Bone Health

The National Comprehensive Cancer Network recommends a daily intake of 1200 mg calcium (diet + supplements) and 800-1000 IU vitamin D for all adults over 50 years who are undergoing therapies associated with bone loss.

Thyroid Cancer

Most rapidly increasing cancer in US.
Two of three cases are in patients less than 55

Increased late effects in patients diagnosed before age 40 - hypertension (more than twice the risk of general population), heart disease, osteoporosis (7.5 times as likely).  Five times as likely to develop swelling around the heart in 10 years after diagnosis.

Excellent prognosis and survival rate, especially in those diagnosed at younger age.

Endometrial Cancer

Endometrial cancer survivors need careful monitoring for heart disease.
Due to shared risk factors from obesity and cancer treatment - esp blood clots, pulmonary heart disease, low blood pressure, irregular heartbeat.

Even after 5-10 years, elevated risk persists (Huntsman Cancer Institute, Utah).

Cardiovascular disease is the leading cause of death among survivors of endometrial cancer in the US.

Most common late effects: high blood pressure and cardiac disease.

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