Cancer treatment programs typically focus on eradicating the cancer tumor and/or reducing future incidences of cancer, using any combination of surgery, chemotherapy and/or radiation. Unfortunately, both the disease itself and the therapy designed to control or eliminate it increase the patient’s stress level.

According to research, an unhealthy stress response (as opposed to a eustress1 or a healthy stress response) has been shown to predispose a cancer patient to Sickness Syndrome2 (an estimated incidence rate of 30 percent, compared to five to 10 percent in the general medical population).3,4,5,6,7,8 Since cancer-related symptoms of Sickness Syndrome are associated with faster tumor progression and shortened survival time (Table 1), it is all the more imperative that cancer patients are taught appropriate strategies to support a healthy stress response.

The Causes of Sickness Syndrome: The Link between Cancer and Depression
One important cause of Sickness Syndrome in cancer patients is chronic stress, or distress.9,10,11 In a normal and healthy state, stress is actually a positive reaction. It enhances your long term memory, fuels your muscles, and helps you to quickly respond to an immediate threat. However, if you experience repeated stressful events (physical, mental or emotional) without giving your body a chance to recover from each one of those events, you will eventually experience distress, which is a negative stress reaction — and the cause of nine out of 10 visits to a doctor's office in the US today.

Distress leads to your body’s inability to use cortisol effectively. A hormone secreted by your adrenal stress glands (two glands that sit atop the kidneys that play a major role in regulating the stress response), cortisol is the key to making sure that your body does not overproduce inflammatory cytokines (which cause silent inflammation in the body, associated with heart disease, cancer, rheumatoid arthritis, depression, anxiety and sleep disorders).12,13,14 You can view cortisol as the switch that turns off the production of these inflammatory cytokines when the time is right.

However, chronic stress or insufficient recovery time from stressful events can diminish your body’s ability to rely on cortisol to regulate the inflammatory response. This leads to production by your brain of those same inflammatory cytokines — the process that causes Sickness Syndrome.

Sickness Syndrome can be caused by an inflammatory disorder or a somatic illness that has an inflammatory component (e.g. heart disease, Alzheimer's disease, cancer, obesity, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome), an inability to handle stress in a healthy way (due to post traumatic stress, major traumatic events, or compromised cortisol function), or a hormone imbalance (e.g. menopause, PMS, andropause).

In either situation, depression inevitably shows up as a symptom - and is often more painful to live with than the situation or illness. And for cancer patients, the incidence of depression correlates conversely with both mean length of survival and serum cytokine level, raising suspicions that proinflammatory cytokines are involved in development of feelings of despair, depression and hopelessness that occur in many cancer patients — not simply a neurotransmitter imbalance. And to further exacerbate the problem, chronic stress is being shown in animal models to promote further tumor growth.15 (See Table 1)

Table 1: Prevalence of Depression in Various Cancer Types Correlates Inversely With Mean Length of Survival and Directly with Serum Cytokine Level16

CANCER TYPE	PREVALENCE OF DEPRESSION	5-YEAR RELATIVE SURVIVAL RATE	SERUM IL-6 LEVELS (PG/ML)
Pancreatic	50%	4.4%	Not determined
Gastric	11%	22.5% (stomach)	10.0–12.5
Oropharynx	22%–40%	37.3%	79.6
Colon	13%–25%	62.3%	35.7
Lymphoma	17%	70.6%	2.0–4.6 (median)
Acute leukemia	1.5%	46.3% (all leukemia)	Not determined
Gynecologic	23%	71.4%	55.6 (median, ovarian)
Breast	10%–26%	86.6%	6.0–86.0
General medical	5%–10%	100%	Varies by condition

Values shown are means, unless otherwise indicated. IL = interleukin

Diagnosing Sickness Syndrome in Cancer Patients Central (brain-mediated) Sickness Syndrome symptoms drastically affect the quality of life in cancer patients . The most obvious physiological symptoms of Sickness Syndrome in those individuals suffering from cancer are: anhedonia (an inability to experience joy), decreased cognition and impaired memory and an exaggerated response to pain (lowered pain threshold).3,4,5,6,7 Related physical symptoms include difficulty falling asleep or staying asleep, difficulty concentrating and fatigue.18,19,20,21

The following emotional or physical symptoms are linked to Sickness Syndrome.

