MONDAY,NOVEMBER25,2019 | THE GLOBE AND MAIL O A
LIFE&ARTS HEALTH&WELLNESS| OPINION| PUZZLES | WEATHER
NEWS |P
arents and siblings of chil-
dren with cancer can strug-
gle with anxiety, stress and
other mental-health issues long
after the initial cancer diagnosis,
according to a new study that
found elevated rates of mental
health-related doctor’s visits
among family members up to 20
years later.
The study, published earlier
this month in the Journal of Clin-
ical Oncology, examined health
data for 4,773 mothers and 7,
siblings of children diagnosed
with cancer between 1998 and
2014 in Ontario.
It found mothers of children
diagnosed with cancer had a 40
per cent higher rate of mental
health-related outpatient visits,
compared with the general pop-
ulation. Siblings had a 10 per cent
higher rate of these visits to their
family doctors or psychiatrists.
Moreover, these elevated rates
persisted up to 20 years after the
child was diagnosed with cancer.
(The researchers were not able to
extract data for fathers.)
“You go through a childhood
cancer diagnosis in your family,
and, of course, that’s going to af-
fect your mental health. What
was a little bit surprising to us is
that the increased rate was seen
quite a long time after the origi-
nal diagnosis,” said senior author
and oncologist Sumit Gupta, an
associate scientist at the Hospital
for Sick Children in Toronto and
adjunct scientist at the non-prof-
it Institute for Clinical Evaluative
Sciences.
“Given these results, it does
make you wonder, well, how are
the fathers doing as well?” he
said.
The findings suggest there is a
need to ensure family members
of pediatric cancer patients have
access to mental-health re-
sources over the long-term, said
Gupta, who is also an associate
professor in the department of
pediatrics at the University of To-
ronto. Even though some hospi-
tals currently offer support to
families, he said, these family
members’ contact with the hos-
pitals tend to dwindle after their
child’s treatment ends.
Gupta added there is also a
need to research ways to inter-
vene while the child is still receiv-
ing treatment, or shortly after
treatment, to lower family mem-
bers’ risk of experiencing mental-
health issues later on.
The study, co-led by SickKids
and ICES, used hospital data and
birth records to identify the
mothers and siblings of children
diagnosed with cancer. The re-
searchers then examined the
number of outpatient visits – that
is, visits to a psychiatrist or a fam-
ily doctor for mental-health rea-
sons – made after a child’s diag-
nosis by their mothers and sib-
lings, compared with visits by
corresponding controls from the
general population. They also
looked at the numbers of “severe
psychiatric events,” defined as
psychiatric emergency depart-
ment visits, psychiatric hospital-
izations and suicide.
The researchers found moth-
ers and siblings did not have
higher rates of severe psychiatric
events. However, mothers had
more mental-health outpatient
visits, compared with the con-
trols, at an elevated rate that re-
mained constant over time (1,
visits for every 1,000 person-
years, versus 766 visits among
controls). In siblings, the rates of
these visits surpassed those of
the controls, starting around 15
years after diagnosis (104 visits
for every 1,000 person-years, ver-
sus 95). More than half of the out-
patient visits by mothers and sib-
lings were for anxiety disorders.
At the Montreal Children’s
Hospital, pediatric psychiatrist
Cécile Rousseau, who was not in-
volved in the study, said eventhough siblings may not fully un-
derstand the situation, they can
sense their parents’ anxiety, and
this anxiety can be contagious.
She encourages parents to give
their children validation, by ac-
knowledging that they are wor-
ried, that it’s not their children’s
fault and that they love them.
“Telling kids, ‘no, no, every-
thing is okay,’ a lot of parents in
cancer situations do that, and I
think this is very distressful be-
cause the kids know that some-
thing is not okay,” Rousseau said.
“They feel it viscerally all the
time, and they become distressed
because of it.”
For Antonia Palmer, a mother
of three in Mississauga, the
study’s findings provide reassu-
rance that she is not alone in con-
tinuing to struggle with her men-
tal health, even though her child
finished his cancer treatment
years ago.
