The line in between life and death is thin. Men and women can cross it in the time it requires for a muscle to contract, an eye to glance into space or a neuron to fire 1 final time. Don Devereux has stood at that mystery-shrouded line quite a few occasions.
At times it was his selection, occasionally it wasn’t. Soon after he failed to safe a deferment on humanitarian grounds, Devereux, then 23, went to Vietnam in December 1969 to fight in the jungles there as a soldier in the 1st Infantry Division. Soon after President Richard Nixon announced the division’s withdrawal from Vietnam in 1970, Devereux had the chance to full his military obligation with an eight-month reassignment to the States in a non-combat function. He chose a riskier route, remaining in Vietnam for 3 far more months to finish his tour.
Devereux returned to the States in 1 piece in February 1971, leaving behind the thickets and rice paddies of Southeast Asia for the California coast. He parlayed his accounting degree from San Jose State University to a job with spice manufacturer and distributor McCormick & Organization, married, helped to raise two daughters and at some point settled in a residence in Santa Cruz. He golfed, hiked and bicycled along the sun-splashed shorelines of central California, and skied frequently at Lake Tahoe.
And then, prostate cancer
But in January 2003, illness forced Devereux to once more look at his mortality – and not for the final time. He was diagnosed with colon cancer, which led to surgery and 24 chemotherapy remedies. Two years later, he discovered the cancer had spread to his liver an additional surgery and 24 far more chemotherapy remedies followed.
His possibilities of surviving two far more years have been slim, but Devereux defied the odds. He moved to Colorado in 2006 and was alive and kicking in 2012 when but an additional blow arrived: a prostate cancer diagnosis. That led to surgery and 39 consecutive radiation remedies.
Sixteen years down this tortuous road, Devereux is nonetheless standing and determined to remain on the living side of the life-death line, 1 leg-lift and pedal-push at a time.
Prostate cancer and physical exercise
Devereux is the initial patient enrolled at UCHealth University of Colorado Hospital in the multinational INTERVAL-GAP four study, sponsored by the Australian-primarily based Movember Foundation. The trial targets sufferers like Devereux who have metastatic castrate-resistant prostate cancer. In these sufferers, the cancer spreads in spite of remedies to suppress their testosterone levels – the major driver of the illness.
The study aims to decide if a very carefully created and tightly monitored regimen of higher-intensity physical exercise can strengthen survival in these sufferers. That objective tends to make it special, mentioned Dr. Elizabeth Kessler, assistant professor in the Division of Medicine Health-related Oncology at the University of Colorado College of Medicine and a genitourinary cancer specialist who practices at the UCHealth Tony Grampsas Urologic Cancer Clinic on the UCHealth Anschutz Health-related Campus. Kessler is co-principal investigator for the INTERVAL study in Colorado with Dr. Kathy Jankowski, an physical exercise physiologist and associate professor with the University of Colorado College of Nursing.
“Many other research seeking at physical exercise have evaluated post-therapy delay of cancer recurrence or its effects on top quality of life or fatigue. Some have evaluated reduction of morbidities, like surgery,” Kessler mentioned. “This study appears straight at the query of ‘Does physical exercise support people today with cancer reside longer?’ It is an essential and difficult query.”
Jankowski, who functions with sufferers in tandem with other physical exercise physiologists in the College of Medicine’s Physical exercise Investigation Lab, mentioned the study intrigued her, in element since it focuses on males weakened and in discomfort since of the spread of the illness, specially to their bones.
“This trial is especially for males who have metastatic cancer and have had failed therapy for it,” Jankowski mentioned. “This is a population that is usually excluded from physical exercise trials since of the danger, but this trial was created for them. It is a new frontier.”
Active resistance to cancer
At the start off of the initial year, which Devereux lately completed, participants enrolled in the physical exercise group – a manage group gets only psychosocial assistance – perform with an physical exercise physiologist 3 occasions a week on a “periodized” regimen of stationary bike and weight-lifting perform, an method made use of by quite a few athletes, Jankowski mentioned.
“It signifies that the intensity and duration of the physical exercise increases and decreases and fluctuates more than weeks and months,” Jankowski mentioned. “That keeps it fresh and makes it possible for the musculoskeletal and cardiorespiratory systems to adapt to the coaching.”
Sufferers also perform at house, finishing 1 weekly 40-minute round of cycling on a stationary bike, she added. Soon after nine months, they move to two weekly sessions on their personal in the second year, they come in for supervised coaching just 1 time a month, with the expectation that they will continue to train frequently at their residences or a nearby recreation center.
“It’s essential that they turn out to be self-reliant and carry the physical exercise more than to their everyday lives,” Jankowski mentioned.
