Survivorship. Barrie Cassileth
to determine best dosage and other important preliminary information. If the new therapy appears safe and effective, a larger, more definitive clinical trial is conducted. This trial will be “randomized,” which means that patients will be randomly assigned to receive or not receive the therapy during the trial’s duration. Determined by an electronic version of a coin-toss random allocation, patients will either belong to a group receiving the new treatment or to a group receiving the standard treatment for that specific cancer diagnosis.
Then, the two or more groups of subjects are followed in exactly the same way, receiving the same tests, visits, etc. Patients and their caregivers do not know to which group they were randomly assigned. Proper randomization balances known and unknown factors that might influence results, helping to assure that their results are not influenced by patient perceptions and are valid. Randomized clinical trials are lengthy and expensive, but they have produced the major advances in cancer treatment that led to the more than 67 percent survival rate of U.S. patients across all cancers.
Complementary treatments offer cancer patients many important advantages. They range from extended survival (exercise) to relieving stress, anxiety, and other symptoms (acupuncture, mind-body therapies, etc.). The several types of complementary therapies that have been studied and found to be beneficial for many cancer patients are profiled on the pages that follow, along with warnings as needed. Beneficial approaches include: diet and being savvy about supplements, physical fitness, acupuncture, mind-body therapies, massage therapies, and creative therapies. In the sections that follow, we’ll look at each of these beneficial approaches, the research results, and what benefit each may offer to cancer patients.
Mary, 47-years old with multiple myeloma
“I was so surprised that guided imagery really helped me. I almost felt childish at first, like escaping to a fantasy world, but really enjoying the visualization actually allowed me to feel free and powerful. I don’t have to be trapped by my circumstances; I can choose how to help myself through this.”
What you eat matters. A simple, perhaps obvious fact, but one that is too frequently overlooked. There is little doubt that what we eat has an impact on our risk of diseases such as cancer, and on the progression of those diseases after diagnosis. The nature of this connection has been, and continues to be, the subject of much scientific research. Although we have a lot more to learn, certain guidelines are becoming well established.
Excessive consumption of red meat, highly processed meats, and other sources of animal fat seems to promote cancer, whereas increased consumption of fruits, vegetables, whole grains, and low-fat animal foods may help to hinder it. Some important basic principles follow. A prospective study of 4,577 men with prostate cancer found that eating foods with trans fat, also called unsaturated fat, was associated with increased risk of all-cause death. Replacing carbohydrates and animal fat with vegetable fat may reduce the risk of all-cause death in prostate cancer, and consumption of vegetable fat may benefit men with prostate cancer.1
In a major overview of large, high-quality studies in patients with breast cancer, most found that higher intake of saturated fat before diagnosis was associated with increased risk of death. Moreover, higher monounsaturated fat intake both before and after breast cancer diagnosis was associated with increased risk of cancer-specific and all-cause mortality. Although further research is needed, it appears that consumption of “bad” fats increases breast cancer recurrence and mortality, whereas omega-3 fats seem to be beneficial.2
The bottom line is that lifestyle choices matter for improving survival after a cancer diagnosis. Survivors should continue to focus on maintaining a healthy weight, being physically active, avoiding smoking, and choosing a diet comprised of fruits and vegetables, lean protein, whole grains, and low-fat foods, including dairy. Replacing carbohydrates and animal fat with vegetables is a smart move. It improves survival in patients with cancer.3
Being diagnosed with cancer brings up many questions. Should I change my diet? Should I gain or lose weight? What diet will help me lose weight? Would I benefit from taking a multivitamin or other dietary supplements? Do healing diets work, and if so, which is best? You may also have heard inconsistent or confusing answers to these kinds of questions. That’s because some promises are false and because some definitive data are not yet in place, but the goal of this chapter is to provide you with an overview of what we know today.
Dietary Fats
As outlined on the Mayo Clinic website,4 there are two main types of harmful dietary fat: saturated fat and trans fats. These are solid at room temperature and include beef fat, pork fat, shortening, stick margarine, and butter.
Saturated fat. This comes mainly from animal sources of food. Saturated fat raises total blood cholesterol levels and low-density lipoprotein (LDL) cholesterol levels, which increase your risk of disease and could impact survival after cancer.
Trans fat. This occurs naturally in some foods, especially foods from animals. But most trans fats are made during food processing through partial hydrogenation of unsaturated fats, which creates fats that are easier to cook with and less likely to spoil than are natural oils. However, that can increase unhealthy LDL cholesterol and decrease healthy high-density lipoprotein (HDL) cholesterol, increasing the risk of disease.
Healthier dietary foods contain mostly monounsaturated and polyunsaturated fats. They are liquid at room temperature and include olive oil, safflower oil, peanut oil, and corn oil.
Monounsaturated fat. Found in a variety of foods and oils, studies show that eating foods rich in monounsaturated fats improves blood cholesterol levels, which can decrease your risk of disease and produce better health.
Polyunsaturated fat. Found mostly in plant-based foods and oils, eating foods rich in polyunsaturated fats improves blood cholesterol levels, which can decrease risk of heart disease and type 2 diabetes. Omega-3 fatty acids, found in some types of fatty fish, appear to be especially healthy.
First, when living with cancer, eating a wholesome diet and maintaining a healthy body weight are priorities. Such lifestyle factors, along with regular physical activity (discussed in the next section), can help maximize the effectiveness of your treatments and help maintain good quality of life, all while minimizing unwanted side effects. In the longer term, they can help reduce your risk of cancer recurrence and your risk of other chronic diseases, and they promote longevity.
As we start our discussion about diet and nutrition, a few guidelines are worth mentioning:
• No food, vitamin, mineral, or other supplement is going to immediately and miraculously cure your disease or cause you to drop 50 pounds. That’s not to say the benefits of a healthy diet are insignificant, just that eating well is not an immediate fix. To achieve the benefits—and there are many—it takes regular, long-term commitment to a healthier lifestyle. The key is to choose a way of eating that makes the most sense for you, given your personal goals and tastes. Short-term bouts on a healthy diet aren’t likely to do much good. But sticking to a healthier diet long term, even if you don’t follow it perfectly all the time (moderation is always important!), can make a significant improvement to your health.
• If you are overweight or obese, weight loss is critical. The importance of achieving or maintaining a healthy body weight cannot be overstated. Evidence is beginning to accumulate in support of what doctors have long suspected: that losing weight, even after diagnosis, can lead to longer survival. Being overweight is associated with increased risk of recurrence and decreased disease-free survival. Moreover, gaining weight after diagnosis is a frequent complication of treatment, which must be avoided. Managing your weight requires a combination of diet and exercise. It doesn’t have to be as daunting as it sounds—the tips in this chapter and the activity chapter will help.