Should doctors prescribe exercise?

“Although the data vary by different cancer types, there is a consistent trend suggesting that moderate daily exercise has a beneficial effect on preventing certain cancers. If you are a reasonably healthy adult, your should exercise regularly.” 

Let’s look at the relationship of exercise and selected cancers. The American Society of Clinical Oncology (ASCO) has done a nice job of summarizing:

Breast Cancer

While the amount of risk reduction varies among studies (20-80%), most suggest that 30 to 60 minutes of moderate to high-intensity exercise per day lowers breast cancer risk. Women who are physically active throughout their life appear to benefit the most, but those who increase physical activity after menopause also fare better than inactive women.1

Colon Cancer

Research suggests that people who increase their physical activity can lower the chance of developing colon cancer by 30 to 40% relative to sedentary adults.1,2 A decrease in colon cancer risk can be achieved regardless of body mass index (BMI) and people who are most active benefit the most. There is insufficient evidence of a protective effect of physical activity on the risk of rectal cancer (a protective effect was seen in some case-control studies, but not in cohort studies).3

Endometrial, Lung and Ovarian Cancer

A handful of studies have suggested that women who are physically active have a 20-40% reduced risk of endometrial cancer compared to those who don’t exercise.1 Higher levels of physical activity seem to also protect against lung cancer (up to 20% reduction in risk), particularly among men.1Although less consistent, research suggests that physical activity possibly reduces the risk of ovarian and prostate cancer.

What about Other Cancers?

While observational data on the benefits of exercise for prevention of the types of cancers listed above are fairly consistent, evidence of the effects of exercise on prevention of any other type of cancer either is either insufficient or inconsistent.2,4

Prostate Cancer

Prostate cancer is one disease in which the data are not consistent, however prostate cancer is a heterogeneous disease and risk factor associations for total non-aggressive disease are different from aggressive / lethal disease. Most population based studies show similar findings, with little effect of exercise on overall incidence of prostate cancer but lower risk of aggressive prostate cancers for those with the highest levels of VIGOROUS activity (rather than any type of activity). In the Health Professionals Follow-up Study men 65 years or older who engaged in vigorous physical activity, such as running, jogging, biking, swimming or tennis at least three hours per week  had a 67% lower risk of advanced prostate cancer and 74% lower risk of fatal prostate cancer.5

Conflicting data for other malignancies

For example, one recent study found no association between physical activity and risk of developing gastric, rectal, pancreatic, bladder, testicular, kidney and hematological cancers.4 In contrast, a pooled analysis of data from prospective trials with 1.4 million participants found that physical activity was linked to lower risk of 13 cancers: esophageal, lung, kidney, gastric, endometrial, myeloid leukemia, myeloma, colon, head and neck, rectal, bladder, and breast.6Interestingly, leisure-time physical activity was associated with a higher risk of melanoma (presumably due to time spent outdoors) and prostate cancer, although it is not clear from these data whether that association was with nonaggressive or aggressive prostate cancer.

While we wait for confirmation and clarity on the role of exercise in preventing all the 200+ types of cancer – should doctors prescribe exercise? The answer is simple: yes, because evidence of the protective role of exercise is already strong for some of the most common cancers.

References

  1. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  2. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239–252.
  3. Pham NM, et al. Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2012 Jan;42(1):2-13.
  4. Friedenreich CM, Neilson HK, Lynch BM. Eur J Cancer. State of the epidemiological evidence on physical activity and cancer prevention. 2010 Sep;46(14):2593-604.
  5. Giovannucci E, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165(9):1005-1010.
  6. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25.
  7. http://www.asco.org/about-asco/press-center/asco-resources-media/cancer-perspectives/should-cancer-doctors-prescribe?et_cid=38723632&et_rid=463715101&linkid=Read+more

I’m Dr. Michael Hunter. Of course, the disclaimer: Do not begin an exercise program without input from an appropriate medical professional. Many can simply start with a brisk walk for 30 minutes daily, 5 days per week. Have a wonderful day!

