| July
11, 2008
Dear Friends,
One of
the goals of the Cancer Survivor Center is to provide resources
to survivors, friends and family. Every season, the CSC receives
copies of “Cure,” a magazine devoted to providing
the cancer community with cancer updates, research, and education.
Unlike medical publications, “Cure” offers relevant
information in an easy to understand format.
In the
recent summer issue of “Cure” (Vol. 7, No. 2 /2008),
author Katy Human presents an article to readers titled, “Good
Behavior; Survivors get motivated to change lifestyle and
reap benefits.” The CSC found this article inspiring
and encouraging and wanted to pass it along to survivors and
their loved ones. (If you would like a copy of “Cure,”
please stop by the CSC office located in the Aspen Club!)
“Good
Behavior; Survivors get motivated to change lifestyle, and
reap the benefits”
Anne
Smithson was active growing up, but when the North Carolina
resident had children, her workouts became less frequent and
then dropped off almost entirely.
“I
had oh 10, maybe 15 sedentary years,” Smithson says
ruefully.
Breast
cancer struck in December 2006, when she was 46. “There’s
so much that’s out of our hands,” Smithson says.
“I don’t know why I got it, or if it’ll
come back, but I decided I can take care of my body.”
She dropped most red meat and alcohol from her diet last year,
and she’s now “hooked” on daily morning
workouts to keep her energy level high.
Most
cancer survivors know they should be doing what Smithson is—eating
better, exercising more, and, if they smoke, quitting. Some,
like Smithson, describe cancer as a powerful “teachable
moment” that inspires major lifestyle change, including
a renewal of attention to spirituality and friendships.
Many
survivors, however, fall back into old patterns after treatment.
With accumulating studies showing that exercise and diet can
affect cancer recovery and recurrence, many researchers are
now trying to figure out what kinds of programs or educational
materials can help cancer survivors make—and sustain—healthy
lifestyle changes.
Tim Byers,
MD, deputy director of the University of Colorado Cancer Center,
says he imagines a future in which cancer survivors are actively
engaged in physical therapy and rehabilitation during and
after treatment, as has become standard with heart disease
patients following decades of research on the effects of exercise
and diet on heart health.
“We
need a norm in oncology like we have in cardiovascular disease,
with rehabilitation after a heart attack,” Dr. Byers
says. Many heart attack survivors make substantial, sustainable
lifestyle changes, researchers have found.
In a
handful of sites around the country, cancer rehabilitation
programs are beginning, Dr. Byers says—recognition of
the accumulating research on the importance of lifestyle changes
for survivors. (Read about cancer exercise programs in “Forward
Motion”.
Studying
Survivors
Smithson
says it was pure hard work to make the changes. There were
months, she says, when it took her husband or a friend to
pry her out for a walk. Studies confirm that difficulty: Of
lung cancer survivors who smoked, about 13 percent keep smoking,
according to one study. In another, 80 percent of cancer survivors
said they were interested in health promotion programs, but
more than half didn’t eat the recommended daily servings
of fruit and vegetables.
“The
reality is that cancer survivors are remarkably similar to
the general population in terms of physical activity, smoking
rates, and other lifestyle measures,” says Keith Bellizzi,
PhD, a scientist at the National Cancer Institute. “Old
habits really die hard, and leading a healthy lifestyle is
difficult.”
One exception,
he and others have found, is that cancer survivors are more
likely than others to follow up with recommended cancer screenings,
especially mammograms, Pap tests, and prostate-specific antigen
tests.
The uncomfortable
truth is that there’s more at stake for cancer survivors,
however, than for the general population, Bellizzi says. Chemotherapy
or radiation may cause health problems, from heart disease
and osteoporosis to secondary cancers and poor quality of
life induced by long-term effects of lifesaving treatments.
“We
have only begun to look at these late medical and emotional
effects of cancer, because [many] people diagnosed 20 years
ago didn’t survive,” Bellizzi says.
