Tag Archives: Cancer

Guest Post: Physical Activity in Childhood Cancer

Amanda Wurz & Dr. S. Nicole Culos-Reed

As it is now nearing the end of August, you should be convinced of the importance of physical activity during childhood, a key factor in the development of healthy children and eventually healthy adults. As Andrew mentioned in “How Much Physical Activity do Children Need?”, physical inactivity in our children and youth is alarming. We know that less than half of children are meeting the Canadian Society for Exercise Physiology (CSEP) Physical Activity Guidelines. And research suggests that childhood cancer patients and survivors are more sedentary than their healthy peers1,2,3. It may seem counterintuitive to focus on physical activity levels while a child is battling cancer, as we typically think children should be resting and recovering from their treatment. However, the research consistently stresses the importance of exercise throughout the childhood cancer trajectory4,5,6,7.

Tremendous advances in research and technology over the past 30 years have resulted in improved treatment and survival rates, with over 80% of childhood cancer patients becoming long-term survivors8,9. Unfortunately, survivorship is often accompanied by negative side-effects that develop both during and after treatments10. Physical early side-effects impact a range of body tissues and functions during or shortly after treatment (i.e., increased risk of infections, bleeding and clotting complications, nausea, vomiting, allergic reactions, skin changes, temporary hair loss, fatigue). Physical late side-effects occur months or years after treatment ends and include, reduced muscular strength, damage to nerves in the extremities, reduced cardiovascular functioning due to damage to the lungs and heart, persistent fatigue. Psychosocial early side-effects include a range of negative social and emotional states that would be expected to occur during or shortly after treatment (i.e., anxiety, fear, depression, social isolation) with many of the late side-effects occurring months or years after treatment ends (i.e., poor social functioning, withdrawal, decreased health related quality of life). Several resources outlining the array and degree of side-effects experienced can be accessed online11,12. Unfortunately, adding physical inactivity into this mix not only worsens the side-effects experienced, but it also increases the likelihood of childhood survivors developing diseases such as hypertension, diabetes, osteoporosis and cancer recurrence4,13,14.

Across childhood cancers, patients report lower amounts and intensity levels of physical activity than healthy children. Pain, fear, anxiety, fatigue, difficulty accessing programs, and the overprotective attitudes of parents and educators have been commonly cited in the literature as barriers to physical activity in this population15,16. Additionally, it is suggested that the low levels of physical activity typically seen in this population may be due to the fact that pediatric cancers peak in incidence between the ages of 2-5 years, a time when many children are introduced to leisure time physical activity4,17. Thus, their disease may impede their ability to play with their peers and establish healthy physical activity habits. Likely it is a culmination of disease timing, fatigue, limited programming, parental attitudes, and an array of personal and familial characteristics that result in lower than average physical activity levels.

Fortunately, researchers and clinicians are aware of the importance of early intervention in this population. The last 15 years have shown physical activity’s beneficial impact on many of the negative physical and psychosocial side-effects of treatment2,4,5,18.

Although the field is still young and the majority of findings are preliminary, the existing evidence consistently suggests that mild to moderate exercise is safe, beneficial and feasible for both childhood cancer patients and survivors. As the field grows it will be important to:

(i) Share the research information we have;

(ii) Create tailored guidelines. Our lab is currently working with an international team to put out the first Pediatric Oncology Exercise Manual – POEM – which will be distributed to physicians and parents at the Alberta Children’s Hospital, as well as across Canada, and through our colleagues worldwide); and,

(iii) Create safe, evidence-informed programs to offer patients and survivors a safe space to exercise (that takes into account their compromised immune systems, lower level of physical functioning etc.). We have developed Pediatric Survivors Engaging in Exercise for Recovery (PEER), and will be launching Yoga Thrive for Youth (YTY) an innovative yoga program for childhood and adolescent cancer patients and survivors in Fall 2013. These programs have a central goal: Provide childhood cancer patients and survivors safe, accessible, evidence-informed activity programming that will enhance and restore their levels of physical and psychosocial functioning. We need to continue reaching out to childhood cancer patients and survivors to ensure they are meeting physical activity guidelines.

A more in depth article expressing our teams vision for the future of physical activity and pediatric oncology can be found here: Chamorro-Vina, C, Wurz, AJ, & Culos-Reed, SN (2013). Promoting physical activity in pediatric oncology. Where do we go from here? Frontiers in Oncology, 3(173), 1-4. doi: 10.3389/fonc.2013.00173 

References:

