Cancer survival is broadly defined as being from the time of a cancer diagnosis to the end of the patient’s life. A more targeted definition is survival from the end of primary treatment to either a recurrence, or if no recurrence until end of life.
In Australia the five-year survival from all cancers increased from 47 per cent in the period 1982-1987 to 66 per cent in 2006-2010. The cancers that had the largest survival gains were prostate and kidney cancer, and non-Hodgkin lymphoma.(1)
Since the much-heralded declaration of the ‘war against cancer’ in the early 1970s, and the ensuing advances in early detection and molecular understanding of biology of cancer and treatment, there has been a steadily growing number of cancer survivors.(2)
In Australia the five-year survival from all cancers increased from 47 per cent in the period 1982-1987 to 66 per cent in 2006-2010
Lifestyle medicine is defined as the application of environmental, behavioural, medical and motivational principles to the management of behaviour-related health problems in a clinical setting.(3) Lifestyle management can reduce the recurrence of primary cancers, improve quality of life and extend the duration of survival. For example, in breast cancer, a 30-40 per cent reduction in the recurrence rate was observed in women who followed weight management and exercised regularly.(4)
After active treatment there is a need to detect recurrence and/or new cancers, the later effects of primary treatment, to prevent future cancers and to treat co-morbidities. As regards the effects of primary treatment the stand-out concerns for patients are fatigue, ongoing fear or recurrence, anxiety, depression and insomnia.
There are also body image concerns, for example after mastectomy. Also, sexual dysfunction is commonly seen with men following prostate surgery. Osteoporosis and sarcopenia (muscle loss) are significant risk factors. Pain can be chronic and cardiac and pulmonary complications can occur.
There is a significant overlap between the risk factors for many types of cancer and those for other chronic diseases. Lifestyle choices such as smoking, unhealthy eating, inactivity, obesity, alcohol and illicit substance abuse all have proven links with chronic disease. These complex connections are illustrated in the intertwining diagram seen below.
To be successful, advice on healthier living needs to be practical, achievable and of course, come across as non-judgemental, hard as this may be at times. For instance, healthy eating tips should avoid specific dieting. Far better is to advocate more natural, less processed food that can be found in our farmer’s markets, or of course supermarkets, despite the many less healthy temptations.
Traditional food choices, such as Mediterranean, Asian, Aboriginal or Nordic, are recommended Be mindful of portion sizes. Limit drinks with high sugar and caffeine content and watch alcohol consumption.
Physical inactivity leads to loss of lean body mass (sarcopenia), increased fat mass, particularly around the waist (central and visceral), but it can also infiltrate muscle (marbling). There may be increased osteopenia and osteoporosis, reduced VO2 max (lower fitness level), and increased insulin resistance, leading to impaired sugar metabolism.
So, what sort of exercise is good for cancer survivors? As with everyone the emphasis should be on aerobic exercise and resistance training. If lower limb mobility is impaired, upper body exercise is an alternative as Paralympians have clearly shown us.
A question often asked by breast cancer survivors is whether resistance training increases the risk of lymphadoema?
A study(4) has found this not to be the case, and there is the added benefit of increased strength and functioning. Now popular amongst breast cancer survivors is the sport of dragon boat racing, which helps women physically as well as emotionally as they group together in teams.
To address all risk factors GPs are well placed to assist cancer survivors though the Medicare systems for managing people with chronic disease. A targeted care plan and engagement of appropriate allied health practitioners can make a big difference in patients’ quality of life and longevity.
As cancer survivors often have other chronic diseases, a lifestyle medicine approach for their cancer will also be of benefit with helping manage the co-morbidities. Care plans can ensure that the vitally important cancer specialist follow-up is also adhered to. A team approach to encourage a healthy lifestyle, along with appropriate specialist care, will offer the best survival prospects and quality of life outcomes for cancer survivors.
(1) Cancer Survival and Prevalence in Australia – period estimates. AIHW 2012
(2) Siegel R, Naishadham D, Jemel A. CA Cancer statistics, 2012 Cancer J Clin; 62:10-29
(3) Egger,Binns,Rossner ‘Lifestyle Medicine’ McGraw Hill (2nd Edition) 2012
(4) Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis:meta-analysis of published studies. Med.Oncol. 2011; 753-765
(5) Kathryn Schmitz: JAMA Dec 2010, Weight Lifting for Women at Risk for Breast Cancer Related Lymphedema RCT