Saturday, May 10, 2008

Do Cancer Survivors Make Suggested Lifestyle Changes?

A recent article published showed the results of a survey conducted by The American Cancer Society that asked cancer survivors about lifestyle changes done after their cancer diagnosis. Here are the findings:
* Only 14–19% of cancer survivors were eating five servings per day of fruit and vegetables.
* Physical activity recommendations were met by 29–47% of cancer survivors.
* Smoking cessation was met by 82–91% of cancer survivors.
* 12.5% were meeting none of the recommended changes
* <10% of the survivors were meeting two of the recommended changes in any of the different cancer diagoses
* Overall, only 5% of survivors met all three of the recommendations.

Hmmm, these data are really good to have documented. However, a higher percentage of diet and lifestyle changes in cancer survivors is not a surprise to me. Yes, a cancer diagnosis is a "teachable moment", but so are other diagnoses or events. Yet, would anyone really expect a person who has just been diagnosed with diabetes or has had an MI or by-pass surgery
to find, sort through, prioritize, and make all the necessary diet and lifestyle changes completely on their own to optimize the disease process and quality of life from that point forward?

I know how hard it was to first physically recover from cancer surgery
and treatments and then both figure out and then make major
meaningful changes myself to my diet and lifestyle. When left on my
own after my cancer therapies were completed, I essentially created my own individual and personal "oncology rehab program" similar to a cardiac rehab program or an intensive diabetes management education program. No only do I know how hard this was to do by myself, even as an RD, I know how hard it is to stick to these changes every single day of the year, year after year after year. (I thank my lucky stars that I did not need to quit smoking, in addition to diet and exercises changes.)

It is beyond my intellectual capacity to understand how the oncology
community expects most cancer survivors to "do this on their own"
without the professional and group education and support that the
cardiac community provides for continuity of care for their patients.
Granted many cancer survivors are "health seekers" and will find their
way to reliable information and find the individual drive and
motivation to make changes, but if that only ends up being 5%, well I
guess 5% is better than 0%. (can you hear me sighing.........?)

Simplifying the goals to eating 5 servings of fruits and vegetables
per day and exercising 30 minutes per day for each day of the week
sounds simple enough, but the point is people are not doing that
before the diagnosis for multiple reasons. With so much else weighing on you, distracting you, and/or needing immediate attention (like figuring out how to sort through the medical insurance info - if you're lucky enough to have insurance - and figure out how to pay for everything else not covered by insurance, just for starters!!), I think it is abundantly clear that cancer survivors are not going to jump on the health bandwagon quickly or easily, and it is unreasonable to expect them to "stop smoking, eat right, and exercise" completely on their own.

I don't know what it's going to take to move oncology to the point
that nutrition and other lifestyle changes are fully incorporated
pro-actively into comprehensive cancer care. Cancer patients need "oncology rehab" as much as people with cardiac disease and diabetes do (and I sure I could add other diagnoses here, too).

As a cancer survivor, I'm glad I'm in the 5% group but as a health
care professional, I'm not proud of the 5% figure. Somehow we have to
figure out a way to do better, much better, and sooner rather than
later. Maybe implementing the use of the upcoming nutrition survival care plans will help increase these figures. (Sounds like a research project to me for some center/RD to do.)

I'd love to hear others' reactions and thoughts to the results of this
survey, and I always love hearing ideas for how RDs can be (and are!!) involved with improving health and quality of life after cancer. I will add that for those of you who moving the curve forward by providing nutrition information and support for cancer survivor, I first say "Thank you!" and then add that I hope some type of outcome data are being collected since "lack of research" always seems to be a reason given for why nutrition is not included in comprehensive cancer care. (I admit to getting weary of hearing that there is not yet enough research; granted, I know I am an impatient person!)

Diana Dyer, MS, RD


Anonymous said...


I am in the 5% and do your BC diet every day (except I give myself 1 cheat day). Originally, I found it hard to get the 9 servings a day in but NOW, some days I'm closer to 13 and I vary ALL on your program (there isn't ANYTHING I don't eat as well as I eat organic, local and seasonal). I belong to an online BC support group I am ALWAYS touting your book/diet and honestly, I find that people don't WANT to eat the food or exercise. They are ALWAYS asking me what supplements I take and there aren't any as I eat it all and am quite confident that my diet has it covered and the response I get is "I don't like...blah, blah, blah". Also, I had a foot injury last fall and have been unable to walk so just purchasing a stationary bike I decided to join Weight Watchers to get me jump started BUT using your diet (did you know the Phytochemical shake has 11 points...when you only get 25 points a day, thats a lot) and doing WW w/ the diet the first week I lost 8 lbs. Everyone at the meeting wanted to know how I did it and as I started to tell them, they all looked at me like "I don't want to hear that, I want to hear about the sugar free, fat free etc latest new product...I'm dropping out as they are not on the same track as me and I don't want to hear it. As far as doctors, mine is very much into med and really has no interest in the nutritional/exercise part of it, but my intuition tells me that your program is right on and I feel great. I also think the author Michael Pollan is on the right track and I would have to say 75-90% of my food are whole foods and not processed. Well, it's time for bed...keep plugging.


