Download Overview of the role of diet in cancer survival

Marie Cantwell PhD, MPH
Centre of Excellence for Public Health
Queen’s University Belfast
Cancer – Chronic condition
Dietary management of cancer patients
is typically seen during the patients
active treatment phase – weight loss,
anorexia, cachexia, nausea, vomitting
Long term survival- No advice for
patients in terms of diet and lifestyle
similar to cardiac rehab or dietary
management of diabetes
Cancer Survivorship
• 62% 5 year survival over all adult cancers
• 60, 000 cancer survivors (diagnosed in the previous 5 years) in
Ireland
• Increased risk for developing secondary cancers, other chronic
diseases (CVD diabetes)
• Environmental factors such as diet and physical activity
contribute
• Unhealthy behaviours tend to cluster in the population at
Aziz;survivors
J Nutr 2002; 132: 3494S
large and specifically among cancer
Major Lifestyle Opportunities for Cancer
Survivors
Opportunity
Prevalence
Inadequate diet
Physical inactivity
Smoking
Overweight/obese
75%
54%
26%
68%
US-NHIS interview, ages 40-64 years
Coups EJ & Ostroff JS Prev Med 2005; 40:702-11
Lifestyle Interventions in Breast
Cancer Survivors
Randomised Controlled Trials
WHEL Study (Women’s Healthy Eating and Living
Study)
RCT 3088 early stage breast cancer survivors (1995-2000); age 27-74 yrs
Diet intervention counselling
Randomised
5 vegetable servings
16 oz vegetable juice
3 servings fruit
30g fibre
15-20% calories fat
Control (print material, 5 a day)
Primary outcome: breast cancer events, death- no effect on disease free survival
Secondary outcomes
Pierce et al. JAMA 2007;278-289
1. Significant diet change
2. Significant change in selected biomarkers
(carotenoids, oestradiol (total and bioavailable)
3. No significant weight change (I year)
Women’s healthy Eating and Living
Study (WHEL)
• Among survivors of early stage breast cancer,
adoption of a diet that was very high in vegetables,
fruit, fibre and low in fat did not reduce additional
breast cancer events or mortality during a 7.3 year
follow up period
WINS
Risk of Recurrence
low fat diet vs. control
Women’s Intervention Nutrition Study
(WINS)- role of low fat diet
• Lifestyle intervention reducing dietary fat
intake (target 20% E), with modest influence
on body weight, may improve relapse-free
survival of breast cancer
• 24% reduction in risk for recurrence; subset
analyses suggest that this effect was even
greater among women with oestrogen
receptor-negative disease
Chlebowski et al, 2006, J Natl Cancer Inst 98(24):1767-76.
Prospective Cohort Studies
Prospective Cohort Studies
1. Healthy Eating Activity and Lifestyle (HEAL) study (USA
multicentre) n = 1182
2. Life after Cancer Epidemiology (LACE) USA multicentre n=2321
3. Shanghai Breast Cancer Survivors Study n= 5000
4. Pathways Northern California n= 4000
5. DietCompLyf Study –UK multicentre n= 3000
Weight management and Breast
Cancer Survival
Change in BMI after diagnosis & association with
recurrence & mortality
Data from cohort of 5204 Breast Cancer Survivors in Nurses Health Study
1.8
1.6
1.2
1
recurrence
breast cancer mortality
all cause mortality
0.8
0.6
0.4
0.2
>0.5 loss maintain
0.5-2.0
gain
>2.0 gain
0
Relative Risk
1.4
Physical Activity and Breast
cancer survival
Relative Risk
Observational Cohort Study of
Exercise After Diagnosis & Association with Recurrence & Mortality
Data from Cohort of 2987 Breast Cancer Survivors in Nurse’s Health Study
Level of Exercise (MET hrs/week)
Holmes et al. JCO 20:2479-86, 2005
Ongoing work - Cancer Survivors
A randomised controlled trial to evaluate
the efficacy of a 6 month dietary and
physical activity intervention for prostate
cancer patients receiving androgen
deprivation therapy
• Androgen deprivation treatment (72%)
• Outcomes of interest: body composition,
fatigue and QoL
Side effects of Androgen Deprivation
Therapy
Body compositionDecrease in lean body mass
Decrease in muscle strength
Decrease in bone mass and BMD
Increase in fat mass
Increase in total body weight
FatigueQuality of Life-
Others-
Impotence
Hot flashes
Growth of breast tissue
Osteoporosis
Anaemia
Ongoing Research
DietCompLyf study - Role of diet, lifestyle and
complementary therapies on breast cancer survival
study
Prospective Cohort Study:
50 centres
3000 breast cancer patients
Collected FFQ, Food Diaries, Serum, Urine
1. Change in food /nutrient intake after breast cancer
diagnosis – Louiza Valentzis
2. Dietary patterns and breast cancer survival and
quality of life in a cohort of breast cancer survivorsSarah Brennan, Marice Lunny
Conclusions
• Adjuvant treatments for breast cancer lowers
disease mortality 25-40%
• Weight maintenance after breast cancer may
lower disease mortality ∼ 40%
• Moderate exercise after breast cancer may
lower disease mortality ∼ 40-50%
Conclusions
• Advising weight maintenance and exercise after breast cancer may help
our patients as much as standard treatments
• Important in our sedentary & obesigenic environment.
• Diagnosis of cancer –”Teachable moment”
• Often demonstrate an enhanced motivation to change their lifestyle
behaviours
• Interventions that address multiple risk factors such as diet and physical
activity in more diverse populations and for other cancer sites, are
required
Thank you for your attention
American Cancer Society
•Achieve or maintain a healthy weight
•Choose foods that help maintain a healthy
weight
•Eat a variety of foods with an emphasis on
plant foods
•Eat 5 or more servings of a variety of
vegetables & fruit each day
•Choose wholegrain in preference to
processed (refined grains & sugars)
•Limit consumption of red meats especially
those high in fat and processed
•If you drink alcoholic beverages limit
consumption
Dietary Intake and body weight change
during WINS and WHEL Intervention