Exercise boosts tumor-fighting ability of

chemotherapy, team finds

Study after study has proven it true: exercise is good for you. But new
research from University of Pennsylvania scientists suggests that exercise
may have an added benefit for cancer patients undergoing chemotherapy.
Their work, performed in a mouse model of melanoma, found that combining
exercise with chemotherapy shrunk tumors more than chemotherapy alone.
Joseph Libonati, an associate professor in the School of Nursing and director
of the Laboratory of Innovative and Translational Nursing Research, was the
senior author on the study, which appears in the American Journal of
Physiology. His collaborators included Penn Nursing's Geetha Muthukumaran,
Dennis Ding and Akinyemi Bajulaiye plus Kathleen Sturgeon, Keri Schadler,
Nicholas J. Thomas, Victor Ferrari and Sandra Ryeom of Penn's Perelman
School of Medicine.
Exercise has long been recommended to cancer patients for its physical and
psychological benefits. Libonati and colleagues were particularly interested in
testing whether exercise could protect against the negative cardiac-related
side effects of the common cancer drug doxorubicin. Though effective at
treating a variety of types of cancer, doxorubicin has is known to damage
heart cells, which could lead to heart failure in the long-term.
"The immediate concern for these patients is, of course, the cancer, and
they'll do whatever it takes to get rid of it," Libonati said. "But then when you
get over that hump you have to deal with the long-term elevated risk of
cardiovascular disease."
Previous studies had shown that an exercise regime prior to receiving
chemotherapy could protect heart cells from the toxic effects of doxorubicin,
but few had looked to see whether an exercise regimen during chemotherapy
could be beneficial.
To do so, Libonati's team set up an experiment with four groups of mice. All
were given an injection of melanoma cells in the scruffs of their neck. During
the next two weeks, two of the groups received doxorubicin in two doses
while the other two groups received placebo injections. Mice in one of the
treated groups and one of the placebo groups were put on exercise regimens,

walking 45 minutes five days a week on mouse-sized treadmills, while the

rest of the mice remained sedentary.
After the two-week trial, the researchers examined the animals' hearts using
echocardiogram and tissue analysis. As expected, doxorubicin was found to
reduce the heart's function and size and increased fibrosis -- a damaging
thickening of tissue. Mice that exercised were not protected from this
damage.
"We looked, and the exercise didn't do anything to the heart -- it didn't
worsen it, it didn't help it," Libonati said. "But the tumor data -- I find them
actually amazing."
The "amazing" result was that the mice that both received chemotherapy and
exercised had significantly smaller tumors after two weeks than mice that
only received doxorubicin.
Further studies will investigate exactly how exercise enhances the effect of
doxorubicin, but the Penn team believes it could be in part because exercise
increases blood flow to the tumor, bringing with it more of the drug in the
bloodstream.
"If exercise helps in this way, you could potentially use a smaller dose of the
drug and get fewer side effects," Libonati said.
Gaining a clearer understanding of the many ways that exercise affects
various systems of the body could also pave the way for developing drugs
that mimic the effects of exercise.
"People don't take a drug and then sit down all day," Libonati says.
"Something as simple as moving affects how drugs are metabolized. We're
only just beginning to understand the complexities."

Source:
University of Pennsylvania. (2014). Exercise boosts tumor-fighting ability of
chemotherapy, team finds. ScienceDaily. Retrieved July 24, 2015 from
<www.sciencedaily.com/releases/2014/09/140918162348.htm>.

Reaction:
Based on the article, I found it more interesting regarding to the latest
beneficial effects of exercise to cancer patients. We know that cancer causes
several complications that could compromise clients health. Exercise is an
important part of preventative strategies for many chronic conditions. However,
often the people who need exercise the most do not exercise at all and attribute
their inactivity to their medical problems.
Evidently, it was found that exercise might have an added benefit for
cancer patients undergoing chemotherapy. Their work, performed in a mouse
model of melanoma, found that combining exercise with chemotherapy shrunk
tumors more than chemotherapy alone.
Specifically, a drug called doxorubicin has been identified that it has toxic
effects on cardiac function if taken for longterm. However, it is a big help that if
complemented with regular exercise could potentially help cancer patients on
their recovery without compromising cardiac function as research suggest.

Thus, it is important for nurses to understand the effects of exercise

inorder to make informed recommendations to their patients about how
appropriate exercise can bring health-related benefits.
Moreover, it has been said that regular participation in moderate physical
activity is an essential component of a healthy lifestyle. Despite evidence of the
benefits of physical activity, both physiological and psychological , few individuals
engage in regular exercise. It is essential that all healthcare providers including
nurses should routinely assess and counsel patients about the frequency,
duration, type, and intensity of their physical activity.

