OverviewLifestyle During and After Cancer Treatment
Introduction
Historically, the link between cancer and lifestyle was highlighted by the increased incidence in Asian men and women after migration to North America and Europe, implying environmental factors in addition to genetics alone [1]. Several cohort studies have subsequently confirmed the risks of a stereotypical Western lifestyle, which include high fat and red meat consumption, a low intake of fresh vegetables and fruit, and low levels of exercise 2, 3, 4. Obesity could account for 14% of male and 20% of female cancer deaths in the UK 5, 6. A lack of physical activity is particularly related to colorectal cancer and cohort studies have shown a lower risk in the order of 40–50% compared with those with a sedentary lifestyle 6, 7, 8. The Harvard Center for Cancer Control, for example, estimates that at least 15% of colon cancers could be prevented by 30 min daily exercise [5].
Cynics may argue that lifestyle change after a diagnosis of cancer is analogous to closing the stable door after the horse has bolted. On the contrary, emerging evidence shows that lifestyle can influence the rate of cancer progression, improve quality of life, reduce side-effects and risks during therapy, reduce the incidence of relapse, and improve overall survival. Furthermore, there is increasing enthusiasm from patients to be involved in their own management decisions, which in practical terms often concerns diet and lifestyle activities [9]. This paper reviews published evidence for the benefits of an improved lifestyle after a diagnosis of cancer and argues that as oncologists we should be formally introducing lifestyle advice into routine clinical practice.
Section snippets
Lifestyle and Cancer Progression
Nutritional deficiencies and malnutrition are associated with poor tolerance and lower dose intensity and hence indirectly reduce therapeutic outcome [10]. The link between improved lifestyle and better disease response rates is more difficult to prove, but emerging reliable data have been published evaluating patients with indolent or relapsing prostate cancer, where slow progression allows time for alternative interventions [11]. These include a number of epidemiological and cohort studies,
Lifestyle Improving Well-being During and After Cancer Treatment
There is a wealth of information linking good nutritional and exercise interventions with improved tolerability and quality of life during cancer therapy [20]. The most reliable data in this area have addressed the benefits of fatigue, thromboembolism, body composition, psychological well-being and constipation.
Preventing Relapse
Previously, data on associations between dietary factors and survival from breast cancer have been derived from follow-up and case–control studies 34, 35. The largest of these is the Nurse's Health Study in which women with breast cancer completed a dietary questionnaire 1 year after radical therapy. Women following their description of a prudent diet (high fruit, vegetable and fibre; low fat and salt) had a statistically significant lower overall mortality rate compared to those with a typical
Interaction between Lifestyle and Cancer
Understanding the interaction between lifestyle and cancer is complicated by the caveat that health-seeking enthusiasts often follow a range of behaviours from exercise to dietary manipulation, smoking cessation, reduction in body size, supplements and analgesic intake, confounding the published data 2, 3, 39. Many of the underlying mechanisms of benefit or risk remain unproven, but emerging evidence is suggesting an interesting causal relationship with the following categories.
Conclusions
A number of methodological limitations confound the interpretation of the benefits of exercise and diet after a diagnosis of cancer from other risks such as smoking, body size, supplements and analgesic intake. Nevertheless, despite these caveats there is now persuasive evidence that a healthy lifestyle during and after cancer is associated with improved physical and psychological well-being, reduced risks of treatment, enhanced self-esteem, reduced risk of recurrence and improved survival.
Acknowledgement
The authors would like to extend their gratitude to the editorial panel of Cancernet.co.uk for their provision of lifestyle guidance and information.
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