By
The Associated Press
WASHINGTON - A bit of exercise can beat back the weariness that is a side effect of chemotherapy and radiation, and give early-stage breast cancer patients better lives, researchers say.
Exercise adds a boost of vitality, say the scientists, whose recommendation to be more active reverses the traditional medical advice that women who suffer fatigue should rest.
"It means something real to the patient," said Dr. Roanne Segal of Ottawa Regional Cancer Center in Ontario, Canada. "They can do more. They have more energy to do what they need to do."
The Canadian researcher and her colleagues looked at 123 women whose breast cancer was classed in stages I or II. In these less-advanced stages, the cancer may have remained in the breast or spread only to the lymph nodes of the armpit. Tumors may be two inches or smaller - or, if they are larger, have not spread beyond the breast.
In these patients, the cancer has not spread so far that it was sapping their strength. The patients also have the best chance of beating the cancer, with up to 70 percent living at least five years after diagnosis.
Treatment typically involves surgical removal of tumors, followed by radiation and chemotherapy - often a combination - to attack any remaining cells. Women also may get tamoxifen, a medication that reduces levels of the female hormone estrogen, which can foster tumor growth.
However, the follow-up treatment, called adjuvant therapy, leaves about 80 percent of patients feeling too fatigued to do things they used to do, Segal said.
In the study, published in the Journal of Clinical Oncology, women were split into three groups. Cancer doctors advised members of one group, which served as a control, to exercise if they felt well enough. Members of a second group were placed in a walking program in which participants met three times a week at the researchers' Ontario clinic and walked twice a week on their own. The third group was given a similar regimen but told to do it on their own five days a week. Their progress was checked by researchers.
Results were assessed after 26 weeks, based on questionnaire responses about physical function.
Women in the control arm of the study reported they felt less able to do things than they were before they started therapy. For instance, 19 percent were unable to work. But women in the exercise arms reported improvements - to levels that were meaningful in their lives. The most dramatic difference was among the women in the on-their-own exercise program, which had only six percent unable to work.
The fact that women in the self-directed program did better than even those in the clinic-based program was unexpected, Segal said. She believed that the self-directed women had been sneaking in more exercise than the study called for.
People with cancer may have more exercise capability than doctors have thought, said researcher Anna Schwartz of Oregon Health Sciences University, who was not connected with the study.
In her previous research at the University of Washington, she had found that women with breast cancer are motivated to exercise, Schwartz said. They see it as something they can do by themselves to cope with their disease, she said.
"They want to get back to their old selves, and most of them are quite delighted with how much stronger they are," Schwartz said. "They are sort of amazed at how much progress they made with relatively little effort."
Because the cancer was diagnosed early, the women were not debilitated by it, and an exercise program can concentrate on fighting the side effects of adjuvant therapy rather than overall rehabilitation, said Dr. Janet Abrahm, director of the pain and palliative care program at Dana-Farber Cancer Institute, Boston.
Such women have busy lives and want to return to them, said Abrahm, who was not affiliated with the study. "These are wives and mothers and workers who need to have the energy they had before," she said.
Exercise seems to benefit patients most when they are most fatigued by their treatment, Schwartz said. "When you are stuck in your chair, that's when you get the most bang for your buck, even if you are just walking five minutes to the mailbox," she said.
Studies, as well as her own clinical experience, indicate being active helps patients as well, such as men with prostate cancer, Schwartz said.
Carefully prescribed activity even can help people with advanced disease, Schwartz said: "They feel they are doing something healthy for themselves, which is a big thing when they think their lives are out of control."
