ESPEN Congress Madrid 2018

Transcription

1 ESPEN Congress Madrid 2018 The Role Of Obesity In Cancer Survival And Cancer Recurrence Nutrition And Lifestyle Strategies In Cancer Survivors S. Beijer (NL)

2 1 Nutrition and lifestyle strategies in cancer survivors Sandra Beijer, dietician / senior researcher Netherlands Comprehensive Cancer Organisation ESPEN congres September 1-4, 2018

3 Disclosure of speaker s interests (Potential) conflict of interest None Potentially relevant company relationships in connection with event Sponsorship or research funding Fee or other (financial) payment Shareholder Other relationship, i.e. (If you select see below please add the company name)

4 Learning objectives Know nutritional strategies in cancer survivors Know the effects of nutritional strategies (physical activity, healthy weight, healthy diet) in cancer survivors Know how to prevent obesity in cancer survivors

5 Percentage The good news Percentage of survivors per period of diagnosis All tumors; All tumors; All tumors; All tumors; All tumors; Number of years after diagnosis Netherlands Cancer Registry

6 The bad news Recurrence Secondary tumors Coronary heart disease Diabetes Obesity Osteoporosis Loss of muscle mass Weakness Depression Fatigue I m so glad that all treatments are behind us What do we have to advice after (curative) treatment? Eh..yes Eh.

7 A lot of hypes in the media

8 Guidelines American Cancer Society

9 Recommendations World Cancer Research Fund

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11 Association ACS adherence and survival in colorectal cancer survivors (n=992) ACS Guidelines Score Including Alcohol Consumption (0-8) N=187 N=199 N=240 N=204 N=162 Overall Mortality Events HR (95% CI) ( ) 0.71 ( ) 0.67 ( ) 0.49 ( ) Cancer Recurrence (Recurrence-Free Survival) Events HR (95% CI) ( ) 0.87 ( ) 0.80 ( ) 0.64 ( )

12 HR mortality Adherence to WCRF recommendations and mortality Total cancer Breast cancer 2,017 women with cancer mean age 78.9 years (range=72 88 years) Inoue-Choi M et al. Cancer Epidemiology Biomarkers Prevention 2013; 22(5): 792

13 Association adherence WCRF/AICR recommendations and quality of life 2,193 women with cancer (Iowa Women s Health Study) Mean adherence score was 4.0 Higher adherence to WCRF/AICR guidelines was significantly associated with better physical and mental component summary scores WCRF adherence score 3 5 Physical component score Mental component score 37,0 43,5 52,0 54,2 Inoue-Choi M et al. J Clin Oncology 2013; 31; 1758

14 Adherence to WCRF recommendations and quality of life (1,096 colorectal cancer survivors) van Veen MR, Mols F, Bours MJL, Weijenberg MP, Kampman E, Beijer S. Submitted.

15 Who follows the guidelines? It is not healthy, is it?

16 Who follows the guidelines? (n=1196 colorectal cancer survivors) Recommendation Intake of red and processed meat 8% Consumption of plant-based foods 9% Body fatness 34% Foods and drinks that promote weight gain 58% Physical activity 73% Alcoholic drinks 74%

17 Changes in fruit and vegetable consumption after a cancer diagnosis Women with no cancer (n=40,511) β Confidence Interval REF REF 122 Cancer (n=4,619) Stage 0-1 (n=2,674) Stage II-IV (n=1,170) Breast cancer (n=2,699) Stage 0-1 (n=1,785) Stage II-IV (n=790) Other cancers (n=1,920) Stages 0-1 (n=889) Stages II-IV (n=380) FV intake (g/day)

18 Use of nutritional supplements Supplement use 1 per week during the last month Supplement use 3 nee 2 4 ja Number of supplements 1 Supplements Multivitamin and minerals Used by 54% Visoil 20% Vitamins Vitamin C 15% Vitamin D 9% Folic acid or B12 7% Vitamin A 2% Minerals Magnesium 14% Iron 14% Calcium 11%

19 Antioxidants accelerate lung cancer incidence and progression New England Journal Medicine 1994

20 Vitamin D and mortality Tretli et al. CCC 2012 Maalmi et al. Eur J Cancer 2014; 50(8):1510

21 Vitamine D and cancer survival remarks Low vitamin D status caused by the tumor?? No evidence for beneficial effect of vitamin D supplementation on survival Vitamin D in nutrition is insufficient sunlight Recommendation vit D supplementation Netherlands: - Women 50 years 10 mcg vit D - Women / Men 70 years 20 mcg vit D

22 Motives for dietary changes and dietary supplement use 1458 stage I-IV colorectal cancer survivors - 57% male - Mean age 70 years Dietary changes post-diagnosis 36% - received dietary advice Current supplement use 32%

23 Beliefs about the role of lifestyle and cancer recurrence Colorectal cancer survivors (20 men, 20 women, yrs) Participants believed they led a healthy lifestyle before the onset of cancer why would a healthy diet reduce their risk of cancer in the future Participants searched for other possible causes for their onset stress was most frequently mentioned Most important lifestyle change psychological approach to life (more relaxed, creative, take up a hobby) Anderson et al. Support Care Cancer 2013; 21:35

24 Cancer survivors views on diet and cancer Aware of diet affecting risk for cancer Less clear about role diet in cancer recurrence Cancer diagnosis prompt for dietary change Changes consistent with healthy eating recommendations Dietary supplements and other non-evidence-based actions were mentioned Participants had not received professional advice about diet and were keen to know more Cancer survivors would welcome guidance from health professionals

25 Take home messages Following healthy lifestyle recommendations for cancer survivors is associated with better survival and higher quality of life Number of cancer survivors following the recommendations is disappointing Always ask how many nutritional supplements patients are using lower supplement use (maximum 100% ADI) The role of diet in cancer recurrence is less clear in cancer survivors dietary advice might positively influence beliefs Cancer survivors welcome nutritional guidance from health care professionals

26 More information Digital version in English published on Oncoline (free access to Netherlands cancer guidelines: =en