Nurses' research settles a common cancer

concern: Skin care
Given the complexity of cancer treatment, skin care may seem like a
small matter. However, a nurse at the James P. Wilmot Cancer Center
knew that skin issues were a constant source of anxiety for many
patients receiving radiation therapy, and through research she
discovered that routine advice was rooted in myth instead of scientific
evidence.
Her findings, which have been published in the Clinical Journal of
Oncology Nursing, are prompting change locally and across the
country.
"We've had a lot of feedback and we're very pleased we could explore
a topic that makes a difference for patients going through cancer
treatment," said Trish Bieck, R.N., the study's lead author, who also
credited co-author Shannon Phillips, R.N. Both are senior nurse
specialists at Wilmot.
As a result of Bieck's study, the National Cancer Institute revised its
recommendations for patients and rewrote its widely distributed
brochure,Radiation Therapy and You, to incorporate the new findings.
The Oncology Nursing Society also invited Bieck to serve on its national
committee to update patient guidelines.
At the crux of her investigation was whether evidence supports the
exclusion of moisturizer or any topical agent on the radiation field

within four hours of treatment. Generally, the use of skin lotion is

viewed as a way to prevent skin changes, which are a common and
distressing side effect of radiation treatment.
However, one widely held theory is that the presence of lotion can
actually increase the risk of a bad skin reaction by inducing a bolus
effect, or inadvertently making the skin thicker and thereby boosting
the surface dose of radiation.
On the other hand, going without lotion can result in skin damage and
dryness. This can lead to infection and pain, resulting in the
interruption of treatment and an increased chance that malignant cells
will repopulate while the skin heals.
So, until now, the patient was left to wonder: Should I use lotion prior
to therapy and worry that my treatment is not as effective as it could
be? Or do I skip the lotion and risk a skin reaction, infection, or
discomfort?
As a compromise, many institutions, including the NCI and the
University of Rochester Medical Center's Wilmot Cancer Center, have
been telling patients for years to avoid lotions at least four
hours before therapy.
"It always bothered me that there didn't seem to be any rationale
behind restricting lotions during that particular timeframe," said Bieck,
who has worked in Radiation Oncology for 20 years. "When I looked
into it, I discovered little evidence to support the four-hour policies.
Instead, the practice was based on historical practice -- in other words,
'just because, that's the way we do it.' ''
She conducted a literature review of relevant articles published
between 1992 and 2009, interviewed experts, examined benchmarks
at international cancer centers, and consulted with professional
organizations. In the United States, she found wide variation in
practice: for example, among five institutions spread across all regions
of the country, their advice ranged from no lotion restrictions at all to
complete avoidance of lotions to restriction of lotions one hour before
treatment.
No scientific evidence supported a four-hour restriction of lotions, and
no evidence showed that lotion or topical agents such as deodorants
made radiation therapy less effective.

Only five scientific articles addressed the topic, though, and based on
that small number Bieck believes more research is needed on the
safety of lotions used on irradiated skin.
Meanwhile, as a direct result of the project, the Wilmot Cancer Center
developed standardized skin-care guidelines and revised its education
materials. Now, staff recommends that patients avoid applying
lotionsimmediately before treatment, but allows the patient to
maintain some control over their usual skin-care regimen.
Source:
University of Rochester Medical Center. (2010). Nurses' research settles a common
cancer concern: Skin care. ScienceDaily. Retrieved July 24, 2015 from
<www.sciencedaily.com/releases/2010/03/100317112051.htm>.

Reaction:
The article as stated above would like point out the prevailing issues
concerning the skin care management among patients receiving radiation
therapy. I found it more interesting to note as it could arouse the curiosity of the
readers. Accordingly, central to this topic is whether evidence supports the
exclusion of moisturizer or any topical agent on the radiation field within four
hours of the treatment. It was identified that a nurse at the James P. Wilmot
Cancer Center knew that skin issues were a constant source of anxiety for many

patients receiving radiation therapy, and through research she discovered that
routine advice was rooted in myth instead of scientific evidence.
In some circumstances especially in hospital setting, we encounter cancer
patients with several concerns. A thought-provoking questions like, Should I use
lotion prior to therapy and worry that my treatment is not as effective as it could
be? Or do I skip the lotion and risk a skin reaction, infection, or discomfort? Then,
what would probably a nurse might respond on this specific clients concern.
Significantly, it is essential that a nurse must provide a more scientific
explanation inorder to address clients concern. In the article, it is stated that no
scientific evidence supported a four-hour restriction of lotions, and no evidence
showed that lotion or topical agents such as deodorants made radiation therapy
less effective. It is believed that more research is needed on the safety of lotions
used on irradiated skin. As implicated to main issue, the staff now recommends
that patients avoid applying lotions immediately before treatment, but allows the
patient to maintain some control over their usual skin-care regimen.
Furthermore, nurses should properly assessed patients about the adverse
reactions of lotion or any topical agents if receiving radiation therapy. It is also
important to continually health educate the cancer patients concerning their risktaking behaviors and health condition to achieve an optimum level of functioning.