How Antioxidants Can Accelerate Cancers

Background: For decades, health-conscious people around the globe have taken antioxidant supplements and eaten foods rich in antioxidants, figuring this was one of the paths to good health and a long life.

Yet clinical trials of antioxidant supplements have repeatedly dashed the hopes of consumers who take them hoping to reduce their cancer risk. Virtually all such trials have failed to show any protective effect against cancer. In fact, in several trials antioxidant supplementation has been linked with increased rates of certain cancers. In one trial, smokers taking extra beta carotene had higher, not lower, rates of lung cancer.

In a brief paper appearing in The New England Journal of Medicine, David Tuveson, M.D. Ph.D., Cold Spring Harbor Laboratory Professor and Director of Research for the Lustgarten Foundation, and Navdeep S. Chandel, Ph.D., of the Feinberg School of Medicine at Northwestern University, propose why antioxidant supplements might not be working to reduce cancer development, and why they may actually do more harm than good.

The Science: Their insights are based on recent advances in the understanding of the system in our cells that establishes a natural balance between oxidizing and anti-oxidizing compounds. These compounds are involved in so-called redox (reduction and oxidation) reactions essential to cellular chemistry.

Oxidants like hydrogen peroxide are essential in small quantities and are manufactured within cells. There is no dispute that oxidants are toxic in large amounts, and cells naturally generate their own anti-oxidants to neutralize them. It has seemed logical to many, therefore, to boost intake of antioxidants to counter the effects of hydrogen peroxide and other similarly toxic “reactive oxygen species,” or ROS, as they are called by scientists. All the more because it is known that cancer cells generate higher levels of ROS to help feed their abnormal growth.

Drs. Tuveson and Chandel propose that taking antioxidant pills or eating vast quantities of foods rich in antioxidants may be failing to show a beneficial effect against cancer because they do not act at the critical site in cells where tumor-promoting ROS are produced — at cellular energy factories called mitochondria. Rather, supplements and dietary antioxidants tend to accumulate at scattered distant sites in the cell, “leaving tumor-promoting ROS relatively unperturbed,” the researchers say.

Quantities of both ROS and natural antioxidants are higher in cancer cells — the paradoxically higher levels of antioxidants being a natural defense by cancer cells to keep their higher levels of oxidants in check, so growth can continue. In fact, say Tuveson and Chandel, therapies that raise the levels of oxidants in cells may be beneficial, whereas those that act as antioxidants may further stimulate the cancer cells. Interestingly, radiation therapy kills cancer cells by dramatically raising levels of oxidants. The same is true of chemotherapeutic drugs — they kill tumor cells via oxidation.

Paradoxically, then, the authors suggest that “genetic or pharmacologic inhibition of antioxidant proteins” — a concept tested successfully in rodent models of lung and pancreatic cancers — may be a useful therapeutic approach in humans. The key challenge, they say, is to identify antioxidant proteins and pathways in cells that are used only by cancer cells and not by healthy cells. Impeding antioxidant production in healthy cells will upset the delicate redox balance upon which normal cellular function depends.

The authors propose new research to profile antioxidant pathways in tumor and adjacent normal cells, to identify possible therapeutic targets.

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cold Spring Harbor Laboratory. “How antioxidants can accelerate cancers, and why they don’t protect against them.” ScienceDaily. ScienceDaily, 10 July 2014. <www.sciencedaily.com/releases/2014/07/140710094434.htm>

Elizabeth G. Phimister, Navdeep S. Chandel, David A. Tuveson. The Promise and Perils of Antioxidants for Cancer Patients. New England Journal of Medicine, 2014; 371 (2): 177 DOI: 10.1056/NEJMcibr1405701

Daily Green Tea Or Coffee May Cut Your Risk of Stroke

green tea can

What You Need to Know: Whether it’s green tea that warms you up, or coffee that gives you that morning lift, a study finds both can help cut the risk of suffering a stroke. The 2013 study, published in the American Heart Association journal Stroke, included 82,369 men and women in Japan. The more green tea a person drank, the more it reduced the risk of suffering a stroke.

