Diet and Exercise for Cancer Survivors

Diet and Exercise for Cancer Survivors

Symptoms	Diet	Exercise
Depression	X	XX
Fatigue	X	XX
Adverse Body composition	X	XXX
Functional Decline	X	XXX
Co-Morbidity	XXX	XXX
Recurrent/Progressive Disease	XX	XX

ACS Nutrition and Physical Activity Guidelines for Survivors

·         Achieve and Maintain a Healthy Weight

o   Worldwide 35% overweight, 11% obese. Doubled since 1980

o   Especially important in Breast/Prostate Ca

o   65% population lives where obesity kills more than underweight

o   Obesity:

§  7 fold increased risk endometrium cancer

§  4.8 fold increased risk esophagus

§  Strong data on 11 other cancers (NEJM 2016)

§  Cancer mortality 15 cancers, including multiple myeloma in females (NEJM 2003)

o   Weight Gain after diagnosis:

§  Breast, 5kg increase increases mortality 30%

§  Prostate, recurrence risk 20% higher

BWEL study

American Society of Clinical Oncology – Position Statement on Obesity and Cancer

Avoid inactivity

Scale not as important as body composition

Sarcopenic Obesity:

                Gains in body fat without gains in muscle

                Recommended treatment is exercise, especially strength training

IARC – red meat is carcinogen, especially processed and cured

                No more than 18oz per week

                Each serving of red meat increases risk 10%

                Each serving processed meat increases risk 16%

                Substituting fish, nuts, legumes decreases risk of mortality 7-19%

Western diet double risk for breast and colon cancer

WHEL study

·         5 vegetables, 3 fruits, 30 grams fiber, 15-20% fat

·         No weight loss but may have had healthier diets at baseline

WINS Study

·         Low fat, especially for ER neg breast cancer. 

·         Women changed diet more and also lost weight, made big difference in survivorship

ETOH

·         H&N Cancer - Increases post treatment complications and reduces survival

·         Women who drink after breast cancer treatment increase risk of second cancer esp bowel

Supplements

·         H&N – supplements fueled second cancer, especially A + E

Important to wean high-dose supplements d/t rebound scurvy

Synergy with lifestyle choices – increases benefit versus just one change

Four Goals:

·         Lose Weight

·         Eat greater than five fruits and veggies

·         Activity

·         Quit Smoking

National Center for Complementary and Integrative Health

SURVIVORSHIP goals for breast cancer

·         D3 cognitive function

·         Bone density

·         Cardiovascular risks

·         Plant foods, exercise

·         Manage weight gain, DM, HTN, cholesterol

·         Omega 3 to reduce inflammation.  Use fish to replace arachidonic acid (meat)

o   Recommendations 2-3 grams/day?  Upper limit is 3

**Handwritten notes; ?? source

ALL – patients at risk for developing obesity during maintenance therapy and after treatment.  Rec increased activity.

Prostate cancer survivorship:

·         Lupron assoc with weight gain (~15# first year)

·         Enc daily exercise

·         Calcium, no more than 1500 mg combined diet and supps

·         ? checking vit D (esp if older, indoors, low intake