Are you fit enough to fight cancer?
The harsh drugs of chemotherapy do a pretty good job of killing cancer cells, but many of them can also make patients ill. Side effects are especially debilitating for older people, but it’s difficult for oncologists to know beforehand exactly which patients will experience the worst side effects.
With that in mind, researchers at the University of North Carolina Lineberger Comprehensive Cancer Center did a study that could help doctors identify which cancer patients will suffer the most from chemotherapy toxicity. They analyzed CT scans of breast cancer patients to estimate fat and muscle composition in the body and compared that information with patient outcomes.
In their study, patients with low muscle mass and low muscle quality had a significantly higher risk of blood-related toxicities, gastrointestinal side effects and neuropathy.
“As you lose muscle mass, your strength and ability to withstand medical treatment does start to decrease,” explained Falmouth Hospital surgeon Peter Hopewood, MD, of Cape Cod Surgeons in Falmouth, and an active member of the Cancer Committee at Falmouth Hospital.
Typically, oncologists do a global assessment of patients using tools like the Karnofsky Performance Status Scale or ECOG Performance Status to assess their ability to survive medical treatment. Both scales rate patients’ ability to care for themselves.
Doctors haven’t specifically been measuring muscle mass, but, especially with older patients, they do assessments that yield similar results like seeing how fast they can walk across a room or if the can get up from a chair or climb onto a stretcher.
“Very simple things like that give you a sense of where people are at,” Dr. Hopewood said. “For patients with lung cancer, we used to do a global assessment by just seeing if they could climb a flight or two of stairs. We would look at their leg strength, if they were sweating, if their pulse went up or they were really short of breath as another way to gauge their ability to withstand an operation.”
Oncologists also do calculations to decide how much medicine a patient can tolerate during chemotherapy, he said. They know the full dose and can adjust it down, depending on the patient’s age, health and strength. This isn’t just a one-time measurement at the beginning of treatment, but part of a continual fine-tuning throughout treatment that includes blood counts and takes into account any side effects that crop up.
If the patient is getting too sick, they either cut the amount of the drugs in the chemotherapy or even stop treatment early. In those cases, doctors would try a less caustic treatment like hormone therapy or biologics.
“The thing about muscle that we underestimate is the importance of exercise and the immune system,” Dr. Hopewood said. “If you exercise, you are actually enhancing the body’s immunity.”
Try This Class
Because exercise is so important to both the physical and emotional well-being of cancer patients, Dr. Hopewood refers people to Kristine Whaples, a registered clinical exercise physiologist who runs the Living Fit for You! Cancer Wellness Program at Falmouth Hospital.