“It’s almost a 20 percent lower risk of stroke in the green tea drinkers” who drank four cups a day, compared with those who rarely drank green tea, explains Dr. Ralph Sacco of the University of Miami. (He’s the past president of the American Heart Association, and we asked him to review the study for us.)

And with coffee, researchers found just one cup per day was also associated with about a 20 percent decreased risk of stroke during a 13-year follow-up period.

“I was still feeling rather surprised” about the findings, Dr. Yoshihiro Kokubo, the study’s lead author, tells The Salt in an email. Kokubo is a researcher at the Department of Preventive Cardiology, National Cerebra and Cardiovascular Center in Osaka, Japan.

How? Kokubo says that green tea contains compounds known as catechins, which help regulate blood pressure and help improve blood flow. The compounds also seem to promote an anti-inflammatory effect. Kokubo says coffee, which contains caffeine and compounds known as quinides, likely influences our health through different mechanisms.

It’s not just the Japanese who seem to benefit from drinking coffee and green tea. Over the past few years, researchers in the U.S. have documented similar reductions in heart disease risk among Americans.

“The accumulating evidence from a variety of studies is suggesting that green tea and coffee may be protective,” says Sacco.

Coffee May Help with Diabetes and Parkinson’s, too: Recent studies have linked a regular coffee habit to a range of benefits — from a reduced risk of Type 2 diabetes to a protective effect against Parkinson’s disease.

It’s interesting to note how much the thinking about caffeine and coffee has changed. In the 1980s, surveys found that many Americans were trying to avoid it; caffeine was thought to be harmful, even at moderate doses. One reason? Meir Stampfer of the Harvard School of Public Health says back then, coffee drinkers also tended to be heavy smokers. And in early studies, it was very tough to disentangle the two habits. “So it made coffee look bad in terms of health outcomes,” says Stampfer.

But as newer studies began to separate out the effects of coffee and tea, a new picture emerged suggesting benefits, not risks. Researchers say there’s still a lot to learn here — they haven’t nailed down all the mechanisms by which coffee and tea influence our health. Nor have they ruled out that it may be other lifestyle habits among coffee and tea drinkers that’s leading to the reduced risk of disease.

And experts say when it comes to preventing strokes and heart attacks, no food or drink is a magic bullet. It’s our overall patterns of eating and exercise that are important.

“It’s a whole lifestyle approach, and we need to remember that,” says Sacco.

So if you are already in the habit of drinking coffee or green tea, this study is one more bit of evidence that you can go ahead and enjoy it. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: http://www.npr.org/blogs/thesalt/2013/03/15/174334493/a-daily-habit-of-green-tea-or-coffee-cuts-stroke-risk

Acupuncture Helps with Breast Cancer Drug Pain

acupuncture

What You Need to Know: For women with breast cancer receiving aromatase inhibitors (AIs), real acupuncture (RA) and sham acupuncture (SA) seem to improve patient-reported outcomes, according to a study published online Dec. 23 in Cancer.

The Study: Ting Bao, M.D., from the University of Maryland Greenebaum Cancer Center in Baltimore, and colleagues randomized postmenopausal women with stage 0 through III breast cancer who received an AI and had treatment-associated musculoskeletal symptoms to receive eight weekly RA (23 patients) or SA (24 patients) sessions.

Results: The researchers identified significantly improved scores from baseline to week eight in the RA arm for the Center for Epidemiological Studies Depression scale (P = 0.022); hot flash severity and frequency (P = 0.006 and 0.011, respectively); the Hot Flash-Related Daily Interference Scale (HFRDI; P = 0.014); and National Surgical Adjuvant Breast and Bowel Project (NSABP) menopausal symptoms (P = 0.022). In the SA arm, significant improvements from baseline were seen for the European quality-of-life survey (P = 0.022), the HFRDI (P = 0.043), and NSABP menopausal symptoms (P = 0.005). Compared with the 38 non-African-American patients, the nine African-American patients benefited more from RA than SA in reduction of hot flash severity and frequency scores (P < 0.01 for both).

