The holistic approach is typified by the emphasis placed on the role of 'mind, body, and spirit' in health and illness management, either by the individual themselves or by those caring for them. In cancer medicine this approach is implemented in three settings:
♦ Psychosocial care given within hospitals, hospices, voluntary sector support groups, or within the community via health visitors, social workers, or the Church.
♦ The palliative care setting, where there is increasing use of complementary therapies, particularly by nurses, for symptom control, comfort, and support.
♦ The patient self-help movement, where a mixture of self-help approaches, complementary and alternative therapies, nutrition, and psychological approaches are used with the aim of improving health, well-being, and treatment outcome.
The purist model is health-based in which individuals and therapists work in partnership to achieve the best levels of health, energy, and emotional and spiritual well-being, whether as a preventive measure or to promote health in the presence of illness. The holistic model is integrative, with the states of mind, body, and spirit inextricably linked—an individual's spirit or will to live, mental state, level of stress, self-expression, lifestyle, and emotional state are all seen as relevant in terms of the illness and potential to improve health. The physical state, in terms of nutrition, fitness, energy levels and oxygenation are also given key attention.
The holistic approach for individuals who are seeking to improve their health is ideally divided into two phases:
During the therapeutic phase, help is sought from:
♦ Holistic doctors and nurses for medical counselling, needs and lifestyle assessment, symptom control with stress reduction and natural remedies (herbal and homeopathic), and specific nutritional advice.
♦ Counselling, psychotherapy, and group work aimed at promoting emotional expression, for examination of lifestyle, stress, and self-stressing attitudes, for re-orientation and rehabilitation of individuals towards more authentic and meaningful personal values and
♦ Nutritional approaches based on replacing high-fat, high-protein, high-salt, high-sugar, highly-processed Western diets with a wholefood, vegan, preferably organic diet, supplemented with antioxidant vitamins and minerals (A, |3-as carotene, C, and E, plus the minerals selenium and zinc). Nutritional changes should be supervised by qualified nutritional therapists to avoid weight loss and an inappropriate diet.
♦ Complementary therapies which include acupuncture, shiatsu, and homeopathy (which may increase energy levels and improve well-being and symptom control) and body work, such as massage and aromatherapy (which can reduce fear, tension, isolation, and the alienation felt by cancer patients towards their diseased or disfigured bodies).
♦ Spiritual healing which lifts underlying energy, improves coping, is calming, and has emotional and spiritual benefits.
♦ Support groups aimed at giving encouragement, social contact, and support.
♦ Alternative cancer therapies that are reputed to have 'anti-cancer' activity, and in this sense are more like allopathic medicines than holistic, health-based therapies. These fall into the categories of:
—Herbal remedies e.g. Rene Caisse herbs (Essiac), Iscador (mistletoe therapy), or Carnivora (Venus flytrap). —Metabolic approaches, which may be immuno-stimulant. —Dietary approaches, which are based on fasting to 'detoxify' the body, followed by 'super nutrition' with very pure, plant-based juice, raw food, or other 'spring cleaning' diets. —Alternative remedies e.g. shark's cartilage, that has some anti-
angiogenesis activity. —Hormonal therapies aimed at inhibiting tumour growth e.g. melatonin, somatostatin, and bromocryptine 'cocktails'.
A point will come when, through the application of holistic therapies, the patient feels sufficiently strong to embark upon self-help approaches. It is important not to encourage patients to take up self-help approaches before they are strong enough to do so, because if they are unable to implement this advice they will blame themselves and feel they have failed. Key self-help strategies include:
♦ Mind/body approaches aimed at calming the mind and inducing states of well-being and happiness (e.g. regular practice of relaxation and meditation). Visualization promotes a positive mental state using pictures or words, in an attempt to affect disease outcome and morale. Visualization is divided into guided imagery, where therapists guide individuals or groups with the sequential use of pleasant visual images into happier states of mind, or personal imaging, where a cancer patient creates images of their cancer being destroyed or images of themselves as completely recovered.
♦ Healthy eating, where once the patient has been taught and guided through dietary changes, healthy eating can be incorporated into their lifestyle.
♦ Creative self-expression, in which patients are encouraged to live a more balanced, expressive life with more emphasis on recreation, self-expression, and the fulfilment of personal goals and ambitions.
These overlap with interventions undertaken in traditional cancer centres and typically involve:
♦ Counselling and psychotherapy
♦ Support groups
♦ Use of creative therapies
Benefits of the holistic approach
Individual patients report significant benefits from the use of these approaches including:
♦ Reduction in fear, anxiety, isolation
♦ A sense of control, involvement, and partnership with health care professionals
♦ Improvement in physical state, energy levels, and sleep
♦ Improved symptom control and tolerance of treatment
♦ Improved quality of life
During the 1990s, studies showed that up to 35% of cancer patients were using complementary therapies, and up to 75% would use them if they were available on the NHS. Currently, use of complementary therapies within palliative care has become accepted, but mainly within the passive/dependent context of patient care. The current challenge in oncology is whether the model of holistic self-help can be incorporated into the spectrum of options available within conventional healthcare settings, or whether at the very least information about, and access to such resources are made routinely available to patients.
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