Tag Archive for: physical activity

What Role Does Exercise Play in Cancer Treatment?

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How can exercise benefit cancer patients? PEN Program Manager Joelys Gonzalez and Communication Manager Nicole Normandin Rueda, LMSW discuss the benefits of exercise to cancer health and recovery, recommended exercise types, and tips for patient support and maintaining some level of activity. 

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Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 How Do Psychological Factors Impact Diet During Cancer Treatment?

How Do Psychological Factors Impact Diet During Cancer Treatment?

Transcript:

Lisa Hatfield:

How can staying active during cancer treatment benefit your overall health and recovery? In this Patient Empowerment Network RESTORE program, we’ll explore the vital role of exercise in cancer care and uncover how incorporating physical activity into your treatment plan may enhance your well-being and support a better outcome. 

Joelys, how can physical activity be safely incorporated into a cancer treatment plan? And what types of exercises are most beneficial for patients? 

Joelys Gonzalez:

Well, incorporating physical activity into a cancer treatment plan requires more of a personalized approach, considering the type of cancer or the treatment being received or the overall health. I often start this discussion with patients by letting them know the importance of exercising during and after treatment, explaining how it can help manage side effects such as fatigue, stress, and depression. I usually recommend starting with low impact activities such as swimming, walking, or gentle yoga, as long as, of course, the patient is able to move around, whatever you’re capable of, which can be just adjusted based on the patient’s energy levels and how they’re feeling on day by day. Of course, if they’re feeling low, they can start doing small activities, light activities, such as moving your fingers or moving your head around. 

I also stress the importance of listening to your body, making sure you know how your body works, and making sure that you’re not overstressing your body. It’s very important. Resting as much as needed. It’s very important to be able to stay active. To ensure safety, I encourage them to check in regularly with their healthcare team just to make sure that they are having a tailored, a personalized plan, a personalized exercise plan with them. That could be involving physical therapists or their dietician to make sure that they have a unique plan. And by making physical activity as flexible as possible and adaptable to their part of their daily routine, patients can enjoy its benefits without feeling overwhelmed and alone.

Lisa Hatfield:

Thank you for that. And I really appreciate your comments. And I know Nicole and I have talked before, even small movements like moving your fingers and your toes or any movement is better than no movement, because sometimes we are just flat out too exhausted or in too much pain to do much more. So I appreciate you saying that for patients that you can do any little movement and that’s beneficial. So thank you. And, Joelys, what are the potential benefits of maintaining an active lifestyle during cancer treatment, particularly regarding treatment outcomes and overall well-being? 

Joelys Gonzalez:

Maintaining an active lifestyle during cancer treatment can have some profound effects on both treatment outcomes and the patient’s overall well-being. And when I mentioned that physically, physically staying active helps fight the treatment-related side effects, such as fatigue or muscle loss or weight changes. It could also support the cardiovascular health, which is very important since most cancer treatments can affect your heart. For instance, if you do such light exercise like walking or cycling, that can help you improve your blood circulation, helping you reduce the risk of blood clots or other complications from the treatment.

And this can also help you mentally. Maintaining that regular physical activity can significantly reduce your stress and improve your mood, especially when it comes to anxiety and depression, which are the most common among patients living with cancer. I’ve seen patients who incorporate daily movements into their routine, which has made them stronger than they have been before in the sense of control over their overall health, which boosts their confidence and their resilience during their cancer treatment.

Additionally, exercise has been shown to improve sleep, which is often disturbed during their treatment. And from a social work perspective, engaging in group activities or even walking with a friend or a family member can reduce your feelings of isolation, the feelings of being alone, and it can actually help you in building that support network that you need through your cancer journey, which is very very important. I really reiterate that having someone next to you not just to talk and just to make small exercise that can help you a lot during your cancer treatment, and the overall maintaining an active lifestyle helps patients manage their treatment better and contribute to a higher quality of life during and after cancer treatment.

Lisa Hatfield:

Nicole, how can healthcare providers effectively support and motivate cancer patients to stay active despite the challenges posed by their treatment? 

Nicole Normandin Rueda, LMSW:

Great question. So healthcare providers are often the first line of defense, right? And so they have this unique opportunity to really invest in getting to know their patients, which will then in turn…it will be the strategy that they use whenever it comes to tailoring the actual like exercise plan, for each patient. What that means really is that we get to know the patient’s needs, their abilities, knowing a little bit more about their diagnosis or their treatment, the side effects, or potential barriers. The more, the better you can tailor the actual personalized plan for each patient.

That also means not just the oncology team, but all the ancillary services. So your physical therapist, your exercise specialists, there are movement specialists. I mean, there’s a whole, a plethora of resources that can be brought in to help make sure that a patient…their treatment stage, their overall health, any secondary or other diagnoses that they may be managing as well as their just physical capabilities are all things that we want to make sure are very…we’re thinking about those at all times. We want to make sure whatever it is that we’re asking them to do is safe and achievable and aligned with their needs.

The encouragement from your oncology team and hearing that you know what you’re doing great, your small steps are baby steps, but they are steps and we are proud of that. Kind of that affirmation is huge. The next thing I would say would be setting the realistic goals and being on top of the potential barriers. So we all know how great it feels to check something off a box or cross something off a list, right? So we want to give patients that sense of pride and the sense that they are able to do whatever it is that we’re asking them to do, even if it’s very small and manageable.

Our goal is to help alleviate any potential future issues or current issues, secondary to their diagnosis. So if that means it’s fatigue, if it’s pain, if it’s the circulation, all of these things that we want to alleviate or inhibit from happening or getting worse, that’s important that patients know why we’re asking them to do something and setting the goals that are small enough and achievable that they can feel that sense of accomplishment is a big deal. Again, I mean, I can’t say this enough, I want every patient to know they are not alone. There are fantastic resources online to get, even if it’s stretching exercises.

I mean, there are things that are tailored to people with cancer that are absolutely incredible and free, that patients should be able to have the support that they need. Not just emotionally, but also physically, if that’s in-person or virtual, there are resources available that can help get whatever it is that patients need under their belt and so that they have the tools they need to go and accomplish whatever it is that they are being asked to accomplish. And that gives them that sense of pride that also makes it usually a success story, right? At least for that small piece of their treatment, they can say, I was able to do what it is that you asked me to do. That’s great.

And healthcare providers, like I said, are the first line of defense. They’re the ones that are checking in and asking the questions and so making sure that we’re always asking, but also listening to what it is that patients are saying. So if they’re saying, no, I didn’t really get around much today. Maybe we need to tailor what it is that your homework is going to be for the next week or whatever, to make sure that you are getting what it is that you need from us. 

Lisa Hatfield:

Okay. Thank you. And I appreciate that you talked about even celebrating the smaller, what seems to be smaller accomplishments. Like, sometimes if you can walk even five feet a day, you’re trying to walk again, even that, Yay, that’s exciting. Instead of thinking, well, before I used to be able to walk a half a mile or whatever. I think celebrating those small, those smaller steps are just as important. So thank you for bringing that up. It does give patients a sense of pride. You’re right.

Nicole Normandin Rueda, LMSW:

Absolutely.

Lisa Hatfield:

Well, you heard it here directly from the experts. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Lifestyle Interventions and Cancer Care Outcomes Research

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What’s important to know about lifestyle interventions and cancer care outcomes? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses lifestyle interventions of physical activity and weight loss on cancer outcomes, controversy about body weight, and exercise levels during cancer treatment that show cancer outcome benefits. 

Download Resource Guide

See More from RESTORE

Related Resources:

How Does Nutritional Screening and Assessment Impact Cancer Care?

How Does Nutritional Screening and Assessment Impact Cancer Care?

 What Supportive Care Treatments Are Available to Patients?

What Supportive Care Treatments Are Available to Patients?

