Exercise should be ‘standard part of cancer care’
Professor Robert Thomas: “You can reduce the chances of cancer coming back if you continue to exercise”
All patients getting cancer treatment should be told to do two and a half hours of physical exercise every week, says a report by Macmillan Cancer Support.
Being advised to rest and take it easy after treatment is an outdated view, the charity says.
Research shows that exercise can reduce the risk of dying from cancer and minimise the side effects of treatment.
The Department of Health says local initiatives can get people moving.
Macmillan’s report, Move More, says that of the two million cancer survivors in the UK, around 1.6 million are not physically active enough.
Adult cancer patients and cancer survivors should undertake 150 minutes of moderate intensity physical activity per week, the reports says, which is what the Department of Health guidelines recommend.
In the report, the American College of Sports Medicine also recommends that exercise is safe during and after most types of cancer treatment and says survivors should avoid inactivity.
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It doesn’t need to be anything too strenuous, doing the gardening, going for a brisk walk or a swim, all count”
Macmillan Cancer Support
Getting active, the report says, can help people overcome the effects of cancer and its treatments, such as fatigue and weight gain.
“The evidence review shows that physical exercise does not increase fatigue during treatment, and can in fact boost energy after treatment.”
“It can also lower their chances of getting heart disease and osteoporosis.
“Also, doing recommended levels of physical activity may reduce the chance of dying from the disease. It may also help reduce the risk of the cancer coming back.”
Previous research shows that exercising to the recommended levels can reduce the risk of breast cancer recurring by 40%. For prostate cancer the risk of dying from the disease is reduced by up to 30%.
Bowel cancer patients’ risk of dying from the disease can be cut by around 50% by doing around six hours of moderate physical activity a week.
Ciaran Devane, chief executive of Macmillan Cancer Support, said physical activity was very important to the survival and recovery process.
“Cancer patients would be shocked if they knew just how much of a benefit physical activity could have on their recovery and long term health, in some cases reducing their chances of having to go through the gruelling ordeal of treatment all over again.
“It doesn’t need to be anything too strenuous, doing the gardening, going for a brisk walk or a swim, all count.”
Traditionally cancer patients were told to rest after their cancer treatment, but the report says this approach could put cancer patients at risk.
Jane Maher, chief medical officer of Macmillan Cancer Support and a leading clinical oncologist said: “The advice that I would have previously given to one of my patients would have been to ‘take it easy’.
“This has now changed significantly because of the recognition that if physical exercise were a drug, it would be hitting the headlines.”
Martin Ledwick, head information nurse at Cancer Research UK, was a little more cautious.
“Anything that improves wellbeing and reduces treatment side effects for cancer survivors has to be a good thing.
“But the evidence that exercise has a bearing on survival is not conclusive. It is important to remember that no two cancer patients are the same, so rehabilitation programmes that include physical activity will need to be tailored to the individual.”
A spokesperson from the Department of Health said it was vital that people with cancer are given the support to lead an active life.
“Physical activity and a healthy lifestyle can impact very positively on cancer outcomes and, as part of the National Cancer Survivorship Initiative, we are working with Macmillan to integrate physical activity services into cancer care pilot sites.
“Locally led initiatives such as Let’s Get Moving are also well placed to signpost cancer patients to community-based physical activity opportunities.”
Breast Cancer Patient Denied Treatment Because He’s a Man
When 26-year-old Raymond Johnson checked himself into the emergency room last month for a throbbing pain in his chest, the diagnosis shocked him. He had breast cancer. What came after that was an equally traumatizing blow. He was denied the Medicaid program that covers breast cancer treatment — because he’s a man.
In order to qualify for the breast cancer program (the Breast and Cervical Cancer Prevention and Treatment Act of 2000), one must meet a litany of eligibility requirements — all of which Johnson met, save for one. See, in order to receive the coverage, one’s cancer must be diagnosed by an “early detection” program funded by the Centers for Disease Control and Prevention. In South Carolina, where Raymond lives, this screening program is only offered to women between the ages of 47 and 64. In other words, since men don’t qualify for the early screening program, they’re not covered by the cancer treatment act.
