It’s February and that means it’s the start of “diagnosis season” for me. At this point in cancer survivorship, I don’t get as affected by everything that happened “on this date X years ago“. However, I have an oncologist appointment and my yearly 3D mammogram around this time, so I can’t forget what this month means.
You would think that since 2024 marks seven (!) years since my initial diagnosis, I’d feel pretty good about having made it this far past my treatment…and you would be right.
I’m now living the feeling that I so desperately wished for seven years ago when everything felt devastating and out of control. My outcome, even with the many pesky moguls that I’ve had to clear, is something I’m so thankful for.
But of course, even as mellow and relatively unconcerned as I am now, there are little reminders of the rough and tumble past that unsettle me.
Like that point in my mammogram when the tech finishes up and leaves the room to consult with the radiologist, and all of a sudden I don’t feel great anymore. It’s maybe 5-10 minutes or so of sitting in a quiet room all by myself, wrapped up in that bathrobe-y gown made out of fabric that seems like it should be less scratchy, trying to focus really hard on the tropical ocean video that they have playing on the tv screen on the wall.
No matter how warm the room is, there is a cold spot in the pit of my stomach. The hospital does its best making the surroundings seem inviting. Really they try. But it’s kind of hard to mellow out the echo of an impending sense of doom.
Same goes for every time my oncologist says something like, “Hmmm, should we do another chest MRI?” No, no we should not. That’s about 45 minutes of being stretched out like superman on a surface that’s clearly meant for a woman much shorter than me, while getting my ears blasted.
In case you’ve never taken a ride in the tube, this is what it’s like. Don’t forget your earplugs. Bonus for chest MRIs: you’re lying on your belly with your arms stretched past your head for almost an hour, giving you plenty of time to reconsider your life choices.
My husband says the MRI sounds like a broken dot matrix printer. I think if your printer is making sounds like that, it’s time to evacuate the building.
Ah the memories. But again, I am talking about this from the vantage point of seven years away. It is nicer being up here above the fray. It also gives me a great view of the potential rollercoaster disaster that this season could become, if my scans go south.
But seven years into this, I’m betting it probably won’t. So far, so good.
If you needed yet another reason to turn to meditative exercise practices in the course of cancer treatment, here it is.
A recent, unpublished study that was presented at the 2023 ASCO (American Society of Clinical Oncology) Quality Care Symposium, entitled “Virtual Mind–Body Fitness Classes Show Unexpected Benefit in People with Cancer” (Mao et al., 2023), examined the effects of virtual mind-body fitness classes on visits to urgent care or unplanned hospitalizations for cancer patients who were in active treatment and were dealing with moderate or greater fatigue.
While mind-body practices are already recommended for cancer patients to help deal with the symptoms of treatment and its emotional fallout, the results of this study illuminated specific benefits. Those patients who had been assigned to the group given access to virtual live mind-body and fitness classes (called Intergrative Medicine at Home, or IM@Home) had fewer hospitalizations and shorter hospital stays, in addition to fewer visits to urgent care, compared to those subjects who were only given access to pre-recorded online meditation resources (Enhanced Usual Care, or EUC).
It’s not surprising that mindfulness benefits cancer patients, although it’s striking how those benefits manifest themselves.
This study was run at the renown Memorial Sloan Kettering Cancer Center (MSKCC) with 200 cancer patients randomized into the two groups (IM@Home and the stan, which makes the design more solid and increases confidence in the results. Nonetheless, as the lead author Dr. Jun Mao (Chief of Integrative Medicine at MSKCC) stated in the National Cancer Institute’s Cancer Currents blog, “I do want to caution that the current trial was designed as an early-phase trial, so we would like to do a larger study with longer follow-up to confirm our results before we are completely confident in the findings.”
A larger study is currently in the works. Dr. Mao would like to explore whether these classes help patients follow through on their treatment plans, and if so, whether these patients also live longer.