 What Is Supportive Care Therapy in Cancer Care?

What Is Supportive Care Therapy in Cancer Care?

Transcript:

Lisa Hatfield:

How can lifestyle changes impact cancer care outcomes? The answer may be more crucial than you think. In this Patient Empowerment Network RESTORE program, we’ll connect with a respected expert on the ground floor of this research. 

Dr. Ligibel, your research highlights the impact of physical activity and body weight on cancer risk and outcomes. Can you explain how exercise and weight loss interventions influence biomarkers associated with cancer risk and outcomes?

Dr. Jennifer Ligibel:

Absolutely. So this research is, I think, both really, really exciting and empowering for patients, because exercise and nutritional change are things that people can do themselves that don’t involve a prescription. But they can also be kind of confusing and leave people sometimes feeling like they’re not sure what the right thing to be doing is to support their long-term cancer outcomes. The truth is we do know that there are patterns that we see in society.

Like if you ask a lot of cancer patients, how much do you exercise and you track their weight. We see that people who exercise tend to have better cancer outcomes. So they tend to have a lower risk of cancer returning and a higher likelihood of surviving their cancer. For common cancers like breast cancer, colon cancer, prostate cancer, not as much evidence in some other cancers. We also know that people who keep their weight in a healthy range are less likely to develop cancer in the first place, and they’re less likely in some cancers, mostly the ones we talked about, breast, prostate, and colon to have their cancer return or die from cancer.

But what we don’t know is what aspect of lifestyle really drives these relationships, because the thing that’s complicated is that somebody who exercises more tends to have a little bit of a different dietary pattern than somebody who doesn’t. It’s not true for every single person. I’ve known marathon runners that live on Twinkies. But for the most part, people that exercise more are thinking more about their diets. They tend to weigh a little bit less, they smoke less. They may be going to do their screening mammograms and colonoscopies more often.

So it can be really tricky when you look at a large group of people and you just ask them what they’re doing and following them to make direct cause and effect relationships between one particular thing, like exercise or eating a particular food and their cancer outcomes. And this is one reason why my group at Dana-Farber, the research that we do really seeks to put people into interventions where we take a group of people that maybe aren’t exercising or they have a body weight that’s kind of above the ideal, and we help them to lose weight or to exercise more.

And we compare two groups of people that were the same at the beginning. One group took part in our program, the other didn’t. And then we’re able to kind of look more directly at whether these types of things affect their cancer outcomes, kind of what happens after their cancer is diagnosed. So we have some ongoing studies that are testing the effect of weight loss programs on cancer recurrence and breast cancer. We have some smaller studies looking at exercise and how that affects cancer. But the truth is we don’t a hundred percent know yet.

If we take a patient who’s not exercising or has weight in a certain range and we change that, is that going to have a direct effect on their cancer? We hope so, but that’s still something that we’re really studying. At this point, what we do know is that healthy lifestyle seems to be linked to lower cancer risk and better outcomes for people who’ve had cancer.

And I think the other thing that is really promising and hopeful is that there’s evidence that shows that even people that maybe didn’t have the healthiest lifestyle before being diagnosed with cancer, if they make some changes, they may have better long-term outcomes. So it kind of shows us that it’s not too late after cancer is diagnosed, but I think we’re still trying to really learn what are the particular factors for an individual person that are going to be most impactful to improve their cancer outcomes?

Lisa Hatfield:

Okay. Thank you. That gives cancer patients a lot of hope too, to know that going forward I can make some changes. In your randomized trials, how have you measured the effects of exercise and weight loss on cardio, respiratory fitness, and body composition in cancer patients? And what have been the key findings in their implications for patient care?

Dr. Jennifer Ligibel:

Absolutely. So we’ve done a lot of work in taking people who’ve been diagnosed with cancer and perhaps aren’t exercising regularly, or their diet is not as healthy as it could be, or their body weight is higher than the kind of there’s…a lot of controversy about the best body weight. But we, we kind of look at different levels of overweight and obesity and how they relate to health outcomes.

So we’ve looked at many different studies where we take people who might not have the healthiest lifestyle, and then we help them exercise more. We work, have them work with a coach or take part in a structured program. The first studies that we did really looked at, just how do you get people to make these changes when they’re going through cancer treatment or afterwards? Because there are a lot of extra barriers. We all know it’s not so easy to eat well or to lose weight or to exercise regularly at any point, but then you add cancer treatment to that, and it becomes more complicated.

So our first studies really just looked at how do you get people to do it? Is it safe? And we found indeed it was safe and that we could get large groups of people to engage in these programs. Not just people we enrolled at Dana-Farber, but people from all over the country. And that was really good to see that we could scale things that way.

Then we were interested in looking at some of the biomarkers you talked about, like what happens when somebody who hasn’t been exercising starts to exercise, or somebody whose body mass index is 27 or 30 or kind of in the higher levels showing that they have excess adiposity. What if they lose weight? What changes? So we’ve been able to show that people who exercise or lose weight have favorable changes in their metabolic hormones, favorable in changes in inflammation, which we know is something that relates to cancer risk.

And most recently, we’ve been able to show that exercise in particular has an effect on the immune system, both throughout the whole body and at the level where breast tumors form. So that’s been really interesting and helps to perhaps show us how is it that exercise could lower someone’s risk of cancer and really seeing how it activates the immune system. We’re also doing studies that then look at really big long-term outcomes, like whose cancer comes back and whose doesn’t. Those studies are really, really complicated to do. They involve enrolling thousands of patients, and they take 10 years to get the results.

And so, we’re still waiting for some of the outcomes of those studies. But the work that we’ve done so far shows that it’s safe for people to exercise and lose weight throughout their whole cancer journey, that it is also very scalable, not just to small groups of patients, but we can do this more broadly across thousands of patients. We’ve shown that when you make these types of changes, your metabolism improves, your risk of cardiovascular disease potentially decreases, then people feel better. We’ve done a lot of work with quality of life and fatigue and other side effects, and showing that when you make these types of changes the side effects of cancer therapy are often lessened.

Lisa Hatfield:

Okay, thank you. One quick follow-up question also as a patient. If you were telling me about exercise and how it might reduce inflammation, is that cardio or strength training or a combination of both? Do you have a recommendation on that for patients?

Dr. Jennifer Ligibel:

So, that is a great question and something that has been studied looking at different kinds of exercise. So there’s definitely value to both cardiovascular exercise, things like walking and running or swimming and to strength training. And that can be done using body weight. Things like squats and lunges, using weights, using machines. Strength training exercise is really important for maintaining muscle, and we know that a lot of cancer patients lose muscle, and that losing muscle is associated with losing function. So, doing strength training exercise is so important for maintaining your muscles.

A lot of the studies that have looked at how exercise relates to long-term cancer outcomes have primarily studied aerobic exercise, and that literature is really strong, that as little as walking three times a week can have benefits, long-term benefits in terms of cardiorespiratory health and perhaps even cancer-related outcomes. There’s an important place for both cardiovascular and aerobic exercise.

here’s a group, the American College of Sports Medicine, who tried to bring together all of the research from intervention studies. So studies where they took people and they put them on exercise programs to look at, well, what changes when you’re on an exercise program? And they looked at all these studies and tried to develop what’s called a fit prescription. So frequency, intensity, time, and type of exercise.

So to be able to tell people, “All right, what you need to do is 30 minutes of cardio three times a week, and that’s what’s going to help you feel better from a fatigue standpoint.” And so, they’ve worked out a couple of prescriptions for things like anxiety and fatigue that really are helpful in thinking about, well, how much do you really need to do to start to see a benefit? And in most of these studies, it was at least 90 minutes of aerobic exercise and a couple of strength training each week were kind of the minimal level of exercise where people really started to have benefit.

Lisa Hatfield:

Okay. That’s really helpful. Thank you.

