The Greenville Health System’s Human Performance Laboratory – expected to open in January 2014 – is the first HPL in the nation to be fully embedded into a cancer research and treatment program.
The HPL, which already is working with a limited number of patients on a pilot basis, is a collaborative effort between GHS and the University of South Carolina School of Medicine Greenville. While its initial focus is on cancer survivor patients in the GHS Cancer Institute, the lab will ultimately serve all GHS clinical populations.
Human performance labs traditionally have been the province of elite athletes who use the state-of-the-art analysis to improve performance. This the first time that a HPL will be used by a cancer institute to measure the changes in post-treatment cancer survivors — from whole body function all the way down the cellular level — in an effort to improve patient health and outcomes. The 1,000-square-foot lab, based at the GHS Cancer Institute, will measure cardiorespiratory fitness, muscular strength, body composition and metabolic fitness down to the mitochondrial level.
“By determining how exercise affects survivor’s health and outcomes, we can develop new cancer management techniques that will help patients overcome the crippling fatigue that too often accompanies cancer treatment,” said the institute’s medical director, Larry Gluck, MD.
If achieved, this patient-recovery milestone would be on par with how chemotherapy-induced nausea was significantly reduced by harnessing better-targeted medications, said Gluck. “It’s not enough to survive. You have to feel like you’re actually living a life,” he said.
As many as 200-300 patients could take part in the Human Performance Lab in its first year.
Gluck is a leader in the national cancer-rehab movement. He started the GHS “Moving On” oncology rehabilitation program in 1992 with a dozen breast cancer survivors. It was the first oncology-rehabilitation program in the nation. What physicians found, while anecdotal, was phenomenal.
“Almost without exception that two-week mark was a psychological and physiological turning point,” said Gluck. “My patients have often told me that ‘You may have cured me of my cancer, but Moving On gave me my life back.’”
The current Moving On program is now housed within GHS’ Center for Integrative Oncology and Survivorship. The center, which opened last summer, also offers psychosocial, spiritual and integrative therapies such as cancer-centric nutrition, yoga and acupuncture. GHS was the first hospital in the nation to partner with Cancer Support Community to offer social and emotional support for cancer patients and their caregivers.
“Thanks to advances in more complete cancer care, we now use oncology rehabilitation for cancer survivors the same way we use cardiac rehabilitation for heart patients,” said the center’s medical director Mark O’Rourke, MD. “Our ultimate goal is to have oncology rehabilitation be insurance reimbursable, just like the other programs.”
Just last year, the American Cancer Society announced that the scientific evidence shows that regular physical activity not only helps prevent cancer, but that physical activity after cancer diagnosis may reduce risk of recurrence and improve overall mortality among multiple cancer survivor groups.
Exercise may decrease the risk of colon cancer by 60 percent, and recurrence of breast cancer may decrease as much as 50 percent, according to current research.
“Exercise is the very thing that cancer survivors need to do to decrease their chances of recurrence or second cancers independent of the first,” said Jennifer Trilk, PhD, lab director and clinical assistant professor at the USC School of Medicine Greenville.
“We can now say with confidence that exercise is an important therapy in cancer survivors in addition to chemotherapy or hormonal treatments,” said Trilk. “In addition, preliminary research demonstrates that exercise may protect against, as well as reverse, some of the muscle wasting that occurs as a result of cancer therapy.”
Trilk and her medical students will be measuring the effects of exercise on patients who have undergone cancer therapy. Using the lab, the group will be able to objectively measure changes after the 12-week nurse-supervised Moving On exercise program.
“Dr. Gluck, Dr. O’Rourke and I believe that cancer survivors who exercise during and after cancer treatment have better physiological health, functional health, cognitive health and quality of life than cancer survivors who don’t exercise,” said Trilk. “I’m thrilled to be able to perform patient-meaningful research in an academic health center – and to work with medical students firsthand to demonstrate the importance of exercise for patients, as well as for physicians’ own health.”
Trilk and colleagues will measure patients’ cardiorespiratory fitness, which is associated with decreased cancer risk and greater longevity, and metabolic fitness, which is associated with muscle quality and function. Using dual x-ray absorptiometry, researchers also will measure cancer survivors’ body composition, which gives a detailed assessment of the body’s muscle and fat content and location.
“Most people are aware that having high body fat is unhealthy, but not everyone knows that fat deposited around the organs in the midsection is highly associated with cardiovascular disease and cancer,” Gluck said.
Gluck has long suspected that chemotherapy and radiation therapy might damage mitochondrial function and help explain cancer patients’ feeling of fatigue. And while most chemotherapy does not cross the blood brain barrier, it does produce elements that do, and researching this may lead investigators to a better understanding of the phenomena.
Mitochondria, called the powerhouse of the cell, are found in every cell in the human body and convert the energy of food into power for the muscle and brain cells. If the mitochondria are damaged, muscle and brain cells lose the ability to function properly, and patients experience extreme muscle and mental fatigue, cognitive impairment and memory loss. Post-chemotherapy cognitive impairment (PCCI), also known as chemotherapy-induced cognitive dysfunction or “chemo brain,” may likewise improve with exercise, said the researchers.
Trilk will use near-infrared spectroscopy (NIRS), a non-invasive instrument that measures muscle health and function at the cellular level, to study mitochondria. This is the first time this technology will be used to investigate mitochondrial function in cancer patients.
“We know, by our research to date, that cancer survivors need to avoid being sedentary and instead engage in physical activity,” said Regina Franco, nurse practitioner and manager of the Center for Integrative Oncology and Survivorship – and herself a breast cancer survivor.
“We also know that cancer survivors after treatment commonly have major functional limitations. Some will participate in physical therapy or occupational therapy, but that’s not the whole picture,” said Franco.
“We want to crack the mystery of this entire process, and the Human Performance Lab will enable us to take the analysis much higher level than ever before,” said Franco. “By combining disciplines and expertise, our team will not only help our own patients, but we hope pave the way toward development of a new worldwide standard that will have a significant impact on survivorship.”