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Yoga in oga in Cancer Car Cancer Care: e: A A Compr Comprehen ehensiv sive e Appr pproac oach to h to Transf ansfor orm m Your Lif our Life and Health e and Health Lorenzo Cohen, PhD Ri Richa hard d E Hay E Hayes Di es


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Yoga in

  • ga in Cancer Car

Cancer Care: e: A A Compr Comprehen ehensiv sive e Appr pproac

  • ach to

h to Transf ansfor

  • rm

m Your Lif

  • ur Life and Health

e and Health

Lorenzo Cohen, PhD

Ri Richa hard d E Hay E Hayes Di es Distingu stinguishe ished d Pr Prof

  • fess

essor

  • rship

ship f for

  • r

Cl Clinical inical Canc Cancer er Pr Preven ention tion Di Director ector, , Int Integrati tive M e Medici edicine Pr ne Prog

  • gram

am

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Making Progress

American Association for Cancer Research

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Challenges Ahead

American Association for Cancer Research

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Challenges Ahead

American Association for Cancer Research

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Only 5-10% of cancers are due to an inherited genetic mutation

American Association for Cancer Research

Preventable Causes of Cancer

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2000

Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4”) 2010 1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2011

¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to

prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2012

¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be

compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013

¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be

compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2014

¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be

compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2015

¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be

compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2016

¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be

compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

39.8%

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Prevalence of Self-Reported Obesity Among Non-Hispanic Black Adults, by State and Territory, BRFSS, 2014-2016

*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Prevalence of Self-Reported Obesity Among Hispanic Adults, by State and Territory, BRFSS, 2014-2016

*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

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Obesity among adults, 2015 or nearest year in OECD Countries

One in five adults is obese in OECD countries Nearly one in six children is overweight or obese

OECD 2017

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Projected Rates of Obesity

OECD 2017

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Global Disability-Adjusted Life-Years and Deaths Associated with a High BMI (1990–2015)

The GBD 2015 Obesity Collaborators. N Engl J Med 2017;377:13-27

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Policy, Policy, Policy

“Taxes and budgeting are a lot less exciting than tumor-zapping proton beams and antibodies with superpowers. But the decisions of technocrats are as important as the work of technicians. Cancer kills millions

  • f people not simply for want of scientific

advance, but also because of bad policy.”

The Economist, September 16, 2017

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Precision Medicine

American Association for Cancer Research

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Precision Medicine

American Association for Cancer Research

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“environmental exposures, lifestyle choices and other factors that could be changed or avoided account for between 70% and 90% of the gene mutations that make cancerous tumors progress.”

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  • No tobacco
  • Improve nutrition, including moderate alcohol use
  • Reduce sedentary behaviors
  • Reduce stress
  • Increase social support
  • Improve sleep quality
  • Decrease enviromental toxins

Cancer Prevention and Control: THE MIX OF SIX

  • Reduce obesity
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Cancer Hallmarks

sustaining proliferative signaling evading growth suppressors resisting cell death enabling replicative immortality inducing angiogenesis evading immune destruction activating invasion and metastasis reprogramming of energy metabolism

Hannahan & Weinberg. Cell 2011

http://healthsciencedegree.info/cancer-cells-under-electron-microscope/

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“See You in Six Months”

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Stress Response

Antoni, et al., Nature Reviews Cancer , 2006

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SNS regulation of the tumor microenvironment

Cole et al., Nature Reviews Cancer , 2015

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Molecular mechanisms for SNS regulation of tumor progression

Cole et al., Nature Reviews Cancer , 2015

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Cancer Hallmarks

sustaining proliferative signaling evading growth suppressors resisting cell death enabling replicative immortality inducing angiogenesis evading immune destruction activating invasion and metastasis reprogramming of energy metabolism

Hannahan & Weinberg. Cell 2011

http://healthsciencedegree.info/cancer-cells-under-electron-microscope/

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Couple Couple-based based Mind Mind-body body Pr Practices actices

PI PI: : Dr Dr. . Ka Kathrin M thrin Milbur ilbury, , As Assist sistant ant Pr Prof

  • fess

essor

  • r
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Ef Effects ects of

  • f Tibetan

Tibetan Yoga

  • ga on F
  • n Fatigue

tigue and and Sleep Sleep in in Women with

  • men with Br

Breast east Cancer Cancer NCI R01 CA105023

TM

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  • Primary Aim:

Determine the extent to which the Tibetan Yoga program (TYP) decreases fatigue and sleep disturbances during and after chemotherapy for breast cancer

Study Aims Study Aims

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  • Randomized to:

– TYP

– Stretching – Usual Care

Study D Study Design esign

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Tibetan Tibetan Yoga Pr

  • ga Prog
  • gram

am

4 sessions, 3 boosters Session 1 – Breathing and visualization exercises and mindfulness techniques; 9 breathings of purification Session 2 – Tsa-lung exercises Session 3 – Tsa-lung exercises and use of subtle channels Session 4 – Breathing and Tsa-lung together/review whole program

