Weight management and physical activity should be incorporated into standard cancer care from the point of diagnosis through to follow-up given the growing evidence for better outcomes in patients with most types of cancer.
According to evidence presented at a US National Cancer Policy Forum (NCPF) workshop, overweight and obesity result in poorer outcomes for breast, endometrial, prostate, pancreatic, colorectal, ovarian and some haematological cancers.
There was also growing evidence linking increased physical activity with better outcomes in breast, prostate and colorectal cancer.
As well as an effect on cancer mortality, weight management and physical activity can mitigate comorbidities and cancer- or treatment-related problems, the forum concluded.
While more research was needed, there was ‘solid evidence that diet, physical activity, and reduced adiposity play critical roles in preventing cardiovascular disease and diabetes, and exert a positive influence on quality of life, physical function, and fatigue.’
Given the ‘diversity of needs amongst cancer survivors, many of whom are older’, more work was required on how to deliver sustainable and accessible weight loss and physical activity interventions.
Associate Professor Prue Cormie, principal research fellow in exercise oncology at the Australian Catholic University, told the limbic clinicians should be having early conversations with patients that a healthy weight and physical activity were important in their cancer journey.
“Here is more evidence from an extensive group of international leaders specifically advocating for weight management and physical activity in cancer care.”
However, oncologists could refer patients to dieticians and exercise physiologists to provide the ‘individualised, best practice’ programs to help patients achieve weight goals and recommended levels of physical activity.
The NCPF workshop said clinic based exercise programs tended to result in higher exercise intensity but hybrid programs starting with an on-site supervised phase then tapering could also support sustained physical activity.
It added that attention to cancer symptom management such as fatigue and pain was also important to optimise adherence with physical activity programs.
Focus flips from cachexia to obesity
Associate Professor Marina Reeves, from the University of Queensland’s Cancer Prevention Research Centre, told the limbic that it was only in recent years that dietetic interest had built around weight management in cancer care.
“Dietetic services within acute care hospitals and cancer care were typically focused on the patients more likely to lose weight as part of their cancer and treatment and at risk of being malnourished.
“At this point there is still increasing awareness for the role that weight management may have in terms of improving outcomes for patients. A lot of these patients will survive the cancer so they are also going to be at risk of other comorbidities and chronic disease.”
She said one the biggest challenges was how to link a cancer patient or survivor into affordable long-term support.
“Patients can access allied health via the Chronic Disease Management plans but what is currently funded through Medicare is fairly limited access to those services and probably insufficient to lose weight.”
She said interventions that encouraged patients to self-monitor physical activity and dietary intake via technology such as apps were useful and cost effective.
“It’s a key component of helping people be aware of their behaviours. Incorporating SMS messaging can also be a cost effective way to support behaviour changes.”
She warned there was a very fine line between acknowledging the role that excess weight played in clinical outcomes and burdening patients with blame and stigma.
“We shouldn’t focus just on BMI or bodyweight but body composition, blood pressure, blood glucose and blood lipids.
“Most studies that have looked at obesity and outcomes are just based on BMI but that could mask a lot of what is probably going on.”