Download Cancer and Exercise

CANCER
SMART
November 2009 • Issue 6 • FREE
Cancer and Exercise
INSIDE
Wellspring Cancer Support Foundation with contribution from Jodi Steele, BKin. BSc (PT) and Ira Henderson
Prostate Cancer:
Lymphedema After
Cancer Therapy
p2
For Breast Cancer Patients &
Survivors: Lymphedema 101
p3
The Value of Integrating
Natural Medicine in Cancer
Prevention and Treatment
Strategies
p4
One of the most exciting advances in
improving the outcomes and lives of patients
with cancer has nothing to do with new
medications or treatments – it is good,
old-fashioned exercise.
Most of us have heard the recommendation
that exercise is a good idea for health. But
exercise for patients with cancer is much
more than a healthy lifestyle practice.
Recent research is showing that exercise can
benefit some patients in many specific ways,
including:
• secondary prevention, meaning there is
less chance of cancer coming back
• symptom management, e.g., less fatigue,
less nausea
• improved treatment compliance,
meaning that patients who exercise are
more likely to complete their treatment
without interruption
• improved emotional well-being, e.g., less
depression, less anxiety
• improved quality of life, e.g., better body
image, better sense of personal control
• improved overall fitness, stamina and
flexibility.
These are exciting findings that are grabbing
the attention of the medical community
worldwide. There is no one medication
or complementary medical intervention
that shows so many benefits for patients’
well-being both during, and after, cancer
treatment.
Benefits of Exercise
Although most of the research to date has
focused on patients with breast, prostate or
colorectal cancer, there is reason to be hopeful
that research will show benefits for patients
with other types of cancer as well. There are
many research studies underway, and the
understanding of its benefits for all patients
will continue to grow.
The following are just some of the important
highlights based on current literature:
• Research has shown that exercise can
decrease mortality for patients with
non-metastatic colorectal cancer, and
women with hormone-responsive breast
cancer tumours.1, 2
Continued on page 5
A Lifeline to Cancer Support
www.wellspring.ca
This newsletter is brought to you
as an educational service of the
Wellspring Cancer Support Foundation.
Charitable Registration # 89272 8940 RR0001
PAGE 2 • CANCERSMART • November 2009 • Issue 6
PROSTATE
CANCER Lymphedema After Cancer Therapy
Early treatment and active self-management are the
Pamela M. Hodgson, Msc, RMT
Reprinted with permission from Parkhurst, Our Voice, Vol. 14 No. 3 • 2009
for prostate cancer, Lymphedema can occur
in the lower part of the trunk, the genitals
and/or the legs.
What does Lymphedema
feel like?
Postoperative swelling often resolves
spontaneously; if it persists, Lymphedema
may be suspected. The swollen limb or
body part may feel uncomfortable, painful,
and heavy or awkward to move. There
may be a feeling of fullness or tightness in
the leg or genitals. The ankle or knee may
feel stiff and less flexible. Genital edema
can interfere with sitting or walking, and
urination can be difficult.
Lymphedema is a challenging condition
that can arise following some prostate
cancer treatments, as a result of damage
to the lymph system. Understanding
the symptoms, early diagnosis and
treatment, and active participation in
your management are important steps to
minimize its effects on your quality of life.
Body image, as well as social, family
and work life can be affected. Especially
for men with scrotal or penile swelling,
psychological distress is as important a
factor as the physical discomfort. With foot
and leg swelling, finding appropriate shoes
and trousers can present a challenge.
What is Lymphedema?
What should I look out for?
Lymphedema is a buildup of fluid in body
tissues leading to swelling, which occurs
when the lymph system has been damaged
or blocked. The lymph system plays a
role in immunity and in circulating body
fluids. Lymph nodes produce white blood
cells to help fight infection; the lymph
vessels transport these cells and help the
veins return fluid and waste products
from muscle metabolism, large protein
molecules, and foreign substances from all
parts of the body. Radical prostatectomy,
lymph node removal or radiation therapy
to the pelvis can damage the system. In
addition, cancer itself can block the vessels
and lead to Lymphedema. After treatment
If your cancer treatment was aggressive to
the lymph system, or if you have developed
mild swelling, it is wise to follow certain
precautions:
• Protect the limb and trunk from
infections, injury or burns and maintain
a normal weight as much as possible.
