Nutrition and Prevention of Cancer Recurrence

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Nutrition and Prevention of Cancer Recurrence

• Andréa Fimrite, RDN
• Angie Bowman, RDN
• BCCA Nutrition Consultants

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Objectives

• Recognize the special nutritional needs of cancer
  survivors during active cancer treatment
• Advise cancer survivors about nutrition and
  physical activity during the recovery phase and
  beyond
• Controversial nutritional issues facing cancer
  survivors

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Cancer Survivor

• Anyone who has been diagnosed with cancer
• DIAGNOSIS REST OF LIFE

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Challenges of Cancer Survivors

• Highly motivated to seek information about diet
  and lifestyle changes
• Often receive conflicting dietary advice
• Claims abound on the use of dietary alternatives
• Currently there are many gaps and inconsistencies
  in the scientific evidence

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ACS Guidelines on Nutrition and Physical
Activity for Cancer Prevention

• (handout)
• similar to those recommended by other agencies
  interested in dietary prevention of chronic
  diseases
• should be regarded as the basis for a healthy
  diet in cancer survivors with no apparent
  nutrition problems
• special nutritional issues and needs of cancer
  survivors are addressed in

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Nutrition and Physical Activity During and After
Cancer Treatment An American Cancer Society
Guide to Informed Choices

• Published in CA Cancer Journal for Clinicians,
  Volume 53, Number 5, September/October 2003
• Working group looked at a wide range of issues
  and choices about foods, physical activity,
  nutritional supplements and nutritional
  complementary and alternative therapies
• NOT a comprehensive review on the effects of
  nutrition physical activity in cancer patients

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• NOT a specific set of guidelines or
  recommendations
• Assumes the patient is already receiving
  appropriate medical care
• A set of suggestions based on both scientific
  evidence and important practical issues to help
  patients make informed choices on self care
  strategies

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The Phases of Cancer Survival

• Phase 1 Active Treatment
• Phase 2 Recovery from Treatment
• Phase 3 Preventing Cancer Recurrence, Second
  Primary Cancers and Nutrition-Related Disease
• Phase 4 Living with Advanced Cancer

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Phase 1 Nutritional Issues During Active
Treatment

• Energy balance is the most important goal
• Energy intake
• Energy expenditure
• Nutritional supplements ??

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Phase 2 Nutritional Issues After Treatment is
Completed

• Most important goal Rebuild muscle
  strength and correct problems
• Adequate food intake
• Physical activity

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Phase 3 Preventing Cancer Recurrence, Second
Primary Cancers and Nutrition Related Disease

• Limited data on nutritional factors that
  influence cancer recurrence
• Reasonable to recommend cancer survivors follow
  guidelines for cancer prevention
• Breast cancer recurrence- risk increased by
  obesity and ?diets low in fruits/vegetables and
  ?high in fat
• Prostate cancer recurrence- risk may be increased
  by high saturated fat intake and reduced by
  micronutrient supplementation(SELECT Trial)

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Phase 4 Living with Advanced Cancer

• Nutrition is an important factor in establishing
  a sense of well being and quality of life in
  survivors with advanced cancer
• Adapt food choices and eating patterns to meet
  changing needs
• Effective management of symptoms and side effects

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Specific Nutritional Issues for Cancer Survivors

• Physical Activity
• Alcohol
• Dietary Supplements
• Flaxseed
• Garlic
• Ginger
• Teas

• Food Safety
• Caloric Intake
• Body Weight Changes
• Dietary Fats
• Carbohydrates and Protein
• Fruits and Vegetables

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Food Safety

• Very important for patients undergoing
  immunosuppressive cancer treatments
• Patients should be careful to avoid eating foods
  that may contain unsafe levels of pathogenic
  micro organisms
• (handout)

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Caloric Intake

• Past belief, starvation would deprive a growing
  tumour of needed nutrition, therefore
  nutritional intake should be severely restricted
  to treat cancer
• Research has shown that starvation does not
  increase survival, but is detrimental due to high
  nutritional needs during and after therapy

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Body Weight Changes

• Intentional weight loss during cancer treatment
  is not recommended
• Some cancer survivors may gain weight during and
  after treatments
• During treatment, a healthy eating plan that
  meets but does not exceed caloric needs (along
  with physical activity) is advisable
• Healthy weight loss is best initiated after the
  recovery phase
• Obesity is associated with increased risk and
  poorer prognosis of breast and ?colon cancers

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Dietary Fats

• Current evidence indicates total fat NOT
  important cause of cancers
• Type of fat are associated with cancer and heart
  disease risk
• saturated fats risk
• monounsaturated, omega-3 risk

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Dietary fats (contd)

• Some studies suggest that women on lower fat
  diets before diagnosis tend to have less
  aggressive cancers than do those on high fat
  diets
• 2 trials testing the effects of low fat diets on
  recurrence and survival from breast cancer (WINS
  and WHEL)

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Carbohydrates and Protein

• Carbohydrates rich in essentail nutritients,
  pyhtochemicals and fibre - whole grains,
  vegetables, legumes and fruit
• Protein choices low in saturated fat, 10 of
  intake (but higher in elderly)

