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.’

Recently, a lady from Malaysia consulted me for a second opinion as she had been diagnosed with stage IV pancreatic cancer. Apart from a history of epigastric discomfort, early satiety and slight loss of weight, she felt fine. The CT scan showed a locally advanced pancreatic cancer with metastases to the liver. The family wanted to know why she developed the cancer. Was it something she had eaten, drunk or something she had come into contact with?

Researchers from the National Cancer Institute, USA, studied the link between 5 lifestyle factors and the risk of pancreatic cancer in 450,416 participants in the National Institutes of Health-AARP Diet and Health Study (Arch Intern Med 2009; 169: 764 – 770). During 1995 – 1996, these participants completed a baseline frequency questionnaire eliciting diet and lifestyle information and were followed up through 31^st December 2003. The participants were scored on 5 modifiable lifestyle factors as unhealthy (0 points) or healthy (1 point), receiving 1 point each for non-smoking, limited alcohol use, adherence to the Mediterranean dietary pattern, body mass index (BMI, ≥ 18 and < 25) and regular physical activity. A combined score of 5 meant most healthy and a score of 0 meant least healthy.

The distribution of lifestyle scores was 1.5%, 10.7%, 27.8%, 31.3%, 21.1% and 7.6% for scores of 0, 1, 2, 3, 4 and 5, respectively. Those with higher scores tended to be older, were less likely to be African-American and had a higher educational level. Having a combined lifestyle score of 5 was associated with a 58% risk reduction for pancreatic cancer. Non-smoking and normal BMI were associated with a statistically significant reduction of pancreatic cancer risk. Among the 5 risk factors, non-smoking had the higher population-attributable risk of 14%; that is 14% of cases would have been prevented if all participants were non-smokers.

Among cancers, pancreatic cancer incidence among men and women is 9^th and 10^th respectively. However, the mortality rate is worse compared to other more common cancers and it ranks 4^th among men and women. It carries a much poorer prognosis because the pancreas lies deep at the back of the abdominal cavity. It tends to grow to a more advanced stage before giving symptoms. In order to reduce the burden of this disease we should think more in terms of prevention. The simplest preventative measures should start with what we do and what we eat / drink. We need to modify our lifestyle habits in order to reduce our risk for pancreatic cancer.

As the saying goes - you reap what you sow!