You survived cancer. Now what?

Roughly a third of cancers are considered preventable and the lifestyle recommended to help avoid them is the focus of ongoing research to help cancer survivors live healthier and, perhaps, longer.

Cancer patients used to be told to go home and take care of themselves without too many specifics for life after treatment. Now, as soon as they’re feeling strong enough, they’re advised to mind their lifestyle: lace up their sneakers, eat healthy, watch their weight and avoid tobacco and excess alcohol.

Cancer survivors often need a tailored lifestyle program because side effects from their treatments can make it harder for them even to put on their shoes and go outside.

While advances in battling cancer have grabbed the spotlight, post-treatment life has gotten much less attention, as detailed more than a decade ago in an Institute of Medicine report called “From Cancer Patient to Cancer Survivor: Lost in Transition.” A patient who turns into a survivor faces many challenges: physical and psychological effects of treatment, including fatigue, numbness, pain and anxiety; and additional disease. Some effects can appear months or years later.

Lifestyle and well-being
A healthy lifestyle can help survivors feel better and cope with the changes that cancer brings.

“Cancer forever changes an individual — not because of the cancer itself; usually, it’s because of the treatment,” Schmitz said.

Fatigue is the most common side effect of many cancer therapies, and some fatigue can persist for months or even years, according to the National Cancer Institute. More than 100 studies have shown that survivors who participate in exercise programs reduce their fatigue levels, said Ligibel, who is also an assistant professor at Harvard Medical School.

Weight loss and exercise improve quality of life and the functioning of the body for cancer survivors, she said.

Studies suggest that exercise may help cognitive functioning in cancer survivors. After treatment some can feel a general mental fog in attention, thinking or short-term memory.

People with early forms of many cancers, including breast and prostate, may have a higher risk of dying of heart disease or other disorders than of cancer, Ligibel said. Cancer and heart disease share many risk factors, such as obesity and inactivity. Cancer treatments can also cause people to gain weight and become less active, increasing the risk of heart disease and diabetes. Finally, some cancer treatments can have a direct adverse impact on the heart. For all of these reasons, physical activity and nutrition are very important for survivors.

Associations with disease
Being fit and eating well may help bolster energy levels and address some of the metabolic and biological factors in survivors that can create conditions for developing cancer and other diseases down the road, said Linda Nebeling, deputy associate director of behavioral research at the National Cancer Institute.

Over the past five years, research has increasingly focused on energy balance, a concept linking exercise, diet and weight: Calories eaten should be balanced by calories burned in exercise, thereby avoiding turning extra calories into excess weight.

Large studies have shown a relationship between energy balance and risk of cancer recurrence and death in people who have had breast, prostate, colon and perhaps other cancers, Ligibel wrote in a review article in the Journal of Clinical Oncology. Although cause and effect has not been established, data reveal that obesity is linked to an increased risk of breast cancer recurrence and breast-cancer-related death in women diagnosed with early-stage breast cancer, Ligibel said. Obesity has also been linked to recurrences of colon and rectal cancers.

Regarding diet, there is no “magic food” that promotes survival, said Cheryl Rock, a professor of family medicine and public health at the University of California at San Diego School of Medicine. Many researchers examine patterns of eating because foods and nutrients are not consumed in a vacuum. Dietary patterns that stress red and processed meat and fat may be linked to an increased risk of colon cancer recurrence. Experts see promise for survivors in a diet rich in fruits, vegetables and whole grains, with low-fat dairy products — a pattern that may aid survival and avoid recurrence as well as keep at bay conditions such as heart disease and diabetes.

Links or relationships have been seen between lifestyle factors and the risk of cancer recurrence, but more-direct evidence, from trials that actually test whether such things as exercising and losing weight reduce the risk of death after cancer diagnoses, is not yet available. Major survivorship studies are underway in such areas as colon cancer and exercise, breast cancer and weight loss, and ovarian cancer and lifestyle interventions.

A page from heart disease
The focus on survivor lifestyle takes a page from heart disease. Cardiac patients were once prescribed bed rest. President Dwight D. Eisenhower toppled that notion in the 1950s after he suffered a heart attack in office. With his doctors’ encouragement, he continued to work and returned to his favorite activities of walking, golfing and fishing. Today, getting heart patients moving as soon as possible is standard cardiac rehabilitation.

Researchers hope to develop similar care standards for cancer survivors, but more work is needed. “You can’t change policy without evidence-based research,”

Missed benefits
As research continues, many survivors fail to incorporate lifestyle changes into their daily routines, often for financial reasons.

Schmitz conducts research trials of exercise interventions for breast cancer survivors. She was lead author of a study published in 2012 that followed 600 survivors for six years to assess needs and benefits of physical therapy and rehab exercise. At six years post treatment, more than 60 percent had at least one symptom that could have been helped by a physical intervention.

Schmitz has been angered to find that many in her studies had developed disabilities because the circumstances they returned to after treatment were ignored. The women had jobs — as child-care workers, nursing aides and cleaners, for example, that required much physical labor. Without adequate physical and occupational therapy, they returned to work and developed such severe upper-body difficulties that they became disabled.

Unlike many other countries, the United States lacks consistency in assessing cancer survivors’ needs and in funding rehabilitation, nutrition counseling and ongoing care. Ligibel said that survivors need an infrastructure that takes them from finishing treatment and being fatigued to a program of being more active and getting help with nutrition. It’s “hard for people to make these changes on their own,” she said.

Research into the possible links between lifestyle and cancer survival may help raise the profile of cancer rehabilitation. “Hopefully that will lead to better development of infrastructure and third-party payment to help people actually do these things,” .

Enormous strides have been made in keeping cancer patients alive, and lifestyle may help many rebuild survivors’ quality of life. “It is no longer enough to say, ‘Well, you’re alive,’ ” .

There is no doubt that many survivors are not living the way they want to. “I think our goal now is to give people the lives back they had before their diagnosis,”

“So we have to help them not only to live longer but also to live better than they are now.”

original article : Washington post more  

View all 6 comments Below 6 comments
Fatigue is the most irritating side effect.Joining back my work helped me tremendously as far as my mental state is concerned but I have to be very careful about my diet and exercise.Fresh coconut water everyday is the most miraculous drink.I used to walk 3-4 km everyday prior to the disease but now I just CANNOT do it. If anyone can suggest some food items to overcome fatigue, it will be very helpful. more  
Hi Mohan, Thanks for the wishes. they simply get us all going without borders. wishes Dr Chandna more  
Mr Sivaraman, please do not hesitate to share with anyone you feel may need this or any information that you find useful. more  
Yhank you sir. very informative and useful. can i share it with my friends and relatives? more  
Dear Dr. Chandra, Thanks for your excellent and elaborate article. Cancer patients and survivors need compassion, moral and physical support from their families and friends for their longer and healthy survival. I treated my father for Ca Prostate at Kidwai Memorial Institute of Oncology, Bangalore, that was detected at Stage IV in 1998 and kept him alive for the next seven years. Doctor, please continue to contribute in this forum to educate and advice patients and relatives as a social cause. With lot of thanks and regards, Mohan more  
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