A reported 22%–58% of patients with cancer experience distress that can occur at any point along the clinical course, and it can interfere with their ability to cope well with cancer, its physical symptoms, and treatment. Oncology nurses can teach patients about mind-body approaches such as deep breathing, progressive muscle relaxation (PMR), and mindfulness to help self-manage distress and guide them to resources for mind-body practices.
In an article in the August 2023 issue of the Clinical Journal of Oncology Nursing, ONS member Linda Eaton, PhD, RN, created a guide for oncology nurses to understand the evidence supporting three mind-body interventions’ efficacy for patients with cancer, how to assess patients for distress, and strategies to approach patient education and awareness. She included key resources for patients and tips for nurses to use the interventions for their own distress and well-being.
Screening Patients for Distress
Because patients can develop distress at any point during the cancer continuum, Eaton encouraged oncology nurses to screen patients at every clinical encounter. The National Comprehensive Cancer Network’s distress thermometer is the gold standard assessment tool for distress in patients with cancer, Eaton said. On the 0–10 scale, a score of 4 or higher indicates distress and that the patient should be referred to a mental healthcare provider or social worker as indicated.
Progressive Muscle Relaxation and Deep Breathing
Relaxation techniques such as PMR and deep breathing are easy-to-use interventions with big benefits, Eaton said. In healthy adults, deep breathing can reduce anxiety, depression, blood pressure, respiratory rate, and cortisol levels, and it’s been shown to reduce procedural anxiety during cancer care. Deep breathing is a foundation of many other mind-body interventions.
How to practice deep breathing: Take a few slow, deep breaths, letting your abdomen expand as you fill up your lungs, then breathe out slowly and completely. Notice where you are holding tension—throat, shoulders, chest—and relax those areas so that each breath becomes slower and deeper.
Breathe deeply through a 15-minute relaxation audio recording, or follow a 5-minute or 15-minute deep breathing video for patients with cancer.
PMR involves systematically tensing and relaxing muscle groups while noticing the release of tension when relaxing, leading to mental calmness, Eaton said. It may decrease anxiety and depression symptoms during chemotherapy, anxiety and fatigue during chemotherapy and radiation, and anxiety with cancer surgery. In advanced cancer, PMR reduces pain intensity, distress, anxiety, and depression symptoms. Finally, it helps patients improve their coping styles.
How to practice PMR: Sit or lie down comfortably, and close your eyes if you wish. Progressing from head to toe or toe to head, contract and release each muscle in sequence while taking deep breaths through your nose and exhaling through your mouth.
Follow along with a 10-minute audio tutorial or a 7-minute video tutorial for patients with cancer.
Mindfulness
Practicing mindfulness brings a person’s awareness to the present moment and accepting what is happening without judgement. With mindfulness training, patients with cancer and oncology nurses can learn how to navigate intense emotions by accepting them and letting go, Eaton said. The evidence shows that mindfulness-based interventions can reduce distress, anxiety, depression, fatigue, or stress and improved quality of life.
How to practice mindfulness: Focus on being aware of what you are sensing and feeling in the present moment—sight, sound, smell, taste, or touch. If you wish to add mindful body scanning, focus your attention on different parts of your body and their sensations in a gradual sequence.
Listen to a 9-minute mindful meditation audio recording, or use an app such as Headspace (subscription based) or Insight Timer (free) for a regular mindfulness practice.
Mind-Body Interventions Are Not Just for Patients
Eaton encouraged all oncology nurses and cancer care providers to try the interventions themselves if they’re not already using them. Not only can they become an essential part of a nurse’s personal well-being practice, but firsthand experience with the interventions can help nurses and other healthcare professionals recommend and discuss them with their patients.
For more information about mind-body interventions for distress in patients with cancer, refer to Eaton’s full article in the August 2023 issue of the Clinical Journal of Oncology Nursing.