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Exercise Benefits Cancer Survivors
- 1. SHSM022/ BJ EXERCISE AND CANCER
- 2. SHSM022/ BJ Exercise and Cancer Survivorship Overview Primary Cancer Prevention Rationale for using exercise Exercise as a form of treatment Contraindications Implications The use of interventions
- 3. SHSM022/ BJ Exercise and Cancer Survivorship Cancer Cancer is a general term for a number of conditions in which cells grow out of control. Partial or complete lack of structural organisation Lacks functional coordination with the normal tissue Usually forms a distinct mass of tissue that may be either benign or malignant 2 million survivors in UK 46% female C breast/31% male C prostate Colon, hematological, endometrial each 10%
- 4. SHSM022/ BJ Exercise and Cancer Survivorship Stem Cells http://stemcells.nih .gov/info/Regenera tive_Medicine/pag es/2006chapter9.a spx Image from:
- 5. SHSM022/ BJ Exercise and Cancer Survivorship Primary Prevention Colorectal Cancer (Thune & Furberg, 2001) 40,000 patients; 10%-70% reduction in incidence Decreased bowel transit time Breast Cancer (Thune & Furberg, 2001) 108,000 patients; 30% risk reduction (In 26/41 studies) Endometrial 8/12 studies show 20-80% reduction Prostate, Ovarian, Testicular Possible inconclusive reductions
- 6. SHSM022/ BJ Exercise and Cancer Survivorship Potential Mechanisms Modulation of reproductive hormone levels Decrease in body weight and adiposity Changes in levels of IGFs and binding proteins Decrease in inflammation Decrease in intestinal transit time Enhanced immune function (Bouchard et al 2012)
- 7. SHSM022/ BJ Exercise and Cancer Survivorship Breast Cancer Menarche, 1st pregnancy, Menopause, Postmenopa use
- 8. SHSM022/ BJ Exercise and Cancer Survivorship PA & Cancer: after diagnosis
- 9. SHSM022/ BJ Exercise and Cancer Survivorship Cancer Treatments Surgery Radiation Therapy Chemotherapy Immunotherapy (Durstine et al, 2009
- 10. SHSM022/ BJ Exercise and Cancer Survivorship Cancer Effects (cancer or treatment) Fatigue Weight changes Urinary bowel problems Peripheral neuropathy Osteoporosis Cardiotoxicity Lymphoedema Hot flushes Night sweats Anxiety Depression Difficulty with memory
- 11. SHSM022/ BJ Exercise and Cancer Survivorship Exercise and survival Evidence that Cancer survivors die of non- cancer causes at a higher rate than general population. Those that exercise... Breast Cancer 24-67% reduction in total deaths 50-53% reduction in risk of breast cancer deaths Colon Cancer 50-63% reduction in risk of total deaths 39-59% decrease risk of colon cancer deaths (see Irwin, 2009)
- 12. SHSM022/ BJ Exercise and Cancer Survivorship Exercise as a treatment (Speck, 2010)
- 13. SHSM022/ BJ Exercise and Cancer Survivorship Biological Markers Insulin Insulin levels linked to risk of death 25% in insulin levels = 5% in survival rate Overweight Breast and prostate may be overweight Head, neck, gastric may be underweight
- 14. SHSM022/ BJ Exercise and Cancer Survivorship Fatigue Up to 70% of patients report loss of energy. 1/3 of survivors experience fatigue for years (Dimeo, 1999) Multi-faceted Tumour-related Conditional-related Disease-related
- 15. Evidence by site of cancer
- 16. SHSM022/ BJ Exercise and Cancer Survivorship Breast Cancer Large number of studies Lymphedema... Caution taken with pain in arm or shoulder Compression garments Increased risk of fracture
- 17. SHSM022/ BJ Exercise and Cancer Survivorship Breast Cancer
- 18. SHSM022/ BJ Exercise and Cancer Survivorship Prostate Cancer By the age of 80, about half of all men will have some cancer cells in their prostate Only 1 in 25 of them will die from prostate cancer. Leading cause of death in prostate is Cardiovascular disease Screening
- 19. SHSM022/ BJ Exercise and Cancer Survivorship Prostate Cancer and exercise Aerobic Fitness Muscular Strength Body Size and composition QOL Fatigue Physical Function – Pelvic Floor Exercises Sexual function Fracture Potential
- 21. SHSM022/ BJ Exercise and Cancer Survivorship Physical Activity Levels in survivors Many not be active enough pre-cancer Reduction in activity levels on diagnosis Intuitive/medical advice to “take it easy” Less than ½ return to pre-diagnosis levels A teachable moment?? (Demark-Wahnefried et al, 2005)