The IM@Home group’s classes included a variety of classes (again, quoted from Cancer Currents blog): “Some of the classes taught participants movement-based activities such as yoga, tai chi, and dance therapy; other classes taught meditation-based practices, such as music therapy and mindfulness.” It is already known that exercise during cancer treatment can reduce fatigue, but the researchers felt that part of the success of this study was due to the participants’ ability to choose the level of exertion based on how they were feeling at the time of the class.
Looking forward to further research on the ways that we can support cancer patients physically, emotionally and spiritually!
As Dr. Mao pointed out, more directed research on this must be done before drawing specific conclusion, but this was a very valuable pilot program, the results of which would not surprise those of us who have made use of various exercise modalities, particularly those with a mind-body angle, for calming ourselves during our cancer journeys.
The more this subject is studied, the greater the chance that cancer centers focusing on whole-patient treatment will be offering such classes to their patients. COVID taught us that there are ways to make classes accessible to people with limited mobility or conditions that may prevent physical travel to classes.
While I believe that attending mind-body oriented classes in person is ideal, this study illustrated that even virtual opportunities can have significant benefits for the patient.
It’s worth pointing out that of the 200 study participants, 91% were female and 77% were white. That is not a diverse spread and reflects the typical clientele at your average yoga studio (based mainly on my personal observations), with the exception being that the average age of these study participants was 60 years. I would be willing to bet that less-represented groups would benefit greatly from the stress relievers offered here and I hope that the researchers expand their subject pool to balance out the participants in their future study.
Regardless, these are intriguing results that underscore the important of mind-body focused classes, and exercise in general, in the well-being and improvement of cancer patients. This study joins a growing list of research that is changing the way that we look at managing cancer treatment side effects.
Research Study Abstract Mao, JJ et al., Effect of virtual mind-body fitness program on reduction in unplanned hospitalizations among patients undergoing active cancer treatments: A pragmatic randomized clinical trial, presented at 2023 ASCO Quality Care Symposium, October 28, 2023: https://meetings.asco.org/2023-asco-quality-care-symposium/15514?presentation=227485#227485 (note: click on “Abstract 473” on right side panel for abstract text)
Apologies because this might sound like a rant but this topic has been on my mind a lot lately.
When you’re diagnosed with cancer, you learn about the many side effects of treatments.
You will be informed about the physical and even psychological effects that cancer patients deal with, but there are also considerable financial repercussions. Patients may struggle with hospital bills: some lose their insurance coverage, others might never have had any to begin with, those who have coverage may find that it’s insufficient. It’s not uncommon to hear how cancer has driven survivors and their families into bankruptcy.
On top of that, cancer can do a number on your career aspirations for years to come.
Money issues are one of the side effects of cancer that don’t get a lot of airtime…but really should. (Photo by Alexander Grey on Unsplash)
In case you think that it’s uncool to complain about one’s career in the face of having survived cancer, let me get this out of the way: being a cancer survivor is a privilege. I’ve written before about how acutely aware I am that I have lasted longer than many cancer patients.
But as the effectiveness of cancer treatments improves, the number of cancer survivors increases and long-term repercussions become a more and more serious consideration, particularly how they affect ongoing quality of life.
For people who are still working out their careers, cancer can derail progress because it plants a huge stop sign in their path.
Think of going into the chemo infusion room: the days leading up to it entail appointments, port placement, purchasing supplies (anti-emetics, anyone?) and in general prepping for being out of commission about a week.
It’s not the time to focus on stressful work deadlines (and most sincere condolences to any patient who has to do that!).
Ironically, as much as I feared infusions, they actually gave me an excuse to focus on myself instead of worrying about everyone else. I posted about that here somewhat sadly that chemo allowed me to rest without feeling guilty.
It was at that point that I’d realized I’d been pushing myself, always expecting more and not feeling like I was measuring up. Chemo gave me a break from that. Which was good…kind of…
But after chemo and radiation came endocrine therapy, so just as I was winding down from one set of side effects, up popped another.
And all those plans I’d had for myself were put off again and again. Career goals seemed more out of reach because my timeline had shifted.