Palmer’s eldest son, Nate Hud-
son, 12, was diagnosed at age 2
with stage 4, high-risk neuroblas-
toma, a solid tumour cancer. For
five years, he underwent inten-
sive, complex and painful treat-
ments that saved his life, but
have left him with long-term ef-
fects, including profound hearing
loss.
Palmer said throughout his
treatment, she tried to put on a
brave face and often hid her fears,
anger and frustration from her
family.
“Once treatment ends, you
have to deal with all those emo-
tions. They all come back ... in
this huge flood,” she said, recall-
ing she collapsed on the kitchen
floor one day, crying and feeling
powerless and overwhelmed.
Palmer said her husband,
Aaron Hudson, experienced anx-
iety as well, and while their
younger sons, Alex, 10, and
Jonathan, 7, have developed a
strong sense of empathy, they
also experienced a lot of stress.
“I still have days that I struggle
to get through,” Palmer said.
“Even when treatment is done,
it’s never gone. It’s never fin-
ished. You don’t close the chapter
on pediatric cancer.”AntoniaPalmer,amotherofthreeinMississauga,continuestostrugglewithhermentalhealthafterherson,
Nate,12,wasdiagnosedwithstage4neuroblastomaattheageof2.FREDLUM/THEGLOBEANDMAIL
Pediatriccancercanaffect
long-termmentalhealth
ofpatients’families:study
Althoughsome
hospitalsoffersupport
tofamilymembers,it
oftentapersoffafterthe
child’streatmentends
WENCYLEUNGHEALTHREPORTER
T
o understand why a new study from researchers at
McMaster University’s NeuroFitLab is making
waves,it helps to look back at one of its previous
findings.
In 2017, a team led by the lab’s director, Jennifer Heisz,
published a five-year study of more than 1,600 adults older
than 65 that concluded that genetics and exercise habits
contribute roughly equally to the risk of eventually devel-
oping dementia. Only one of those two factors is under your
control, so researchers around the world have been striving
to pin down exactly what sort of workout routine will best
nourish your neurons.
Heisz’s latest study, published last month in the journal
Applied Physiology, Nutrition, and Metabolism, offers a ten-
tative answer to this much-debated question.
Older adults who sweated through 12 weeks of high-in-
tensity interval training improved their performance on a
memory test by 30 per cent compared with those who did a
more moderate exercise routine.
But the real significance of the findings may have less to
do with the specific details of the workout routine than with
the fact that even subjects as old as 88 were able to stick with
a challenging exercise routine and improve their memory.
Because in the quest for brain health, as in the parallel quest
for physical health, the real challenge is finding ways of mak-
ing exercise accessible and sustainable.
The new study involved 64 sedentary adults older than 60
who were divided into three groups that each met three
times a week for 12 weeks. Before and after the training peri-
od, their physical fitness and cognitive performance were
assessed.
The interval group warmed
up and then did four-minute
bouts of hard treadmill walk-
ing at 90 per cent to 95 per cent
of their maximum heart rate,
repeated four times, with three
minutes of easy walking for re-
covery.
The moderate exercise
group walked at 70 per cent to
75 per cent of max heart rate
for 47 minutes, which burned
the same total number of calo-
ries as the interval group. The
control group, meanwhile, did
30 minutes of relaxed stretch-
ing.
Perhaps the most worrying observation was that many
people in the control group showed measurable declines in
both physical fitness and memory. Staying active isn’t just
about boosting your performance; it’s necessary just to keep
what you’ve got.
And while the headline result was that the interval group
did better, Heisz points out that previous work by her group
and others has found that more moderate exercise can also
help, albeit over a longer time frame. Adding intensity –
“this can be as simple as adding hills to [a] daily walk or
picking up the pace between light posts,” she says – just
speeds things up.
In fact, when you zoom out to survey the larger body of
literature in this area, the picture gets even murkier.
Yes, both moderate and intense aerobic exercises such as
walking or running seem to work. But so does resistance
training, as do “gross motor skills” exercises that engage
your brain as well as your body, such as yoga or ball games or
simply walking in a rich and unpredictable outdoor envi-
ronment rather than on a treadmill.
