Page 24 - Today's Dietitian (February 2020)

symptoms, and sleep disturbances; and improve health-related CARDIO-ONCOLOGY
quality of life. 2,24 Exercise’s potential benefits for treatment-
related cardiotoxicity, peripheral neuropathy, and cognitive RESOURCES
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functioning remain uncertain. In addition to its potential for
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reducing risk of several forms of cancer, moderate evidence
supports postdiagnosis physical activity to improve cancer- CANCER SURVIVORSHIP
specific and all-cause survival following breast, colorectal, and American Institute for Cancer Research
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prostate cancer. Diet, Nutrition, Physical Activity and Cancer: A Global
Health professionals need to recognize unique exercise- Perspective: The Third Expert Report: www.wcrf.org/
related needs of some cancer survivors. For example, dietandcancer
anemia, compromised immune function, neuropathy, The New American Plate Challenge guides weekly behavior
balance problems, an ostomy or indwelling catheter, bone change to meet recommendations: https://napchallenge.org
metastases, presence of or risk factors for breast cancer–
related lymphedema, and decreased bone density as a result American Society of Clinical Oncology
of hormonal treatments may require modifying the type Cancer.Net provides information for cancer survivors on
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or amount of exercise. A 2018 international roundtable managing side effects: www.cancer.net/coping-with-
of experts developed guidelines for assessing the needs of cancer/physical-emotional-and-social-effects-cancer/
people during and after cancer therapy, and referring them to managing-physical-side-effects
appropriate options to support physical activity. 24,26
Oncology Nutrition Dietetic Practice Group
Nutrition Eat Right to Fight Cancer provides information for patients and
Nutrition is a core component of primary and secondary pre- health professionals on dealing with side effects and addressing
vention of CVD, reducing cancer risk, and lifestyle recom- hot nutrition topics: www.oncologynutrition.org/erfc
mendations for cancer survivors. The American Institute for
Cancer Research (AICR) recommends that after the acute CARDIOVASCULAR NUTRITION
stage of cancer treatment, people should follow the AICR National Lipid Association
recommendations for cancer prevention, unless otherwise
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advised by their health professional. As cancer survivors Clinician’s Lifestyle Modification Toolbox (with patient education
increasingly live longer, they’re at risk of developing new pri- tear sheets): www.lipid.org/clmt
mary cancers as well as other chronic diseases, and these rec- University Health Network at the Toronto
ommendations are appropriate for overall health as well as Rehabilitation Institute
cancer-specific risk. Cardiac College offers free videos and handouts:
Guidelines from national organizations specifically for www.healtheuniversity.ca/EN/CardiacCollege/Eating
cancer survivors recommend a dietary pattern that’s high
in vegetables, fruits, and whole grains; limits red meat and
refined sugars; minimizes alcohol; and provides heart-
healthy sources of dietary fat. 9,23 This pattern is consistent
with the AICR recommendations for prevention. For breast cancer, though overweight, obesity, and unintended weight
cancer survivors, limited evidence suggests foods providing gain also are associated with a worse prognosis for other
dietary fiber and foods containing soy (in moderation) may cancer survivors. 2,9,21
reduce all-cause mortality. Research is still unclear about the benefits of promoting
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During cancer treatment, and if ability to consume or weight loss in cancer survivors. Evidence does show reduction
metabolize food has been impaired by treatment, people may in comorbidities and in biomarkers linked with cancer risk
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have special nutritional needs. Dietitians can help address and prognosis. Some clinical guidelines for cancer survivors
taste changes or other side effects. encourage those with overweight or obesity to achieve and
9,23
Nutrition is also vital in combination with exercise to help maintain a weight that’s healthy for them. Identified com-
cancer survivors achieve and maintain a healthy weight and ponents for CORE include addressing the spectrum of weight
2
2,9
body composition, as advised by current recommendations. management issues.
Weight alone doesn’t adequately reflect changes in lean body Through their content knowledge and behavior change pro-
mass, which can dramatically decrease with aging and during motion skills, dietitians can play a valuable role in the growing
cancer treatment. Low lean body mass, whether reflecting field of cardio-oncology, whether in specific CORE programs or
unhealthy weight loss or as part of sarcopenic obesity, is associ- as part of the overall health care system.
ated with poor health outcomes. Androgen deprivation therapy
for prostate cancer can cause rapid development of sarcopenic Karen Collins, MS, RDN, CDN, FAND, is a nutrition consultant
obesity, so preventive attention is appropriate for care. specializing in cancer prevention and cardiometabolic health, and
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Many survivors today have overweight or obesity at the nutrition advisor to the American Institute for Cancer Research.
time of their diagnosis, and this often continues or increases
9
following treatment. Prediagnosis obesity increases the risk of For references, view this article on our
cancer recurrence, cancer mortality, and all-cause mortality. website at www.TodaysDietitian.com.
These associations are most strongly documented for breast

24 TODAY’S DIETITIAN • FEBRUARY 2020