Exercise as a Standard of Care for Breast Cancer

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:13latest information on cancer
00:13 --> 00:15care by welcoming oncologists and
00:15 --> 00:17specialists who are on the forefront
00:17 --> 00:19of the battle to fight cancer.
00:19 --> 00:21This week, it's a conversation about
00:21 --> 00:23the benefits of exercise in the care
00:23 --> 00:25of patients with breast cancer with
00:25 --> 00:27doctors Tara Sanft and Melinda Irwin.
00:27 --> 00:29Doctor Sanft is an associate professor
00:29 --> 00:31of medicine and medical oncology
00:31 --> 00:32and Dr. Irwin
00:32 --> 00:33is the Susan Dwight Bliss
00:33 --> 00:35Professor of Epidemiology at the
00:35 --> 00:37Yale School of Medicine,
00:37 --> 00:39where Doctor Chagpar is a
00:39 --> 00:40professor of surgical oncology.
00:41 --> 00:43So maybe we'll start off with each
00:43 --> 00:45of you telling us a little bit more
00:45 --> 00:47about yourselves and what it is you do.
00:47 --> 00:49Tara, can we start with you?
00:49 --> 00:51So I'm a breast medical oncologist.
00:51 --> 00:55I've been practicing for about 14 years.
00:55 --> 00:57I see patients who are recently
00:57 --> 00:59diagnosed with breast cancer,
00:59 --> 01:03and I also run a survivorship program
01:03 --> 01:06here where we have a multidisciplinary
01:06 --> 01:08approach to cancer survivorship
01:08 --> 01:11in a clinic that includes a
01:11 --> 01:12physical therapist, a dietitian,
01:12 --> 01:15a social worker, and a physician's assistant.
01:15 --> 01:17There we see patients of all
01:17 --> 01:19diagnoses after treatment.
01:19 --> 01:21And Melinda, can you tell us a little
01:21 --> 01:22bit more about yourself and what you do?
01:23 --> 01:27Sure, happy to. So I am trained in both
01:27 --> 01:30epidemiology and exercise Physiology.
01:30 --> 01:33And for about the past 20 years I've
01:33 --> 01:35been leading, along with colleagues such
01:35 --> 01:38as Tara, clinical trials where we look
01:38 --> 01:41at the effect of exercise and also
01:41 --> 01:43sometimes the role of weight management
01:43 --> 01:46and nutrition on various cancer outcomes.
01:46 --> 01:49We've looked at this in breast cancer
01:49 --> 01:51and other cancers really trying to
01:51 --> 01:53figure out the role of exercise in
01:53 --> 01:55mechanisms for improving prognosis,
01:55 --> 01:59but also its role in patient reported
01:59 --> 02:02outcomes and how exercise can improve that.
02:02 --> 02:05And much of the research that we
02:05 --> 02:07and others have done has informed
02:07 --> 02:09guidelines that are now making its way
02:09 --> 02:11into standard of care for treatment.
02:12 --> 02:14And so to that point, Tara,
02:14 --> 02:17can you talk a little bit about the
02:17 --> 02:18role that exercise plays in the
02:18 --> 02:20treatment and management
02:20 --> 02:22of patients with breast cancer?
02:24 --> 02:29Sure. You know exercise has been
02:29 --> 02:32shown to improve many outcomes in
02:32 --> 02:35survivorship and even during
02:35 --> 02:37treatment there's very strong
02:37 --> 02:39data that suggests that exercise
02:39 --> 02:41improves cancer related fatigue,
02:42 --> 02:44reduces anxiety and depression,
02:44 --> 02:47improves sleep quality and helps
02:47 --> 02:48patients maintain function
02:48 --> 02:51both during and after treatment.
02:51 --> 02:54There's also data that's emerged that
02:54 --> 02:57shows that patients who have more
02:57 --> 02:59physical activity in their life may
02:59 --> 03:01have better long term outcomes in terms
03:01 --> 03:03of reduced breast cancer recurrence
03:03 --> 03:06and better overall survival.
03:07 --> 03:09And I might just add to that,
03:09 --> 03:11what's really exciting is the
03:11 --> 03:13research that we and many others
03:13 --> 03:16have done has really shown that
03:16 --> 03:18even little bits of exercise or
03:18 --> 03:21physical activity can have an impact.
