Highlights June 2011:
Welcome to Junes website update – firstly, apologies for the lack of updates
recently, what with all the work we have been doing lately, time to update the
website has been a little bit short!
This June is Cancer
Survivorship Month in Canada and also Bowel Cancer Awareness Week, from the 8th
to the 14th. With this in mind we have combined the two topics to
look at the current evidence base in relation to bowel cancer, exercise and
Colorectal cancer is the second most prevalent within the UK, and incidence is
increasing as the population ages and people adopt more sedentary lifestyles and
risky health behaviours such as smoking and fatty diets but despite this,
survival rates are increasing (NICE 2004, Slattery 2004, Ganz 2005, National
Cancer Intelligence Network 2009).
Encouraging patients and those at risk of developing bowel cancer to adopt a
healthier lifestyle is gaining more and more weight. A review by Slattery (2004)
identifies the protective effect of physical activity against colorectal cancer,
with the risk being reduced by 30-40% in more active adults. There also appears
to be a ‘dose response’, with more intensive activities being associated with a
bigger risk reduction, all though this is widely debated within the literature.
Slattery (2004) does not discuss the selection criteria imposed on studies
included in her review, which could influence the strength of the conclusions
Barbaric, Brooks et al
(2010) and Spence, Heesch et al (2007) have also established a convincing link between physical activity and a
reduction in colorectal cancer risk. This is supported by Haydon, MacInnis et al
(2006), who identify over fifty studies reporting a link between physical
activity and reduced risk of colorectal cancer. The mechanisms for this remain
unknown, but it is suggested that exercise speeds gastrointestinal transit,
reducing contact between the digestive tract and potential carcinogens. Exercise
is also thought to modulate insulin and insulin like growth factors that are
associated with the development of malignancies and to promote the circulation
of ‘natural killer cells’, which provide defence against cancer (Slattery 2004,
Spence, Heesch et al 2007). Although this relationship may seem irrelevant to
those who have already been treated for colorectal cancer, delivering this
information in a sensitive manner to survivors, may encourage them to share it
with family members potentially at risk, which could help reduce future
incidence of colorectal cancer. (Tod, Wadsworth et al 2001, Randhawa and Owens
2004, Vishram, Crosland et al 2008).
There is also plenty of evidence supporting the use of exercise in the
management of symptoms, for both colorectal survivors and cancer survivors in
general. Courneya, Friedenreich et al (1999b) found that a mild increase in
exercise frequency was associated with improved quality of life in colorectal
cancers. However, a questionnaire response rate of only 42% was recorded, the
main reason for non-response being lack of interest. This could indicate that
only those who were regular exercisers responded, skewing the results. Despite
these limitations, Peddle, Plotnikoff et al (2008), Blanchard, Courneya et al
(2008) and Korstjens, May et al (2008) also note a better quality of life in
cancer survivors who exercise. This is further supported by Lynch, Cerin et al
(2008) who found that colorectal patients achieving 150 minutes of physical
activity per week had an 18% higher quality of life score than those who
A systematic review by
Schmitz, Holtzmann et al (2005) reveals that exercise also had statistically
significant effects on fitness, body
image, mental health and vitality, and was well tolerated by patients.
Additionally, there was good qualitative evidence for the beneficial effects of
exercise on fatigue, but changes in quantative measures were too small to be
significant. These conclusions contrast with the results of a systematic review
and meta-analysis by Cramp and Daniel (2008), which found that exercise was
associated with a meaningful reduction in fatigue, although the specific dose
and type of exercise required to achieve the greatest benefits remains unclear.
Speck, Courneya et al (2010) also found physical activity had moderate effects
on fatigue, larger positive effects on strength and a smaller impact upon
quality of life, fitness, anxiety and self- esteem.
A randomised controlled trial by Courneya, Friedenreich et al (2003) comparing
quality of life, fatigue, anxiety, depression and fitness outcomes in colorectal
survivors who exercised with a control group, found that there was no difference
in outcomes between the two. These findings were attributed to contamination as
52% of the control group reported exercising, and there was poor compliance in
the intervention group. Another trial by May, Van Weert et al (2008) found that
physical fitness was significantly increased with exercise, but unfortunately
the sample included relatively few colorectal patients, making it unclear if
similar results would be seen exclusively in colorectal patients.
Morey, Snyder et al (2009) compared a home-based diet and exercise intervention
in older survivors, including those with colorectal cancer. Results indicate
that those in the intervention group had clinically and statistically
significant changes in physical functioning, quality of life and lower limb
strength. This is supported by Mosher, Sloane et al (2009) who found that higher
levels of exercise and healthier diets were associated with better quality of
life scores in older survivors.
There is also convincing evidence that survivors who engage in regular physical
activity have improved survival rates (Demark-Wahenfried and Jones 2008, Irwin
2009). Meyerhardt, Giovannucci et al (2006) found that greater post diagnosis
physical activity was associated with a 50% decrease in colorectal cancer
specific and overall mortality. Haydon, MacInnis et al (2006) concur with these
conclusions, reporting that regular exercisers had a five year survival rate of
71% in comparison with non-exercisers, whose five year survival rate was 57%.