Emotional Symptoms

• Sadness throughout the day, nearly every day
• Loss of interest in or enjoyment of your favorite activities
• Feelings of emptiness or hopelessness
• Feeling stressed, nervous, or overwhelmed
• Trouble concentrating or making decisions
• Feelings of worthlessness
• Excessive or inappropriate feelings of guilt
• Irritability or restlessness
• Thoughts of death or suicide

Physical Symptoms

• Fatigue or lack of energy
• Difficulty falling asleep or staying asleep
• Wake up feeling tired
• Change in appetite or weight
• Aches and pains
• Heightened sensitivity to physical pain

Cancer patients experiencing some combination of the above symptoms for more than two weeks are encouraged to take the Sickness Syndrome Inflammation in the Brain and Depression Assessment (available at www.sicksyndrome.com). The graded questionnaire takes into account the mechanisms involved in Sickness Syndrome-including symptoms specific for the DSMIV criteria for major depression, adrenal function, vagus nerve function, stress-related lifestyle factors, and hormone function.

The results of the assessment are then paired with 24 hour salivary cortisol/DHEA levels and urinary neurotransmitter levels (serotonin, GABA, dopamine, nor-epinephrine, epinephrine and glutamate). These diagnostic aids provide a clear picture of whether or not a patient is challenged with Sickness Syndrome.

Follow-up tests to further confirm the condition and to assess successful treatment outcomes may include estrogen, progesterone and testosterone levels, a CBC chem panel with 24 hour fasting glucose, and C reactive protein. These all provide data on the level of inflammation in the body but the Sickness Syndrome Inflammation in the Brain and Depression Assessment, paired with cortisol/DHEA and urinary neurotransmitter testing provides the information that is specific for Sickness Syndrome.

Once the diagnosis is confirmed, patients can then be educated as to the available natural treatments, therapies and lifestyle guidelines that can help ease or eliminate the emotional and physical symptoms of Sickness Syndrome.

Managing Sickness Syndrome in Cancer Patients
Managing Sickness Syndrome in cancer patients must include dietary and lifestyle modifications aimed at reducing stress levels and regulating the hypothalamic-pituitary-adrenal axis. While it is beyond the scope of this article to address specific treatment guidelines for Sickness Syndrome, the following fundamental strategies will assist the physician, or patient interested in self-healing, to successfully reduce inflammatory cytokine levels in the brain. The three week program offers an evidence-based, integrative approach to treating the symptoms associated with stress and inflammation and their impact on depression.

5 Step Program
To learn about the 3-week program designed by Dr. Nick for Sickness Syndrome please visit this page on the Official Sickness Syndrome website.

Beyond the Sickness Syndrome Program
Below is a quick list of sixteen simple and easy to understand vital principles to live by for optimal health. Incorporating these practices into your daily life after you have completed the 21-day Inflamed Brain Program is a wonderful way to create a new, health-giving physical body that will support a clearer, more balanced mental, emotional and spiritual body that thrives and fulfills your desired purposes in Life.

16 Vital Principles to Live by for Optimal Health

1. Avoid eating if you feel stressed or anxious.
2. Listen to your body: don't eat if you’re not hungry, and conversely, don't put up with hunger pains. Stop eating once you begin to feel full and no longer have an appetite.
3. Drink 8 to 12 glasses of filtered water daily. Avoid large amounts of fluid with meals.
4. Avoid eating large amounts of sugar — especially refined sugars.
5. Avoid caffeine.
6. Avoid foods you may be allergic to.
7. Chew your food slowly.
8. Limit your intake, and if possible avoid packaged and processed foods containing artificial chemicals such as preservatives, colorings, flavorings and synthetic sweeteners.
9. Try to eat organically-grown fresh produce, free of pesticides and herbicides.
10. Try to eat organically-reared animal products, stay clear of reheated meats and always buy free-range eggs.
11. Obtain your protein from diverse sources (including legumes) not just from animal products such as meat, eggs and fish. You can obtain first-class protein by combining in one meal any three of the four following foods: grains (wheat, buckwheat, rice, barley, rye, oats, millet etc.), nuts, seeds and legumes.
12. Choose your breads wisely. It is important to eat only good quality breads, which provide fiber, minerals and the B and E vitamin complexes. Most bread you find today is made by mass production methods using ingredients like hydrogenated vegetable oils, monoacetyltartaric acid, disodium dihydrogen diphosphate, and other artificial chemicals.
13. Avoid constipation by eating plenty of raw fruits and vegetables and drinking plenty of water during the day. Supplement with a whole food based gastrointestinal purification product.
14. Avoid excessive saturated or hydrogenated fats and incorporate essential fatty acid oil blends into your diet as a replacement. Recommended oils include coconut oil, cold pressed organic hemp seed oil and flax seed oil.
15. Help someone out, no matter how small or grand the task, each day.
16. Smile…Laugh

