Tuesday, June 10, 2014

EXERCISE DURING CHEMOTHERAPY: Can it help prevent cancer reoccurrence?

Can EXERCISE DURING CHEMOTHERAPY help prevent cancer reoccurrence?

June 10th, 2014

If you are on chemotherapy for cancer, or know someone who is, you might want to discuss an idea I came up with during my wife's chemotherapy treatments. She recently became a breast cancer "survivor." I am not a doctor, but the doctors that have been taking care of her have been very enthusiastic about the idea of EXERCISE DURING CHEMO.

You're probably learning about EXERCISE DURING CHEMO for the first time here. As far as we know, I invented the idea.

In general terms chemotherapy works by killing ALL the fast-dividing cells in your body for a limited period of time during actual treatment sessions (which last several hours) and for a brief period of time after that while the drugs remain in the patient's system. Many chemo drugs are administered intravenously because they are so harsh. In fact, the drugs are so damaging at the point of injection, that doctors often recommend a "port" be implanted in the patient's shoulder, below the clavicle, so that specially trained nurses can just push a special needle into a special rubbery device just under the skin, which is left inside the patient for the entire 4 to 6 months of chemotherapy. The "port" has a thin little tube that runs just under the skin to the jugular vein, and is then threaded INTO the jugular to just about an inch above the heart itself. This allows the harsh chemotherapy chemicals to immediately mix with as much blood as possible as quickly as possible. Even so, they have to drip in the chemo "cocktail" (it's usually a mixture of two or three different drugs) very slowly, with lots of saline solution to water it down. If there is an allergic reaction to one of the chemo drugs, there are often others that can be prescribed instead.

Most breast cancers -- including my wife's -- are considered fast-dividing, fast-growing cancers. But where was the "cell factory" that generated the cancer that took hold in her breast, and apparently spread to her lymphatic system? The starter cell (or colony) could be anywhere in her body. Cancers often take hold in the breast because fatty tissue is easy for the dislodged cancer cells to cling to. Finding the "cell factory" is a hit-or-miss business in every sense of the term. Maybe the chemo drugs will kill all the fast-dividing cancer cells the first time through, but maybe they won't. Chemo treatments are often eight or more sessions; my wife's was only six sessions. Each treatment is supposed to knock the cancer back, killing any cancer cells or clusters that survived the previous go-round.

During the interim period, normal cells replace the killed normal cells, but cancer clusters tend not to recover as well. So after several treatments, often the cancer is completely gone.

One problem with chemotherapy is that the chemo drugs tend to kill ANY cells that are dividing at the time the drugs are administered and active in the body. Fortunately brain cells don't divide after childhood, but nearly everything else does -- but much more slowly than cancer cells tend to do. (For example, taste buds live about 10 days; while most muscle cells live several decades.) Some chemo drugs are not "cell-cycle specific," but they also need the drug to be "pumped" into every cancer cell in the body for them to be effective.

Chemotherapy is very rough on the body, and the intervals between sessions are to give the rest of the body a chance to recover. Then they knock you -- and hopefully the cancer -- back again.

By the end of chemotherapy my wife had lost all her hair. She needed two or three -- or more -- extra hours of sleep each night. She couldn't climb a flight of stairs without needing to stop and rest midway up the flight. Just a few months earlier she was mountainbiking up steep hills!

After the second treatment, one day I said to my wife, "why do you (and all the other chemo patients) just sit there while they're putting the drugs into you? It's not like you can't move around -- you can get up, go to the bathroom, walk around if you want. But isn't the idea to get the drugs EVERYWHERE in your body (and in her case, especially throughout that cancerous inoperable lymph node under her rib cage)? Shouldn't you be helping to get the blood flowing EVERYWHERE by getting your heart rate up, so it forces the blood (and the chemo drugs) into the tiniest crevices throughout your body? Don't just sit there! Exercise!"

Besides, I added, you're probably going to get more and more tired, and the more time you spend exercising, PERIOD -- the better. And also, if the idea is to mix the drug into the bloodstream as much as possible as quickly as possible, quadrupling the flow rate (which exercise can easily do) should help tremendously.

She immediately agreed with my idea. Before her next chemo treatment, we saw the doctor who specified the chemo cocktail and was watching my wife's "T-cells" and blood work to make sure she's not having an infection or other problem. We explained what we wanted to do. The doctor also liked the idea and offered to look through the medical literature to find out if anyone had previously researched the effects of EXERCISE DURING CHEMO. She later told us she was only able to find research indicating a benefit from generally getting exercise -- which my wife also did throughout the treatments -- but could find nothing about exercising during the actual chemo sessions themselves.

So before my wife's next chemo session, we bought a portable stair-stepping device, some stretchy things of various resistances, and some weights, and she started working out with them so she wouldn't tire out too fast during the chemo session (two or three hours of hard exercise is not easy for anyone, especially with equipment you're not used to!).

Adding exercise to all the other hassles of surviving cancer wasn't really all that hard for my wife, in the grand scheme of things. Not that life was easy -- and she's still recovering. I would attend the chemo sessions with her and act as a "spotter" so she wouldn't fall (her balance wasn't always what it should be; who knows why not). I would hold her hand as she did the stair-stepper and so forth.

We didn't want to disturb others, so we chose a quiet corner of the chemo room. We were plainly visible, but of the dozen or so patients who must have seen her during the four sessions when she was exercising, only a few even looked our way, and only one showed any interest. To anybody who asked, we explained what we were doing and why; we explained it to the various nurses as they set up the intravenous drips. One day a different oncologist, not my wife's doctor, walked in and saw her exercising, and simply said, "That is MARVELOUS!" We explained our reasoning and he also thought it made perfect sense.

If you know someone who is going through chemotherapy, or if you are going through it, perhaps they or you will feel too run down to work as hard as my wife did. She was able to exercise less and less each time, but always gave it her best effort. It may be very hard to do, but what if I'm right? What if hard exercise could save your life? Wouldn't it be worth it to try? She certainly didn't seem to suffer any ADDITIONAL ill-effects although admittedly, it would be very hard to tell. Certainly "additional studies need to be done." But if you are undergoing chemotherapy, even if it's your last treatment and you feel miserable and exhausted, please consider at least a little exercise during the chemo session itself. Get the heart pumping. It will do you good no matter what, and MAY make the chemo drugs more effective.

Ace Hoffman
Carlsbad, CA


Comment from an ER doctor regarding the above blog: "Ace, exercise may be good, but have to make sure the chemo will not weaken the patient and make them syncopize or pass out...."  I pointed out that this suggestion should only be acted on with your doctor's approval!

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