Professor Robert Thomas

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Professor Robert Thomas Oncologist
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(No Transcript)
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Evidence Lifestyle after cancer
116 good quality trials found
Inform patients Medical journal
publications The DoH survivorship program Grant
applications Application to set the standards
for a level four course in cancer exercise
rehabilitation
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Lifestyle after Cancer
116 good quality trials found
Reduce risks and side effects of treatment
Slow the growth of an established cancer
Prevent relapse after initial therapy Improve
overall chance of cure.
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Lifestyle after cancer
Initial DNA damage
Continuing DNA damage and chemical signaling
Proliferation, de-differentiation, loss of
adhesion, inhibition of apoptosis, angiogenesis,
invasion, metastasis
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Lifestyle cancer

• 93 men with indolent prostate cancer
• 47 randomised to lifestyle intervention
• Exercise (Average gt20 mins brisk daily walking 6
  days a week)
• Yoga
• Healthy diet
• PSA measured at twelve months

Ornish, 2005 92
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PSA at 1 year
Control - increase by 6
PSA
10 difference significant at Pgt0.01
Intervention - decrease by 4
Trial entry
At one year
Ornish D, et al The Journal of Urology, 2005.
174 p. 1065-1070.
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An anti cancer chemical
Prostate cell lines

• Intervention - 70 growth reduction
• Control group 6 growth reduction
• 64 difference highly significant at Pgt0.001
• Those with greatest adherence to lifestyle had
  highest effect

Ornish D, et al The Journal of Urology, 2005.
174 p. 1065-1070.
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Nurses Health Study (Breast cancer)

• 37,562 registered nurses - dietary questionnaire
  1 yr
• Prudent lifestyle
• Exercise, fruit, vegetable, fibre, antioxidants
• Western lifestyle
• Sedentary, fat, processed food, salt, carcinogens
• - relapse rate lower
• - overall better survival

Kroenke CH, et al JCO 2005. 23(36) p. 9295-0303.
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Obesity after Colorectal cancerNational
Surgical Adjuvant Breast and Bowel project (NSABP)

• 4310 patients, treated colon cancer, 1989-94,
• Obese patients (BMI gt 35)
• Very underweight (BMI lt 19)
• - Greater recurrence risk
• - Worse overall survival (all deaths)

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Fat intake after breast cancer Lifestyle
intervention study

• 2,437 postmenopausal women with early breast
  cancer
• Randomised to nutritional, exercise and lifestyle
  counselling, or not.
• Eight bi-weekly individual counselling sessions
  for median 60 months.
• Results In the Intervention group
• - Dietary fat intake reduction was
  significantly greater.
• - Relapse rate was significantly lower (p0.03)
• - Overall survival greater

Chlebowski RT, et al., JCO 2005(10) p. 3s
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Lifestyle to prevent relapse
Obesity Dietary fat intake Exercise Smoking Se
nsible sun exposure Diet carcinogen antioxidant
ratio, health oils, supplements
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Exercise after cancerThe Melbourne Collaborative
Cohort Study.

• 526 patients, colorectal cancer 1990-4,
• Exercise questionnaire (metabolic equivalent
  tasks METS)
• Results at 5 years
• - 57 alive (non-exercisers)
• - 71 alive (exercisers)
• - Relapse rate 14 less (plt0.05)
• - Death rate less
• (gt25METS/wk
  3.5hrs jogging weekly or brisk walk daily)

Giles GG, IARC Sci Publ, 2002. 156 p. 69-70.
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Exercise after cancer CALGB 89803

• Cohort study, 816, colon cancer, stage III, USA
• Exercise questionnaire
• - 35 difference in absolute relapse rate
  between in the those in the upper to lower
  quartiles of activity
• - overall survival significantly different

Meyerhardt JA, et al., Proc Am Soc Clin Oncol,
2005. 24 3534
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Exercise Mechanisms of benefit

• Loose weight (oestrogen/progesterone ratio)
• Reduce cholesterol and lipids
• Increased the bowel transit time
• Lower IGF-1 and higher IGFBP-3 levels
• Prostaglandin and COX inhibition

Reduced tumour growth and spread
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Exercise after cancer
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Cancer related fatigue

• Evidence
• 28 randomised trials (gt3000 clients)
• No adverse events very safe
• Supervised aerobic / resistance training - yes
• Home programme No benefit
• Important role of Exercise Professional

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Who will do the work?
Exercise professionals

• No hospital exercise rehabilitation planned
• DoH / Macmillan recommendation
• Most cost efficient

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Need for a level 4 course
DoH / Macmillan recommendation
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How many would benefit

• 13 lifetime risk of cancer
• Incidence increasing
• 1.8 million cancer survivors (increasing)
• More treatment side effects

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Uptake

• Evidence improving
• Health professional awareness increased
• Patient awareness increasing
• Press awareness increasing
• Patient advocacy advice
• NICE recommendations

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Referral route

• Bedford Hospital prospective audit
• 50 consecutive eligible patients
• 8 (16) declined referral
• 40 (80) accepted referral scheme
• 10 (20) previously exercised
• 2 (4) continue existing gyms

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Conclusion

• Emerging evidence is convincing
• Patients are embracing exercise rehab
• A level 4 course is needed
• Most will be referred via the national referral
  scheme