Megan Kinkade

While the ability to change one’s surroundings may be limited, a sense of ease, using a number of technique, can be created wherever a person happens to be. The practice of mindfulness pioneered by Jon Kabat-Zinn, PhD, emphasizes calm and quiet in a world overloaded with frenetic activity. 

Through mindfulness, the practitioner focuses on the moment, recognizing that each one holds something unique. By pausing to appreciate the moment and being fully present, people can make peace with the things that stress, scare or threaten them, recognizing those dangers are just a sliver of a whole, healed self. In addition, each moment becomes crystalline and precious. 

Practitioner Elana Rosenbaum, at first overwhelmed when she was diagnosed with non-Hodgkin’s lymphoma in 1995, used her mindfulness training to “consciously bring attention to the present moment as clearly and as kindly as possible, with direct perception, direct experience.” 

The stem cell treatment she had to undergo was painful and kept her isolated. She focused on her breathing, closing her eyes and thinking only about her breath. Even though her lung capacity was impaired, she breathed slow, deep breaths. She mentally scanned her body, noting each minuscule sensation. She did not distance herself from the pain, but observed it without labeling it “good” or “bad.” 

The meditation eased Rosenbaum’s recovery, and Susan Bauer-Wu, MD, took notice. Bauer-Wu had already been studying how the mind affects physical health through its impact on the nervous and immune systems. 

Inspired by Rosenbaum, Bauer-Wu began examining the effect of mindful meditation on cancer patients. She says she found “consistent benefits — improved psychological functioning, reduction of stress symptoms, enhanced coping and well-being.” 

In general, people who use mindful meditation are less stressed and experience less fatigue, reported Bauer-Wu, an associate professor of nursing at Emory University. 

Such meditation also seems to improve immune function, she has found, although more research in that area is needed. 

“By using a mindfulness practice,” Bauer-Wu says, “you end up being OK with what is and being fully aware of your present.”

 Mindful meditation may be particularly useful for cancer patients, she says.

 “For most people, an average person in modern society, it’s pretty common to think about things we’ve already done or to plan what we are going to do next,” Bauer-Wu says. “Cancer patients may have regrets or blame about their past and what may have caused their cancer, and how they’ve lived their life. And for the future, they have a fear of recurrence or that they are going to die, or how they are going to be impacted by the cancer.”

Mindful meditation can help a patient focus on those fears and see them for what they are— transient emotions, she says. 

“If you can notice it, you can just see the fear for what it is; you can just see the discomfort, and not the worry.”

To try mindful meditation, Rosenbaum, a practitioner for 30 years, recommends taking a moment to S.T.O.P., as she describes it:

“Stop, pause, look around you; notice whatever is happening.

“Observe, and open to the experience without struggling against it.

“Just being willing to pause and stop, look around, observe what is happening, really allow it, whatever it is, including thoughts, feelings, sensations, allows you to proceed more calmly, carefully, and lets you notice more,” says Rosenbaum.

Noticing these feelings and sensations, without allowing them to take control, creates a more peaceful and healing environment. 

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Mindfulness-based stress reduction programs have been started in hospitals and universities across the country. The University of Massachusetts Center for Mindfulness, Medicine, Health Care, and Society lists 335 registered mindfulness leaders. To find one, go to 

, by mindfulness pioneer Jon Kabat-Zinn, PhD.

To contact Rosenbaum with any questions about mindfulness meditation, go to 

Articles

Mindfulness-based stress reduction may help cancer patients and survivors to overcome the stress and chaos that cancer initiates.

Healing Wherever You Go

Quitting one of the world’s most addictive substances isn’t easy, as the many smokers who have tried and failed can attest. But finding a way to stop smoking is particularly important to the health of cancer survivors: Recent studies have shown that smoking reduces survival time for all forms of cancer and can affect other aspects of healing.

Indeed, whether smoking caused the initial cancer or not, lung cancer patients who continue to smoke experience a lower quality of life compared with their peers who quit, and separate studies of smokers with lung cancer and head and neck cancers found that the habit increases the risk of developing a second primary tumor. 

Smoking also aggravates side effects of cancer treatment such as dry mouth, and research shows smokers are more likely to develop infections such as pneumonia. In addition, smokers’ wounds heal more slowly.  

Despite this, 20 percent of cancer survivors continue to smoke (compared with 23 percent of the general population). And among survivors who are able to quit during their cancer treatment, many relapse as soon as treatment ends. 