- 22. SHSM022/ BJ Exercise and Cancer Survivorship Barriers to activity (Irwin, 2009)
- 23. SHSM022/ BJ Exercise and Cancer Survivorship Cancer & Exercise Guidelines Broadly the same as population guidelines Avoid inactivity
- 24. SHSM022/ BJ Exercise and Cancer Survivorship Contraindications (in addition to CV) Heamoglobin Level < 8.0 g/dL Absolute neutrophil count <0.5 x 109/mL Platelet count <50 x 109/mL Fever>38C (100.4F) Ataxia, dizziness, or peripheral sensory neuropathy Severe cachexia (loss of >35% premorbid weight) Dyspnea Bone Pain Severe Nausea Extreme Fatigue and/or muscle weakness
- 25. SHSM022/ BJ Exercise and Cancer Survivorship Considerations for exercise programming Fatigue Pain Nausea Mouth Sores Lymphedema Peripheral Neuropathy Radiation Dermititis Constipation Diarrhoea Infection Mode of activity Falls (Schwartz, 2005)
- 26. SHSM022/ BJ Exercise and Cancer Survivorship Psychosocial benefits Mood Functional Independence Self-esteem Sense of control
- 27. SHSM022/ BJ Exercise and Cancer Survivorship Our work http://vimeo.com/69834141
- 28. SHSM022/ BJ Exercise and Cancer Survivorship Health Behaviour Change Transtheoretical model. What stage? Social Cognitive Theory Mastery experiences Modelling Verbal persuasion Physiological states and affect
- 29. SHSM022/ BJ Exercise and Cancer Survivorship Strategies to increase PA (Irwin, 2009)
- 30. SHSM022/ BJ Exercise and Cancer Survivorship Jones’ experiences 311 survivors (breast, prostate colorectal, lung) 84% would prefer to receive ex counselling during cancer experience. Only 28% reported that oncologist raised issue of exercise. 14% raised issue themselves. Of 42%, 14% referred to ex specialist Only 16% in total reported exercising at recommended level (Jones et al, 2002) Most want to receive exercise counselling but variety of interventions and methods key
- 31. SHSM022/ BJ Exercise and Cancer Survivorship Intervention Content Group v Individual Adherence rates high “brothers in arms” (Adamsen et al, 2001) Home Exercise Adherence acceptable
- 32. SHSM022/ BJ Exercise and Cancer Survivorship Adherence (Vallance et al , 2008) Exercise promotion booklet (n=377) Random allocation Booklet Pedometer Booklet and pedometer Standard recommendation to increase PA PA ↑ ~90min/wk in 2 pedometer groups 6 months later ↓ in all groups Pedo’s ~50 min/wk more than baseline but standard 9 min/wk more (not sign diff.) Click the booklet to go to it online
- 33. SHSM022/ BJ Exercise and Cancer Survivorship Implications of evidence “What can I do to improve my survival?” Improved treatment Return on investment for NHS funding??
- 34. SHSM022/ BJ Exercise and Cancer Survivorship Marjon Projects Prostate Cancer Hematological Cancer Exercise Referral Scheme for Cancer Survivors
- 35. SHSM022/ BJ Exercise and Cancer Survivorship Conclusions Stage Evidence During Cancer treatment PA improves, or prevents the decline of physical function without increasing After cancer treatment PA helps recover physical function During and after cancer treatment PA can reduce the risk of cancer recurrence and mortality for some cancers and can reduce teh risk of developing other long term conditions Advanced cancer PA can help maintain independence and wellbeing Click here for link
- 36. SHSM022/ BJ Exercise and Cancer Survivorship Issues with evidence QoL, fatigue subjectively measured Multiple natures of diagnosis, conditions, ages PA at different stages of life
- 37. SHSM022/ BJ Exercise and Cancer Survivorship Further reading
- 38. SHSM022/ BJ Exercise and Cancer Survivorship Further reading www.benjanefitness.com – Click here for Exercise and Cancer page Ehrman, J., Gordon, P., Visich, P.S., Keteyianby, S. (2009) Clinical Exercise Physiology (2nd Ed) Champaign IL: Human Kinetics Durstine, J.L. et al (2009) ACSM's exercise management for persons with chronic diseases and disabilities (3rd Ed) Champaign, IL: Human Kinetics [google books] Irwin, M.L. (2009) Physical activity interventions for cancer survivors. Br J Sports Med Vol.43, 32-8 [full text] Schwartz, A.J. (2005) Cancer Fitness: Exercise Programmes for patients and survivors. New York, NY: Fireside [amazon][amazon preview] Swain, D.P. & Leutholtz, B.C. (2007) Exercise Prescription: A case study approach to the ACSM Guidelines (2nd Ed). Champaign, IL: Human Kinetics.
