Walking up the six steps that separated her room from the elevator was like climbing Everest, so it seems like a miracle to see her today moving her hips with the hula hoop, her hair perfectly gelled and shiny. Mari Carmen is one of 70 pediatric oncology patients at the La Paz University Hospital (Madrid) who have been through a unit set up specifically for boys and girls diagnosed with the condition to do physical exercise as part of their treatment.
“The oncologist prescribes exercises and here we do it, adapting to each patient and seeing their situation day by day,” explains Rocío Llorente, one of the physiotherapists in charge of the non-pharmacological therapy unit promoted and managed by the Unoentrecienmil Foundation in the Madrid Public Hospital. It has been in operation for a year and is one of the few in Spain. Of the 49 hospitals nationwide with pediatric oncology, only eight have a space for physical exercise.
In this case, clinical practice is also complemented by a research project to further explore the evidence that some studies already confirm: training in pediatric cancer patients reduces the side effects of chemotherapy, improves muscle strength and cardiorespiratory capacity; in addition to strengthening the immune response against tumors.
Fewer hospital admissions, fewer consequences
“The reaction ten years ago when we heard that patients had to exercise was that we were crazy, how could a child with cancer exercise. But over time it became clear that they had fewer sequelae, that they healed better in a comprehensive way and returned to their routine,” says Carmen Fiuza, doctor of biomedicine and part of the Exercise and Pediatric Cancer Research group at Hospital 12 de Octubre.
She is co-author of An investigation which gives figures on the benefits of physical exercise. After comparing the evolution of patients who did and those who did not, it was confirmed that the hospital stay of the former patients was reduced by 17%.
That’s why the La Paz unit is called “Accelerator.” It looks like a gym with machines, mats, weights, and a basket in a room with large windows. Helios just walked through the door. He comes every two weeks, when he has to go to the hospital for checkups. He’s still recovering from leukemia that was diagnosed a little over a year ago, with treatment that now consists of pills they call “maintenance.”
“Coming takes your mind off things. You don’t think you’re bad, not even in healing yourself, but in sports,” says Helios, who is about to turn thirteen and is slowly returning to one of his great hobbies, playing basketball. Rocío has prepared a table of irons for him and thinks about who has seen him and who sees him. He remembers arriving at the ward and falling to the floor exhausted, just from walking out of his room. They have fought together in very complicated arenas.
The reaction when we heard ten years ago that patients had to exercise was that we were crazy. But over time it became clear that they had less consequences, that they healed better in a comprehensive way.”
Carmen Fiuza, biomedicine doctor and researcher at the 12 de Octubre Hospital
The condition of children varies greatly depending on whether they have just been diagnosed, are undergoing treatment or have had a relapse. “We assess with the multidisciplinary team what they can do, whether we go to their room or if they can go upstairs; or if the sessions have to be suspended because they have a fever or a virus,” Llorente describes.
An upcoming integration
“We associate rehabilitation with knee surgery, but not with other pathologies, because people are not aware of the positive effect it has on recovery. It is like nutrition: there will come a day when they are integrated, but we have not yet reached that moment,” says Mercedes Hermosilla, supervisor of the hospital’s pediatric transplant unit.
Chemotherapy heals, but at the same time it poisons the good cells. “Cardiotoxicity” is common, especially at the end of treatment, due to accumulation. The most common symptom is fatigue due to loss of cardiorespiratory capacity. “The side effect that worries us most at a scientific and clinical level is the involvement of the heart. The function of the left ventricle, which is responsible for sending blood around the body, is negatively affected by the treatment,” Fiuza develops.
The reduction in muscle mass is usually another problem directly related to chemotherapy, which is also accentuated during recovery because patients move much less. “Muscles are very important because they become an endocrine organ that releases many substances into the bloodstream. If they are in good condition, they can help other tissues to improve as well,” the researcher continues. “Keeping the patient as healthy as possible guarantees that they can receive the sessions when it is their turn,” he adds.
“By coming, you can't think for a while. You don't think about being sick or getting better, but about exercising.”
Helios, 13 years old
In addition to the physical, there is “the emotional benefit of getting up and having the illusion that you are going to a place to relax and have a chat”, defends Hermosilla. Illness paralyzes life. It takes you out of your environment and routines from one day to the next. Even more so, a treatment that is as demanding and long as oncology. Patients with leukemia in particular go through a very intense first phase that usually involves at least one hospitalization.
There could be many more. The balance during treatment is very delicate: if they have a fever of more than 37.5, run to the hospital; also if there is a suspicion of a virus. Teresa Viejo tells us about her daughter Alicia, who is shooting baskets with Helios a few meters away. “He had a very bad time. But as she says: it is better with family and friends, even if you have to vomit.”
Viejo requested special leave of absence and for Alicia, school, training and the swimming pool were over. “There are always unexpected incomes, you live with uncertainty, but from the first day I stuck to a number. They told me that 93% of the children are cured,” he recalls. Alicia is still treated with pills, but today she is disease-free.
Mari Carmen’s mother, Eudis, lost half of her upper jaw teeth when things got bad. The girl had graft versus host, a rejection complication that can occur after a bone marrow transplant, and was hospitalized for four months. He was discharged two years ago. “This has been very helpful in such a difficult process. She could barely walk up stairs because she lost a lot of muscle mass and look now,” she says happily and excitedly.
Mari Carmen felt so bad that she didn’t want to hear anything about exercises or getting out of bed. Rocio persisted. “I try to get closer by telling them that what’s happening to them is shit. Most of them are angry and feel very bad about the effect of the treatments,” says the physiotherapist, who has had a lot of joy in the past year. But he has also seen patients with a bad prognosis who have died. “We tell them the good things, but not everything always ends well,” he laments.
The vocation of the Unoentrecienmil Foundation, dedicated to research into childhood leukemia, is to extend the model to more hospitals in Spain. Go where public health has not yet finished with its funds. “Now we see that it has gained momentum and is starting to be implemented in more places, but there is still a long way to go because there are communities that do not have a single hospital with a non-pharmacological therapy unit of this type and it is not fair,” says Fiuza.