03:21 --> 03:25So it's not necessarily you know,
03:25 --> 03:27high levels or high intensities or high
03:27 --> 03:29amounts of exercise that are required,
03:29 --> 03:31but it's pretty compelling evidence that
03:31 --> 03:33doing something is better than nothing.
03:33 --> 03:36So even if it's
03:36 --> 03:38the recommended amount of physical
03:38 --> 03:40activity, 2 1/2 hours per week,
03:40 --> 03:41but there's evidence showing
03:41 --> 03:44that even less than that amount
03:44 --> 03:45is beneficial for outcomes.
03:47 --> 03:50And so when should
03:50 --> 03:52patients really start exercising?
03:54 --> 03:57I think that when people are initially
03:57 --> 03:59diagnosed with breast cancer,
03:59 --> 04:00their first concept is,
04:00 --> 04:04oh my God, I've got breast cancer,
04:04 --> 04:06not let me see what I can
04:06 --> 04:07do to increase my exercise.
04:07 --> 04:10So can you talk a little bit about
04:10 --> 04:14when people should start integrating
04:14 --> 04:17more exercise into their lives?
04:17 --> 04:18Ideally it should be before
04:18 --> 04:20they ever get breast cancer.
04:20 --> 04:23But how do you have that conversation
04:23 --> 04:26with people and start getting
04:26 --> 04:29exercise into the
04:29 --> 04:31treatment algorithm if you would
04:31 --> 04:33for people with breast cancer?
04:34 --> 04:36Yeah, thanks for asking that.
04:36 --> 04:39I find this to be one of the
04:39 --> 04:42most compelling times in medical care
04:42 --> 04:46which is soon after diagnosis.
04:46 --> 04:49It's unusual for us as adults to
04:49 --> 04:52really make major life changes sometimes
04:52 --> 04:55until we have a teachable moment.
04:55 --> 04:57An example is maybe becoming pregnant for
04:57 --> 05:01the first time or having a heart attack
05:01 --> 05:03for instance and cancer is one of
05:03 --> 05:06those times when as adults we tend to be
05:06 --> 05:09open and motivated to make major changes.
05:09 --> 05:11So first of all we should
05:11 --> 05:13all be exercising, all of us.
05:13 --> 05:14But we know that the vast majority
05:14 --> 05:16of us do not meet the recommended
05:16 --> 05:18guidelines of 2 1/2 hours per week.
05:18 --> 05:19And as Melinda said,
05:19 --> 05:21something is better than nothing.
05:21 --> 05:23But a lot of people are not
05:23 --> 05:25meeting even close to that.
05:25 --> 05:28So soon after diagnosis is this teachable
05:28 --> 05:31moment where we can start to help our
05:31 --> 05:33patients become a part of their care
05:33 --> 05:36by giving them more control over what
05:36 --> 05:38they're doing between visits,
05:38 --> 05:41at home, by moving a little bit more.
05:41 --> 05:42That being said,
05:42 --> 05:44there are a significant number
05:44 --> 05:47of patients who are overwhelmed with
05:47 --> 05:48the diagnosis process,
05:48 --> 05:49understandably.
05:49 --> 05:51And certainly we don't want to shame
05:51 --> 05:54people for not being able to adopt
05:54 --> 05:56these healthy behaviors right away.
05:57 --> 05:59That's where survivorship comes in after
05:59 --> 06:00treatment to really encourage
06:00 --> 06:02patients at that point to start to
06:02 --> 06:04rethink their approach and maybe
06:04 --> 06:06tweak what they're doing a little
06:06 --> 06:09bit to optimize their health after
06:09 --> 06:12treatment anywhere along the spectrum.
06:12 --> 06:14We want to encourage patients
06:14 --> 06:16do this because it has so many
06:16 --> 06:18upsides and very few downsides.
06:18 --> 06:20And Melinda, maybe you can
06:20 --> 06:22talk a little bit about some of
06:22 --> 06:24the trials that you've done
06:24 --> 06:26and shed a bit of light into the research.
06:26 --> 06:28Has the research been done more in the
06:32 --> 06:35survivorship period when people are
06:35 --> 06:37going through chemotherapy afterwards?
06:37 --> 06:39And talk a little bit about
06:39 --> 06:43kind of where this little bit is better,
06:43 --> 06:45something is better than nothing
06:45 --> 06:47comes in and whether there's
06:47 --> 06:49a minimum.
06:49 --> 06:52If I exercise only 10 minutes,
06:52 --> 06:53is that good enough?
