Quick Study: Chemotherapy fatigue, prostate cancer surgery

Exercise may reduce chemo-related fatigue.

THE QUESTION Fatigue is a frequent complaint of people getting chemotherapy for cancer. Might exercise change that?

THIS STUDY involved 269 adults (average age, 47) who, as a group, had 21 cancer diagnoses; all were undergoing chemotherapy. All got standard medical care for cancer; some were assigned to supplement that care with nine hours of supervised exercise. The exercise included high-intensity cardiovascular and resistance training and low-intensity relaxation and body awareness techniques; massages also were given. After six weeks, people in the exercise group reported less fatigue and greater vitality and emotional well-being than the non-exercisers. They also were found to have improved aerobic capacity, muscular strength and overall physical functioning.

WHO MAY BE AFFECTED? People being treated for cancer with chemotherapy, which uses drugs to kill cancer cells. But the drugs' effect on healthy cells produces a range of side effects, including fatigue. The disease itself also can make people feel unusually tired.

CAVEATS No one with cancer should begin an exercise regimen without first consulting with a doctor. If approval is given, supervision might be suggested; for safety, study participants were closely monitored during all exercise. Exercise regimens that differ from that used in the study might yield different results. Some data came from the participants' responses on questionnaires. Though fatigue was lessened, it remained greater, on average, than in the general population.

FIND THIS STUDY Oct. 13 online issue of BMJ.

LEARN MORE ABOUT chemotherapy at http://www.cancer.gov and http://www.cancer.org.


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Well: Overweight Patients Face Bias

Stuart Bradford

Are doctors nicer to patients who aren’t fat?

A provocative new study suggests that they are — that thin patients are treated with more warmth and empathy than those who are overweight or obese.

For the study, published in the medical journal Obesity, researchers at Johns Hopkins obtained permission to record discussions between 39 primary care doctors and more than 200 patients who had high blood pressure.

The Well ColumnTara Parker-Pope on living well.

Although patients were there to talk about blood pressure, not weight, most fell into the overweight or obese category. Only 28 were of normal weight, meaning they had a body mass index below 25. Of the remaining patients, 120 were obese (B.M.I. of 30 or greater) and 60 were classified as overweight (index of 25 to 30).

For the most part, all of the patients were treated about the same; there were no meaningful differences in the amount of time doctors spent with them or the topics discussed.

But when researchers analyzed transcripts of the visits, there was one striking difference. Doctors seemed just a bit nicer to their normal-weight patients, showing more empathy and warmth in their conversations. Although the study was relatively small, the findings are statistically significant.

“It’s not like the physicians were being overtly negative or harsh,” said the lead author, Dr. Kimberly A. Gudzune, an assistant professor of general internal medicine at the Johns Hopkins School of Medicine. “They were just not engaging patients in that rapport-building or making that emotional connection with the patient.”

In conversations with patients of normal weight, the doctors offered simple comments to show concern — for example, “I’m glad you’re feeling better” to a woman who had experienced hot flashes. When a normal-weight patient had trouble getting an appointment with a specialist, her doctor shared her concerns. “I agree with you,” the doctor said. “That gets extremely frustrating when that happens.”

Another patient lamented a scar on her leg after surgery and the ugly shoes she was forced to wear. “You went through a lot,” the doctor told her, adding compliments to lift her spirits. “You still got great legs. Chunky shoes are still in. Get something pretty, something for spring. That always makes you feel good.”

While such expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients.

And statements like these are no small thing. Studies show that patients are far more likely to follow a doctor’s advice and to have a better health outcome when they believe their doctor empathizes with their plight.

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.

Dr. Katz said his grandmother, who was obese, was so tired of physicians’ negative comments about her weight that she stopped going to the doctor altogether, even when she developed a breast tumor. When she finally sought treatment, she had advanced-stage breast cancer and died in her 50s.

“Every time she went to the doctor for any reason, they wagged a finger at her and talked about her weight,” Dr. Katz said. “We need to understand that the stakes are very high.”

The solution, he said, is better training so that medical students and doctors understand the complex nature of obesity as well as their own (perhaps subconscious) biases. Yale, for one, offers a continuing education program for doctors on compassionate and effective lifestyle counseling for patients.

“I think a lot of them are compassionate and don’t realize this is going on,” Dr. Katz said. “The antipathy for obesity is really rooted in our culture. We should expect better from doctors and train them better.”

Tara Parker-Pope on living well.


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