Pauline Collins marked the end of a gruelling course of chemotherapy for breast cancer in October with a five-day break in a thermal spa in Austria’s Nockberge Mountains. It was a health choice for the university lecturer as well as a treat.
“The chemo had got rid of a large tumour that had spread to my liver,” explains Pauline, 45. “As therapy it was a success, but I’d never felt more ill in my life.”
After a week in hospital on intravenous antibiotics, as the chemo had almost obliterated her immune system, the mother of two who lives in London “needed a healthy break – and that’s what I got.”
A modern-day Alpine sanatorium
Das Ronacher is a ski resort hotel that doubles up as a modern-day Alpine sanatorium. It is famous for the thermal spring that trickles out of the centre of 12th-century church next door.
The warm spring water - rich in calcium, magnesium, sodium and potassium - has long attracted health pilgrims. Today’s guests are encouraged to knock back beakers of the stuff and bathe in one of five thermal pools. It is the believed that this can stabilise circulation and strengthen connective tissues, blood vessels and the immune system.
Treks through surrounding pastures, woods and mountain ridges offer nature therapy, too.
Can a stay here help people like Pauline? The spa’s medic, Dr Wolfgang Hofmeister, is cautious. “There is no evidence as such that we can help people with cancer,” he tells her.
Helping people with secondary breast cancer
Yet check out the latest science, and maybe it can offer more than we dare to think. Not least for the estimated 35,000 people who are living with secondary breast cancer in the UK.
Pauline was found to be among this number in 2017, when metastases were discovered throughout her body. She had first been diagnosed with cancer eight years previously.
It is currently incurable - though she has already benefited from two courses of chemotherapy, including breakthrough cancer drugs. Should scans show that her cancer has returned, she can have further chemo. There is also the hope that an immune-based therapy, similar to that for advanced melanoma, will become available.
“My priority,” says Pauline, “is to stave off relapse for as long as possible.” Mainstream medicine offers a “maintenance” drug such as tamoxifen.
Exercise can really help
But Swedish researchers reported in March in the journal BMC Complementary and Alternative Medicine that one in three cancer patients also turn to lifestyle change, including exercise, massage and yoga, “to improve well being and increase the body’s ability to fight cancer”.
The team behind cancerfit.me, set up by “survivors” of the illness, including breast cancer surgeon Liz O'Riordan, are confident that exercise can help in “reducing side effects and decreasing cancer-related fatigue and bringing enhanced self-esteem - and possibly reduced risk of recurrence and improved survival”.
Dr Trisha Greenhalgh, professor of primary care health sciences at Oxford University who has had primary breast cancer herself, agrees.
“As well as reducing the risk of a recurrence, exercise helps with the side-effects of treatments like chemotherapy and just helps you feel good, especially important when life gets tough,” Dr Greenhalgh said at the launch of her book The Complete Guide to Breast Cancer in April 2018.
Cancer Research UK is beginning to invest in “reliable, high-quality, scientific” studies on the matter. This includes an international clinical trial to find out if physical activity reduces the risk of bowel cancer coming back after treatment.
“We need results from well-designed trials to give reliable evidence on which doctors, therapists and patients can make informed decisions about exercise,” Dr Rachel Shaw, the charity’s research information manager, tells i.
What’s more, there’s now a model of how this might work, with the beginnings of its own evidence base.
Breast cancer advocate Jo Taylor set up the ABCD (After Breast Cancer Diagnosis) Retreat, with funding from the Government’s Big Lottery Fund. She had recognised the benefits of exercise on her own health after a diagnosis of secondary breast cancer five years ago.
Five times a year, a two-day stay-over retreat is organised on Saddleworth Moor in the Peak District. It is open to women with breast cancer and offers group activities including cycling, walking, running, yoga and massage.
Exploring the benefits of exercise
Now Emma Rodaway, a PhD student at Bradford University, has produced an exploratory study of the effects on 19 retreat participants. It showed the positive impact on the mental wellbeing and motivation to continue exercise..
“I want to stay as healthy as possible to still be here in the next 10 to 15 years,” says one participant. “I’m not daft enough to think it won’t come back, but if I can keep that period of time between now and when it does come back as long as possible, then that’s motivation for staying healthy.”
Rodaway concludes that the study should “encourage primary and secondary patients participating in physical activity groups”. And it should lead to “recommendations to NHS and cancer charities on the benefits of such interventions for breast cancer survivors”.
Mental and physical wellbeing
“Exercise is medicine,” Taylor wrote in a recent blog. “I urge healthcare professionals to encourage exercise and good nutrition for recovery from cancer and its treatments. Exercise really is a pill for both for mental and physical wellbeing”.
Of course the retreats are not intended to be therapies in themselves, in the way that months spent in Alpine sanatoriums were once seen as a cure for TB. “The idea is to motivate participants to start or continue exercising,” says Taylor.
The same message comes from Hofmeister. “My advice to everyone is to spend as much time as possible in nature,” he says. “It’s very easy for our guests but it’s important to keep it up.”