- 39. SHSM022/ BJ Exercise and Cancer Survivorship Ted’s story
Notes de l'éditeur
- 2m expected to rise by 3% each year (Maddams, 2009)
- More likely to contract cv and diabetes disease
- 5% in survival rate same as chemo
- 1/3 or more of physical decloine attributed to inactivity Inactivity also leads to joint imobility, osteoporosis, balance loweed pain threshold
- Unlike many other cancers, prostate cancers can be there for years before they are found. This type of cancer can often grow very slowly indeed and may not cause any symptoms at all during a man's lifetime. By the age of 80, about half of all men will have some cancer cells in their prostate, but only 1 in 25 of them will actually die from prostate cancer. On the other hand, some types of prostate cancer are faster growing and can spread to other parts of the body.
- Fatigue The most commonly reported side effect of cancer treatment is fatigue. Some considerations Plan a progressive programme and try to stick to it, this means that youshould try to avoid overdoing it at times when you feel at your best. Make a list of chores that you need doing, prioritise them and then ask friends and family to help you out. This will prevent you from becoming unnecessarily tired and from being unable to complete your exercise programme. Nausea On their own, or in combination, chemotherapy and radiation can cause nausea and/or sickness which is why it is important for survivors to take anti-nausea medication if it is prescribed. If this medication is not working then it is important to let the healthcare team know so they might make adjustments to the dose or prescription. Some other tips that might work are as follows: Hot foods can have stronger odours, so eating cold or room temperature foods can sometimes help. Drink lots of fluids and try a range of flavours as some may be more palatable than others. Avoid fatty, spicy, fried or excessively sweet foods as these may increase the feeling of nausea. Bland foods such as crackers, rice and pasta may help. Keeping the mouth clean by brushing twice a day and rinsing the mouth with salt water can help. Mouth Sores Many of treatments used in chemotherpay and immunotherapy are unable to target only the Cancer cells and target a broad range of rapidly dividing cells in the body. This can result in the hair follicles and lining of the mouth and stomach from being damaged leaving the digestive tract red and painful. Some tips for managing this side effect are as follows: Gently brush the gums, tongue and top of the mouth. Keep the lips coated with a water-based lip moisturiser. Lymphedema Lymph nodes are important in the proper functioning of the immune system and are found all over the body. They act as filters or traps for foreign particles and are packed full of white blood cells. Lymphedema is caused by a blockage of the lymph nodes and is a swelling that is usually found in the armpit or groin area. It's a good idea to monitor any changes by measuring the extremity in question regularly. Any swollen extremity can be elevated at least 20 minutes, 3 to 4 times a day. Exercise, self-massage and gentle stretching can move the fluid toward the body. Unaccustomed heavy lifting should be avoided although with careful exercise programming on a cautious timescale, lifting weights can still be possible. Peripheral Neuropathy This is a loss of sensation that usually occurs in the fingers, hands, toes and feet and can make tasks such as dressing, eating and walking difficult. Radiation Dermititis Radiation therapy can result in skin irritation, itchiness, redness and peeling. If an exerciser has patches of dermititis then activity can result in sweat aggravating these areas. It may be beneficial to take steps to avoid sweating excessively such as exercising outdoors or in shorter bouts, or to cover the area with a gauze. Constipation Whilst some medications can cause constipation, it can be a result of reduced activity levels, dietary changes or decreased fluid intake. Some ideas for avoiding constipation are below: Eat foods that are high in fibre, and lots of fruit and vegetables. Try to develop a daily routine so there is a regular time for bowel movements. Drink plenty of fluids Diarrhoea Radiation therapy to the bowel area or certain forms of chemotherapy can cause diarrhoea. There are some actions one can take to reduce the incidence of diarrhoea below: Avoid eating foods high in fibre, fatty foods, rich desserts, or other foods that increase boewl activity. If diarrhoea occurs after meals, plan activities accordingly. Increase the intake of fluids. Infection chemotherapy and immunotherapy can cause low blood counts and immunosupression. At times where the blood count is low it may be sensible to ensure high levels of personal hygiene are maintained and that large group situations, or classes, are avoided. Mode of activity As a result of disease, some patients may have weakness to their bones. Those with disease to the pelvis or lower legs should avoid high-impact exercise and may benefit from seated exercise such as cycling or chair exercises. Exercising in the water may also be an option for these individuals. Water-based activities will be suitable for some and not for others. Those with intravenous catheters, nephrostomy tubes, and urinary bladder catheters may not be able to use a pool but those with indwelling central venous catheters, continent urinary devices, or colostomies may be able to. (Ehrman, 2009) Additional considerations An exercise buddy system that pairs up a novice survivor/exerciser with a more experienced partner can provide support and improve initial adherence to any programme. Identifying barriers to exercise and jointly devising some strategies to overcome these barriers can be an efficient use of time at the start of any exercise programme.
- Anger, hostility, depression, helplessness, tension, anxiety