Nutrition in Cancer Survivors

More than 10 million persons in the United States are cancer survivors, and 65% of Americans diagnosed with cancer now live more than 5 years with a need for informed recommendations on nutrition and lifestyle, and yet the advice given by healthcare professionals is often conflicting. The current report by a panel of experts in nutrition, physical activity, and cancer convened by the ACS, based on current available evidence and updated from the 2003 report, has been prepared to guide healthcare professionals and patients about clinical practice recommendations for nutrition and lifestyle after a diagnosis of cancer. The sections address phases of survivorship, nutrition and physical activity, and selected cancer sites with specific recommendations. Even when evidence is incomplete, reasonable conclusions and recommendations are made based on noncancer studies to guide choices about body weight, foods, physical activity, and nutritional supplement use. Study Highlights At diagnosis and during cancer treatment, anorexia, early satiety, taste, smell, and gastrointestinal tract disturbances are most prevalent, with malnutrition and weight loss occurring in more than 50% of patients. The goal is to prevent deficiencies, preserve lean body mass, maximize quality of life, and consider effects of radiation, surgery, and chemotherapy. For cancer survivors, smaller, more frequent meals and intake of nutrient-dense foods can increase caloric intake. Short-term measures, such as pharmacotherapy, enteral, or intravenous parenteral feeding, can be considered. The American Society for Parenteral and Enteral Nutrition and the American Dietetic Association recommend using total parenteral nutrition selectively. Maintenance of a healthy weight is recommended as obesity has been linked to increased cancer risk. Exercise has been shown to be safe and can improve prognosis in breast and colorectal cancer. In the Nurses Health Study, as little as 1 to 3 hours per week of moderate intensity exercise was associated with a 26% to 40% reduction in risk for recurrent, breast-cancer–specific, and all-cause mortality. Patients who are immunocompromised should avoid public gyms until their white blood counts return to normal. Those undergoing irradiation should avoid chronic exposure to chlorine in swimming pools. Careful attention should be paid to balance to prevent falls. For patients who are obese or overweight, slow weight loss (no more than 2 lbs per week) using a well-balanced diet and increased physical activity to achieve 5% to 10% weight loss can confer survival benefits. A low-fat diet with avoidance of trans fatty acids (< 3% of total calories) and saturated fats (< 10% of daily calories) can improve survival for patients with breast and prostate cancer. At least 5 servings of colorful fruits and vegetables are recommended daily and considered protective for cancers, including lung, oral, esophageal, stomach, and colon cancer. Sugars do not contribute nutritional value and limiting sugar consumption is recommended. Patients who may be immunosuppressed should avoid foods with pathogenic organisms and practice food safety guidelines. The role of soy foods and supplements is uncertain, but soy is an excellent source of protein that can be recommended. High doses of soy isoflavones as supplements are not recommended for those with estrogen-receptor–positive breast cancer. There is no clear answer for whether antioxidants help or harm, and no more than 100% of the daily recommended dose should be taken. No direct evidence has determined whether consuming a vegetarian diet is healthful or harmful and individuals should be guided by the nutritional content. Alcohol intake advice should be tailored to individual survivors. Benefits relate to cardiovascular protection and are not specific for any cancers. Survivors with oral mucositis should avoid alcohol, which can irritate the mucosa. Cancer survivors should consume at least 8 cups of liquid daily. The role of calcium, folate, and selenium in preventing polyp recurrence in colorectal cancer is uncertain. Current evidence suggests that adherence to treatment and colonoscopic surveillance are the most important prognostic indicators. Low microbial diets are recommended for transplant recipients. High-dose beta-carotenes may increase risk for lung cancer. Malnutrition is the primary issue during cancer diagnosis and treatment, and exercise, healthy weight maintenance, and a balanced diet are key recommendations after treatment to prevent relapse and improve prognosis. Nutritional supplements, such as soy isoflavones, beta-carotene, and antioxidants, should be used with caution in cancer survivors, and low microbial diets are recommended for immunocompromised and transplant patients.