Theories
of Change
Many
behavioral researchers use psychological models to describe
lifestyle changes. The models describe the stages survivors
may move through in, say, going from a sedentary lifestyle
to exercising regularly. The Health Belief Model, for example,
posits that a person is more likely to take healthy actions
when he believes his health is in danger, with potentially
serious lifestyle consequences—and when the cost of
taking action seems less than the risk of not taking it.
According
to the Theory of Planned Behavior, an individual may start
with “pre-contemplation, when individuals may be unaware
of the consequences of their behavior or that they perceive
too many barriers at the moment,” Bellizzi says. “Then
there’s the assessment phase, where someone is when
contemplating the costs and benefits of change, and the action
stage of overtly changing one’s behavior.”
Increasingly,
studies show people’s belief systems and their environments—from
socioeconomic status to the availability of diverse fruit
and vegetables—play a role in who makes the progression
from pre-contemplation of lifestyle changes to action, and
why.
Antronette
Yancey, MD, a professor at the University of California Los
Angeles School of Public Health, believes environmental changes
are more effective than comprehensive educational programs
at getting people to exercise and eat better.
In one
of her studies involving African-American women in a fitness-based
cancer prevention program, Dr. Yancey compared the diet and
fitness changes made by women in an intervention group and
a control group. Women in the intervention group lost more
weight immediately than those in the control group, but more
significant than the educational intervention was the free
gym membership offered to women in both groups, which served
as an economic environmental intervention, Dr. Yancey and
her colleagues found.
Now,
Dr. Yancey says, she’s focused on “captive audiences”
for interventions—engaging people in their workplaces,
schools, churches, or other settings where they spend a lot
of time. She gave an example of a man, interviewed by another
researcher, who wasn’t terribly interested in losing
weight. He accepted the offer of a cheap parking spot a 10-minute
walk from work, and that made a difference for him, she says.
“By
intervening with captive audiences, we’re not getting
everyone, but we’re getting a lot of people who would
not go out of their way to engage,” Dr. Yancey says,
pointing out another of her studies that found participating
in brief structured group exercise breaks, lasting only 10
minutes each day, led to improvements in weight, waist circumference,
blood pressure, mood, and physical activity participation
outside of work.
Beliefs
clearly matter, too. Those who believe there is a strong link
between, for example, exercise and cancer recurrence, are
more likely to progress into an active exercise program. Those
who believe they are personally at risk for cancer or recurrence
are more likely to plan and make changes. And people who participate
in worksite wellness programs, with the social support of
colleagues, were more likely to eat better and exercise more.
Practicing
Change
Trauma
may also play a role in motivating some people. “What
I, as well as others, have found is that individuals who report
positive change in the aftermath of cancer report the experience
as being a life event that shakes them to their core,”
says Bellizzi, who was diagnosed 13 years ago with stage 3
testicular cancer. He was 24, and three months after his first
diagnosis, doctors found a second, independent cancer—renal
cell carcinoma, a type of kidney cancer.
“I
remember one afternoon, lying in the hospital looking at my
family, my doctors, my wife, who was then my girlfriend, and
I said, ‘If I survive this dreadful disease I’m
going to quit my job and dedicate my life to cancer.’
”
Now,
he has two masters’ degrees and a PhD (a wife and three
girls, too) and is a researcher at the NCI, no longer a business
consultant.
Smithson,
now 47, also found her diagnosis shocking. Her annual mammogram
revealed a lump that didn’t worry her doctors. “They
said, ‘Let’s just take it out anyway.’ ”
When the initial pathology report came back normal, friends
and family sent Smithson congratulatory cards and e-mails.
“Two
days later I got an unexpected phone call and was told on
further review it was malignant,” Smithson says. “I
had been prepared for bad news earlier—not then.”
Smithson
had radiation following surgery and hormonal therapy with
tamoxifen, but she chose against chemotherapy. She’s
a family practice doctor at Meredith College in Raleigh, and
she pored through the studies before making the decision.
For her invasive ductal carcinoma, Smithson says, chemotherapy
might have given her a slight increase in risk reduction over
hormonal therapy alone, with additional side effects and possible
complications.
