Today I saw the medical oncologist. She recommends that I receive adjuvant chemotherapy. Dose dense adriamycin + cytoxan x 4 cycles followed by dose dense paclitaxel x 4 cycles. This will be given every 2 weeks. Although this may seem crazy, this was exactly what I wanted to hear. I want to be as aggressive as possible in treating this breast cancer now in order to minimize the chance that I will ever have to deal with it again. But at the same time, this recommendation was exactly what I feared. I had no doubt that my body would fully recover from surgery and that I would ultimately have no physical limitations, but I know way too much about chemotherapy. I know that there is a potential for permanent serious toxicity. Although I really can’t envision life without running, I feel like I need to come to terms with the possibility that going through chemotherapy may change me in a way that may prevent me from ever getting back to this pre-treatment for breast cancer level of fitness.
After meeting with the oncologist, the nurse came in to provide more detailed information about what to expect while receiving chemotherapy. My husband understands how important running is to me, so he asked the nurse if it would be ok if I continued to run while receiving chemotherapy. Her response was that she doubted that I would actually want to continue running while on chemotherapy because I would be so tired and anemic. Ok, that was not very inspirational. I know because of my background as an oncologist that exercise while on chemotherapy is beneficial. But I realize now that my knowledge on what and how exercise is beneficial is very superficial. I was not specifically trained on this. I can also honestly say that I never had a patient ask me if it was ok to run or exercise intensely while receiving chemo. Now I find myself as a patient desperate for specific advice. My gut tells me that I should stay active and the fact that I have started this journey in very good shape leads me to believe that there is no reason that I should not try to continue this activity. But I also know that adriamycin can damage my heart. I know that taxol can damage my nerves. I know that all of the chemotherapy will suppress my bone marrow which means that I will become anemic which means that my heart will need to work harder to deliver the oxygen needed to my working muscles. The big question I have is where is that line between doing something that is beneficial and doing harm?
Here is what the National Comprehensive Cancer Network (NCCN) says about exercising during cancer treatment:
“If you have been recently diagnosed with cancer or are undergoing treatment, it’s important to take special care of yourself. Studies show that one of the best waist do this is to stay physically active. That doesn’t, of course mean you should run a marathon or scale a mountain. Moderate aerobic exercise such as riding a stationary bicycle or taking a daily walk with the use of light weights for strength training can enhance physical well-being and spur recovery. Your goal should be at least 30 minutes of aerobic exercise 5 days a week or more. Be cautious. If you try to do too much, you may become discouraged and stop exercising altogether. On the other hand, if your were a regular at the gym before cancer, you may have to lower the intensity of workouts for a while.”
I frankly find the nurse’s response to my husband’s question about me continuing to run while receiving chemotherapy and the Guidelines provided by the NCCN to be very discouraging. Both seem so conservative and cautious without giving any specific guidance on how to determine what is safe and beneficial.