Post-chemo exercise intervention for a sarcoma patient

Medical Q&A [Moderated]
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Hello again.
First of all, thank you for everything that you do for the community. Barbell medicine should be a golden standard of quality information regarding health and fitness and I hope you get the global recognition you deserve.

I have a question regarding my mother, but I think I should provide you the anamnesis first:

My mother (63 years old) has been diagnosed with uterine leiomyosarcoma cca.15 months ago.
Total abdominal hysterectomy along with bilateral salpingo-oophorectomy was performed, however despite the adjuvant chemotherapy with doxorubicin, the cancer had metastasized to her pleura.
A more aggressive approach was chosen and she has switched to receiving a combination of gemcitabine and docetaxel.

As a combination of both the side-effects chemotherapy and (patho)biopsychosocial factors, significant weight loss has occurred and she is often in pain (although I cannot be certain whether the pain is a downstream result of the disease itself or something else).
Since she is constantly suffering from drops in total red blood cell count, hemoglobin concentration etc., I haven’t advised her to try any type of exercise as I do not believe that that kind of additive stress would provide the hormetic response I’m looking for.

However, when she finishes her last cycle (and hopefully normalizes her blood count), I would like to devise an intervention with the intent of promoting some gains in strength, aerobic fitness, balance and improvements in psychological processing of pain.

I am a molecular biologist and, despite the fact that it seems like a good idea to me because of the above-mentioned potential benefits of exercise, I do not have access to clinical data and/or experience with working with patients.
So please, give me your opinion(s) and experiences.

Thanks again,
T.

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Hi,

I’m sorry to hear about this situation. It sounds quite challenging.

With that said, just because she is anemic does not mean that she won’t respond to an exercise stimulus. If she is up for it, I would encourage increasing her physical activity (even formalized exercise, if able) sooner rather than later.

It is difficult to give specific exercise recommendations for her without knowing more detail, but I would strongly recommend a resistance exercise intervention first, in order to maintain as much physical function as possible. She would also likely tolerate resistance exercise better than aerobic given her anemia.

There are a number of other considerations – e.g., is she neutropenic, making a crowded/public gym environment risky, or does she have docetaxel-related neuropathy issues that would present unique challenges. For these reasons, I would inquire with her oncologist about whether they have access to an exercise oncology department, as these are available at many academic centers and can help with these very issues.

But again, if I could make one specific recommendation here – it would be to start now, and to start with resistance exercise, dosed to her initial abilities and tolerance.

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