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Fruits and Vegetables

• May be associated with lower incidence of
  colorectal, lung, oral, esophageal, and stomach
  cancers
• Few studies have examined F/V benefits for
  improving cancer survival
• WHEL Study
• Benefits of eating F/V might be much greater than
  are the effects of any vitamin they contain
• Recommend at least 5 servings of F/V each day -
  with emphasis on veg

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Physical Activity

• Regular physical activity is associated with
  reduced risk of colorectal cancer, CHD,
  osteoporosis DM
• The impact on the prognosis of people with cancer
  is less clear

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Physical Activity (contd)

• Activity levels tend to decrease after cancer
  diagnosis and treatment
• Very few studies have looked at the effect of
  exercise on prevention of cancer recurrence or
  disease progression
• Studies with survivors have shown that regular
  exercise can

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Benefits of Moderate Regular Physical Activity
for Cancer Survivors

• reduce anxiety
• reduce depression
• improve mood
• boost self esteem
• reduce symptoms of fatigue,
• beneficial effects on heart rate, lean body mass
  and respiratory capacity

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Physical activity recommendations for cancer
survivors

• Moderate regular physical activity on most if not
  all days of the week
• Before beginning any exercise program, cancer
  survivors should undergo a complete health
  assessment to develop an individualized plan that
  maximizes benefits while reducing risks of injury

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Physical activity recommendations for cancer
survivors (contd)

• Individuals confined to bed rest, even those with
  advanced cancer, can benefit !
• Survivors with disabilities should consult
  specialist to assist in development of
  individualized program
• Survivors with metastasis to the bone or bone
  loss due to therapy should be careful to prevent
  bone fractures
• Survivors with chemo induced neuropathy that
  effects their balance should choose activities
  that avoid the risk of falls

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Physical activity recommendations for cancer
survivors(contd)

• Community programs that are designed for
  individuals beginning or resuming physical
  activity should be recommended as a starting
  point
• As the level of activity improves, more
  challenging programs can be tolerated and
  additional benefits can be gained

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Alcohol

• Evidence that alcohol intake both /- health
  effects
• Individualize advice depending on cancer type,
  stage, risk for recurrence and comorbid
  conditions

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Alcohol (contd)

• Evidence is substantial that alcohol may increase
  the risk of primary cancers of the head/neck,
  liver, and possibly breast and colon
• There is less evidence related to alcohol and
  survival from cancer
• Consistent evidence, general population modest
  alcohol intake associated with risk of CVD
• If alcohol is consumed, cancer survivors should
  be encouraged to limit its use to no more than
  1-2 drinks per day
• Survivors with head/neck cancer or survivors who
  have previously had problems controlling their
  intake should avoid alcohol completely

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Dietary Supplements

• Dietary supplements vitamins, minerals, herbs,
  botanicals, amino acids and glandular products
• In U.S. reported 25-80 of cancer survivors use!
• Little evidence that any nutritional supplements
  can reproduce the apparent benefits of a diet
  high in fruits vegetables
• During cancer treatment, probable benefit to a
  multivitamin/mineral supplement

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Dietary Supplements (contd)

• DRIs identify the UL for most health people
• Only few studies epidemiological or clinical
  studies to confirm safety or efficacy of high
  doses of single vitamins and minerals - (beta
  carotene, zinc, antioxidants effects) in cancer
  survival/recurrence
• Caution with high dose supplements -
• beta-carotene!

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Flax Seed and Fish Oils (omega 3 fa)

• Associated with reduction of heart disease
• Preclinical studies show conflicting results for
  omega 3/lignan effects on tumour growth and
  metastasis
• Evidence is insufficient to recommend dietary
  supplementation of flax or fish oils to reduce
  risk of cancer recurrence or to improve prognosis

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Fish Oil Studies...

• Nutritional supplements with added fish oils
  combined with Megace during treatment to promote
  weight gain and muscle protein and enhance
  appetite
• Fish oils use in enhancing cancer therapy and
  lessening side effects

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Flax Seed Studies

• Looking at the different effects of flax on
  breast, prostate, colon and skin cancer
• Results are too limited to make conclusions, more
  work needs to be done especially long term studies

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Garlic

• Studies on progress investigating cancer
  prevention, antibacterial, or antifungal effects
  of garlic - no conclusive evidence to date
• Large doses potentially harmful - stomach pain,
  gas, vomiting, inhibition of platelet formation

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Ginger

• Has antinausea properties and is useful in
  management of motion sickness, when nausea is
  triggered by a local effect (I.e. acts on
  stomach)
• Chemotherapy induced nausea is CNS stimulated
  response and therefore often requires specific
  medication to block/prevent stimulation of the
  emetic response
• Taste and aroma of ginger may be calming
• Large doses of ginger have been shown to have
  antiplatelet activity

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Teas

• Epidemiologic evidence mixed regarding cancer
  risk amongst black or green tea drinkers
• Tea contain high levels of catechins and
  polyphenols known to affect cancer cell growth in
  vitro
• Very little research has been done on the effects
  of tea consumption among cancer survivors
• Moderate amounts of green or black tea can be
  considered safe

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Questions?
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BCCA NUTRITIONISTS

• Andrea Corwin
• Shirley Hobenshield
• Chris Ko
• Shelly Monkman
• Danielle Moreau
• Charitini Orphanidou
• Satnam Sekhon
• Cheri Van Patten