06:53 --> 06:55Can you talk a little bit about the
06:55 --> 06:57research that's been done in this area?
06:58 --> 07:01Sure, yes. So for probably
07:01 --> 07:03a good 10 or so years,
07:03 --> 07:05most of the research looking at
07:05 --> 07:07exercise after cancer diagnosis has
07:07 --> 07:09been in the post treatment setting.
07:09 --> 07:13So after chemotherapy and radiation
07:13 --> 07:17treatment looking at how exercise might
07:17 --> 07:19improve patient reported outcomes,
07:19 --> 07:23sleep, quality of life, fatigue.
07:23 --> 07:24And from the research that Tara
07:24 --> 07:26and I have done as well as many
07:26 --> 07:28others, has shown that some patients,
07:28 --> 07:31not all but some patients, when they
07:31 --> 07:33hear of the benefits of exercise in
07:33 --> 07:36that post treatment time setting and
07:36 --> 07:37they hear of potential benefits that
07:37 --> 07:39it could have had during treatment,
07:40 --> 07:42they ask, why didn't I receive this
07:42 --> 07:44information sooner at diagnosis?
07:44 --> 07:45And so as Tara suggested,
07:45 --> 07:48some people do want that information
07:48 --> 07:51earlier and assistance in adding
07:51 --> 07:54exercise into their routine during treatment.
07:54 --> 07:57And so Tara and I actually led a
07:57 --> 07:59trial together that just completed and
07:59 --> 08:02was recently published that was an
08:02 --> 08:03exercise and nutrition intervention
08:03 --> 08:06during chemotherapy for breast cancer.
08:06 --> 08:08And when we say exercise,
08:08 --> 08:10what we mean is we prescribe
08:10 --> 08:12for these women primarily a brisk
08:12 --> 08:14walking program that could be done
08:14 --> 08:16at their home, in their neighborhood,
08:16 --> 08:20as well as we developed a home based
08:20 --> 08:22resistance strength training
08:22 --> 08:24program in their home, and
08:24 --> 08:26we create creative material to help
08:26 --> 08:29them figure out which exercises to do.
08:29 --> 08:31And the importance of initiating this
08:31 --> 08:33during treatment is to maintain or
08:33 --> 08:36even maybe increase a bit your muscle
08:36 --> 08:38mass because we know that muscle
08:38 --> 08:40is important for various outcomes
08:40 --> 08:42and there could be adverse effects
08:42 --> 08:44of chemotherapy on muscle.
08:44 --> 08:46So the idea of exercising either
08:46 --> 08:48with just brisk walking which is
08:48 --> 08:50a weight bearing activity during
08:50 --> 08:52treatment to maintain muscle mass,
08:52 --> 08:55but if not then in the post treatment
08:55 --> 08:57setting helping to improve other outcomes
08:57 --> 08:59is really important to think about.
08:59 --> 09:01And one of the approaches we had
09:01 --> 09:03our study participants consider is
09:03 --> 09:06that shortly after diagnosis
09:06 --> 09:08friends and family and neighbors
09:08 --> 09:10want to help out and often
09:10 --> 09:12bringing over meals or whatnot.
09:12 --> 09:15And so we recommended that if there
09:15 --> 09:17was an opportunity for them to set up
09:17 --> 09:19a time each week to walk with someone,
09:19 --> 09:20a neighbor or a friend,
09:20 --> 09:22that might be helpful as well.
09:22 --> 09:23And you know,
09:23 --> 09:25these walks could be for 10
09:25 --> 09:28minutes or 30 minutes depending on the
09:28 --> 09:30individual's ability and how they feel,
09:30 --> 09:32how many days post chemotherapy it might be.
09:32 --> 09:34We know that those couple
09:34 --> 09:35days post chemo are a little bit
09:35 --> 09:37more challenging than say the week
09:37 --> 09:38or two thereafter.
09:39 --> 09:43I love the idea of
09:43 --> 09:46instead of bringing over a cake
09:46 --> 09:49to offer to walk with somebody,
09:49 --> 09:52it might actually be just as good
09:52 --> 09:56for their heart and soul and
09:56 --> 09:58might actually be helpful in their
09:58 --> 10:00survivorship journey.
10:03 --> 10:05Tara, Melinda had mentioned resistance training
10:05 --> 10:08and walking. Is one better than the other?
10:08 --> 10:10Do you prescribe both to your patients?
10:10 --> 10:12How much of each?
10:12 --> 10:14What should patients be aware of?
