s Health
Sheraton Hotel and Conference Center, Burlington, Vermont
October 2, 2015
Roz Grossman, MA
The Neshamah Center
Burlington, VT 05401
(802)
Yu–Jing Sun, PhD
(802) (C)
Vermont Cancer Center
(802) (O)

2. Mindfulness Tools
Interests to Disclose/All Potential Conflicts of Interest have been Resolved:
Roz Grossman, Owner of the Neshamah Center

3. Workshop Intentions
Explore and describe the benefits of mindfulness practices known to help reduce stress and promote wellness for cancer patients
Review mindfulness research studies from peer-reviewed journals with a highlight on cancer
Impact on psychological stages, physiological and immunological functions
Impact on breast cancer population
Research opportunities at Vermont Cancer Center

4. MINDFULNESS
MBSR 4

5. “Mindfulness” in the media

6. We aren’t trying to make things different
Awareness of Breath
The Breath Can Be Used as An Anchor Between the Mind and the Body to help us Focus
We aren’t trying to make things different

7. Yoga/Gentle Stretching
Awareness of Body
Paying attention
to sensations in the body
can help us to make
healthy choices
Body Scan
Yoga/Gentle Stretching 7

9. Stress and Mindfulness Reduction
Our Autonomic Nervous System
Sympathetic Parasympathetic
Activity Rest phase
Fight or Flight Relaxation

10. Studies with Nurses & Physicians
MBSR for Nurses
Mindfulness for Physicians
Improvements in
Stress, burnout and anxiety
Increased focus & self-care
Improvement in mood and decrease in depression
Potential to improve patient satisfaction & turnover
Use of Appreciative Inquiry - reinforcement of positive experiences more likely to change behavior in positive directions
May result in improvement in well being, burnout, mood, empathy and psychosocial beliefs
Smith, S. (2014) Mindfulness-Based Stress Reduction:
An Intervention to Enhance the Effectiveness of Nurses’
Coping with Work-Related Stress
International Journal of Nursing Knowledge, 25, No
Krasner, M. S., et al. (2009) Association of an
Education Program in Mindful Communication
With Burnout, Empathy, and Attitudes Among Primary
Care Physicians. JAMA 302,

11. It’s not the stressors in our lives but how we respond to them

12. Mindfulness Science Research
What has been found?
Why to study?
How to study ?

13. Neuroendocrine Immunology
Stress has significant adverse effects on health and is a risk factor for many illnesses.
From: Sternberg EM. Neural regulation of innate immunity: a coordinated nonspecific host response to pathogens. Nat Rev Immunol Apr;6(4): Review. PubMed PMID:
Schematic illustration of connections between the nervous and immune
systems. Signalling between the immune system and the central nervous system (CNS)
through systemic routes, the vagus nerve, the hypothalamic–pituitary–adrenal (HPA) axis,
the sympathetic nervous system (SNS) and the peripheral nervous system (PNS) are
shown.

14. Assessments used pre- and post-intervention
and follow-up
Demographics and Medical History Form
Health Behaviors Form
Cancer Quality of Life Questionnaire (QLQ-C30)
Profile of Mood States (POMS)
Symptoms of Stress Inventory (SOSI)
Sleep quality
Psychological and behavior measurement
Characterization of Leukocytes Subclasses
Intracellular Cytokine Determination
Natural killer (NK) Cell Function Assay
Hormone Assays (Cortisol, DHEAS, melatonin)
Gene and Protein Expression
Endocrine and
Immune function
Physical assessment
Blood pressure
Heart rate

16. Mindfulness Intervention for Cancer patients can :
Reduce stress (Carlson, 2003, 2007, 2013, Zainal 2013)
Increase quality of life (Carlson, 2007, Witek-Janusek, 2008)
Increase sleep quality (Carlson 2004, Lengacher 2014)
Decrease cortisol level and positive change on cortisol pattern. (Carlson 2004, 2007, 2013, Matchim 2011)
Improve immune profile (Carlson 2003, 2007, Lengacher 2013)
Decrease blood pressure (Carlson 2007, Matchim 2011)
Increase cell telomerase function (Lengacher 2014)

17. MBSR intervention reduce stress and cortisol level in breast and prostate cancer patients
Data on 49 BC and 10 PC patients showed significant improvements in overall symptoms of stress in MBSR participants which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up.
Carlson L, 2007, Brain, Behavior and Immunity.

18. MBSR intervention re-establish breast cancer patients immune function
Natural Killing cells activity(NKCA)
Interferon Gamma production levels
Witek-Jnausek, 2008, Brain, Behavior and Immunity.

19. MBSR intervention increase telomerase activity(TA) in breast cancer patients
PBMC TA increased steadily over 12 weeks in the MBSR(BC) group (approximately 17%) compared to essentially no increase in the control group (approximately 3%, p < .01).
Lengacher, 2014, Bio Res Nurs

20. 271 breast cancer patients(stage 0-III),
In the largest trial to date, MBCR was superior for improving a range of psychological outcomes for distressed survivors of breast cancer. Both SET and MBCR also resulted in more normative diurnal cortisol profiles than the control condition. The clinical implications of this finding require further investigation.
271 breast cancer patients(stage 0-III),
Randomized controlled design into MBCR, SET and control
MBCR group improved more over time on stress symptoms compared with women in both the SET (P = .009) and control (P = .024) groups.
MBCR group showed greater improvements in the MBCR group in quality of life compared with the control group (P = .005) and in social support compared with the SET group (P = .012).

21. Society for Integrative Oncology Guidelines Working Group
Clinical Practice Guidelines of Integrative Therapies in Breast Cancer Patients
Society for Integrative Oncology Guidelines Working Group
Greenlee et al, J Natl Cancer Inst Monogr Nov;2014(50):

22. Potential research opportunity in Fletcher Allen Hospital
1 Psychological outcome and relationship with medication usage in cancer patients taking 8 week MBSR participants.
2 Application for grant to study how MBSR can improve cancer patients physical, immunological and neurological condition, like “Chemobrain”.
Note: Dr. Yujing Sun’s slides can be found on
program

23. Mindfulness helps us to23

24. Thank You! Handouts Re-minders
Upcoming Mindfulness Classes with Roz and Sunny
Contact Information
Slideshow found on websites
Thank You!
Wild Geese
By Mary Oliver
…Meanwhile the wild geese, high in the clean blue air are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting-over and over announcing your place in the family of things. 24