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I was recently diagnosed with breast cancer. Along with tests, treatments and surgeries, what else can I do?

July 04, 2013

This question is quite common during our initial discussions with a patient who has just received the new diagnosis of breast cancer. We often have very little to offer on this subject. Western medicine, with all its advances, does not always engage the active participation of the patient. We instruct what tests, what medications, what operations are best; and these recommendations are based on a thorough knowledge of the disease, reflect the most current thinking, and achieve good results. However, at the end of all these consultations, there is often a recurring question, "What else can I do?"

The internet is full of sites offering help in this arena. Unfortunately, some are the modern day equivalent of snake oil salesman. Large on promises but low on delivery. However, many patients are drawn to the realm of complementary care (care that is "in addition to" traditional standard of care, as opposed to alternative care which is defined as "in lieu of" current recommendations). A recent study from Columbia University found that 85 percent of breast cancer patients partook in some form of complementary therapy. The reasons for this interest is varied but, in large part, stems from the drive of a patient to be more fully engaged in their care, health, and outcomes. Another reason is that many patients experience a disturbing lack of control during medical therapy. By seeking out, and participating in complementary care, some semblance of control can be regained. Despite well intentioned efforts, many of these options do not afford an appreciable benefit.

However exciting results are being studied and can be found as close as your nearest gym, fitness center or yoga studio: EXERCISE.

Breast cancer treatment has several relatively distinct treatment phases during which exercise is being realized as having a beneficial effect. The landmark study on exercise and breast cancer treatment was initiated in the 1980s at the Ohio State University (this is totally disturbing being a University of Florida grad, but whatever). The study demonstrated that exercise during treatment was not only safe (a major shift in and of itself), but that patients experienced improvements in aerobic capacity and experienced less treatment-associated nausea. Since then, additional studies have confirmed and expanded on identifying the benefits of exercise during therapy. Patients in the exercise groups were noted to have an improved quality of life, less fatigue, less anxiety, and improved self-esteem.

As more patients were enrolled in exercise regimens, the beneficial effects of exercise were reported for long-term results as well. For example, one of the feared complications of breast surgery is the development of lymphedema (a swelling of the arm resulting from surgically removing potentially affected lymph nodes). Exercise has been shown to be helpful in both preventing and treating lymphedema. Another complication of treatment is the potential for chemotherapy to cause heart damage. Laboratory studies have suggested that aerobic exercise can minimize the chemotherapy-associated cardiotoxicity by strengthening the heart and minimizing oxidative damage.

So, if the benefits of exercise is minimized treatment side effects and improves one's overall feeling, that would be reason enough to begin showing up for spin class, right?

More recently, an even more exciting trend has been noticed - exercise may reduce recurrences and improve overall survival. In other words, exercise may treat cancer. A recent meta-analysis which included results of six studies looking at outcomes of more than 12,000 patients reported that taking up exercise after the diagnosis cuts the risk of dying from breast cancer by 34 percent. Women who had exercised before diagnosis and continued to exercise noted an 18 percent benefit compared to women who became inactive during treatment. Several pathways are thought to be involved in these benefits, including changes in hormonal environment, improvements in the body's response to insulin (insulin can act as a growth hormone), and improvements in the immune systems surveillance. Other mechanisms include interactions with altering proteins produced by adipose (fat) cells and reducing overall inflammation. There are even newer studies suggesting that exercise may activate tumor-suppressing genes.

Hopefully your interest is piqued. There are many avenues to begin an exercise program. Certainly, if you have any history of heart disease, begin a discussion with your primary medical doctor. The studies discussed involved moderate to vigorous-intensity ranging in time from 30 to 60 minutes. Aerobics, resistance (weights), and combination of both were reviewed, all with beneficial effects. There is no doubt that a cancer diagnosis can be physically and emotionally devastating. Becoming active in an exercise program can help empower one to better endure treatment, reduce cancer recurrence, and improve overall health.

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