Overall, most smokers who try to quit fail at least once, says Joy Schmitz, PhD. “Twenty to 30 percent will achieve long-term abstinence,” says Schmitz, a professor in the department of psychiatric and behavioral sciences at the University of Texas Medical Research Center. “We always tell our patients, if you try once and relapse, that’s just a sign that you need to try again. Relapse is inherent in the definition of tobacco dependence.”

Part of the reason so many smokers feel hopeless is that they’ve tried the most common quit-smoking method, going “cold turkey,” which is also widely considered the least effective method. Research shows the cold turkey approach doesn’t address a smoker’s addiction to nicotine or the psychological challenges associated with 

Jed Rose, PhD, director of Duke University’s Center for Nicotine and Smoking Cessation Research, says the cold turkey approach — sudden, total abstinence &mdash; is “like climbing a mountain and not taking any rope or climbing tools. Given the statistics, it isn’t wise to invest the effort in quitting cold turkey and then fail.”

No matter how hard it is to quit, experts stress that it is possible to succeed with the help of a doctor and the right combination of individualized tactics.  

Medicines are among the tools available to help a smoker who wants to quit climb that mountain. Pharmacotherapy (often prescribed for at least 12 weeks) can double the odds of smoking abstinence compared with the use of a placebo, according to an analysis by the Mayo Clinic published this spring.

Zyban, released in 1997, became the first non-nicotinic prescription medication approved by the U.S. Food and Drug Administration for tobacco dependence. Zyban was created when researchers found that the antidepressant Wellbutrin had the serendipitous side effect of helping smokers quit (Zyban, known generically as bupropion, is a modified dose of Wellbutrin).

While it’s not clear exactly how Zyban works, research has shown it partially blocks norepinephrine, serotonin and dopamine, chemicals in the brain that regulate, among other things, alertness, mood and feelings of pleasure. This blocking may help reduce cravings and alleviate some of the symptoms associated with nicotine withdrawal, as well as ultimately reduce the brain’s perception of nicotine as a “reward."

Besides helping smokers quit initially, Zyban appears to reduce or delay relapse, the Mayo Clinic analysis found. Zyban is the most commonly prescribed non-nicotinic treatment for smoking cessation because it has been shown to be effective in smokers with a high risk of relapse or with other medical ailments, and because it can be safely taken with nicotine replacement therapies, noted the analysis, contributed by Amit Sood, MD, an assistant professor of medicine at the Mayo Clinic. 

Another prescription medication for nicotine dependence, released in June 2006, appears to double the odds of quitting compared with Zyban, and quadruple the odds compared with a placebo, researchers have found. The drug, Chantix (varenicline), mimics nicotine, partially stimulating nicotine receptors in the brain, a 2007 study by Canadian researchers found. This helps relieve withdrawal and cravings and prevents relapse by blocking smoking’s rewarding aspects.

Chantix might also stimulate dopamine release in the brain, making the smoker feel good about not smoking. The long-term effects of Chantix, however, are still being studied, although there is evidence that staying on the treatment prevents relapse months after quitting.

Another pharmaceutical option may one day be available — a nicotine vaccine. Such a vaccine would trap the nicotine that the body derives from cigarettes, preventing it from leaving the bloodstream and thereby blocking the effects on the brain. At least five companies are developing nicotine vaccines, according to a March 2007 article published in the 

Annual Review of Pharmacological Toxicology

Nicotine replacement therapy, or NRT, the most commonly used drug treatment to help kick the habit, addresses a smoker’s addiction by administering nicotine without the other harmful chemicals present in tobacco. The smoker keeps getting the nicotine the addiction craves, reducing withdrawal symptoms. 

prescription, yet the FDA recommends that a person’s doctor be contacted before he or she begins any over-the-counter NRT.

Different types of NRT deliver the nicotine slightly differently: In the gum, inhalers and lozenges, it is taken up by the saliva and absorbed through the lining of the mouth; the patch supplies nicotine through the skin; and the nasal spray delivers nicotine through the lining of the nose. The inhaler and nasal spray are available only with a 

A recent study led by Duke University’s Rose, who holds several nicotine patch patents, tested the effects of NRT when used before the smoker stopped smoking. Rose found that half the smokers who started using the patch two weeks before their quit date were still smoke-free a month later, compared with 23 percent of the placebo group. 

Rose says that lighting up while wearing a nicotine patch isn’t as rewarding as is usual smoking because the smoker has not been deprived of nicotine. “So they don’t get as intense a release or reward, and over several days of not getting that reward, the sensory characteristics become less appealing,” Rose says. 

That lessening of the reward might make it easier for smokers to wean themselves off nicotine, Rose says, though the FDA has always discouraged using NRT while smoking, due to concerns about possible nicotine overdose.