Well, I’m not stupid, so I changed my career goals. Makes sense, right? Cancer provided a different perspective on things and motivated me in another direction.
But in the wake of cancer treatment, I feel like I’m walking in cement shoes…if it’s not one thing it’s another. I got off aromatase inhibitors (early) and then realized that I was having memory and focus issues. Whether Cancer Related Cognitive Impairment (CRCI) or menopause-driven brain fog, all of a sudden I’m dealing with something else.
It feels as though the train to prosperity has left the station and I was just a little too late to catch it.
Great.
Right now I’m looking at sky-rocketing costs-of-living in a part of the country that literally got expensive around me. Instead of moving up in the world, my family and I are desperately searching for less pricey housing which will put us in worse conditions and a longer commute to work.
And at age 57, when most of my friends are looking at enjoying retirement in the years to come, planning for what they’ll do in their golden years, I’m trying to reeducate myself, shifting into a career that doesn’t make much use of previous work experience.
And it feel exhausting. Sometimes I want to cry.
I want to believe this, I really do. But I don’t think that there’s a reward for surviving cancer beyond simply surviving cancer. (Photo by Nik on Unsplash)
Yes, I’m happy to be alive. But no, this was not the way I thought things would go. When initially I was told that I had a decent chance of surviving for five years, that was all I could think about. In fact, that was all that mattered.
I wasn’t thinking about the fact that if I managed to live through this, I’d still need to find a way to make a living. And the interruption that was cancer could do a number on that.
At this point, I need to stress that my intention is *not* to try to scare cancer patients into dreading survivorship. Goodness knows, there are enough things to navigate within the cancer experience as relate to the usual treatments that will take your energy and attention.
I wish nothing less for you than 100% remission and many years ahead to enjoy your “survivor” label.
At the same time, I encourage you to remain present and mindful of the fact that you might have to pivot if you’re not already well-established in your career. If things start to change in a direction that’s southward of what you expected, be patient and readjust your expectations. Nuture acceptance and keep an eye on how you can put yourself in a good position to meet the future. And be kind to yourself.
With all the focus on breast cancer during October, pushing us to be warriors and fight our way through this, the concept of survivorship can get lost in the fray.
We talk about cancer treatment and get very granular about the procedures, whether surgery, chemotherapy or radiation therapy. And those do deserve a lot of discussion as they can be difficult to endure. Some, like chemo, have an almost legendary reputation and it’s important to be able to separate fact from fiction.
After all the noise and attention associated with cancer treatment, survivorship can leave some of us feeling alone. Photo by Atharva Tulsi on Unsplash
Consider: how many of us, upon hearing that we have breast cancer, preoccupy ourselves with worrying about what life will be like five years down the road? More likely, we’re thinking about what treatment will be like and are hoping that we’ll be around when it’s done!
But with so many women surviving breast cancer, it’s important to talk about what happens after the dust settles and you realize you’re on the other side of the treatment that you had so feared. Is it really the “other” side?
So much of my blog has been devoted to the life after cancer. After I documented my treatment journey, I turned around to get hit in the face with all the stuff that I wasn’t expecting.
One of those was endocrine therapy. Women with hormone receptor positive cancers aren’t done when the “tough stuff” is over. Tamoxifen and aromatase inhibitors are a whole new round of treatment that can affect your hair, your libido, your joints and more. Some women get hot flashes and night sweats. Some experience weight gain. And these are medications intended to be taken for a number of years.
There may be body image issues. Breast cancer surgery can leave women looking very different from their pre-cancer days. Like it or not, breasts are associated with womanhood. Whether lumpectomy or mastectomy, with or without reconstruction, there is a new normal that needs to be dealt with.
By seeking support and relating your story, you help not only others who are dealing with something similar in addition to yourself. Photo by Ivana Cajina on Unsplash
And then cognitive issues like distractibility, loss of memory and difficulty processing concepts may come up. To make things more complicated, these may appear after treatment is in our rear view mirror and our loved ones may simply not appreciate what we’re dealing with. The bodies and minds of survivors may change in a way that they are not prepared for. Because, how do you anticipate something like this?
