The majority of cancer patients who receive chemotherapy and / or radiotherapy tend to experience a basket of symptoms secondary to the disease process or the treatment itself. The most common and burdensome symptoms for these patients is fatigue. Will exercise help in reducing the feeling of fatigue?

Researchers from the University of Copenhagen studied the effect of a supervised exercise program on fatigue in 235 cancer patients who were receiving treatment for solid and haematological tumours (BMJ 2009; 339: b3410). These patients were randomly assigned to the intervention group (n=118) or control group (n=117). The control group received usual medical care and was permitted to increase physical activity as they desired. The intervention group, supervised by trained nurses and physiotherapists, undertook high-intensity exercise training on Mondays, Wednesdays and Fridays and low-intensity exercise on Tuesdays and Thursdays for 6 weeks. Each week they received 9 hours of intervention in groups of 7 to 10. High-intensity exercise consisted of 30 minutes of warm-up, 45 minutes of resistance training and 15 minutes of cardiovascular training. Low-intensity training consisted of relaxation for 30 minutes weekly, body awareness and restorative training for 90 minutes weekly and massage for 30 minutes weekly. The study found that, in the intervention group, there was a significant reduction of fatigue. The patients also showed significant improvement on 7 of 10 Short Form-36 subscales on general well-being, physical functioning, vitality, mental health, physical and mental components scale. The leisure time physical activity was 66% in the intervention group compared to 33% in the control group. In the intervention group, muscle strength improved 29.6%. The researchers concluded that a structured exercise program improved fatigue and physical and mental functioning among patients with advanced cancer who were receiving chemotherapy.

Quite often my cancer patients will ask if they should exercise. However, family members tend to discourage the patient because they fear exercise will make the patient even more tired. Whenever I am asked if a patient should exercise, my answer is invariably yes.  Yes because physical activity will not only make the patients get out of the house but also will help take their mind off their condition.

Next time, when your loved one who is undergoing chemotherapy / radiotherapy wants to go for a walk, try saying ‘Yes, lets.’

Cellular telephones are ubiquitous. In some places, such as Africa, their use has helped to transform communities as it has bypassed the need for a land-line phone service which would be prohibitively costly to establish in the African continent. Worldwide, the use of cell phones has mushroomed. In 1993, there were only 15 million cell phone users in North America, but by 1999 the number had swelled to more than 100 million. It is estimated that there are now 4 billion people on earth using a cell phone. Before the introduction of cell phones to the masses, there was no requirement on the manufacturers to prove that their use was not hazardous to health. Consequently, one of the most controversial health hazard questions ‘Does prolonged cell phone use cause brain tumours?’ remains unanswered. This is an even more emotive subject in the case of children as many parents now equip their 8 year old with a cell phone.

About 10 years ago, the Interphone study was established in order to settle the issue of cell phone safety. This was a 13-nation industry funded study. Although data collection was completed in 2004, the results have yet to be published and the European Parliament has demanded an explanation for the delay. Partial results of the 14 studies within the Interphone study have been published. All, except 4, studies found no increased risk for brain tumours from cell phone usage. Publication of the full study is awaited with interest.

In August 2009, the International Electromagnetic Field (EMF) Collaborative released its new report “Cellphones and Brain Tumors: 15 Reasons for Concern. Science, Spin and the Truth Behind Interphone.” (http://www.radiationresearch.org/pdfs/reasons_us.pdf)

The collaborative group includes Powerwatch and the Radiation Research Trust in the United Kingdom, The EMR Policy Institute, ElectromagneticHealth.org and The Peoples Initiative Foundation in the United States. The conclusions of the report include:-

1. Studies that are independent of the telecom industry consistently show a ‘significant’ risk for brain tumours from cell phone use.
2. The EMF exposure limits advocated by industry and used by governments are based on a false premise that a cell phone’s electromagnetic radiation has no biological effects except for heating.
3. The danger of brain tumours from cell phone use is highest in children. The younger a child is when he / she starts using a cell phone, the higher the risk.

The report was endorsed by more than 40 scientists and officials from 14 countries.