“I
said, ‘OK, if I’m not going to do chemo, I have
got to do every single thing I can to try to decrease my chances
of this thing coming back,’ ” she says. Today,
Smithson exercises about 90 minutes a day. She’s also
very strict about her diet, focusing on fruits and vegetables
and minimizing processed food.
Sustaining
Change
Diana
Ryall, a 37-year-old breast cancer survivor in Spruce Grove,
Alberta, in Canada still smokes. Ryall says she cut her fat
consumption and eats more salads since her diagnosis in 2006,
and she has lost nearly 20 pounds of the extra 80 she put
on because of cancer and treatment.
Smoking,
though, has proved harder. Ryall wants to quit, and is working
with her family doctor to identify patterns in her smoking—when
she’s picking up a cigarette because of her addiction,
and when it’s merely out of habit, for example. When
she’s down to just a few cigarettes a day, then she’ll
try quitting. “It is a lot less stressful to cut out
a cigarette each day or two than it is cutting them out all
together,” Ryall says.
Small
steps are the key to sustainability, many experts have found,
and there’s evidence that very small changes, such as
walking at a slow pace for three to five hours a week, can
decrease a person’s cancer recurrence and mortality
risk, according to research published in the Journal of the
American Medical Association.
In Dr.
Yancey’s study of African-American women in a fitness-based
cancer prevention program, women in the control group made
the most lasting changes in waist circumference and exercise.
“The changes occurred more incrementally and were likely
better integrated into their existing lifestyles because they
had to figure it out for themselves, both associated with
greater sustainability,” Dr. Yancey says.
Comprehensive
lifestyle changes, such as suddenly being asked to meet public
health recommendations for exercise and nutrition, would simply
overwhelm many people, Bellizzi says. “People have a
tendency to avoid or ignore important information that’s
not within their beliefs or perceived capabilities,”
he says, and the University of Colorado’s Dr. Byers
agrees.
“People
can get fatalistic about this, because they can’t make
major changes, but people don’t really need to make
big changes,” Dr. Byers says. “If you’re
60 pounds overweight, you don’t need to lose 60 pounds—losing
10 or 20 helps.”
Smithson
made her changes slowly. She first did short workouts two
or three times a week. In September 2007, after she’d
fully recovered from surgery and radiation, she hired a personal
trainer at a customized studio near her home. Now, Smithson
and her family work out at a big gym, where her high school
son can play basketball, her husband can take spinning classes,
and Smithson can rotate between strength training, elliptical
trainers, treadmills, and an exercise bike.
Most
fun for her, Smithson says, was a fitness assessment—pulse
rates, flexibility, and body fat—she took every month
or two when she was regaining her feet. “For pushups,
I went from well below average for my age to well above,”
Smithson says, joyfully. “In three months, I went from
zero to 28—and these are man pushups, not girl pushups.”
**************************************************************
THIS
WEEK’S TRAINING TIP: When NOT to exercise when you have
cancer.
While we believe cancer survivors can and should participate
in low, moderate and vigorous exercise during and after treatment,
there are times when you should cease physical activity and
contact your health care team: These include the following:
If at
any time during the treatment phase you experience neutropenia
(< 0.5 x 109?L-1), decreased total red blood cell count,
eosinophilia, decreased hematocrit and/or hemoglobin values
(< 8.0 g?dL-1) outside of acceptable ranges (based on your
doctors clinical laboratory standards). Additional precautions
used for safe exercise prescription after the treatment phase
are based on work of Courneya et al., and include decreased
platelet counts (< 50 x 109?L-1), fever (> 38°C),
ataxia/dizziness/peripheral sensory neuropathy, severe cachexia,
dyspnea, bone pain, severe nausea, extreme fatigue/muscle
weakness, and dehydration. Should you experience any of these
complications, contact your health team for advice before
continuing the exercise program. It is important to find out
the reasons for these symptoms before moving forward.
If you
have any questions or comments regarding the tip, please do
not hesitate to contact one of our Certified Cancer Exercise
Specialists here at the CSC.
In health,
Riggs
|