Survivorship does not mean that you never again have to think about cancer or its repercussions. There will be adjustments to your expectations as to how your life will be from now on. It’s important that those around you understand that just because you are done with the major cancer treatments, things might not feel familiar or normal.
So we need to be having this conversation with those around us and making opportunities for affected women to seek help and support. There is no shame in being a survivor who is also struggling. While it’s true that we are “lucky to be alive”, it does not mean that we have no right to seek a higher quality of life.
About a year or so before I felt a cancerous lump in my breast, I was tasked with planning an academic conference, which I’d never done before. The project was running behind schedule, procedures had changed and I felt panicky and lost.
As a result, I was working seven days a week with most workdays lasting into the night. This was in addition to having to break in the early afternoon to pick up my children from school, then continuing work from home.
Everything was a rush and I had a constant lightheaded feeling.
When you have the least time to move is when you need to move the most! Photo by niu niu on Unsplash
Most non-work activities fell by the wayside (Cooking? Cleaning? What’s that?). But the most pivotal of these was exercise. I’d been through highly stressful situations before but always had the opportunity to work off my anxiety. This time there was none of that.
Anxiety sat like a boulder in my stomach. I could feel my brain buzzing from the stress but couldn’t do anything about it. There was SO MUCH to take care of that my work-life balance was non-existent. There was only work, and this went on for weeks. My mental well-being plummeted, sleep was filled with night sweats…and the agony of not having the time to work out magnified my anxiety.
We know how bad sitting is for you physically, but not everyone is aware of the psychological ramifications of being sedentary, especially when it comes to managing stress. I found it so ironic that after my tumor was confirmed, the doctors estimated that it had started developing a year or so prior…during the time that I felt my life falling apart.
Stress did not cause my tumor. But it didn’t help my body counter it either.
~~~~~~~~~~~~~~~~
I personally am convinced that there’s no healthier, more positive way to tame anxiety than exercise. COVID’s remote work situation demonstrated to me that I feel much saner when I can stick a workout into the middle of my day, even if it lengthens my workday a bit, and the increased blood flow helps with my mood and productivity.
There is a Zen saying: “If you don’t have time to meditate for an hour everyday, you should meditate for two hours.” I believe that this saying also holds true if you substitute the word “exercise” for “meditate”.
Find movement that you enjoy and then stick it into your day. Photo by Ahmad Odeh on Unsplash
Obviously, I’m not suggesting that you do either for two hours. The idea is that when you are overwhelmed with responsibilities and stress, that is an indication that you need meditation AND exercise all the more.
Frankly, it’s also time to reevaluate your life priorities, but that can be difficult.
How to get more movement into your day? Based on the research* that I’ve seen, it’s best to take breaks about every half hour. That might seem impossible for some people and some work situations, but do the best you can. The last thing you need is more pressure on yourself.
Even just standing up and stretching is better than sitting glued to your seat. If you can walk around, take the long way to the bathroom. Hike up and down the stairs. Breathe deeply. Start there and you can add more later, keeping in mind that energy begets energy: the less you move, the harder it will be to get started; the more you move, the easier.
If you have time for a considerably longer break and don’t yet have an established training program, start by picking a rhythmic movement like walking, running, cycling or swimming and lose yourself in the rocking motion. Not only does that give you exercise, but the gentle back-and-forth is soothing for the nervous system.
Most importantly, make the experience a positive one.
My personal recipe for mind-happy exercise is: (1) indoor rowing (for the rhythm and cardio load), (2) strength training (with a focus on each repetition) and of course (3) yoga (for deep breathing and unwinding the stressed-out body). But these recipes will vary for every individual. What’s yours?
*I had a choice between getting my workout and meditation in or digging up these references. Guess which I chose? 😉 I’ll be back with the science in another post.
Since we are just at the start of October, aka Breast Cancer Awareness Month, I thought I’d go through some basics about getting information on breast cancer.
