1. Diet, Lifestyle and Cancer Survival
Marie Cantwell PhD, MPH
Centre of Excellence for Public Health
Queen’s University Belfast

2. Cancer – Chronic condition
Dietary management of cancer patients is typically seen during the patients active treatment phase – weight loss, anorexia, cachexia, nausea, vomitting
Long term survival- No advice for patients in terms of diet and lifestyle similar to cardiac rehab or dietary management of diabetes

3. Cancer Survivorship 62% 5 year survival over all adult cancers
60, 000 cancer survivors (diagnosed in the previous 5 years) in Ireland
Increased risk for developing secondary cancers, other chronic diseases (CVD diabetes)
Environmental factors such as diet and physical activity contribute
Unhealthy behaviours tend to cluster in the population at large and specifically among cancer survivors
Aziz; J Nutr 2002; 132: 3494S

4. Major Lifestyle Opportunities for Cancer Survivors
Opportunity Prevalence
Inadequate diet 75%
Physical inactivity 54%
Smoking %
Overweight/obese 68%
US-NHIS interview, ages years
Coups EJ & Ostroff JS Prev Med 2005; 40:702-11

5. Lifestyle Interventions in Breast Cancer Survivors Randomised Controlled Trials

6. WHEL Study (Women’s Healthy Eating and Living Study)
RCT 3088 early stage breast cancer survivors ( ); age yrs
Diet intervention counselling
5 vegetable servings
16 oz vegetable juice
3 servings fruit
30g fibre
15-20% calories fat
Control (print material, 5 a day)
Primary outcome: breast cancer events, death- no effect on disease free survival
Secondary outcomes 1. Significant diet change
2. Significant change in selected biomarkers
(carotenoids, oestradiol (total and bioavailable)
3. No significant weight change (I year)
Pierce et al. JAMA 2007;
Randomised

7. Women’s healthy Eating and Living Study (WHEL)
Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, fibre and low in fat did not reduce additional breast cancer events or mortality during a 7.3 year follow up period

9. WINS Risk of Recurrence low fat diet vs. control

10. Women’s Intervention Nutrition Study (WINS)- role of low fat diet
Lifestyle intervention reducing dietary fat intake (target 20% E), with modest influence on body weight, may improve relapse-free survival of breast cancer
24% reduction in risk for recurrence; subset analyses suggest that this effect was even greater among women with oestrogen receptor-negative disease
Chlebowski et al, 2006, J Natl Cancer Inst 98(24):

11. Prospective Cohort Studies

12. Prospective Cohort Studies
1. Healthy Eating Activity and Lifestyle (HEAL) study (USA multicentre) n = 1182
2. Life after Cancer Epidemiology (LACE) USA multicentre n=2321
3. Shanghai Breast Cancer Survivors Study n= 5000
4. Pathways Northern California n= 4000
5. DietCompLyf Study –UK multicentre n= 3000

13. Weight management and Breast Cancer Survival

14. Change in BMI after diagnosis & association with recurrence & mortality
Data from cohort of 5204 Breast Cancer Survivors in Nurses Health Study
Relative Risk

15. Physical Activity and Breast cancer survival

16. Observational Cohort Study of Exercise After Diagnosis & Association with Recurrence & Mortality Data from Cohort of 2987 Breast Cancer Survivors in Nurse’s Health Study
Relative Risk
Level of Exercise (MET hrs/week)
Holmes et al. JCO 20: , 2005

17. Ongoing work - Cancer Survivors

18. A randomised controlled trial to evaluate the efficacy of a 6 month dietary and physical activity intervention for prostate cancer patients receiving androgen deprivation therapy
Androgen deprivation treatment (72%)
Outcomes of interest: body composition, fatigue and QoL

19. Side effects of Androgen Deprivation Therapy
Body composition-
Decrease in lean body mass
Decrease in muscle strength
Decrease in bone mass and BMD
Increase in fat mass
Increase in total body weight
Fatigue-
Quality of Life-
Others- Impotence
Hot flashes
Growth of breast tissue 
Osteoporosis
Anaemia

20. Ongoing Research
DietCompLyf study - Role of diet, lifestyle and complementary therapies on breast cancer survival study
Prospective Cohort Study:
50 centres
3000 breast cancer patients
Collected FFQ, Food Diaries, Serum, Urine
Women with histologically confirmed invasive primary breast cancer grade I to III
May enter the study after their active treatment for primary breast cancer has finished, from 9 months to 15 months post diagnosis
Age up to and including 75 years old

21. 1. Change in food /nutrient intake after breast cancer diagnosis – Louiza Valentzis 2. Dietary patterns and breast cancer survival and quality of life in a cohort of breast cancer survivors- Sarah Brennan, Marice Lunny

22. Conclusions
Adjuvant treatments for breast cancer lowers disease mortality 25-40%
Weight maintenance after breast cancer may lower disease mortality ∼ 40%
Moderate exercise after breast cancer may lower disease mortality ∼ 40-50%

23. Conclusions
Advising weight maintenance and exercise after breast cancer may help our patients as much as standard treatments
Important in our sedentary & obesigenic environment.
Diagnosis of cancer –”Teachable moment”
Often demonstrate an enhanced motivation to change their lifestyle behaviours
Interventions that address multiple risk factors such as diet and physical activity in more diverse populations and for other cancer sites, are required

24. Thank you for your attention

25. American Cancer Society
Achieve or maintain a healthy weight
Choose foods that help maintain a healthy weight
Eat a variety of foods with an emphasis on plant foods
Eat 5 or more servings of a variety of vegetables & fruit each day
Choose wholegrain in preference to processed (refined grains & sugars)
Limit consumption of red meats especially those high in fat and processed
If you drink alcoholic beverages limit consumption

27. Dietary Intake and body weight change during WINS and WHEL Intervention