A case report
A 70-year-old male with small bowel adenocarcinoma involving retroperitoneal invasion had undergone chemotherapy after non-curative operation. However, this patient had to discontinue the first and second lines of chemotherapies within one month due to serious side effects of anti-cancer agents. Subsequently, the patient complained of severe low-back pain and there was evidence of local recurrence around the resected small intestine. Therefore, phototherapy was applied three times a week to relieve the low-back pain while the patient underwent the third line of chemotherapy. It was interesting to note that these combination therapies coincidentally ameliorated the various side effects caused by anti-cancer drugs. For one year during the third line of chemotherapy, the patient had to temporarily discontinue chemotherapy only two times when phototherapy was not available for one week due to consecutive national holidays in May and November. The quality of life of this patient was well maintained, and he only needed to be hospitalized for the last two months before he died.
Epidemiological studies have shown a high incidence of cancer in people less exposed to solar rays. The sunshine “vitamin” 1 alpha, 25-dihydroxy vitamin D₃ (1, 25(OH)₂D₃) is involved in these epidemiological studies based on the evidence that 1, 25(OH)₂D₃ is an antiproliferative agent that may inhibit proliferation of cancer cells in vitro and development in animals. To elucidate the synergetic effect of phototherapy in combination with chemotherapy, we assayed serum levels of 1, 25(OH)₂D₃ in this patient compared with those of end-stage cancer patients undergoing chemotherapy alone. Serum levels of 1, 25(OH)₂D₃ in this patient after receiving the combination therapies were higher than those in other cancer patients treated with chemotherapy alone.
Our results indicate that phototherapy may be a good complementary therapy with chemotherapy for cancer patients.

Aims
Yufuin is one of the most famous spa resorts in Japan. However, little attention has been paid to public spa facilities from the viewpoint of their roles in health promotions for the residents. The Yufuin Onsenkan (spa facility) is located in the central portion of the Yufuin spa and has a complete set of spa baths and pools. The aim of this study is to assess the effect of spa-aqua therapy on various lifestyle-related diseases in collaboration with this public spa facility.
Methods
We have introduced spa-aqua therapy to patients who had been diagnosed and treated as having certain lifestyle-related diseases (diabetes, hypertension, hyperlipidemia, etc) in our outpatient clinic. One hundred and twenty-four patients consented to participate in the program of aqua exercises (30 minute walk) at least three times a week for more than three months under the supervision of medical doctors, aqua therapists, and public health nurses. These patients were assessed for clinical symptoms and laboratory data at 12 months following the spa-aqua therapy. Subsequently, brachial-ankle pulse wave velocity (baPWV) was measured on 92 healthy volunteers, 21 diabetes patients, and 39 hypertension patients to evaluate the effect of aqua-therapy on arteriosclerosis caused by lifestyle-related diseases.
Results
Decreases in clinical symptoms, improvement of laboratory data, and decreases in frequency and dosage of medical prescription were observed in 89 of 124 patients. Specifically, lowered levels of fasting blood sugar and hemoglobin Alc were observed in 20 of 24 diabetic patients and remarkable effects such as lowered blood pressure and decreased dosage of medicine and frequency of medical prescription were observed in 16 out of 20 hypertensive patients. As an index of arteriosclerosis caused by some lifestyle-related diseases, we also measured baPWV on 92 healthy volunteers, 21 diabetes patients, and 39 hypertensive patients before and after introduction of aqua-exercise. From the viewpoint of health insurance, annual medical fees of 35 patients, who were randomly selected from among 124 patients, decreased significantly after receiving aqua therapy combined with medicines. The baPWV values of diabetic and hypertensive patients were significantly higher than those of healthy volunteers before commencing aqua-exercise, and the baPWV values of diabetic and hypertensive patients did not improve significantly after six months of aqua-exercise, suggesting that a longer period of exercise is required.
Conclusion & Discussion
In collaboration with a public spa facility used daily by many residents, we succeeded in naturally introducing aqua-spa exercise to the usual habitual behavior of patients with lifestyle-related diseases. This kind of preliminary trial may have future potential not only of promoting health care for local residents but also providing prospects for health care businesses in spa resort areas.