Wednesday, March 10, 2010

And for prevention?

Patient-doctor interaction of the day:

Patient (just finished chemotherapy treatment): What can I do for prevention?

Doctor: Nothing. The only thing I can tell you is to have moderate alcohol intake. There is some evidence for that.

No word on exercise and nothing on diet.

The thing is, he's a great doctor and his patients absolutely love him. I just think this reflects how doctors are being trained these days... trained to think about treating a disease rather than creating health.


  1. Do you really, truly believe that whether this woman exercises will significantly influence the odds of her cancer recurring? And how strong is the evidence for this effect, in support of this belief?

    I love exercise and eating well. I wish more people did those things. But I disagree with you here.

    Maybe this physician is being honest. And trying not to raise her/his patient's expectations too high. And trying not to stress this patient out that eating a piece of cake will make the cancer come back. Maybe this patient needs to just go and live and move on from her cancer, and make diet and exercise decisions based on her needs and overall well-being, and nothing more complex than that.

  2. Thanks for your comment and I agree with you that perhaps the MOST important role of the doctor in this situation is to reassure the patient -- to calm them, to give them hope and confidence, to help them relax and live a normal life, and to not stress about every little thing she does or eats.

    Recognizing this may be more important than any evidence out there for exercise/diet reducing recurrence.

    But at the same time, many patients look to their physician for guidance on how to improve their overall health and well-being. I saw this interaction today as a missed opportunity to encourage this patient to proactively take control of her health (which she wanted and was asking for!).

    And yes, there is evidence for diet and exercise reducing cancer recurrence - here are a couple examples:

    -"Breast Cancer and the Role of Exercise in Women"
    [A decreased risk of breast cancer death and all deaths was observed among women in the highest versus the lowest quartiles of recreational activity (MET-hr/week/year) (HR = 0.54, 95% CI = 0.36-0.79). Both moderate (0.56, 95% CI = 0.38-0.82) and vigorous intensity recreational activity (0.74, 95% CI = 0.56-0.98) decreased the risk of breast cancer death. Moderate intensity recreational activity decreased the risk of a recurrence, progression or new primary cancer (0.66, 95% CI = 0.48-0.91).]

    -"Soy Food Intake and Breast Cancer Survival"
    [Soy food intake, as measured by either soy protein or soy isoflavone intake, was inversely associated with mortality and recurrence. The hazard ratio associated with the highest quartile of soy protein intake was 0.71 (95% confidence interval [CI], 0.54-0.92) for total mortality and 0.68 (95% CI, 0.54-0.87) for recurrence compared with the lowest quartile of intake.]

  3. Walking by Stemmler today, I saw a poster for a Penn study on Yoga and Blood Pressure that was currently enrolling members. I didn't know if you knew about this. I copied the website address below.

  4. Thanks Mike! I do know about this study and have talked a bit with the PI about it -- very exciting!