Nutritional Advice for Cancer Survivors

Authors

  • Dr. Harmon J. Eyre MD

    1. Eyre is Executive Vice President for Research and Medical Affairs, American Cancer Society, Atlanta, GA, and Editor in Chief of CA
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It is a testament to the successes of the American Cancer Society and other such organizations, as well as the countless researchers and clinicians who engage daily in the ongoing battle against cancer, that there are about nine million cancer survivors living in the US today.

FOCUSING ON NUTRITION TO MAINTAIN CONTROL

A diagnosis of cancer often plunges the individual into a dizzying whirl of diagnostic tests, staging procedures, and treatment choices. The sense of losing control over one's destiny, one's health-related choices, and even over seemingly small and insignificant daily decisions is often profound.

One of the ways in which patients and their loved ones can continue to exert some control in their lives is by focusing on nutrition. On being diagnosed, and certainly after completing cancer treatment, many individuals become highly motivated to actively improve their diets and to begin exercise programs in the hope that these strategies will enhance their quality of life, as well as their outlook for survival.

Unfortunately, although we currently know a great deal about nutrition and physical activity as they influence cancer incidence, much less is known about how they affect cancer recurrence and prognosis. Thus, while studies have demonstrated, for example, that women who exercise regularly are less likely to develop breast cancer than women who do not exercise,1 very little is known about the effect of physical activity on recurrence of breast cancer. Likewise, it cannot be assumed that results of observational or even interventional risk reduction studies looking at supplementation with micronutrients in healthy individuals can be applied to preventing recurrence among cancer survivors.

Complementary and alternative nutritional approaches are becoming increasingly popular, and clinicians need to be aware that many cancer survivors are keenly interested in these products and methods. Although consumers tend to think that “natural” substances, such as are found in teas or soy, are always safe, not much is known about the safety or efficacy of the active ingredients found in these compounds.

PROTECTING NORMAL CELLS OR TUMOR CELLS?

Another area with no definitive answers, for example, centers on the impact of certain supplements on the effectiveness of cancer treatments. As the authors of the nutrition guide2 that appears in this issue of CA point out, although most experts agree that adequate dietary intake of micronutrients, such as vitamins C and E, and folic acid, are beneficial for overall good health and may even reduce cancer incidence, we do not know how these substances might affect people undergoing chemotherapy. Could they protect normal cells from damage? Or might they protect tumor cells against treatment?

Despite the relative lack of evidence on many of these issues, there is no lack of opinions—many of which are offered with a degree of certainty that is out of proportion to the degree of evidence available.

Despite the relative lack of evidence on many of these issues, there is no lack of opinions—many of which are offered with a degree of certainty that is out of proportion to the degree of evidence available.

A GUIDE FOR CANCER SURVIVORS

This issue of CA presents a guide for cancer survivors about informed nutritional choices that we hope will help readers open a dialogue with their patients. The report contained in these pages is a summary of available data on which to base reasonable, informed decisions. A more complete version of the report can be accessed online at www.cancer.org. It is not, however, a clinical primer on medical issues in nutrition and metabolism, or on how to calculate nutritional needs in specific medical situations.

Rather, we offer an evidence-based practical guide for clinicians whose patients wish to be involved in self-care. It is assumed that cancer survivors are receiving appropriate medical and nursing care, as well as any prescription medications that may be indicated, and are looking for ways to take an active role in their own care.

To facilitate clinician-survivor communi-cation, to encourage questions, and to disseminate good information, we have also included a patient handout with commonly asked questions that can help initiate important discussions about nutrition and physical activity.

“Caring for the patient” includes helping individuals care for themselves. We hope that this guide will be useful for clinicians and survivors.

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