10:15 --> 10:17Yeah, and I'll welcome
10:17 --> 10:19Melinda to chime in, too.
10:19 --> 10:22But you know, I have to say for a
10:22 --> 10:24long time the only thing I was really
10:24 --> 10:26recommending to my patients was walking.
10:26 --> 10:29And that's a lot because of the
10:29 --> 10:31trials leading into our most recent
10:31 --> 10:34study showed the benefits of walking.
10:34 --> 10:36It's free for most people.
10:36 --> 10:37If you have a safe place,
10:37 --> 10:39you can do it right out of your home.
10:39 --> 10:42I have to say that the evidence is
10:42 --> 10:44emerging that also strength training
10:44 --> 10:47is extremely beneficial and I
10:47 --> 10:49feel like it's been undervalued
10:49 --> 10:53socially because at least in the
10:53 --> 10:54female population that I take care of,
10:54 --> 10:56very few women are strength
10:56 --> 10:58training on a routine basis.
11:00 --> 11:01I think it points towards
11:01 --> 11:03easier treatment completion.
11:03 --> 11:05There's some data that suggests
11:05 --> 11:07that when strength training is added,
11:07 --> 11:09so cardiovascular and strength
11:09 --> 11:11training are both two parts
11:11 --> 11:14of a Ying and a Yang to
11:14 --> 11:16exercise that I think we need to
11:16 --> 11:18really be enforcing both of them.
11:18 --> 11:18And Melinda,
11:18 --> 11:21I'd love to hear your opinion on that.
11:21 --> 11:22Yeah, I agree with that.
11:22 --> 11:24I mean first and foremost if we
11:24 --> 11:27just get people going from not
11:27 --> 11:29very much to doing something and
11:29 --> 11:31if they choose walking and are
11:31 --> 11:33not able to or they're not really
11:33 --> 11:34enjoying the strength training,
11:34 --> 11:35then that's better than not
11:35 --> 11:37doing either or vice versa.
11:37 --> 11:39We have found that some of our
11:39 --> 11:40participants have really appreciated
11:40 --> 11:43the home based strength training program
11:43 --> 11:45and that was easier for them to do
11:45 --> 11:47than to get outside and go walking.
11:47 --> 11:50And the nice thing is nowadays if
11:50 --> 11:52someone has an iPhone or an iPad,
11:52 --> 11:54there's so many apps that they
11:54 --> 11:57can download for free that do
11:57 --> 11:58a different daily workout.
11:59 --> 12:01Whether it be a Pilates or a
12:01 --> 12:02resistance strength training program,
12:02 --> 12:05we've developed one as well for participants.
12:07 --> 12:10But I encourage walking and or strength
12:10 --> 12:12training and while both are fantastic,
12:12 --> 12:15just doing something that really
12:15 --> 12:17makes them feel good and it's
12:17 --> 12:18easier for them to initiate is
12:18 --> 12:20probably a good place to start.
12:21 --> 12:24And one of the things that you
12:24 --> 12:27mentioned was that it's free and
12:27 --> 12:30doesn't really require a lot of equipment.
12:30 --> 12:32So even the strength training, Tara,
12:32 --> 12:35can you talk a little
12:35 --> 12:38bit about what you are advocating?
12:38 --> 12:40I mean some people when they hear
12:40 --> 12:42strength training, they think, jeez,
12:42 --> 12:43I'm going to need to go to the gym.
12:43 --> 12:45I'm going to need to
12:45 --> 12:47pick up heavy weights,
12:47 --> 12:49but other people might say,
12:49 --> 12:51you know, what if I have a couple
12:51 --> 12:53of jugs of laundry detergent,
12:53 --> 12:55I can do a bit of strength
12:55 --> 12:56training in my own home.
12:56 --> 12:58Can you talk a little bit about that?
12:59 --> 13:01Yeah, you're reminding me that I used to
13:01 --> 13:03tell my 80 year old grandmother to just
13:03 --> 13:07you know, bicep curl a soup can
13:07 --> 13:09because she wasn't doing
13:09 --> 13:12anything and she would do this in
13:12 --> 13:14her kitchen while she was cooking.
13:14 --> 13:16I think we overlook
13:16 --> 13:19body weight strength training, right?
13:19 --> 13:23So there are simple moves that can
13:23 --> 13:26place a load on certain parts of your
13:26 --> 13:30body like a plank or a squat that
13:30 --> 13:33again requires no equipment at all.
