Karen Hebert and Helen Cook argue that providing holistic care can make patients' experience of cancer less painful

Treating cancer is still based on three options-surgery, radiotherapy, and chemotherapy.¹ However, these may simply treat the disease, rather than the person. The oncology community is increasingly recognising the benefits to be gained from holistic cancer care, and more oncology centres now offer some form of complementary therapy, such as aromatherapy. Medical students and our patients stand to gain so much by learning more about available holistic therapies and how they can be used.

In the past, holistic medicine would be studied by anthropologists and laughed off by cynics. However, evidence now supports a holistic approach, particularly with regards to patients with cancer.² Psychoneuroimmunology examines the interaction between the psyche and the nervous, immune, and endocrine systems. Research has already shown that natural killer cell levels are related to your social support level and general outlook on life.³ This is particularly interesting because natural killer cells are involved in surveillance of tumours,⁴ suggesting a link between a patient's general wellbeing and happiness and their prognosis and response to treatment.⁵

Higher levels of natural killer cells are found in people with good support groups; this is backed up with evidence that people who are stressed, such as carers of spouses with dementia, have poorer immune responses than those who are not stressed.⁶ Although the evidence is still unclear with regards to survival statistics, experts agree that a patient who is treated holistically is more receptive to treatment, more able to withstand treatment, and, in the worst case scenario, better able to cope with terminal illness. Treatments for cancer are described as being worse than the disease. Fundamental to the ethos of holistic cancer care is the notion that looking after the patient emotionally and psychologically enables the them to cope better with the rigours of treatment and to fight harder against the cancer.

Holistic therapies

Visualisation is a form of therapy that increases patients' response to treatment and quality of life.⁷ In visualisation, a patient visualises their cancer as a tangible object-for example, a slab of granite. Once they have managed this, they can then begin to imagine a way to destroy their cancer. For example, the patient may imagine using a drill to blast away at the granite until it has all gone. This enables the patient to feel in control and to feel as though they are actively helping themselves.

Another way of using visualisation is in pain control. This is particularly useful for patients with terminal cancer. By imagining their pain and then physically soothing it, many patients find they can manage pain quite effectively. Patients can also use visualisation to transform their attitude to medical treatment. Most patients dread their chemotherapy, which in turn often results in a tricky relationship with medical staff. If patients can visualise the chemotherapy going into their body and zapping cancer cells then the whole experience turns around and becomes a positive one.

DAMIEN LOVEGROVE/SPL

Massage can help patients with cancer to relax

Research also shows that relaxation and meditation are helpful.⁸ Relaxation clearly is of use both within the hospital setting and outside it. A relaxed and rested patient is much more able to deal with the difficulties of cancer treatment, and this should not be underestimated. Meditation is different from relaxation. Relaxation makes you sleepy, but meditation is used to concentrate the mind and leaves you feeling refreshed. When meditating, the patient should not be thinking about anything in particular, only about the rhythms of their own breathing. Once you are adept, you can do this anywhere, including in the hospital, to mentally escape from a situation.

Aromatherapy with massage is one of the most accessible treatments available. Aromatherapy is known for its relaxing, soothing properties and, in conjunction with the actual physical contact, is immensely beneficial to a patient with cancer. Holistic doctors have a wealth of knowledge and can advise patients about natural remedies to help with the side effects of conventional treatment such as nausea and radiotherapy burns.

Common sense therapies

Counselling should be encouraged. Most of us know from personal experience that talking through a problem helps to make us feel better even if it does not solve anything. Regardless of prognosis, counselling enables patients to cope better emotionally with their situation.

Hairdressers can be needed in an oncology centre. We sometimes think that because a patient is in such pain, and going through terrible treatment, the last thing they are worried about is their appearance. But this is not true and a hairdresser is greatly appreciated by patients. The hairdresser can also be involved in choosing and styling wigs, making the whole experience more acceptable.

Patients should also be encouraged to exercise if they can. Exercise is well known for its psychologically benefits, and so any exercise is beneficial. Sometimes patients feel as though they are being made to be the invalid, and so taking exercise can serve to restore a sense of humanity.

A diagnosis of cancer is a serious life event and one that will turn a patient's world upside down. As medics, we think our role is to treat and to cure-to get rid of the cancer. But sometimes that is not possible. Even when it is, a patient needs to be strong and hopeful to get through the treatment. If we can inform patients and offer them holistic care we can address all their needs and ensure that they are emotionally and psychologically supported. As modern medics, we need to understand the importance of empowering our patients and enabling them to take some control of their illness. Even in terminal illness, holistic care can enable a good death and allow a patient to be ready and at peace with their situation, as well as supporting those left behind.

The BMJ had a theme issue on the 26 July 2003 all about "good deaths" (http:bmj.com/content/vol327/issue74081). This issue was dedicated to exploring issues surrounding what constitutes a good death and looked at experiences internationally.

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