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Nutrition and Physical Activity During and After Cancer Treatment
Approximately 9.5 million persons in the United states are cancer survivors. Sixty-two percent of Americans with cancer now live more than 5 years after diagnosis. Cancer survivors are often highly motivated to seek informationabout food choices, physical activity, dietary supplement use,and complementary nutritional therapies to improve their treatmentoutcomes, quality of life, and survival. Should I change what I eat? Should I exercise? Should I loseweight? Should I take dietary supplements? To address these concerns,the American Cancer Society (ACS) convened a group of expertsin nutrition, physical activity, and cancer to evaluate clinical practices related to optimalnutrition and physical activity after the diagnosis of cancer. It is important for both health care providers and cancer survivorsto consider the nutritional and physical activity issues within the context of the individual survivor'soverall medical and health situation. Achievingand maintaining a healthy weight with appropriate diet and physicalactivity is important A healthful diet and physical activityare important to improve well-being, quality of life, and survival..Surgery, radiation therapy, chemotherapy, common cancer symptoms and the toxiceffects of cancer treatments can influence nutrition and physicalactivity. Fatigue, anorexia, weight change, nausea, vomiting,changes in taste or smell, pain, and bowel habits are just some of the symptoms.. During active cancer treatment, maintaining energy balance and/ orpreventing weight loss is the most important nutritional goal. This goal can be greatly assisted by the use of IV infusions.
Adequate protein intake is essential during all stages of cancertreatment, recovery, and long-term survival. The best choicesto meet protein needs are foods low in saturated fat (eg, fish,lean poultry, eggs, low-fat meat, nonfat and low-fat dairy products,nuts, seeds, and legumes).Healthful carbohydrate choices are foods that are rich in essentialnutrients, phytochemicals, and fiber, such as whole grains,vegetables, legumes, and fruit. These foods should constitutethe majority of carbohydrate-containing foods in the diet. Becausenutrient-poor, low-fiber, carbohydrate-rich foods (highly refinedfoods such as white bread and rice or foods with added sugar)simply add calories to the diet or replace more healthful foods,and thereby reduce the overall diet quality, these foods shouldbe only a small source of carbohydrate in the diet. Foods highin refined sugars or carbohydrates may also exacerbate insulinresistance.
Balancing fat, protein, and carbohydrate is challenging forthe cancer survivor who eats a vegetarian diet. Vegetarian dietsdiffer with respect to inclusion of dairy foods, fish, and/oreggs, but avoiding red meat is a universal feature. Vegetarian dietsthat include fish and dairy foods typically contain the samequantity and quality of protein provided by nonvegetarian diets..Adults eating vegan diets can meet protein needs if they consumenuts, seeds, legumes, and cereal-grain products in sufficientquantity. Vegetables should be especially encouraged because theyare more nutrient dense than most fruits. Selection of a variety of colorsis a simple way to ensure that the diet includes a variety ofdifferent nutrients. Steaming or otherwise cooking organic vegetables increases the absorptionof many nutrients and other phytochemicals, improves tolerance,and decreases the risk for infection. A serving size of vegetablesor fruits is defined as one medium piece of fruit; one-halfcup of chopped, cooked or canned fruit; one-quarter cup of driedfruit; 6 ounces of 100% fruit or vegetable juice; one cup ofraw leafy vegetables; or one-half cup of cooked or raw vegetables. .
Exercise has been shown to improve cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, and overall quality of life. The decision regarding how to maintain or when to initiate physicalactivity should be individualized to the survivor's conditionand personal preferences. Recommendations on the type, frequency,duration, and intensity of exercise should be individualizedto the survivor's age, previous fitness activities, type ofcancer, stage of treatment, type of therapy, and other physical conditions. Persons receiving chemotherapy and radiationtherapy should change their program or begin exercise at a lowerintensity and progress at a slower pace compared with personswho are not receiving cancer treatment. For those who were exercisingbefore diagnosis, the principal goal should be to maintain activityas much as possible. For those who were sedentary before diagnosis,low-intensity activities such as stretching and short, slowwalks should be adopted and slowly advanced. Some clinicians advise some survivors to waitto determine their response to chemotherapy before beginningan exercise program. Physical activity for these survivors,even those who are confined to bed, may help increase appetite,reduce constipation, and combat fatigue. Achieving and maintaining appropriate diet and physical activity are important to improve well-being, quality of life and survival.