13:33 --> 13:35And there's also resistance bands
13:35 --> 13:38that you can buy on the Internet or
13:38 --> 13:40or at your local department stores.
13:40 --> 13:43And those also provide
13:43 --> 13:45some just natural resistance that
13:45 --> 13:48don't require massive number of
13:48 --> 13:49weights and dumbbells.
13:49 --> 13:52I think we're really evolving with
13:52 --> 13:54how we talk about strength training.
13:54 --> 13:56It's no longer just beefing up
13:56 --> 13:57to get big muscles.
13:57 --> 13:58Well, that's great information.
13:58 --> 14:01We are going to take a short
14:01 --> 14:02break for a medical minute.
14:02 --> 14:04Please stay tuned to learn
14:04 --> 14:05more about exercise and breast
14:05 --> 14:07cancer with my guests Dr.
14:07 --> 14:09Tara Sanft and Melinda Irwin.
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15:25 --> 15:28You're listening to Connecticut Public Radio.
15:29 --> 15:31Welcome back to Yale Cancer Answers.
15:31 --> 15:33This is Doctor Anees Chagpar and
15:33 --> 15:35I'm joined tonight by my guests, Dr.
15:35 --> 15:37Tara Sanft and Melinda Irwin.
15:37 --> 15:40We're talking about exercise as a standard
15:40 --> 15:42of care for women with breast cancer.
15:42 --> 15:43Now before the break,
15:43 --> 15:46we were talking about the value of
15:46 --> 15:48exercise and how there have been a
15:48 --> 15:50number of studies that have demonstrated
15:50 --> 15:53that it improves quality of life,
15:53 --> 15:57it can improve chemotherapy completion rates.
15:57 --> 15:59Overall, it's just good for us.
15:59 --> 16:01And so Tara, maybe you can talk
16:01 --> 16:04a little bit about how it is now
16:04 --> 16:06becoming a standard of care.
16:07 --> 16:11I'm so excited to see exercise
16:11 --> 16:15become a part of the treatment plan.
16:15 --> 16:17And you know, one way that we see this
16:17 --> 16:20is in program standards as you mentioned.
16:20 --> 16:23And the national accreditation
16:23 --> 16:26program for breast centers is one
16:26 --> 16:29of those programs that's been in
16:29 --> 16:30existence for quite some time.
16:30 --> 16:33And their goal is really
16:33 --> 16:36to make sure that NAPBC accredited
16:36 --> 16:39programs are offering all the components
16:39 --> 16:42of care that make care excellent.
16:42 --> 16:45And recently they've just revamped
16:45 --> 16:46their standards.
16:46 --> 16:48And I'm just going to read one of
16:48 --> 16:50the lines from the standard and to
16:50 --> 16:52me this as a patient experience
16:52 --> 16:54officer speaks volumes.
16:54 --> 16:57They say that patients must be viewed
16:57 --> 17:02in the context of their entire personhood.
17:02 --> 17:05And I just think that is what we
17:05 --> 17:06should all be doing across medicine.
17:06 --> 17:09And I love to see that in writing
17:09 --> 17:11and part of that personhood
17:11 --> 17:13includes how someone is functioning.
17:13 --> 17:16So really starting at diagnosis and
17:16 --> 17:17spanning throughout the treatment
17:17 --> 17:19trajectory and into survivorship.
17:19 --> 17:22All patients must be considered
17:22 --> 17:24for functional assessment and
17:24 --> 17:27the program standards want to see
17:27 --> 17:29documentation of exercise therapy
17:29 --> 17:30recommendations.
17:31 --> 17:33Melinda, I want to go back to you.
17:33 --> 17:35What are the recommendations
17:35 --> 17:38that based on the evidence
17:38 --> 17:39doctors should be suggesting?
17:39 --> 17:41I mean, we talked about the 2 1/2
17:41 --> 17:43hours being the current guidelines but
17:43 --> 17:46something being better than nothing.
17:46 --> 17:48Can you talk a little bit about,
17:48 --> 17:52you know what you would suggest as
17:52 --> 17:54an initial recommendation both from
17:54 --> 17:56the walking standpoint as well as
17:56 --> 17:59from a strength training standpoint,
17:59 --> 18:01where should patients
18:01 --> 18:03and doctors start?
18:03 --> 18:04I'd like to just first
18:04 --> 18:06make two quick comments.