The study’s broad physical exercise framework contains cautious focus to the desires and security of each and every patient, each and every of whom receives normal bone scans, blood and urine draws and other tests and an physical exercise program prescribed via the study’s central web-site for his certain healthcare situation.
“The study is really thoughtful in its style in that the physical exercise is tailored about the web sites of the metastatic illness,” Kessler mentioned. “It tries to meet people today exactly where they are.”
For instance, Devereux’s prostate cancer has invaded the bones of his shoulders, sacroiliac joint, and pelvic crest, as nicely as various joints of his thoracic spine. To stay clear of stressing and possibly fracturing these bones, he concentrates on leg lifts and curls, as nicely as his stationary bike perform.
Devereux mentioned the normal perform with the physical exercise trainers at UCH and self-directed sessions at recreation centers close to his house in Gilpin County and in Washington Park for the duration of visits with a lady pal have helped to restore strength in his calves and thighs. He’s also benefited considerably from therapy with the oral medication Zytiga, which assists to block the production of testosterone and other hormones from the testes, adrenal glands and cancerous tumors themselves.
The Zytiga therapy, supervised by Dr. Thomas Flaig, a UCHealth healthcare oncologist, urologic cancer specialist and associate dean of clinical investigation at the CU College of Medicine, has tamed Devereux’s previously soaring prostate certain antigen (PSA) numbers. But the side effects of hormone-blocking remedies can be daunting: hot flashes intense sufficient to fog up his sunglasses “immense” muscle loss weight get and lethargy, Devereux mentioned.
When Flaig talked about to him the possibility of enrolling in the INTERVAL trial, Devereux jumped at the likelihood.
“I wanted to do far more physical exercise to offset the side effects of therapy,” he mentioned. “It has carried out that extremely nicely.”
The hot flashes have tapered off, Devereux added, even as his motivation to confront his illness has taken off. “[The exercise] got me up and going, gave me new strength and animation. My life and days are far more complete than they have been beforehand,” he mentioned.
Devereux estimated that his commitment to the study regimen, with path and encouragement from the physical exercise physiologists, has helped him strengthen his 40-minute bike-ride distance and leg extension and curl strength about 50 % each and every. But he added that the perform is element of a bigger tapestry that contains the Zytiga therapy, care from Flaig, renewed social connections and a common refusal to surrender to the solitude of illness.
Living in a house above 9,000 feet with a view of Mount Evans and uncomplicated access to the Arapaho and Roosevelt national forests for snowshoeing was for quite a few years a good supply of strength, Devereux mentioned. But his prostate cancer diagnosis dimmed his view.
“Solitude turned to depression,” he mentioned. “I was nowhere close to as constructive a individual as I had normally been recognized. I felt like my days have been numbered. Now I’m substantially far more outgoing. I’m acquiring back to undertaking far more walking and hiking and I hope to get back to golfing.”
Top quality issues
His encounter underscores a important secondary outcome the INTERVAL trial researchers want to measure: improvements in top quality of life. It is a query that keenly interests each Kessler and Jankowski.
Kessler, for instance, focuses substantially of her investigation and clinical practice on discovering the most efficient techniques to assistance sufferers with cancer. That contains lowering discomfort, managing fatigue, enhancing sleep and stabilizing mood.
“Inevitably, nonetheless, substantially of cancer investigation ends up getting boiled down to this aspect of ‘did we support people today living longer?’” she mentioned. “Is that the ideal query to ask? I’m not confident. Ought to we be exploring other folks? Unquestionably. We may well uncover that the major outcome of this study is not accomplished, that physical exercise does not strengthen all round survival. Nonetheless, it may well strengthen patients’ lives in so quite a few other techniques that it is nonetheless anything we appear at as useful.”
Jankowski, who spent years in clinical investigation with CU’s Division of Geriatric Medicine, noted that in geriatrics, “health span” is distinguished from “life span” – the latter getting how extended 1 lives the former getting the quantity of healthful years 1 lives.
“Our objective is to add higher-top quality time to one’s life,” Jankowski mentioned. “There are nicely-getting requirements in this trial, and we hope to study far more about the effects of physical exercise on well being top quality in this patient population.”
For his element, Devereux mentioned he’s not worried about handling the physical exercise regimen on his personal. He’s created it element of his improbable battle against illness. The guy who figured he had a couple of years left immediately after getting diagnosed with liver cancer in 2005 continues to not only lengthen his life but uncover techniques to strengthen it.
“I’m living on borrowed time,” Devereux mentioned. “I look at each day a new day and a blessing.”
To study far more about the INTERVAL trial, get in touch with Dr. Elizabeth Kessler at [email protected].