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Parkway Cancer Centre Counsellor Chia Hui Erl talks about how patients can manage their journey with cancer by learning to stay in the present moment.

A cancer diagnosis is a profoundly stressful experience because of its life-threatening implications and the potential side effects of treatment. The diagnosis is traumatising not only to patients but to their families as well, as it can have significant implications on their immediate and long-term psychological well-being.

The possible loss of routine and predictability, and the perceived loss of control, challenge patients’ sense of security.

There are fears about the future, about treatment, and about the recurrence of cancer. There are also concerns about treatment-related side effects such as nausea, vomiting, diarrhoea and mouth sores.

These immediate concerns can compound the fear and fuel anxiety, adding to the depressive mood that patients experience.

Cancer can, therefore, make it difficult for patients to be present and fully engaged with what is happening. With their minds preoccupied with worries and feeling stressed, most patients struggle to be present and be aware of the time they have right now.

Given the chronic nature of cancer and its ongoing complex emotional and physical stressors, those living with and beyond cancer face many crises and challenges. They may struggle to cope with symptoms such as emotional distress and side effects, life changes, and uncertainty about the future.

Intervention is thus needed, to enhance their ability to cope with stress and symptoms. One such intervention is Mindfulness-Based Stress Reduction (MBSR).

Developed by Professor Jon Kabat-Zinn, MBSR was first introduced in 1979 to an outpatient stress reduction clinic at the University of Massachusetts Medical Center. Its efficacy had been extensively researched for decades, and studies of mindfulness in oncology have been growing since 2000.

Research has shown the potential of MBSR in improving mood and sleep, psychological functioning and adjustment, reducing fatigue and stress, enhancing coping and well-being in cancer patients. Examples of mindfulness practices include sitting meditation, body scan meditation, mindful yoga and breathing exercise.

Mindfulness meditation is one type of mind-body therapy that is becoming increasingly popular, and is gaining credibility in the oncology world.

Professor Jon defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally”. The practice of mindfulness is essentially a state of being, and can be included in every aspect of our daily living.

How is mindful living relevant to a cancer patient’s experience, and how can it help to enhance his well-being?

Patients with anxiety symptoms often experience anxious thoughts and feel a sense of hopelessness and helplessness, which might further drive depressive moods.

Anxiety and depression are fuelled by engagement in worry and rumination (for example, “What if the treatment doesn’t work?” or “Is there an end to my suffering?”). The experiential avoidance of pain conditions, as well as anxiety and depression, can cause further suffering.

Practising mindfulness is about observing the thoughts as they appear rather than becoming absorbed in the content, suspending attempts to control one’s thoughts and feelings, and observing them nonjudgmentally and accepting them as they are. This may help patients relate to their experience differently and accept their condition without the mental chattering that creates distress.

By bringing attention inward, mindfulness empowers patients to take a proactive and conscious stance to direct their attention to present-moment experiences, even in stressful situations. This can enhance their ability to experience pain sensations without reacting with excessive emotions, which may help to alleviate distress.

The use of mindfulness is a promising intervention in cancer care, potentially across the cancer trajectory. It is not a concept that, upon hearing about it, one becomes present and decides to live in the present and reap the potential benefits of reduced anxiety and depressive symptoms right away.

Rather, mindfulness is something to be developed over time with consistent efforts and practice. The focus is to experience life fully and be in touch with ourselves (our thoughts, emotions, sensory experiences).

A patient once shared with me a moving moment that she experienced, when her attention was captured by a tree. The sight made her burst into tears: “I did not realise I was surrounded by such beauty,” she said.

This patient experienced the wonder of being present with herself and the environment. She made a silent promise to live life fully. That was a moment of being which communicated infinite possibilities.