HYANNIS – The harsh drugs of chemotherapy do a pretty good job of killing cancer cells, but many of them can also make patients ill. Side effects are especially debilitating for older people, but it’s difficult for oncologists to know beforehand exactly which patients will experience the worst side effects.
With that in mind, researchers at the University of North Carolina Lineberger Comprehensive Cancer Center did a study that could help doctors identify which cancer patients will suffer the most from chemotherapy toxicity. They analyzed CT scans of breast cancer patients to estimate fat and muscle composition in the body and compared that information with patient outcomes.
In their study, patients with low muscle mass and low muscle quality had a significantly higher risk of blood-related toxicities, gastrointestinal side effects and neuropathy.
“As you lose muscle mass, your strength and ability to withstand medical treatment does start to decrease,” explained Falmouth Hospital surgeon Peter Hopewood, MD, of Cape Cod Surgeons in Falmouth, and an active member of the Cancer Committee at Falmouth Hospital.
Typically, oncologists do a global assessment of patients using tools like the Karnofsky Performance Status Scale or ECOG Performance Status to assess their ability to survive medical treatment. Both scales rate patients’ ability to care for themselves.
Doctors haven’t specifically been measuring muscle mass, but, especially with older patients, they do assessments that yield similar results like seeing how fast they can walk across a room or if the can get up from a chair or climb onto a stretcher.
“Very simple things like that give you a sense of where people are at,” Dr. Hopewood said. “For patients with lung cancer, we used to do a global assessment by just seeing if they could climb a flight or two of stairs. We would look at their leg strength, if they were sweating, if their pulse went up or they were really short of breath as another way to gauge their ability to withstand an operation.”
Oncologists also do calculations to decide how much medicine a patient can tolerate during chemotherapy, he said. They know the full dose and can adjust it down, depending on the patient’s age, health and strength. This isn’t just a one-time measurement at the beginning of treatment, but part of a continual fine-tuning throughout treatment that includes blood counts and takes into account any side effects that crop up.
If the patient is getting too sick, they either cut the amount of the drugs in the chemotherapy or even stop treatment early. In those cases, doctors would try a less caustic treatment like hormone therapy or biologics.
“The thing about muscle that we underestimate is the importance of exercise and the immune system,” Dr. Hopewood said. “If you exercise, you are actually enhancing the body’s immunity.”
Try This Class
Because exercise is so important to both the physical and emotional well-being of cancer patients, Dr. Hopewood refers people to Kristine Whaples, a registered clinical exercise physiologist who runs the Living Fit for You! Cancer Wellness Program at Falmouth Hospital.
The program offers cancer patients 12 free visits for exercise and education, either during or after their cancer treatment. In each session, participants do cardiovascular exercise for 30 minutes and then light weight lifting for 10 to 15 minutes. They are also educated on topics like nutrition and how to exercise safely at home.
“Exercise is medicine for a lot of issues,” Whaples said. “During cancer treatment there are days that you just need to recover, but in between you need to keep moving. Even athletes will lose their conditioning in two weeks.”
In Whaples’ experience, it is hard to predict which cancer patients are going to have a hard time with treatment. She’s seen elderly people come through with no significant problems and she’s seen young people really suffer.
She recently worked with someone who was only 40 and seemed to be plenty strong when diagnosed. Three months later, after surgery, chemotherapy and radiation, the patient could barely walk down the hall.
“In this case, the patient was able to exercise here at the hospital with staff who were monitoring heart rate, blood pressure, fatigue levels and then making recommendations,” she said. “It was the boost the patient needed to get their confidence back.”
Whaples prefers if patients join her program while they are actually in treatment because even though they may not feel like exercising, that is when they need it the most. It actually helps with cancer fatigue, which Dr. Hopewood said is the most common complaint of cancer patients. It also prevents further problems.
People lose so much functioning and endurance during treatment that it can cause a downward spiral. The fatigue makes them want to stay in bed and then they become even more fatigued and deconditioned.
“One of my goals with the program is to help patients during treatment to prevent them from becoming frail,” Whaples said. “In the past friends would tell you to sit back while you were going through treatment and let other people take care of you and cook for you. Sometimes that’s not the best advice. You want to keep moving”
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