“Both RA and SA were associated with improvement in patient-reported outcomes among patients with breast cancer who were receiving AIs, and no significant difference was detected between arms,” the authors conclude.

My Take: Small study, but provides some support for those who wish to try acupuncture for aromatase inhibitor-related symptoms.The authors disclosed no financial ties to the pharmaceutical industry. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cancer 120(3)

Music Therapy and Cancer Care

music therapy brain

Complementary therapies can improve your strength and control of the physical and emotional symptoms associated with cancer and other illnesses. Ideally, such approaches are rational, evidence-based practices delivered or taught by trained practitioners. Examples include mind-body practices such as meditation and self-hypnosis; massage therapies; dietary counseling and manipulation; physical fitness (including aerobic and anaerobic exercise, qigong, tai chi, yoga, and many other practices); acupuncture; and music therapy. Today we turn to music therapy.

What: Music therapy is the use of usic to encourage healing and to promote a general sense of well-being. Patients listen or perform music under the guidance of a professionally trained and certified music therapist. Music therapists perform, listen to music with patients, analyze their lyrics, write songs, and join in music improvisation. Patients may play or listen to music, based on their historic experiences and clinical condition. After assessing a patient’s condition, the music therapist selects the music type and activities most appropriate to the individual patient. (Sometimes music therapy is conducted on a group basis).

What Can It Do For You? Music therapy (MT) has several purposes. MT can alleviate pain and ease psychological distress associated with many medical conditions. It helps improve physical and mental functioning among those with neurologic or developmental disorders. Music therapy can help terminally ill patients decrease anxiety, depression, and pain; improve the ability to sleep; and enhance overall quality of life. It can reduce the need for medication for women during childbirth, and it distracts dental patients from the pain of a root canal. It can improve the ability of mentally challenged and autistic children to learn, and to interact with other people and the environment around them. Elderly patients can experience improved well-being, including those suffering from dementia.

Where to Get It: Check out musictherapyworld.de; music therapy.ca/en (Canada); austmta.org.au (Australia); and music therapy.org (USA).

My Take: Music therapy is especially desirable because, for most people, it is an intrinsically pleasant, soothing experience. Few know about its value. So now you do! If you have cancer or conditions such as those listed above, check it out. I’m Dr. Michael Hunter (and I will get some points here, as my wife is a music therapist). I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: awomanshealth.com (Cassileth BD. Complementary Therapies in Cancer Care.

Herbal Products: Contamination Common

alternative complementary herbal medicine

Background: Researchers report that most herbal products, available as alternative medicines, may be contaminated. There is no “best practice” for identifying plant species in herbal products. Traditionally, plants are identified through the appearance of the whole plant. But this method is not useful when analyzing processed plant material. DNA barcoding analyzes a short genetic sequence from the plant’s genome and identifies small differences, thus allowing species identification. In a recent study, investigators used barcoding to examine the plant species found in a sample of herbal plant produces.

Results: Of the products examined, 59 percent had plant species not listed on the labels. Over tw0-thirds of the products tested had plant species present which were a substitute for the plants listed on the label, and a third of products also contained other species that may be a filler or contamination.

My Take: Caveat emptos (buyer beware). The World Health Organization views the adulteration of herbal products as a threat to public safety. In the current analysis, investigators detected plant species that could pose serious health risks when consumed. It would be nice to have some certification process, perhaps through the use of barcoding. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Newmaster SG et al. DNA barcoding detects contamination and subsitution in North American herbal products. BMC Medicine, October 2013 DOI:10.1186/1741-70150110222