© COPYRIGHT 2006 Dr. Gina L. Nick

References

1. www.en.wikipedia.org/wiki/Eustress
2. Illman et al. Are inflammatory cytokines the common link between cancer-associated cachexia and depression? J Support Oncol 2005;3:37-50.
3. Sharpe M, Strong V, Allen K, et al. Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs. Br J Cancer 2004;90:314–320.
4. Carr D, Goudas L, Lawrence D, et al. Management of cancer symptoms: pain depression and fatigue. Evidence Report/Technology Assessment No. 61. AHRQ Publication No. 02-E032. Agency for Healthcare Research and Quality. July 2002.
5. Ballenger JC, Davidson JR, Lecrubier Y, et al. Consensus statement on depression, anxiety, and oncology. J Clin Psychiatry 2001;62(suppl 8):64–67.
6. Chochinov HM. Depression in cancer patients. Lancet Oncol 2001;2:499–505.
7. Demetrashvili M, Raison CL, Miller AH. Depression in at-risk populations. Cent Nerv Syst News 2002;4:9–12.
8. McDaniel JS, Musselman DL, Porter MR, Reed DA, Nemeroff CB. Depression in patients with cancer: diagnosis, biology, and treatment. Arch Gen Psychiatry 1995;52:89–99.
9. Glaser JK, Glaser R. Depression and immune function: central pathways to morbidity and mortality. J Psychosom Res 2002;53:873–876.
10. Song C, Lin A, Bonaccorso S, et al. The inflammatory response system and the availability of plasma tryptophan in patients with primary sleep disorders and major depression. J Affect Disord 1998;49:211–219.
11. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, et al. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A 2003;100:9090–9095.
12. Dantzer R. Cytokine-induced sickness behaviour: a neuroimmune response to activation of innate immunity. Eur J Pharmacol. 2004 Oct 1;500(1-3):399-411.
13. Hellhammer J, Schlotz W, Stone AA, Pirke KM, Hellhammer D. Allostatic load, perceived stress, and health: a prospective study in two age groups. Ann N Y Acad Sci. 2004 Dec;1032:8-13.
14. Dantzer R. Innate immunity at the forefront of psychoneuroimmunology. Brain Behav Immun. 2004 Jan;18(1):1-6.
15. Thaker, P.H., et al. Chronic stress promotes tumor growth and angiogenesis in a mouse model of ovarian carcinoma. Nature Medicine. 2006; 12:939 - 944 (2006)
16. Illman et al. Are inflammatory cytokines the common link between cancer-associated cachexia and depression? J Support Oncol 2005;3:37-50.
17. Raz Yirmiya. Depression in medical illness: The role of the immune system. West J Med. 2000 November; 173(5): 333–336.
18. Tchekmedyian NS, Kallich J, McDermott A, Fayers P, Erder MH. The relationship between psychologic distress and cancer-related fatigue. Cancer 2003;98:198–203.
19. Raison CL, Nemeroff CB. Cancer and depression: prevalence, diagnosis, and treatment. Home Health Consultant 2000;7:34–41.
20. Standard Process offers a Purification Program that is based on the recommendations outlined in Clinical Purification: A Complete treatment and Reference Manual.  Dr. Nick does not receive royalties or other remuneration for sale of the products included in the program.  The program is only available through licensed healthcare professionals. For more information visit www.standardprocess.com.
21. Nick, G. Clinical Purification: A Complete Treatment and Reference Manual. LTP Publishing, 2001.