Dr. Jennifer Ligibel:

Sure.

Lisa Hatfield:

Dr. Libel, how do you integrate quality of life assessments into your research on energy balance factors? And what role do these assessments play in evaluating the effectiveness of lifestyle interventions for cancer patients and survivors?

Dr. Jennifer Ligibel:

This is really important, because supportive care is designed to help people feel better. And if we are making people more active or changing their lifestyle in a way that doesn’t help them feel better, then we’re really not satisfying kind of the primary goal of supportive care interventions. And so, this is why we really make sure that we measure what are called patient-reported outcomes. So how does the patient feel as an integral part of the work that we do.

And so, most of the time these types of measurements are done through questionnaires where you ask people, how do you feel? How much does this side effect affect you? How much does fatigue impact your daily life? What about nerve-induced, what’s called chemotherapy-induced peripheral neuropathy? How much does that affect you? How much does that stop you from doing the things that you want to do? So we generally evaluate like, is the symptom present? And if it is, how much does it impact your ability to do the things you want to do? And I think that, when we see that people feel better that these side effects lessen as a result of interventions, that’s really what leads us to want to take things from being part of a research study to part of the standard care that we provide to our patients.

Lisa Hatfield:

That’s great. Thank you. You heard it here from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

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How can diet and lifestyle changes impact cancer care and recovery? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses diet and exercise, comorbidities, self-regulation methods, and oncology dietitian support. 

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Transcript:

Lisa Hatfield:

How do patients optimize nutrition during cancer treatment? What are some actionable steps towards supporting behavior change during this critical time? I’m connecting with a respected expert to learn more on this Patient Empowerment Network RESTORE program. 

Dr. Thomson, how can changes in daily habits like diet and exercise really impact cancer care and recovery, and why is this something that patients and care partners should pay attention to? 

Dr. Cynthia Thomson:

Well, importantly, we move every day and we eat every day. And we can make decisions about what we eat and how we move that really can optimize not just our response to cancer treatment, but also our longer-term health, right? And keep that cancer at bay as well as reduce comorbidities, things like diabetes or hypertension that might sneak up on us as we age. And so it really is important to make healthy decisions about what we’re eating and how active we are as cancer patients, but also in general, everyone needs to think about these things.

Lisa Hatfield:

Okay, thank you. And Dr. Thomson, in your study, self-regulation was strongly associated with meeting nutritional and physical activity recommendations. What strategies could be employed to enhance self-regulation in cancer survivors, particularly through mobile app interventions? 

Dr. Cynthia Thomson:

Yeah, so, self-regulation is always a bit of a challenge for each of us, but it’s so important, right? And it starts really with mindfulness and really thinking about the connection between what we eat, how active we are, and how it affects our health. And believe it or not, a lot of people really haven’t given a lot of thought to that. And it’s amazing to me because as I work with patients, what I realize is when they make that connection, when they realize how much better they feel, it makes them kind of self-motivated to continue to self-regulate.

Now there are a lot of different ways you can self-regulate, and one is self-monitoring. And I think that’s probably the most common. Many of us have our watches, right? We have our little devices on our wrist that we use to monitor our activity and perhaps our sleep and maybe even some health outcomes. But in addition, you can do things like think about how you walk through the grocery store. You start in the produce section, right? Instead of going to the cookie aisle. You can think about where you park your car and are you allowing yourself to park further away so that you can walk. So setting some of those self-regulatory behaviors can really help.

You can, in terms of eating, write down what you eat. There are literally hundreds of apps where you can download information about what’s in the food you eat and guide yourself to make better choices. Most people will get tired of writing down what they eat. And so usually if people want to do kind of the written or the app approach, I’ll recommend that they pick a few days of a week or maybe the first week of the month and not burden themselves with doing this day in and day out because over time it begins to lose its excitement. The feedback that you’re getting is not quite as enticing and you begin to feel burdened and you may even change your habits for a lower quality diet simply because you’ve kind of had it with the app.

Lisa Hatfield:

Okay, thank you. Now for patients who are trying to monitor what their intake is and what their diet looks like and maybe they do have access to an app but maybe they don’t, do most cancer centers have a dietitian that a cancer patient can work with on nutritional information surrounding their cancer diagnosis? 

Dr. Cynthia Thomson:

Well, Lisa, I wish they did. But the data that we have suggests there is one dietitian for about every 1,208 patients, which is just dismal. So I do think it’s really important when you’re in care to ask for that referral and try to get in with an oncology dietitian. There are dietitians who practice outside of oncology that certainly can be helpful, but they’re not going to have the insights that you’re going to get from an oncology dietitian. You may have to go to a larger kind of academic or what we call comprehensive cancer center in order to locate a dietitian with this expertise. But I think it’s important to speak up and maybe we’ll get more dietitians on staff if patients advocate for this important information and support during their care.

Lisa Hatfield:

Okay, thank you. Dr. Thomson, how do you think self-efficacy and self-regulation can be effectively promoted in cancer survivorship programs, especially among populations with lower initial adherence to health behaviors? 

Dr. Cynthia Thomson:

Well, I think there’s a number of different ways that we can help people to self-regulate. I think the important thing is to meet people where they are. I think a lot of times as professionals, we’re really quick on giving advice that comes from our own context and our own set of values and beliefs. And most times when we’re asking people to do things that align with our values and beliefs, it doesn’t always work.

And so many times they say it’s really about listening. It’s about hearing the patient and really having patients share what is it that, why are you coming to see a dietitian or why are you interested in nutrition? What motivated you to come here today? What are you expecting to get out of these counseling sessions? And really focusing on having people understand where the gains are for them. I would say that many times it’s important to think about knowledge, right? Because a lot of times people will not have the foundational knowledge to make the right choices.

And certainly we need to support knowledge, but it really is much bigger than that. We have to support self-efficacy. We have to help them build belief in themselves that they can adapt a whole new dietary plan if that’s what is necessary. And so I think it’s really important for us to reward good behavior, support them in any way with information or advisement when they ask for it. And then also to really make sure that we repeat, repeat, repeat. Because I think a lot of times, especially patients in cancer therapy are dealing with a lot. And if you’re trying to work on changing your diet on top of everything else, sometimes it goes in and out and you have to kind of be there to repeat the messaging and support all along the way.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield.

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

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What are nutrition and intervention strategies for age-inclusive cancer survivorship? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses cancer research studies on diet and exercise behaviors, strategies to make studies more age-inclusive, and ways to increase self-determination in cancer survivorship.

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Does Diet Adjustment Impact Cancer Care?

Does Diet Adjustment Impact Cancer Care?

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

Navigating cancer treatment is challenging at any age. How can age-specific strategies support better outcomes for cancer patients? I’m getting insightful answers from a leading expert in this edition of the Patient Empowerment Network RESTORE program. 

Dr. Thomson, your study suggests that age at diagnosis was not a significant effect modifier. What implications does this have for designing interventions that address diet and physical activity behaviors across different age groups? 

Dr. Cynthia Thomson:

Yes, I think it’s really important when we think about designing studies that we think about what is best for the individual patient, right? And, unfortunately, when we’re designing trials and we’re trying to evaluate diet and physical activity, we have to keep what’s called treatment fidelity. We have to kind of give everyone the same package, right? Because we want to know if this package works.

On the other hand, we know that patients do best when we individualize that care. And so it’s kind of a dance that we do as researchers to make sure patients get what they need, but also are relatively adherent to a plan that we’re testing with hypotheses. And so I would say that in some of my research, age has not been an effect modifier. In others, it has. And it really comes down to two things, I think. One is in individual studies, the age range may be very narrow, right? A lot of times when we go to do exercise and diet studies, we focus on, oh, we don’t want anyone who has heart disease, or we don’t want anyone who might fall, or we don’t want anyone who’s, we’re going to drive up their blood pressure.