Being overweight or getting an infection
(cellulitis) in the skin of the treated area
increases the risk of lymphedema. The
body responds to injury by making extra
fluid that is hard to get rid of if the lymph
drainage system is compromised. If
injury occurs, clean the area immediately
and apply standard first aid.
• Skin care is important, because the
•
•
•
•
affected tissues gradually thicken and
are susceptible to inflammation and
infections. Keep the skin clean, soft
and supple by using lotion or oils as
needed. Dry skin tends to crack more
easily, creating an entry point for
infection. Avoid fungal infections by
keeping the skin between the toes dry
and soft.
Be aware of the signs of infections:
heat, redness, swelling, tenderness,
fever or chills. Cellulitis needs prompt
treatment. Call your doctor right away
or seek treatment if you think you have
an infection, so you can get the proper
antibiotics immediately.
Deep vein thrombosis (DVT) is also a
potential risk following cancer surgery.
With DVT there may be symptoms of
pain, redness, heat and swelling. It is
best to check with your doctor when
any symptoms of swelling occur.
Other precautions to protect the
skin and avoid injury include using
sunscreen and insect repellent when
outdoors in summer, avoiding extreme
temperatures such as hot tubs that can
increase swelling, wearing comfortable
socks and shoes, and wearing loose
clothing to avoid constriction of the
limb or trunk.
Regular exercise, such as walking and
swimming, maintains strength and
flexibility and helps reduce swelling
and stiffness associated with treatment
and/or Lymphedema. Check with a
doctor or exercise specialist before
beginning any new program, to ensure
it is appropriate for your health and
fitness level. When exercising, intensify
your program gradually; listen to your
body and avoid overexertion, swelling
or discomfort.
Continued on page 3
PAGE 3 • CANCERSMART • November 2009 • Issue 6
For Breast Canc
ARE YOU AT RISK
e best routes to success
Kathleen Gotts, Lymphedema: Take Control Projec
Have you...
Treatment
The aims of treatment are to reduce and control
swelling and to encourage you to be an active
participant in your own management. Health
professionals (including nurses, physiotherapists,
occupational therapists, massage therapists)
with special training in Complex Decongestive
Therapy (CDT) can offer assessment, education
and treatment. The mainstay of treatment is
compression. For mild Lymphedema, wearing a
compression stocking and/or bicycle shorts may
be enough. If it is more serious, the therapist
may perform a special, light type of massage
called manual lymph drainage and will often
teach you how to do it yourself. This gentle
massage encourages lymph flow and moves the
excess fluid from the swollen part to an area
where the lymph system still functions normally.
This may be followed by the application of
compression bandages that are worn day and
night in the intensive, first phase of treatment.
In the second, maintenance phase, CDT
therapists will educate you about proper
exercise, skin care, and long-term management
with compression garments or different types
of devices (special scrotal pouches, nighttime
compression garments, etc.) and self-drainage
techniques as necessary. Together, you and
your therapist will find what works best for
you. If you suspect you have lymphedema,
seek prompt assessment and diagnosis; early
treatment leads to best results.
Where can I find help?
Lymphedema support groups in many
provinces of Canada provide education,
links to therapists and patient support (see
Resources table below). Lymphovenous Canada
has also developed an informal network of
contacts where support groups do not yet
exist. The National Lymphedema Network
and Cancer Supportive Care in the US, and
Cancerbackup in the UK are among many
informative websites offering patient-friendly
information.
The most specific site on Lymphedema
following prostate cancer treatment (www.
hrpca.org/lymphedemema.htm) is hosted
by an enterprising patient with hormone
refractory prostate cancer. I met Howard
Hansen in Vermont, and was most impressed
by his positive and generous approach to
lymphedema and to life. We know how
important it is to maintain an optimistic
attitude throughout cancer diagnosis and
treatment. It is the same with Lymphedema.
Symptoms and swelling can vary with changes
in weather, diet, exercise, etc. Lymphedema is
a very individual condition the challenge is to
find what works for you and to keep a positive
outlook. Family, friends and a supportive
therapist can all help. Fortunately, there are
many more resources today than even 10 years
ago, thanks in large part to the advocacy of
patients and patient support groups.