The smokers in Rose’s study “didn’t exhibit symptoms of nicotine overdose,” he says, “but their biochemical levels of nicotine did go up about 50 percent over their baseline.” Because of the chemical change, Rose is investigating a treatment whereby smokers switch to reduced-nicotine cigarettes while they are using the patch.

Using the nicotine patch with another form of NRT could also help smokers quit, studies suggest, by maintaining a steady balance of nicotine to the body through the patch and allowing for self-dosing with a fast-acting NRT, such as nicotine gum. This sort of combination therapy has only recently been studied and is not approved by the FDA, and so should be attempted only under a doctor’s supervision.

Physical addiction to nicotine is only part of the problem when it comes to quitting smoking; other obstacles are the thoughts and behaviors that contribute to the habit of smoking. Cognitive and behavioral therapy attempts to change those thoughts — or cognitions &mdash; and the habitual behaviors that accompany them. 

habitually smoke when they read the newspaper, at a bar, or when they feel stressed, the next time that mental cue occurs, they are likely to feel the urge to smoke.

Those habits are often triggered by an environmental “cue” — something the smoker has come to associate with smoking. If smokers 

“The hardest things for many people to kick are the cue associations that smoking has been linked to — so many situations that it is almost a knee-jerk reflex,” Rose says. “Even though the physical withdrawal is not so bad, the cue associations are so strong it is very hard to break them.” 

After a smoker has quit, those associations are often the cause of a relapse. “When somebody does quit, they should avoid those situations that would be a very strong trigger for them to smoke,” Rose advises.

A 2003 study also found that how much a person believes he or she is able to perform a task “predicts effort and persistence, especially when the behavior has implications for his or her health.” Smokers who believe they can’t quit probably won’t, concluded the study, published in 

To counteract such expectation of failure, Schmitz, who works with smokers at the University of Texas Substance Abuse Research Center in Houston, focuses on building patients’ confidence as they try to quit. “You start with small goals; instead of going from two packs to zero, you go down half a pack,” she suggests. “Little baby steps, and focus on what has worked, and if something hasn’t worked, that means you have to try a different strategy. Focus on the positive.”

She also tells her patients to expect an occasional lapse. “Just about every smoker is going to have a slip,” she says. She encourages smokers to reframe the way they think about lapsing. “Is it so much that you are a failure? Or that this is a trigger that we didn’t plan for or a skill that we need to strengthen?”

Behaviors to address — either alone or with the help of a behavioral therapist &mdash; include setting (and sticking with) a quit date, avoiding tempting situations, and adopting alternative behaviors like sucking on hard candy. The Internet offers many resources where people can find tips to break the smoking habit.

Because smoking is a lifestyle, not just a physical addiction, breaking those patterns that promote the habit is key to success, some experts stress. 

Smokers also want complementary and alternative, or CAM, therapies, according to a study conducted by the Mayo Clinic’s Sood. The study showed that a quarter of patients use alternative methods and two-thirds were interested in trying them. 

That study, published December 2006 in the journal 

, found that tobacco users were interested in the benefits of hypnosis, relaxation techniques, acupuncture, botanicals and meditation. 

However, the effectiveness of those therapies remains in question. Hypnosis “might be useful for some people,” the American Cancer Society’s “Guide to Quitting Smoking” suggests. The guide also notes another popular therapy, acupuncture, isn’t backed by solid evidence. No CAM treatments are clearly effective, Sood says, because not enough large, thorough studies have been completed.

Whatever combination of therapies smokers choose in an effort to quit, they don’t have to go it alone. By sharing experiences and struggles, support groups can be essential tools to quit smoking. 

In fact, the only problem with support groups, as Rose sees it, is “most people don’t take the time to do it. But if they do, it’s as effective as many over-the-counter medications.”

It is important to find a support group that meets your needs and that is led by someone trained in smoking cessation, experts advise. Be wary of programs that claim success is easy; studies have shown that the best programs are generally also the most intense.

Even without a traditional support group, a support network of family and friends can prove very important to a would-be former smoker. 

“I see smoking cessation as landing an airplane; when you land a plane it has to be perfect, the wings have to go down, the pilots have to be focused and it needs to be a well-thought-out process,” Sood says. “When planning smoking cessation, smokers should try to surround themselves with supportive colleagues; have supportive physicians and psychologists; [and have] a family that understands that they will be a bit cranky through the process. Enough planning should go into a quit attempt; it should not be a hurried, impulsive decision.”

Experts agree that individualizing the smoker’s plan is the most important aspect of quitting. A quit-smoking plan tailored to the preferences and habits of the smoker is essential to help ensure that this quit attempt will be the last.