A recent Swedish study examined the risk of brain tumours in mobile phone and cordless phone users (Int J Oncol 2009; 35: 5 -17). The study involved 905 cases with malignant brain tumours, 1254 cases with benign brain tumours and 2162 population-based controls. The risk for brain tumours was highest for those who first used the phone below 20 years of age. Mobile phone users were 5.2 times more likely to develop brain tumours than controls. The risk was 4.4 times more for cordless phone users.

Do you really need to have irrefutable proof that cell phones do or do not cause brain tumours before you buy your 8 year old child a cell phone? Not everyone is comfortable waiting for the result of the definitive study on this topic. France, the United Kingdom, Finland and Israel have decided not to wait for additional data and have issued warnings about the use of cell phones and advise taking precautionary measures especially for children. In France, new legislation will ban advertising of cell phones that is directed at children under 12 years of age and the sale of cell phones designed for children younger that 6 years. Furthermore, it will also introduce new limits for radiation from phones and require cell phones to be sold with earphones.

Before the evidence is out, it is everyone’s right to decide whether they want to ‘risk it’ or not. However, should we ‘risk it’ with our children? Perhaps we, as parents, should ask “Is a cell phone a ‘must have’ or a ‘nice to have’ object? Is it something that my child cannot do without?” I do not have the answer; but to me, a degree of caution and restraint may well be in the child’s best interest.

No doubt many of us have come across children who constantly complain of abdominal pain or headache. Despite multiple visits to doctors, including several tests, no cause can be found. These children are normally treated with various types of medication but many are still troubled by the attacks. Children who attend cognitive-behavioural therapy (CBT) sessions at treatment centres do benefit, but due to the physical limitation of how many children can be treated per day and the problem of travelling to the facility involved, some children may miss out, wait a long time for an appointment or may not benefit as much as the sessions are too sparse. In the 21^st century, perhaps access to CBT could be made easier by digital media and the internet, thus, benefiting more people. Two recent reports have shown that using audiotape and the internet at home to deliver CBT can significantly help these children with recurrent pain.

Researchers from Oregon Health & Science University studied 48 children, aged 11 – 17 years, with chronic headache, abdominal or musculoskeletal pain and associated functional disability (Pain 2009; 146: 205 – 213). These children were randomly assigned to a wait-list group or an internet-delivered family CBT intervention group. The wait list group continued with the current medical care only. The internet group, in addition to their medical care, had 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies and sleep and activity interventions. The children in the internet group had significantly greater reduction in activity limitations and pain intensity. These effects were maintained at the 3 month follow-up. The rate of pain improvement was also significantly faster than the control group.

Another study from the University of Arizona involved 22 children, aged 5 to 18, diagnosed with functional abdominal pain (BMC Pediatrics 2009; 6: 29). These children were randomized to receive either breathing techniques (control) or guided imagery therapy. Children assigned to the guided imagery group were instructed on progressive muscle relaxation which led into the guided imagery. On achieving relaxation, the children were asked to invite an image to come to mind that represented their pain. They were encouraged to describe the image in great detail. Once this image was established, they were then asked to invite a second image to come that would get rid of the pain. An audiotape of the relaxation and image was given to the children to practice at home twice daily.  Three weekly follow up sessions were done to assess competence. In the control group, children were taught 3 breathing techniques that facilitate relaxation. An audiotape of the breathing exercise was given to the children to practice at home twice daily. These children also had three weekly follow up sessions to assess competence. When compared to the breathing exercise group, children from the guided imagery group had significantly greater decrease in days with pain during the initial month and 2 months of follow up. Those learning guided imagery also had significantly fewer days with missed activities during the first and second months of follow up. At the end of two months, 70% of the children in the guided imagery group were ‘healed’ (≤ 4 days of pain with no missed activities during each month), whereas only 14% were healed in the breathing exercise group.

It is estimated that 10 – 30% of children suffer from functional abdominal pain. Do adults suffer from chronic functional pain? They do! Perhaps what we have learnt from the studies on children with functional pain can be applied to adults.