Chemotherapy and exercise: The right dose of workout helps side effects
Researchers at the University of Rochester Wilmot Cancer Institute discovered something simple and inexpensive to reduce neuropathy in hands and feet due to chemotherapy–exercise.
The study, involving more than 300 cancer patients, is to be presented this weekend and honored as a "Best of ASCO" among 5,800 abstracts at the world's largest gathering of oncologists, the American Society of Clinical Oncology (ASCO) annual meeting 2016. More than a dozen other Wilmot scientists also were invited to present data at the meeting.
Investigators in the exercise study directly compared the neuropathic symptoms in non-exercisers to the pain among patients who took part in a specialized six-week walking routine with gentle, resistance-band training at home.
The exercisers reported significantly fewer symptoms of neuropathy–which includes shooting or burning pain, tingling, numbness, and sensitivity to cold–and the effects of exercise seemed to be most beneficial for older patients, said lead author Ian Kleckner, Ph.D., a biophysicist and research assistant professor in Wilmot's Cancer Control and Survivorship program. Kleckner also won an ASCO Merit Award in the pain and symptom management category, and was invited to give a talk about his work.
Not all chemotherapy drugs cause neuropathy, but 60 percent of people with breast cancer and other solid tumors who receive taxanes, vinca alkaloids, and platinum-based chemotherapies will likely suffer this type of side effect, Kleckner said. Neuropathy is more commonly associated with diabetes or nerve damage. No FDA-approved drugs are available to prevent or treat chemotherapy-induced neuropathy, he added.
Wilmot's specialized exercise program, called EXCAP (Exercise for Cancer Patients), was developed several years ago at the UR by Karen Mustian, Ph.D., M.P.H., an associate professor in the Cancer Control program. In recent years she has copyrighted and evaluated EXCAP in several clinical trials. Last year at ASCO, Mustian presented data from a randomized, controlled study of 619 patients showing that EXCAP reduced chronic inflammation and cognitive impairment among people receiving chemotherapy. Kleckner's study involved a subset of patients from Mustian's trial, which is the largest phase 3 confirmatory exercise study ever conducted among cancer patients during chemotherapy. Their work is funded by the National Cancer Institute and Mustian's PEAK lab.
Exercise–as a cancer prevention tool and potential treatment–is a hot topic among the nation's oncologists and their patients.
Kleckner, a longtime drug-free body builder and former college rugby player, said he's committed to understanding more deeply the benefits of exercise for cancer patients. "Exercise is like a sledgehammer because it affects so many biological and psycho-social pathways at the same time–brain circuitry, inflammation, our social interactions–whereas drugs usually have a specific target," he said. "Our next study is being designed to find out how exercise works, how the body reacts to exercise during cancer treatment, and how exercise affects the brain."
Mustian is also giving two talks at ASCO, about the use of exercise in geriatric cancer patients and how innovation can help exercise investigators reach their goals.
"Our program at the University of Rochester, which now includes more than a half-dozen researchers, is becoming a real powerhouse in exercise oncology," Mustian said. "Twelve years ago when we started this work a lot of people said it was not safe for most cancer patients to exercise. Now we know it can be safe when done correctly, and that it has measurable benefits. But more exercise isn't always better for patients who are going through chemo–so it's important to continue our work and find a way to personalize exercise in a way that will help each individual. "
Other Wilmot investigators presenting at ASCO include:
- Matthew Asare, Ph.D., who has a poster showing the impact of race and socioeconomic status on more than 7,500 cancer survivors' behaviors after treatment. These behaviors include exercising, smoking, binge drinking, and completing routine medical checkups. Among the findings: black survivors are less likely to exercise and more likely to be smokers. Physicians should consider using interventions to improve healthy behaviors, the study suggests.
- Richard Dunne, M.D., and a team of gastrointestinal cancer researchers at Wilmot, found that expression of the FoxP3 gene is associated with worse prognosis in bile duct cancer, according to microarray analysis of tumor biopsies from 60 patients. The biomarker is present in the immune system and is also active in other cancers–suggesting that immunotherapy targeting FoxP3 might be a strategy for treating bile duct malignancies.
