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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...

Discussing New Cancer Prevention Guidelines

[xyz_lbx_custom_shortcode id=5] According to recent reports from national and international research teams, approximately one-third of all cancers can be prevented by maintaining a healthy weight, eating a healthy diet, and exercising regularly. Published studies have indicated that obesity plays a major role in cancer development through a number of biological mechanisms. Since the American Cancer Society (ACS) last published guidelines on nutrition and physical activity for cancer prevention in 2006, there has been mounting evidence addressing the role of obesity in the development of cancer. While it is not a new concept that daily exercise is important to helping prevent cancer, what has emerged in the literature is that prolonged sitting time (eg, watching television or sitting at the computer) also appears to significantly increase risks. Educate Patients on Cancer Prevention In the CA: A Cancer Journal for Clinicians, the ACS published an update to the 2006 guidelines that focused on reducing cancer risk with healthy food choices and physical activity. “The new recommendations emphasize that any level of positive change in diet or exercise is a step in the right direction to encourage patients to achieve optimum weight and exercise levels,” says Elisa V. Bandera, MD, PhD, who was a coauthor of the guidelines. “The loss of only a few pounds for obese and overweight people is beneficial. Small changes may lead to bigger ones and further encourage people to start changing their lifestyle for the better.” Dr. Bandera says that clinicians should educate patients about the health risks associated with being overweight and obese and provide them with the recommendations outlined in the guidelines (Table 1). She...

Counsel Patients on Healthy Eating

The American Medical Association has launched an online training module to help clinicians counsel patients on healthy eating through use of ChooseMyPlate.gov, which explains the MyPlate icon that recently replaced the long-used food pyramid. The module, available at www.amacmeonline. com/myplate, offers tips on interpreting information from the ChooseMyPlate website and how to present it to patients. Source: American Medical...

The Endocrinologist’s Role in Bariatric Surgery

Bariatric surgery is indicated for certain high-risk patients who have clinically severe obesity. A key aspect of care for the post-bariatric surgery patient population is addressing non-surgical aspects of perioperative care, most notably nutritional and metabolic support. Clinical endocrinologists can and should play a central role in assisting bariatric surgery patients with this support and in making decisions on the most appropriate bariatric operation to select. A multidisciplinary team approach has been emphasized in the care of patients with metabolic diseases, including obesity, but this emphasis has not been as strong for patients undergoing or considering bariatric surgery. Clinical endocrinologists have been largely underutilized in bariatric surgery. However, these specialists can be of great assistance by: Helping manage the causes and complications of obesity. Discussing surgical risks and benefits, procedural options, and choices of surgeon and medical institution. Providing patients with education and guidance throughout the course of treatment. Nutritional Evaluation Before Bariatric Surgery According to guideline recommendations, all patients considering bariatric surgery should undergo an appropriate nutritional evaluation, including selective micronutrient measurements, before any procedure is performed. Clinical endocrinologists can help during this phase of treatment, especially for malabsorptive procedures in which more extensive perioperative nutritional evaluations are required. They can also assist patients during their protocol-derived staged meal progression based on the type of surgical procedure that is selected. Patient education on nutrition and meal-planning guidance before bariatric surgery and during the early postoperative hospital course is critical. This education can be reinforced during future outpatient visits. Additional education can be given on a balanced meal plan; appropriate intake of protein, nutritional supplements, and fluids; and parenteral...

Good Nutrition Critical to Chemotherapy

Great strides have been made in treating cancer to achieve a 5-year survival rate of 68%. Targeted therapies and advances in genetics are enabling more personalized patient care for several cancer types. Treating cancer patients goes beyond the cancer itself; clinicians need to treat the whole patient. Nutrition is an often overlooked element of care. Weight loss has been shown to be a poor prognostic sign in cancer. Malnutrition can impair the response to treatment, quality of life, and the immune system. Patients need recommendations that extend beyond the broad strokes of adding calories, drinking more, and picking up nutritional supplements. Specific food restrictions or recommendations can depend on chemotherapy treatment, disease, and symptoms. A personalized approach to nutritional care must include a medication review, an assessment for nutritional risk, weight loss, food intake, symptoms, and comorbidities. It has been estimated that 80% of cancer patients never receive an evaluation from a registered dietitian (RD). Meeting Patient Needs Medical, surgical, and radiation oncologists likely realize the need to address nutrition. However, practitioners are increasingly overloaded and time demands hamper achievement of this objective. New solutions for the patient are needed. Pharmacists who are specially trained in drug toxicity, drug interactions, and counseling can help meet many patient needs. Several academic centers have integrated clinical pharmacist practitioners into outpatient oncology clinics. Specialist pharmacists in Medco’s Oncology Therapeutic Resource Center integrate food restrictions or recommendations within the counseling they routinely provide by phone to a population of about 900,000 people. This is particularly important for those taking oral cancer medications because intake influences absorption and bioavailability, thus circulating drug levels. “…80%...
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