With so many high-profile people diagnosed with cancer we are confronted with the stark reality the disease can strike any of us at any time. There are also reports certain cancers are increasing among younger people in their 30s and 40s.

On the positive side, medical treatments for cancer are advancing very rapidly. Survival rates are improving greatly and some cancers are now being managed more as long-term chronic diseases rather than illnesses that will rapidly claim a patient’s life.

The mainstays of cancer treatment remain surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy and hormone therapy. But there are other treatments and strategies – “adjunct” or supportive cancer care – that can have a powerful impact on a patient’s quality of life, survival and experience during cancer treatment.

Keep moving if you can

Physical exercise is now recognised as a medicine. It can be tailored to the patient and their health issues to stimulate the body and build an internal environment where cancer is less likely to flourish. It does this in a number of ways.

Exercise provides a strong stimulus to our immune system, increasing the number of cancer-fighting immune cells in our blood circulation and infusing these into the tumour tissue to identify and kill cancer cells.

Our skeletal muscles (those attached to bone for movement) release signalling molecules called myokines. The larger the muscle mass, the more myokines are released – even when a person is at rest. However, during and immediately after bouts of exercise, a further surge of myokines is secreted into the bloodstream. Myokines attach to immune cells, stimulating them to be better “hunter-killers”. Myokines also signal directly to cancer cells slowing their growth and causing cell death.

Exercise can also greatly reduce the side effects of cancer treatment such as fatigue, muscle and bone loss, and fat gain. And it reduces the risk of developing other chronic diseases such as heart disease and type 2 diabetes. Exercise can maintain or improve quality of life and mental health for patients with cancer.

Emerging research evidence indicates exercise might increase the effectiveness of mainstream treatments such as chemotherapy and radiation therapy. Exercise is certainly essential for preparing the patient for any surgery to increase cardio-respiratory fitness, reduce systemic inflammation, and increase muscle mass, strength and physical function, and then rehabilitating them after surgery.

These mechanisms explain why cancer patients who are physically active have much better survival outcomes with the relative risk of death from cancer reduced by as much as 40–50%.

Mental health helps

The second “tool” which has a major role in cancer management is psycho-oncology. It involves the psychological, social, behavioural and emotional aspects of cancer for not only the patient but also their carers and family. The aim is to maintain or improve quality of life and mental health aspects such as emotional distress, anxiety, depression, sexual health, coping strategies, personal identity and relationships.

Supporting quality of life and happiness is important on their own, but these barometers can also impact a patient’s physical health, response to exercise medicine, resilience to disease and to treatments.

If a patient is highly distressed or anxious, their body can enter a flight or fight response. This creates an internal environment that is actually supportive of cancer progression through hormonal and inflammatory mechanisms. So it’s essential their mental health is supported.

Putting the good things in: diet

A third therapy in the supportive cancer care toolbox is diet. A healthy diet can support the body to fight cancer and help it tolerate and recover from medical or surgical treatments.

Inflammation provides a more fertile environment for cancer cells. If a patient is overweight with excessive fat tissue then a diet to reduce fat which is also anti-inflammatory can be very helpful. This generally means avoiding processed foods and eating predominantly fresh food, locally sourced and mostly plant based.

Muscle loss is a side effect of all cancer treatments. Resistance training exercise can help but people may need protein supplements or diet changes to make sure they get enough protein to build muscle. Older age and cancer treatments may reduce both the intake of protein and compromise absorption so supplementation may be indicated.

Depending on the cancer and treatment, some patients may require highly specialised diet therapy. Some cancers such as pancreatic, stomach, esophageal, and lung cancer can cause rapid and uncontrolled drops in body weight. This is called cachexia and needs careful management.

Other cancers and treatments such as hormone therapy can cause rapid weight gain. This also needs careful monitoring and guidance so that, when a patient is clear of cancer, they are not left with higher risks of other health problems such as cardiovascular disease and metabolic syndrome (a cluster of conditions that boost your risk of heart disease, stroke and type 2 diabetes).

Working as a team

These are three of the most powerful tools in the supportive care toolbox for people with cancer. None of them are “cures” for cancer, alone or together. But they can work in tandem with medical treatments to greatly improve outcomes for patients.

If you or someone you care about has cancer, national and state cancer councils and cancer-specific organisations can provide support.

