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CBC
3 days ago
- Health
- CBC
A brisk walk a few times a week could help keep colon cancer away, study suggests
James Smith woke up from a colonoscopy to be told devastating news. At 59, he was diagnosed with colon cancer. Doctors found a mass so large it completely blocked their view of the rest of his colon. Smith said he was shocked. "It was hard, it was a hard diagnosis," he said. "It was hard to believe it was actually happening." Smith underwent surgery and four rounds of chemotherapy. When his doctors suggested he join a study to examine regular exercise and its possible role in preventing cancer recurrence, he said yes. He was concerned — through the course of his treatment he had lost about 26 kilograms, as well as muscle mass. But he joined, anyway. "At the beginning it was difficult, I won't deny. It was like, 'How am I going to do all this?'" Though he wasn't included in the final study, he ended up finding the program helped him gain a sense of control over the cancer and his treatments. Smith is now cancer-free and his prognosis is good, he says. The study, which was published in the New England Journal of Medicine on Sunday, found that for patients with colon cancer, structured exercise did make a difference. Seven years after being diagnosed, 90 per cent of the patients who took part in the structured exercise program over a three-year period were still living. In the group that had only received an informational pamphlet, 83 per cent of participants were still alive. The researchers don't know exactly why the program had such an impact. But the findings could have significant future implications for how patients with colon cancer, one of the most common cancers, receive treatment. Helping with traditional treatments The study enrolled 889 patients from 55 hospitals in Canada, Australia and the United Kingdom. The clinical trial focused on high-risk stages 2 and 3 colon cancer patients who had received surgery and chemotherapy. Half of the group was given the traditional take-home pamphlet recommending diet and exercise and the other half was prescribed a structured exercise program for three years. The study lasted for 15 years, with about half of the participants joining in the beginning and the rest later on. Patients in the exercise group were assigned a physiotherapist or a personal trainer to check in with at least once a month. But they were free to decide what kind of exercise they wanted to do. They just had to do it for up to 45 minutes, depending on the type, three times a week. For Smith, that meant walking briskly on a treadmill. Other participants biked, swam or hit the gym. In each case, the exercise had to include a sustained, elevated heart rate. (They didn't specify a figure.) "If someone saw you walking, they would think you are late for an appointment," said Kerry Courneya, a kinesiology professor at the University of Alberta and the lead author of the study. Courneya launched the research because previous studies had hinted at the benefits of exercise, but nothing was definitive enough to convince doctors. The exercise program is not meant to replace traditional treatments, like surgery and chemotherapy, but is meant to enhance them. "There was a lot of skepticism with the observational studies, and many health-care providers and oncologists felt like they didn't act on them because they were methodologically limited." Researchers found differences in cancer recurrence, as well. Eighty per cent of the exercise group was cancer-free five years after their diagnosis, compared with about 74 per cent in the group that received the pamphlet. Colon cancer typically recurs in about 30 to 40 per cent of patients. Benefits comparable to some chemo drugs Dr. Chris Booth is a senior author of the study and an oncologist at Queen's University in Kingston. Booth suggests that when combined with traditional treatments, the benefits of the prescribed exercise program are comparable to some chemo drugs. "There are treatments we use every day that have much smaller benefits and some of the treatments we think are important have benefits that are comparable to this [exercise]." Dr. Sami Chadi is a colorectal surgeon and clinician investigator at the Princess Margaret Cancer Centre, part of Toronto's University Health Network. He was not involved in the research, and already encourages his patients to exercise. But he says he plans to use this research to help convince his patients to follow a structured exercise routine. "I don't think there is any question about it. I think a structured exercise program after surgery and after treatment is absolutely necessary, so we should be strongly recommending it as strongly as we recommend chemotherapy to our Stage 3 patients." The researchers don't know why exactly the exercise program impacted the recurrence and improved survival. They do know it wasn't about weight loss or improved cardiovascular function, because there was no significant change in either factor during the study. Dr. Booth describes it as a mystery that he aims to solve. "We banked blood on all the patients," he said. "In the next couple of years, we will be doing detailed biomarker analysis to try and understand what it is about exercise that is reducing the risk of cancer recurrence." WATCH | Dr. Booth on the study's findings: Prescribed exercise could be as effective as chemo for colon cancer, researcher says 2 minutes ago Duration 1:25 Dr. Christopher Booth, oncologist from Queen's University, discusses the results of his study that looked at the impact of an exercise program on people with colon cancer. In the meantime, he says this study should give enough evidence to convince patients, doctors and governments that structured exercise programs should be an important part in their arsenal to reduce the risk of a recurrence of colon cancer. As for Smith, it's been nearly five years since his diagnosis. He is doing well and still exercising and playing hockey in Edmonton. Recurrence is still something he worries about, but he's thrilled to hear the results of the research, calling them fantastic.
