Small But Mighty: Why Staying Active During Cancer-Related Therapy is Important

Research studies show that some of the common side effects that patients experience from chemotherapy treatments are muscle weakness, balance impairment, fatigue, nausea, and decreased mobile ability (Ness et al., 2005; Huang & Ness, 2011; Yi, Kim, & Tian, 2012; Turner et al., 2013; Andersen et al., 2013; Jenkins, 2013). These side effects can interfere with an individual’s ability to participate in physical activity and exercise. Research also demonstrates that staying active during cancer-related therapy can have a positive outcome on the patient by reducing fatigue, improving muscle strength, increasing quality of life, and decreasing mortality rates (Ness et al., 2005; Huang & Ness, 2011; Eilerstein et al., 2012; Ruegg et al., 2012; Thorsteinsson et al., 2013; Stene et al., 2013; Singh et al., 2014). The results of these studies suggest the importance of implementing exercise and regular physical activity into an individual’s rehabilitation plan.

On Labor Day in 2014, my sister spent most of the day helping my dad outside with yard work. It was an extremely hot day with the sun beaming down and not a cloud in the sky. My sister, Ariana, had just turned three years-old in June.

That evening she experienced some nausea. My dad didn’t think much of it, assuming she might have been slightly dehydrated. The next day her activity and appetite began to decrease immensely. Despite her relatively small stature, Ariana was a bottomless pit when it came to food, and she was always chasing the cat around the house. My dad quickly realized something was wrong.

Upon initial exam by her pediatrician, she was rushed to Upstate University Hospital for further examination. I received a text from my dad on September 4th asking if I was free. It was my second day of graduate school, and I was just getting ready to go to night class. He said they were at the hospital getting some tests done on Ariana, but at the time didn’t sound too concerned. When I got out of class, I called him immediately and received the unfortunate news that they found a tumor on Ariana’s kidney. My heart sank into my stomach. No one is ever prepared to get that phone call.

She was supposed to be starting preschool and living a normal childhood life. After a few days of uncertainty, we soon learned the official diagnosis : Nephroblastoma-Wilms’ Tumor, Stage 3 Kidney Cancer. The tumor that began on her kidney had already grown to the size of a melon, and was invading her blood vessels in her pelvis and was growing into her heart. For the next several months, she would undergo intense chemotherapy treatments in an effort to shrink the tumor, in order to perform a more complicated surgery.

Within days, she experienced high levels of fatigue and nausea. She was refusing to eat or get out of bed. Due to a continued loss of appetite and decreased physical activity levels, she experienced excessive weight loss and muscle weakness just after a couple weeks of treatment. She had trouble walking and using step over step mobility pattern on the stairs, and was falling easily due to an impairment in balance abilities.

After spending a couple weeks in the hospital, an exercise plan was quickly implemented into Ariana’s rehabilitation plan. She began going to physical therapy and tried to remain active when she was at home. Elements of positive mental therapy were also incorporated, such as having her articulate events she was looking forward to (e.g. “Going to the playground”). During physical therapy, she participated in activities such as, jumping on lily pads with two feet, stair mobility, repeated squat to stands with proper form, balancing in a tall knee position to stimulate activation of the glute and abdominal muscles, balance activities on a BOSU ball, and the use of an exercise ball for rotational skills and core strength. At home, she remained active through Wii games, puzzles, stair exercises, and regular participation in childhood play.

Ariana received chemotherapy treatments for 14-weeks. By attending scheduled physical therapy sessions and remaining active despite some minor setbacks, she demonstrated an increased participation in normal childhood activities, increased mood/quality of life, improvement in muscle strength and mobile ability, reduced fatigue, a better appetite, and weight gain.

After months of treatment and therapy sessions, Ariana was scheduled to have a major surgery to remove the tumor. As the chemotherapy did reduce the size of the tumor, it did not reduce the severity of it, making for a very complicated surgery. In January of 2016, my family anxiously sat in the waiting room as she underwent a six to seven hour surgery. After what seemed like an eternity, the doctor came in to say the surgery was successful.

After surgery, she continued to receive treatments. April of 2016 we received the phone call that her final scans showed no more cancer! It was a major sense of relief. Through all the hardships, tears, late nights, and constant fear, we finally had some sense of hope.