Diana Dyer, MS, RD said...

Thanks for your many kind words and both plugging my book and offering me personal encouragement to keep plugging. Sometimes I do feel like I am trying to move a mountain, but it sure is reassuring to know that I'm working toward that goal with a bucket brigade of others who share that goal.

People often ask me if I "cheat" on my diet. I can honestly answer a resounding "no", but maybe not for the reason you are thinking.

I am intentional about what I eat. I look at everything I eat and give it a quick thought about how this or that will nourish me. I call this mindful eating versus mindless eating. Most of what I eat is food filled with uncountable health-promoting and cancer-fighting molecules. I simply love knowing that so much food both tastes delicious and is also helping to keep me healthy (that is "double-dipping!).

However, some of the food I eat simply nourishes my soul as I am the first to tell you that food is definitely more than just biochemistry. When I choose to eat something for pure pleasure or happiness, I next ask myself how much of that food I really need to eat to satisfy my soul. Taking that little step allows me to (1) enjoy and savor little treats (not "cheats") and (2) also keeps me from eating the whole box of whatever.

Maybe this is just a word-game, but using this framework and style for choosing what I eat has given me years of enjoyment without any guilt. :-)

Thanks for reading my blog, Rhonda!
Diana Dyer, MS, RD

Anonymous said...

I am a RD in a major medical center, which has a huge cancer program and BMT program, and they do not have an RD in cancer center. The reason is "no funding". I think the traditional medical establishment doesn't really grasp it, either. I have heard presentations from some PhD types from the cancer center who present epidemiological diet data as if it were almost not worth mentioning, because "there's only a 10-15% reduction in cancer rate" or they can't pick out only one factor (e.g. fat intake) that influences outcome. They seem unable or unwilling to believe that the entire diet matters. I suspect if one could neatly package and sell an appropriate diet and lifestyle, the pharmaceutical industry would have claimed patent rights long ago...15% (or more) reduction in cancer with no adverse effect? They'd be all over it! Likewise, patients do not know diet can make that much difference, and even the ones who beleive it have a difficult time with it because they don't know who to cook or eat that way. I recently found a program that teaches low fat vegan cooking for cancer survivors, I think it is a great program:


booboo said...

Thanks for all the time you invest in sharing your ideas and diet information. It obviously took alot of time and research, and you are so gracious to share it. I was diagnosed with breast cancer in 2003. In 2005 the cancer returned in my bones. I underwent radiation, grueling chemo, a total hysterectomy, and in 2006 two back surgeries in 3 days. My body was in a battle, and I went from 145# to 86#. I did not stop throwing up for a single day for over 1 1/2 years. I agree that it is very difficult if not impossible to engage in a total health diet without help. When I asked my oncologist what he suggested he simply replied they don't really believe much in nutrition, and to just eat whatever I wanted. I have always been nutrition minded, and had a pretty healthy diet, but I wanted to kick it up to a whole new level....but it was just beyond my realm to tackle at that time since I was so weak, and pretty much confined to my bed. I always loved vegetables, but really could not digest them at that time. The only thing I seemed to tolerate was yogurt, tomato soup, and ensure drinks. I have grown stronger in the past year, and have gained my weight back, stopped vomiting for over a year now, and can eat pretty much anything. The cancer is stable for now. I am on an oral chemo pill Xeloda, and a new drug Tykerb Lapatanib that I am tolerating very well, other than fatigue. I was so happy to come across your blog, and read about your book. It will be so much easier to try and adopt an even better way of eating with all the research and information you provide. Thank You so much. I would also like to recommend the book IN DEFENSE OF FOOD....i can't remember the author, but it is a very good read, and makes so much sense.

All the Best,


Diana Dyer, MS, RD said...

Thanks for finding my blog and sharing a bit of your own cancer story. Your efforts and persistence to heal and thrive are inspiring to me, and I know they are to others you know also. You are an embodiment of what I like to call "Active Hope".

I have also read In Defense of Food by Michael Pollan and highly recommend it.

All my best wishes,
Diana Dyer, MS, RD