Does anyone else see a problem with this system?
Actually, yes. The state Medicaid agency agrees. The department called the federal policy “discriminatory” and for at least the second time in two years is calling on the Centers for Medicare & Medicaid Services to change it. They said in a statement:
We are again urging CMS to reconsider. It’s a very clear example of how overly rigid federal regulations don’t serve the interests of the people we’re supposed to be helping.
I lost someone very near and dear to me to this awful disease, so my heart aches a little harder when I hear about someone diagnosed with it. But when I hear of people who can’t get proper treatment or coverage, my blood boils. My mother’s battle with cancer wasn’t a long one — and it certainly wasn’t a pretty one — but there was never a time when coverage or money was an issue for her and our family. She had good insurance, so we were always comfortable with the care she was receiving. That should be the case for everyone in this country.
In addition to the emotional and physical pain Raymond is going to experience while battling this disease (not to mention, most likely, a small sense of embarrassment for being diagnosed with a “female disease”), he’s going to have to deal with financial troubles as well. It’s going to be an non-stop uphill red tape battle for him all because he was born a man.
I am fully aware that breast cancer is predominantly a “woman’s disease,” but the fact is, 2,140 men are diagnosed with it each year. They should be covered as well, because, as Raymond himself eloquently put it, “Cancer doesn’t discriminate, so this program shouldn’t discriminate.”
Drugs’ scarcity strains care: Cancer patients may be affected
Shortages of drugs used to treat everything from leukemia to black widow spider bites are putting patients at risk — nationally and more recently in El Paso. And there appears to be no long-term solution in sight.
“We are facing an unprecedented shortage of critical medications used to treat a wide range of illnesses — from cancer to cystic fibrosis to cardiac arrest — that is causing significant risks to patient safety,” said U.S. Sen. Amy Klobuchar, D-Minn., who has proposed legislation intended as a first step in dealing with the issue. “Given the scope of the problem, it’s clear we need a coordinated strategy to root out the causes of these drug shortages and prevent them before they happen.”
Although drug shortages have been a problem since the 1990s, the scarcity of cancer treatment drugs has worsened in the last year, said Dr. Zeina Nahleh, chief of the Division of Hematology-Oncology in the Texas Tech Paul L. Foster School of Medicine’s Department of Internal Medicine. The only good news is that, so far, neither Nahleh nor Robert Reilly, University Medical Center associate pharmacy director, are aware of harm to patients in the El Paso area.
“We have been somewhat sheltered compared to the rest of the country,” said Reilly, a doctor of pharmacy. Larger cancer treatment centers were the first to feel the pinch, he said.
During the last six years, according to the U.S. Food and Drug Administration, the number of drug shortages nationally nearly tripled, jumping from 61 in 2005 to 178 in 2010. That includes cancer treatment drugs, anesthetics, antimicrobials and pain medications, but not products such as vaccines that are made from biological materials. A list maintained by the American Society of Health-System Pharmacists — which includes the biological drugs — earlier this week identified 193 shortages.
“We are on high alert now because we always have to look at the inventory and the drug list. It’s been really nerve-racking,” Nahleh said. “We’re trying to shield the patients, (but) we came very close to delaying treatment on a patient with leukemia. Somehow, we have been able to obtain the drug on time. … You cannot delay treatment for serious diseases like leukemia.”
Doctors are forced to make decisions about which patients are in the greatest need of the drugs available. And even when an alternative drug is identified, it can interact with other drugs, create more severe side effects and be less effective.
With first choices, “the cure rate is significantly improved,” Reilly said.
Many reasons for the shortages are cited, including manufacturing problems, distribution disruptions, difficulties obtaining raw materials, regulation issues and even natural disasters. But those tend to be temporary. Longer-lasting shortages often are related to drug manufacturers’ business decisions to discontinue or cut back production.
“One can’t help notice that generic (cancer treatment) drugs with their lower profit margins are particularly affected by the shortage,” Nahleh said.