Resources:
Lymphovenous Canada
www.lymphovenous-canada.ca
Cancer Supportive Care Programs (US)
www.canersupportivecare.com/lymphedema.html
Cancerbackup, a British charity
www.cancerbackup.org.uk/info/
lymphoedema.htm
National Lymphedema Network (US)
www.lymphnet.org
Howard Hansen’s Hormone Refractory
Prostate Cancer site
www.hrpca.org/lymphdema.htm
Lymphedema support groups in Canada
AB www.albertalymphedema.com
BC www.bclymph.org
ON www.lymphontario.org
QC www.infolympho.org
MB Edith Mulhull at: [email protected]
CAN www.lymphovenous-canada.ca/groups1.htm
been diagnosed with breast can
had radiation treatment?
had a lymph node dissection?
had a mastectomy or lumpecto
Treatment for breast cancer, and other cancers,
condition called lymphedema. Although not li
it can be debilitating and may seriously affect d
functioning. With early detection and effective
lymphedema can be improved or prevented fro
an advanced stage.
Breast Cancer Action (Ottawa) developed the f
information to raise awareness about lymphed
breast cancer and to promote the value of proa
its risk reduction and management.
READ ON to learn the basics of breast cancerlymphedema.
What is the lymphatic system?
The lymphatic system is the body’s filtration sy
consists of organs, ducts and nodes located thr
body. The lymphatic system has several functio
• drains fluid from tissues back into the blo
• filters the clear fluid called lymph
• filters the blood
• provides immune cells which fight infect
What is lymphedema?
Lymphedema (pronounced lim-fa-DEE-ma) o
lymphatic system is unable to transport lymph
affected area of the body.
When lymphatic tissue or lymph nodes have b
destroyed or removed, lymph fluid cannot dra
the affected area. Excess lymph fluid builds up
swelling that is characteristic of lymphedema.
There are two types of lymphedema. Primary l
caused by a faulty lymphatic system and is ofte
Secondary or acquired lymphedema can develo
surgery, radiation, infection or trauma.
PAGE 3 • CANCERSMART • November 2009 • Issue 6
cer Patients & Survivors
K? Lymphedema 101
ct Coordinator, Breast Cancer Action (Ottawa)
ncer?
omy?
, can lead to a
ife-threatening
day-to-day
e treatment,
om progressing to
following
dema related to
active strategies for
-related
ystem, which
roughout your
ons. It:
loodstream
tion.
occurs when the
h fluid through an
What is secondary lymphedema related to
breast cancer?
Lymphedema risk reduction & management:
What can you do?
If you have been treated for breast cancer you may be at risk of
developing lymphedema, which causes swelling of the chest,
arm or hand. The swelling may be accompanied by numbness,
discomfort and sometimes infection.
Here are some strategies you can follow now.
Lymphedema is not life threatening but it can occur immediately
or months, even years, after cancer treatment. Early intervention
can lessen its impact.
What are some of the signs & symptoms of
breast cancer-related lymphedema?
•
•
•
•
Arm or chest feels full or heavy and tires easily
Arm or chest feels achy or numb
Skin feels tight
Notice less movement or flexibility in your chest,
shoulder, wrist or hand
• Clothing or jewellery feels tight in the affected area
Experts agree that recognizing early symptoms and starting
treatment promptly is a good way to manage the condition. If
you experience a sensation of heat or skin redness, consult your
doctor immediately as this may be a sign of infection.
What treatment options are available?
You can help yourself by learning about lymphedema risk
reduction and management from the healthcare professionals
involved in your care.
Treatment for lymphedema may focus on therapies to decrease or
contain the swelling. Contacting a certified lymphedema therapist
is a good place to start. With the help of a specialist, you can
reduce the risk of developing lymphedema or manage an existing
condition.
been damaged,
ain normally from
and results in
The most common treatment is Complete Decongestive Therapy.
Treatment includes skin care, manual lymphatic drainage massage,
compression bandaging and garment fitting. To learn more about
these treatments, or to locate a certified lymphedema therapist in
your area, contact Lymphovenous Canada at:
www.lymphovenous-canada.ca
lymphedema is
en genetic in origin.
lop as a result of
Exercise has many benefits including decreasing the risk of cancer
recurrence or of developing lymphedema. It also helps improve
flexibility, well-being and overall quality of life.
