More scientific evidence about the importance of nutrition and physical activity for cancer survivors has emerged in the past 10 years, prompting the American Cancer Society (ACS) to update its guidance for physicians and patients.
The ACS tapped Tracy E. Crane, Ph.D., RDN, co-leader of the Cancer Control Research Program and director of Lifestyle Medicine and Digital Health for Survivorship at Sylvester Comprehensive Cancer Center, a part of UHealth – the University of Miami Health System, to co-author the guidelines with 29 other specialists.
“We now have strong evidence to suggest that nutrition and physical activity play a key role in survivorship and in the reduction of cancer recurrence,” Dr. Crane said. “The comprehensive guidelines not only address specific cancer types, but also have information for family members and caregivers, and on factors that impact our cancer survivors, such quality of life and patient-reported outcomes.”
Physical activity recommendations are now more specific for cardio, strength, balance, and flexibility since the prior version of the guidelines. Guidance on alcohol consumption among survivors, including recommendations by cancer type, is new, as well.
Goals of the Guidelines
The goals of the new guidelines are to reduce recurrent and new primary cancer(s), reduce co-morbid illness and optimize quality of life for cancer survivors.
The full recommendations were published in CA: A Cancer Journal for Clinicians on March 16.
The experts also recommend screening of all cancer survivors for nutritional deficiency.
“In reviewing the evidence for the guidelines, we found this is a major gap across the country, with few patients routinely assessed for nutrition status” added Dr. Crane, who is also associate professor of medicine in the Division of Medical Oncology at the University of Miami Miller School of Medicine.
Furthermore, previous versions of the guidelines incorporated total body weight in risk calculations. Now, more attention is paid to not only weight, but also body composition, because weight alone may not tell the whole story. Sarcopenic obesity, the presence of both sarcopenia and obesity, is a common problem among survivors and the distribution of fat, or adipose tissue, may be more dangerous in some locations, such as the abdomen, than in another location.
Another suggestion is referring cancer survivors to dietitians and exercise physiologists, where available, Dr. Crane said. In addition, the ACS provides a patient summary in consumer-friendly language that providers can give to patients so they are up to date on the latest guidance, as well.
The ACS also addressed health inequities in cancer survivor care. Many of the approximately 17 million cancer survivors in the U.S. “face environmental, social, and structural barriers that impact their ability to adhere to nutrition and physical activity recommendations. These include disparities in cancer care, food insecurity, targeted marketing, and lack of access to healthy food and opportunities to be physically active,” the guidelines note.
In addition to overall recommendations for diet, nutrition and living long-term in remission or with stable disease, the guidelines include recommendations for people who survived specific cancers including breast, genitourinary, gynecologic, lung, hematologic, and childhood cancers.
Going forward, Dr. Crane predicted, “You’re going to see in the next 10 years even more specific recommendations and things that we can be doing to improve outcomes with nutrition and physical activity while people are undergoing treatment and move through the treatment continuum.”
More evidence specific to cancer survivors is forthcoming, as well, in part through the National Cancer Institute’s Exercise and Nutrition Interventions to Improve Cancer Treatment-Related Outcomes (ENICTO) in Cancer Survivors Consortium.
“It’s a new consortium of cancer centers, including Sylvester, that is specifically evaluating the role of diet and physical activity during cancer treatment,” Dr. Crane said.