  1. Ness, K.K., Leisenring, W.M., Huang, S., Hudson, M.M., Gurney, J.G., Whelan, K. et al. (2009). Predictors of inactive lifestyle among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer, 115(9), 1984-1994.
  2. Kelly, A.K. (2011). Physical activity prescription for childhood cancer survivors. Current Sports Medicine Reports, 10(6), 352-359.
  3. Ness, K.K., Hudson, M.M., Ginsberg, J.P., Nagarajan, R., Kaste, S.C., Marina, M. et al. (2009). Physical performance limitations in the Childhood Cancer Survivor Study cohort. Journal of Clinical Oncology, 24(14), 2382-2389.
  4. San Juan, A.F., Wolin, K., & Lucia, A. (2011). Physical activity and pediatric cancer survivorship. In: Courneya K.S., & Friedenreich, C.M. (eds) Physical activity and cancer: Recent results in cancer research (pp.319-347). New York: Springer – Berlin Heidelberg.
  5. Huang, T-T., & Ness, K.K. (2011). Exercise interventions in children with cancer: A review. International Journal of Pediatrics, 1-11.
  6. Soares-Miranda, L., Fiuza-Luces, C., Lassaletta, A et al. (2013). Physical activity in pediatric cancer patients with solid tumors (PAPEC): Trial rationale and design. Contemporary Clinicial Trials, 5(1), 106-115.
  7. Winter, C., Muller, C., Brandes, M., Brinkmann, A., Hoffman, C., Hardes, J. et al. (2009). Level of activity in children undergoing cancer treatment. Pediatric Blood and Cancer, 53(3), 438-443.
  8. Jemal, A., Siegel, R., Ward, E., Hao, T., Xu, J., & Thun, M.J. (2009). Cancer statistics, 2009. CA – A Cancer Journal for Clinicians, 59(4), 225-229.
  9. Ellison, L.F., Prithwish, D., Mery, L.S., & Grundy, P.E. (2009). Canadian cancer statistics at a glance: Cancer in Children. Canadian Medical Association Journal, 180(4), 422-424.
  10. Oeffinger, K.C., Mertens, A.C., Sklar, C.A., Kawashima, T., Hudson, M.M., Meadows, A.T. et al. (2006). Chronic Health Conditions in Adult Survivors of Childhood Cancer. New England Journal of Medicine, 355, 1572-1582.
  11. Shad, A.T., Late Effects of Childhood Cancer and Treatment. (2010). http://emedicine.medscape.com/article/990815-overview.Retrieved August 28, 2013.
  12. American Cancer Society. (2012). Children diagnosed with cancer: Late effects of cancer treatment. http://www.cancer.org/treatment/childrenandcancer/whenyourchildhascancer/children-diagnosed-with-cancer-late-effects-of-cancer-treatment. Retrieved August 28, 2013.
  13. Finnegan, L., Wilkie, D.J., Wilbur, J., Campbell, R.T., Zong, S., & Katula, S. (2007). Correlates of physical activity in young adult survivors of childhood cancers. Oncology Nursing Forum, 34(5), E60-E69.
  14. Wolin, K.Y., Ruiz, J.R., Tuchman, H., & Lucia, A. (2010). Exercise in adult and pediatric hematological cancer survivors: An intervention review. Leukemia, 24(6), 1113-1120.
  15. Arroyave, W.D., Clipp, E.C., Miller, P.E., Jones, L.W., Ward, D.S., Bonner, M.J. et al. (2008). Childhood cancer survivors’ perceived barriers to improving exercise and dietary behavior. Oncology Nursing Forum, 35, 121-130.
  16. Aznar, S., Webster, A.L., San Juan, A.F., Chamorro-Vina, C., Mate-Munoz, J.L., Moral, S. et al. (2006). Physical activity during treatment in children with leukemia: A pilot study. Applied Physiology, Nutrition and Metabolism, 31, 407-413.
  17. Oeffinger, K.C., Buchanan, G.R., Eshelman, D.A., Denke, M.A., Andrews, T.C., Germak, J.A. et al. (2001). Cardiovascular risk factors in young adult survivors of childhood acute lymphoblastic leukemia. Journal of Pediatric Hematology/Oncology, 23(7), 424-430.
  18. Keats, M.R., & Culos-Reed, S.N. (2008). A community-based physical activity program for adolescents with cancer (project trek): Program feasibility and preliminary findings, Journal of Pediatric Hematology and Oncology, 30, 272-280.

A word from the DBL:

Many thanks to our guest contributors, Amanda Wurz and Dr. S. Nicole Culos-Reed. Dr. Culos-Reed is the director of the Health & Wellness Lab, University of Calgary, Faculty of Kinesiology. She is an Associate Professor in Health and Exercise Psychology in the Faculty of Kinesiology and Adjunct Associate Professor in the Department of Oncology in the Faculty of Medicine at the University of Calgary. She also holds a Research Associate appointment with the Department of Psychosocial Resources in the Tom Baker Cancer Centre. Her research is focused on the benefits of physical activity throughout the cancer trajectory. Amanda Wurz holds a BA in Psychology and is currently a MSc student at the University of Calgary, in the Health & Wellness Lab. Her research is exploring the effects of a 12-week yoga intervention in childhood cancer out-patients. Additionally, she assists with both the PEER and YTY programs.

Vitamin D what is its Link to Cancer?

By: Andrew Stewart                                                                                          Published 07/29/13

There has been a lot of buzz in the news recently talking about Vitamin D and Cancer prevention. With the exception of daily recommended allowances, this is the most controversial area relating to Vitamin D.

