Sports Medicine: Just the Facts

CHAPTER 102 • CANCER AND THE ATHLETE 599

• Ninety percent of rhabdomyosarcomas occur before
  the age of 20 and usually present as an enlarging
  mass.


• Multiple myeloma needs to remain in the differen-
  tial in anyone presenting with back pain, particu-
  larly if they are over 50. It can also present as chest
  pain. The pain usually does not occur at night. It is
  induced by movement it is easily confused with
  mechanical back pain. Diagnosis is made by the
  presence of Bence-Jones protein in the urine.

EXERCISE PRESCRIPTION

• No specific guidelines exist for exercise prescription
  in patients with cancer. The approach to starting an
  exercise regimen should be multidisciplinary,
  involving physicians, physical therapists, nutrition-
  ists, and other local rehabilitation resources. Each
  program must be designed individually, based on
  clinical status, complications, and risk factors for
  exercise.
  •Patients undergoing chemotherapy, radiation, and hor-
  mone therapy for cancer have very different compli-
  cations (Table 102-1). Side effects of the agents used
  in treatment should be understood before a patient is
  given clearance for exercise.
  
  
  • Cancer treatment may cause osteoporosis and bony
    metastasis may weaken bone leading to a higher risk
    for pathologic fracture. In patients with osteoporo-
    sis, vigorous, open-chained activity should be
    avoided. Instead, alternatives such as biking, swim-
    ming, water aerobics, or stair climber should be con-
    sidered. Bone-density testing is helpful in guiding
  
  
  
  

exercise choice. Bisphosphonates should be consid-

ered in osteoporotic patients.

•Fatigue is a common side effect of both cancer and

its treatment. A search for other etiologies such as

anemia, secondary malignancy, electrolyte imbal-

ance, dehydration, and improper nutrition (catabolic

state) should be undertaken and corrected if possi-

ble. Exercise has many positive effects in patients

receiving chemotherapy. A low to moderate inten-

sity aerobic exercise regimen can reduce fatigue

associated with chemotherapy. Schwartz et al.

enrolled 72 newly diagnosed patients with breast

cancer and recorded daily levels of fatigue as they

followed a moderate intensity exercise regimen.

Results showed a significantly reduced fatigue level

and improved functional ability over an 8-week

exercise program (Schwartz et al, 2001).

• Cardiac complications may be a side effect of some
  chemotherapeutic agents, particularly the anthracy-
  clines. These put patients at high risk for cardiac
  arrhythmia, cardiomyopahty, heart failure, and
  coronary vasospasm. Exercise stress testing may
  need to be performed prior to any exercise pre-
  scription in this subset of patients.

EXERCISE AND IMMUNE FUNCTION

• Macrophages, natural killer cells, and polymorphonu-
  clear neutrophils are the first line of defense against
  cancer. It is unclear what effects exercise can have on
  the function of these cells. The “inverted-U” hypothe-
  sis suggests there is an optimal level of physical activ-
  ity that results in enhanced immune function and
  protection from the development of cancer. The two
  ends of the “U” represent sedentary people on the one
  end and those who engage in chronic, intense, and
  exhaustive exercise on the other end. Both of these
  groups may have an increased susceptibility to cancer
  compared to moderately physically active persons
  (Woods et al, 1999).


• Studies examining the effect of immune function
  during cancer treatment have mixed results.
  
  
  • In a study examining children with acute lympho-
    cytic leukemia, there were nonsignificant decreases
    in T-cells (Shore and Shepard, 1999).
  
  
  • Another study looking at participation in an exercise
    program after peripheral blood stem cell transplan-
    tation found that exercise did not facilitate or delay
    immune cell recovery (Hayes et al, 2003).
  
  
  
  


• Three of four studies measuring immune function
  status in cancer survivors reported significant
  improvements in immune function status as a result of
  exercise (Fairey et al, 2002).

TABLE 102-1 Common Side Effects
of Chemotherapy/Radiation

Dehydration
Catabolic state
Electrolyte imbalance
Anemia
Thrombocytopenia
Secondary malignancy
Cardiomyopathy
Arrhythmia
Congestive heart failure
Coronary artery vasospasm
Pulmonary fibrosis
Diarrhea/vomiting
Immunosuppression
Osteoporosis
Radiation necrosis (CNS, GI tract, Respiratory)
Neuropathy

ABBREVIATION: CNS =central nervous system; GI tract =
gastrointestinal tract.