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by Jeffrey A. Sklar, DC 

 

Chiropractors concern themselves deeply when it comes to quality of life issues.  This notion is apparent to patients that embrace a wellness based life style and paradigm. Phrases like “it is easier to stay well than to get better” or “objects in motion stay in motion” are not uncommonly heard in chiropractic offices or lectures. However, those who subscribe to wellness life styles are not always immune to hereditary and environmental factors that can impede on an otherwise healthy functioning organism.
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by Jeffrey A. Sklar, DC
Chiropractic Eastern Regional Director,  Cancer Treatment Centers of America®

Chiropractors concern themselves deeply when it comes to quality of life issues.  This notion is apparent to patients that embrace a wellness based life style and paradigm. Phrases like “it is easier to stay well than to get better” or “objects in motion stay in motion” are not uncommonly heard in chiropractic offices or lectures. However, those who subscribe to wellness life styles are not always immune to hereditary and environmental factors that can impede on an otherwise healthy functioning organism.

In plain words, life happens and healthy people can become diseased through no fault of their own. At this point, the daily affirmations like “Today I will be the best person I can be” or “Do the right thing for the right” can fall by the wayside as fear and uncertainty permeate through ones emotions. When dealing with a life threatening disease, the unknown and often unpredictable outcomes, a course of treatment that embraces quality of life issues is paramount.

Chiropractors not only see many patients that fall into this population, but sometimes face the same challenges in their own health status. When life altering diagnoses occur, difficult choices are made and rigorous regimens of care are recommended. These treatment decisions and implementation of care plans requires vigilance that some have never known prior to their new condition. The stress of life style change and possible decline in performance status can be both physically challenging and emotionally debilitating.  Moreover, every effort should be made to prevent this decline of functional status and address a patient’s quality of life from the onset of a diagnosis. Instead of viewing diseases like cancer as life threatening, it might make sense to see them as chronic illnesses that need to be managed in a cooperative and collaborative integrative team approach. This would hopefully facilitate an improved quality of life for the patient and care givers as well.

Before QOL is addressed in this underserved patient population, it must be assessed. One very effective tool that is used is The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire ( EORTC QLQ-C30) which is composed of 5 multi-item function scales and 9 symptom scales. A literature review of the use of the EORTC QLQ-C30 demonstrates how its validity and reliability are widely accepted.

Using the EORTC QLQ – C30, a Korean study by Park KU (Oncology. 74 Suppl 1:7-12, 2008. [Journal Article. Multicenter Study] ) looked at supportive care, pain management and QOL in advanced prostate cancer. It was concluded that QLQ-C30 can be used effectively in the palliative care settings in order to assess the effects of cancer pain management on quality of life of advanced-stage cancer patients.

Furthermore, literature suggests that issues of pain are not being adequately addressed as suggested by

the article published in JOURNAL OF CLINICAL ONCOLOGY.  In Prospective, Observational study of Pain and Analgesic Prescribing in Medical Oncology Outpatients With Breast, Colorectal, Lung, or Prostate Cancer,  Michael J. Fisch, et. al ( American society of clinical oncology 2012)reports that in the United States, pain is as prevalent in ambulatory oncology patients with common solid tumors as it was more than 20 years ago, despite the fact that opioid prescribing in the United States has increased more than 10-fold since 1990. Furthermore, they state innovative pain treatments and refined measures of pain management adequacy as well as the better integration of non-oncology clinical resources into the oncology setting all hold promise for improving outcomes in outpatient care of patients with cancer. Improved communication between providers and all patients about pain and pain treatment holds promise to help formulate the most appropriate patient-centered treatment goals and maximize health outcomes.

Additionally, in the landmark study reported in the NEJM (Early Palliative Care for Patients with

Metastatic Non–Small-Cell Lung Cancer, Jennifer S. Temel, et. al.  ( n engl j med 363;8 nejm.org august 19, 2010), it was reported that among patients with metastatic non–small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. 

