Simms/Mann UCLA Center for Integrative Oncology

Information Resources > From the Director

Optimizing Wellness

Anne Coscarelli, Ph.D.

As many of you may know we have changed the name of our Center from the Ted Mann Family Resource Center to the Simms/Mann – UCLA Center for Integrative Oncology in order to better capture our new and expanding services. Our new mission:

A center of integrative oncology . . . maintaining wellness, maximizing health, and complementing the best oncologic practices and scientific research through individualized care offered by a multidisciplinary team committed to enhancing the physical, psychological and spiritual well-being of people touched by cancer.

We believe this broad statement encompasses the range of existing and new services offered through the Center, and creates for further expansion. We also wanted to capture our work in a single phrase and settled on “Optimizing Wellness,” which can be seen in our new literature. I thought it might make sense to describe what we mean by this phrase and suggest the practicalities of how patients and family members might “optimize wellness” in the context of a cancer diagnosis.

Turning to the dictionary for assistance, I found the following definitions:

Optimize

to make as perfect, effective or functional as possible
to make the most of

Wellness

the quality or state of being in good health especially as an actively sought goal
the condition of good physical and mental health

By joining these words together we are affirming that our goal is to help patients and family members make the most of their current situation while striving to help all patients attain their most functional states of physical and mental health. I believe that there is an inherent process of preserving, strengthening, healing and optimizing physical, mental and spiritual health throughout the continuum of cancer care. While cancer may change life experiences, there is opportunity for each of us to try to make the most of the situation and in some circumstances, as I have discussed in other articles, there are opportunities for personal growth from the challenges of cancer and its treatments.

For many years there has been an emphasis on the biomedical aspects of cancer care to the exclusion of psychological, social or spiritual well-being. While I believe that treating cancer with the most advanced strategies of innovative Western medicine is the first step, there are many more components that are part of comprehensive humane cancer care. The psychological impact of the diagnosis and treatment must be considered and, regardless of the physical state of the disease, people can strive to be emotionally healthy during the process. Emotional health allows each person to live life to the fullest within the limitations imposed by the disease. Individuals can express feelings freely, actively cope with the symptoms, treatments and situations that arise and learn to manage anxiety, depression or loss. Ultimately, we are looking for pathways that improve each person’s quality of life--no matter the stage or state of physical wellness. There are many components of quality of life, such as social relations, physical health, mental well-being, symptom control, spiritual connection, activity, sexuality, work and family relations. The value placed on each of these components changes from person to person and, thus, quality of life can only be judged by the individual. Cultural factors influence how these components are weighted as well as how disease, illness and wellness are defined. Here at the Center we recognize the importance of helping each person find their individual pathway in order to optimize the individual’s perception and state of wellness.

At times there may be greater emphasis on one particular area of health and healing, but it is likely to be an ongoing process to find the optimal state of equilibrium within the context of cancer. Patients at all stages of the disease can optimize their wellness because care at the Center is tailored to focus on individual needs. We know the cancer continuum is an unknowable journey for patients in which the outcomes are often uncertain and variable. Thus, optimizing wellness is a goal for all patients with cancer whether they are patients who are just entering treatment, entering the survivorship phase, having a recurrence or even dealing with end of life issues. By focusing on optimizing wellness rather than a particular outcome, we create room for many different scenarios and opportunities for success in achieving individual goals. Consider each of these widely different situations and how strategies for optimizing wellness changes.

1. A person is diagnosed with localized cancer and receives treatment. Strategies to optimize wellness might include getting information about disease state, decision making for treatment, managing the symptoms of treatment. The person may benefit from help adjusting to the myriad changes in their work and personal lives, managing anxiety and beginning to envision a future in which physical health returns with lifestyle changes that may include diet, nutrition and stress reduction.

2. A person is finished with treatment and is believed to be cancer free. Optimizing wellness might take the form of repairing and strengthening the body from the effects of treatment through diet, exercise, and nutritional supplementation. It may be important to learn how to live with the fear of recurrence and develop a plan to minimize anxiety when any ache and pain arises. Another important and pro-active move at this stage is to develop new and specific nutritional and exercise strategies that are effective for illness prevention. In addition, there may be emotional processing of the cancer experience in a new way as the specific management of the disease is no longer so prominent, but the after effects and memories still need to be understood.

