This medical headline caught my eye the other day:
"Prescribe exercise to all cancer patients"
It was in an emailed news alert. I didn't feel it was anything new - everyone knows exercise is good for you, right? Not just for cancer patients. Apparently this does mark a shift in thinking though. It is not so long ago that the emphasis was on advising patients to rest.
Anyway, I followed the link which turned out to be from Australia: a position statement from the Clinical Oncology Society, but it could easily have been written for the UK or NZ health care system.
https://www.mja.com.au/journal/2018/209/6/clinical-oncology-society-australia-position-statement-exercise-cancer-care
What surprised me most was quite how much exercise was being recommended:
I assume there will be far more detail for health professionals who are implementing the recommendations, but I do hope they will be pragmatic and sensible. By the way, this has turned into a long blog post so feel free to jump to the end for a summary!
I offer up some personal reflections on my own experience of exercise and cancer. You never know, it may strike a chord with someone.
[Quick recap for anyone who doesn't know - I was diagnosed with Stage 3 bowel cancer - a rectal tumour - eight years ago, and went through about a year of treatment: chemoradiotherapy, surgery and chemo. All OK now thankfully.]
Before treatment
With two young children - one of whom was under 2 at the time of diagnosis - I did not have much of an exercise routine, but I was going to ballet once a week and was generally active in terms of taking kids to the playground - that kind of thing. I'd need to look back at my blog to know if I was doing much more than this, but I think I was still in the "I need to get back to more regular exercise" phase of early motherhood. No way would I say I was achieving 150 minutes of moderate intensity aerobic exercise with resistance sessions on top. Assuming carrying a toddler on a hip doesn't count as resistance exercise...
At the point of first diagnosis would have been an excellent time to talk about building up the amount of exercise I was doing.
When I found out it may be cancer, I was more determined than ever to get to my weekly ballet class. I also made more of an effort to take a short walk at lunch time on work days. This was an instinctive response to knowing I needing these things to manage the stress of having had a shock diagnosis while waiting for scans and to find out what I had to do to get rid of the tumour.
But if the nurse had said if I could try to build up my exercise level a bit more - perhaps with an extra brisk walk or two for half an hour, or swimming, cycling, a gym session or even a boxercise class - I would have done it. It was nearly two months between my first diagnostic test and the start of treatment so I could have packed a bit more in I suspect.
Radiotherapy
My radiotherapy - technically chemoradiotherapy because it was accompanied with a low dose of oral chemo - was a five and a half week regime of Monday-Friday appointments.
Some forms of exercise are discouraged rather than encouraged at this time. Swimming becomes no go - your skin is already being dried out and you don't want to make it worse. E45 becomes your friend. I seem to remember ignoring the swimming advice and going with the kids on the first weekend of treatment, but by week five the skin was so badly damaged in the most delicate of areas there was no way I could have contemplated a dip in the pool. Cycling would have been out by then too.
But here's another factor: time pressure. I was trying to maintain a part-time job. Fortunately, I had a very understanding employer and could work flexible hours including work from home. I was driving myself to my appointments. With a half hour journey each way, ten minutes to find a parking space, quarter of an hour for treatment, up to three quarters of an hour waiting for delays in the radiotherapy suite... well, you get the picture. You've lost your whole morning.
Plus, trying to keep things "normal" for the kids so prioritising doing things for them.
For me, most of this was during the summer holiday so no ballet.
Exercise week one? Probably managed a bit of walking, active play with the kids and the aforementioned swim. Exercise week five? With accumulated tiredness as a result of the treatment? More or less non-existent. Perhaps a gentle stroll or two at the weekend. I guess the weekends were where more could have been fitted in if I'd been in the brave new world of exercise physiologists.
Surgery
In the gap (8 weeks?) between radiotherapy and surgery, skin heals, energy returns and yes, a good time to be building up the exercise again. I was back to ballet. Notwithstanding the aforementioned time pressure, I guess a more intensive regime would have been feasible.
Then. Bam! Seven hours in surgery, rearrangement of the innards, doses of morphine to try and keep the pain at bay. For the first couple of days, I could hardly get out of bed - with a drop in blood pressure stopping me every time I tried. All the same, through determination (bloody mindedness) and help from some - sadly not all - of the health team I was out of hospital in record time. Well, not a record as such. but it was just under a week.
However, it was at this time that I did actually have some exercise advice. It was about managing life after a colostomy. Having had the surgery - heavy lifting was not recommended for 6 weeks, but then I was encouraged to try and not let my stoma get in the way of having an active lifestyle.
This was a period of healing and recovery, a steady return to physical fitness such as it was by then (and maybe one or two ballet classes?!). Ready for the next onslaught:
Chemotherapy
I was on a three week cycle of IV and oral chemo. These included days where all efforts went into keeping food down. Of course with chemo, your immune system takes a hefty knock and you need to be careful about mixing in crowds which could limit your options when you do actually start to feel human enough to leave the house.
It wasn't all bad though. In the three week cycle, there is one week free of drugs and feeling much better. I was managing to dance more weeks than not. There was generally getting out and about. Not much of high intensity, but a general sense that fitness could build up again.