18:06 --> 18:08I really appreciate what Tara just
18:08 --> 18:10read and the importance of
18:10 --> 18:13focusing on the whole person.
18:13 --> 18:14And I'm reminded of one
18:14 --> 18:16of our study participants.
18:16 --> 18:18In fact, there were many study
18:18 --> 18:20participants in our trial that was
18:20 --> 18:22of exercise during chemotherapy where
18:22 --> 18:25these women reported at the end of
18:25 --> 18:27the intervention which was at the
18:27 --> 18:28end of their chemotherapy that they
18:28 --> 18:32felt stronger and physically more fit
18:32 --> 18:36at the end of chemotherapy than before.
18:36 --> 18:38And the program we offered them was
18:38 --> 18:40a primarily brisk walking upwards
18:40 --> 18:43of 2 1/2 hours per week and twice a
18:43 --> 18:46week the at home resistance
18:46 --> 18:47strength training program with
18:47 --> 18:50dumbbells that were 2 lbs and 5
18:50 --> 18:53lbs and also resistance bands.
18:53 --> 18:56The other thing to note is that exercise
18:56 --> 18:59has benefits also for other outcomes
18:59 --> 19:01including cardiovascular disease and
19:01 --> 19:04hypertension and cholesterol and diabetes.
19:04 --> 19:06So while it's improving cancer outcomes,
19:06 --> 19:08it's also improving other outcomes
19:08 --> 19:10we know that are important
19:10 --> 19:12to patients with breast cancer.
19:12 --> 19:14I also think it's important that
19:14 --> 19:17the research and the focus shift
19:17 --> 19:21on helping providers be able
19:21 --> 19:24to not just recommend exercise,
19:24 --> 19:26but who to refer them to.
19:26 --> 19:27There's survivorship clinics
19:27 --> 19:30and programs at cancer centers,
19:30 --> 19:32cancer hospitals and community
19:32 --> 19:33based organizations.
19:33 --> 19:35So it's important that we
19:35 --> 19:36just don't recommend it,
19:37 --> 19:39but we follow up with who to refer
19:39 --> 19:43them to and are writing them a
19:43 --> 19:45prescription that meets
19:46 --> 19:48what they're able to do in their
19:48 --> 19:49neighborhood or in their home.
19:49 --> 19:52If they just leave being told to walk
19:52 --> 19:54more and maybe do some resistance training,
19:54 --> 19:57that's probably a little bit more
19:57 --> 19:58challenging for the patient to
19:58 --> 20:01understand how much when and where.
20:01 --> 20:03So if we can get even more specific
20:03 --> 20:05with the referral process and or
20:05 --> 20:08writing a prescription that would be
20:08 --> 20:10really important to take these standards of
20:10 --> 20:12incorporating physical
20:12 --> 20:13activity into clinical care.
20:13 --> 20:16And one of the things,
20:17 --> 20:19Tara, in the studies,
20:19 --> 20:22there was somebody kind of
20:22 --> 20:24presumably checking in on these patients.
20:24 --> 20:25How are you doing?
20:25 --> 20:28Did you do your walking?
20:28 --> 20:32What are the resources available to
20:32 --> 20:35patients in the community in terms
20:35 --> 20:38of having someone check in on them
20:38 --> 20:40and provide this kind of ongoing
20:40 --> 20:43support in terms of their exercise?
20:43 --> 20:45I'm glad you asked this.
20:46 --> 20:49I do want to mention that
20:49 --> 20:51in addition to prescribing let's say
20:51 --> 20:54a walking program or again if
20:54 --> 20:57there's something you like to do
20:57 --> 21:00because that's the best form of exercise.
21:00 --> 21:04There is also a movement towards more
21:04 --> 21:07formal assessments and prescriptions
21:07 --> 21:08through professionally trained
21:08 --> 21:10physical therapists for instance.
21:10 --> 21:13And many places label this
21:13 --> 21:15an oncology rehab program.
21:15 --> 21:18And often if it's instilled sort of at
21:18 --> 21:20diagnosis before all your treatments
21:20 --> 21:23get started, we call it prehab.
21:23 --> 21:27So rehab and prehab and for extensive
21:27 --> 21:30surgeries or extensive treatments or
21:30 --> 21:34an individual who has a lot of
21:34 --> 21:36issues going on that may impact their
21:36 --> 21:39safety as it relates to exercise,
21:39 --> 21:42a physical therapist or an ANC rehab
21:42 --> 21:45program is definitely the way to go.