And so in order to keep things safe, we may develop an age range for enrollment in our trial that kind of excludes people at either end. And so that lack of significance as an effect modifier may just reflect that it was a pretty narrow age range. The other thing is I always tell people when I hang up my flyer and say, come join my diet and physical activity study, cancer survivor, we need you. It attracts the people who are already walking, the people who go, well, I’m a vegetarian, I’d be great for this study. And so one of the things that we really need to do in research is to be more inclusive and to get those different age groups into different studies. And we are starting to do that. I think there are more and more studies that are reaching higher and higher age groups, younger age groups, trying to be more inclusive.

Lisa Hatfield:

Okay, thank you. And then considering that health behaviors and beliefs among adolescent and young adults and adults or older cancer survivors were found to be similar, how should this influence the way that we approach the development of age-inclusive survivorship care plans? 

Dr. Cynthia Thomson:

Yeah, so care plans I think are imperative to really help people kind of have that self-determination about where they’re going during and after their cancer journey. And I think it’s important to think about age. I think it’s also important to think about race, ethnicity, resources that individuals have. We need to think about the individual overall and adapt our care plans to meet individual goals and individual needs. Even things like language, preferable language, many times are not addressed during cancer care or survivorship. And so we really have to get back to that and make sure that we’re meeting all of those needs across the spectrum of cancer survivors that we treat.

Lisa Hatfield:

Okay, thank you. And I just want to clarify a little bit the word or the term survivorship care plan. What exactly is that and what would that include for people who are wondering, hmm, I don’t have, I’m a cancer patient, but I don’t have a survivorship care plan. What might you tell them about that? 

Dr. Cynthia Thomson:

Usually it’s the nurses that really take charge of helping patients develop their survivorship care plan. And really, this is a written plan that goes within your medical record that really details, what your current health status is, what your goals are as a cancer survivor. It may even detail different resources, different providers you need to meet with, the frequency that you need to follow up on your survivorship care. And so diet and physical activity should be part of that survivorship care plan, but those plans are much broader. They’re really addressing all of the healthcare needs that a cancer patient will need to tap into both immediately and long-term.

Lisa Hatfield: Okay, thank you for explaining that. You heard it here directly from Dr. Cynthia Thompson. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

Does Diet Adjustment Impact Cancer Care?

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How is cancer care impacted by diet adjustments? Oncology dietitian Dr. Cynthia Thomson from the University of Arizona discusses potential impacts of strategies for symptom management, immune response, nutrient deficiencies, inflammation, and diet patterns. 

Download Resource Guide

See More from RESTORE

Related Resources:

What Is an Oncology Dietitian vs. a Nutritionist?

What Is an Oncology Dietitian vs. a Nutritionist?

 Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

Age-Informed Nutrition and Intervention Strategies for Cancer Patients Across All Ages

 Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Nutritional Essentials: Supporting Behavior Change During Cancer Treatment

Transcript:

Lisa Hatfield:

How can adjusting your diet support you through your cancer journey? I’m excited to connect with a top expert to help us find the answers on this Patient Empowerment Network RESTORE program.  

Dr. Thomson, what are the key components of nutrition that patients should be thinking during their cancer treatment? 

Dr. Cynthia Thomson:

I think to start with, people need to think about what kind of symptoms they might be having during treatment and how can nutrition help them manage symptoms because I think symptom management is probably the most central nutritional issue in terms of making sure people can get through their cancer treatment in a timely manner that aligns with the prescription and optimizes their outcome after treatment. So I think managing those symptoms is one of the key components.

The second is to really do an assessment of what you’re eating and the quality of that diet. Are there nutrient deficiencies that need to be addressed and really honing in on specific nutrients or eating patterns that need to be evaluated and addressed. And then I think the third is really to move towards that long-term cancer survivorship eating plan. Where we’re really promoting a diet that’s more plant-based, a diet that is going to help reduce comorbidities, a diet that’s going to help you have the highest level of vigor and vitality after treatment. And so it’s kind of a continuum from symptom management, address those deficiencies and inadequacies in the diet, and then let’s go after optimization to reduce any risk of cancer recurrence as well as keep us healthy overall.

Lisa Hatfield:

Okay, thank you. And, Dr. Thomson, can you speak to the connection, if there is one, between the immune system and blood type and its impact on diet for cancer patients? And is this a consideration during care for you and your colleagues while supporting patients through their cancer journey? 

Dr. Cynthia Thomson:

Yeah, so I do think there are a number of different, what we call fad diets, like the blood type diet, that are intriguing. Could our blood type actually dictate what diet we should be on and what diet is optimal for our health? I would say that there’s just a total lack of evidence for the blood type specifically. And so will research evolve in the future? I don’t know. I think right now we need a lot more preliminary evidence that this matters, and this is an important factor before we would move forward.

In terms of the immune system, I think this is where diet is critical, as well as physical activity. There is a lot of evidence that when we get active and when we eat certain foods, we can modulate how our immune system responds. And in fact, our immune system is the checkpoint, to make sure cancer does not develop in our bodies or that when it does develop, we can counter it.

I think it’s really important to think about what we eat and our physical activity to enhance our immune system. And I’ll give you, One of the more common examples is adequacy of vitamin C and making sure that we have adequate vitamin C for our immune system to respond. We also know that people who are deficient in vitamin D can have lower immune response. It can happen with other nutrients as well, but on the other side, we have things like inflammation, which is a hallmark of cancer. And so If we can select dietary components that are anti-inflammatory that reduce the inflammatory response within our bodies, then that also can help to modulate our cancer risk. So I think this connection between lifestyle behaviors and the immune system is critical. It is the primary mechanism by which these health behaviors protect us and keep us healthy.

Lisa Hatfield:

Okay, thank you. I do have a follow-up question. As a cancer patient myself, and I know you’re a cancer survivor also, so we hear a lot about different diets, the blood type diet we just talked about, and then things like the keto diet, eat more protein, eat less protein, eat plant-based, importance of the health of the gut microbiome. Is there any evidence that any one type of diet works better than another when it comes to not just cancer prevention, but maintaining where we’re at with our cancer, whether it’s curing it or maintaining, stabilizing the cancer when it’s not curable? Do you have any comments on that? 

Dr. Cynthia Thomson:

Yeah, I mean, I think, first of all, there is a lack of randomized controlled trials, what we consider the gold standard, right? So, in terms of, can I say to you, we have 18 studies that say, the Mediterranean diet is the way to go. We don’t have that. What we do have is a lot of what we call epidemiological data.

So when we look at the diets of individuals who are either prior to their diagnosis of cancer, during their treatment, or after their treatment, we have increasing evidence that people who eat certain diet patterns, like a Mediterranean diet, like an anti-inflammatory diet, or score high on what we call the healthy eating index, where the quality of the diet is very plant-based, lower in fat, lower in processed foods, particularly processed meats. When those patterns are followed, we see better outcomes in terms of survival, but we also see that we can modulate certain inflammatory responses, oxidative stress, et cetera, that lead to cancer. So the mechanisms are there as well.

Lisa Hatfield:

Is there any evidence that there are cancer superfoods that might help stop the cancer or prevent cancer? I hear about blueberries being a superfood. Can you name any superfoods, or is there evidence to support that? 

Dr. Cynthia Thomson:

Well, I think we all have our own superfoods, right? Broccoli, because it’s a cruciferous vegetable, or garlic and onion, which are known to enhance immune response against viral infections, or, on and on and on omega-3 fatty acids. And it could go on and on. So I always hate to say that any one food is going to prevent cancer. That is so unlikely. If there is one, it must be hidden somewhere. I just can’t imagine and so it really and increasingly we know this.