When asked for comment, the Pharmaceutical Research and Manufacturers of America emailed a statement released last month. The organization represents many of the largest pharmaceutical drug companies, but not generic drug manufacturers.
“Our companies are deeply concerned with patients’ well-being and their ability to get needed prescription medications,” the statement says. “Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders — including innovative biopharmaceutical research companies and generic manufacturers, whose products accounted for 78 percent of prescriptions filled last year.
“(I)n order to provide patients with uninterrupted access to medicines, it is important for all of us who provide life-saving medications to work collaboratively to minimize unexpected disruptions in the supply.”
An American Hospital Association survey of 820 hospitals nationwide, including some in Texas, revealed that nearly all had reported at least one shortage in the last six months and nearly half had 21 or more shortages. During that time, 82 percent had delayed treatment and more than half were not consistently able to provide recommended treatments, according to the study, which was released in July. Sixty-nine percent reported being forced to give patients a less-effective drug.
Nearly half reported experiencing shortages daily. And 35 percent reported that patients were experiencing “adverse outcomes.”
“Overall, the whole situation is stressful,” Reilly said. “We spend 20 or 30 hours a week trying to manage this situation.”
According to the hospital association, “labor costs associated with managing shortages translates to an estimated annual impact of $216 million nationally.”
And alternative drugs, which usually are not purchased in large quantities, can be more expensive, Reilly said.
Texas Tech staff members have been successful in avoiding bad outcomes by maintaining regular communication with other physicians in the area, Nahleh said.
“We share and borrow drugs,” Nahleh said. And “we are not preparing ahead of time so we don’t waste the drugs.”
Nahleh also credits the University Medical Center pharmacy.
“They should be praised with their good communication as to whether drugs will be back-ordered or in short supply,” Nahleh said. “If shortages hit you without any time to prepare, that would be the worst, worst situation.”
Notification from manufacturers has been a problem, Reilly said.
“A lot of times, we don’t find out about these shortages until we order the product,” he said. “That’s just not acceptable.”
Drug manufacturers are not legally required to report problems that could lead to shortages. Companies that are sole-source providers of drugs considered “medically necessary” — when no substitutes exist and they are part of life-saving therapies — must report to the FDA six months before they discontinue such a drug. However, there is no legal penalty for failure to comply.
The bill sponsored by Klobuchar and Robert Casey, D-Pa., would change that.
In most cases, the manufacturer would be required to notify the Secretary of Health and Human Services at least six months prior to the discontinuance or planned interruption of any pharmaceutical drug. It requires the secretary to establish fines for noncompliance.
“Physicians, pharmacists and patients are currently among the last to know when an essential drug will no longer be available. That’s not right,” Klobuchar said in an email. “This common-sense solution will help set up an early-warning system so pharmacists and physicians can prepare in advance and ensure that patients continue to receive the best care possible.”
A letter from the hospital association and other professional medical associations supporting the bill says it would give the FDA “tools to better manage — and hopefully prevent — shortages of life-saving medications.” It would make it easier for the FDA to monitor drugs that might soon be in short supply and to work with drug manufacturers to “establish contingency plans for manufacturing interruptions.”
Klobuchar’s bill was introduced in February. On Friday, it still was sitting in a Senate committee. If it passes, then it would be a first step, experts say.
One industry association has concerns that the bill would create “unintended consequences.”
“These concerns range from the potential release or sharing of proprietary information to competitors to the six-month notification requirement,” says the Generic Pharmaceutical Association in a recent press release.
The association recommended some solutions, including an expediting of approval for raw material suppliers that can step in when needed, removing regulatory barriers and expediting approval of changes to manufacturing lines and construction of new facilities, creating financial incentives such as tax credits, building government stockpiles of pharmaceutical ingredients and raw materials, and improving communication between the FDA’s enforcement arm and its drug shortage staff.
Reilly suggested that when a company owns a patent but is not producing the drug, other companies should be allowed to step in. Nahleh said measures could include “extending the expiration dates of drugs if appropriate and safe” and “expediting the approval of (new) drugs.”
“I believe one should focus on treating their patients and not scrambling to find the right drug,” Nahleh said.