“I feel 20 years younger, doctor!” Maria’s face lit up with a big smile, and her expressive eyes became shinier. Maria is wearing a bright purple jacket and a matching hat. Her nose and cheeks are red from the cold outside. She stood up and gave me a hug, and I reflected on her journey…
Marie had been a teacher for about 20 years. As a single mom, she raised three girls and sent all of them to college. When her daughters got married and moved away, she, too, was looking for a change. Because of her insatiable curiosity (and maybe because she likes the smell of books), she decided to become a librarian.
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A while later, after a routine mammogram, Maria was diagnosed with breast cancer. Her life was forever changed. Initially, she struggled — after years of working hard, she had started to think about slowing down and enjoying a more relaxed lifestyle. But, she also realized it’s never a good time to get cancer.
Maria had surgery, followed by about five weeks of radiation. She did not need chemotherapy, which was a big relief for her. She started an anti-estrogen therapy pill, which can cut down the chance of breast cancer recurrence by more than 60 percent. For her, this meant improving her chance of seeing her granddaughters grow up. More than anything, she was relieved to be one of the 2.8 million breast cancer survivors in the country.
Maria lived a healthy life, and the diagnosis of breast cancer made her to think about her mortality and vulnerability for the first time. Any new aches and pains, which she had normally ignored, kept her awake at night. She anxiously thought about her aunt, who many years ago had breast cancer that eventually went into her bones.
Two months after she began taking the anti-estrogen therapy pills, she started experiencing severe back and joint pain. It took more than an hour for her to get moving in the morning. She was convinced the cancer was back. This is exactly what happened to her aunt.
For two weeks, she tried various over-the-counter pain medicines, but they didn’t help. When Maria came to see me next, she was in tears.
“Tell me the truth, doc. Is it back?”
Joint pain and stiffness are common side effects of ant-estrogen therapy; nearly half of women will have some form of pain, and about 20 percent of patients will discontinue the lifesaving cancer medicine due to it.
“Maria, I don’t think the cancer is back. I think it’s a side effect of the pills.”
After a long discussion, we weighed how to manage this side effect. I asked her to stop taking the anti-estrogen pill for six to eight weeks.
I then took a prescription pad and wrote: Walk for 15 minutes every day for five days, and increase that to 30 minutes in one to two weeks. She began the regimen and soon joined a local support group for a regular yoga class, too. This physical activity dramatically changed her life; her pain is completely gone, and she says she feels like a new person.
A recent prospective study that looked at 150 minutes per week of aerobic exercise and twice-a-week supervised strength training found the activity cut down the pain by 30 percent. Other breast cancer studies have shown that exercise can increase adherence to medications, plus decrease joint pain and other side effect of cancer treatment. Exercise can also cut down the chance of recurrence, improve quality of life and help with weight loss.
A study published in JAMA in 2005 showed that “physical activity after a breast cancer diagnosis may reduce the risk of death from this disease. The greatest benefit occurred in women who performed the equivalent of walking three to five hours per week at an average pace.”
If exercise was a pill, I’m sure doctors would write that prescription for the vast majority of patients. Unfortunately, lifestyle and behavior are not commonly discussed with our patients, who would benefit immensely from some changes. I’d encourage physicians to introduce this topic in conversations with patients. It may help identify easy lifestyle adjustments a patient can make, and encourage them to think differently about how their everyday decisions can have an impact on how they feel.
After adding exercise to her regimen, Maria was able to begin taking the life-saving pill again. She’s also enjoying her life — a side effect she welcomes without hesitation.
More from U.S. News
What Not to Say to a Breast Cancer Patient
A Tour of Mammographic Screenings During Your Life
Exercising After You’ve Gone Under (the Knife, That Is)
This Prescription Can Save Your Life — and It’s Free originally appeared on usnews.com
