EXERCISE & CANCER Class Examples

Anti-metabolite chemotherapy Methotrexate, flurouracil, (intravenous)

gemcitabine

Anti-tubulin chemotherapy (intravenous)

Alkylator chemotherapy

Anthracycline chemotherapy (intravenous)

Platinum salt chemotherapy (intravenous)

High-dose chemotherapy with bone marrow/stem cell transplantation

Glucocorticoid hormonal therapy (oral) Anti-oestrogen hormonal

therapy (oral) Anti-androgen hormonal

therapy (oral) Leutenizing hormone

releasing hormone agonists (subcutaneous injection)

Table 1: Classes of systemic therapy for cancer and common adverse effects

tumours including breast, lung, colon, rectal, cervical, ovarian, prostate, and oesophageal carcinomas as well as many sarcomas and aggressive lymphomas.

Cancer and quality of life The process of diagnosing and treating cancer may last months or even years. Not surprisingly, cancer and its treatments often result in significant reductions in quality of life (QOL). Some of the more common psychological difficulties experi- enced by cancer patients include depres- sion, anxiety, stress, body image con- cerns, decreased self-esteem and loss of a sense of control. The physical and func- tional effects of cancer and its treatments may include, ataxia (shakiness or unsteady gait), cachexia (general decline in body health), reduced cardiovascular and pulmonary function, muscle weakness and atrophy, weight change, difficulty sleeping, fatigue, nausea, vomiting, and pain.

18 SportEX

Although the side effects tend to peak during treatment and dissipate fairly rapidly following treatment, therapy-relat- ed symptoms may persist for months or even years after treatment is completed.

Benefits of exercise The role of exercise in coping with, and recovering from, cancer and its treatments has only recently received systematic research attention.

We have recently reviewed this literature and found 36 studies on the topic (2,3). Eighteen of the 36 studies examined breast cancer patients or survivors who were predominantly at Stage I and II of the disease. Nine additional studies have examined cancer patients following high dose chemotherapy and bone marrow/stem cell transplantation. Two studies each have examined colorectal cancer survivors and adolescent cancer survivors while a single study has exam-

ined head and neck cancer survivors, and four studies did not specify the type of cancer. The studies comprised 10 observa- tional and 26 intervention designs although few of the interventions were randomised clinical trials. The sample sizes of the 26 interventions ranged from five to 70 with a mean of 21. The exercise intervention itself was implemented dur- ing treatment in eight studies and post- treatment in 18 studies and typically last- ed less than 12 weeks. Supervised exercise programs were reported by 19 interven- tion studies whereas five studies reported unsupervised, home-based exercise pro- grammes, and two studies reported a par- tially supervised exercise programme.

Overall, the results of these studies have consistently demonstrated that an exer- cise intervention during or following can- cer treatment has many positive effects on QOL. In fact, all 26 studies showed beneficial changes in QOL and 22 out of

Goseralin, buserelin

Taxol, taxotere, vinorelbine, vincristine

Common adverse effects

Fatigue, anorexia, nausea, anaemia, neutropenia, thrombocytopenia

Fatigue, muscle pain, sensory and motor peripheral neuropathy, ataxia, anaemia, neutropenia, thrombocytopenia

Cyclophosphamide, chlorambucil Fatigue, anorexia, nausea, anaemia, neutropenia, thrombocytopenia

Doxorubicin (Adriamycin), mitoxantrone

Cisplatin, carboplatin

Combinations of 2-4 chemotherapy drugs in maximally tolerated doses

Dexamethasone (Decadron), prednisone

Tamoxifen Flutamide

Fatigue, cardiotoxicity (cardiac failure in <5% of patients), nausea, vomiting, anemia, neutropenia, thrombocytopenia

Fatigue, nausea, sensory and motor peripheral neuropathy, anemia neutropenia, thrombocytopenia

Loss of muscle mass, deconditioning, nausea, vomiting, neuropathy, anaemia, neutropenia, thrombocytopenia, infection

Fat redistribution (truncal and facial obesity), proximal muscle weakness, osteoporosis, oedema, infection

Weight gain, fatigue, hot flushes

Weight gain, fatigue, loss of muscle mass, hot flushes, osteoporosis

Weight gain, fatigue, hot flushes, osteoporosis