A person’s quit-smoking plan should be like a cafeteria, with a “menu” of options that can be blended to create the most beneficial plan for the individual, the experts suggest. No one therapy will be appropriate for everyone, they say; the best plan is to keep trying different techniques until something works.

Don’t get discouraged, Sood says. “When you shake a tree, the apples that are loosely attached fall off easily, leaving the hardier ones,” he says. “Similarly to smokers — the ones [for whom] it was easy to quit, have already.” 

But the apples always eventually do fall. And in the same way, a determined smoker can quit.

Sood believes smoking is predominantly a lifestyle problem that can’t truly be corrected only with pharmaceuticals, so he advocates lifestyle solutions — including yoga, meditation, tai chi and other relaxation techniques as helpful additional therapies. Dietary supplements, he notes, have a limited role for smoking cessation. In the current state of science, “I would rather have 20 percent of Americans meditate than 20 percent of Americans taking botanicals to quit smoking,” Sood says, because a program like meditation is likely to have profound impact on overall well-being, whereas botanicals are just a “natural” variation on pharmaceuticals.

Smokers try CAM therapies because they are hoping to find that one therapy that can help them cross the line between relapsed smoker and former smoker, Sood says.

The most important thing, he notes, is to “be kind to yourself, to make yourself happy. If you are chronically stressed, you don’t sleep well, you have a difficult job, no amount of pharmacotherapy is going to fix that.”

The cold turkey approach — sudden, total abstinence &mdash;is “like climbing a mountain and not taking any rope or climbing tools. Given the statistics, it isn’t wise to invest the effort in quitting cold turkey and then fail. 

I see smoking cessation as landing an airplane; when you land a plane it has to be perfect, the wings have to go down, the pilots have to be focused and it needs to be a well-thought-out process. 

Finding ways to stop smoking is particularly important to the health of cancer survivors, who can use a variety of methods to help them succeed

Helping Quitters Quit

Whish—the broom handle often swung wide, missing the tiny bottle top hurtling through the thick summer air of 1956 New Orleans. The boys would rotate positions and a new batter would step up, according to the rules of “topball,” the baseball-like game they  invented. The game would continue, filled with the four boys’ laughter and friendly taunts. Most of the jests came from Ellis, the jokester of the group. He always knew how to get a laugh. Ronald was the biggest, but Benny the most athletic. Preston was always  the leader, keeping things from getting too fierce.

Decades later, as men, the four often sat around the table in Preston Edwards’ living room, eating seafood and discussing their cancer treatments. 

“It’s not like being in a regular support group where you put a bunch of people who you don’t know together,” Preston says. “With this support group, we didn’t feel awkward; we’d just kid and clown all the time.”

This group could discuss anything, even normally taboo subjects like religion, fear and deep sadness, hard things for these strong black men to discuss openly.  

“We’d talk about prayer and getting emotional and crying—and no one would admit to that&mdash;and we’d say ‘well, you’re lying,’ ” Benjamin “Benny” Priestley says.

The boys lived in a largely black neighborhood in the Garden District of New Orleans, attending the same high school. Ellis, Ronald and Preston first met in kindergarten; Benny joined the group when they were in seventh grade, playing basketball near the tall brick incinerator that burned refuse all day, every day. They spent most of their time outside, playing touch football, basketball or “topball,” causing the normal mischief of boys loose in a neighborhood.

With this support group, we didn't feel awkward; we'd just kid and clown all the time.

Around middle-age they would rely on each other to get through their illnesses. In their own ways, each took an ‘I won’t let this stop me’ attitude. 

“It was a matter of saying ‘you’ve got to do what you’ve got to do,’ ” Benny says. “Sometimes the children would fuss at me and say to me, ‘I told you if you stopped smoking, you wouldn’t be in this situation.’ ”

Benny, the first to get a High Fidelity record player, introduced the group to Charlie Parker, John Coltrane and others. The 15-year-olds listened in the second room of Benny’s shotgun-style house, smoking furtively. If they were discovered, they moved to Mazie’s Sweet Shop on the corner. They‘d go for their favorite bottled drinks—locally made pineapple, strawberry and root beer&mdash;but they’d stay because they could smoke there.

Looking back, none of the four friends could pinpoint what caused their cancers, but that didn’t stop them from guessing. There were many possible causes from their youth; they would puzzle over them often during their talks. 

After high school, the boys began to drift apart. Ronald was drafted into the Army, wading through vegetation poisoned with Agent Orange in Vietnam. After bouncing around the country, he ended up back in New Orleans. Ellis was drafted into the Air Force, which helped him get his position in Atlanta with the Department of Housing and Urban Development. Benny served in the military before working with a social organization in Portland, Ore. Preston earned an MBA and moved back to New Orleans, where he started his own business. The friends attended one another’s weddings, celebrated the births of all 11 of their children, and stayed in touch, though over time they met less frequently.

