Consider Optimal Diet, Lifestyle Medicine When Treating Patients With Cancer

Counseling patients with cancer on lifestyle interventions such as optimal diet and activity levels is crucial to improved outcomes, according to a presentation during the 2023 Community Oncology Alliance meeting.

Significant advancements have been made regarding the efficacy of cancer treatments, but there are also increasing data showing that advanced diagnoses are growing, resulting in more challenging treatments and worse outcomes. An estimated 609,820 individuals will die from cancer in 2023, averaging approximately 1670 deaths per day.

“We’re doing great, we’re treating cancers, but we’re also seeing this at the other end of the spectrum,” said presenter Amber Orman, MD, DipABLM. “So, we have to have a conversation about both primary and tertiary prevention to really serve our patients in the best way that we can.”

In addition to the growth of advanced-stage cancers, Orman said there is an ongoing chronic disease epidemic, including heart disease, chronic lung disease, stroke, Alzheimer disease, and obesity. These chronic conditions drive 90% of health care costs and are all interrelated.

Key lifestyle risk factors for chronic diseases include tobacco use, poor nutrition, lack of physical movement, and obesity. Of these, dietary risks and tobacco use are the top 2 causes of death, according to data from 1990 to 2016, and are areas in which pharmacists can provide a lot of counseling.

Orman noted that 90% of US adults do not consume the 5 servings of fruits and vegetables recommended per day, and 75% fail to meet exercise guidelines. Despite this evidence to the contrary, 75% of Americans said they eat a healthy diet.

Cancer survivors are at a greater risk for developing chronic diseases, which Orman attributed to the bodily damage done by the disease itself as well as the treatments. Notably, survivors have a 37% greater risk for cardiovascular disease than those without prior cancer, and this risk is predominantly driven by an increased risk for heart failure. Addressing lifestyle modifications is a significant way to minimize these risks.

Lifestyle medicine as a field focuses on these chronic conditions and is organized into a series of pillars: nutrition, sleep, exercise, substance abuse, stress management, and healthy relationships. Orman said that addressing these 6 pillars through lifestyle medicine can manage, prevent, or treat at least 15 of the most common chronic diseases.

According to the World Health Organization, 80% of heart disease, stroke, and type 2 diabetes, as well as 40% of all cancers, could be prevented, primarily through improvements in diet and lifestyle. Orman added that with physical activity, healthy weight management, not smoking, a healthy diet, and moderate alcohol intake, 83% of heart disease cases and 91% of diabetes cases could be preventable.

In cancer survivors, the clinical elements of lifestyle medicine include surveillance for cancer recurrence, screening for second primary cancers, genetic risk updates, assessing and managing the adverse effects (AEs) of treatment, addressing psychosocial issues, and promoting healthy behaviors.

A growing body of evidence and guidelines recommend that clinicians and patients pay close attention to diet and exercise. For example, the American Society of Clinical Oncology (ASCO) made obesity and cancer one of its core initiatives in 2014, with a key goal of increasing oncologists’ core knowledge about diet, exercise, and weight management.

In addition, American Cancer Society guidelines specify that patients with cancer should have diet and exercise assessments to evaluate how they will respond to treatments. Survivors should also follow primary prevention guidelines to reverse the pre-existing damage to the body caused by their disease and treatments. Orman said general themes of dietary recommendations include plant-based foods and less red meat or processed animal products.

ASCO also provides guidelines for during active cancer treatment, with the exception of patients with breast cancer receiving endocrine therapy. The guidelines encourage patients to exercise once they are able following treatment. Providers should recommend aerobic and resistance exercises during active treatment with curative intent, both to mitigate AEs and reduce anxiety and depression.

For patients receiving chemotherapies, neutropenia diets are not recommended, and there is insufficient evidence for or against dietary interventions such as a ketogenic diet, low-fat diet, or fasting. Data regarding optimal diets during the active treatment period are not robust but continue to recommend things that are known to promote general health.

REFERENCE

Orman A. Empowering Cancer Patients Through Lifestyle Medicine: An Innovative Approach to Wellness. Presented at: Community Oncology Alliance 2023 meeting. March 24, 2023.