Lifestyle Medicine for Cancer Survivors

InformalJohnJohn A. Patterson MD MSPH FAAFP
September 2012

A cancer survivor is anyone who has been diagnosed with cancer, from the time of diagnosis through the rest of their life. Modern medical, radiaton and surgical treatments have led to a growing population of cancer survivors, who now number over 12 million, or 1 in 25 Americans.

Lifestyle choices such as health-supportive nutrition, maintaining a healthy weight, regular physical activity, stress management, group support and spirituality are important components to consider in a cancer survivor’s recovery and prevention plan. Such lifestyle choices may help prevent recurrent cancer and the development of new cancers. They also may help prevent and treat many other common medical conditions.

Major cancer advocacy groups provide guidelines for lifestyle behaviors based on medical research evidence. These guidelines are the place to start in developing one’s own plan for living as a cancer survivor. They help cut through the hype and promotion for unproven approaches.

The American Cancer Society (ACS) recommends that cancer survivors experiencing nutrition issues consult a registered dietitian (RD) for personal, individualized nutrition counseling. Special nutritional needs may arise during treatment and recovery that are best handled by an RD with additional training as a certified specialist in oncology (CSO). This dietary referral can be made by the treating oncologist or primary care provider.

The ACS offers general guidelines for nutrition in cancer survivors, including achieving and maintaining a healthy weight. An RD can assist in determining a reasonable target weight in conjunction with the oncologist or primary care provider. The ACS suggests choosing whole grains rather than refined and processed grains (whole wheat instead of white flour, whole ‘old-fashioned’ oats instead of ‘quick’ oats, brown rice rather than white), 2 cups of vegetables and 1 ½ cups of fruit daily, limiting or avoiding the consumption of processed meat and red meat, and avoiding or limiting alcohol to no more than 1 drink daily for women and 2 daily for men. Women at high risk for breast cancer are advised to consider avoiding alcohol completely.

Research has not demonstrated conclusive benefit from dietary supplementation with the antioxidant vitamins C and E, carotenoids or other phytochemicals. In fact, some harm has even been found. Therefore, the ACS recommends that cancer survivors not use such supplements. Smokers in particular are warned to avoid high dose beta carotene supplementation which was associated in 2 studies with an increase in lung cancer in smokers. The ACS and several nutrition organizations suggest that if supplemental vitamins and minerals are taken at all, they should be limited to a balanced multivitamin/mineral providing no more than 100% of the daily value for most nutrients. Many groups recommend such a multivitamin/mineral supplement be taken only every other day to avoid causing unintended harm.

The ACS also recommends resuming or beginning regular physical activity as soon as possible after the cancer diagnosis, aiming for 150 minutes per week of moderate physical activity (ballroom or line dancing, leisurely bicycling, general yard work and gardening, doubles tennis, brisk walking, water aerobics, ice or roller skating, horseback riding, canoeing, yoga, downhill skiing, golf, volleyball, softball, baseball, badminton, mowing the lawn, walking and lifting as part of one’s job) or 75 minutes of vigorous physical activity (aerobic dance, biking faster than 10 miles an hour, heavy gardening, hiking uphill, jumping rope, speed walking, jogging, fast swimming, singles tennis, circuit weight training, cross country skiing, soccer, racquetball, basketball, heavy manual labor at work). Strength training is recommended at least 2 days a week.

A National Cancer Institute fact sheet explains that, while the exact mechanism is unknown, psychological stress can affect tumor growth and spread. For some people, there seems to be a relationship between attitudes, emotions, the immune system and cancer. Psychological factors, especially feelings of helplessness and hopelessness or suppressing emotions, seem to impact the growth or spread of cancer in some cancer survivors. It seems prudent, therefore, to recommend stress management. Even if there is no connection between a given individual’s cancer and stress, the many positive side benefits of stress management can improve overall mental and physical health.

Religiosity and spirituality are receiving long overdue attention by medical researchers. Most studies examining this issue have found that greater religiosity and spirituality are associated with lower risk of onset of cancer, lower rate of progression of cancer over time and improved long term survival compared with those for whom religiosity and spirituality are a less important part of their lives.

Many cancer centers are now integrating conventional biomedical cancer treatment, nutrition and physical activity education, and comprehensive lifestyle programs personally tailored to individual needs. Such programs include support groups, spiritual assessments and support, coping skills and stress management using mind body skills (including relaxation, imagery, meditation, mindfulness, yoga, tai chi, humor/laughter therapy, journaling and artistic expression).

Such comprehensive lifestyle programs will likely become a universal standard as we continually improve the art and science of caring for cancer survivors.

Resources-

American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention  http://www.cancer.org/Healthy/EatHealthyGetActive/ACSGuidelinesonNutritionPhysicalActivityforCancerPrevention/index

National Cancer Institute- Psychological Stress and Cancer: Questions and Answers http://www.cancer.gov/cancertopics/factsheet/Risk/stress

National Institute of Mental Health Fact Sheet on Stress http://www.nimh.nih.gov/health/publications/stress/fact-sheet-on-stress.shtml

Cancer Treatment Centers of America http://www.cancercenter.com/complementary-alternative-medicine/mind-body-medicine.cfm

About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.