The Importance of Exercise for Cancer Survivorship With Nagashree Seetharamu, MD, MBBS

Oncology Data Advisor: Thank you, Dr. Seetharamu, for meeting with me today to talk about this important subject. Would you like to introduce yourself?

Nagashree Seetharamu, MD, MBBS: I'm Nagashree Seetharamu, a Professor in the Division of Hematology and Medical Oncology in the Department of Medicine at Hofstra Northwell Health and the System Lead for Head and Neck and Thoracic Medical Oncology, and I specialize in head and neck and thoracic malignancies.

Oncology Data Advisor: Thank you again for being here today. What we're going to talk about today is exercise and cancer. So, first question I wanted to ask you is why is exercise a crucial factor in the cancer treatment process?

Dr. Seetharamu: Exercise has many advantages to it. A lot of times, I mean, we are seeing patients have wonderful outcomes with the current diagnostics and new therapeutics, patients are living longer, but sometimes it comes with the cost of affecting their quality of life. So, on the one hand, we have the disease itself causing a lot of symptoms, and then on the other hand, we have their treatments that can cause significant side effects. Some of the more commonly reported symptoms include loss of muscle mass, fatigue, neuropathy, and inability to function or affecting quality of life. So, for all of these, exercise can be a solution, and it is a crucial factor based on several retrospective studies, as well as several prospective studies. In fact, there have been randomized studies in different types of cancer showing that having patients in a rigorous, or in a structured exercise program, can improve outcomes, can improve adherence to planned treatment, and can minimize side effects and improve survival.

Oncology Data Advisor: I know you started to touch a bit on how exercise habits affect the cancer, but if you would like to just touch on that a bit more, on how exercise habits affect an individual's cancer, and can regular exercise prevent or decrease one's likelihood of developing a cancer?

Dr. Seetharamu: Studies have shown that patients who maintain a level of active exercise and maintain an active lifestyle tend to do better in terms of how they respond to treatments and how they're able to tolerate treatments. Cancer patients are also at risk for developing other cancers or other conditions that many of us are, but particularly cancer patients, because of the types of treatments that they receive, they could be at risk for having, let's say, a cardiovascular event in the future or a pulmonary event in the future. So, being involved in an exercise program not only helps them with their current cancer diagnosis and treatment, but also in the future, by decreasing the risk of developing another cancer, for example, or developing another condition that may be an offshoot of some of the treatments that they're receiving.

Oncology Data Advisor: The next question I have for you is, is there any form of exercise that you've noticed that has a better outcome in terms of managing the cancer that you recommend patients try? And are there different forms of exercise that are better for different cancers?

Dr. Seetharamu: Each one of the types of exercises that you mentioned here has shown [improvement], but they're not being compared head-to-head, and it depends on what the patient is comfortable with. Any type of these activities would be helpful. Keeping an active level of activity and being active during treatment is something that is extremely important for many patients. I mean, you need to do it with instruction. So, kind of doing it on your own perhaps might be difficult with some of these, for example, the aerobic exercises or yoga, you need a trainer. You need to be able to tailor it to your individual needs or what you're capable of.

So, for us, what we are looking at here is individualized program for patients. Not just prescribing the same exercise for every patient, but kind of individualizing it based on what they can tolerate, what would be beneficial for them, and what might make the most meaningful impact for these patients. So, for that, I think involvement of physiatry or physical medicine and rehabilitation is important. For example, a simple example, a walking exercise may be great for patients; however, patients who have severe neuropathy may not be able to do this and they may have to do it in a very graded, careful fashion. So, just prescribing the same exercise for everyone might not be the best way, and as such, each one of these have their merits, but it has to be taken in the context of an individual patient.

Oncology Data Advisor: Going forward, to talk a bit about the recovery process, how can exercise help with the recovery process and survivorship?

Dr. Seetharamu: Yes, that's a huge thing. We are seeing more and more survivors. That's great news because we have patients surviving lung cancer—that's what I do, lung and head and neck cancers—I mean, we want them to actually thrive, not just live. So, for that reason, it is important to be active and be able to completely go back to an active lifestyle, but it may have to be a slow graded process.

The studies have shown that recovery process can be much quicker if patients are involved in an exercise program. Just taking the example of lung cancer patients, a pulmonary rehabilitation may be extremely helpful for patients to get back to an active lifestyle, get away from the support of oxygen if they have required it after surgery, and also be able to tolerate additional treatments that we sometimes recommend after surgery. That's just one example, but in general, exercise is an integral part of recovery process. Almost every patient does that to some extent, but we can always guide them and try to make it as seamless as possible. It should be a part of a prescribed plan for survivorship.

Oncology Data Advisor: Last question that I had for you is, do you have any advice for how to encourage cancer patients to exercise and maintain a regular exercise routine?

Dr. Seetharamu: Yes, the first thing is to capture where they're at, what they're actually doing. I'm not an expert by any means in giving them an instruction on a particular exercise type; however, I do have colleagues who are experts in this. So, just maintaining that multidisciplinary interaction is extremely important. I do refer a lot of my patients to PM&R, physical medicine rehabilitation, so they can make a proper assessment and advise patients. So, the first step is to assess where patients are at. The next step is to get them engaged in a discussion, and the third step is when they are motivated, I think immediately after surgery, or when they're diagnosed with something, that's the best time; it's a window of opportunities, the best timing for any type of lifestyle changes, whether it be smoking cessation or getting into a very active exercise routine. That's the best time that patients are receptive to suggestions. Using that, or utilizing that opportunity, we can make suggestions and recommendations and refer patients to appropriate experts so that they can get engaged in a particular program. We're also trying to come up with virtual programs for patients who are logistically challenged. Like an in-person exercise program might be difficult for a lot of people, but perhaps they can get engaged in a virtual program in the comforts of their home, under the guidance of somebody who can guide them through this. So, that's something that we are looking at, and those are a few things that we are doing. This is something that I'm actively capturing in my electronic medical records, as to what type of activity they're doing, and then how receptive they are to any type of suggestion, and actively making referrals to individuals who can help them.

Oncology Data Advisor: Thank you so much, Dr. Seetharamu, for your insights and your expertise on this topic.

Dr. Seetharamu: Thank you. Thanks so much for engaging me in this discussion.

About Dr. Seetharamu

Nagashree Seetharamu, MD, MBBS, is a Professor of Medicine and the System Lead for Head and Neck and Thoracic Medical Oncology at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell Health. Dr. Seetharamu's specialty and research interest revolve around head and neck and thoracic malignancies in which she maintains an active role in clinical research and bringing awareness to the topic of individualized, compassionate care for patients. She has shown a plethora of leadership when it comes to partnering with advocacy groups and oncology organizations to further guide the conversation of clinical oncology care and research internationally.

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.