Can imitating ways astronauts prep for spaceflight help cancer patients? Researchers say it could benefit them
During spaceflight, astronauts experience physical stress. This is similar to what cancer patients who are undergoing treatments such as chemotherapy, immunotherapy, and targeted therapy experience. Researchers now suggest that cancer patients could reduce the long-term impact their treatments often have on their bodies by mimicking a NASA astronaut's schedule of exercising before, during, and after a mission.
The findings — says the team from Memorial Sloan Kettering Cancer Center, New York, and NASA Johnson Space Center, Houston, among other institutes — shows that the ways astronauts prep for spaceflight could benefit cancer patients.
"It was surprising when we looked at similarities between astronauts during spaceflight and cancer patients during treatment. Both have a decrease in muscle mass, and they have bone demineralization and changes in heart function," says senior author Jessica Scott, an exercise physiology researcher at the Memorial Sloan Kettering Cancer Center's Exercise Oncology Service.
"We really need to do a lot more research and a lot more work, but it's very promising that this NASA exercise framework could be applied to help the approximately 1 million individuals who will be diagnosed with cancer in the US this year, as well as the over 15 million cancer survivors in the US today," says Scott.
According to the research team, the similarities extend to brain function: "Astronauts may get something called space fog, where they have trouble focusing or get a little forgetful. That's very similar to what some cancer patients experience, which is called chemo brain," says Scott.
Before their missions, astronauts have to exercise while physicians monitor their cardiorespiratory fitness and other systems to develop a baseline level. During their mission, the astronauts have to exercise by using specialized equipment made for working out in space. When they return to Earth, physicians continue to monitor the astronauts until their cardiorespiratory fitness and other systems return to their pre-mission baseline levels.
In the case of cancer patients, however, they are advised to rest before their treatment and during their treatment. Subsequently, they might need to ask their doctors if it is okay for them to exercise.
"In stark contrast to other chronic disease conditions, structured exercise rehabilitation is not the standard of care in any cancer population or setting. Nevertheless, a growing body of evidence demonstrates the utility of exercise therapy to improve cardiorespiratory fitness (CRF) and numerous patient-reported outcomes across the cancer treatment continuum," says the study published in Cell. The work was primarily supported by the National Cancer Institute.
However, says the research team, basic exercise such as walking on a treadmill could benefit cancer patients in the long term.
Like astronauts preparing for spaceflight, cancer patients who are monitored using similar tests such as cardiorespiratory fitness could develop their own baseline levels prior to receiving treatment. Exercising during and after treatment could then potentially reduce the adverse side effects of treatments such as heart problems, says the team.
"Astronauts and cancer patients are subject to similar multisystem physiological toxicities driven by comparable preflight/pre-diagnosis risk factors and the direct and indirect consequences of spaceflight or anticancer treatment. A tremendous opportunity exists to leverage 60 years of space medicine to establish a program of research that optimizes preparation for, tolerability of, and recovery from a cancer diagnosis and treatment," says the study.
Currently, the research team is investigating whether exercise can offset the side effects of therapy in cancer patients. By providing patients with in-home treadmills and video call software, the patients can participate in the study from the comfort of their home while following the astronaut practice of exercising before, during, and after a mission, say experts.
Explaining further, the researchers say that an underappreciated innovation with significant clinical impact is NASA's spaceflight counter-measures program or CMP.
NASA scientists initially feared that injury to all major organismal systems (for example, heart, lungs, and blood vessels) would occur within minutes of microgravity exposure.
"Accordingly, a CMP was developed with two major objectives: comprehensive characterization of spaceflight multisystem physiological toxicity, and toxicity management with exercise therapy-based intervention before, during, and after spaceflight," says the study.
The researchers recommend translating fundamental elements of the spaceflight counter-measures program to cancer. "Fundamental CMP elements to translate from NASA to cancer include toxicity prevention and treatment with exercise therapy-based intervention before, during, and after treatment," they say.
Translation to clinical care, says the team, will require rigorous evidence demonstrating that the cancer-specific CMP is cost-effective with clinical benefit across established clinical outcomes — such as surgical complications/recovery, re-admissions, therapy discontinuation, and mortality.
"Such work not only is critical given the growing burden of cancer multisystem toxicity but also has the potential to change the landscape of cancer care and management," the findings state.
The report says that during the 1960s, physicians were scrambling to discover new cancer treatments. With only 50% of patients with cancer surviving five years past their diagnosis at the time, the immediate concern for oncologists involved reducing the size and spread of tumors. NASA, on the other hand, could focus on developing ways to keep their astronauts healthy. Today, NASA has technologies that can keep astronauts safe in space for up to 11 months. But, for 90% of patients who now survive early-stage cancer, there have not been similar efforts to counteract the stress their body undergoes during treatment, says the team.
"That's why it's very timely that we start thinking about how to utilize NASA's tactics to manage some of these long-term side effects of cancer treatments. Many patients are not dying from their cancer, but they are now at risk of dying from these side effects. Using NASA's exercise plan could help with this," says Scott.