It’s a diet pattern, right? Like if you are, Lisa, putting blueberries on your cereal every morning, but that cereal is Cap’n Crunch or some other sugared cereal versus something that’s higher in fiber, like steel-cut oats or, you know. So I feel like we cannot look at foods in isolation because while one food may have a beneficial effect, we can easily counter that by making other choices that are not so healthy. And so we can eat this anti-inflammatory food and then counter it with a pro-inflammatory food. So it’s really the pattern of eating that we need to think about.

Lisa Hatfield:

Okay, thank you. You heard it here directly from the expert. Thanks for joining this RESTORE program. I’m your host, Lisa Hatfield. 

What Are the Benefits of Early Integration of Lifestyle Medicine?

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How can early integration of lifestyle medicine benefit cancer patients? Expert Dr. Amy Comander from Massachusetts General Hospital discusses the importance of lifestyle medicine and the pillars of lifestyle medicine as part of oncology care. 

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See More from RESTORE

Related Resources:

Enhancing Cancer Survivorship Through Wellness Strategies

Enhancing Cancer Survivorship Through Wellness Strategies

 Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

 Equity in Cancer Care: Accessing Lifestyle Medicine for All

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Transcript:

Lisa Hatfield:

The future of lifestyle medicine and cancer care holds immense potential for innovation. How do we harness the benefits early on? I’m connecting with a Harvard researcher to understand more in this Patient Empowerment Network RESTORE program. 

Dr. Comander, from your perspective, what are the key benefits of incorporating lifestyle medicine early in the cancer treatment continuum rather than solely focusing on survivorship?

Dr. Amy Comander:

When we think about individuals with cancer, who already have a very serious diagnosis, we want to help empower those individuals to improve their health to the best they can to help reduce the risk of other chronic diseases, reduce the risk of cancer recurrence potentially, and just feel better. And that’s why I think lifestyle medicine is so important and that these tools should be accessible to all individuals after a diagnosis of cancer.

And again, just focusing on learning about the importance of physical activity and nutrition and stress management and adequate sleep and social connection and avoiding risky substances. Again, it sounds overwhelming, and I usually tell my patients, just pick one thing that you want to start working on to help improve your health. And I will tell you, it’s amazing the progress that my patients have made. And I would say, like I think of a patient I saw the other day, she would tell you, “There’s no way in the world I ever wanted to get breast cancer.” It was definitely like the last thing on her list that she wanted.

But she did acknowledge that since her diagnosis, it was almost like a wake-up call, or a teachable moment that this is the time that I am now going to take charge of my health and be the healthiest version of me that I can. And I think that was really inspiring. And so I love hearing those kinds of comments from my patients once they have really taken charge and trying to improve their health behaviors in this way.

Lisa Hatfield:

Thank you. Dr. Comander, looking ahead, what innovations or advancements in lifestyle medicine do you anticipate will have the greatest impact on cancer care and survivorship in the coming years?

Dr. Amy Comander:

Well, there are so many exciting research studies coming out that are really further demonstrating the benefits of these lifestyle interventions for patients with a diagnosis of cancer. For example, so much research coming out about, learning about the mechanisms of the gut microbiome, or why exercise is important, or the benefits of achieving a healthy body weight, which I know is very complicated by the way.

So I think the more data we have to really demonstrate the importance of these tools for lifestyle medicine will really result in more widespread adoption of cancer centers around the United States, and around the world, really emphasizing that these tools need to be a key component of oncology care. And that’s certainly something I’m trying to do and I’m so grateful to partner with you to help spread this important message so we know that patients can learn about these tools to help take charge of their health as they’re going through cancer treatment.

Lisa Hatfield:

Well, you heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Enhancing Cancer Survivorship Through Wellness Strategies

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How can wellness strategies enhance cancer survivorship? Expert Dr. Amy Comander from Massachusetts General Hospital discusses research on lifestyle interventions, the role of nutrition and gut microbiome, and other impactful lifestyle interventions.

Download Resource Guide

See More from RESTORE

Related Resources:

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

 What Are the Benefits of Early Integration of Lifestyle Medicine?

What Are the Benefits of Early Integration of Lifestyle Medicine?

 Equity in Cancer Care: Accessing Lifestyle Medicine for All

Equity in Cancer Care: Accessing Lifestyle Medicine for All

Transcript:

Lisa Hatfield:

Ensuring overall well-being during cancer treatment involves more than just addressing the illness itself. Wellness strategies are key but do they really optimize the health of cancer survivors? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, what are some of the most effective wellness strategies you recommend for patients to incorporate during cancer treatment to support their overall well-being?

Dr. Amy Comander:

I’m really excited that over the past few years, we’re seeing more and more research demonstrating the important role of lifestyle interventions in terms of improving our patient’s outcome after a diagnosis of cancer. So I’m a breast oncologist, and of course there’s so much data in the field of breast oncology. But now we’re seeing so much data emerging with regard to individuals with prostate cancer or gynecologic cancers or hematologic malignancies, such as multiple myeloma.

So this is really an exciting time to be paying close attention to this field. So when you say, what are some of the most effective strategies? I have to pick my favorite exercise. This field of exercise oncology is really exciting, demonstrating that individuals who are able to engage in physical activity after their cancer diagnosis have improved quality of life, reduce cancer-related fatigue, and in many cases, improve outcome. And a lot of this data has certainly come from the field of breast oncology, but again, we are seeing it more and more in other types of cancers as well.

In terms of other wellness strategies, we’ve talked a lot about the important role of nutrition and thinking about some of those key concepts of what we consider an overall healthy diet, a predominance of fruits and vegetables, whole grains, limiting red meat, avoiding processed foods, and avoiding sugar-sweetened beverages and alcohol. So that’s kind of all part of a healthy diet that we think about. But more and more research is also demonstrating that diet can actually potentially influence outcome as well. And there’s a lot of research trying to understand the mechanisms of this.

And I think if your listeners are wondering, what’s an area where I can read more about this? I feel like the gut microbiome, learning more about that is really interesting. We know, for example, in the field of multiple myeloma research, or in the field of looking at immunotherapy drugs, a healthy, diverse gut microbiome, meaning those bacteria in your GI tract have favorable characteristics, and they’re very diverse and healthy, that is a reflection of the diet. Lots of healthy fruits and vegetables, fiber in the diet helps result in a healthy, diverse gut microbiome, which in emerging studies is showing that that is associated with an improved microbiome responsiveness to certain drugs, particularly immunotherapy.

So this is an exciting time. The field is evolving, but I’m excited to learn more as we continue to see these studies emerge.

Lisa Hatfield:

Thank you. And, Dr. Comander, how do you see lifestyle medicine contributing to optimizing the health of cancer survivors, particularly in reducing late effects and improving overall well-being?

Dr. Amy Comander:

I’m a strong advocate that these tools from lifestyle medicine should be a part of every patient’s cancer treatment. And these are pretty basic things when we think about, again, physical activity, encouraging exercise, following a healthy diet pattern, getting adequate sleep, social connection. Actually, let’s talk about social connection. I feel like that’s one when I first started getting to this field, I’m kind of like, yeah, social connection, that’s important.

But I will tell you, as I’ve been doing this more and more and working with groups of patients, focusing on providing education about diet and exercise and stress management and sleep and all of these important things that we’ve been talking about, I’ve noticed that the support from other individuals who truly get it, if you bring a group of patients together who are all going through treatment for multiple myeloma, or prostate cancer, or breast cancer, or whatever it may be, that support piece, talking to another person who’s facing the same challenge, who might want to meet you at the YMCA and go to that exercise class, or might be willing to text you, “Hey, how are you doing with those salads you’re trying to have for lunch each day?”

That accountability and support is such an important component of health. And I think we really learned during the pandemic how much social connection and support is so integral to our health. So I think in the field of oncology, the work this organization does, and so many others, that building up community, social connection, social support is really something we should invest more in to help improve the health and well-being of our patients with cancer.

