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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.

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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.

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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 I Maintain a Healthy Diet During Ongoing Cancer Treatment?

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How can cancer patients maintain a healthy diet during and after cancer treatment? Expert Dr. Amy Comander from Massachusetts General Hospital discusses common side effects of cancer treatment and advice for boosting nutrition during and after cancer treatment.

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Related Resources:

How Does Cancer Treatment Impact Nutrition?How Does Cancer Treatment Impact Nutrition?

What Is Whole Person Care Exactly?

 Why Is It Important to Address Whole Person Care?

Why Is It Important to Address Whole Person Care?

Transcript:

Lisa Hatfield:

As a patient living with cancer where there’s no cure and treatment is ongoing, I’m constantly navigating the challenges of maintaining my health during treatment and avoiding unwanted side effects. Nutrition is a big part of that, but it’s not the whole picture. I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program.

Dr. Comander, how can patients manage treatment side effects that affect their appetite or ability to eat? And what role does hydration play in supporting cancer treatment and recovery?

Dr. Amy Comander:

We know that many individuals going through cancer treatment really have a poor appetite, often don’t feel like eating, and this can be due to a multitude of factors. Maybe it’s due to nausea from the medication, or other side effects from the chemotherapy agents or other medications that a patient’s taking. So this can really be a challenge. And I encourage a patient to really talk to his or her doctor about these concerns if really poor appetite is a major problem because, yeah, actually sometimes there’s strategies we can think about, sometimes there’s medications that can be helpful to boost the appetite, or sometimes it’s really thinking about introducing certain foods that may perhaps be appealing, such as making a smoothie.

Sometimes maybe you weren’t a smoothie person before going through cancer treatment, but now that might be a great way to get in some calories. Obviously you can put a lot of healthy things into a smoothie. So this is one strategy that some of my patients employ. But I certainly encourage someone listening to this to kind of talk to their doctor about this, if it’s a real problem like not being able to eat.

In terms of hydration, we know that is so important. Many of our treatments get metabolized by the liver or cleared by the kidneys. So it’s really important to stay well hydrated, especially in the summer months, if it’s really hot outside. So I always encourage my patients to have a trusty water bottle by their side at all times.

There’s so many fun water bottles out there, so I’m like, “Get one that you like. If it has to be pink, that’s great, whatever it is,” but have a water bottle with you at all times. Certainly think about water, other drinks with electrolytes, some people like Gatorade, whatever that might be, but it’s really important to be drinking throughout the day to stay hydrated, to keep yourself healthy as you’re going through cancer treatment.

Lisa Hatfield:

Okay, thank you. Dr. Comander, what strategies do you recommend for cancer patients to maintain adequate nutrition when experiencing treatment side effects such as nausea or taste changes? And additionally, are there specific foods or supplements that can help alleviate these side effects?

Dr. Amy Comander:

Right, so many patients when they’re going through chemotherapy, or receiving other treatments for their cancer, really note nausea, changes in taste, and have a really tough time finding what they want to eat during this time. And I will say, obviously, sometimes it’s playing around with the diet to find what things work and what things don’t work. And often that’s the first thing we might try. But if nausea is the primary issue, I will say we now have such an amazing array of anti-nausea medications that we can use for our patients going through chemotherapy.

And these are really game changers in the field of oncology. I can just see it even over my career how some of the newer medications we have, such as olanzapine(Zyprexa), to use for nausea, are really beneficial. So I think if you’re going through chemo and having a real hard time with nausea and that’s preventing you from eating, talk to your doctor. “What other anti-nausea medication can I consider taking so I can get nutrition into my body?”

Taste changes, it really is something that can evolve often during active chemotherapy treatment. Patients may experience that. It tends to get much better when you’re done with some of these drugs, such as cisplatin, for example, that can cause a lot of changes in taste. So that’s usually something that’s hopefully more of a short-term thing and will get better with time. In terms of specific foods or supplements, I really very much advocate that my patients get nutrition from whole foods with a focus on fruits and vegetables and whole grains. I’m not a big supplement person.

In fact, organizations such as the American Institute of Cancer Research really counsel patients not to focus on supplements as a major way to get nutrition into their body. Of course, there are some instances where supplements are needed. For example, a patient with anemia could have deficiency in iron or vitamin B12. Those are supplements that may be necessary to help boost those red blood cells. Or one of my patients, for example, a diagnosis of breast cancer, an aromatase inhibitor, where she may be experiencing a decline in bone density, she may need a vitamin D supplement because she lives in New England and doesn’t get enough sun exposure, which is how we get vitamin D.

So vitamin D, iron, B12, things like that sometimes are necessary, but there are a lot of supplements out there that people are encouraged to buy and spend a lot of money on, and I really would encourage you to shy away from that. That would be my recommendation.

Lisa Hatfield:

Okay, thank you. And a quick question for those patients who are on the flip side of the decrease in appetite. Sometimes patients going through cancer treatment are on high dose steroids, and they have the increase in appetite and they have certain cravings. Do you have any suggestions or recommendations for those patients?

Dr. Amy Comander:

Yes, we know that we use steroids a lot in oncology to help our patients manage nausea or other side effects related to their treatment. And you’re absolutely right, being on steroids can sometimes really rev up the appetite, make it hard to sleep at night, cause a whole wide array of other side effects. So certainly with my patients who have this problem, sometimes I try to cut down the steroids a little bit, see if we can get away with that to kind of minimize those adverse side effects from the steroids themselves.

