REP 22: CAN PHYSIOTHERAPISTS PREVENT CANCER?
There are over 200 different types of cancer that affect Canadians of all ages. The evidence on the benefits of exercise for cancer survivors is growing. Each year, more physiotherapists are becoming interested in helping cancer survivors and are investing in learning to manage their care. However, can physiotherapists prevent cancer?
The big idea
While all the causes leading to cancer development are not known, factors such as environmental carcinogens, genetics, age, and others are implicated in disease development, and may not be affected by lifestyle modifications. Relevant to physiotherapists are thosemodifiable risk factors known to increase the risk of cancer development, such as obesity and physical inactivity. The idea that we can prevent cancer is interesting, but how does it work?
My take on things…
Before I explain my theory of how we can prevent cancer, first here is a very brief review on the theory on how cancer develops:
Cancer develops when normal cells are exposed to some type of Initiating Factor that alters the cell and causes it to proliferate and grow in an uncontrolled manner. These Initiated Cells are then exposed to Promoting Factors, which eventually develop into cancer (neoplasms). Cancer development is a complicated process that is affected by many factors, and in 2008 Rogers et al.summarized the literature demonstrating that exercise can:
- blunt some Initiating Factors
- inhibit carcinogen activation
- enhance carcinogen detoxification (i.e. body self-cleaning), and
- enhance DNA repair
Other effects of exercise include reducing chronic systemic inflammation (high levels are associated with cancer development and progression), enhancing apoptosis (cell death), boosting the immune system, and more.
Another factor being investigated in cancer prevention currently is the concept of maintaining energy balance. That is, balancing the amount of energy intake (i.e. eating high calorie/high fat foods) with low energy expenditure (i.e. sedentary lifestyle). A key theme from Roger’s review is that exercise programs need to be long-term with a minimum of 30 days to see the benefits observed in the studies.
“So, there is some evidence that exercise may prevent some cancers. What do we do with this information?”
This is where I see the role of physiotherapists. We can use our patient visits, regardless of their diagnosis, to promote exercise. That is, we should be more active in Health Promotion forPrimary Prevention. This means that, in my opinion, we should be more active in educating Canadians on healthy living (not only exercise) with the goal of preventing diseases from developing (in this case, cancer). There have been several studies (Ontario guide to health promotion and disease prevention, Canadian Public Health guides, AFMC Primer on Population Health) that sought to identify the most effective method for health promotion. However, the bottom line is that there is no one superior method. Successful methods include web pages, newspaper articles, specific education classes, and even informal education at hair salons!
“OK, I posted information on my orthopedic clinic’s web page. Do I have a greater role than a bulletin board?”
Again, I think that physiotherapists can do more than post information. First, we know a lot. We can educate our patients on the fact that that exercise and physical activity are not the same thing (a topic for a future discussion, perhaps). In order to reap the benefits of exercise, well, we need to exercise. There are no shortcuts. As we all know, maintaining long-term commitments to exercise programs is not easy. Here we can use our motivational interviewing skills. A client may say “I feel well regardless of my sedentary lifestyle.” A counselling strategy response could include something like “Diseases that can be attributed to physical inactivity develop slowly, without impairments at the beginning. Regular exercise reduces the risk of developing these diseases and improves well-being.”
Another comment we often hear is “I don’t have enough time to exercise…” This is a common challenge for our clients’, and our own, current crazy lives. Again, by taking a counselling strategy we might respond that “exercise of moderate intensity is beneficial for your health. There are opportunities to engage in these activities without taking too much time. For example, taking the stairs instead of an elevator, parking farther from your office, or getting off the bus sooner.”
More samples and the principles of motivational interviews for cancer prevention were published by Cornuz & Bize in 2006.
“Be specific, what can physiotherapists do to prevent cancer?”
Well, to be honest, I am not sure we can prevent cancer. But I do think we can help Canadians reduce the risk of developing cancer. We can educate our patients, their accompanying care givers, community programs, and whomever will listen on the benefits of exercise and healthy lifestyle. We can also lead by example, and be, as much as possible, a fit profession.
We all know people who live as healthy as possible, yet still develop cancer. We cannot promise cancer prevention, we can only reduce risk. To some degree, luck (or bad luck) seems to be part of the equation as well. There is still much to learn. What I do know, is that certain levels of exercise can reduce the risk of developing cancer and improving survival after diagnosis. Canada has adopted exercise guidelines which are freely available on line and can be used as an exercise starting point.
Even for our patients who already have a diagnosis of cancer, starting an exercise program is not too late. Exercise has been shown to have many benefits for people with cancer – but that is another discussion entirely.
The AFMC Primer on Poppulation Health is the place to start if you’re interested in learning more about health promotion and primary prevention.
Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res 2008;25(9):2097-116.
Cornuz J, Bize R. Motivating for cancer prevention. Recent Results Cancer Res 2006;168:7-21.
Rogers CJ, Colbert LH, Greiner JW, et al. Physical activity and cancer prevention : pathways and targets for intervention. Sports Med 2008;38(4):271-96. (Not open access)
Do you think physiotherapists have a role in cancer prevention? How about in Health promotion and disease prevention?
Can we bill insurance companies on preventing a condition? It would be cheaper for them in the future, but hard to prove now, and not guaranteed…
About Oren Cheifetz
Oren Cheifetz is a Clinical Specialist – Oncology, and PhD, working in front-line patient care on a Hematology/Oncology ward at Hamilton Health Sciences in Hamilton, Ontario. Oren conducts clinical-based research focusing on exercise for people with cancer, and leads an award-winning, community-based, exercise program for cancer survivors (Cancer Care Ontario Innovation Award, 2010). He is also an Associate Clinical Professor in the School of Rehabilitation Science at McMaster University. Oren was the inaugural Chair of the Oncology Division of CPA and was instrumental in the development of the Oncology Interest Group which achieved CPA Division status in 2009.
You can learn more about Oren’s activities at www.aoren.ca.