eNews Online - July 2001 Edition

eNews Online
July 2001 Edition

This Lymphedema eNews is being generated through your request from our website.

The Effect of Exercise on Fatigue During Chemotherapy

One of the questions that seems to come up frequently relates to fatigue after treatment for breast cancer. Many people experience fatigue because of chemotherapy or radiation or both. One cause of fatigue is anemia or low red blood cells. Several recent studies have demonstrated that when fatigue is due to anemia, a medication called Epogen can be used to help increase the red blood cell count and decrease overall fatigue. However, many people experience fatigue even though they have adequate amounts of r ed blood cells. Several recent studies suggest that a moderate exercise program can improve sleep and reduce fatigue and lead to an over-all improved sense of well-being. These studies suggest that fatigue levels correlate with sleep difficulties and that walking as little as 12 minutes per day can significantly improve sleep and decrease fatigue and anxiety. I have attached several abstracts that summarize some of the recent research on the value of exercise during chemotherapy. Many therapists recommend a moderate exercise program along with good skin care and compression as part of the comprehensive management of lymphedema.

The Effect of Tamoxifen on Prevention of Breast Cancer Recurrence

Since many of our readers are breast cancer survivors, I thought it would be helpful to summarize some of the new and exciting data coming out for breast cancer treatment. Many women who have breast cancer are treated with a medication called Tamoxifen. This is a drug that resembles estrogen, the female hormone. Estrogen binds to receptors in a cell in a lock and key fashion. When estrogen is present, it binds to the estrogen receptor and stimulates the development of female characteristics such as breast development. Many breast cancers are dependent on the presence of estrogen for their growth and survival. Breast cancer cells can be grown in a dish in the laboratory. When these cells are grown in the presence of estrogen, they are healthy, functional cells; however, when the estrogen is removed, many of these cells will stop growing and die. So, estrogen is critical for growth of many tumor cells.

One way to deprive tumor cells of estrogen is to make a compound that will bind to the estrogen receptor in a lock and key fashion but to alter the compound so that while it fits into the lock, it cannot open the lock. Tamoxifen works in much the same way. Tamoxifen can bind to estrogen receptors and block the function of the receptor. If Tamoxifen is added to breast cancer cells grown in the laboratory, many of these tumor cells will stop growing and die. Even if estrogen is present, the Tamoxifen can suc cessfully compete with the normal estrogen for the binding sites for estrogen found on tumor cells. If Tamoxifen has bound to the estrogen receptor, then normal estrogen cannot get into the receptor to stimulate the normal functions of estrogen. Some breast tumors have lost the estrogen receptor and have adapted to growth without estrogen stimulation. These cancers are estrogen receptor negative and generally do not respond to treatment with Tamoxifen.

A recent study was performed to determine how effective Tamoxifen was in women at risk for recurrent breast cancer. This study demonstrated that daily treatment with Tamoxifen could reduce the incidence of breast cancer by 49%. The use of Tamoxifen is recommended for post-menopausal women with breast cancer cells that have estrogen receptors. The current recommendation is for 5 years of daily treatment. Currently, there is a study comparing Tamoxifen with a similar drug, Roloxifene to determine which drug is more effective.

Exericise and Fatigue

  1. TI - Daily fatigue patterns and effect of exercise in women with breast cancer.
    SO - Cancer Pract 2000 Jan-Feb;8(1):16-24
    AU - Schwartz AL
    AD - University of Washington School of Nursing, Seattle 98195-7266, USA.
    AB -
    Cancer treatment-related fatigue is a common and disruptive side effect of chemotherapy. Exercise is an intervention proposed to reduce fatigue in cancer patients. The purpose of this study was to describe the patterns of daily fatigue in women with breast cancer who did and did not exercise while receiving the first three cycles of adjuvant chemotherapy.
    Women received instruction to follow an 8-week home-based exercise program and to maintain daily exercise and fatigue diaries. Functional ability (12-minute walk) was measured pretest and post-test.
    Several distinct patterns of fatigue emerged. The most common pattern of fatigue after chemotherapy demonstrated a sharp rise in fatigue. However, several women demonstrated a chaotic pattern with erratic and wide swings in their fatigue throughout the entire study period. Women who adopted exercise experienced fewer days of high fatigue levels and more days of low levels of fatigue for both average and worst levels of fatigue. Women who did not exercise experienced more bad days (high fatigue) and fewer g ood days (low fatigue).
    Exercise appears to reduce the levels of average and worst fatigue and may help women recognize their pattern of fatigue. Exercise may reduce the intensity of fatigue by reorganizing women's interpretation of fatigue. Routine clinical assessment and education about fatigue by health professionals can help patients to understand their pattern of fatigue and may help them to manage the symptom.

  2. TI - Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.
    SO - Oncol Nurs Forum 1997 Jul;24(6):991-1000
    AU - Mock V; Dow KH; Meares CJ; Grimm PM; Dienemann JA; Haisfield-Wolfe ME; Quitasol W; Mitchell S; Chakravarthy A; Gage I
    AD - Johns Hopkins Hospital in Baltimore, USA.
    AB -
    To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidenced by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate.
    Experimental, two-group pretest, post-test.
    Two university teaching hospital outpatient radiation therapy departments.
    46 women beginning a six-week program of radiation therapy for early stage breast cancer.
    Following random assignment, subjects in the exercise group maintained an individualized, self-paced, home-based walking exercise program throughout treatment. The control group received usual care. Dependent variables were measured prior to and at the end of radiation therapy. In addition, symptoms were assessed at the end of three weeks of treatment.
    Participation in the walking exercise program, physical functioning fatigue, emotional distress, and difficulty sleeping.
    Hypothesis testing by multivariate analysis of covariance, with pretest scores as covariates, indicated significant differences between groups on outcome measures (p < 0.001). The exercise group scored significantly higher than the usual care group on physical functioning (p = 0.003) and symptom intensity, particularly fatigue, anxiety, and difficulty sleeping. Fatigue was the most frequent and intense subjective symptom reported.
    A self-paced, home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy.
    Nurse-prescribed and -monitored exercise is an effective, convenient, and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment.

  3. TI - An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation.
    SO - Bone Marrow Transplant 1996 Dec;18(6):1157-60
    AU - Dimeo F; Bertz H; Finke J; Fetscher S; Mertelsmann R; Keul J
    AD - Department of Rehabilitation, Prevention and Sports Medicine, Freiburg University Medical Centre, Germany.
    AB - We describe the effects of an aerobic exercise program designed to improve the physical performance of patients undergoing bone marrow transplantation. Twenty patients entered the rehabilitation program, consisting of walking on a treadmill, and carried it out for 6 weeks. Patients started the training program 30 +/- 6 days (range 18-42) post-BMT. By the end of the program we observed a significant improvement in maximal physical performance and maximum walking distance, and a significant lowering of the heart rate with equivalent workloads (P for all significances < 0.001). All participants of the program reached a peak performance (calculated in metabolic equivalents, METs) more than sufficient for carrying out all basic activities of daily living. These results contrast with literature reports indicating that spontaneous recovery of physical functioning after BMT can take many months and that about 30% of patients experience long-lasting impairment of physical performance. We conclude that fatigue a nd loss of physical performance in patients undergoing BMT can be corrected with adequate rehabilitative measures.