Life beyond chemotherapy

For decades, oncologists have focused on ways to help patients survive cancer.

    What they didn't pay much attention to was what happened when people did.

    That thinking has begun to change in recent years with advancements in treatment and an increase in the number of survivors.

    A growing number of hospitals are turning to fitness to combat cancer and often-debilitating treatments. The idea replaces the longheld notion that patients, weakened and wasted by their ordeal, should simply go home and rest, left to regain ground on their own.

    Memorial Hospital Central began offering exercise and other physical therapies to cancer patients two years ago. In January, Penrose-St. Francis Health Services launched a program. Both hospitals say patients have generally experienced fewer side effects from chemotherapy and made bigger strides in bouncing back.

    Hospital officials predict physical therapy will be a staple in cancer treatment in another five years.

    "It's changing their world," said Charles Stine, director of rehab for Penrose-St. Francis. "It's no longer a life sentence. . . . We're preparing them for life after cancer."

    Traditionally, doctors have been so consumed by combating cancer that they've been slow to consider what happens when patients go home, said Dr. Anuj V. Peddada, a radiation oncologist at Penrose Cancer Center. Patients suffering from the severe fatigue, muscle wasting and depression could take years to fully recover, if at all.

    But with successes in treating more cancers, he said, some physicians are beginning to look beyond the chemotherapy, radiation and the surgical knife to assess patients' lives when they go home.

    Baby boomers are fueling that trend, he and others said. Many are active before cancer strikes, and they are determined to get back to the jobs, families and lifestyles of before. People such as cyclist Lance Armstrong, who beat testicular cancer to win seven consecutive Tour de France road races, have fueled that fight-back mentality.

    Research on the benefits of exercise in these patients, coupled with revised American Cancer Society guidelines in 2003 to include fitness, have provided the clinical credibility for hospitals such as Memorial and Penrose to invest in the idea.

    Insurance companies, according to hospital officials, have traditionally been willing to pay for rehab in oncology. It just wasn't routinely recommended.

    The concept is simple: The same benefits of exercise in healthy people - lower stress, more energy, a stronger and better-conditioned body - apply to cancer patients. The benefits in many ways come faster and are more significant in cancer patients than in the general population.

    Memorial physical therapist Liz Bauer points to one patient whose pain, according to an assessment, declined by 50 percent in a month while his oxygen level during exercise improved by 53 percent. The patient also reported 39 percent less fatigue.
    Statistics aside, patients say it gives them something they can control.

    For Pat Heinz, a 51-yearold mother of three with Stage 4 lung cancer, rehab has given her something to take charge of - and look forward to - in a situation mostly out of her hands. A nonsmoker who two years ago ran a half marathon, she was diagnosed in August after a dry cough would not go away.
    "Your life can change in the matter of a CAT scan," she said.

    In therapy, she can focus on extending the distance of her six-minute walk, and her will to walk helps determine her success.

    Physical therapists are quick to say they are not personal trainers. Too much exertion can be harmful, and cancer patients are heavily monitored during activity.

    The goal is to get cancer victims back to work, holding their children, or even going to the grocery store, said Britta Newcomer, Memorial's manager of oncology services.
    "A big part of our job is cheerleader," Bauer said.

    In April 2007, Memorial received a $25,000 grant from the Lance Armstrong Foundation to strengthen its oncology exercise program, called Energy for Life. The program has been modeled after The Rocky Mountain Cancer Rehabilitation Institute in northern Colorado, a leader in cancer rehab research.

    At Penrose, physical therapy assistant Lynette Olson spends part of her time in the Penrose Cancer Center helping patients get into rehab.

    Exercise isn't easy in the throes of chemo, radiation and cancer. Patients and health care workers say that cancer-related fatigue does not go away with rest, and it's more severe than a healthy person has experienced, even with no activity.

    Add to that a treadmill and it can be Herculean. Therapists are trained to keep people within a well-defined range of moderate activity, but moderate is a challenge in itself.
    For Regina Topp, a 53-yearold mother of two with Stage 2 breast cancer, "it was like climbing a fourteener."

    Heinz said the first time she attempted exercise after chemo it felt like "pulling lead" and was comparable to the half marathon she'd run.

    Yet both say they seemed to rebound faster and felt better than before they started physical therapy. Bauer points to a patient who came to her after breast cancer treatment with little use of her arms. After a few sessions of therapy, she got involved in a swimming program at the YMCA.
    "We really changed her perception of what she believed she could do," Bauer said.

    Peddada thinks oncology-related rehab marks the beginning of increased research in looking at helping patients in holistic ways to supplement traditional treatments. Doctors, he said, are starting to recognize as they search for cancer cures that it's not just about "quantity of life."

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