Education can empower survivors to make healthy lifestyle choices.
After a cancer diagnosis, healthy lifestyle choices, which up to that point may have seemed merely worthwhile advice for the future, can quickly become a significant priority in the present.
As patients progress through treatment and enter recovery, questions about diet, exercise and mental health often arise: How much sugar is healthy? Can I still have a glass of wine with dinner? Will exercise make a difference in my long-term prognosis? What will my life look like now?
The number of people facing questions like these today is significant: There are 14.5 million cancer survivors in the United States—and that number will grow to 19 million by 2024, according to a report released by the American Cancer Society in June 2014. The field of survivorship after diagnosis is exploding,” explains Lisa Poormon, PT, DPT, MEd, CLT-LANA, Rehabilitation Services Manager at Cancer Treatment Centers of America® (CTCA) in Goodyear, Arizona. “As increasing numbers of patients are surviving and baby boomers enter a stage of life when they are more at risk of developing cancer, there is much more awareness today about how to keep this population healthy.”
According to Poormon, gathering accurate information from reliable sources is one of the most effective tools patients can use when navigating lifestyle decisions after diagnosis. Those sources may include members of a health care team as well as educational materials published by reputable organizations such as the American Cancer Society and the American Institute for Cancer Research. Poormon says that patient education—or sometimes re-education—is an integral part of her treatment sessions.
Mental Health Matters
For many survivors, translating new information into lifestyle changes starts with processing the emotional impact of diagnosis and treatment. Understanding and coming to terms with the “new normal” of their lives, which may include physical challenges and emotional issues related to treatment, can provide inspiration to make healthy choices that will help ensure wellness moving forward. “Much of the distress we see starts with physiological difficulties,” says Britt Hermann, LCSW, Clinical Social Worker and Sex Therapist at CTCA® in Zion, Illinois. She adds that physical side effects such as neuropathy, erectile dysfunction or lymphedema, for example, may have an impact on a patient’s psychological health: “If someone is experiencing long-term neuropathy, for example, this may significantly impact daily life and lead to feelings of loss, grief, sadness, depression or anxiety.”
One of the strategies Hermann uses to help patients who are feeling limited by side effects is to help them redefine their sense of self: “Patients who are farmers, for example, who have been active their whole lives, can be challenged by changes in their physical function that take them out of work. In this case we may talk about new goals they can set to stay active, such as joining the YMCA or the senior center.”
Longer-term physiological changes may also have a potential impact on physical intimacy for some survivors and their partners. Treatments can affect a survivor’s ability to experience pleasure as well as one’s sense of sexual self, Hermann says, and couples often wish to discuss these challenges. “I work with couples to help them redefine sexuality,” Hermann says. “Most couples have a sexual script that they are accustomed to following, and they may need to replace the old script with a new one.”
Hermann recalls a patient she worked with who had undergone a pelvic resection to treat ovarian cancer. Sexual intimacy had been an important, nonverbal form of connection for the patient and her husband before cancer, and they felt that the treatment had robbed them of this form of intimacy. Hermann worked with the couple to help them learn how to communicate verbally about intercourse and how to experience intimacy outside the bedroom. After a year of sessions, they felt that they had rediscovered their sexual intimacy and learned how to communicate better in their relationship in general.
Another common area of psychological distress for survivors is fear of recurrence, which is most prevalent during the first year after treatment, Hermann says. She has found that educating patients about how the brain processes these fears, and providing coping tools, can be an effective strategy to help reduce worry about recurrence. “Cancer throws the brain into crisis mode and makes people hypervigilant, anxious and worried,” she explains. “If a patient feels pain, such as a stomachache, the brain is often conditioned to respond with fear of a cancer recurrence. This can trigger them back into crisis mode.” Hermann helps patients manage the fear of recurrence by teaching them to identify their triggers and understand the things they have power over to reduce the risk of recurrence, such as follow-up testing and a healthy lifestyle.
Healthy Food Is Medicine
As survivors adjust emotionally to life after treatment, questions about diet often come to the fore. As with mental health, seeking expert advice is an effective strategy because there are a plethora of misconceptions about this area of survivorship. “People usually have a lot of fear,” explains Nathan Schober, MS, LD, RD, a Clinical Dietitian at CTCA in Newnan, Georgia. “They see things on television or read something in a magazine, which leads to questions such as Can I eat any sugar? Should I avoid meat? and Should I eat low fat?”
Schober encourages patients to follow the suggestions of the American Institute for Cancer Research (AICR), which outlines 10 recommendations for cancer prevention. “They don’t recommend a no-sugar diet but instead suggest that people get sugar from healthy sources such as fruit and dairy,” he says. The AICR also urges people to limit the consumption of energy-dense foods, which are processed foods high in added sugar, low in fiber and/or high in fat. People can avoid becoming overweight or obese and reduce their cancer risk by choosing foods that are high in fiber and water, such as vegetables, fruits and beans.