21:45 --> 21:47And again not every place is fortunate
21:47 --> 21:49to enjoy these resources,
21:49 --> 21:51but I think putting them into the
21:51 --> 21:54standards will ensure that institutions
21:54 --> 21:57who want to be accredited will spend
21:57 --> 21:59more investment in getting
21:59 --> 22:01these programs up and running.
22:01 --> 22:03In terms of the coaching
22:03 --> 22:05or having someone check in,
22:05 --> 22:07we had our trained interventionist
22:07 --> 22:09check in with the patients 11
22:09 --> 22:12times over the course of the year.
22:12 --> 22:15So again it wasn't a daily check in process.
22:15 --> 22:17It was more intense at
22:17 --> 22:19the beginning and then spaced out
22:19 --> 22:21over the following months.
22:21 --> 22:24There are other wonderful community programs.
22:24 --> 22:26One that comes to mind that my patients
22:26 --> 22:29love is the LIVESTRONG program,
22:29 --> 22:31which is a national program offered
22:31 --> 22:35at many YMCAS that is specific to
22:35 --> 22:38cancer patients and the programming
22:38 --> 22:39allows for more of a community feel.
22:39 --> 22:41So if you like to exercise with
22:41 --> 22:43a group of people who have been
22:43 --> 22:45through something that is
22:45 --> 22:47not exactly your experience,
22:47 --> 22:49but maybe close to it because of
22:49 --> 22:51the common thread of being a
22:51 --> 22:53cancer patient or a cancer survivor,
22:53 --> 22:55this is really something that I
22:55 --> 22:57encourage people to take advantage of.
22:57 --> 22:59And then of course,
22:59 --> 23:01there's other supervised programs at,
23:01 --> 23:02you know,
23:02 --> 23:04community centers and things where
23:04 --> 23:07you can do not as intense exercise maybe,
23:07 --> 23:10but also build a community and whatever
23:10 --> 23:12exercise that feels right for you.
23:13 --> 23:15Yeah, Melinda, I'm just thinking
23:15 --> 23:18about people who may be listening
23:18 --> 23:20to this and thinking, you know,
23:20 --> 23:23I was diagnosed whatever last year,
23:23 --> 23:27last month, a decade ago, and wasn't
23:27 --> 23:29really provided this recommendation.
23:29 --> 23:33But in hearing about the benefits of
23:33 --> 23:36exercise, it may be helpful for me to start,
23:36 --> 23:39even though I didn't start at the
23:39 --> 23:41time of diagnosis. Two questions, first,
23:41 --> 23:45is it still valuable to start a week,
23:45 --> 23:48a month, a decade after diagnosis?
23:48 --> 23:51And 2nd, where can people get resources
23:51 --> 23:54if they're finished their cancer journey,
23:54 --> 23:56at least their acute cancer journey?
23:56 --> 24:00Are the recommendations that you had
24:00 --> 24:03provided to patients available in
24:03 --> 24:07an online accessible kind of
24:07 --> 24:10platform where survivors can access that?
24:11 --> 24:12Yeah, really important questions.
24:12 --> 24:13And I would say yes,
24:13 --> 24:16it's never too late to start a
24:16 --> 24:18program whether they were diagnosed
24:18 --> 24:21yesterday or 10-20 years ago.
24:21 --> 24:25I would say the the first stop could
24:25 --> 24:28be outreach to if they're still
24:28 --> 24:29regularly seeing their oncologist
24:29 --> 24:32reaching out to them or to their
24:32 --> 24:35primary care doctor and asking them
24:35 --> 24:38about resources that might be available
24:38 --> 24:40at the hospital or in the community.
24:40 --> 24:43They might have documents available that
24:43 --> 24:46list resources if they're just diagnosed
24:46 --> 24:49or just recently completing treatment.
24:49 --> 24:53I would like to see hospitals think about
24:53 --> 24:55their cardiovascular rehab programs,
24:55 --> 24:58cardiac rehab programs that are
24:58 --> 25:00available and thinking about how to
25:00 --> 25:02share resources either to broaden it
25:02 --> 25:06to include a cancer rehab program.
25:06 --> 25:08And many times those are offered
25:08 --> 25:10at least cardiac rehab is offered
25:10 --> 25:12right after a cardiovascular event
25:12 --> 25:14and maybe not years later.
