Latest news with #healthOutcomes


The Guardian
04-07-2025
- Health
- The Guardian
Is exercise really better than drugs for cancer remission? It's an appealing idea – but it's misleading
You might have seen the recent headlines on a new study on exercise and cancer recovery suggesting that 'exercise is better than a drug' in preventing cancer returning. Cue a wave of commentary pitting 'big pharma' against fitness, as if we must choose between pills and planks. It's an appealing narrative – but it's also misleading. We don't need to choose between the two. In fact, the best health outcomes often come from combining medicine with a broader view of health that includes movement, diet, social connection and mental wellbeing. Let's consider what the study, published in the New England Journal of Medicine, actually looked at. It focused on colon cancer – the third-most common cancer and second leading cause of cancer-related deaths worldwide. Between 2009 and 2024, researchers set up a randomised trial across 55 centres – mainly in Australia and Canada – where 889 patients who had had surgery for colon cancer, and who had completed chemotherapy, were split into two groups randomly. Over a three-year period, one group received a structured exercise programme (the exercise group of 445 patients) and the other received health education materials alone (the health education group of 444 patients). One thing you may already have clocked here is that the patients all received chemotherapy after their cancer surgery. So nothing about the experiment put exercise head-to-head with cancer medicines. Instead, they asked what kind of exercise support after surgery and chemotherapy treatments might improve overall health, and potentially keep the cancer from recurring. The structured exercise group received health education materials, such as an exercise guidebook for colon cancer survivors, and support from a certified personal trainer for three years. In the first six months, they received 12 mandatory in-person behavioural-support sessions, 12 mandatory supervised exercise sessions plus 12 optional supervised exercise sessions. Over the next two and a half years, the frequency of in-person and supervised sessions slowly decreased to help patients transition to more independent exercise routines. In contrast, the health education group received only general health education materials on the benefits of physical activity and a healthy diet. At a median follow-up of almost eight years, disease-free survival was significantly longer in the structured exercise group (90.3%) than in the health education group (83.2%). Both groups increased their physical activity levels over the three years, but the structured exercise group met the goal of increasing moderate to vigorous physical activity. This roughly added to their existing activity levels about an hour of brisk walking three to four times a week or a 30-minute jog three to four times a week. The better health outcomes could also be linked to the social contact that patients in the exercise group had, given they were enrolled in a structured and supervised programme with a personal trainer to support them and not left on their own. What struck me, and the authors, from their study is that knowledge alone – even among those who have had colon cancer and have been advised to exercise – isn't enough to shift activity levels. Structure, supervision and social contact matter. Being told to 'move more' is easy. Actually changing your habits – especially after cancer treatment – is hard. That transition requires coaching, encouragement, and the support and time to build confidence. We have known for a long time that a generally physically and socially healthy life can be very effective in warding off disease, even cancer. What this study actually gives us is some direction for the best way to make that happen, and a look at how positive the effects can really be. Perhaps I'm biased as a personal trainer, but structured exercise is one of the best investments you can make for your health – whether it's in recovery from cancer or trying to prevent getting cancer. This doesn't have to be one-on-one gym sessions, which can be costly and out of reach for many. It could be joining affordable boot camps in the park – that cost as much as your morning latte – or free classes in discount gym chains. Plus, you might make a few new friends and improve your social life too. The real headline isn't that exercise is better than drugs for cancer recovery. It's that just telling people to move without offering support – ie the health education movement – isn't enough. Prof Devi Sridhar is chair of global public health at the University of Edinburgh, and the author of How Not to Die (Too Soon)


Medscape
25-06-2025
- Health
- Medscape
Cancer Survivors Are Skipping the Primary Care Doctor
Fewer than half of cancer survivors visit a primary care clinician during their fifth through seventh years following their diagnosis, according to a new study published in JCO Oncology Practice . 'Primary care providers' engagement with cancer survivors is viewed as really important, not just for detection of a recurrence or a new cancer but to manage chronic diseases that are not cancer-related, like diabetes, and diseases caused or complicated by cancer treatment, like cardiovascular disease,' said Sarah Birken, PhD, associate professor at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, and an author of the study. Previous research found cancer survivors have improved health outcomes for comorbid conditions when primary care clinicians are involved in their care. The study included 516 survivors of breast, colorectal, or uterine cancer treated at the Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem. Birken and her colleagues linked cancer registry data to outpatient visits with a physician, nurse practitioner, or physician assistant working in family or internal medicine. Fewer than half (43%) of patients had one of these visits in years 5, 6, and 7 following their initial diagnosis, defined as 'sustained' engagement. Those with sustained engagement were 4.6 years older, on average, than those who did not have these visits. The odds of engaging with a primary care clinician rose by 36% for every decade older a person was at the time of cancer diagnosis. Previous Research Birken said the findings reinforce those of a 2023 study which found 40% of patients diagnosed with breast cancer reported communicating with primary care clinicians less over time. Kevin Oeffinger, MD, professor at the Duke University School of Medicine and founding director of the Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina, said he was surprised by the findings because of the research showing the importance of primary care in the follow-up of cancer survivors. 'The study highlights the need for better collaboration between primary care providers and oncologists,' Oeffinger, author of an editorial accompanying the journal article, told Medscape Medical News . A 2005 report by the Institute of Medicine recommended clinicians who coordinate oncology treatment provide patients a survivorship care plan. Despite 20 years of work since the report, 'there does not appear to be an overall improvement in the quality transition of survivors from the oncology team to the primary care team or evidence that shared care is becoming the norm,' Oeffinger and his coauthors wrote in the editorial. Going Forward Birken and her colleagues said their findings should be used to promote engagement of primary care clinicians in long-term care of these patients. However, she cited some challenges to achieving this goal. Oncologists must have connections with a large number of primary care clinicians for referrals. Primary care clinicians are also often disconnected from patient care during cancer treatments. Birken said one of the notable findings in the study younger patients were less likely to have visits with primary care clinicians. 'We know that people are being diagnosed with cancer at younger and younger ages, and so an implication of this study could be that we're setting ourselves up for things to worsen with respect to primary care engagement,' Birken said. 'Younger people tend to be less engaged in healthcare; after so many oncology visits following a cancer diagnosis, primary care my feel like yet another unwanted provider visit.' The study was supported by a grant from the National Cancer Institute's Cancer Center. Oeffinger reported being a consultant for and having stock and other ownership interests in Maia Oncology and receiving research funding from GRAIL.