“I’d like to put this message out to all the guys I was in the service with and that were exposed” Ronald Bazile says. “Have a yearly checkup, mainly on your birthday—that way you can’t forget.”

Ellis had been keeping a secret since 1995—he had mantle cell lymphoma. He told no one, making excuses for slipping out of work, explaining away his fatigue. He was afraid people would look at him differently if they knew he had cancer. Finally, in 2000, he told his family, and the news filtered through the New Orleans grapevine.

“He had that mentality that he had this horrible disease that he couldn’t figure out where it came from,” says Ellis Brossett’s wife, Joyce. “It was something he was ashamed of. If people knew, they would pity him.”

She adds, with a touch of sadness: “He was kind of hostile with it. It was like, ‘Don’t feel sorry for me, don’t try to treat me differently because I have this dread disease called cancer.’ ”

Preston was the first to realize the surprising truth: By the end of 2001, each of the friends had been diagnosed with a different cancer—Benny had lung cancer; Preston had cancer of an unknown origin; Ronald had prostate cancer; and the three had finally learned of Ellis’ lymphoma.

 “It was a blessing that even though I had cancer,” Preston says, “I was going through it with my very best friends.” 

After some research, they discovered African-American men had the highest cancer mortality rate, information that stunned them. 

“If [cancer deaths] are preventable, we ought to be dealing with preventing those deaths,” Preston says.

That gave the four friends a new goal—to reach out to others, Benny recalls. “Let’s write a book and at least express that concern.” 

They struggled to find a publisher. Then Ellis, who had been with his friends at Preston’s annual New Year’s Eve party, died suddenly in early 2004 of heart-related complications of lymphoma. Ronald, Benny and Preston decided to self-publish the book in his honor. When Hurricane Katrina obliterated the New Orleans landscape, only one copy of the manuscript survived the flood. Finally, last April  they published their book,

Today, Benny, Ronald and Preston hope the book, which combines the personal stories of the life-long friends with a list of cancer resources, will save lives. The focus is on encouraging black men to get cancer screenings regularly, “but it is important for everyone,” Preston emphasizes. 

That’s because, Preston says, when he was in chemotherapy treatment, “the white guy sitting next to me was suffering just as much as me. We were going through the same thing and we probably had the same questions in mind. That was, ‘What is going to happen to me?’ ”

The shared experience of cancer gives four childhood friends a common goal.

Friends for Life

Some 47 million Americans live without health insurance, and many of those with insurance struggle to pay premiums and out-of-pocket costs. This makes it no surprise that the No. 1 domestic issue on the minds of voters in relation to next year’s election is healthcare, according to a Kaiser Family Foundation poll. For the American Cancer Society, uninsured Americans also top the list of issues, with the oldest cancer organization committing its entire advertising budget to keeping the topic in the public eye. The ACS joins AARP, the Business Roundtable, Service Workers International, and heart, diabetes and Alzheimer’s groups to press candidates to offer solutions.

 has assembled a collection of online resources to shed light on the healthcare debate and candidates’ approaches to the health insurance quandary.

 and download “Health Care Coverage in America” (under “publications” on the toolbar, click on “other publications” and scroll down) for a clear explanation of the current healthcare system and the alternatives being offered. The material comes from the Alliance for Health Reform, a nonprofit, nonpartisan think tank that focuses on healthcare. 

For quotes directly from the candidates about healthcare, see 

www.nytimes.com/ref/us/politics/HEALTH_POSITIONS_2.html

To see where the candidates stand on all the issues, check 

http://projects.washingtonpost.com/2008-presidential-candidates/

Find out which industries fund which candidate at 

, a website run by the nonpartisan, nonprofit Center for Responsive Politics, which researches campaign spending and its effect on elections. (Under “Who Gets” on the toolbar, go to “Presidential Data.”) This provides totals raised by each candidate so far. To find out which candidates have received the most from which industry, click on the category “Selected Industries” on the left. 

The Kaiser Family Foundation offers a detailed discussion with each candidate about healthcare reform. Go to 

. Analysis and updates of candidates’ positions on healthcare can be found at 

. The voting records of each candidate can be found at 

Online resources to help shed light on the healthcare debate and 2008 Presidential candidates’ approaches to the health insurance quandary. 

Megan Kinkade

Healing Wherever You Go

Helping Quitters Quit

Friends for Life

And the Winner Is?

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