“Living Your Best After Cancer: Healthy Diet Choices”

Wendy Demark-Wahnefried, PhD, RD, LDN

• Professor, Duke University School of Nursing & Duke University Medical Center’s Dept. of Surgery

• Nationally-recognized nutritionist with research focusing on the relationship between diet and cancer diagnosis and treatment

• 2003-2005—Director of the Cancer Prevention, Detection & Control Research Program at Duke Comprehensive Cancer Center

• 2003—Named Susan G. Komen Professor of Survivorship

Living Your Best After Cancer: Healthy Diet Choices

Wendy Demark-Wahnefried, PhD, RD, LDNProfessor: School of Nursing & Dept. of Surgery

Duke University Medical Center

Outline

• How important is diet for the cancer survivor?

• What dietary changes are the most helpful?

ACS Dietary Recommendations

Achieve or maintain a healthful weight. Choose foods that help maintain a healthful weight. Adopt a physically active lifestyle.

Eat a variety of healthful foods, with an emphasis on plant sources. - eat 5 or more servings of a variety of vegetables & fruit each day.

- choose whole grains in preference to processed (refined) grains & sugars.

- limit consumption of red meats, especially those high in fat & processed.

If you drink alcoholic beverages, limit consumption.

Striving for a

Healthy Weight

Body Mass Index

BMI = _ (Weight in Pounds) X 703        (Height in inches) x (Height in inches)

If 25 or over: Overweight

If 30 or over: Obese

Trends in Overweight* Prevalence (%) Adults 18 & Older, 1992-2004

1992 1995

1998

Less than 50% 50 to 55% More than 55% State did not participate in survey

*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005.

2004

Weight Management

& Energy Balance

Anorexia/Cachexia • Patients with select

respiratory, G.I. & childhood cancers

• Patients living with advanced cancer

• Increasing weight to desired range important for recovery, well-being, functional status

• Diet & exercise key roles +/- pharmacotherapy

Overweight/Obesity • Overweight a risk factor for

cancers of endometrium, colon, esophagus, kidney,& breast(post-menopausal)–high proportion overweight (71% of breast/prostate survivors)

• Overweight at dx poor prognostic indicator for cancer overall & cervical, esophageal, gastric, colo-rectal, uterine, pancreatic, hepatic, prostatic, biliary, renal, & breast cancers, & multiple myeloma & non-Hodgkin’s lymphoma

• Weight gain common during & after treatment–linked with co-morbidity, functional decline & maybe recurrent/progressive CA

Weight Change After Diagnosis & Association with Recurrence & Mortality

Data from Cohort of 5204 Breast Cancer Survivors in Nurse’s Health Study

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

>0.5 loss maintain 0.5-2.0gain

>2.0 gain

recurrencebreast cancer mortalityall cause mortality

Change in BMI

Kroenke et al. JCO 23: 1370-8, 2005

Re

lativ

e R

isk

• Maintain a healthful weight throughout life.

• Balance caloric intake with physical activity

• Lose weight if currently overweight or obese

How are we doing???On any given day in the United States...

815 billion calories are consumed (200 billion more than needed)

47 million hot dogs

4 million pounds of bacon

60 million pounds of red meat

170 million eggs

On any given dayin the United States...

3 million gallons of ice cream

10 million pounds of candy

16 million gallons of beer and ale

1.5 million gallons of hard liquor (enough to make 26 million people drunk!)

Remember Portion Size

210 Calories2.4 oz.

610 Calories6.9 oz.

350 Calories6” diam.

French Fries 1980 vs. 2000400 Calorie Difference

Bagel1980 vs. 2000210 Calorie Difference

http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm and http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2

140 Calories3” diam.

Think Volumetrics -Choose Lower Calorie Foods that Fill-you-up

…6 potato chips or 3 cups of popcorn

To date there are limited data showing a benefit of a healthful diet on cancer-related survival, however data show that cancer survivors who eat a plant-based diet have lower death rates from other diseases Compared with those who eat a Western diet

Kroenke et al JCO 23:9295-303, 2005

Choose whole grains in preference to processed (refined) grains and sugars.

Include grain products such as breads, cereals rice, pasta, or beans in every meal.

Eat other foods from plant sources several times each day.

Limit consumption of refined carbohydrates, including pastries, sweetened cereals, soft drinks, and sugars.

Eat AT LEAST 5 or more servings of vegetables and fruits each day

Include vegetables or fruits in every meal and for snacks.

Limit french fries, snack chips, and other fried vegetable products.

Choose 100% juice if you drink fruit or vegetable juices.

Alcohol among Cancer Survivor

Alcohol linked to cancers of the kidney, head & neck and breast.

Head & neck survivors who continue to drink have more complications, higher recurrence, other diseases and death

Alcohol protects against heart disease, so survivors need to weigh risks. If do drink alcohol, do so in moderation (ACS)

Survivors and Supplements

• No supplements have proven benefit on cancer-related outcomes, though some may reduce anxiety, etc.

• Refer to responsible sources of information, i.e., National Center for Complementary & Alternative Medicine (http://nccam.nih.gov)

• Rely on food as a source of nutrients

Calcium Herbal Miracle

60-89% of survivors take supplements

40-50% begin additional supplements after diagnosis

A healthful body weight & healthy diet are important for the

cancer survivor

• Achieve/maintain a healthful weight

• Consume a plant-based, nutrient-dense diet

• Moderate alcohol intake

• Seek local, regional or national programs that can provide support (i.e., ACS, NCCAM, clinical trials, hospital-based or community initiatives.

• Test the impact of a diet-exercise mailed material/telephone counseling program on weight loss & physical functioning in 640 prostate, colorectal & breast cancer survivors

• 65+ years of age

• 5+ years out from diagnosis

• No progressive disease

Reach Out to ENhancE Wellness in Older Survivors

(R01 CA106919)

Thank you!