Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices

Department of Surgery, Duke University, Durham, North Carolina, United States
CA A Cancer Journal for Clinicians (Impact Factor: 115.84). 11/2006; 56(6):323-53. DOI: 10.3322/canjclin.56.6.323
Source: PubMed


Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplement use to improve their treatment outcomes, quality of life, and survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information from which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity issues during the phases of cancer treatment and recovery, living after recovery from treatment, and living with advanced cancer; select nutrition and physical activity issues such as body weight, food choices, and food safety; issues related to select cancer sites; and common questions about diet, physical activity, and cancer survivorship.

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    • "This not only presents a significant problem for cancer prevention, but as we improve our treatment capabilities, it may also present challenges for long-term survival in obese cancer patients. The American Cancer Society recommendations for cancer patients and survivors are similar to those for cancer prevention and state that in addition to not smoking, eating a healthy diet, and being physically active, individuals maintain a normal weight (Doyle et al, 2006). However, a U-shaped relationship with improved survival among overweight, as compared with normal and underweight, CRC patients has also been observed (Hines et al, 2009; Sinicrope et al, 2010; Baade et al, 2011; Min et al, 2012; Schlesinger et al, 2014; Wu et al, 2014), and suggests that moderate adiposity or overweight status may be protective for initially enduring the arduous cancer process (Parkin et al, 2014; Renehan, 2014; Schlesinger et al, 2014). "
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    ABSTRACT: Background: In contrast to the consistent evidence for obesity and colorectal cancer (CRC) risk, the impact of obesity in CRC patients is less clear. In a well-characterised cohort of CRC patients, we prospectively evaluated class I and class II obesity with survival outcomes. Methods: The CRC patients (N=634) were followed from the date of diagnosis until disease progression/first recurrence (progression-free survival (PFS)) or death (overall survival (OS)). Body mass index (BMI) was calculated from reported usual weight prior to diagnosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in models adjusted for clinicopathologic, treatment, and lifestyle factors. Results: Over a median follow-up of 4 years, 208 (33%) patients died and 235 (37%) recurred or progressed. Class II obesity, as compared with either overweight or normal weight, was associated with an increased risk of death (HR and 95% CI: 1.55 (0.97-2.48) and 1.65 (1.02-2.68), respectively), but no clear association was observed with PFS. In analyses restricted to patients who presented as stages I-III, who reported stable weight, or who were aged <50 years, obesity was associated with a significant two- to five-fold increased risk of death. Conclusions: In CRC patients evaluated at a large cancer centre, severely obese patients experienced worse survival outcomes independent of many other factors.British Journal of Cancer advance online publication, 17 December 2015; doi:10.1038/bjc.2015.424
    Preview · Article · Dec 2015 · British Journal of Cancer
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    • "For the CE group individualized exercise programs were prescribed by an ACSM certified Clinical Exercise Specialist®. The program components were based on the participants' individual baseline fitness results, following ACSM guidelines (American College of Sports Medicine 2013), and consistent with the levels of activity as described in the public health guidelines for physical activity for adults (United States Department of Health and Human Services 2008; Haskell et al. 2007) taking into account the participants' breast cancer survivor status (Schmitz et al. 2010; Doyle et al. 2006). CE programs included components of aerobic, resistance and flexibility training focused on three 1-hour sessions per week. "
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    ABSTRACT: Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the effect on inflammatory biological markers for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises. “Pre” and “post” assessments included measures of anthropometrics, cardiorespiratory capacity, and inflammatory markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP). Descriptive statistics, effect size (d), and dependent sample ‘t’ tests for all outcome measures were calculated for the YE group. Significant improvements were seen in decreased % body fat, (−3.00%, d = −0.44, p = <.001) but not in cardiorespiratory capacity or in inflammatory serum markers. To compare YE outcomes with the other two groups, a one-way analysis of co-variance (ANCOVA) was used, controlling for age, BMI, cardiorespiratory capacity and serum marker baseline values. We found no differences between groups. Moreover, we did not see significant changes in any inflammatory marker for any group. Our results support the effectiveness of yoga-based exercise modified for breast cancer survivors for improving body composition. Larger studies are needed to determine if there are significant changes in inflammatory serum markers as a result of specific exercise modalities.
    Full-text · Article · Mar 2015 · SpringerPlus
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    • "Evidence is also emerging that these factors are associated with survival after a diagnosis of CRC: all-cause and cancer mortality were lower among active than inactive CRC survivors (Meyerhardt et al., 2006a, 2006b), and rates of CRC recurrence and mortality were lower in those consuming a 'prudent' than a 'western' diet (Meyerhardt et al., 2007). Healthy behaviours among cancer survivors have also been associated with better quality of life, reduced fatigue, and improved physical function (Doyle et al., 2006). "
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    ABSTRACT: Purpose Evidence that lifestyle factors are associated with better outcomes in colorectal cancer (CRC) survivors highlights the need for behaviour change interventions. This study examined feasibility and acceptability, and provided an indication of behavioural impact, of a telephone-based, multimodal health behaviour intervention for CRC survivors. Method Participants were recruited from five London hospitals. Patients (n = 29) who had recently completed treatment for CRC participated in a 12 week intervention. Behavioural goals were to increase physical activity (PA) and fruit and vegetable (F&V) intake, and reduce consumption of red/processed meat and alcohol. Self-report measures of PA and diet were completed in all patients, supplemented by objective measures in a sub-set. Results Uptake of the study when patients were approached by a researcher was high (72%), compared with 27% contacted by letter. Methods for identifying eligible patients were not optimal. Study completion rate was high (79%), and completers evaluated the intervention favourably. Significant improvements were observed in objectively-measured activity (+70 min/week; p = .004). Gains were seen in diet: +3 F&V portions a day (p < .001), −147 g of red meat a week (p = .013), −0.83 portions of processed meat a week (p = .002). Changes in serum vitamin levels were not statistically significant, but the small sample size provides limited power. Clinically meaningful improvement in quality of life (p < .001) was observed. Conclusion An intervention combining print materials and telephone consultations was feasible and acceptable, and associated with improvements in PA, diet and quality of life.
    Full-text · Article · Sep 2014 · European Journal of Oncology Nursing
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