Experience tells us: got cancer? Get an extended warranty!

AMAA Journal, Spring, 2004 by Fran Mason

Longevity has been a topic of great interest among members of the American Medical Athletic Association. Our nation is home to 70,000 centenarians. And according to United Nations projections, "Close to 1 in 20 American boomers are expected to live to 100, thanks to breakthroughs in treatments for heart disease and cancer and longstanding memberships at the gym."

Science has given us the tools to effectively detect, manage, and even cure many forms of cancer. It is realistic to assume that cancer does not have to be an impediment to attaining great longevity, and in attaining longevity, living a life of continuing vigor and good health.

A decade ago, it was rare to see cancer survivors participating in strenuous endurance athletic events. As an oncologist, it was almost never part of my job to counsel patients about aerobic exercise, resistance training, weight management or healthy lifestyle choices. My professional efforts were overwhelmingly dedicated to the "war" against cancer, and all of the battlefields encompassed therein--the alphabet soup of chemotherapy regimens, dealing with terminal illness, the potentially life-threatening side effects of treatment and a multitude of medical and personal crises.

All that has changed. We have gained more knowledge about the biological basis of cancer and have developed a better toolbox for treatment of the disease and management of symptoms during treatment. There is now a cohort of 9 million cancer survivors in this country. And in this group, there are individuals who have been affected by cancer and have developed careers as accomplished athletes. Many survivors are exemplary role models of fitness and health. They seem to have the physical prowess to remain healthy forever; however, survivors are susceptible to a variety of long-term sequelae of their illness and its treatment. They may end up with second cancers, heart disease, diabetes, hormone deficiency and/or cognitive disorders.

On personal and professional levels a couple of years ago, I became convinced that as a cancer specialist I needed to focus my energy on a different "toolbox" for my patients and indeed for all cancer survivors. Many cancer survivors are truly motivated to achieve the best possible fitness and health. To this end, the majority (60-84%) has invested in complementary cancer treatments and is willing to incorporate a wide range of therapeutic interventions into conventional medical treatment and recovery plans. Patients are investing time, energy and money in a wide range of supplements, herbs, therapeutic touches, spiritual retreats and so forth. Some are making radical changes in their lifestyle choices, diets and exercise regimens. Although few of these complementary and alternative therapies have been shown to impact cancer risk, recovery and prognosis, one intervention has repeatedly been shown to be effective--exercise!

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Instead of incorporating fitness counseling and exercise prescription into traditional medical oncology practice, I have chosen to focus my practice on helping cancer survivors become physically active and stronger, improve body composition and make healthy lifestyle choices. This can help them attain a realistic goal of longevity, and in working toward this goal, an improved quality of life.

The "Skinny" on Activity and Prognosis

Recent studies have examined the therapeutic value of exercise during primary cancer treatment. There is good evidence that exercise is not only safe and feasible but can enhance physical capabilities and functional well-being while recovering from surgery, undergoing radiation, receiving chemotherapy or hormonal therapy, and even while undergoing bone marrow transplantation. Integrating the exercise program into treatment is possible and requires a highly individualized evaluation and prescription with frequent modifications as treatment progresses. To accomplish this, we conduct very comprehensive intake examination. We interview the patient to understand their current medical status and details of treatment as well as pre-existing conditions which could impact on an exercise program. We learn of their exercise preferences and dislikes, their accomplishments, goals and insecurities. We ask about clothing, footwear, where they live and who might accompany them in an exercise program, including family pets. We ask about eating, drinking, sleeping, intimacy, mood and other lifestyle matters.

Physical examination includes a calculation of body mass index along with other vital signs, calculation of predicted maximal heart rate, and body composition analysis. Careful attention is given to cardiopulmonary systems and the neuromuscular exam.

Almost everyone is then objectively assessed for fitness level with formal testing so that we can individualize an exercise prescription. This includes a 12 lead EKG stress test, V[O.sub.2]max, strength and balance analysis, and calculated lactate threshold.

A comprehensive exercise plan is then developed, and patients are brought in to exercise two or three times per week. Each session is individually supervised and monitored by an exercise physiologist, physical therapist or graduate student intern.