For breast cancer survivors like Marie McCrone, the worry never quite stops.
Despite a lumpectomy and lymph node removal in 2002, she feared recurrence of the cancer or the onset of lymphedema, a painful swelling of the arm that can occur long after surgery.
"I heard all sorts of horror stories about it," recalls McCrone, 52, of Warrington, Bucks County. "How you might get it just from lifting a grocery bag."
Four years later, she heard about a weightlifting program for breast cancer survivors being tested at the University of Pennsylvania.. The study by Kathryn Schmitz and colleagues eventually found that survivors who went through the program showed improvement in body image and satisfaction with their intimate relationships, compared with a control group. They were also 35 percent less likely to get lymphedema. McCrone remains symptom free and is still exercising: "I wouldn't do without it," she said.
The Penn study was one more example of how the treatment of breast and other cancers is going beyond the three major cancer-fighting weapons of traditional Western medicine: chemotherapy, radiation, and surgery.
The side effects and aftereffects of these are well known to be harsh, particularly in breast cancer. But knowledge of how to cope with them - and even to use that knowledge to hike survival odds - is growing.
For example, until a few years ago, McCrone and patients like her would have been advised to remain physically inactive for weeks or months after surgery.
"Unfortunately, the [standard] treatments we have can create problems in and of themselves, enduring physical and emotional symptoms," said Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center in New York. "Proper oncology care must include attention to these symptoms. That's what complementary therapy is all about."
In breast cancer, "we've known for decades that women with higher stress levels have worse overall outcomes," said Daniel Monti, director of the Integrative Medicine Program at Thomas Jefferson University Hospital. "And we're just scratching the surface of how stress affects cell biology."
Philadelphia is blessed with many cancer facilities, and complementary care is common too: namely acupuncture, exercise - from weightlifting to yoga - and mind-body therapies for stress reduction.
Their use in cancer and beyond is growing. A 2011 survey for the American Hospital Association showed that 42 percent of hospitals surveyed gave some form of complementary care, up from 37 percent in 2007.
A recent analysis of the 2007 National Health Interview Survey by Penn researchers found that cancer survivors are more likely to use complementary or alternative therapies than the general population. ("Complementary" and "alternative" are often used interchangeably but are different. "Complementary" or "integrative" therapies are generally limited to those used by doctors along with standard, widely accepted treatments.)
The Penn study team, headed by acupuncturist Jun Mao, a family medicine doctor, did sound one caution. Cancer survivors disclosed less than 25 percent of their use of these therapies to their primary doctors which should be done all the time.
Acupuncture helps cancer patients tolerate larger doses of radiation and chemotherapy.
And both acupuncture and exercise are useful in the prevention or treatment of lymphedema. Almost half of breast cancer patients develop the condition, and it's "extreme" in 30 percent. No complete cure exists.
Schmitz and other Penn researchers reported in separate studies that weightlifting can reduce the odds of a patient developing lymphedema by up to 70 percent and reduce symptoms in patients with the condition.
Another Penn study showed that five hours of vigorous exercise per week lowered estrogen levels in women at high risk of developing breast cancer. "It's not going to prevent a woman from developing cancer," Schmitz said. "Maybe they'll develop it five or 10 years later, and it will be less virulent."
Acupuncture also may help with lymphedema. At Sloan-Kettering, a small pilot study showed that acupuncture was successful enough in relieving lymphedema symptoms that the hospital is applying for a federal grant for a larger trial.
Researchers there have also found acupuncture can help ward off the aftereffects of cisplatin, a chemotherapy drug often used in ovarian cancer. Besides attacking the cancer cells, the drug can harm the nervous system, causing pain. Acupuncture "has been a lifesaver for many patients," Cassileth said.
Like many hospitals, Sloan-Kettering uses the mind-body trend, offering music therapy, nutrition, touch therapy, yoga, and tai chi. "We work hard to make patients' lives less stressful," Cassileth said, "teach them deeper forms of meditation, self-hypnosis. We pay attention to the physical and emotional systems."
In Philadelphia, both Penn and Jefferson hold mindfulness meditation classes for cancer patients. Jefferson's stress-reduction program for breast cancer patients emphasizes what Monti calls "mindfulness-based meditation skills," diet, and nutrition. The hospital offers "mindfulness-based art therapy" to encourage self-expression as a form of stress relief.
Nutritional supplements are used as long as they don't counteract standard drugs and are supervised. "You don't want to be going online and taking a lot of funky things," Monti said.
Another common program - whose roots go way back - is offered at the for-profit Cancer Treatment Centers of America hospital in Northeast Philadelphia: spiritual support.
"We're there to alleviate stress without giving people false hope," said Michael Barry, a Presbyterian minister, who directs six other chaplains.
"No one knows how long someone will live," he said. "It's tantamount to malpractice to steal someone's hope."
Contact Paul Jablow at pjablow@comcast.net.