Louis Bherer, a researcher who studies exercise and brain
health at the University of Montreal, points to a recent re-
port by the Global Council on Brain Health, which concludes
that there simply isn’t enough evidence yet to pinpoint a
“best” form of exercise for warding off cognitive decline.
With that in mind, Bherer suggests aiming for a mix of
different types of exercise – and, more important, finding
something you enjoy. “The name of the game is to sustain
it,” he says. “As soon as you stop, you start losing the bene-
fits.”
In Heisz’s study, the most consistent feedback was how
much subjects liked the social aspects of group training. The
ingredients of an enjoyable exercise routine might be differ-
ent for you, but figuring that out is probably more important
than fretting over your heart rate zone.
“The positive message from this study,” Heisz says, “is
that it is never too late to start.”Alex Hutchinson is the author ofEndure: Mind, Body, and the
Curiously Elastic Limits of Human Performance. Follow him on
Twitter @sweatscience.Therightworkout
routinecouldhelp
fightdementia,
researchsuggests
ALEX
HUTCHINSONOPINIONThenewstudy
involved64sedentary
adultsolderthan
whoweredividedinto
threegroupsthateach
metthreetimesa
weekfor12weeks.
Beforeandafterthe
trainingperiod,their
physicalfitnessand
cognitiveperformance
wereassessed.JOCKOLOGYW
hile companies are pro-
moting e-cigarettes to
young Canadians, re-
searchers do not yet know how
nicotine delivered by these vap-
ing devices affects teenagers’
brains.
“We don’t really know very
much at all with respect to [nico-
tine’s impact on] human adoles-
cents,” said Laurie Zawertailo, se-
nior scientist with the Nicotine
Dependence Service at Toronto’s
Centre for Addiction and Mental
Health.
The vast majority of studies on
the effects of the drug on devel-
oping adolescent brains have
been on laboratory rodents, she
said. Some of those studies have
suggested rats may be more re-
sponsive to nicotine during ado-
lescence, but these findings do
not necessarily translate to hu-
mans.
In human studies, teens who
smoke have been found to be
more likely than non-smokers to
be impulsive and take risks, and
are heavily influenced by their
peers, Zawertailo said. Imaging
studies on humans have also
shown some differences in brain
structure and brain activity be-
tween adolescent and youngadult smokers and their non-
smoking counterparts.
But scientists do not know
whether any of these are pre-ex-
isting differences, or the effects
of nicotine exposure. Moreover,
the brains of teenage smokers do
not appear very different from
those of adult smokers, she said.
So while nicotine certainly
stimulates the brain’s reward sys-
tem, it’s unknown whether it af-
fects brain development, she
said.
The way in which people ad-
minister or consume a drug has
an impact on how addictive the
drug may be, Zawertailo said.
While there is the potential for e-cigarettes to become habit-form-
ing, “by far, smoking is the most
addictive,” she said. “That’s the
way that nicotine can get to the
brain the fastest and with the
highest peak.”
Even so, she emphasized the
purpose of e-cigarettes is to help
smokers stop smoking tobacco.
“If you don’t smoke cigarettes,
you shouldn’t vape,” she said.
Although researchers still
have many unanswered ques-
tions, neuroscientist Huib Mans-
velder, head of the department
of neurophysiology at Vrije Uni-
versiteit in Amsterdam said he
worries that e-cigarette compa-
nies are targeting teens with vari-ous sweet flavours and colourful
packaging.
Over the past two decades, his
own research on lab animals has
convinced him e-cigarettes
should be treated as a controlled
medicine, available through
pharmacies or doctors and kept
far away from teens who have
never been exposed to nicotine.
Even then, he said he believes
they should only be used as a last
resort for long-term smokers,
who have tried counselling, med-
icine and nicotine patches or
gum.
“That would be the only use of
e-cigarettes that I can think of
that would make sense,” he said.Scientistsstilldon’tknowhownicotineaffectsteenagers’developingbrain
WENCYLEUNGHEALTHREPORTER