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.’

Colorectal cancer (CRC) is now a common cancer in both the western and eastern countries. Apart from the regional lymph nodes, the next most common site for colorectal metastases is the liver. In the past, these patients, when treated solely with fluorouracil / leucovorin, would have an overall survival of 8 – 12 months only. With the advent of safer liver surgery and better chemotherapeutic agents, most doctors have the distinct impression that the outlook for patients with metastatic colorectal disease has improved over the last 10 years. Is this observation correct?

Researchers from the University of Texas M D Anderson Cancer Center and the Mayo Clinic performed a retrospective review of 2470 patients with metastatic CRC treated at the Mayo Clinic (n=856) and MD Anderson (n=1614) during the period 1990 to 2006 (J Clin Oncol, epub 2009 May 26). From 1990 to 1997, the median overall survival for patients with metastatic CRC was 14.2 months. However this improved to 29.2 months for the time period 2004 – 2006. The overall 5 year survival rates showed similar improvements, from 9.1% in the 1990 – 1997 period to 19.2% for the 2001 – 2003 period.

Overall Median Survival – 1998 to 2006

Overall 5-Year Survival Rates – 1998 to 2006

From 1990 to 2006, 231 patients had liver resection for metastatic CRC. Liver resections were performed with increasing frequency from 1998 and between 2000 and 2006 approximately 20% of patients had liver surgery. From 1998 to 2006, the 5 – year survival rate among patients who had undergone liver resection was different from those with unresectable disease. The 5 – year survival rate was 55.2% for resected patients compared to 19.5% for unresectable patients. The median overall survival for these 2 groups of patients was 65.3 months and 26.7 months respectively.

Survival analyses of patients with metastatic CRC who could not undergo liver surgery but treated with chemotherapy only, showed that the survival rates from 1998 to 2000 were not different from that before 1998. From 2001 to 2003, the survival rates improved only minimally but improved significantly for those diagnosed between 2004 and 2006.

In the last 5 years, newer chemotherapy drugs have made a difference to patients with metastatic CRC. It has improved overall survival and in some cases, can convert metastatic CRC into a ‘chronic’ condition. However, chemotherapy alone cannot provide a cure. If liver surgery can be performed, it can potentially provide a chance to cure. Even if it could not cure, liver surgery can significantly increase your survival time. While liver surgery is a very major operation, it is very safe when performed properly. Even though it is a big operation, it does not mean you will have a long hospital stay. Can you hazard a guess on the average length of hospital stay for someone undergoing liver surgery for metastatic CRC?

7 days!

Nausea is a common side-effect in patients who are undergoing chemotherapy. Despite the use of powerful anti-nausea medication such as ondansetron (Zofran, GlaxoSmithKline) and granisetron (Kytril,Roche), many patients still experience significant nauseous feelings. This can affect food intake and adds to the unpleasantness of undergoing chemotherapy.

Researchers from the University of Rochester are going to present the results of a study on the use of ginger in patients undergoing chemotherapy, at the upcoming 2009 Annual Meeting of the American Society of Clinical Oncologists (ASCO). Six hundred and forty four, primarily female (90%), patients (from the University of Rochester-affiliated Community Clinical Oncology Programme) were randomly assigned to receive a placebo or 0.5 gm, 1.0 gm or 1.5 gm of ginger in capsule form. All patients undergoing chemotherapy received 5-HT₃ receptor antagonist antiemetics – ondansetron (Zofran, GlaxoSmithKline) or granisetron (Kytril, Roche) – starting on day 1 of all chemotherapy cycles and began supplementation with either ginger or placebo 3 days before the first day of a chemotherapy cycle. The ginger was given in 2 doses daily for 6 days. The degree of nausea was rated on a 7-point scale during the first 4 days of each chemotherapy cycle. The study found that all doses of ginger significantly reduced nausea more than the placebo. Patients taking ginger capsules rated their nausea as 1, which was none at all, or 2, which was slight nausea. Patients who were taking placebo rated their nausea as 4, which was extremely nauseated. The greatest anti-nausea effect was with the 0.5 gm and 1.0 gm doses, which is equivalent to ¼ and ½ a teaspoon of ground ginger, respectively.

Ginger, the rhizome of Zingiber officinale Roscoe (Zingiberaceae), has been used as a spice and condiment in many societies since time immemorial. It has also been use as a medicine for treating common colds, fever, rheumatic disorders, gastrointestinal complications, motion sickness, diabetes and cancer. If we can prevent nausea with the help of ginger, it would indeed be a relief for many patients who are undergoing chemotherapy. Furthermore, the cost of ginger capsules would be negligible compared to the cost of the chemotherapeutic agents.

Perhaps, one day, the serving of ginger cakes and biscuits to patients in a chemotherapy centre will be a common sight!