However, activity levels were estimated based upon participant’s recall of their
average weekly exercise levels over six months, which may have led to
inaccuracies. Barbaric, Brookes et al (2010) report an increased survival rate
in more active colorectal cancer survivors, but the studies included in their
review were only of moderate quality, and the best protective effects were only
seen in those with stage II-III cancers. No link was found between survival and
activity levels prior to diagnosis, although Irwin (2009) suggest that patients
who exercised more post diagnosis were more likely to have always adopted
exercise behaviours, leading them to develop less aggressive forms of colon
cancer, that had better prognoses.
Barbaric, Brookes et al
(2010) found no conclusive evidence on what ‘dose’ of exercise would achieve an
increased survival rate. According to Irwin (2009) moderately intensive exercise
three times per week is enough to reduce cancer related mortality by 50-63%,
whilst Demark-Wahenfried, (2006b) states that colorectal patients need to
exercise more frequently and more intensively than other cancer populations.
This more intensive level may not be feasible or safe in a population who are
likely to be deconditioned, struggling to reach standard exercise guidance and
may unaccustomed to physical activity (Crespo 2000, Connor 2000, Wilcox 2002,
Redecker and Musanti 2002, Qureshi 2004, Ganz 2005, Bellizzi, Rowland et al
2005, Lee, Sullivan et al 2006, Stull, Snyder et al 2007, Peddle, Plotnikoff et
al 2008, Demark-Wahenfried and Jones 2008, Courneya et al 2009, Irwin 2009,
Morey, Snyder et al 2009, Yeowell 2010,).
Despite the evidence currently available, many colorectal cancer survivors are
relatively inactive, their exercise levels being lower than the recommended
guidelines for health benefits, indicating that although a cancer diagnosis may
provide a ‘teachable moment’, where patients may be more susceptible to health
promotion messages, this is not indicative of long term behaviour change. Cancer
survivors access healthcare services much more frequently than the rest of the
population, and they are at greater risk of additional co-morbidities, secondary
malignancies and psychological problems, although the majority are unaware of
these potential issues. This indicates that a physical activity intervention
would have a positive impact on the prevention of co-morbidities and enhance
self-management, and as it is relatively low cost, may also ease the burden on
hospital services. The overall message to get more active is clear for those
with and at risk of colorectal cancers; even if the specifics of how to do this
are still becoming evident. It is up to us, as physiotherapists, to deliver
these messages and the support patients need to help them reap the health and
psychological benefits. (Ganz 2005, Bellizzi, Rowland et al 2005,
Demark-Wahenfried 2006b, Spence, Heesch et al 2007, DOH 2007, Sabatino, Coates
et al 2007, Stull, Snyder et al 2007, Demark-Wahenfried and Jones 2008,
Blanchard, Courneya et al 2008,ACSM 2009, Morey, Snyder et al 2009, Irwin 2009,
NCSI 2009, NCSI 2010b).
Please feel free to get in touch if you would like any of the references
included in this article.
TEENAGE AND YOUNG ADULTS’ CANCER MEASURES
In the News
- Can brisk walks for three hours a week improve
outcomes in prostate cancer and prevent progression of the disease? NHS behind
the headlines warns that whilst the study results are encouraging, this
prospective cohort study included only a small number of men, and very few
engaged in vigorous walking. Men were also asked to estimate there activity
levels over a year, which may lead to inaccuracies.
- Coffee may reduce the risk of developing
prostate cancer by 20%, although you do have to drink 6+ cups a day, which may
lead to other health issues!!!
-The most common form of MND may be linked to
the length of the ring and index finger in adults, a new study has shown. This
however does not rule out the influence of other genetic and environmental
factors which may be involved
- Three new breast cancer genes have been found,
but it is not yet clear how they are linked to the behaviour of cancer cells,
and further research is required (NHS behind the headlines)
- Terminally ill patients are encouraged to
provide their GPS with directives for resuscitation and how they wish to be
cared for in the last days of their life (The Telegraph)
ACPOPC - The Role of Physiotherapy in Oncology and Palliative Care
Scarborough, 1999, Spring Conference and 10th Anniversary of ACPOPC
ACPOPC Committee 2009
Welcome to the website of The Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC). We:
- actively develop and promote high standards of physiotherapy practice for patients with cancer and/or palliative care needs
- we inform and influence healthcare policy and strategy on your behalf, at both a local and national level
- we strive to modernise service model delivery
- we support and champion education and research
Anyone may follow us on twitter, but joining ACPOPC as a member allows you to benefit from these great additional extras:
- full access to our website, and our quarterly newsletter to keep you up to date
- the opportunity to share ideas, good practice and evidence based knowledge with other therapists working within the field
- peer support and networking opportunities via the regional ACPOPC meetings
- support for research and continuing professional development through education grants and access to twice yearly study events at a discounted rate.
- the ability to make your views heard at policy level, via the committee.
Please visit our membership page for more information on how you can join us!
Last updated 28th June 2011. View
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