Let’s face it, as soon as you suspect that you feel a lump in your breast, feel a lump in your breast, have something funny show up on a mammogram and get called in for an ultrasound, are told that there’s something weird on the ultrasound and you need a biopsy, the biopsy reveals a tumor, as you’re in between any of the above, have a loved one go through this, or ANYTHING like the above really, you’ll have the urge to consult Dr. Google.
BE CAREFUL. When I asked my cancer surgeon about getting more info, she gave me a few websites and told me not to go anywhere else. These included:
The National Cancer Institute (NCI) is one of your best and most reliable resources for solid cancer-related medical information.
I was very surprised at the limited number of websites she suggested, but the reasoning made sense. You want to be sure that the information you’re receiving is accurate, up-to-date and vetted by cancer professionals. Both NCI and ACS can provide you with references to clinical studies to back up their information.
This was in 2017. I expect that you can find additional reliable resources now. However, as I discovered when I was looking up other sites, the Internet moves fast and what was once a good source may now be a broken link.
I want to stress: My blog should not be used as a source for making treatment decisions. I mean that with all my heart. I started my blog to relate my own experiences and research in the hopes of being able to provide the view of a cancer patient/survivor about what it’s like to go through a cancer journey.
I had been frustrated by not having an idea of what a lumpectomy looks like, no month-by-month photos of the process of hair regrowth, no good rundown of what to expect during my first chemo infusion, not understanding what that ‘chemo port’ thing was, having my medical team draw a blank when I asked why I had no body odor…and so many more things. So I decided to post photos and write about them in short, to-the-point posts.
But everyone’s experience is different. We have different backgrounds, different lifestyles, varying levels of risk factors and therefore different cancer journeys. The best resource that you have is your medical team. Make sure that you feel comfortable with them, get a second opinion if your treatment options seem inappropriate and definitely change doctors if you feel that yours do not listen to your needs.
Stick with the lastest scientific info.
Even though there are many complementary treatments you can try (I personally benefitted from meditation and exercise), do not use them as alternatives. Your best bet for survival remains conventional medicine.
Please seek out the resources offered by your cancer center. If you need someone to talk to, consult with whatever mental health support is available–this was also invaluable to me. This is not something you should feel you need to “tough it through”. You don’t have to prove anything. Just showing up for your treatments shows your strengh. Same thing goes for those providing care for you during this time, which can more more emotionally taxing than many are willing to admit. Look into support groups for both patients and caregivers.
Understand that you did nothing wrong. You didn’t deserve this.
And everything that I suggested above? Yes, check with your medical team even about my recommendations. The list of sites may very well have expanded by now but my admonishment to watch your step where your get your information for making decisions remains. Please, you are worth it.
As you navigate the experience that is cancer, whether your own or of someone you care about, please know that I am rooting for you, thinking about you and can’t wait to see you on the other side! ❤
A few days ago, I took my daughter to the train station, about a 7-mile drive.
As we pulled out of our driveway, I noticed a honeybee on my side window, close to the middle of the pane. It was a foggy morning so the little girl must have lost her way.
In the past, when I start accelerating and there’s a bug on the glass, the insect takes off (or the wind “encourages” her to take off). But not this little bee. She hung on tightly.
Part of the drive was along a stretch of road with a faster speed limit, reaching over 50mph. I wanted to get my daughter to the train early, so I couldn’t drive much slower. At the same time, I was getting very invested in the bee, still hunkered down and holding on.
My daughter suggested that we take the freeway for part of the trip, but I protested, concerned that the bee’s grip wouldn’t be able to handle the acceleration.
Through faster and slower speeds, my tiny hitchhiker clung hard. Her little wings seemed to be fluttering, battered by the wind, but she was not letting go.
She made it all the way to the train station, holding on like crazy! My tenacious little girl! Then took the opportunity to clean herself up. ❤
And then we finally arrived at the station. My daughter made her train with time to spare and I sat in the lot nearby waiting for it to depart. In the meantime, my little bee had started to preen herself, cleaning up her antennae and straightening the hairs on her legs.