Oh yes, one more limiting factor - a PICC line fitted to allow the chemo to be delivered straight into the blood stream. Not suitable for swimming with. It didn't stop me dancing but made my arm feel a bit more tired.
After three rounds of chemo, the IV drug I was on was cancelled. My body just wasn't tolerating it sufficiently - with platelets and white blood counts dropping to worrying levels. So that was that, four more rounds of tablets only. The side effects of these were minimal so I was back on track. It would have been another good time to discuss exercise...
After treatment
I'd survived! Hurrah! And with that, I was ready to live life to the full. I started a year of fundraising for Macmillan Cancer Support which included activity as well as the ubiquitous coffee mornings. I was very happy to be able to do things, so I did them. A family sponsored walk? I'm in. Swimming with the kids? Don't mind if I do. Cycling? Get me some padded cycling shorts and we'll see what can be done! (I kid you not, cycling shorts were on my Christmas list that year and made all the difference to getting back on the saddle).
I was lucky. For some, the period after treatment is no less hard than what has gone before. You have become used to people looking out for your well being at every stage. I know many people feel low finishing treatment when they are expected to face the world without frequent contact with caring professionals, while they are still coming to terms with the long term effects of their experience - whether that is physical changes or the emotional fall out.
This is probably a phase where many would benefit from an ongoing supervised exercise programme. Good for the mind and body.
In summary...
On the other hand, there is inspiration to be had out there. I found this article:
https://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=12047228
How this young mother managed to hit the treadmill after her chemo is beyond me. But perhaps that is partly the point. The chemo doesn't actually affect you as badly if you add a cardiovascular work out into the mix?
If exercise really is the wonder drug, then services could usefully build gyms and gardens next to their oncology suites. Exercise sessions could be timed around appointments. It will be interesting to see if new ways of working evolve as the evidence mounts.
I am not an expert. I just offer this reflection as one illustration that cancer treatment has ups and downs. What works for one person may not for another. If anyone is going through this right now, you have my sympathy. I wish you strength.
Take care x
"Prescribe exercise to all cancer patients"
It was in an emailed news alert. I didn't feel it was anything new - everyone knows exercise is good for you, right? Not just for cancer patients. Apparently this does mark a shift in thinking though. It is not so long ago that the emphasis was on advising patients to rest.
Anyway, I followed the link which turned out to be from Australia: a position statement from the Clinical Oncology Society, but it could easily have been written for the UK or NZ health care system.
https://www.mja.com.au/journal/2018/209/6/clinical-oncology-society-australia-position-statement-exercise-cancer-care
What surprised me most was quite how much exercise was being recommended:
COSA encourages all health professionals involved in the care of people with cancer to:
- discuss the role of exercise in cancer recovery;
- recommend their patients adhere to exercise guidelines (avoid inactivity and progress towards at least 150 minutes of moderate intensity aerobic exercise and two to three moderate intensity resistance exercise sessions each week); and
- refer their patients to a health professional who specialises in the prescription and delivery of exercise (ie, accredited exercise physiologist or physiotherapist with experience in cancer care).
I assume there will be far more detail for health professionals who are implementing the recommendations, but I do hope they will be pragmatic and sensible. By the way, this has turned into a long blog post so feel free to jump to the end for a summary!
I offer up some personal reflections on my own experience of exercise and cancer. You never know, it may strike a chord with someone.
[Quick recap for anyone who doesn't know - I was diagnosed with Stage 3 bowel cancer - a rectal tumour - eight years ago, and went through about a year of treatment: chemoradiotherapy, surgery and chemo. All OK now thankfully.]
Before treatment
With two young children - one of whom was under 2 at the time of diagnosis - I did not have much of an exercise routine, but I was going to ballet once a week and was generally active in terms of taking kids to the playground - that kind of thing. I'd need to look back at my blog to know if I was doing much more than this, but I think I was still in the "I need to get back to more regular exercise" phase of early motherhood. No way would I say I was achieving 150 minutes of moderate intensity aerobic exercise with resistance sessions on top. Assuming carrying a toddler on a hip doesn't count as resistance exercise...
At the point of first diagnosis would have been an excellent time to talk about building up the amount of exercise I was doing.
When I found out it may be cancer, I was more determined than ever to get to my weekly ballet class. I also made more of an effort to take a short walk at lunch time on work days. This was an instinctive response to knowing I needing these things to manage the stress of having had a shock diagnosis while waiting for scans and to find out what I had to do to get rid of the tumour.
But if the nurse had said if I could try to build up my exercise level a bit more - perhaps with an extra brisk walk or two for half an hour, or swimming, cycling, a gym session or even a boxercise class - I would have done it. It was nearly two months between my first diagnostic test and the start of treatment so I could have packed a bit more in I suspect.
Radiotherapy
My radiotherapy - technically chemoradiotherapy because it was accompanied with a low dose of oral chemo - was a five and a half week regime of Monday-Friday appointments.
Some forms of exercise are discouraged rather than encouraged at this time. Swimming becomes no go - your skin is already being dried out and you don't want to make it worse. E45 becomes your friend. I seem to remember ignoring the swimming advice and going with the kids on the first weekend of treatment, but by week five the skin was so badly damaged in the most delicate of areas there was no way I could have contemplated a dip in the pool. Cycling would have been out by then too.