25:14 --> 25:18But I know for example survivorship programs,
25:18 --> 25:20they might see patients anytime
25:20 --> 25:22after diagnosis upward to 10-20
25:22 --> 25:23years after diagnosis.
25:23 --> 25:26And so that's a really good first
25:26 --> 25:29stop as well to to reach out
25:29 --> 25:30to those survivorship programs.
25:30 --> 25:33Also Tara mentioned the YMCA and
25:33 --> 25:35the Livestrong program.
25:35 --> 25:38Many YMCA's also offer related programs,
25:38 --> 25:40not necessarily specific to cancer,
25:40 --> 25:42but for example,
25:42 --> 25:45the Diabetes Prevention program is
25:45 --> 25:47open that focuses on exercise and nutrition.
25:47 --> 25:49Those are at YMCA's there's
25:49 --> 25:51programs called the Silver Sneakers
25:51 --> 25:53Exercise programs at the Y.
25:53 --> 25:56For people of a certain age,
25:56 --> 25:58Medicare reimburses programs that
25:58 --> 26:01are more weight management focused
26:01 --> 26:03that includes exercise.
26:03 --> 26:05So definitely talking to the primary
26:05 --> 26:07care physician and the oncologist
26:07 --> 26:09can provide some information
26:09 --> 26:11and is a good starting point.
26:14 --> 26:15If I could add into that,
26:15 --> 26:18you know we do see patients long
26:18 --> 26:21after treatment has ended in our
26:21 --> 26:23multidisciplinary clinic and
26:23 --> 26:25we always reminisce or say that
26:25 --> 26:27patients find us when they need us
26:27 --> 26:29and then our other mantra is
26:29 --> 26:31that we meet them where they're at.
26:31 --> 26:33So you know there are people who used
26:33 --> 26:35to run marathons and then maybe had
26:35 --> 26:37extensive cancer treatment and thought,
26:37 --> 26:39I don't think I could ever do that again.
26:39 --> 26:41But eventually they want to
26:41 --> 26:43know if they could and so you know
26:43 --> 26:46I think it's never too late to
26:46 --> 26:48reevaluate goals and hopes
26:48 --> 26:51and dreams and that can come
26:51 --> 26:52anytime after cancer treatment.
26:54 --> 26:58Yeah. One of the questions
26:58 --> 27:01that I'm thinking about is that
27:01 --> 27:03there must be some barriers right
27:03 --> 27:05to getting patients to exercise.
27:05 --> 27:08One might be I'm too tired.
27:08 --> 27:11One might be I don't have enough time.
27:11 --> 27:13One might be I'm too stressed out.
27:13 --> 27:17How do you counsel patients
27:17 --> 27:22about getting over those barriers, Tara?
27:23 --> 27:25Yeah, I think these are
27:25 --> 27:28really good points and so true.
27:30 --> 27:33Our culture, our work culture in this
27:33 --> 27:36country is one of exhaustion, time limited
27:36 --> 27:39resources and a lot of stress.
27:39 --> 27:41So I think validating that is
27:41 --> 27:43really important.
27:43 --> 27:47And then we try to encourage
27:47 --> 27:50patients that whatever they're doing,
27:50 --> 27:53is there a way to do a little bit
27:53 --> 27:56more or to make certain trade-offs so
27:56 --> 27:58that you're still meeting your goals?
27:58 --> 28:02You know, and I've had the privilege of
28:02 --> 28:04working with the physical therapist who does
28:04 --> 28:06all of our exercise counseling and you know,
28:06 --> 28:09he has a little tip sheet on ways
28:09 --> 28:11to get in a little bit more movement.
28:11 --> 28:13And I think everyone
28:13 --> 28:15understands the concept of parking
28:15 --> 28:17in the furthest away parking spot.
28:17 --> 28:19But that counts and
28:19 --> 28:20are we doing that?
28:20 --> 28:22I would love to see the stairways,
28:22 --> 28:23even in our hospitals,
28:23 --> 28:25be the central focus
28:25 --> 28:27rather than the elevator banks.
28:27 --> 28:30Doctor Tara Sanft is an associate professor
28:30 --> 28:33of Medicine and Medical oncology, and Dr.
28:33 --> 28:35Melinda Irwin is the Susan Dwight
28:35 --> 28:36Bliss Professor of Epidemiology
28:36 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu,
28:42 --> 28:45and past additions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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Exercise as a Standard of Care for Breast Cancer with guests Dr. Melinda Irwin and Tara SanftDecember 31, 2023