Skin Care
• Avoid trauma or constriction to the affected area
• Avoid injections or blood pressure monitoring on
the affected arm
• Use a skin moisturizer
• Apply antibiotic cream immediately to small skin
abrasions or cuts
• Practice careful nail and cuticle hygiene to prevent
entry points for infection
• Avoid saunas or hot tubs if you have lymphedema
Diet
• Maintain a healthy body weight
Compression Therapy
• Compression garments can help reduce swelling
• Consult a certified lymphedema therapist for proper
fitting and advice
Infection
• Infection can be serious in those who have had surgery
to the lymph nodes. It can cause lymphedema or worsen
an existing condition
• If you notice skin redness, swelling or heat to the affected
area, call your doctor immediately
This information and other resources were developed by Breast
Cancer Action (Ottawa)’s Lymphedema: Take Control project
(July 2007-August 2009). This community-based project was
informed by current evidence on breast cancer rehabilitation.
It was made possible with funding from the Canadian Breast
Cancer Foundation – Ontario Region. For more information
and resources, please visit: www.bcaott.ca/lymphedema/info
PAGE 4 • CANCERSMART • November 2009 • Issue 6
The Value of Integrating Natural Medicine in
Cancer Prevention and Treatment Strategies
Christine Matheson, ND
There is an unquestionable rise in
public interest and demand for natural
medicine. From a desire for a more
holistic approach, many people now
seek out natural medicine specifically for
cancer prevention and/or to complement
cancer treatment strategies.
It is of utmost importance that natural
medicine be administered by a qualified practitioner and that it
is safely integrated with all conventional medicines or treatments.
This is essential, for example, to avoid any drug/nutrient/
herbal interactions. Naturopathic doctors (ND’s) are qualified
practitioners and leaders in the field of natural medicine. In a
well-regulated profession with extensive training required, ND’s
are able to offer health care that focuses on disease prevention,
diagnosis and treatment using natural therapies and natural
substances to promote healing. A key principle of naturopathic
medicine is to tailor the treatment to the individual. Each patient’s
protocol is unique utilizing a combination of the broad range of
naturopathic therapies available that include: clinical nutrition,
homeopathy, traditional chinese medicine and acupuncture,
herbal medicine, lifestyle counseling, hydrotherapy and bodywork.
Naturopathic Strategies for
Cancer Prevention
One of the fundamental themes of naturopathic medicine is
prevention. By assisting patients to enhance their overall health
and vitality, ND’s are always aiming to prevent chronic diseases.
If a patient is concerned about preventing the onset of cancer,
or is focused on avoiding a recurrence, here are examples of key
naturopathic strategies that may be suggested.
•
•
•
•
•
•
•
Optimizing nutritional health
Improving digestive health
Assisting the body’s detoxification process
Strengthening the immune system
Decreasing exposure to environmental toxins
Promoting regular and effective exercise
Enhancing positive emotional health
Naturopathic Strategies during Cancer Treatment
Naturopathic medicine functions most often as supportive or
complementary care. This means that it is used at the same time as
conventional cancer treatments, such as chemotherapy or radiation, and
does not replace these treatments. These are the most common reasons
to safely include naturopathic therapies with conventional cancer
treatment.
• To enhance recovery time from surgery
• To minimize the side effects of conventional treatments
• To ensure proper nutrition when appetite is poor or body is
depleted
• To enhance the quality of sleep in order to aid healing
• To safely protect healthy cells and tissues when possible post
chemotherapy or radiation
• To detoxify after use of potent conventional drugs
• To regenerate the body post conventional treatments
• To provide emotional support
At whatever point a person is in their healing journey with cancer,
natural medicine can add value to the experience of many patients. They
may feel a sense of empowerment by choosing an effective blend of
therapies/treatments that are suited to their own medical and emotional
needs. In this way, it is an opportunity to ensure that the mind, body and
spirit are all being addressed in a truly integrative medical approach.
To ensure that natural therapies are both safe and effective it is essential
that a qualified practitioner administer them. It is highly recommended
that patients advise their oncologist of all complementary medicines
being taken or being considered.
