Download Cancer Survivorship - Cancer Action Coalition of Virginia

Cancer Survivorship
Steven Duffy, MD
Bon Secours Cancer Institute
St. Mary’s Hospital
Richmond, VA
“People are living longer after a cancer diagnosis.
Cancer survivors often face physical, emotional,
social, and financial challenges as a result of their
diagnosis and treatment. As the number of cancer
survivors grows, CDC is working with partner
organizations to help survivors, along with the
people in their lives, throughout their cancer
experience.”
-cdc.org
According to the American Cancer
Society, there are now more than 14.5
million cancer survivors in the United
States. That number is expected to
grow to nearly 19 million by 2024.
What is a cancer survivor?
“An individual is considered a cancer
survivor from the time of diagnosis,
through the balance of his or her
lives.”
-NCCN (National Comprehensive Cancer Network)
Overview
I have 15 minutes.
Buckle up!
Definition of cancer survivorship.
Broad view of what it entails.
It’s all important, it’s all skimmed
over by many.
Focus on lifestyle.
When to focus on survivorship:
Most guidelines (including NCCN) focus
on survivorship after completion of
cancer treatment and when the survivor
is in clinical remission
Treatment Overview
Neoadjuvant Definitive Tx Adjuvant
Palliative
Standards for survivorship care
 Prevention of new and recurrent cancers.
 Surveillance for cancer spread, recurrence, or second
cancers.
 Assessment of late psychosocial and physical effects.
 Intervention for consequences of cancer treatment
(medical problems, symptoms, psychologic distress,
financial and social concerns).
 Coordination of care between primary care providers
and specialists to ensure that all of the survivor’s
needs are met.
When cancer treatment finishes
 National Cancer Institute (cancer.gov) to patients:
 “A new normal”
 physical and emotional (coping with fear of cancer coming back)
 Focus on things you can control
 being involved in your health care, keeping your appointments
 making changes in your lifestyle
 no one can control every thought, some say that they try not to dwell on the
fearful ones
 Follow-up care
 the survivorship care plan (stay tuned)
Surveying Patients (NCCN)
 Cardiac toxicity (symptoms, anthracycline and
targeted chemotherapy, radiation)
 Anxiety and depression
 Cognitive function
 Fatigue
 Pain
 Sexual dysfunction
 Sleep disorder
 Healthy lifestyle
 Immunizations and infections
Healthy Lifestyle
 Survivors should be encouraged to achieve and maintain a
healthy lifestyle with attention to weight management, physical
activity, and healthy dietary habits.
 Healthy lifestyle habits have been associated with improved
overall healthy and quality of life. For some cancers, a healthy
lifestyle has been associated with a reduced risk of recurrence
and death.
 Maintain a healthy diet high in fruits, vegetables, and whole grains
and low in red and processed meats, sugars, and fats in order to
promote weight control and avoid obesity.
Healthy Lifestyle
 Minimize alcohol.
 Avoid tobacco products.
 Practice sun safety.
 Age appropriate health screening.
 Follow with primary care physician
regularly.
 Routine use of dietary supplements is not
recommended for the purpose of cancer
control.
Diet
 “Diet and nutrition are estimated to account for
approximately 30% of all cancers in developed
countries and 20% in developing countries.”1
 Two important points:
 Disease of the affluent.
 Prevention of nihilism.
We are taught the molecular basis of carcinogenesis.
“Multiple hit” hypothesis, tumor suppressors, protooncogenes, etc.
Can we have an impact on this?
1American
Cancer Society. Global Cancer Facts and Figures 2nd Edition [report on the internet]. Atlanta (GA): American Cancer Society; 2011.
Diet
So, what’s the optimal diet?
Many studies on this subject.
No perfect study.
Many different answers.
Diet
 Huang et al. Cardiovascular disease mortality and cancer
incidence in vegetarians: A Meta-Analysis and Systematic Review.
Annals of Nutrition and Metabolism. 2012.
 Review of studies from UK, Germany, USA, the Netherlands, and
Japan.
 124,706 participants in the analysis
 All cause mortality 9% lower in vegetarians
 29% lower mortality from ischemic heart disease
 16% lower mortality from circulatory disease
 12% lower mortality from cerebrovascular disease
 18% lower incidence of cancer
 There is no differentiation in the type of “vegetarian”.
Diet
 So, what about cancer rates among different types of vegetarians.
 Hard to drill down because of study limitations and small numbers
of patients.
 Tantamango-Bartley et al. Cancer Epidemiology Biomarkers and
Prevention. 2013 February.
 Study out of Loma Linda University looking at the 7th Day
Adventist population.
 Seventh-day Adventists are encouraged to eat a well balanced
vegetarian diet.
Diet
 Different kinds of vegetarian:
 Vegans ate red meat, poultry, fish, eggs, and dairy <1
per month
 Lacto-ovo-vegetarians ate red meat, poultry, and fish <1
per month, and eggs and dairy ≥1 per month
 Pesco-vegetarians consumed red meat and poultry <1
per month, and fish ≥1 per month;
 Semi-vegetarians ate red meat, poultry, fish 1 per month
to 1 per week, and eggs or dairy at any level
 Non-vegetarians, red meat, poultry, fish >1 per week,
and eggs or dairy at any level.
Diet
 69,120 participants in the Adventist Health
Study-2
 2,939 cancer cases were identified
 The rate of cancer was statistically significantly
lower in vegetarians vs non-vegetarians (8%).
 Overall those following vegan diet had a 16%
lower incidence of cancer.
 Those following vegan diet had a 34% reduction
in the rate of female specific cancers.
Diet
 Animal Protein and Cancer (The China
Study)
 Began with research on Aflatoxin contamination of
peanuts and childhood rates of liver cancer in the
Philippines.
 Liver cancer became disease of affluent – those who
could afford to eat meat.
 This lead to animal experiments confirming these
findings.
Diet
There is too much focus on:
Medication
Good where there’s data, but if there is no medication, it
doesn’t mean there is nothing else to do.
Genetic destiny
Where is there consensus?
A plant based diet and eating animal
products in moderation.
MD Anderson, NCCN, ASCO, NCI, ACS
Diet
 Is it best to avoid all animal protein and adapt
WFPB diet?
 Some studies show benefit, but not all do.
 Processed food is bad. Is benefit due inherent
avoidance? Candy?
 Can a WFPB diet cure cancer? No.
 Can it make you cancer proof? No.
 Can it improve quality of life, make you healthier
and decrease the chance of developing cancer or
having it return after treatment?
Overview
Definition of cancer survivorship.
Broad view of what it entails.
It’s all important, it’s all skimmed
over by many.
Focus on impact of lifestyle.
Survivorship Resources
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National Coalition for Cancer Survivorship (NCCS)
American Association for Cancer Research (AACR)
American Cancer Society
American Institute for Cancer Research (AICR)
American Society of Clinical Oncology (ASCO)
Cancer Care
Center for Disease Control and Prevention (CDC)
Leukemia & Lymphoma Society
LIVESTRONG
National Cancer Institute (NCI)
National Comprehensive Cancer Network (NCCN)
MedlinePlus
Thank You!