Week 4: #RunningWithCancer
Updated: May 2, 2020
10k run in Wanstead Park, 10th April, 2020
From the outset I always planned to write a blog post on keeping up with my running during cancer, and I had in the back of my head that I would prove everyone wrong and that this was totally doable right up until the very end of my treatment, and I would be showing myself what fortitude I had etc. What guff!! From before the chemoradiation therapy even started, I quickly realised from the moment my gastrostomy took place, I had lost complete control of what was possible when treating my illness.
But then, thinking about the bigger picture, although I was diagnosed with cancer only on February 12th (my birthday!), in all likelihood I’ve actually been running with cancer for months beforehand. So although #RunningWithCancer gives a neat hashtag to write around, it is not the real issue; it’s running with the ongoing chemoradiation treatment that poses the greatest challenges. An obvious point, but one that I had forgotten. So I’m still trying to develop a new partnership with my body that finds a way to work with cancer treatment, not despite it.
Some of you will know that in January 2020 I raised money via Red January for the charity Mind, with a pledge to run at least 5km every day for a month. With my addictive personality, I quickly got hooked to daily running. In January, I ran 273 km, and then, in February, I ran 296 km. I think I had planned, in the back of my head, that I would continue with this forever more. I’ve been inspired by other LGBTQ+ runners on Instagram, many running and campaigning for better mental health, and one guy I know has a continuous running streak of almost 2000 days!!! So when March came and I had the PEG tube fitted, this was the first time I had to curtail what running I could do. Thankfully, on the day of the operation, I also found out that the minimum for a running streak was 1 mile, so even when I’ve been in the most pain, or most nauseous, I’ve always managed to go out for at least a 1 mile walk, which I take as a very slow run indeed 😉
My investigations over the past few days on the benefits of exercise and cancer have actually blown me away – there’s a rapidly growing discipline called exercise-oncology, that, when first developed in the late 1980s by two oncology nurses, went against the conventional wisdom, which was to rest and avoid strenuous exercise during breast cancer treatment.
tl:dr Bursts of intense exercise, such as running or weight- and resistance band- training, have been shown to reverse mental and physical deterioration in cancer patients, and even to the slow and reduce tumour growth directly.
So grab a glass of wine and an Easter egg (hey, it's the holidays), and find out how exercise really is a positive force for good for people undergoing treatment for cancer. And think of me while eating said Egg, as I can no longer now eat chocolate 😭
It is pretty much accepted that being in good physical shape leads to better health outcomes as one gets older. This is true of the risks of developing cancer, where excess weight and a sedentary lifestyle cause 25% of cancers worldwide. In recent years, meta-studies (where different studies are combined to include greater numbers of people for potentially more statistically robust results) show that the more leisure-time, physical activity one does, the lower the risk of developing many cancers. In a study of 1.44 million adults, lower risks of developing cancer were found for 13 out of 26 cancers investigated. Interestingly, this was independent of one’s smoking history or body size (BMI). Moreover, the risk of disease recurrence in breast, colon and prostate cancer, was also reduced by increased leisure-time physical activity.
What I found most exciting however, is that exercise can itself impact tumour growth, regardless of specific diagnoses, and ultimately, exercise may itself play a role in clinical outcomes. So people with cancer should not just exercise for better health, but to:
regulate cancer progression
ameliorate the adverse events associated with cancer
The cartoon below shows the exercise benefits of all stages cancer management, from initial tumour detection, to prevention of cancer recurring. Exercise plays an important role in preventing cancer, in reducing tumour size, in aiding the efficacy of cancer treatments, and ameliorating the impact long-term side effects.
This is where I’ve really become interested in finding out how this may relate to my own diagnoses and potential for an improved outcome. Studies have shown that exercise can reduce toxicity associated with chemotherapy, and improve treatment completion rates. This is obviously completely anecdotal and I’m an n=1, but my blood count levels have actually improved since I started weekly chemotherapy. In the charts below, the first bar in the paler colour are my blood counts before I started chemotherapy! Moreover, apart from the first evening after the first treatment, I have not suffered any nausea at all. Of course, this is in part due to the antiemetics I take when receiving the Cisplatin, but maybe my fitness plays a role as well, such that even after 4 treatments, I hold no dread of going in for a fifth treatment; to be honest I quite liked the peace and quiet of just lying on the chair on the 7th floor in Barts, watching the world go by for 3-4 hours.
However, there are a few caveats here, in that the number of intervention studies done in relation to cancer and exercise have mainly been done on women with early-stage breast cancer (over 300 intervention studies out of approximately 700 (covering 50,000 cancer patients), with probably less than 10 studies done on those who have Head and Neck cancer, with even fewer studies just looking at radiation therapy treatments. And most research undertaken on how exercise impacts people with cancer is done at the rehabilitation stage.
However, such is the shift towards the field of exercise oncology, that, increasingly, patients are recommended to do regular weight- and resistance- band training during treatment to prevent muscle loss, alongside cardiovascular exercises such as running. Bursts of intense exercise have been shown to reduce breast cancer cell viability by up to 10-15%. So having several bouts of exercise in any one week may significantly inhibit tumour growth. An exciting candidate of compounds here are the exercise-dependent myokines, a group of over 20 compounds including interleukin-6, known to slow tumour growth in mice and direct natural killer cells to the tumours - see figure below. But exercise has multiple effects which can help with recovery from cancer.
Exercise activates natural killer cells (purple) and helps to them to home to tumours (yellow)
As part of my chemoradiation therapy, I’ve now finished 4 out of 7 weeks. Yay. And in that time I’ve managed 3 proper runs (one 5k, and two 10ks), the latest on Friday the day after chemotherapy.
But running for me now poses a new dilemma. After last week’s post on mucositis, and my general health check on Tuesday for nutrition, pain management and blood counts, I need to ensure that I eat over 2,600 calories per day. This is harder than it sounds as there are swathes of foods I can no longer eat (too spicy, too acid, not soft enough).
And now because of the radiation therapy, almost every mouthful of food I have causes pain, so every meal now really is quite traumatic and takes about an hour to eat. But every 10k run means having to eat an extra 750 calories to make up the deficit, which I'm finding that really hard to do.
So, finding out that weight training has also been shown to be an effective treatment for when having cancer, I’ve set up a home gym routine with new gymnastic rings, kettlebells, medicine balls etc that I managed to buy just as lockdown started! So as long as I keep up a minimum of 1 mile per day walking / running, I’m really happy now that there are good medical reasons for doing resistance training to complement my #runningwithcancer.