Texto original do relato dado pela Dra. Roanne Segal à coluna Paciente em Forma de Outubro
Breast cancer is one of the most commonly occurring cancers
among women worldwide. Early detection and improved treatments have resulted in
increased survival rates; with the current five year relative survival
estimated to be 80%. These improvements come at the cost of multiple sequlae as
a result of combination therapies including surgery, radiotherapy, systemic
chemotherapy, and/or hormonal treatment.
In addition to the standard toxicity of these treatments
there are also additional significant reductions in many different aspects of quality
of life, strength and or cardiovascular fitness. Both during and post
completion of therapy women would complain of fatigue and what followed was the
traditional medical response; to rest. Coming from a background of
Physiotherapy this recommendation seemed counter intuitive. We also had a growing body of literature both
in the aging healthy adult population as well as in those living with chronic
illness that rest further worsening these symptoms and that physical activity
could improve them. What was required
was objective research that would demonstrate that exercise was beneficial for women
living with breast cancer.
Initially many barriers were encountered including resistance
from research ethics boards as well as oncology colleagues. Concerns included: it will not be safe for
these women to exercise while they are receiving their chemotherapy, the women
themselves will not want to participate in these programs, and in fact if they
do, they will be unable/too fatigued to do any real amount exercise that would
be of any value to them. Finally grave
concerns were expressed about acute heart or cardiac concerns as the standard
of care for these women included a drug that could have both acute and long
term heart toxicity.
As per the publication this was one of the first studies
that took the risk of asking this question and proving that not only is
exercise safe, but of value for these women. We now have systematic reviews and
guidelines proving that exercise is an effective intervention to improve
quality of life, cardiorespiratory fitness, physical functioning, and fatigue.