- Jonathan Friedberg, M.D., director of the Wilmot Cancer Institute and a lymphoma expert, was invited to give a commentary on the top lymphoma studies at ASCO; he also participated in a high-profile National Cancer Institute clinical trial on the benefits of CAR T-cell therapy (a type of immunotherapy) for lymphoma patients, which is being highlighted at the meeting on June 5.
- David Hicks, M.D., director of Surgical Pathology, is giving a talk about correctly interpreting breast cancer test results for a critical biomarker, the HER2 gene.
- Michelle Janelsins, Ph.D., an expert in what is known as "chemo brain," has a poster suggesting that breast cancer patients, compared to a healthy control group of approximately the same age (early 50s), have significantly more perceived cognitive impairment for up to six months following chemotherapy. The study, believed to be the largest and most definitive prospective study of its kind, also found that anxiety, depression, and individual differences in susceptibility to brain changes are important factors in long-term cognitive function.
- Charles Kamen, Ph.D., has a poster showing that lesbian/gay cancer survivors have a higher rate of depression than heterosexuals, but that exercise can lessen depression by reducing inflammation. The Phase 1/2 study is believed to be the first to test two exercise interventions to reduce inflammation and depression in lesbian/gay and heterosexual cancer survivors.
- Sarah Kerns, Ph.D., M.P.H., assistant professor of Radiation Oncology, has a poster showing that cumulative health problems due to chemotherapy for testicular cancer appear relatively early and are associated with worse health, as reported by patients. Approximately 750 survivors most commonly reported that they cope with obesity, neuropathy, ringing in the ears, and hearing loss due to treatment toxicity.
- Melissa Loh, MBBch, a geriatric oncology fellow at Wilmot, evaluated data from a series of studies supporting the use of geriatric assessment tools to inform treatment decisions. However, she found that few community oncologists use geriatric assessment routinely. Loh was given a 2016 Conquer Cancer Foundation Merit Award for her study.
- Allison Magnuson, D.O., is presenting information at a geriatric oncology education session on how to assess and manage cognitive issues in older patients with cancer; she conducted a pilot study to evaluate the impact of a geriatric oncology intervention for older patients getting chemotherapy.
- Supriya Mohile, M.D., a geriatric oncology specialist, is chairing an education session to discuss how to assess and manage bladder cancer in older patients. Mohile, plus a radiation oncologist and surgeon, will show how geriatric assessment tools can help with decision making for difficult treatments in older patients who have other medical issues beyond bladder cancer.
- Anita Peoples, Ph.D., has a poster suggesting that in breast cancer survivors with sleep disturbance, a specialized gentle yoga program developed at the UR (YOCAS) improves quality of life by improving sleep and reducing fatigue.
- Luke Peppone, Ph.D., will showcase a phase 2 clinical trial comparing the use of omega-3 supplements (fish oil) with omega-6 supplements (soybean oil) for improving cancer-related fatigue in 108 breast cancer survivors. High-dose omega-6 supplements reduced fatigue, and further analysis is underway to study how omega-6 fats work in this regard. Peppone recently won a Young Investigator Award for this study from a professional organization dedicated to researching supportive care for people with cancer.
- Timothy Quill, M.D., an end-of-life care expert, will lead a discussion among oncologists on how palliative care has changed over the years and reflect on his personal experiences with patients and families.
- Two surgery residents, who conduct research for the UR's Surgical Health Outcomes & Research Enterprise (SHORE) team, are presenting separate data on colon and rectal cancer. Christopher Aquina, M.D., is giving a talk on complications and survival among patients who had colon cancer surgery in New York State. His study shows that complications after surgery have an impact well beyond the critical 30-day period, and are associated with a higher risk of death at the one-year mark among patients of all ages but particularly for those who are older than 65 years. Most of the oldest patients also suffered from cardiovascular disease, and the study suggests that oncologists pay close attention to this complication. Zhaomin "Tim" Xu, M.D., studied a national database of nearly 15,000 patients with rectal cancer and discovered poor compliance and wide variation among hospitals in terms of giving chemotherapy after surgery, which is recommended by the National Comprehensive Cancer Network because it improves survival. The study found that older age and a high number of other medical problems were the factors most associated with not receiving chemotherapy.