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Should people with cancer be given lifestyle advice?

Posted Feb 08 2013 12:00am

PhD student Kate Williams talks about her team’s new research paper

Keep active; eat healthily; don’t smoke: general lifestyle advice isn’t hard to come by.

And a range of organisations – including the UK government and charities like Cancer Research UK – put a lot of time and effort into explaining and encouraging people to live healthily , so that they increase their chances of avoiding a range of diseases – including cancer.

But what about advice for people who already have cancer, or who are in long-term follow-up?  Are there things they could do to boost their chances of avoiding subsequent illness? And even if there are, what’s the best way to get this information across, without seeming insensitive or inappropriate?

Obviously, people with cancer aren’t all the same. They differ – not just in terms of where they are in their treatment, which treatment they have, or which cancer they have – but also in terms of their general health, and their attitudes and beliefs about lifestyle change. It’s not a ‘one-size-fits-all’ situation.

But it turns out that cancer patients and survivors are given very little lifestyle advice, even though, as well see, there’s evidence it could be really helpful.

My Cancer Research UK-funded research group, based at UCL , is looking at this issue. We’re trying to work out whether and how to offer advice to cancer patients in a sensitive, appropriate manner.

This week, we’ve published new findings  in the British Journal of Cancer , so we thought it would be good to explain the background to what we’ve found, what it means, and where we go next.

As the UK population ages and treatments continue to improve, more and more people will survive a diagnosis of cancer . This is great news, and a testament to our colleagues in biology labs and hospital wards around the world.

But cancer survivorship carries with it long term risks of various diseases – not just a recurrence of cancer. For example, people who have been diagnosed with cancer are at a greater risk of cardiovascular disease and osteoporosis .

This is thought to be due to a combination of factors including lifestyle, genetics and treatment effects – hence the importance of a healthy lifestyle.

Although still in its early stages, there’s a growing body of evidence suggesting that healthy lifestyles could help cancer patients and survivors.

For example, a recent study of previous research (a so-called ‘meta-analysis’) found that exercise can reduce fatigue and depression, and improve quality of life among cancer survivors. This same review also found that exercise may even help prevent the disease coming back in breast cancer survivors.

Other studies have suggested that changes to diet can have positive effects, for example, reducing fat intake seems to be associated with a longer ‘disease-free survival’.

Based on the evidence currently available, the World Cancer Research Fund suggests that following treatment, cancer survivors try follow the lifestyle guidelines for cancer prevention . These include trying to be active for at least 30 minutes a day, limiting energy-dense foods such as sugary drinks, and eating more fruit and vegetables.

But despite these guidelines, and despite patients and survivors being in regular contact with doctors, nurses and other health professionals, they don’t seem to be given reliable, structured advice.

There are a whole range of possible reasons, such as lack of time in consultations, and the worry that raising the issue of lifestyle may seem insensitive or upsetting at a time when you’re trying to cope with the stress of diagnosis and treatment.

Understanding which of these is important is the first step in improving things.

In our new paper, published today, we set out to find out what those closest to cancer patients (their friends and family) think about doctors giving cancer patients lifestyle advice.

We asked 1273 people who knew someone close with cancer a series of questions to assess their attitudes towards giving cancer patients advice on exercise, healthy eating and weight loss.

We’ve shown for the very first time that people don’t think it would be inappropriate to give lifestyle advice to cancer patients – in fact, quite the opposite.

More than eight out of ten (over 85 per cent)  of those closest to cancer patients saw lifestyle advice as ‘beneficial’ and a similar proportion (over 80 per cent) believed that doctors had a ‘duty’ to provide it.

We also found that fewer than two out of ten (less than 20 per cent) of people felt such advice was ‘unnecessary’, ‘interfering’, ‘insensitive’, or implied ‘blame’.

For comparison, we also asked a small number of people with cancer – or who had been diagnosed with cancer in the past – what their thoughts were on lifestyle advice. They were equally as positive, with the majority agreeing that lifestyle advice was a good thing.

These findings are very encouraging, and suggest even those closest to cancer patients think lifestyle advice is a good idea. We hope that these findings will help encourage health professionals to broach the subject of lifestyle with their cancer patients.

So, clearly, there seems to be a lot of support for the idea of giving patients evidence-based advice on what they could do to reduce the likelihood of ill health later on.

But there are still questions that need answering, such as:

  • When is the best time to give cancer patients lifestyle advice?
  • Who is the best person to give the advice – should it be a doctor, a nurse, a physiotherapist or a dietician?
  • What format should the advice take – would patients prefer a leaflet, a dvd or verbal advice?

These are all questions I hope to answer in the next stages of my PhD, where I’m planning to find out much more about what cancer patients, cancer survivors and health professionals all think of this issue.

Kate

  • Williams K., Beeken R.J. & Wardle J. (2013). Health behaviour advice to cancer patients: the perspective of social network members, British Journal of Cancer, DOI:
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