The 2012 American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors suggest achieving and maintaining a healthy weight, engaging in regular physical exercise and following healthy dietary patterns.
Despite the notion that patients who survive cancer are thin and frail, more survivors are overweight or obese, similar to the worldwide rates of obesity and overweight, which have doubled since 1980.
Wendy Demark-Wahnefried, PhD, RD, professor and Webb Chair of nutrition services, associated director of cancer prevention and control, and ACS clinical research professor at the University of Alabama at Birmingham, discussed healthy lifestyle choices, per the ACS guidelines, for patients who survived cancer during a session at the Oncology Nurse Advisor Navigation Summit.
Demark-Wahnefried described the five A’s for managing patients who are obese or overweight
- Ask (including “Have you heard about the relationship between body weight and cancer?” and “Have you tried to lose weight recently?”)
- Advise (orient the body mass index chart where the patients are and assess weight goals)
- Assess (readiness to purse weight loss)
- Set a start date and incremental goals
- Provide brochures and websites for help
- Promote foods low in calories and high in nutrients and limit foods high in calories and low in nutrients
- Make environmental and behavioral modifications (i.e., minimize food cues and encourage purposeful eating)
- Arrange (refer the patient to a registered dietitian, primary care physician, or specialist, such as a bariatric medicine doctor).
Loss of as little as 3% of body weight is associated with a health benefit, said Demark-Wahnefried, who advised going slow with weight loss goals in both young and old patients (up to two pounds per week). She also advised patients self-monitor through daily weigh-ins, keeping a food journal, and using electronic devices to monitor progress.
She then discussed studies related to dietary patterns and cancer. One found that substituting fish, poultry, nuts, legumes, or low-fat dairy for red meat would equate to a 7%−19% lower mortality risk. Another study of patients with breast cancer found that those who ate a low-fat diet compared to a regular diet had reduced recurrence rates (p = 0.034).
Demark-Wahnefried also discussed how the associated between alcohol and cancer is linear and no amount is “safe.” Alcohol can cause cancer by damaging cells, increasing damage from tobacco use, affecting hormones linked to breast cancer, and breaking down cancer-casing chemicals. Specifically, head and neck cancer survivors should not drink, because it increases complications and reduces survival. Studies have also shown an increased risk for breast cancer survivors.
Lastly, Demark-Wahnefried said patients should rely on food for dietary needs before considering supplements, and have a dietitian analyze any deficiencies.