I was so impressed with her ability to hold on!
By this time, the fog had lifted but it was still very cloudy–not proper bee-navigation weather. And I was concerned that if the bee took off from the station, 7 miles from home, she’d never find her way back. I needed to return her to familiar lands!
When we returned home, she sat very still. I held my breath.
Now I was 100% into this. And apparently, so was my little bee. Because in the process of grooming she had edged closer to the frame of the car window. Smart girl, because that meant less air resistance! As I started driving, she expertly tucked her wings together, widened her stance, and…if a bee could give a thumbs up, I’m sure that’s what she’d have done.
On the way home, I drove a little more slowly, trying not to go over 40mph and a lot slower whenever possible. She looked determined to make it.
But when I pulled into our driveway and parked the car, she and I both sat motionless. C’mon, I thought, you’ve made it this far. You’re home. You’ve got to be okay!
Looking more closely it seemed like one of her legs was moving, perhaps twitching a bit. But nothing more.
I wasn’t going anywhere until I knew all was well. At that point, clouds were starting to thin and the outline of the sun becoming visible through them. THE SUN! Coming to the rescue!
My little heroine recovered and immediately took to smoothing her antennae, as if 14-mile journeys were an everyday thing. ❤
Eventually, my little bee started straightening her hairs again, then grooming quite vigorously. The air was warming, the sun was coming out, and my darling girl was getting herself together after taking a battering on the road.
Finally, the sun was bright enough to cast shadows, increasing in strength by the minute. And my bee, stalwart little travel companion, walked up the glass onto the door frame to finish warming up.
One last view of her as the sun was coming out. She was vigorously brushing through her hairs and antennae. Ready to return to her sisters and charm them with stories of where she’d been, what she’d seen and how she’d held on. ❤
I returned to my apartment feeling uplifted by the tenacity of that little creature. She had a purpose and was committed to it. What a beautiful analogy for holding on when we think we can’t go any further, when no one would expect us to keep going. Even then, we manage. Because no matter how bad things seem, the sun will come out and we will find our way home.
It’s hard to believe that six years ago I was a week and a half away from my final chemo infusion, in the thick of being a cancer patient with no idea of what tomorrow would bring.
Cancer survivorship used to be a whole lotta “looking over your shoulder” for the next thing to hit.
I also thought that I’d live the rest of my life, however much or little of it there was left, in fear, always looking over my shoulder to see if cancer was close behind. In fact, after my active treatment was over, I expected that my anxiety would increase because I imagined that whatever had triggered my tumor growth would again be unleashed and ready to attack my again.
And when I had to stop aromatase inhibitors early due to side effects, I envisioned even more terror because I wouldn’t have the medication’s protection anymore.
None of this suggested that I would have a very pleasant future. Either I would get cancer again…or I’d be consumed by worry over getting cancer again.
Reality turned out to be quite different.
The more (1) I practiced being present, coupled with the (2) increasing distance between my last dose and today, the easier it has become. Now, that might sound like a no-brainer, but it was news to me.
And I don’t know exactly when I turned the corner on my fear but it was probably after the worst letrozole side effects ceased and I was able to reflect on and accept that cancer happened and now I was moving past it.
It took years to get to that point, but it would have probably come sooner if I hadn’t convinced myself that I’d never get there.
And how are things different now? I don’t think of cancer every minute of every day. And when I do think about it, it doesn’t seem as daunting.
So far, so good.
I realized this after meeting a cancer survivor who works at a store that I frequent. She revealed that she’d just received her three-year “all-clear”. The relief on her face was unmistakable.
And it struck me that I used to have that incredible sense of gratitude too. And I still kind of do for a short bit, but it fades quickly as I turn my focus to the rest of my daily responsibilities.
Yes, I am still seeing my oncologist twice a year, having annual 3D mammograms AND the occasional MRI, so it’s less likely that something’s going to sneak up on me. But the concern is no longer as all-encompassing because it doesn’t feel as likely.