For a list of qualified ND’s in your area, contact the Canadian
Association of Naturopathic Doctors at www.cand.ca
Tel: 416.496.8633 Toll-free: 1.800.551.4381
For more information, recommended resources are:
• Complementary Cancer Therapies, Dan Labriola, ND
• The Complete Natural Medicine Guide to Breast Cancer, Sat
Dharam Kaur, ND
www.ChristineMathesonND.com
PAGE 5 • CANCERSMART • November 2009 • Issue 6
Cancer and Exercise
Continued from page 1
Exercise decreases mortality for women with
hormone-responsive breast cancer tumours2:
< 3 hours per week: 3 to 9 hours per week:
9 to 15 hours per week: 15 to 24 hours per week: > 24 hours per week: 20% reduction
50% reduction
44% reduction
40% reduction
40% reduction
• Exercise has been shown to reduce
fatigue in men with prostate cancer3
and women with breast cancer. Women
with breast cancer have also reported a
decrease in nausea.2
• Women with breast cancer who
exercise were more likely to complete
their treatment without interruption
compared with women who did not
exercise. This is most likely due to the
implication that exercise may boost
white cell counts, which is an important
indicator of chemotherapy readiness. 2
• Exercise can increase a patient’s level of
physical fitness and ability to cope with
anxiety and stress. Exercise improves
body composition and decreases body
fat; improves bone mineral density;
increases functional capacity, muscle
mass and strength.5
• A study of women with breast cancer
also showed an increase in self-esteem.2
Patients who exercise have also reported
an improved mood, sense of control
and over all improved quality of life.
Exercise is Accessible
The research has also shown that exercise,
as a complementary cancer intervention,
is accessible to the majority of patients. To
benefit, people need not be transformed into
fitness experts, have been physically active
before the cancer diagnosis, or invest in
expensive equipment.
Groups studied had the greatest benefits with
moderate exercise, which is also equivalent to
three to nine hours of walking per
week at an average pace. There is
little evidence that higher levels
of exercise provide additional
benefit.2 This means that most
people can practice the level of
exercise that provides the greatest
benefit.
In addition, a person’s level of
physical activity before their
illness was not predictive of
mortality.1, 2 In other words,
people with low levels of physical activity
prior to their cancer diagnosis showed the
same benefits from exercise as compared to
people who were fit and physically active prior
to their cancer diagnosis. This is a hopeful and
encouraging finding for people who are not
physically active prior to diagnosis, and means
that it is never too late to start.
Further, patients need not invest in expensive
equipment or gym memberships to access the
benefits of exercise. Walking as exercise has
been shown to produce the same benefit as
cardio exercise through other activities, such
as at a gym or swimming pool. A good pair
of running shoes is all that is needed.
Tips for Getting Started
Cancer patients may be initially concerned
about exercising during cancer treatment, a
time when many feel unwell and uncertain.
Here are some suggestions to move forward
with an exercise plan:
• For guidance and confidence, talk with
your oncologist before starting a personal
exercise program, and address any
concerns you might have.
• Keep an exercise log (e.g., type, amount
and frequency of exercise) for your own
records, and to show to your oncologist
if you have any questions or concerns.
• If you can, integrate support into your
exercise program by exercising with
family, friends, or other patients.
• Ask members of your medical team if
there is a cancer exercise specialist in
your area, or if there are cancer exercise
programs (such as at the Wellspring
Cancer Support Foundation; see
sidebar) or research studies available
to you. A detailed exercise routine
may be available to you through these
sources. If not, remember that benefits
are achievable simply by walking at an
average pace.
References:
1. Chambers, Suzanne K., Lynch, Brigid M., Aitken, Joanne, et
al. JCO Apr 1 2009: 1600-1606.
2. Holmes, Michelle D.; Chen, Wendy Y.; Feskanich, Diane; et
al. JAMA. 2005;293:2479-2486.
3. Segal, Roanne J., Reid, Robert D., Courneya, Kerry S., et al.
JCO May 1 2003: 1653-1659.
4. Marques, Kristan, Jamnik, Roni, York University, CSEP
member newsletter, Communiqué, September 2007.