I strongly believe that incorporating regular exercise and physical activity into her rehabilitation plan had a major impact on her progress. By increasing her muscle strength, weight, and energy levels, she was much stronger before and after a complex surgery.

Ariana demonstrated how staying active during treatment can be beneficial. Cancer therapy has both short-term and long-term side effects on an individual. By implementing exercise and physical activity into an individual’s rehabilitation plan, some of the side effects from treatment can be decreased (Ness et al., 2005). However, future studies should be conducted to emphasize the importance of a healthy lifestyle on patients undergoing cancer treatments.

I’m happy to say my sister is a little over two years cancer free now. In all she spent about 30 days total in the hospital, 8 months of chemotherapy and radiation treatments, and underwent two

serious surgical procedures. Through it all, she never ever gave up.

“Sometimes, real superheroes live in the hearts of small children fighting big battles.”

References

Andersen, C., Rørth, M., Ejlertsen, B., Stage, M., Møller, T., Midtgaard, J., Adamsen, L. (2013). The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue. European Journal of Oncology Nursing : The Official Journal of European Oncology Nursing Society, 17(3), 331–9. doi:10.1016/j.ejon.2012.09.003

Eilertsen, M-E.B., Jozefiak, T., Rannestad, T., Indredavik, M. S., & Vik, T. (2012). Quality of life in children and adolescents surviving cancer. European Journal of Oncology Nursing : The Official Journal of European Oncology Nursing Society, 16(2), 185–93. doi:10.1016/j.ejon.2011.08.001

Huang, T.T., & Ness, K. K. (2011). Exercise interventions in children with cancer: a review. International Journal Of Pediatrics, 1-11. doi:10.1155/2011/461512

Jenkins, A. (2013). Late effects of chemotherapy for childhood cancer. Pediatrics and Child Health, 23(12), 545–549. doi:10.1016/j.paed.2013.06.003

Ness, K. K., Mertens, A. C., Hudson, M. M., Wall, M. M., Leisenring, W. M., Oeffinger, K. C., Gurney, J. G. (2005). Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Annals of Internal Medicine Article, 143(9), 639–648.

Rueegg, C. S., von der Weid, N. X., Rebholz, C. E., Michel, G., Zwahlen, M., Grotzer, M., & Kuehni, C. E. (2012). Daily physical activities and sports in adult survivors of childhood cancer and healthy controls: a population-based questionnaire survey. PloS One, 7(4). doi:10.1371/journal.pone.0034930

Thorsteinsson, T., Helms, A. S., Adamsen, L., Andersen, L. B., Andersen, K. V., Christensen, K. B., Larsen, H. B. (2013). Study protocol: rehabilitation including social and physical activity and education in children and teenagers with cancer (RESPECT). BMC Cancer, 13(1), 1–19. doi: 10.1186/1471-2407-13-544

Turner, M., Gagnon, D., Lagace, M., & Gagnon, I. (2013) Effect of treatment for pediatric cancers on balance: what do we know? A review of the evidence. European Journal of Cancer Care VO - 22, (1).

Singh, F., Newton, R. U., Galvão, D. A., Spry, N., & Baker, M. K. (2014). A systematic review of pre-surgical exercise intervention studies with cancer patients. Surgical Oncology, 22(2), 92–104. doi:10.1016/j.suronc.2013.01.004

Stene, G. B., Helbostad, J. L., Balstad, T. R., Riphagen, I. I., Kaasa, S., & Oldervoll, L. M. (2013). Effect of physical exercise on muscle mass and strength in cancer patients during treatment--a systematic review. Critical Reviews in Oncology/hematology, 88(3), 573–93. doi:10.1016/j.critrevonc.2013.07.001

Yi, J., Kim, M. A., & Tian, T. (2014). Perceived long-term and physical health problems after cancer: adolescent and young adult survivors of childhood cancer in Korea. European Journal of Oncology Nursing : The Official Journal of European Oncology Nursing Society, 18(2), 145–50. doi:10.1016/j.ejon.2013.11.006

Upstate Magazine Story Link:

http://issuu.com/upstate/docs/cancer_care_magfall15fnl (P.9)