How Can I Maintain a Healthy Lifestyle During Cancer Treatment?

Guidelines Address Diet and Exercise During Cancer Treatment

Eating nutritious foods and exercising are important for good health, even during cancer treatment. But how can you ensure you’re using your limited energy and time well, all while coping with your treatment schedule and side effects?

The American Society of Clinical Oncology now provides guidance on exercise and diet for people in active treatment for cancer. This is the first published guideline specifically about the time of treatment, although research-backed recommendations already exist for weight control, dietary choices, and physical activity to prevent cancer, and also during the period of survivorship.

These guidelines, which appear in the Aug. 1, 2022 edition of the Journal of Clinical Oncology, are based on 52 systematic reviews of published data (42 for exercise, nine for diet, and one for weight management). Systematic reviews are formal reviews of all published peer-reviewed scientific papers on a particular topic. Researchers reviewed an additional 23 randomized controlled trials to see if there was enough evidence to make specific recommendations for exercise and diet during the time of active treatment. Below is a recap of these guidelines and key points of interest.

Exercise Improves Mobility, Quality of Life

Jennifer A. Ligibel, MD, a medical oncologist at the Dana-Farber Cancer Institute in Boston, is one of the guideline’s authors and explained that information on exercise for patients during active treatment has been lacking.

The studies that she and her colleagues looked at found good rationale for starting or continuing an exercise routine during treatment for cancer.

“People who did aerobic exercise and/or a strength training program had less fatigue, a better quality of life, and they are more able to maintain their fitness. That’s important in terms of how well they recover from therapy,” Dr. Ligibel said.

Although there wasn’t sufficient evidence to recommend exercise to improve cancer outcomes like survival, the researchers did note that other benefits could include reduced anxiety and depression.

This might sound counterintuitive, considering previous recommendations to rest during treatment, but getting in some steps and increasing them each day can have lasting benefits.

“Certainly you should listen to your body, but being on the couch for the duration of your treatment is not the best thing,” she said.

Dr. Ligibel said to start slow, maybe by walking around the block, and then slowly increase your distance each day.

Additionally, the American College of Sports Medicine offers specific guidelines for exercise to address cancer-related fatigue, physical function, anxiety, and depression.

No Specific Diet Is Recommended

One of the most common questions patients have is about what to eat (and what not to eat) during treatment, but there isn’t enough evidence to recommend any specific diet plan.

“Diet and exercise are both important lifestyle factors that are generally considered together,” said Wendy Demark-Wahnefried, PhD, RD, one of the guideline authors and a nutrition scientist at O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham. However, because there were so few studies of an adequate size that looked at diet during treatment, no recommendations could be made. Notably, the researchers found little evidence to support the neutropenic diet, which was sometimes used to reduce the risk of foodborne infection. Neutropenia occurs when you have too few neutrophils, a type of white blood cell that fights infections, and the neutropenic diet involves avoiding foods, such as raw fruits and vegetables, that could cause infection.

“The guidelines do not recommend a neutropenic diet, because there is no evidence to support it, and people are needlessly restricting their intake of fruits and vegetables when these very foods could be helpful,” Dr. Demark-Wahnefried said. The guidelines do recommend having excellent kitchen safety habits, including carefully washing raw fruits and vegetables.

The guidelines also noted that there isn’t enough information to recommend for or against specific eating regimens like ketogenic diets, low-carbohydrate diets, low-fat diets, functional foods, or fasting.

For people in long-term cancer care or who have finished cancer treatment, Dr. Demark-Wahnefried suggested looking into the American Institute of Cancer Research (AICR) for ways to eat a well-balanced diet while decreasing the risk for secondary cancers. AICR has a Food Facts library to help in making healthy choices.

Be Part of the Research

The lack of evidence is a call to action for more research into diet modification, as well as whether weight loss is beneficial during active treatment for patients who are carrying extra pounds.

The National Cancer Institute is currently sponsoring the AMPLIFY diet and exercise study for cancer survivors. This web-based diet and exercise program is for people who are committed to taking the next year to lose weight, eat healthier, and move toward better health. By logging only 15 to 20 minutes each week and interacting with the program, cancer survivors can begin their journey to better health through evidenced-based lifestyle plans, personalized just for them.

The study is open to survivors age 50 and older in the United States who completed treatment for breast, prostate, colorectal, endometrial, ovarian, renal, and thyroid cancers, as well as multiple myeloma and Non-Hodgkin lymphoma.

A Patient’s Perspective

Beckie Gladfelter, an educator, and author of My Warrior Mommy: Our Breast Cancer Journey was diagnosed with breast cancer just shy of her 40th birthday.

During her treatment, which included bilateral mastectomy, axillary node dissection, chemotherapy, and radiation therapy, Gladfelter’s doctors emphasized the importance of exercise and diet as an ongoing component of treatment.

“Walking would improve my bone and physical health as well as my mental health. And diet was important to ensure I was eating foods that would support and maintain my recovery,” she said.

But sometimes, it wasn’t easy to follow the recommendations.

“At times, exercise and diet have been challenging to successfully achieve or maintain, either because I did not have the energy to walk, my treatment changed the taste of food, or I did not take the time it deserved,” she said. “But with the encouragement of my doctors and a will to do better, I continue to take diet and exercise as a serious part of my treatment.”