Promoting Healing and Resilience in People with Cancer: A Nursing Perspective (Paperback)

Detailed Table of Contents

PART  1

Stress, healing and resilience in the whole person with cancer 

Chapter 1. Introduction

My earliest memories about cancer and healing were derived from a true story my father once told me. He was an ENT surgeon working at an academic hospital in the early 1950s when a curious event concerning one of his patients, occurred.   A priest had made an appointment to see my father because of a chronic problem with hoarseness that had befuddled previous doctors. My father located a tumour of the larynx. As per the protocol of the newly established hospital tumour board my father presented the diagnostic evidence, and the board members fully concurred with his diagnosis.     

A cancer diagnosis was dire in those days, so the evening before the surgery, my father dropped by the priest's hospital room with the nurse-in -charge.  The priest was praying, but stopped on seeing his surgeon and the nurse. My father who was not particularly religious, but respectful of the priest's devotion to his faith, asked if they could all pray together, which they did in the priest's room.  They were three individuals from different faiths praying to their own higher Being, encompassing the priest with their presence, caring and support. The next morning, my father and the medical residents started the operation.  But they soon discovered to their amazement that the tumour had disappeared. It was inexplicable.   

When I have shared this story with nursing students it has been met, unsurprisingly, with the highest degree of skepticism. A couple of students have had the courage to say what I am sure many others were thinking: that it could be explained away by poor diagnostic tools in those days or medical incompetence! Still, it was equally difficult to dismiss,  out of hand, the diagnostic capabilities of a group of surgeons working at an eminent university hospital in Montreal, all members of the Tumour Board,  who had arrived at the same conclusion. It was a mystery. 

Years later, doing research for this book I came across a scientific review of the placebo effect in oncology, now recognized as an innate healing effect, triggered by strongly held cognitive expectations for a positive clinical outcome. Based on WHO criteria, the review reported that  the  cancer tumours were significantly reduced in about  2.4% or 10 out of 375 patients from 10 trials (Chvetzoff & Tannock, 2003). From a scientific perspective, it was an unimpressive result to be normally discounted out of hand. 

Yet the finding left open the possibility for the medically inexplicable. Although humans throughout history have been known to heal physical and psychic wounds,  it is only recently that medical scientists  have come to realize that strongly held human beliefs can  trigger innate processes of healing via various physiological pathways such as the  reward system, down regulating the stress response system, enabling the  re emergence of  healing processes that also enhance cell -mediated immunity, a critical anti cancer defense (Colloca & Barsky, 2020; Dutcher & Creswell, 2018).   

Healing and health in the whole person have been much revered core concepts  of the Nursing discipline,  since  Florence Nightingale's  Notes on Nursing,  which was published  over 100 years ago (Skretkowicz, 2010). Nightingale's scientific observations suggested  that  distressed patients  possessed an innate  ability to heal or restore wholeness,  when certain environmental conditions, such as  uninterrupted sleep, a clean, restful or quiet environment, and a caring and thoughtful approach were implemented. These observations led her to hypothesize  that the mind  influences  physical well being; and conversely,  physical health  has a significant impact on the mind (Skretkowicz, 2010).   Both involved reparative processes within the interactive context of the patient's environment. These mind-body connections laid down the first essential ideas about what constituted the whole person (an integrated mind-body) in relation to stress, health and healing within  the discipline of Nursing.

Since then Nurse scientists have argued that human beings are more than the sum of their parts, in stanch contrast to a  healthcare system mostly shaped by a reductionist perspective in which the clinical focus remains the  individual's illness and treatment. Their thinking was also influenced by von Bertalanffy's general systems theory (1973))  and Roger's conceptualization of the human being  as an 'irreducible whole', fuelled by homeo-dynamic energy interrelating with the environment'   (Malinski 2011, p. 446).  Von Bertalanffy  (1973) argued that systems are distinguished by non- linear interactions among their constituent parts, which was a prescient idea that has since been supported by research findings that highlight  the human's non linear process of  biological adjustments in response  to environmental stressors (B. S. McEwen, 2007).  In other words, the whole person both influences and is influenced by the environment.   

McGill University's  School of Nursing under the leadership of Moyra Allen developed  the  key concepts of the McGill  Model of Nursing.  In contrast to prevailing thinking  in  the 1960s,  that health and illness were at opposite ends of the same continuum,  the McGill Model envisioned  health as co- existing with illness (L.  Gottlieb & Rowat, 1987).  Influenced by the work of Spiegel (1997) and Bronfenbrenner (1981)  health was described in terms of  multidimensional developmental processes that grow toward greater complexity and self actualization while maintaining coherence over the life span (L Gottlieb & Gottlieb, 2007)..  

Around the same time, research in the field of environmental stress and psycho- neuro-endocrine and immune sciences provided scientific legitimacy to Nursing's foundational beliefs about the mind-body relationship, healing and resilience (in terms of both biological as well as psychological processes of adaptation in relation to the  environment (e.g.B. McEwen, 2008; B. S. McEwen & Stellar, 1993).  McEwen and colleagues built upon  earlier landmark research on stress  by  introducing concepts of allostasis (healthy resilience) to exemplify the adaptive changes that occur in response to  stress, and allostatic load (maladaptive changes)  to  reflect the measurable burden caused by chronic stress on the whole person (McEwen, 2007;McEwen & Stellar, 1993). They advanced knowledge of the whole person through their work  on the main biological regulator of stress and the dynamic  non -linear networks of biological mediators triggering widespread temporary or prolonged changes  to neural structures, pathways and functions  throughout the whole being.  These stress-induced changes suppress  neuro-biological processes (eg the parasympathetic nervous system) associated with regeneration, reparation and restoration  (healing) of myriad  biological functions including  cell mediated immunity, which is vital for  promoting  long- term health particularly in patients with cancer (Lutgendorf & Andersen, 2015; Lutgendorf, Sood, & Antoni, 2010; Wang et al., 2017). Knowledge of these stress- induced neuro-biological impairments negatively affecting healing and resilient processes have  added immeasurably to the clinical context within which resilient- and healing- promoting clinical interventions may be developed and evaluated.  

These scientific advances underscore  the clinical need for an integrated  formulation of the whole person based on stress, healing, resilience and related concepts that may be  delineated by a conceptual model so that  nursing interventions may target relevant  unique and overlapping endpoints  that promote or protect the individual's resilience and health. This is a clinical imperative in caring for patients with cancer and their family caregiver who must confront diverse stressors along the continuum.

Finally I conclude with this last thought: Delineating a substantive body of knowledge that can be leveraged on behalf of patients and loved ones  also offers the potential for  further  levelling of the healthcare  playing field within which nursing and medicine continue to exchange biological as well as behavioural perspectives of their shared patients, expressed via the complementary prisms of their respective professions,  which together  can only benefit the patient and family.  

Part 1 introduces the Stress, Resilience and Healing Model.  Chapter 1 presents the whole person's key concepts of central interest, the desired outcomes and proposed interventions known to enhance healing and resilience. Chapter 2 reviews the different forms of environmental stress; some serve to trigger  he development and adaptive capabilities  of  resilience, others, such as chronically stressful experiences  alter  neural structures and  disrupt  signalling pathways and molecular processes that ultimately can drive the development of cancer, its progression, and or a cancer recurrence, particularly in the absence of adequate personal and social resources. 

References

Benson, Herbert, & Stark, Marg. (1997). Timeless healing : the power and biology of belief. New York: Simon & Schuster.

Bertalanffy, Ludwig von. (1973). General system theory : foundations, development, applications. New York: G. Braziller.