Lisa Hatfield:

Absolutely agree. Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers

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What are key lifestyle changes for cancer patients navigating treatment and recovery? Expert Dr. Amy Comander from Massachusetts General Hospital discusses survivorship care and lifestyle advice for coping with and recovering from cancer treatment.

Download Resource Guide

See More from RESTORE

Related Resources:

Enhancing Cancer Survivorship Through Wellness Strategies

Enhancing Cancer Survivorship Through Wellness Strategies

 What Are the Benefits of Early Integration of Lifestyle Medicine?

What Are the Benefits of Early Integration of Lifestyle Medicine?

 Equity in Cancer Care: Accessing Lifestyle Medicine for All

Equity in Cancer Care: Accessing Lifestyle Medicine for All 

Transcript:

Lisa Hatfield:

Navigating cancer treatment and recovery is a journey that involves more than just medical care. Lifestyle choices play a crucial role too. What other factors play into this journey? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program. 

Dr. Comander, many patients often worry about secondary cancers. What are key lifestyle changes you recommend for cancer prevention and how do they differ from those recommended for post-cure recovery or post-treatment?

Dr. Amy Comander:

So an important component of survivorship care, which is care of the patient, certainly at the time of diagnosis and beyond, but in that follow-up phase as well, is screening for secondary cancers. And what does that mean? That means that a cancer that can develop after the diagnosis of the primary cancer. And I know to some listening that sounds really overwhelming. “You mean I can get another cancer?” But unfortunately, none of us have a crystal ball and that could happen. So what are strategies we can use to help reduce the risk of someone getting another cancer down the road?

And I first want to emphasize the importance of cancer screening. So we now have all these great tools for cancer screening; mammograms, breast MRIs, colonoscopy, pap smears, pelvic exams, CT scans for detection of lung cancer, and now we’re having these blood tests that we’re going to learn more about in the next few years. So there’s many screening strategies that are super important. So I encourage my patients to talk to their doctor. About making sure they’re staying on top of that because, my patients who I see in breast cancer follow-up, I always ask them, “When was your last colonoscopy?” And nobody loves getting that, but it’s really important as our major strategy for screening for colon cancer.

In terms of lifestyle recommendations, we know that a lot of the lifestyle recommendations that we talk about with our patients to improve their health during the survivorship phase of their care are also associated with a reduced risk of getting another type of cancer. So we know that physical activity is very beneficial to reduce the risk of many cancers, including breast cancer, colon cancer, and others. We know that being at a healthy body weight is really important in terms of thinking about risk for a future cancer. Again, a healthy diet with a focus of lots of whole grains, fruits, and vegetables is also so important.

So I think all the lifestyle strategies that we’ve really emphasized for cancer survivorship are also really important to optimize health, to reduce the risk of a secondary cancer and other chronic diseases, which I do have to mention, such as heart disease, stroke, type 2 diabetes. All of these things can happen too, because they can happen to all of us here. So we need to think about how can we optimize our health to reduce the risk of all of these potential conditions.

Lisa Hatfield:

Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

How Can Wellness Interventions Aid Patients During and After Treatment?

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How can wellness interventions aid cancer patients during and after treatment? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss benefits of different wellness practices, practical wellness strategies, and support resources.

Download Resource Guide

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Transcript:

Lisa Hatfield:

How can wellness interventions help patients during and after cancer treatment? And what specific practices might help? I have many questions. I’m getting to the bottom of it in this Patient Empowerment Network RESTORE program.

Dr. Comander, how can wellness interventions help folks like myself during and after treatment? And while there seems to be only pros here, can you also speak to any risks of certain wellness practices during cancer treatment? And how can patients mitigate these risks?

Dr. Amy Comander:

Such an excellent question. And I do think it’s really important for us to focus on things that a patient can do after his or her diagnosis to take control of one’s health. We know there’s nothing scarier than getting a diagnosis of cancer and going through treatment for cancer. So we want to think about practical strategies that people can employ to feel better, tolerate their treatments better, and ultimately improve their health.

So let’s pick one of my favorites, which is exercise. I know for some people that word exercise sounds intimidating, scary. Maybe they’re not someone who ever really practiced exercise on a regular basis and so when their doctor or nurse practitioner or social worker is talking to them about this, they feel kind of intimidated. Well, I will say a new field emerging is actually called exercise oncology. It’s really fascinating. And we’re really learning about what is actually happening in the body when an individual exercises, what is going on at the cellular level that may actually be fighting the cancer.

And this is really interesting and exciting. And I love reading these scientific papers. But we’re not going to get into that right now. Let’s just talk about, when you talk about practical strategies, if you’re someone who really has not been active, just walking to the mailbox to get the mail. Try to do that each day. Maybe taking a walk in your dining room, a few laps around the dining room table, if you have one, just something basic like that, walking your dog, walking a friend’s dog. Like everyone has to start somewhere.

So when we talk to our patients about exercise, we just meet them where they are and help them get started with something. And I know this sounds very intimidating, but organizations such as the American Cancer Society, American College of Sports Medicine, and my organization, American Society of Clinical Oncology, strongly recommend that individuals going through cancer treatment engage in exercise. And so you just have to start somewhere. So why is this important? Exercise has been shown to help patients tolerate their treatment better, reduce side effects, reduce the need for dose reductions, improve the fatigue that is often associated with cancer, and in many cases, reduce risk of recurrence and improve the outcome. So there are so many reasons to do it.

You also ask about risks. And I can understand that many people are fearful of starting an exercise program if this is not something they’ve been doing on a regular basis. So I would encourage patients to talk to their doctor just to address any particular concerns. Certainly, let’s say an individual has cancer involving their bone and they’re worried that they might be at risk for a fall and a fracture. That’s something they should certainly talk about with their doctor.

As a breast oncologist, I care for many women who are concerned about risk for lymphedema. Lymphedema is swelling of the arm, perhaps on the side of the surgery. And my patients are often worried, will that get worse if she starts a strength training program? Actually, it will not, but that’s a good question for her doctor or her physical therapist. So I think it’s really important to think about exercise as the number one wellness intervention that we want to address. 

Lisa Hatfield:

Okay, thank you. And over to you, Nicole, what are some common wellness practices that cancer patients can adopt during treatment? And how can patients be empowered to take an active role in their wellness during and after cancer treatments?

Nicole Normandin Rueda:

Great question. So just like Dr. Comander said, so physical activity, starting somewhere is going to be of the utmost importance. Nutrition, balanced diet, making sure you’re hydrated, you are following all the recommendations from your medical team regarding what you consume, avoiding anything that you probably shouldn’t be consuming. Stress reduction techniques are all, mindfulness, meditation, deep breathing, the things that help you kind of get back to calm is really critical. We want to make sure patients are aware of their sleep. So the sleep cycle is one of those things that people often complain about, but aren’t really informed on how important it is to your actual overall well-being.

And so if that is an issue, we want to make sure that we are referring them to the appropriate specialist in order to help get that resolved. Social connections, again, huge. We want to make sure people understand that there are organizations and people out there that are here to just serve and help as much as we can. Maintaining the relationships, not just with their immediate family and friends, but also making new connections and new relationships with people that are going to support them throughout this journey is important.

For me as a social worker, empowering patients is what I do…it’s why I’m here. We want patients to have an active role in their wellness, both during and after treatment, because we know, as trained individuals, we know that that is going to overall have a positive impact in their quality of life, in their family’s experience throughout the cancer journey. And that’s important. This is a stressful time for a lot of people. So in order to do that, we always want to make sure we’re providing education and that is first and foremost going to come from the medical providers. Follow up to that would then be everything else, all the ancillary services.