Vitamin D Researchers and the Media

When health research is passed on to the general public it is often reduced down – it is a challenge for anyone to reduce 10 years of work into a succinct newspaper article or 2 minute news clip. This coupled with the “publish or perish” mentality in academia results in the production of news that while not necessarily untrue is greatly exaggerated. To help clarify, I’ll start by giving a brief summary on the general progression researchers take from theory to scientific fact.

science_by_herryc-d4gp9xuDue to the nature of medical research and the progress we have made regarding ethics researchers generally have to start on a small scale and work their way up the scientific totem-pole. Long gone are the days of the Dr. Frankensteins who perform questionable experiments in their attic. When medical research pertaining to humans is done in a new area it is the researcher’s responsibility to prove (within reason) that what they are attempting to do won’t have unforeseen effects that endanger the people they are trying to help.

As a result, much work is done on clumps of cells from various donor species or on animal models that we recognize (through additional research) to be similar in some particular way to the human body. The work done in this area is termed “pre-clinical”. It is often a much easier, cheaper, and safer to study something. This however often comes at the cost of application – not everything that is true on a small scale is true in the real world.

The jump from pre-clinical testing to clinical testing in humans can be a rather large one. There is no guarantee that what worked before will work in humans. The human body is amazingly complex with many variables that can get in the way.

In the case of Vitamin D it appears that promising results in the lab do not always result in medical breakthroughs in humans. In 2011 a researcher by the name of Simone Mocellin collected a large body of scientific literature and dissected it to see if different researchers around the world were in agreement regarding the effects of Vitamin D on Cancer. The conclusion that was drawn was that “overall a relationship between vitamin D and cancer does exist, although its strength appears to weaken as we move from the preclinical to the clinical ground” (Mocellin 2011).

Below I have broken down what I have found researchers are generally saying about Vitamin D and different types of Cancer.

Prostate Cancer

Upon writing this article, it would appear that the majority of the work done regarding the relationship between the circulating levels of Vitamin D in your blood and the risk of developing prostate cancer has lead to the conclusion that low levels of Vitamin D either do not lead to an increased risk of developing prostate cancer (2011 Mocellin, 2009 Yin et al, 2010 Gandini et al.). I found this agreement across three different meta-analyses which lend a significant amount of support to this conclusion.

Breast Cancer

Similar to the case of Prostate Cancer, low circulation levels of Vitamin D in the blood currently do not appear to increase the risk of developing Breast Cancer (Gandini 2011, Chen 2010). Within the literature studied by Mocellin, there was one exception which indicated that increased risk of Breast cancer occurred with lower levels of Vitamin D. I tried to find a copy of this paper (Yin 2010) to take a look at it to see what they said but was unsuccessful – it does appear that their opinion is in the minority.

Colorectal Cancer

Now so far it appears that researchers haven’t come up with much regarding Vitamin D and Cancer, I did however save the best for last. When researchers have studied Colorectal cancer they found that increased levels of Vitamin D does result in a reduction in Cancer risk! (Gorham 2007, Yin 2009, Gandini 2010)

It is commonly accepted that diet and nutrition plays a large role in protecting ourselves from the risk of developing Colorectal cancer.

stay_healthy_by_forshaka-d52ctqyCurrently it appears that keeping up your levels of Vitamin D does as well. This finding reinforces the requirement of a healthy and balanced diet for the maintenance of long term health.

Well, I believe that this concludes our month on Vitamin D. I hope these posts have contributed to your knowledge on the subject and hopefully addressed some of the controversy that exists on the topic. If you are looking for more in depth information on the topic feel free to peruse the works cited, the researcher papers I have referenced all come from reputable journals with rigorous peer-review processes.

References

Mocellin, S. (2011). Vitamin D and cancer: Deciphering the truth. Biochimica et Biophysica Acta (BBA) – Reviews on Cancer, 1816(2), 172-178. doi: http://dx.doi.org/10.1016/j.bbcan.2011.07.001

Yin, L., Raum, E., Haug, U., Arndt, V., & Brenner, H. (2009). Meta-analysis of longitudinal studies: Serum vitamin D and prostate cancer risk. Cancer Epidemiology, 33(6), 435-445. doi: http://dx.doi.org/10.1016/j.canep.2009.10.014

Gandini, S., Boniol, M., Haukka, J., Byrnes, G., Cox, B., Sneyd, M. J., . . . Autier, P. (2011). Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. International Journal of Cancer, 128(6), 1414-1424. doi: 10.1002/ijc.25439

Chen, P., Hu, P., Xie, D., Qin, Y., Wang, F., & Wang, H. (2010). Meta-analysis of vitamin D, calcium and the prevention of       breast cancer. Breast Cancer Research and Treatment, 121(2), 469-477. doi: 10.2105/AJPH.2004.045260

Gorham, E. D., Garland, C. F., Garland, F. C., Grant, W. B., Mohr, S. B., Lipkin, M., . . . Holick, M. F. (2007). Optimal Vitamin D Status for Colorectal Cancer Prevention: A Quantitative Meta Analysis. American Journal of Preventive Medicine, 32(3), 210-216. doi: http://dx.doi.org/10.1016/j.amepre.2006.11.004

Image: Science” by herryC (©2011-2013)

Image: “Stay healthy” by Naivaan (©2012-2013)