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Guidelines for Nutrition & Exercise in Cancer Survivors

In 2001, the American Cancer Society (ACS) first published an article summarizing the relatively small amount of scientific evidence regarding the impact of nutrition and physical activity among cancer survivors. Since that time, new studies have emerged, demonstrating the benefits of maintaining a healthy weight, getting adequate physical activity, and eating a healthy diet. The key benefits include reducing the chance of recurrence and increasing the likelihood of disease-free survival after a diagnosis. Based on this new and accumulating evidence, an expert panel convened by the ACS issued formal guidelines for cancer survivors for the first time in the CA: A Cancer Journal for Clinicians. Encourage Regular Exercise The ACS update recommends that clinicians encourage survivors to participate in regular physical activity. Patients should aim to exercise at moderate intensity at least 150 minutes per week and perform strength training exercises at least 2 days per week. Clinicians need to encourage patients to avoid inactivity and return to normal daily activities as soon as possible following a diagnosis. However, in some cases, particular issues affect the ability of patients who are recovering from cancer treatment to exercise. The guidelines provide information on many of these issues and how these circumstances should be factored into the equation when recommending activities. Weight Management & Diet Among Cancer Survivors Many patients are overweight or obese when they are diagnosed with cancer, and there’s increasing evidence that obesity increases risks for cancer recurrence and reduces survival. Achieving and maintaining a healthy weight is another key recommendation in the 2012 guidelines. If cancer survivors are overweight or obese, they should be encouraged to limit...

Treatment Trends in Laryngeal Cancer

Of the 13,000 Americans diagnosed with laryngeal cancer in 2010, 3,660 were projected to die from the disease. Traditionally, early-stage disease has been treated using radiation therapy (RT) or surgical resection with comparably successful outcomes. While total laryngectomy was the treatment of choice for advanced disease prior to 1991, publication of the VA Laryngeal Cancer Study that year displayed the usefulness of chemoradiation as a treatment option. Chemoradiation allowed 62% of patients to preserve their larynx with no significant differences from surgery in overall survival. In a 2003 comparison of RT alone, chemotherapy followed by RT, and concurrent chemoradiation for advanced laryngeal cancer, the validity of chemoradiation as a treatment option for these patients was solidified. Reevaluating Laryngeal Cancer Treatments In a study published in the October 2011 Archives of Otolaryngology- Head & Neck Surgery, my colleagues and I sought to compare 4-year survival trends of surgical and nonsurgical treatment for patients with laryngeal cancer. Using the National Cancer Database we analyzed, more than 131,000 patients who were diagnosed from 1985 to 2007. For those with early-stage cancer, 4-year survival rates were 79% for surgery and 71% for RT. In patients with advanced disease, survival rates were 51% for total laryngectomy, 48% for chemoradiation, and 38% for RT. These findings contrast those of clinical trials from the late 1990s, which demonstrated equivalent survival rates for the aforementioned treatment options. These survival differences are likely explained by the use of “real world” data, in which patient inclusion criteria aren’t nearly as strict. In addition, completion of therapy regimens is not observed. Factors Influencing Treatment Choice For early-stage laryngeal cancer in...
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