Cancer Exercise
Wellspring
Cancer Exercise at Wellspring was introduced in
January 2009, and was met with unprecedented
demand. In the first six months, over 225 patients
successfully completed the program in the
comfort of Wellspring’s cancer support centres.
Features of the program include:
• Leadership by a team of qualified and
trained cancer exercise specialists
• Personalized physical fitness assessment,
and personalized exercise plan
• Consent from oncologists to ensure safety
• Twice-weekly exercise sessions for ten weeks
• Updated personal exercise plan at
completion of program
• Opportunity for re-assessment six
months later
Cancer Exercise is available at no charge and
without referral at most of Wellspring’s centres.
For more information, visit www.wellspring.ca
LIVING WITH CANCER
A Lifeline to Cancer Support
Where do I start?
Start here at Wellspring.
WE CAN HELP YOU GET THE PERSONAL
SUPPORT YOU NEED.
WELLSPRING ODETTE HOUSE
& THE COACH HOUSE
Wellspring Niagara Stevensville Satellite
81 Wellesley Street East
Toronto, Ontario M4Y 1H6
416.961.1928
2763 Stevensville Rd. Unit #3
Stevensville, Ontario L0S 1S0
905.382.6121
WELLSPRING SUNNYBROOK
WELLSPRING CALGARY
2075 Bayview Avenue
Toronto, Ontario M4N 3M5
416.480.4440
#4 Parkdale Crescent NW
Calgary, Alberta T2N 3T8
403.521.5292
WELLSPRING HALTON-PEEL
Wellspring at Doane
House Hospice
2545 Sixth Line
Oakville, Ontario L6H 7V9
905.257.1988
WELLSPRING CHINGUACOUSY
5 Inspiration Way
Brampton, Ontario L6R 0L7
905.792.6480
WELLSPRING at
WOMEN’S COLLEGE HOSPITAL
(just off main lobby)
76 Grenville Street
Toronto, Ontario M5S 1B2
416.323.6400 ext. 4240
Newmarket, Ontario
905.967.0259
Wellspring at Matthews
House Hospice
Alliston, Ontario
705.435.7218
Wellspring at Hospice of
Windsor and Essex County
Windsor, Ontario
519.974.7100
Wellspring at hospice
northwest
WELLSPRING LONDON
AND REGION
Thunder Bay, Ontario
807.626.5570
231 Hyman Street
London, Ontario N6A 1N6
519.438.7379
Wellspring at Warmhearts
Palliative Caregivers
Sudbury/Manitoulin
WELLSPRING NIAGARA
3250 Schmon Parkway, Unit #3
Thorold, Ontario L2V 4Y6
905.684.7619
Sudbury, Ontario
705.677.0077
Toll-free 1.877.499.9904
www.wellspring.ca
A Lifeline to Cancer Support
Wellspring is a network of centres that offer support, coping skills
and educational programs to cancer patients and their loved ones at
no charge and without referral.
CANCERSMART is now available online.
Please visit www.wellspring.ca/cancersmart
Toll-free 1.877.499.9904
www.wellspring.ca
CANCERSMART
November 2009 • Issue 6
CANCERSMART is published three times a year as
an educational service of the Wellspring Cancer Support
Foundation, under the auspices of its Program Committee:
Kathryn Lennox (Chair), Mary Brown, Yvette Matyas,
Harvey Nelson, Dr. Yasmin Rahim, Dr. Sheila Tervit, and
Magdalene Winterhoff.
The information in this newsletter is for informational
purposes only, and is not intended to be used for selfdiagnosis or as a substitute for medical advice. Readers
should address all questions and concerns about their health
to qualified health care professionals, such as their family
doctor or oncologist, and seek their advice before acting
upon any information contained in this newsletter.
All information in this newsletter is owned by or licensed
to Wellspring and all rights are reserved. Copyright in the
newsletter as a compilation is owned by Wellspring. All
requests for reproductions of any part of this newsletter
should be directed to Wellspring.
For more information about this newsletter and Wellspring’s
privacy policies, please visit www.wellspring.ca or call
416.961.1928. For subscription inquiries contact:
[email protected]
© Copyright 2009
Wellspring Cancer Support Foundation
Charitable Registration # 89272 8940 RR0001
100% post-consumer paper • FSC certified paper
paper made with 100% green energy • certified processed chlorine free paper