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Str Stretc etching hing Pr Prog

  • gram

am

4 sessions, 3 boosters STP Sessions 1-2 – learning stretching exercises in a stepped fashion Session 3-4 – practice all exercises

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227 analyzed = baseline and at least one follow-up

Study Study Flo low

Consented N=452 Randomized N=352 Yoga N=74 Stretch N=68 Waitlist N=85 N=64 N=59 N=79 End of Treatment 3 Months 6 Months 12 Months N=63 N=52 N=55 N=46 N=70 N=62 N=47 N=39 N=60 Analyzed

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Daytime Dysfunction

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Hungry Panda Thirsty Hippo Curious Sloth

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Sleep Sleep Ef Efficienc ficiency y (within TY)

p=0.01

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Sleep Sleep Quality Quality (within TY)

p=0.03

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  • 6
  • 5
  • 4
  • 3
  • 2
  • 1

1 2 3 4

End of Treatment 1 Month Follow-Up 2 Month Follow-Up 3 Month Follow-Up

Change Score

Yoga Stretch Control

Benefit Finding Benefit Finding

p=0.026

End of Treatment 1 month follow-up 3 month follow-up 6 month follow-up

p<0.039

* *

Chandwani……..Cohen, JCO, 2014

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ANNAMAYA PHYSICAL PRANAMAYA LIFE FORCE MANOMAYA MENTAL VIJNANAMAYA INTELLECTUAL ANANDAMAYA BLISS

These Kosas are subtleties of existence, and not water tight

  • compartments. They are one merging into other.

……… Taitari tariya ya Upanisa anisad d

Panca kosa

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DEFINITION OF YOGA

  • YUJYATE ANENA ITI YOGAH

– JOINING INDIVIDUAL SOUL TO UNIVERSAL SOUL Classical

  • TAM YOGAM ITI MANYANTE STIRAM INNDRIYA DHARANAM

– YOGA IS HOLDING THE SENSES STEADY Upanishad

  • MANH PRASAMANA UPAYAH YOGAH

– A TECHNIQUE TO MAKE THE MIND QUIET Yoga Vasista

  • SAMATVAM YOGA UCCHYATE

– YOGA IS A STATE OF EQUANIMITY Bhagavad-Gita

  • YOGAH CHITTA VRITTI NIRODHAH

– YOGA IS CONTROLLING THE DISTURBANCES OF THE MIND Patanjali Yoga Sutras Courtesy of NV Raghuram

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Physical Psycho- Spiritual Social Health

Inte Integrativ tive e Medicine Clinical Model Medicine Clinical Model

Engel GL. Science. 1977;196(4286):129-136.

The Need for a New Medical Model A Challenge for Biomedicine George L. Engel

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Andersen BL, et al. Cancer. 2008;113(12):3450-3458.

Psy Psycholog hologic ic Inter Intervention Impr ention Improves es Sur Survival vival for Br

  • r Breast

east Cancer P Cancer Patient tients

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Ornish et al. Lancet Oncology, September 2013

Ef Effect of ect of Compr Comprehen ehensiv sive e Lif ifestyle estyle Change Change

  • n T
  • n Telomer

elomere e Length Length

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Clinical Trial of a Novel, Comprehensive Integrative Oncology Intervention for Women with Stage II and III Breast Cancer At MD Anderson Cancer Center

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The Comprehensive Lifestyle Change Clinical Trial

(aka – Yoga with a “Y”)

  • Randomized controlled trial of an Integrative

Oncology approach to health and recurrence prevention in women with Stage III breast cancer.

  • N=160; half randomized to the Integrative

Oncology group (aka: MyLifeStylist) and half to usual care.

  • Aims: Prevent recurrence; increase survival

time; increase QOL; biological

  • utcomes/HRV/microbiome; fitness levels/diet;

cost-effectiveness analysis

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Study Personnel

Lisa Connelly, MEd, LPC Counselor Courtney Blair West, CI-CPT Exercise Coach Sue Thompson, RD, LD Dietitian Smitha Mallaiah, DYSc, YICC Mind-Body Specialist

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Tools

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“Through meditation and deep relaxation my answers are flowing”

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Change Happens

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Next Steps

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“See You in Six Months”

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Yoga with a Capital “Y”

“Yoga…it is a living process that changes moment by moment. Watching when we eat - how we eat; when we walk - how we walk; what we say - how we say it. All these things are in us and we must be pationately interested in them all.” Vanda Scaravelli: Awakening The Spine.

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Academic Consortium for Integrative Medicine and Health

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New Journal

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“DISEASE CARE” PROVIDERS

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HEALTHCARE PROVIDERS

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  • 23 chapters with theory, rationale, research & practice
  • ~60 chapter contributors, ~30 yoga therapist contributors