3. A person has a cancer that is progressing with intermittent periods of stabilization. Optimizing wellness might include addressing acute physical symptoms such as pain, fatigue, sleep difficulties, managing the anxiety and disruption of continuous cancer care, coping with the loss of specific activities, maintaining hope and learning to live each day to its fullest. It might also include developing short, medium and long term goals and developing good communication with family and friends as the landscape of cancer changes. It may require nutritional strategies to support the body during frequent and regular cancer treatments.

4. A person has aggressively progressing widespread cancer in which many treatments have been tried, none seem to be stopping the progression of the disease and end of life may be likely. Optimizing wellness might focus on management of symptoms, addressing the fears and concerns associated with end of life, providing information, finding strategies that bring comfort and spiritual peace, facilitating communication with family and friends and helping the person to express their needs. Establishing small short term goals for connection to family, having a plan for a dignified pain-free death, and communicating what one wants after death can help to bring about a sense of control and peace. Utilizing mind/body relaxation techniques to help with clarity and comfort can be very meaningful. Creating connections to spiritual leaders and communities who can provide comfort can also be part of optimizing wellness during end of life.

While each scenario is quite different with regard to the physical impact on the body, they all have opportunities for optimizing wellness of the body, mind, emotions and spirit.

Our goal is to help patients and family members embrace their own journey and to assist them to make the most of their individual experience. It is our hope that by offering a range of strategies patients and family members will have a stronger sense of self-efficacy which is confidence in one’s own ability to perform specific tasks. We know that self-efficacy can enhance adjustment to cancer and help patients feel empowered to manage their stress, symptoms and well-being.

The Center offers a range of programs that can be individually tailored to help each patient and family member to optimize wellness. I invite you into the Simms/Mann -- UCLA Center for Integrative Oncology to learn more about our services including:

Psychological Support and Counseling. Offered by psychologists and oncology social workers, we provide education, information, reassurance and problem-solving through one-on-one counseling or family counseling.

Education about Nutrition, Dietary Supplements and Complementary Approaches. Through both individual integrative oncology assessments and groups, people can learn about enhancing their physical well-being both now and in the future from highly trained physicians who understand both Western and other complementary approaches. There are many strategies that can help you achieve greater physical and psychological wellness through nutrition, supplements and complementary approaches.

Support groups. We offer a range of groups that address psychological and physical wellness such as meditation, art therapy, QiGong and specific groups oriented toward support from others who have similar types of cancer (see our listing in this newsletter).

Mind/Body techniques to facilitate relaxation and stress reduction. Through group interventions or individual sessions, our clinicians can teach you specific relaxation, imagery, and stress management skills that help the mind, body and spirit to optimize stress reduction and well-being.

Assistance with specific needs. Our oncology social workers are able to identify specific resources that may be helpful in reducing some of the stress caused by particular problems.

Advocacy in the medical environment. Because we operate within UCLA’s comprehensive health system, we frequently work with teams of doctors and nurses to help you to identify and express your needs in the medical environment and to help the medical staff to better address your individual needs. Working together can assist in optimizing wellness.

Assistance with advance directives and communication around end of life. While this is often the most difficult area about which to communicate, it is also one of the most important. Too often patients and family members live in fear of pain or suffering. In my mind, this is in opposition to optimizing wellness. Having a plan in place that is well-thought out, understood by everyone involved and truly expresses the wishes of the individual facing end of life can bring peace and comfort. Having a plan that focuses on symptom management, pain control and reduction of discomfort can bring a sense of peace. The first step in this process is communication.

Educational resources. Having the right information to answer your questions can alleviate stress and improve the quality of your life. At the Center we can help you find accurate information on a wide range of relevant topics ─ everything from information about supplements, diet, specific treatments, management of symptoms to where to obtain information about financial options. We also offer a lecture series that presents many important issues and provides information. Join us for our Insights Into Cancer lecture series and bring your many questions (see the listing in this newsletter).

Optimizing wellness is about knowing what tools are available to you to bring about relief, increase knowledge and insight, reduce negative symptoms, increase positive growth and self-efficacy throughout the cancer experience. It is about making the most of the situation and actively seeking the best physical and mental health possible throughout the continuum of cancer care. We look forward to meeting with you to achieve these goals.

Anne Coscarelli, Ph.D.

Wallis Annenberg Director’s Initiative in Psychosocial Oncology

For reprint authorization, contact SimmsMannCenter@mednet.ucla.edu.