When Patients Are Open to Lifestyle Changes: Take Advantage of ‘Unique Window of Opportunity'


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Colon cancer survivors who followed guidelines for healthy eating, maintaining a healthy weight, and staying physically active had higher 5-year survival rates than those who did not adhere to those guidelines, according to a study among 992 patients treated with stage III colon cancer.1 The 5-year survival probability was 85% for patients with more strict adherence to American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors (ACS)2 vs 76% for those with low ACS scores—“a 9% absolute reduction in the risk of death at 5 years,” the study authors reported.

“The real message,” study coauthor Charles S. Fuchs, MD, MPH, told The ASCO Post, “is that we as oncologists, myself included, need to be counseling people on a healthy lifestyle.” The time period following diagnosis presents “a unique window of opportunity,” he added. “Previous studies show that about 75% of newly diagnosed cancer patients believe there is a diet, lifestyle, or supplement that will improve their outcome. So this is a relatively teachable moment. What better opportunity to counsel people on a healthy lifestyle that will hopefully not only improve their outcome from colon cancer but actually reduce their mortality from the major ailments that afflict Americans?” Dr. Fuchs is Director of the Yale Cancer Center and Physician-in-Chief of Smilow Cancer Hospital, New Haven, Connecticut.

‘Worth Re-engaging’

“It shouldn’t be a one-time conversation, because changing your lifestyle and modifying your behaviors with respect to diet and lifestyle is a process,” Dr. Fuchs stressed. He starts the conversation “relatively early in the process, when we are talking about adjuvant therapy. It is not the first thing I discuss,” he said, realizing that for patients, “a lot of their initial focus is going to be on their diagnosis, knowing about their adjuvant chemotherapy, and their likelihood of cure. But I definitely introduce it then.”

Periodically throughout the treatment period, “it is worth re-engaging” patients, who may report what diet improvements or exercise they have undertaken and could benefit from further encouragement, Dr. Fuchs said. “A critical opportunity” is when patients have completed adjuvant chemotherapy. These discussions could be included in survivorship planning sessions, an initiative the ACS, the American College of Surgeons, and other groups “are encouraging,” he added.

“For many patients who finish adjuvant therapy, there is an element of ‘I’ve done everything, but did I do enough?’ They are just waiting to see whether it worked or not, which can be anxiety-producing. A great way to further empower them, to think about what they can continue to do to maintain their health, is once again to reengage in the conversation” about diet and exercise. Continuing to reinforce the message during routine follow-up visits is also important, he said. “A very common problem for people who change their diet and lifestyle for the better is sustaining that, which isn’t easy.” ■

DISCLOSURE: Dr. Fuchs reported consulting or advisory roles with Lilly, Sanofi, Bayer, Merck, Entrinsic Health Solutions, Five Prime Therapeutics, Agios, CytomX, Gilead Sciences, Taiho Pharmaceutical, and Genentech/Roche.

REFERENCES

1. Van Blarigan EL, Fuchs CS, Niedzwiecki D, et al: Association of survival with adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors after colon cancer diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol. April 12, 2018 (early release online).

2. Rock CL, Doyle C, Demark-Wahnefried W, et al: Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:243-274, 2012.


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