Schober says that another common question among cancer survivors is whether they should buy organic food. Although research has not proven conclusively whether organics reduce the risk of cancer, Schober recommends that patients opt for organic produce when choosing items on the Environmental Working Group’s “Dirty Dozen” list. This organization tests fruits and vegetables to determine which ones have the highest and lowest pesticide residues.
Schober also encourages cancer survivors to limit the amount of red meat in their diets and to instead opt for chicken, turkey and fish. It is also wise to limit the intake of foods rich in omega-6 fatty acids, such as corn oil, mayonnaise and butter, he says. When patients have questions about whether they can consume alcohol, Schober explains that ideally alcohol should be avoided; if it is consumed, men should limit themselves to two drinks per day and women to one, according to the AICR.
If implementing these dietary recommendations seems daunting, Schober suggests a simple approach: focus on the AICR’s suggestion to fill two-thirds of the plate with plant foods—such as quinoa, vegetables, beans, whole grains and fruits—and one third of the plate with animal products, such as lean meat, eggs or yogurt.
While these recommendations can mean making significant changes in lifestyle and eating habits, Schober says the potential to reduce the risk of cancer recurrence ultimately inspires many survivors to make the effort. He cites the example of one patient who had been diagnosed with breast cancer and was reluctant to change her eating patterns; she previously had no interest in cooking and usually ate sandwiches, fast food or frozen meals. “Once she understood how food was impacting her body’s ability to fight off cancer, she became very motivated,” he says. “She went out and bought a lot of cookware and started making things like vegetable lasagna and healthy snack bags with nuts. She lost weight and felt much better about herself, too.”
The Power of Exercise
For many patients, concerns about diet are often accompanied by questions about exercise. Misconceptions about what is possible when it comes to physical activity during and after treatment are common, Poormon says. “Two of the most common misconceptions I hear from patients are, first, that they cannot exercise and, second, that they will not be able to get back to what they were doing before they were diagnosed with cancer,” Poormon says. “In my experience both of these are untrue.”
Poormon has seen many patients not only return to the activities they once enjoyed but even surpass their previous level of activity, fueled by a new understanding of the benefits of exercise. According to the American Cancer Society (ACS), one-third of the cancer deaths each year are linked to poor diet, physical inactivity and carrying too much weight.
Each person’s exercise practice is unique, and for this reason Poormon encourages patients to consult a professional, such as a physical therapist, before starting an exercise routine. A therapist can evaluate a patient’s functional deficits and recommend an appropriate plan to achieve the desired long-term goals. Activity may start with such simple things as playing with children, gardening or vacuuming. Any type of physical activity that elevates the heart rate and activates the muscles can help survivors reach the ACS’s recommendation of 150 minutes of exercise per week, Poormon says.
She is careful to explain, however, that it takes time to return to previous levels of activity. “You cannot expect to be back in a month,” she says. “You almost have to let go of the timing and expectations and be willing to travel the journey of recovery.”
Patience and perseverance paid off for one of Poormon’s patients, who had been diagnosed with breast cancer. Before her diagnosis the woman worked a physically demanding job in the package delivery business, but after a year of treatment that included chemotherapy, radiation and a bilateral mastectomy, she struggled to simply get out of bed. To decrease the pain in her chest and back, the patient pursued regular massage, physical therapy, occupational therapy and chiropractic care. At home she started with simple exercises like standing up from a chair for several repetitions and progressed to lifting light weights and walking. Eventually, she was able to work out at the gym several times a week. “It was a long journey for her, but after one and a half years of steady progress, she was able to return to her job,” Poormon says. “Now her hair is long, she feels strong and she is back to her active lifestyle.”
Any Change Makes a Difference
Although the prescription for a healthy lifestyle may seem like a daunting overhaul, Schober reminds his patients that making just one change can decrease cancer risk. According to a study published in Cancer Causes & Control in May 2014, participants lowered their risk of cancer mortality by following at least one of the recommendations outlined by the AICR. With each additional recommendation that was followed, the risk decreased—and people who adhered to five of the 10 recommendations lowered their risk by 50 percent.2
The survivors who implement any of these recommendations not only decrease their mortality risk but also start to see positive changes in many areas of life, Schober explains. “I’ve seen people lose weight, and they always talk about feeling better,” he says. “They need less blood pressure medication, have more energy, no longer need sleeping pills at night and feel like they can do so much more in life without feeling tired.”
References 1. Simon, S. (2014, June 1) Report: Number of Cancer Survivors Continues to Grow. Retrieved May 26, 2015, from http://www.cancer.org/cancer/news/news/report-number-of-cancer-survivors-continues-to-grow 2. Hastert, T. A., Beresford, S. A. A., Sheppard, L., & White E. (2014). Adherence to the WCRF/AICR cancer prevention recommendations and cancer- specific mortality: Results for the Vitamins and Lifestyle (VITAL) Study. Cancer Causes & Control, 25, 541–552. Retrieved May 26, 2015, from http://link.springer.com/article/10.1007%2Fs10552-014-0358-6 3. Recommendations for Cancer Prevention. American Institute for Cancer Research. Retrieved May 26, 2015, from http://www.aicr.org/reduce-your- cancer-risk/recommendations-for-cancer-prevention
