Expert Highlights Positive Impact of Lifestyle Factors on Cancer Outcomes/QOL

Amy Comander, MD, Massachusetts General Hospital

Managing cancer needs to go beyond treatment and include experts such as oncology-focused registered dietitians, psychologists, and advanced practice providers. These individuals can help to manage symptoms and connect patients with resources to encourage positive lifestyle choices and improve quality of life, according to Amy Comander, MD.

Comander explained that factors such as exercise can help with managing common adverse effects such as fatigue but, importantly, guidance is needed to help patients find the right place to start; this could mean even taking a walk around the house.

“It’s important for oncologists and other members of the care team to counsel patients about the important benefits of being active during treatment,” Comander explained. “We certainly need more resources to help our patients become more active as they are going through cancer treatment.”

In an interview with CancerNetwork^®, Comander, the medical director of Mass General Cancer Center-Waltham, director of the Breast Oncology Program at Newton-Wellesley Hospital, and director of Lifestyle Medicine at Massachusetts General Hospital, detailed how diet and the gut microbiome could potentially impact outcomes from immunotherapy, and how multidisciplinary care teams to collaborate and support patients’ lifestyle efforts.

How do lifestyle choices play a role in patient quality of life?

We know from data that lifestyle factors play an increasingly important role in helping our patients improve their quality of life after a cancer diagnosis. Certainly, this is true during treatment and beyond. For example, cancer-related fatigue is the most common problem that many of our patients complain about each day in clinic. Interestingly, an intervention such as physical activity has been shown to significantly improve symptoms related to cancer fatigue.

We know that all our patients are starting in a different place, and for some that might mean getting out of bed and walking around the living room a few times, but we do know that being active is a very important tool for our patients to combat cancer-related fatigue.

What are some different options physicians can recommend patients do to improve their quality of life?

We know that attention to various lifestyle changes can significantly improve a patient’s quality of life and experience both during cancer treatment and beyond. For example, physical activity is now incorporated into the ASCO [American Society of Clinical Oncology] guidelines.¹ We know that patients who are able to be physically active during treatment tolerate their treatments better, are less likely to require dose reductions or interruptions of therapy, and certainly, overall feel better during the course of treatment.

Could you describe the role diet plays during treatment?

There are many studies now focusing on the importance of diet. For patients undergoing certain types of treatment, diet does play a key role and perhaps may influence a patient's response to treatment. For example, there’s work now in the field of immunotherapy showing that patients may respond better to these treatments based on changes in their gut microbiome. [In terms of] what causes these changes, it’s related to diet. We’re going to see increasing research focused on the importance of diet, along with standard therapies and immunotherapy for our patients with cancer.

From a multidisciplinary care perspective, how can a patient’s care team work to support these positive lifestyle choices?

Caring for patients with cancer requires a dedicated team and our patients greatly benefit from this multidisciplinary approach. As an oncologist, I like to tell my patients about all the important things they should be doing, whether that’s changing their diet, adopting more of a physical activity routine, or improving their sleep habits. If I have colleagues who have expertise in these areas who can provide dedicated 1:1 counseling about these behaviors or patients derive such benefits.

It's wonderful to work with a team that may include a physical therapist, a psychologist, a registered dietitian with expertise in oncology, a psychologist, a social worker, and certainly our advanced practice provider colleagues. All these individuals and many more than I’m probably not mentioning, are integral to the team for providing appropriate whole-person care for individuals facing a diagnosis of cancer.

Are there any resources that care teams should provide to patients with cancer or their caregivers?

There are many great resources out there for our patients to find more information about, for example, how to incorporate more physical activity into their routine, and what types of nutrition advice are out there. We know there’s a lot of misinformation on the internet, therefore it’s important that we provide our patients with evidence-based resources. When it comes to physical activity, one website I often refer [patients] to is a portion of the American College of Sports Medicine website, which has a section called the Moving Through Cancer Initiative.²

There are some great figures there that provide some concrete advice about what the exercise recommendations should include for an individual going through cancer treatment. When it comes to nutrition, we know there’s all kinds of information [including misinformation] out there, and we do have to be careful. I often refer my patients to the American Institute of Cancer Research website, which has lots of evidence-based information about the role of diet, physical activity, and other behaviors for patients with cancer patients. There are some great recipes there, as well.

Do you have any parting pieces of advice for your oncology colleagues?

We know that our patients with cancer are facing so many challenges as they undergo treatment, and we want to support our patients the best way we possibly can. In addition to recommending the standard treatments, it is very important that as oncologists we counsel our patients about the other important aspects of their care, namely lifestyle factors that can certainly improve their health and well-being and ultimately outcomes from cancer. This includes multiple areas such as physical activity, nutrition, good sleep habits, social connection, and avoiding the use of risky substances such as alcohol, that are key for our patients.

The changes our patients go through are very challenging. Therefore, I would also encourage our oncology colleagues to think of ways to help our patients find support when they’re trying to embark on these changes. Maybe the local YMCA has a Livestrong program, maybe there's a local support group that helps individuals meet for a walk on a Saturday to get some exercise together. This social connection piece is very important for our patients who are going through cancer treatment.

References

1. Ligibel J, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO Guideline. J Clin Oncol. 2022;40(22):2491-2507. doi:10.1200/JCO.22.00687
2. Moving Through Cancer. American College of Sports Medicine. 2021. Accessed April 14, 2023. https://bit.ly/43zgp3h