A recent U.S. publication compared the adaptations and challenges astronauts face before, during, and after a space mission with the difficulties and physical stress experienced by cancer patients during and after chemotherapy and other anticancer treatments.

Astronauts and cancer patients: different but with something in common

Space missions and cancer treatments: two vastly different experiences, yet they share many similarities. In fact, they have so much in common that the Memorial Sloan Kettering Cancer Center in New York decided to conduct a scientific study in collaboration with NASA and the U.S. National Cancer Institute. The goal of the study was to compare the common aspects between cancer patients undergoing therapy and astronauts during missions. The study revealed a marked decrease in bone and muscle mass, along with an increased risk of cardiovascular diseases in both cancer patients and astronauts [1].

But the similarities between these two groups do not end there. The so-called Brain Fog (translated as “clouded brain”) is another factor that cancer patients and astronauts share [1]. It is a multifactorial neurophysiological phenomenon, meaning that multiple factors interact to cause a reduction in cognitive function. These include cancer treatments and biological processes directly related to the disease. Attention, working memory, and inhibitory control are among the main cognitive functions affected. These functions are essential for reasoning and problem-solving. We previously discussed this condition in cancer patients in another article, where synonyms for Brain Fog include Chemobrain or, technically, Cancer-related Cognitive Impairment [2]. In astronauts, however, this condition is specifically known as Space Fog, a cognitive impairment that appears upon their return from space missions [1].

Similar difficulties, different solutions

Despite these similarities, the strategies used to address these issues in astronauts differ significantly from those applied to cancer patients. Before any space mission, astronauts follow personalized training programs supervised by specialized trainers. The goal of these programs is to improve cardiovascular fitness, muscle strength, and other key parameters essential for successfully completing a space mission without severe health consequences. These training programs begin months before the mission launch and continue aboard the space station, thanks to treadmills and machines specifically designed for zero-gravity environments. Furthermore, once the mission ends, astronauts continue these training programs for several months until their health returns to pre-mission levels [1].

For cancer patients, however, personalized training programs before, during, and after oncological treatments are not typically provided. Over the past few decades, scientific research has made great strides in developing more targeted and effective treatments, significantly increasing survival rates across most cancer types. Unfortunately, these treatments come with side effects, such as those mentioned earlier, which often seriously impact patients’ lives. However, just as with astronauts, personalized physical training has proven to be an effective and efficient solution for counteracting these side effects and improving the patient’s health and well-being.

Physical exercise before, during, and after treatment

Intervening before, during, and after cancer treatments is crucial for helping patients manage the negative effects of therapy. Physical exercise is an economical, effective, efficient, and potentially accessible solution for all cancer patients. Like NASA astronauts, supervised and personalized physical exercise could be incorporated throughout the patient’s treatment journey. Specifically:

• Before cancer treatment: The goal in this phase is to improve the patient’s overall fitness to better prepare their body for treatment. This follows the prehabilitation model, as described in a previous article [3].
• During cancer treatment: The aim here is to minimize the side effects and toxicity of therapies.
• After cancer treatment: Once therapies are completed, the main function of physical exercise is to restore the patient’s health to pre-diagnosis levels and improve their quality of life.

Scientific research suggests that the training programs used by NASA astronauts before, during, and after space missions can serve as inspiration for designing and adapting exercise programs for cancer patients to help them recover post-treatment. The field of exercise oncology has advanced significantly in recent decades. Today, official guidelines suggest how, when, and how much to exercise based on specific treatment-related side effects. In other words, different exercise programs exist depending on the patient’s particular side effects. These guidelines are based on one of the fundamental principles of exercise prescription [4], known as FITT:

• Frequency – how many workouts per week;
• Intensity – the effort required for each session;
• Type – the specific form of physical activity;
• Time – the duration of each training session.

Preliminary evidence and future developments

Preliminary scientific evidence has shown that physical exercise can influence tumor mass, vascularization, and growth mechanisms [4]. The number of researchers in the field of Exercise Oncology is continuously increasing, with a particular focus on how exercise affects tumor biology and morphology. A recent study from the MD Anderson Cancer Center in Houston (Texas), published in Nature last September, found that an aerobic and strength training program conducted during pre-operative chemotherapy (also called neoadjuvant chemotherapy) can reshape tumor blood vessels in pancreatic cancer patients, potentially improving drug delivery and chemotherapy effectiveness [5]. In the coming years, scientific research will likely focus more on understanding the relationship between physical exercise and cancer.

Cancer patients and their space mission

The success of a space mission depends on those who conduct it: the better the astronaut’s physical condition, the higher the likelihood of mission success. Similarly, the better a cancer patient’s health before their “mission,” the better their response to therapy, health outcomes, and overall well-being. Throughout the mission and even after, astronauts train to maximize success. Cancer patients should follow the same approach: exercising during and after treatment could increase the chances of success in their mission called life—not just in terms of years lived but also in quality of life.

Therefore, we must pay close attention to the physical fitness of cancer patients, just as we do for astronauts. Physical exercise can be a great ally—not just for cancer patients, but also for doctors. However, if it is not implemented, none of this will be possible. Fortunately, even in Italy, the first initiatives linking exercise and cancer treatment are emerging. It will take many more years before cancer patients receive full training for their “mission” and are guided throughout their journey. But the most important step is to start. The guidelines are in place—let’s put them into practice!