But if someone really is having cravings, usually the steroids are used around chemo for just a few days. So I usually encourage them like, again, if you’re craving carbs, try to focus on some healthy carbs, again, focus on whole grains, try to avoid some of the potato chips and other stuff, which we know are not so good for us, but usually it’s a short-term thing, but maybe cutting down the steroids a little bit might be the first step if possible in collaboration with your oncology team.

 

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

How Does Cancer Treatment Impact Nutrition?

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What are the impacts of cancer treatment on nutrition? Expert Dr. Amy Comander from Massachusetts General Hospital discusses the impact of chemotherapy and nutrition advice for overcoming the impacts of cancer treatment.

Download Resource Guide

See More from RESTORE

Related Resources:

How Do Wellness Practices Impact Cancer Care Outcomes?

What Is Whole Person Care Exactly?

How Can Wellness Interventions Aid Patients During and After Treatment? 

Transcript:

Lisa Hatfield:

As a patient living with cancer, I’m always thinking about how my treatments might impact my nutrition or vice versa in some cases. Do I need to increase or decrease anything? Should I change my dietary patterns? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE Program. 

Dr. Comander, can you give us a general overview of cancer treatment and its impact on nutrition?

Dr. Amy Comander:

Cancer treatment certainly has an impact on nutrition. And as I think about that, it kind of really depends where the patient is along his or her treatment journey. When we think about nutrition, certainly we know if an individual is going through active chemotherapy, often the taste buds change and things that used to be delicious don’t taste as good, and things that maybe a person didn’t like to eat all the time is the only thing he or she can tolerate, like a bagel. Nothing wrong with a bagel, but some of my patients tell me, “That’s all I can eat.”

But in general, when we think about a healthy approach to nutrition, I really counsel my patients on the benefits of a whole foods plant-predominant diet. Note I use the term plant-predominant. That just means it is so beneficial to consume a wide variety of fruits and vegetables and whole grains. Of course, it’s okay to incorporate a protein and maybe that’s a plant-based protein or maybe that’s fish or chicken, okay? But just thinking about the concept of half of the plate being full of fruits and vegetables is so important. And you might say, why is that so important?

Fruits and vegetables, the beautiful colors of various fruits and vegetables really reflect all those beneficial nutrients in the food that are also good for our gut microbiome, which is a term a lot of us hear now in the news, this term gut microbiome. And what does that really mean? Really refers to those microorganisms in our GI tract, gastrointestinal tract. And what’s really interesting is emerging research in some cancers is demonstrating that a healthy gut microbiome is really associated with how well certain treatments for cancer work.

So again, eating fruits and vegetables makes our gut microbiome healthy. And so this is so important for our health. Whole grains as well. Limiting red meat, limiting processed foods, limiting sugar-sweetened beverages. These are all the tips and tricks that I talk about with my patients. And if you want to really look this up and read about it and have a good understanding, again, the American Institute of Cancer Research and World Cancer Research Fund, on their website, they kind of have bullet points illustrating each of these points in terms of how we can approach a healthy diet after a cancer diagnosis.

Lisa Hatfield:

Okay, thank you so much for that information. A little shout out to a multiple myeloma doctor that I watch a lot, because that’s the type of cancer I have, her name is Dr. Urvi Shah, and she has done some research on that and recommends getting 30 different plant-based foods per week, not servings, but just the variety helps your gut microbiome. She’s done some research on that that I won’t go into here but, and it’s not that hard because we get to count all different kinds of lettuce in my salad, if I have romaine, spinach, and iceberg, there’s three right there. So thank you for those comments.

Dr. Amy Comander:

Yes, it’s a great tip to think about how can I get 30 different types of fruits and vegetables into my diet in a given week? And actually it’s kind of a fun challenge. So I love incorporating different types of lettuces into my salad. By the way, herbs count. So parsley, cilantro, things like that, those are plants. So it’s a fun game and it’s really a great way to make your gut microbiome happy and healthy.

Lisa Hatfield:

Okay, thank you. Dr. Comander, what are some key nutritional guidelines for cancer patients during and after treatment?

Dr. Amy Comander:

It’s so important to think about guidelines for nutrition because we know out there on the internet, TikTok, Instagram, Facebook, there’s all kinds of people giving nutrition information. And for a cancer patient, it is very confusing and very overwhelming. That’s why I like to stick to the basics. What do research organizations such as the American Cancer Society, American Society of Clinical Oncology, AICR, American Institute of Cancer Research, what are we recommending?

And again, it’s thinking about a healthy diet pattern which includes an emphasis on whole foods, with fruits and vegetables and whole grains, limiting red meats, avoiding processed meats, limiting sugar-sweetened beverages, avoiding processed foods. If you go to the grocery store and you pick up something and it has 35 ingredients and you don’t understand what most of them are, you probably shouldn’t be eating it, okay?

So these are all some of the general themes that we think about when it comes to nutrition. I know it can be very scary and overwhelming, but just if you, again, think of your plate and if half of it is comprised of fruits and vegetables, a quarter is some type of whole grain, when I say whole grain, think about brown rice, whole wheat pasta, and some grains out there like quinoa and farro that maybe you’ve never tried but are really delicious and good for us.

And then a quarter of that plate, some type of protein source, whether that’s a plant-based protein or perhaps fish or chicken or something like that. But that’s really a great approach to thinking about nutrition. Another point I really need to emphasize is limiting alcohol. So, many people don’t really think much of having a glass of wine or two with their dinner each night, but unfortunately we know that for an individual with a diagnosis of cancer, especially if you’re on new medications or going through chemotherapy, in the best case scenario, alcohol really should be avoided or limited really to special occasions. 

Lisa Hatfield:

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