While undergoing cancer treatment, patients can often overlook the widespread importance and life-changing nature of whole-person care. With the intent to spread awareness regarding the power of wellness and lifestyle modifications, two physicians at AdventHealth in Orlando, Fla., have established an innovative education solution for the public to rely on at home, eliminating pandemic-related clinical risks.
Nathalie McKenzie, MD, and Amber Orman, MD, originally developed the Healthy Eating & Active Lifestyle (HEAL) wellness program in 2019. Based on the principles of lifestyle medicine, including plant-based nutrition, physical activity, and mindfulness, the traditionally in-person program is broken into two communities: those with breast cancer and those with gynecologic cancer. Independently, small groups of cancer patients/survivors work through eight sessions of topics including nutrition, physical activity, mindfulness, stress, sleep and relationships, and the impact they have on overall health.
“Data shows that you can actually reduce your risk of getting cancer in the first place, and also reduce your risk of cancer coming back quite substantially, when you invest in lifestyle measures,” explained Orman, a double board-certified radiation oncologist and lifestyle medicine specialist. “We work with patients both in the clinic and through our HEAL program to educate them on the benefits of lifestyle change and to impact their cancer outcome, but more importantly to improve their overall health and that of their friends and family. It often has a trickle-down effect.”
Healing in a Pandemic
Yet, with the coronavirus pandemic rose the need to eliminate any unnecessary exposure to the virus, especially in the case of oncology patients. This resulted in similar wellness programs being forced to pause their endeavors or seek out technological alternatives. Faced with the challenge of how to continue educating their patients, McKenzie asked her office manager, “How are we going to [continue to] impact the community? What are we going to do for the community during [the pandemic]?”
After a request from one of her HEAL program graduates who wanted to be able to continue the initiative's yoga sessions, McKenzie organized a remote class. From there, she decided that the HEAL program should be opened up to the public in a way that is both free and accessible.
Together with Orman, they launched HEAL at Home, a four-part webinar series educating cancer patients and community members on the six pillars of health and wellness. Participants in this program do not necessarily have to be AdventHealth patients; it's simply a free service available to the public.
“We wanted to co-host something really meaningful with important topics for the community that would really surround lifestyle medicine,” McKenzie said. “It's something where people can get some education on healthy living, which doesn't just impact cancer prevention or recuperation, but feeling well overall and decreasing the likelihood of long-term sequelae if one were to be exposed to the virus. We know that those who are the healthiest statistically have the highest chance of recovering from [COVID-19] exposure.”
Healing the Whole Person
Prioritizing health in her own life, McKenzie added that her journey to advocating for whole-person care actually stems from personal experience. During her second year of residency in 2004, she identified a mass which she initially believed was a benign fibroadenoma. However, after seeking medical attention, she was diagnosed with stage II breast cancer.
“For me, [whole person care] is very personal. I have seen firsthand both through my oncology practice, my personal experience, and that of close family members how lifestyle changes certainly impact recovery from cancer treatment, survival from cancer, and the likelihood of developing cancer,” McKenzie shared. “I wanted to become a credible source for patients so that the information I was providing was founded and evidence-based.”
In doing that, she and Orman were part of the third class to become board-certified in lifestyle medicine in 2019. Now, their breast and gynecologic teachings from HEAL have largely transferred over to what they teach in the HEAL at Home series. The measures presented are designed to help decrease chronic diseases, including cancer, while giving those isolated due to the coronavirus something to look forward to.
Originally, the four HEAL at Home webinar topics were merely a condensed version of the original 8-week HEAL program. McKenzie and Orman took what they thought were the most pertinent topics that would impact anyone's health journey—whether it was related to cancer, COVID-19, or anything else—and transferred them to a digital platform.
Since May, the HEAL at Home sessions have transformed to become much broader and nonspecific. They have come to include the “Science of Healthy Eating,” which involved an interactive discussion on the dos and don'ts of healthy eating during the COVID-19 pandemic. Another topic was “Mindfulness During a Crisis,” which consisted of a panel discussion about how to cope with the downsides of social distancing.
Additionally, AdventHealth's Chef Edwin Cabrera hosted a live cooking demonstration and discussed the importance of healthy eating during a crisis. An online discussion of yoga then presented the benefits of physical activity, movement, and breathing to improve health and immune function during the COVID-19 pandemic and beyond.
“The goal is to improve people's health. That's the bottom line, but we've tailored these things to groups of people so that we can bring them together so they can experience a sense of community. You can have breast cancer patients and survivors with each other sharing their similar experiences, and likewise in the gynecologic space,” Orman said. “With HEAL at Home, our hope is to introduce participants to the benefits of a healthy lifestyle, so that they might seek care with us so that we can educate them further on the benefits of lifestyle modifications.”
She added that, through COVID-19, the community has been presented with an “unprecedented and beautiful moment in time,” where whole-person care can reach an increasingly captivated audience. With more people working from home, furloughed, or without a job, they are presented with the opportunity to use this time to take their health into their own hands. By doing something as simple as taking a walk or modifying food choices, the public can use the education put forth by the HEAL at Home program to become more resilient than ever. Optimizing on the timing can help to change their lives in a positive way, yielding a greater ability to cope with stress.
“One hundred percent of the participants in the program say that it is life-changing,” McKenzie said. “They are so fortunate that they happen to receive care at a hospital that takes whole-person care seriously, and they wish this was available to every cancer patient around the globe.”
“They don't want the program to stop,” Orman added. “[We] take things that are confusing and somewhat inaccessible and make them digestible and help people to incorporate them into their own lives. It really does make a difference.”
Moving forward, the physicians hope to soon be able to return to in-person care, at least partially. They believe that many patients thrive being physically present at the HEAL program sessions, but they also intend on maintaining telemedicine as a viable option. Together, they also hope to someday extend the program to men, and to expand to other sites and offer other providers the training necessary to similarly promote whole-person care.
“Sometimes it's just that one mention that sparks something inside the patient and then they seek out more information,” Orman stressed.
“The more patients that can go through the program, the more lives we can save,” McKenzie said.
Lindsey Nolen is a contributing writer.