BCSC Clinical Director Interviewed in CT Post
Melinda Irwin was only 18 when she lost her mother to breast cancer. At the time, attitudes about cancer were much different than they are now. Breast cancer, in particular, was not something that one discussed openly, Irwin said.
"I remember my parents saying `Don't tell anyone about this, because you don't want to bother anyone,'" said Irwin, now 39 and an associate professor in the Yale University School of Public Health's division of Chronic Disease Epidemiology.
Cancer was scary. It was a burden. And, more alarming, it was something of a mystery. In those days, Irwin said, few people thought there was a connection between cancer and lifestyle changes. Nobody, it seemed, thought you could prevent or affect the outcome of cancer with something as seemingly simple as diet or exercise.
Today, experts see a much stronger link between cancer and the way a person lives his or her life. According to the American Cancer Society, about one third of the cancer deaths expected every year are related to nutrition, overweight or obesity, and physical inactivity. There's also been some observational research to show that exercising can decrease one's risk of death from certain cancers, including breast. But, Irwin said, "the field is very young," and a lot more study needs to be done.
To further examine the possible benefits of exercise to cancer patients, Irwin is launching two studies, both focusing on women's cancers. The first will study women who have completed treatment for ovarian cancer, and examine how adding a regimen of moderately intense aerobic exercise (such as walking) improves their quality of life. The second study will focus on breast cancer and whether regular aerobic and weight-bearing exercises will help lessen side effects associated with hormone therapies give to women recovering from the illness.
Irwin is hoping if enough evidence is established to link exercise and cancer survival, doctors will eventually offer exercise programs as part of the treatment plan for cancer, just as cardiac rehabilitation is prescribed to some heart patients.
Irwin is the principal investigator on the studies, but several others are working on it with her, including fitness coach Linda Gottlieb, of Milford. Gottlieb, a certified exercise trainer, has worked with cancer patients in the past, and has found that exercise has a significant positive effect. In her experience, patients who exercise have better self-esteem, sleep better and reap a number of other benefits.
She said she's eager to contribute to a greater understanding of how physical activity affects cancer patients. "None of us know how long we're going to be on this earth and every day is precious," Gottlieb said. Though the studies have a similar focus, the reasons for -- and details of -- the two projects are distinctly different. Irwin said she wanted to look at ovarian cancer because little to no research has been done on the impact of exercise on that cancer.
The American Cancer Society estimates that there were about 21,550 new cases of ovarian cancer diagnosed in the United States in 2009, and roughly 14,600 deaths from the disease. Though ovarian cancer is a serious health concern, it often doesn't get the attention the breast cancer does, Irwin said.
"A lot of women with ovarian cancer get frustrated because there's so much out there for women with breast cancer, and not much for those with ovarian cancer," she said.
The ovarian cancer study will look at 230 Connecticut women over a period of several years. Half of the women will be put on the exercise regimen, and the remaining participants will be used as a control group. Irwin said the exercising women will be monitored to see if adding physical activity significantly improves their quality of life following treatment. "At the minimum, we'd like to show that exercise can impact fatigue and other side effects (of treatment) in women with ovarian cancer," she said.
The breast cancer project, meanwhile, will look at 180 postmenopausal Connecticut women with breast cancer over the course of four years. Irwin said the study is specifically geared toward women taking aromatase inhibitors. Aromatase is an enzyme in the body that converts androgens, such as testosterone, into estrogen. Estrogen can help grow breast cancer tumors, so women with the cancer are sometimes put on aromatase inhibitors to block the growth of the tumors.
Those on the medication can experience certain side effects, including arthralgia, a condition that results in severe joint pain similar to arthritis. Sometimes the side effects are so bad, Irwin said, that the women stop taking the medication, putting themselves at risk.
In the study, Irwin and her team will examine whether exercising can help alleviate the side effects of hormone therapy, thus encouraging women to stay on it. Nina Marino, clinical director of the Breast Cancer Survival Center in Norwalk, was intrigued by the breast cancer wing of the study. Marino leads the survival center's three support groups, and said most of the women in the groups are on hormone therapy, and experience side effects.
The women are told that exercise is important following cancer treatment, but some just don't feel up do it.
"When people are in pain, they kind of pull in a little bit and do less," she said.
If studies like Irwin's prove that exercise can help lessen side effects, Marino said, maybe they'll fight their natural instinct to rest. "Maybe more women will integrate exercise into their lives if there's hard data," she said.