The practices of complementary and alternative medicineinclude many types of therapies. Complementaryapproaches are those that are used in combination with standardmedical treatment. Complementaryapproaches can be useful to enhance a person's response to treatmentand provide relief from symptoms without interfering with theeffectiveness of standard cancer treatment. An intravenous vitamin-and-mineral formula, has been found to be effective against mal absorption, cachexia, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm and other disorders. Survivors shouldshare information on their use of complementary therapies withhealth care providers. www.helpmycancer.com. Jean K. Brown, PhD, RN, Tim Byers, MD, MPH, Colleen Doyle, MS, RD, Kerry S. Courneya, PhD, Wendy Demark-Wahnefried, PhD, RD, LDN, Lawrence H. Kushi, ScD, Anne McTiernan, MD, PhD, Cheryl L. Rock, PhD, RD, Noreen Aziz, MD, PhD, MPH, Abby S. Bloch, PhD, RD, Barbara Eldridge, MS, RD, Kathryn Hamilton, MA, RD, CDN, Carolyn Katzin, MSPH, CNS, Amy Koonce, Julie Main, Connie Mobley, PhD, RD, Marion E. Morra, MA, ScD, Margaret S. Pierce, RN, MPH, MSN and Kimberly Andrews Sawyer , Roberta Shepard-Mardocco, Kathryn Browning
Dr. Brown is Associate Professor, Nursing and Nutrition and Associate Dean, Academic Affairs, University at Buffalo School of Nursing, The State University of New York, Buffalo, NY. Dr. Byers is Professor, Preventive Medicine, University of Colorado Health Science Center, Denver, CO. Ms. Doyle is Director, Nutrition and Physical Activity, American Cancer Society, Atlanta, GA. Dr. Courneya is Professor and CIHR Investigator, Faculty of Physical Education, University of Alberta, Edmonton, Alberta, Canada. Dr. Demark-Wahnefried is Associate Professor of Surgery, Duke University Medical Center, Durham, NC. Dr. Kushi is Associate Director for Etiology and Prevention Research, Division of Research, Kaiser Permanente, Oakland, CA. Dr. McTiernan is Member, Fred Hutchinson Cancer Research Center, Cancer Prevention Research Program, Seattle, WA. Dr. Rock is Professor, Department of Family and Preventive Medicine, University of California, San Diego, Cancer Prevention and Control Program, La Jolla, CA. Dr. Aziz is Program Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD. Ms. Bloch is Nutrition Consultant, New York, NY. Ms. Eldridge is Clinical Research Associate, Saint Alphonsus Cancer Treatment Center, Boise, ID. Ms. Hamilton is Clinical Oncology Dietitian, Carol G. Simon Cancer Center, Morristown, NJ. Ms. Katzin is Nutritionist, Center for Health Enhancement at St. John's Health Center, Santa Monica, CA. Ms. Koonce is Public Health Advisor, Program Services Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Ms. Main is General Manager, Santa Barbara Athletic Club, Board Member, International Health Racquet and Sports Club Association, and Founder, WellFit Program, Santa Barbara, CA. Dr. Mobley is Associate Professor-Nutrition, University of Texas Health Science Center at San Antonio, San Antonio, TX. Dr. Morra is President, Morra Communications, Milford, CT. Ms. Pierce is Assistant Professor, University of Tennessee College of Nursing, Knoxville, TN. |
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Nutrition & Physical Activity During and After Cancer Treatment
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