[ASCO Guideline] Exercise, Diet, Weight Management ‘During’ Cancer Treatment

Cancer prevention facts are irrefutable, but they do not get communicated to the general population in a meaningful, sustainable way. Doing so would greatly reduce new cancer cases and the enormous financial and human toll they leave in their wake.

You may be aware that lifestyle guidelines from the American Cancer Society (ACS) and National Cancer Institute (NCI) on how best to prevent cancer have existed for some time. I’ve written about this extensively here in association with my view on the shortcomings of Joe Biden’s Cancer Moonshot.

In a perfect world, we would invest equally the time and resources to rigorously investigate the impact of healthy lifestyle choices on the three legs of cancer’s continuum: cancer prevention; during active cancer treatment; post-treatment survivorship.

New Guidelines from ASCO on Lifestyle During Cancer Treatment

Enter a first edition: a published guideline from the esteemed American Society of Clinical Oncology (ASCO) titled Exercise, Diet, and Weight Management During Cancer Treatment. I eagerly consumed this 20-page paper as soon as it arrived in my inbox.

Never before has ASCO published formal guidance on this critical subject; one that, as a cancer coach, I’m asked about every day.

The question the guidance endeavors to answer, representative of what I’m asked, is this:

How do our lifestyle choices influence active cancer treatment, in terms of helping to mitigate various side effects or otherwise potentiate the efficacy of treatment itself?

Integrative Oncology Experts Take The Lead

Jennifer Ligibel, an oncologist at Dana-Farber Cancer Institute in Boston, is the director of The Leonard P. Zakim Center for Integrative Therapies and Healthy Living, and is first author of this important paper.

Zakim Center, inception 2000, was one of the first integrative oncology centers launched within an academic cancer hospital and, as an integrative oncology clinic, offered support, by way of acupuncture, massage, and dietary consults, to those undergoing active cancer treatment to enhance their quality of life.

As a longtime patient of Dana-Farber, I recall the center opening a decade after my diagnosis. I’ve only met Dr. Ligibel once, at a Society for Integrative Oncology (SIO) conference.  Her predecessor was oncologist David Rosenthal, Zakim’s founding director, as well as a founding member of SIO. Rosenthal, a past president of the American Cancer Society, would become a colleague and mentor of mine when I first became involved in the integrative oncology field in 2009, and joined SIO’s board.

SIO itself has developed and published a number of important clinical practice guidelines on integrative therapies for a range of conditions.

More recently, SIO has partnered with ASCO (made possible by an unrestricted grant from the Samueli Foundation) to publish three sets of evidence-based guidelines for adults, which focus on cancer-related pain management, fatigue in cancer survivors, and care of anxiety and depressive symptoms experienced by those with cancer.

In the new ASCO Guideline, Exercise, Diet, and Weight Management During Cancer Treatment, the expert panel included 52 systematic reviews and 23 randomized controlled trials focused on diet, exercise, and weight management interventions for those undergoing systemic therapy (chemotherapy) or radiation therapy. The most common cancer types were breast, colorectal, lung, and prostate.

The study’s authors stated “Oncology providers should recommend aerobic and resistance exercise during active treatment with curative intent.” But there was “insufficient evidence” to recommend for or against specific dietary or weight management interventions. The authors went on to say they are “not discouraging clinicians from discussing diet and weight with their patients”, just refraining from making specific recommendations.

This guidance lays to rest the common belief that patients should ‘rest’ during cancer treatment … engaging in regular exercise during cancer treatment can help patients avoid toxicity and recover more quickly from cancer treatment. ~Jennifer Ligibel, MD.

Where We Were

Over thirty years ago, when I was diagnosed with incurable leukemia, there was a paucity of literature and meaningful guidance on the impact of lifestyle on cancer. In terms of the major academic institutions, government-led institutions (NIH and NCI), and nonprofit organizations and societies—little was available specific to lifestyle and cancer prevention, lifestyle and approaches to mitigate the deleterious effect of active treatment, lifestyle to potentially enhance the efficacy of standard cancer treatment, or utilizing lifestyle to help improve survivorship.

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In 1991 I didn’t have the luxury to wait for ‘new studies’ and, of course, more studies are always needed. A guideline such as this under the imprimatur of ASCO will, by default, be conservative but, as I’ve mentioned, we cancer ‘thrivers’—wherever we are in the journey—live in the here and now. We must take ownership and act now to become a horrible host to cancer.

Where We’re At

This new ASCO guideline is conservative, but paramount to collective survivorship. I highly recommend you take the time to read it. I see it as a starting point, to evolve as new literature informs more detailed, actionable recommendations.

While, sadly, this new guidance may have little impact on how (and how many) oncologists will discuss the importance of lifestyle with their patients, it is an important milestone. We’re getting there, even though there’s so much more definitive guidance, education, and support needed on the topic of sensible, healthy lifestyle approaches in the context of active cancer care and how best to position patients to thrive.

The authors of this new guidance made clear the limitations of the science and data reviewed to inform the publication:

Our review of the published literature demonstrates a profound gap in quality research focusing upon defining optimal diet, weight management, and to a somewhat lesser degree, exercise strategies to maximize therapeutic responses and the reduction in both acute and long-term toxicity. Unfortunately, the shallow evidence base limited the recommendations this Panel could make, especially for diet and weight management. There is a critical need for greater investment in clinical research in this area. Outcomes of interest are diverse. Improving efficacy of therapy and reducing toxicity are of foremost interest and potential impact. ~ASCO Guideline Authors

Where We’re Going

I have never been more hopeful, as I’ve seen significant progress in the field over the last 10 years, even as it relates to investigating the impact of lifestyle behavior during active cancer treatment.

This week I learned that the National Cancer Institute (NCI) awarded $7-million to the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and Yale Cancer Center, to study the impact of nutrition and exercise on ovarian cancer outcomes. This is exactly the type of study that will inform future clinical practice guidelines in this vital area.

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Progress in the dynamic fields of lifestyle medicine and integrative oncology is inexorable. And while waiting for the science to mature to a point where more definitive and specific diet and exercise guidance can be made for those undergoing active cancer treatment as relates to proactively managing your own health and wellbeing during the cancer journey, you can start here.

As a part of your proactivity, share this new ASCO guideline with your oncologist. And, keep this in mind: if your oncologist does not have the training, expertise, or inclination to advise you on all aspects of how lifestyle choices impact cancer at all stages—its prevention; during active treatment; long-term remission or disease control for long-term quality survivorship—then find it from a different provider. Or consider expanding your care team with an experienced cancer coach.

Join my private Facebook Group Anticancer Thrivers—a community forum for achieving your best life while living with cancer.

Photo credit: bigstock.com/Juliana_Nan