Of course, I could be kidding myself. Even after six-plus years I know that every set of scan results is a door to either “no evidence of disease (NED)” or “we’ll get you in to see the oncologist ASAP”. So far I keep going through the NED door…and it keeps opening onto a bright day.
In the midst of taking things for granted, it’s nice to stop and think about that.
As the saga of our building’s leaky pipes continues, this experience reminds me of some of the best advice I received for getting through my cancer treatment.
How could cancer relate to a plumbing emergency? In how I perceived the news and possible outcomes. My cancer diagnosis was terrifying because I had grown up understanding that the disease meant difficult treatment and a real possibility of death. Now that I was dealing with cancer, I was jumping to conclusions, driven by FEAR.
And the leak in our unit? That meant a huge disruption in our lives as workmen enter and our belongings are piled together. But even more so, FEAR of the future, as we didn’t know the extent of the damage and whether we’d be able to to keep living here.
Getting a first glimpse of restoration. Lost some ceiling, light fixtures and a lot of kitchen cabinets.
The thought of moving brought anxiety about higher rental rates, dealing with belongings after nine years in the same apartment, even simply fear of change and uncertainty.
But that best bit of advice that I mentioned above? I found that it applied well to this situation also. And it goes like this: don’t try to tackle everything at once; take it bit by bit.
When I was diagnosed with cancer, the experience was nothing if not overwhelming. So many new terms, treatment options, possible outcomes. It was too much to handle. Someone I worked with suggested that I deal with things on a day to day basis. Not obsessing about the future, only what I needed to get through for today.
This was not easy for me, as being FEARful came naturally to me. But I understood what he was saying, even if I struggled to actually follow this advice at the time.
As with cancer, so with plumbing. My mind had already “gone there”, struggling to afford another unit (this is an older unit with rent lower than other places around us), staying up day and night to pack. Ending up in an even worse situation with inconsiderate neighbors…
But reality was not like that.
Behold, the FORCE AIR 2000EC! This monstrosity is the heart of the asbestos abatement operation. The workmen couldn’t fit it back in their truck so we’re babysitting it for a couple of days. Also, it looks like it was built by orks, but that has nothing to do with anything.
Within a weekend we had moved much of the kitchen and dining area. And really overhauled our possessions — even something as complicated as draining our 20-gallon fishtank and relocating its inhabitants to my husband’s office was not as difficult as anticipated.
I had time. I had time to move things, I had time to reorganize, to declutter, to stop and think about what was next. I had time because it wasn’t all happening at once. Stopping and breathing and noticing all the space around gave me space inside my head.
Discussions with our landlady suggested that we would take it one day at a time. No one was throwing in the towel yet…
…and even if the worst case scenario happened and we had to move, there were other places that were available (all with air conditioning, which we don’t currently have), and the rental cost would have been similar to what we pay now. In some cases the places were newer and most allowed pets (!), which I’ve been longing for.
All of a sudden, things didn’t look that bad. The options seemed promising.
Taking it bit by bit gave back a sense of control. All those fears slowly fell away.
And now, I find myself hovering with acceptance. Not landing on an expectation that THIS or THAT will happen. I don’t know what will happen and I’m finding a comfortable place to simply hang here, not gripping or holding on or needing for anything to be different.
One of the strongest chemotherapy drugs used for breast cancer is doxorubicin, a drug in the anthracyline family that you might know as Adriamycin. It’s called “The Red Devil” due to its bright red color and tendency to temporarily dye the bodily fluids of its recipient red, but also due to its toxicity.
While it is highly effective, its use is limited by its potentially serious side effects, including damage to the heart. According to Drugs.com, “[b]ecause of its heart toxicity, doxorubicin has a maximum cumulative dose that can be given to each patient. The higher the total dose you receive over time, the greater your chance of heart side effects.”
Doxorubicin is a highly effective chemotherapy, but carries with it a considerable risk of heart toxicity.