For exercise medicine support it is best to consult with an accredited exercise physiologist, for diet therapy an accredited practising dietitian and mental health support with a registered psychologist. Some of these services are supported through Medicare on referral from a general practitioner.

For free and confidential cancer support call the Cancer Council on 13 11 20.

Rob Newton, Professor of Exercise Medicine, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Last week in a post on X, owner of the platform Elon Musk recommended people look into disc replacement if they’re experiencing severe neck or back pain.

According to a biography of the billionaire, he’s had chronic back and neck pain since he tried to “judo throw” a 350-pound sumo wrestler in 2013 at a Japanese-themed party for his 42nd birthday, and blew out a disc at the base of his neck.

In comments following the post, Musk said the surgery was a “gamechanger” and reduced his pain significantly.

Musk’s original post has so far had more than 50 million views and generated controversy. So what is disc replacement surgery and what does the evidence tells us about its benefits and harms?

What’s involved in a disc replacement?

Disc replacement is a type of surgery in which one or more spinal discs (a cushion between the spine bones, also known as vertebrae) are removed and replaced with an artificial disc to retain movement between the vertebrae. Artificial discs are made of metal or a combination of metal and plastic.

Disc replacement may be performed for a number of reasons, including slipped discs in the neck, as appears to be the case for Musk.

Disc replacement is major surgery. It requires general anaesthesia and the operation usually takes 2–4 hours. Most people stay in hospital for 2–7 days. After surgery patients can walk but need to avoid things like strenuous exercise and driving for 3–6 weeks. People may be required to wear a neck collar (following neck surgery) or a back brace (following back surgery) for about 6 weeks.

Costs vary depending on whether you have surgery in the public or private health system, if you have private health insurance, and your level of coverage if you do. In Australia, even if you have health insurance, a disc replacement surgery may leave you more than A$12,000 out of pocket.

Disc replacement surgery is not performed as much as other spinal surgeries (for example, spinal fusion) but its use is increasing.

In New South Wales for example, rates of privately-funded disc replacement increased six-fold from 6.2 per million people in 2010–11 to 38.4 per million in 2019–20.

What are the benefits and harms?

People considering surgery will typically weigh that option against not having surgery. But there has been very little research comparing disc replacement surgery with non-surgical treatments.

Clinical trials are the best way to determine if a treatment is effective. You first want to show that a new treatment is better than doing nothing before you start comparisons with other treatments. For surgical procedures, the next step might be to compare the procedure to non-surgical alternatives.

Unfortunately, these crucial first research steps have largely been skipped for disc replacement surgery for both neck and back pain. As a result, there’s a great deal of uncertainty about the treatment.

There are no clinical trials we know of investigating whether disc replacement is effective for neck pain compared to nothing or compared to non-surgical treatments.

For low back pain, the only clinical trial that has been conducted to our knowledge comparing disc replacement to a non-surgical alternative found disc replacement surgery was slightly more effective than an intensive rehabilitation program after two years and eight years.

Complications are not uncommon, and can include disclocation of the artificial disc, fracture (break) of the artificial disc, and infection.

In the clinical trial mentioned above, 26 of the 77 surgical patients had a complication within two years of follow up, including one person who underwent revision surgery that damaged an artery leading to a leg needing to be amputated. Revision surgery means a re-do to the primary surgery if something needs fixing.

Are there effective alternatives?

The first thing to consider is whether you need surgery. Seeking a second opinion may help you feel more informed about your options.

Many surgeons see disc replacement as an alternative to spinal fusion, and this choice is often presented to patients. Indeed, the research evidence used to support disc replacement mainly comes from studies that compare disc replacement to spinal fusion. These studies show people with neck pain may recover and return to work faster after disc replacement compared to spinal fusion and that people with back pain may get slightly better pain relief with disc replacement than with spinal fusion.

However, spinal fusion is similarly not well supported by evidence comparing it to non-surgical alternatives and, like disc replacement, it’s also expensive and associated with considerable risks of harm.

Fortunately for patients, there are new, non-surgical treatments for neck and back pain that evidence is showing are effective – and are far cheaper than surgery. These include treatments that address both physical and psychological factors that contribute to a person’s pain, such as cognitive functional therapy.

While Musk reported a good immediate outcome with disc replacement surgery, given the evidence – or lack thereof – we advise caution when considering this surgery. And if you’re presented with the choice between disc replacement and spinal fusion, you might want to consider a third alternative: not having surgery at all.

Giovanni E Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.