Tuesday, March 29, 2011

Running for your life

The realization that treatment may result in irreversible harm is a fact of life for cancer patients receiving chemotherapy. Many of the chemotherapy drugs, because of their cell-killing qualities, result in side effects that do not disappear when the drug is no longer administered.

The chemo regime I'm on involves four doses of Epirubicen, part of a class of drugs called anthracyclines. The anthracyclines are very effective against breast cancer, but are known to be "cardiotoxic." What that means is that a percentage of people treated with these drugs die of congestive heart failure. Some studies show that almost half of the patients exposed to anthracyclines show cardiac abnormalities 10 to 20 years after the original infusion, including approximately 5% who develop congestive heart failure because of dysfunction of the left ventricle.

The most vulnerable to suffer from heart failure are the elderly, diabetic, and those with pre-existing heart problems. Though I do not fit into those categories, the high percentage of patients who suffer from anthracycline damage is a cause for concern.

Still, the use of anthracyclines, I am told, will reduce my risk of recurrence of the breast cancer from 35% to 20%. Additional therapy from 5-years administration of a pill called an "aromatase inhibitor" which inhibits the production of estrogen will further reduce the percentage to 10%.

Clearly there is a compelling need to go through chemotherapy. Though I can't help but think that if the cancer won't kill you, it is ironic that the treatment will.

It is one of the choices that I, as a cancer patient, need to make. And I have very little control over the dosage given to me of a certain drug, or the drugs that are offered. Either I consent to the recommended treatment or not. Weighing the risks, it is clear that future heart problems may not be as much of a concern to a healthy person like myself than the risk of having this breast cancer return. After a bilateral mastectomy, if it returns, it will show up somewhere else in the body, such as the bones, liver or lungs. That is not a possibility I want to risk. Going through this as a Stage II once is bad enough. Going through this a second time as a Stage III or IV would be devastating.

So I move forward with my anthracycline therapy, the third one to be administered tomorrow, March 31.

Fortunately I have come across one identifiable step I can take to protect my heart. Running. Endurance exercise. An oncologist I spoke to, told me that the Rocky Mountain Cancer Rehabilitation Institute in Colorado had overseen some studies on rats concerning the impact of exercise on anthracycline therapy.

I got on the internet and searched for those studies and was able find detailed abstracts. The studies show that the rats who exercised during chemotherapy had, in the short run at least, healthier hearts. In one study, the rats were forced to run on a treadmill for ten weeks before chemotherapy. Their heart function was tested four weeks after chemotherapy. The result: the rate of heart malfunction was higher in the control group made up of rats who were sedentary couch potatoes. The runners were healthier.

At least half a dozen studies were done. Some with five weeks exercise, some with five days exercise, some with a single burst of exercise before chemotherapy. The result of every study shows that the hearts of running rats showed less damage than the sedentary rats

So, finally, there is something to this process I can control. I am a runner, I can run. Pushing myself aerobically during chemotherapy is at least one way I can protect myself from damage caused by the treatment that is supposed to help me.

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