There has been interest in discovering other drugs that can decrease the cardiotoxicity of doxorubicin, particularly since in addition to breast cancer, it is used against a variety of other cancers.
But as with so many things cancer-related, the drugs given to protect against chemotherapy side effects themselves have side effects, so it’s useful to explore other means of achieving protection from the toxic effects of doxorubicin.
Can Exercise Help?
In a webinar for the American College of Sports Medicine (ACSM) that I attended on May 18, 2023, University of Florida, Department of Applied Physiology and Kinesiology researcher Dr. Ashley Smuder and her lab presented research about the protective effects of exercise on the heart and muscle doxorubicin.
Importantly, Dr. Smuder’s lab was able to demonstrate that exercise-trained rats who were then given doxorubicin showed a decrease in the amount of drug that accumulated in the heart and diaphragm compared to sedentary rats, echoing the results of Parry and Hayward (2015, Am J Physiol Regul Integr Comp Physiol). Those results had suggested that exercise didn’t diminish and even increased the amount of doxorubicin that made it to the cancer tumor while decreasing the amount of the drug that went to the heart (left ventricle) and diaphragm.
Exercise keeps rodents healthier, even under a punishing chemotherapy regimen.
While the actual mechanism of this protective effect is still being researched, once again these studies show the benefits of exercise in a cancer situation.
Additionally, a doctoral student in Dr. Smuder’s lab, Brendan Nguyen, reported on work that he’s done showing the differences of exercise on fat mass and lean mass in rats administered doxorubicin using the same infusion schedule that a human patient would received (4 doses, 3 weeks apart). There were four conditions: (1) a sedentary group that received saline injections, (2) a sedentary group that received doxorubicin, (3) a moderate-exercise group that received doxorubicin, (4) a high-intensity exercise training (HIIT) group that received doxorubicin.
Moderate exercise: rats ran on a treadmill 3 days/week at a speed of 30 meters/min for 60 min/session.
HIIT exercise: rats ran on a treadmill 3 days/week, four 4-min bouts at 45 meters/min with 3 minutes of active recovery in between the bouts.
Not surprisingly, the exercise training had a significant effect on the body composition of the animals. Sedentary rats in both groups had an increased risk of obesity. Both groups of exercising rats (both moderate exercise and HIIT) saw a decrease in fat mass during this time and were able to avoid doxorubicin-induced cardiorespiratory weakness. Also, the HIIT exercise animals showed a significant increase in lean mass in addition to the drop in fat mass.
For reliable protection from the negative physiological effects of chemotherapy, exercise is still your best bet.
The take-home message here remains the same as it’s been in my other posts. If you don’t currently exercise, start now. And then don’t stop. It’s easy to keep laboratory rats active and fit, but humans find many reasons not to challenge themselves with physical activity. If you needed a reason, these studies provide a little encouragement to find your favorite movement modality and make exercise a life-long habit.
REFERENCES
Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, Hackney AC (2014) Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature. World J Clin Oncol, 5, 177-190. https://doi.org/10.5306/wjco.v5.i2.177.
Lee K, Kang I, Mack WJ, Mortimer J, Sattler F, Salem G, Dieli-Conwright CM (2019) Feasibility of high intensity interval training in patients with breast Cancer undergoing anthracycline chemotherapy: a randomized pilot trial. BMC Cancer, 19, 653. https://doi.org/10.1186/s12885-019-5887-7.
Lee K, Norris MK, Wang E, Dieli-Conwright CM (2021) Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy. Support Care Cancer, 29, 6863-6870. https://doi.org/10.1007/s00520-021-06294-7.
Parry TL, Hayward R (2015) Exercise training does not affect anthracycline antitumor efficacy while attenuating cardiac dysfunction. Am J Physiol Regul Integr Comp Physiol, 309, R675-83. https://doi.org/10.1152/ajpregu.00185.2015.
Smuder AJ, Nguyen BL (May 18, 2023) Cardiorespiratory muscle response to chemotherapy and exercise. ACSM’s From Around The Field webinar.
Frantic Shanti 