Exercise and Complementary Therapies
There is a very simple statement that sums up everything that I’m going to talk about in this section that I want to say up-front: Exercise is THE most important thing that you can do for yourself to help prevent your cancer from coming back, to help treat the cancer if it has come back, make you live longer, function better, and feel better. Cancer treatments play a huge role here too, but that is something I can help you with – I can’t exercise for you.
The benefits of exercise are plain to see for those of us without cancer, and it is crucial for those with cancer. Regardless of whether you are receiving chemotherapy after a surgery to try and make you’re your cancer never comes back (in what we call the adjuvant setting), or if you are receiving chemotherapy for incurable disease (for metastatic disease), you must exercise. If the benefits of exercise were available in tablet or injectable form, it would be the first thing I would prescribe; it’s as simple as that. The benefits that have been shown include:
So how much? How often? How intense? The answers for these really depend on you and may need a tailored exercise program, preferably by an accredited Exercise Physiologist or Physiotherapist with experience working with people with cancer. These specialists are highly educated in how to target the benefits we need to reduce the impact both the cancer, and the cancer treatments, will have on your body over time. They may use exercises to maintain or improve your muscle strength, to improve bone health, or maximise heart and lung function, all depending on what the evidence has shown them is necessary given your cancer type, current function, and expected changes in the future.
If you aren’t exercising now, you need to. If you are physically restricted, that may be difficult, but there almost certainly will be a way to improve your health through physical activity. I used to be an Exercise Physiologist before studying to become a doctor – I know how important they are at improving patients’ overall health and ability to live longer and thrive through treatment; not just survive it.
Please talk to your GP if you feel you could benefit from seeing an Exercise Physiologist or bring it up with me and I will link you in with someone who can help.
The use of complementary and alternative medicines (CAMs) is a fairly hot topic these days. Some studies of CAM use in Oncology suggest that more than half of our patients use them. If you ask most Oncologists, we would report far less of our patients telling us that they’re using these treatments. There seems to be some unspoken embarrassment about taking complementary treatments; whether patients are worried it will come across as a sign of incomplete trust in their Oncologist, or a fear of confrontation – there are many reasons that people may not want to bring it up.
I think to start off with, I’d like to separate the two types of non-conventional treatments: complementary, and alternative, therapies. Complementary treatments are those that someone takes alongside their standard cancer treatments. Alternative treatments are those that someone takes instead of their standard cancer treatments. Using this definition, I would strongly advise against “alternative” treatments, although will defend your right to choose whatever treatments you want to pursue. Complementary treatments are important to let me know about so that I can look up if there are any known interactions with the cancer treatments I’m recommending in case I need to increase or decrease my dosing calculations.
There are many reasons that people choose to take complementary medicines – sometimes to alleviate the side effects of cancer treatments, sometimes because they believe it will improve their outcomes, sometimes because they feel pressured into it by family or friends, and there are probably 101 other reasons.
There’s a few things I want to flag for you to be aware of. Sometimes complementary medicines make the side effects of your treatment better by reducing the effectiveness of those treatments. If you reduce the absorption of your medicine by 50%, of course the side effects will be better. You may, however, be compromising the effect of the treatment on your cancer. One particular example that comes to mind is the use of antioxidants with chemotherapy – some (not all) chemotherapy agents work by causing oxidative stress and creating free radicals that damage the cancer cells; you can imagine why we as Oncologists get nervous about the use of complementary medicines such as antioxidants in this scenario. If you have an iPhone, I would highly recommend an app produced by Memorial Sloan Kettering Cancer Centre (MSKCC) called AboutHerbs (available here). MSKCC has ranked as either the number 1 or 2 cancer hospital in the U.S. for 29 years in a row and have developed a huge database on complementary and alternative medicines, and listed their potential biochemical actions and possible interactions with anticancer therapies. This, along with my knowledge of how your cancer therapies work, is what I use to give you the most accurate advice I can, so you can make the most informed decision possible about complementary therapies.
I want my stance on complementary medicine use to be clear from the outset: it is your business what goes into your body. I will not stand in the way of any treatments you feel convinced will help you. I promise to talk plainly and honestly about what I do and don’t know about these products, and I will never disrespect your opinions or desire to take them. If asked about any alternative therapies, I will try and look them up and give you as good an answer as I can, but almost invariably, that answer will be that the product hasn’t been researched to the level that I can comment one way or another on its effectiveness.