Mindfulness-based Stress Management Course for cancer survivors

Cancer, like so many other overwhelming or life-altering situations, can really stick with a person. For many, the end of treatment is met with a flood of emotions that can make it difficult to get back to normal life. Learning how to recognize and live with a cancer diagnosis is a struggle that can last for years even after being given a clean bill of health. For Penn patient Catherine Hagele, the end of treatment was simply the end of one chapter in her journey, and the beginning of another.

At age 50, Catherine led a pretty healthy life, as she always had, so when she found a lump in her breast in February 2017, she was thrown. "I had no family history of cancer. None," she said. "I know cancer can happen to anyone, but it was just never something that was on my radar as a possibility."

Catherine, a trainer with Penn's Standardized Patient Program – which trains specialists to portray patients in medical situations for the purposes of teaching clinical skills to medical students, residents, fellows and other professionals – called her doctor and made an appointment to have the lump checked right away. "I was diagnosed with stage one triple negative breast cancer, and from that moment, I went into survival mode," she said. Through surgery, 16 weeks of chemotherapy, and 4.5 weeks of radiation, Catherine and her husband focused on just getting through treatment. "We just put our heads down, put one foot in front of the other, and did what we had to do to get through it."

And then… it was over. "Just like that, I was done," she said. Her oncologist, Kevin Fox, MD, director of the Rena Rowan Breast Center at the Abramson Cancer Center, warned her that the next six months could be tough. Trying to re-acclimate to normal, daily life after a cancer diagnosis wasn't the weightless, seeing-life-in-a-whole-new-way kind of experience Catherine had expected. There was anxiety – sometimes crushing – and stress.

Stress affects "your whole biology and cognition in a way that is not helpful. When you really notice it clearly, it stops running the show," Michael Baime, MD, a clinical associate professor of Medicine and director of the Penn Program for Mindfulness, told the Philadelphia Inquirer.

Even after treatment Catherine was worried about the future, and had a persistent heaviness of all the feelings she hadn't had time to process while she was busy just trying to survive.

"You feel so well cared for while you're going through it. Everyone from the parking attendants to your doctors and nurses make you feel supported. But then, you're just done, and you're let loose to go back to your regular life," Catherine said. "Going back to regular life is strange. It's like everything is filtered through the lens of the diagnosis. It's hard not to feel a little bit lost when all the feelings you hadn't had time to acknowledge suddenly hit you all at once."

Catherine wanted to celebrate. She was relieved and grateful that her cancer had been caught early and could be treated. She knew it could have been so much worse, but still, her anxiety was overwhelming. That is, until she found a flyer for the Penn Program for Mindfulness in the mix of other support and resource materials she received during her treatment.

Catherine had never practiced meditation or mindfulness before, and had never really considered it, either. But, when her father-in-law gave her a generous sum and told her to spend it on something for herself, Catherine thought, "If mindfulness isn't something for yourself, what is?"

"I didn't want to use this gift on something like clothes," she said. "My father-in-law said it was for me – just me – and I wanted to use it on something that would be positive, and would help me be my best self."

Catherine signed up for the Mindfulness-based Stress Management Course, part of the Program for Mindfulness which was established by Baime in 1992 and has since trained more than 15,000 people. Stress management, she thought, was exactly what she needed. Still, she was skeptical. Understanding how to deal with all that stress and anxiety seemed like a tall order.

When we are stressed, Baime says, our attention becomes hijacked by loops of thoughts that remind us of all the disasters that are in store. "If you could watch your mind, you would find it's ping-ponging all over the place," he said. "But, if you notice how you feel when you are not stressed, the attention is steady and stable and fully present. With a little bit of practice, we can realize that steadiness is part of what we are, and we can connect with it even as everything else is crazy."

For eight weeks, Catherine attended group sessions with others who were also dealing with trying times – some were working through issues with pain management, going through a divorce, or had been diagnosed with cancer, but most were just looking for more peace in their lives. Though at first she feared the group setting would make it feel more like therapy and the group did in fact share their personal stories and journeys, Catherine said it was "an intensely private experience."

The class, she said, started with "baby steps," which included the commitment to practicing mindfulness for 40 minutes every day. "It seemed like a lot at first," she said, adding, "I thought maybe five minutes would be a good challenge." But, as she quickly learned, the course instructors arm participants with tools and exercises to help with practice and learning the basics of being mindful.

Baime says the reason people turn to mindfulness is because "it enhances their experience of depth, meaning, and connection in their life." And when it comes to stress, that may be the best antidote around. "On the surface, it seems as though the goal of mindfulness is to calm people and help them cope with difficult circumstances. But in fact, it often works the opposite way, giving them strength and clarity."

That was certainly Catherine's experience. Simply learning to acknowledge her feelings, she says, made her feel as though she could do something about them.

"I don't know that I'm less stressed, or feel less anxiety," she said. "Mindfulness doesn't take away from what life is – stressful, messy, and emotional at times – but I have a new confidence and tangible tools to handle it. I learned how much I want to be in the moment that 'is' and not be stuck in the past or worry about the future. I don't want to miss 'now' by being worried about what happened or what will happen."

The reason recognizing those feelings is so key to managing them, Baime says, is because when you're upset, anxious, or stressed, your attention accelerates, and your whole being becomes a very active, energized system. But, when you learn to practice mindfulness, you learn to stabilize that attention, giving yourself a chance to see what's really happening and make better choices.

The practice of mindfulness, Baime says, is growing exponentially, with studies showing it cuts negative emotions by almost half. For Catherine, who recently signed up for her second eight-week course, the only regret is how her journey could have been changed had she started the class sooner.

"I do wonder how it might have changed how I experienced everything if I'd started the class as soon as I was diagnosed," she says. "I'm still me, but it feels like a life change. Cancer is life-changing, but the journey you go through after treatment can be life-changing, too."