So you have organizations, Patient Empowerment Network. We are very focused on providing evidence-based information in an easy to understand way. And so that is one of those organizations that, as a social worker, I would refer everybody to. But there are others that are doing fantastic things providing education on all sorts of topics, anything that you could possibly want. There are organizations that are doing it well. Now that’s the thing, we want to make sure that we are referring patients to get evidence-based, research-backed information for them to consume and digest at their own pace. Next would be advocacy. If you don’t have a strong advocate in your corner, or if you are not comfortable speaking up or asking questions, this is one of those things that is so incredibly important when it comes to empowering patients to really be involved in their care.

And I can tell you firsthand, my mom was my dad’s biggest advocate. It was kind of embarrassing at times, but in hindsight, thank goodness, because had she not been so ferocious and asked so many questions, there’s a lot of things that we wouldn’t have known as a family going through a cancer diagnosis. So that’s really important. And I know working with medical teams, they want somebody to ask questions, they want to be able to provide as much information as they can. That’s a good backbone for people to understand, that their medical teams are going to want to make sure that they walk out of the room feeling like they have the information they need. 

And so we want to make sure that we are providing as much information, as many resources as we can. And then it is up to the patient and their care partners or their family members to then take that and run with it. But we want to be able to make sure that we’re giving them what they need in order to ask the right questions at the right time to the right people. And if they have the resources that they need to go and make it happen.

Lisa Hatfield:

Okay, thank you so much, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

How Do Wellness Practices Impact Cancer Care Outcomes?

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What are the impacts of wellness practices on cancer care outcomes? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the field of lifestyle medicine, the six pillars of lifestyle medicine, research results, and wellness resources for cancer patients. 

Download Resource Guide

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Transcript:

Lisa Hatfield:

How do wellness practices impact cancer care outcomes? I’m getting to the bottom of it in this RESTORE Program. Dr. Comander, you have a strong interest in cancer survivorship, lifestyle medicine, and improving outcomes of patients facing cancer. Can you speak to the impact of wellness practices on cancer treatment outcomes and what are we learning?

Dr. Amy Comander:

So I’ve gotten very interested in the field of lifestyle medicine over the past few years. And I think it’s really important to define what that is to those who are just learning about that term for the first time. So lifestyle medicine refers to the therapeutic use of evidence-based lifestyle interventions to prevent and treat chronic diseases. In addition, those who are trained in lifestyle medicine work to empower the patient to adopt these tools and make effective behavior changes. 

The six pillars of lifestyle medicine include physical activity, attention to diet, social connection, avoidance of risky substances, stress management, and adequate sleep. These are so important for the care of our patients with cancer from the time of diagnosis and beyond. And at our hospital we’ve developed a program where we provide individualized consultations to counsel our patients on each of these pillars to help them optimize their health and well-being, and in many cases, outcome from cancer. There are emerging studies demonstrating the important role of these lifestyle behaviors for improving outcome for our patients.

As a breast oncologist, I can tell you that there are significant studies demonstrating that individuals with a diagnosis of breast cancer who are able to exercise, whether that’s during treatment or after completion of primary treatment, actually have a lower risk of recurrence and improved outcome from their breast cancer. This is very powerful data, and we’re actually seeing this in other cancer types as well. So it’s very important that we in the oncology field provide our patients with these tools so they can engage in these six pillars of lifestyle medicine to improve their health and well-being.

Lisa Hatfield:

Okay, thank you for that. One quick follow-up question, and then I have a question for Nicole. So if a patient does not have a lifestyle medicine specialist, I guess that’s how I think of you, who, what is the resource, like at a local community center, could they ask the social worker there to help me out with these additional aspects of my cancer treatment? Who would they go to for those questions?

Dr. Amy Comander:  

Such an excellent question, and I know I’m fortunate that we have this wonderful program that we started. I would say that in terms of exercise, if you have access to a YMCA, many YMCAs have a program called the  LIVESTRONG Program, which is a free exercise program for cancer survivors, and many individuals take advantage of that, and that’s a great resource. If you can’t access a YMCA, thankfully, due to technology like this, we now have the opportunity to offer all kinds of exercise programs on YouTube or through an entity called the Maple Tree Cancer Alliance. There’s so many options potentially available online for somebody who wants to take on an exercise program. I’ll pick another important pillar of lifestyle medicine, nutrition.

One, we know there’s so much information out there on the internet, but one organization that does a very good job on conveying important evidence-based nutrition information is the American Institute of Cancer Research, AICR. So I often refer my patients to that site where they can read articles about nutrition, check out recipes, and, again, it’s very evidence-based and based on research that I trust, and so I think that’s a great resource for individuals who might not have access to an oncology-registered dietician at their hospital.

Lisa Hatfield:

Okay, thank you. And Nicole, are there specific wellness practices that have been shown to improve treatment outcomes for patients facing a cancer diagnosis?

Nicole Normandin Rueda:

Yeah, absolutely. So research has shown that adopting certain wellness practices can significantly improve your quality of life and potentially enhance treatment outcomes. Patients that have physical activity, and what that looks like is different for every patient. So regular exercise can mean a lot of different things. At the end of the day, from my perspective, the importance is that you’re moving your body. So if you start with just stretching, yoga, things to get your body start to start moving, it’s better than absolutely nothing, and then you work your way up to as much as you can endure. That’s key, I think, just like Dr. Comander just said.

Second, we have nutrition. So the balanced diet is difficult for everybody, but whenever it comes to a cancer diagnosis, you really want to take into consideration whatever your doctor’s recommending, and that’s specific to your treatment potentially. But as well as just making sure that you are nourishing your body, getting enough water, staying hydrated, all of the basics.

Next, I know that mindfulness and stress reduction techniques are huge. These practices, including like meditation, yoga, just deep breathing exercises to help kind of reduce that stress level, improve your overall clarity and mental health is really important. We want patients to stay as cool, calm, and collected as they can be. And so even just taking some deep breaths in through your nose, out through your mouth, these things are critical. And then I think another big one is the psychological side of things.

So psychosocial is one of those words that doesn’t mean anything to a lot of people, but to those of us who are trained, we understand that psychosocial means everything around you, everything that interacts with you is impacted by this cancer diagnosis. So we want to make sure we are connecting patients with all of the support groups that we can possibly think of. If that’s what they’re looking for. We also want to take into consideration the cultural situation. So if that means that you really don’t want to sit in a room with others, but you want to just read a blog from somebody like an empowerment lead or something like that, that can also be helpful.

And that is what patients are looking for now is easy access to information that is evidence-based, of course, but also that is just testimonial, somebody that’s been there and can guide them through what it’s like to, yeah, it is okay to talk to others, and it is okay to ask for help when you need it. So we really want to encourage that as much as possible. And obviously we want to foster a sense of community. We want everybody to understand you’re not alone. And there’s organizations out there doing fantastic things. Patient Empowerment Network is one of them, but there’s also so many others that are just doing fantastic things to support patients in every aspect of their cancer diagnosis.

Lisa Hatfield:

Thank you, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.

Recovering From CAR T-Cell Therapy | What Can Myeloma Patients Expect?

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Recovering From CAR T-Cell Therapy | What Can Myeloma Patients Expect? from Patient Empowerment Network on Vimeo.

What can myeloma patients expect after undergoing CAR T-cell therapy? Myeloma expert and researcher Dr. Beth Faiman discusses returning to life after the CAR T process, advice for physical activity, and immune system concerns during recovery.

Dr. Beth Faiman is an Adult Nurse Practitioner in the department of Hematologic Oncology and Blood Disorders at the Cleveland Clinic. Learn more about Dr. Faiman.

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Transcript:

Katherine Banwell:

Beyond monitoring of any issues, what can someone expect related to returning to life as they knew it before the diagnosis? Is there a timeline for resuming lifestyle and activity?   