But here's another factor: time pressure. I was trying to maintain a part-time job. Fortunately, I had a very understanding employer and could work flexible hours including work from home. I was driving myself to my appointments. With a half hour journey each way, ten minutes to find a parking space, quarter of an hour for treatment, up to three quarters of an hour waiting for delays in the radiotherapy suite... well, you get the picture. You've lost your whole morning.
Plus, trying to keep things "normal" for the kids so prioritising doing things for them.
For me, most of this was during the summer holiday so no ballet.
Exercise week one? Probably managed a bit of walking, active play with the kids and the aforementioned swim. Exercise week five? With accumulated tiredness as a result of the treatment? More or less non-existent. Perhaps a gentle stroll or two at the weekend. I guess the weekends were where more could have been fitted in if I'd been in the brave new world of exercise physiologists.
Surgery
In the gap (8 weeks?) between radiotherapy and surgery, skin heals, energy returns and yes, a good time to be building up the exercise again. I was back to ballet. Notwithstanding the aforementioned time pressure, I guess a more intensive regime would have been feasible.
Then. Bam! Seven hours in surgery, rearrangement of the innards, doses of morphine to try and keep the pain at bay. For the first couple of days, I could hardly get out of bed - with a drop in blood pressure stopping me every time I tried. All the same, through determination (bloody mindedness) and help from some - sadly not all - of the health team I was out of hospital in record time. Well, not a record as such. but it was just under a week.
However, it was at this time that I did actually have some exercise advice. It was about managing life after a colostomy. Having had the surgery - heavy lifting was not recommended for 6 weeks, but then I was encouraged to try and not let my stoma get in the way of having an active lifestyle.
This was a period of healing and recovery, a steady return to physical fitness such as it was by then (and maybe one or two ballet classes?!). Ready for the next onslaught:
Chemotherapy
I was on a three week cycle of IV and oral chemo. These included days where all efforts went into keeping food down. Of course with chemo, your immune system takes a hefty knock and you need to be careful about mixing in crowds which could limit your options when you do actually start to feel human enough to leave the house.
It wasn't all bad though. In the three week cycle, there is one week free of drugs and feeling much better. I was managing to dance more weeks than not. There was generally getting out and about. Not much of high intensity, but a general sense that fitness could build up again.
Oh yes, one more limiting factor - a PICC line fitted to allow the chemo to be delivered straight into the blood stream. Not suitable for swimming with. It didn't stop me dancing but made my arm feel a bit more tired.
After three rounds of chemo, the IV drug I was on was cancelled. My body just wasn't tolerating it sufficiently - with platelets and white blood counts dropping to worrying levels. So that was that, four more rounds of tablets only. The side effects of these were minimal so I was back on track. It would have been another good time to discuss exercise...
After treatment
I'd survived! Hurrah! And with that, I was ready to live life to the full. I started a year of fundraising for Macmillan Cancer Support which included activity as well as the ubiquitous coffee mornings. I was very happy to be able to do things, so I did them. A family sponsored walk? I'm in. Swimming with the kids? Don't mind if I do. Cycling? Get me some padded cycling shorts and we'll see what can be done! (I kid you not, cycling shorts were on my Christmas list that year and made all the difference to getting back on the saddle).
I was lucky. For some, the period after treatment is no less hard than what has gone before. You have become used to people looking out for your well being at every stage. I know many people feel low finishing treatment when they are expected to face the world without frequent contact with caring professionals, while they are still coming to terms with the long term effects of their experience - whether that is physical changes or the emotional fall out.
This is probably a phase where many would benefit from an ongoing supervised exercise programme. Good for the mind and body.
In summary...
- For the 52 weeks following diagnosis, any exercise beyond walking would have been nearly impossible for around six of those weeks. And for another six it would have been tough to have managed more than moderate exercise.
- It is easier to do an exercise you love (dancing), but your treatment may limit your options - if you are a swimmer, or weight lifter for example.
- I would have responded well to discussions about exercise before treatment started and at the end. Not sure about in between times.
- Life is busy. Exercise is important, but so too is holding down a job and reading bedtime stories to your children.
On the other hand, there is inspiration to be had out there. I found this article:
https://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=12047228
How this young mother managed to hit the treadmill after her chemo is beyond me. But perhaps that is partly the point. The chemo doesn't actually affect you as badly if you add a cardiovascular work out into the mix?
If exercise really is the wonder drug, then services could usefully build gyms and gardens next to their oncology suites. Exercise sessions could be timed around appointments. It will be interesting to see if new ways of working evolve as the evidence mounts.
I am not an expert. I just offer this reflection as one illustration that cancer treatment has ups and downs. What works for one person may not for another. If anyone is going through this right now, you have my sympathy. I wish you strength.
Take care x
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| A bit of family exercise after treatment: fundraising walk for Macmillan Cancer Support, 2011 |
Thank you for sharing your assessment. I think you managed quite a lot of exercise even in your worst weeks and childcare definitely counts!
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