The below is an article from Ron Murray on why wellness services are integrated into the cancer treatment programme at Harbour Cancer & Wellness.
Cancer care has come a long way from the days when doctors struggled to find anything that would stop the spread of tumours, let alone cure the disease behind them.
At the frontline, surgery, radiation therapy and chemotherapy were the main tools to try to beat the many different forms of cancer that could appear in the body. More recently, science has revealed more about how cancer works biologically, paving the way for researchers to develop new treatments based around supporting the immune system to better fight cancer.
But whatever the growing promise of more effective treatments and possibly even cures, a cancer diagnosis is still a scary event in a person’s life. It can come at any age, to someone who may otherwise be fit and well. Suddenly, your world changes utterly. You no longer have control of your life and control and treatment of the disease is almost certainly out of your hands. It’s very hard to understand what is happening.
But that sense of powerlessness, of not being in some control of your life, may be changing too
More reassuringly, there are ways to gain a greater quality of life through your cancer journey. And while the term gets kicked around and teased a lot, those new ways are increasingly in the wellness arena.
That striving for quality of life in cancer therapy and care is Megan Schmidt’s key driver. A trained oncology physiotherapist, Megan leads a seven-strong wellness team at Harbour Cancer & Wellness in Auckland. Teams of wellness practitioners focusing solely on cancer aren’t unusual; but what sets the Harbour Wellness Centre team aside is total integration with Harbour’s oncology and haematology team on the same site.
Patients of Harbour’s oncologists automatically get an introduction to the wellness team – and a free oncology massage from specialist oncology masseur Ash Walsh, says Megan. The wellness services also include dietary advice and counselling.
Wellness treatments are not an afterthought or an optional piece of the cancer care puzzle
Wellness support can come at any stage of the journey – before surgery or chemotherapy, during a chemo’ cycle and certainly post-treatment. The sooner the better, says Megan. “Each patient pathway is different – it could be chemotherapy then surgery, or vice-versa. That changes the way we treat someone. The body is more receptive to massage therapy, for example, at different stages of the chemotherapy cycle.”
The key to cancer care is to take a personalised approach, says Megan. “No two patients are going to be identical in what they need. The treatment regime they’re on might throw up quite different side-effects for the same cancer – and we need to individually map out what mix of therapies suit this person and when they should be applied.”
In the past, says Megan, there had been a disconnect between what doctors would recommend as treatment and what wellness therapies offered. “They weren’t convinced of the case for those therapies or didn’t know how to prescribe them.”
The evidence base is growing
Major advances in wellness research had taken that roadblock away, she says. There was now considerable strong evidence proving the effectiveness of exercise, for example, as a highly beneficial part of cancer treatment.
“With breast cancer, the data from studies shows that if you meet exercise guidelines after a breast cancer diagnosis the chance of your cancer returning is reduced by up to 30 percent. Exercise has been proven to be protective; the real skill for us is to unlock that in people – to persuade a non-exerciser to take it up.”
That is a total turnaround from past practice, says Megan. “For a long time, massage and exercise were considered contraindicated for people with cancer – the belief was that massage would spread the cancer. But that’s been totally debunked.
“For us, the evidence-base is important. We still see a lot of alternative care out there that isn’t based on evidence, such as the use of Vitamin C in cancer – which is unproven. We need to uphold standards around proper evidence-based training for cancer care and eliminate the misconceptions, like the supposed risk of massage.”
Specialist oncology massage therapist Ash Walsh says evidence is growing for the benefits of massage for cancer patients. “Research shows massage two days before chemotherapy for breast cancer increases the patient’s B and T cells, your immune system’s defences again cancer. And the same applies when they are 10-14 days into the chemotherapy cycle and probably feeling at their lowest - a massage leaves them feeling so much better afterwards.”
Massage also has a critical place where patients experience lymphoedema – swelling of the lymph system following surgery, says Ash. After physiotherapy, the massage aids healing.
Ash says meditation also has a role in wellness care for cancer patients. “I try to bring elements of meditation into the massage room. My job is to relax the patient so they can get through their treatments or cope with a bad diagnosis. If patients are stressed, they’re in a sort of fight or flight mode; massage evokes the relaxation response that gets them out of that mode so the body can function and support their recovery.”
Integration with the rest of the team is crucial
Megan says the wellness team’s closeness to the oncologists at Harbour is crucial to their care. “What our doctors do with their wellness assessment is central to how they want to practice. They want to integrate what they can fully into their overall plan for the patient.
“The fact that we have that therapeutic relationship with our patients is vital. Trust is so important. What we know is that people are much more likely to change their behaviour, and perhaps take on an exercise programme for the first time, if they come to us from our doctors. We still have to convince them; we want them to make an informed decision.”
The partnership between wellness and mainstream cancer treatment at Harbour came about in 2019 when Megan, then running a physiotherapy practice, wanted to start a wellness centre for people with cancer. “I had considered starting my own wellness practice but to create the biggest change I knew I needed the support of oncologists. It’s well known that people are much more likely to be receptive to the idea of exercise if the message comes from a doctor and the Harbour Cancer Centre team was also looking to extend their scope of care at the same time - so it was a perfect union.”
Megan was introduced to oncologist Karen Amies through a surgeon and through Karen met fellow oncologist Gareth Rivalland, who along with Karen and three other oncologists, were preparing to set up a cancer centre on the North Shore.
Gareth, managing director of Harbour Cancer & Wellness, says he didn’t need any persuading to make wellness part of the harbour model. “The argument for this sort of holistic care is very strong. And we are seeing great success in the wellness interventions happening at Harbour, like greater toleration of treatments and reduced side effects”.
Megan says the Wellness team is driven by what patients seek outside of the scope of the doctors and their treatment regimes. The main non-treatment questions doctors get asked at Harbour are around exercise and diet. “Diet is a rapidly changing area; there is no one diet that helps reduce the risk of cancer – and a lot of the information out there is wrong. Our main role is to help patients with dietary issues related to side effects, like constipation, or weight gain.”
Mental health is key
The other side to the physical treatment is caring for mental health, says Megan. “When people are going through diagnosis and treatment it can be quite mentally traumatic; the doctors often see the flags to issues there and will raise them. Our goal is to support the body and mind by any means we can. Asking for help with mental health is not easy for people, but we encourage them to see our centre as a safe space to talk about things. Our psychologist is very experienced at supporting patients and their families.”
Megan says the future is full of promise for the role of wellness therapies in cancer care, seen, for instance, in the increasing use of exercise equipment, like treadmills and exercycles, in the actual chemotherapy treatment space.
For Ash, the new developments revealed by research around the world are heartening. “One of the biggest breakthroughs is in new ways to massage people who can’t actually lie on a massage bed because of their cancer or the surgery they’ve had. We’re starting to see techniques and technologies that cater for those different needs – like a new type of waterbed that enables you to access the whole body.
“We review the research regularly to see what’s new. It’s very exciting.”