Dr. Beth Faiman:

Yeah. So, I should say I because it’s from my perspective. I am a real strong advocate. I tell people to do what you feel like you can physically do. We know that myeloma can affect the bones and put your bones at risk for breaking and so we give you medicines to protect it. So, I do put some restrictions however on physical activity in terms of, “I don’t want you to bench press 40 pounds or 20 pounds,” in most cases. And depending on what the bones look like on x-ray, I’ll even restrict it to about five to 10 pounds.  

If you think about it, that’s a bag of potatoes. So, you don’t want to put too many restrictions on for everybody. But talk to your healthcare provider about what your specific restrictions are with physical activity. Because I don’t really put any restrictions on but I encourage things like riding a bike, especially a stationary bike in your own home, so that if you fall off – hopefully, you won’t fall off a stationary bike. But if you injure yourself, then you’re able to be in a place that somebody can help you.   

But riding a bike. Also, exercising in water. Water therapy is a great weight bearing exercise and there are times of day where you can go when the YMCAs or YWCAs aren’t as busy – or community centers. So, you’re less at risk for bacterial or other illnesses. But during that first month, I try to limit their exposure to people because you’re at risk for the different viruses that are all over the place, the bacterial infections.  

So, that first month is the critical period where I try to say, “Okay, try to lay low. Let’s get you through this period. Your immune system will start getting stronger on its own after this period.” And then, that month two you start feeling like doing more. You go to the grocery store. You maybe go to eat out at a restaurant but pick a time of day that’s less busy. So, go for an early dinner. There’s no shame in eating at 5:00 p.m. if you want to go out. And then, get a table in the corner with your own wipes. And so, that’s where your immune system is getting stronger. 

And then, by month three, I think most people will feel much, much better and much, much stronger. And if you can keep moving throughout this whole time, then you’ll be stronger on the way out.  

Can Lifestyle or Supplements Impact CLL Treatment Response?

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Can Lifestyle or Supplements Impact CLL Treatment Response? from Patient Empowerment Network on Vimeo.

Can chronic lymphocytic leukemia (CLL) patients use supplements or lifestyle changes to impact treatment response? Expert Dr. Danielle Brander shares her perspective and information from other cancer studies.

Dr. Danielle Brander is an Assistant Professor in the Division of Hematologic Malignancies & Cellular Therapy at Duke University Medical Center. Learn more about Dr. Danielle Brander.

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Transcript:

Lisa Hatfield:

So we have another patient who is concerned about chances of relapse and is asking if there are any lifestyle changes through diet and supplements or anything that you can speak to that may enhance their response or their duration response to the treatment?

Dr. Danielle Brander:

Yeah. So a very very great question to bring about. And this is the one area, understandably where many of us feel frustrated because we can’t tell patients specifically that this trial has been done and says this specific diet is helpful or this specific lifestyle change is helpful to make the treatment work for longer. I think some of that is because some of the general advice we give meaning maintaining daily activity or a well-balanced diet sound non-specific or simple, but I think do help in patients staying in an overall general health wellness so that they can benefit from the treatment and potentially have less side effects from the therapy. 

But getting back to the question we just talked about, I think certainly trials or studies really need to be continuing to look at this, because I think there likely are things that we can be more specific to patients about. There are studies looking at physical fitness and exercise regimens not necessarily specific to CLL, although there are studies being done in that space, but to other cancers showing that physical activity and exercise can help even for patients not on treatment maintain control of their cancer. So general daily activity and exercise are important in studies that look at how do you tailor that to an individual I think are important too.

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Can Diet and Exercise Reduce MPN Symptoms?

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Can Diet and Exercise Reduce MPN Symptoms? from Patient Empowerment Network on Vimeo. 

What can YOU do to make a positive impact on your overall MPN care? Researchers Dr. Jennifer Huberty and Ryan Eckert review the latest research on how movement and diet can benefit people living with myeloproliferative neoplasms (MPNs).

Dr. Jennifer Huberty is an Associate Professor at Arizona State University. She focuses her research on the use of complementary approaches to manage symptoms and improve quality of life for patients living with myeloproliferative neoplasms. More about Dr. Huberty here: chs.asu.edu/jennifer-huberty.

Ryan Eckert currently works at Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. Ryan is the Research Coordinator for the MPN QoL Study Group and assists in research related to complementary health approaches in myeloproliferative neoplasms and other hematological disorders. More about Ryan here: mpnqol.com/research-team.

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Can Diet and Exercise Reduce MPN Symptoms?

Transcript:

Ryan:

So, as far as the benefits of exercise for MPN patients, there’s many, and so, I guess starting with cancers as a whole, there’s a lot more research that’s been done in recent decades that looks at the effects of various forms of exercise and physical activity on other cancers. They just tend – researchers tend to do a lot more of that work in breast cancer, lung cancer, colon cancer, et cetera.

And so, the research in exercise for MPN patients is actually really new, and nobody outside of Dr. Huberty in conjunction with Dr. Mesa and a few other researchers have done any research related to exercise specifically in MPN patients. Our yoga studies that we’ve done have been the first venture down that route for MPN patients. But, what we do know in general is that exercise has obviously systemic effects across the whole body.

So, you’re gonna get health benefits just in general from exercise, but as far as for MPN patients specifically, some of the things that we’ve seen with our yoga studies, which is obviously a form of physical activity, is that we’ve seen sleep improve in MPN patients, so we’ve seen a reduction in sleep disturbances or disruptions in their sleep, a quicker time to fall asleep, and then, less waking up throughout the night – so, just better sleep in general.

We’ve seen some reductions in fatigue that have been reported by MPN patients who have gone through our yoga studies, and then, we’ve also seen a few other reductions in some other symptoms, such as anxiety and reduced depressive symptoms, a little bit of reduced pain is another one we’ve seen. So, just in general, we’ve seen some of those effects on MPN patients through some of our yoga studies.

Dr. Huberty:

So, in terms of adding to what Ryan just said, I would just say that exercise – maybe yoga or walking – is good for your body. It’s good for your health. It’s a recommendation that we get 150 minutes of moderate-intensity activity every week. The more that MPN patients can be achieving that goal towards 150 minutes – yoga counting at that – the better off they’re gonna be, and it doesn’t have to be going for a run.

It can simply be going for a walk around the block. It can be standing at your desk when you’re working instead of sitting all the time. That’s not necessarily activity per se, but it is moving your body and less sedentary. So, I think just focusing on the more that patients can move their body every day, the better off they’re gonna be.

Dr. Huberty:                

So, yeah, the role of diet in MPN patients – so, this is the beauty about the quality of life study group, because we have all these wonderful investigators that are part of the team, and we do have Dr. Robyn Scherber, who’s at Mays with Dr. Ruben Mesa. She’s doing some work with keto diet right now, so it’s very new, so I don’t know if you’re familiar with the keto diet, but it’s very high-fat and very low-carbohydrate, extremely low levels of carbohydrates. I wouldn’t tell any patient to go start doing those things unless they’ve talked to their physician for sure, but we do know that based on how you eat does certain things to your body.

So, MPNs have high inflammatory markers, and so, we wanna decrease inflammation; we probably wanna eat foods that are going to be anti-inflammatory. So, berries, let’s say, is a good example of fruits that are anti-inflammatory, almonds are anti-inflammatory, and I’m not a dietitian by any means, it’s just that things that I know to be true for my own diet because everybody should be thinking about having an anti-inflammatory diet.

Processed foods are not healthy. They are higher-inflammatory. Breakfast foods, eating out, and the foods that you get when you eat out a lot are going to be more inflammatory than not. So, just those small things – lots of vegetables. Vegetables are very good. Lots of greens. But, there is research going on – again, just like exercise and yoga, it’s in its infancy because MPN has been an under-studied population for years, and we’re trying to power through and make that difference.