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Nutrition and Prevention of Cancer Recurrence

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... fibre - whole grains, vegetables, legumes and fruit ... Fruits and Vegetables ... can reproduce the apparent benefits of a diet high in fruits & vegetables ... – PowerPoint PPT presentation

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Title: Nutrition and Prevention of Cancer Recurrence


1
Nutrition and Prevention of Cancer Recurrence
  • Andréa Fimrite, RDN
  • Angie Bowman, RDN
  • BCCA Nutrition Consultants

2
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

3
Cancer Survivor
  • Anyone who has been diagnosed with cancer
  • DIAGNOSIS REST OF LIFE

4
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

5
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

6
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

7
  • 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

8
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

9
Phase 1 Nutritional Issues During Active
Treatment
  • Energy balance is the most important goal
  • Energy intake
  • Energy expenditure
  • Nutritional supplements ??

10
Phase 2 Nutritional Issues After Treatment is
Completed
  • Most important goal Rebuild muscle
    strength and correct problems
  • Adequate food intake
  • Physical activity

11
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)

12
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

13
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

14
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)

15
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

16
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

17
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

18
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)

19
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)

20
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

21
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

22
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

23
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

24
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

25
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

26
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

27
Alcohol
  • Evidence that alcohol intake both /- health
    effects
  • Individualize advice depending on cancer type,
    stage, risk for recurrence and comorbid
    conditions

28
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

29
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

30
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!

31
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

32
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

33
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

34
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

35
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

36
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

37
Questions?
38
BCCA NUTRITIONISTS
  • Andrea Corwin
  • Shirley Hobenshield
  • Chris Ko
  • Shelly Monkman
  • Danielle Moreau
  • Charitini Orphanidou
  • Satnam Sekhon
  • Cheri Van Patten
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