Again, assessing the patient’s QOL either by survey or even care giver interview can reveal the need for therapeutic intervention with a focus on non-pharmacological symptom relief. Although research supports the need to address symptoms such as cancer related fatigue sleep disturbances, pain and nausea, meeting the supportive needs of patients remains an immense challenge for providers. 

With a spotlight on fatigue, offering patients cardiovascular exercise has shown to be effective in reducing fatigue, improving flexibility and muscle strength and overall QOL as reported in the 2007 study “Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. (Monga U. Garber SL. Thornby J. Vallbona C. Kerrigan AJ. Monga TN. Zimmermann KP. (Archives of Physical Medicine & Rehabilitation. 88(11):1416-22, 2007 Nov. )

Furthermore, in a study that looked at fatigue, sleep, pain, mood, and performance status in patients with multiple myeloma (MM), it was concluded that among patients with MM, fatigue, pain, sleep, mood, and functional performance are interrelated. The implication from the findings suggests that interventions are needed to decrease fatigue and pain and to improve sleep, mood, and functional performance. Coleman EA. Goodwin JA. Coon SK. Richards K. Enderlin C. Kennedy R. Stewart CB. McNatt P. Lockhart K. Anaissie EJ. Barlogie B. Cancer Nursing. 34(3):219-27, 2011 May-Jun.

Although this study focused on patients with multiple myeloma, it stands to reason that many forms of cancer that cause anemia may cause fatigue and other symptoms that impede quality of life. With patients that express concerns about the side effects of pain medication and  fear of addiction from strong pain medications, a case for non-pharmaceuticals interventions like chiropractic, acupuncture and naturopathic medicine.  To this end, the study a study in Washington State found that a large number of cancer patients were also submitting claims for chiropractic care, acupuncture massage and naturopathic medicine. These patients were believed to be integrating more natural approaches with their convention treatment to help their overall quality of life. (Lafferty, Bellas, Corage, Tyree, Standish, Patterson) Cancer 2004; 100:1522-30

The literature is voluminous when it comes to cancer and quality of life. But, what lacks is the research of how chiropractic can help this undeserved patient population. There are efforts toward evidence based research of cancer patient outcomes with chiropractic, but there few.  This should not prevent or deter the chiropractic profession from asserting its patient centered tenet.  Although, contra-indications to certain side effects, treatments, and components of disease do exist, there are countless non-aggressive and gentle techniques to utilize and improve the daily lives of these patients regardless of the stage of their disease.   Although many DCs may be apprehensive when it comes to treating patients with cancer, chiropractors should embrace these patients and seek out opportunities to collaborate with oncologists. 

With the concepts of patient centeredness and integration, it appears that the researches are proving a case for more complimentary applications of treatment for pain. The fact that pain is still as prevalent today as it was 20 years ago(M J. Fisch et. al.) certainly states a case for looking beyond prescription medication.  Additionally, it is believed that by empowering patients to become more involved in care, self directed and to be given choices through a process known as Recovery Preference Exploration(RPE), a greater quality of life is promoted through  directed learning, increased communication, and enhanced self-knowledge(Exploring the personal reality of disability and recovery: a tool for empowering the rehabilitation process. Kurz AE. Saint-Louis N. Burke JP. Stineman MG. Qualitative Health Research. 18(1):90-105, 2008 Jan. [Journal Article. Research Support, N.I.H., Extramural] UI: 18174538 Authors Full Name Kurz, Ashley E. Saint-Louis, Nicole. Burke, Janice P. Stineman, Margaret G. 

As more MDs from the Wilks-AMA era look toward retirement, a newer generation of physicians is emerging, a generation that grew up with a family chiropractor. This is a generation surgeons, cardiologists, ER doctors, radiologists and oncologists that recognize and value the profession of chiropractic and how patients benefit from chiropractic care. Moreover, these physicians may be delighted to learn how chiropractic can improve their patient’s quality of life.