Medscape
12-05-2025
- Health
- Medscape
Prophylaxis in Vasculitis Cuts Risk for Non-PJP Infections
Prophylactic treatment with trimethoprim-sulfamethoxazole (TMP-SMX) significantly reduced the risk for serious infections by approximately 50% in patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis, with the greatest benefits observed during the first 180 days of treatment. METHODOLOGY: Researchers conducted an observational study that used a target trial emulation framework to examine the effect of prophylactic TMP-SMX on the incidence of serious infections in patients with ANCA-associated vasculitis. They included 296 patients with new-onset or relapsing ANCA-associated vasculitis from four tertiary referral hospitals in South Korea who received either rituximab or cyclophosphamide as induction therapy between 2005 and 2023. Of these, 240 patients received TMP-SMX prophylaxis (prophylaxis group; mean age, 63.7 years; 55.8% women) within 14 days of induction therapy, and 56 patients did not receive prophylaxis (control group; mean age, 61.5 years; 60.7% women) during the same period. Physicians at each institution determined patient eligibility for prophylactic TMP-SMX, with dosage being either one single-strength tablet (TMP 80 mg and SMX 400 mg) daily or one double-strength tablet (TMP 160 mg and SMX 800 mg) every other day, adjusted for renal function. The primary outcome was the incidence of serious infections requiring intravenous antimicrobial treatment, hospitalization, or extended hospital stay. Secondary outcomes included infection-related deaths and severe adverse drug reactions related to TMP-SMX. TAKEAWAY: Approximately 45.8% of patients discontinued the use of prophylactic TMP-SMX within the first 180 days. During 252.1 person-years of observation, 77 serious infections occurred in 65 patients, with an incidence rate of 30.5 per 100 person-years and a fatality rate of 18.5%. Most serious infections (85.7%) occurred within the first 180 days of observation (incidence rate ratio, 5.43; 95% CI, 2.87-10.28). The prophylaxis group had a significantly lower 1-year incidence than the control group (hazard ratio [HR], 0.48; 95% CI, 0.32-0.72), particularly during the first 180 days (HR, 0.41; 95% CI, 0.22-0.76) but not thereafter (HR, 3.76; 95% CI, 0.46-29.43). Infection-related mortality was also significantly lower in the prophylaxis group than in the control group (HR, 0.23; 95% CI, 0.10-0.53). Over 127.4 person-years of TMP-SMX prophylaxis, 35 cases of adverse events occurred, eight of which were adverse drug reactions related to prophylactic TMP-SMX, and 27 patients discontinued TMP-SMX. Only one case of severe adverse drug reaction was noted, which was resolved after treatment discontinuation. IN PRACTICE: 'Our results strongly suggest that prophylactic TMP-SMX provides additional benefits in patients with AAV [ANCA-associated vasculitis] beyond reducing the risk of PJP [ Pneumocystis jirovecii pneumonia],' the authors wrote. SOURCE: This study was led by Yun Kyu Kim, MD, Seoul National University College of Medicine, Seoul, Republic of Korea, and was published online on April 14, 2025, in Arthritis & Rheumatology . LIMITATIONS: Unmeasured confounders, such as compliance with prophylactic TMP-SMX, may have influenced the findings. The varied duration of TMP-SMX use in the prophylaxis group, with many patients discontinuing within 180 days, may have led to biased estimates. Additionally, the impact of TMP-SMX on COVID-19 incidence and related infectious complications could not be estimated for patients with an index date prior to 2018. DISCLOSURES: This study was supported by a grant from the National Research Foundation of Korea. One author reported receiving salary from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Two authors reported receiving grants and consulting fees from various pharmaceutical companies.
