9/16/16. Weight Management, Lifestyle and Cancer Risk. Cynthia Buffington PhD LIFESTYLE

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1 9/16/16 Weight Management, Lifestyle and Cancer Risk Cynthia Buffington PhD LIFESTYLE Cancer is 30-50% preventable over time, by appropriate food and nutrition, regular physical activity and avoidance of obesity. WCRF/AICR GOOD LIFESTYLE Appropriate Diet/Nutrition Physical Activity Stress Management Sufficient Sleep Weight Management 1

2 OBJECTIVES 1. To discuss the link between obesity and cancer 2. To identify lifestyle contributors to cancer risk 3. To study the anthropometrics (body size and composition) and lifestyles of BRCA mutation carriers BMI (KG/M2) Cancer Risk BMI OBESITY-CANCER RISK Endometrial Cancer Thyroid Ovarian Liver Breast Cancer Kidney Prostate (aggressive) Esophagus Colorectal Cancer Pancreatic Gallbladder Hematopoietic System Non-Hodgkin s Lymphoma Multiple Myeloma Leukemia WCRF/AICR CUP 2009; 2012; 2016 WHO 2016 AICR Obesity and Cancer 2

3 OBESITY CANCER Why is there a Link Between Obesity and Cancer? Cancer Risk Factors Hormone Changes Products of Adipose Tissue Metabolic Conditions Initiation, Growth/ Progression, Metastasis Feola A et al. J Cell Physiol 2016 Ivengar NM et al. Annu Rev Med 2015 O-Rourke RW. Surg Obes Relat Disord 2014 Byers T& RL Sedjo. Endocr Relat Cancer 2015 BEHAVIOR q Obese less likely go doctor q Cancers go undetected in obese until late stage q Obesity is surrogate for other cancer risk factors such as: -Poor diets -Low physical activity -Sleep Loss -Psychosocial distress Wolin KY et al. Oncologist 2010 Rooney M & A Wald. Clin J Oncol Nurs

4 SUBOPTIMAL TREATMENT q Obese may receive suboptimal doses of chemotherapy q Obese may be less responsive to chemotherapy q Aromatase Inhibitors (BC) less effective Griggs JJ et al. J Clin Oncol 2012 Azrad M, W Demark-Wahnefried. Curr Nutr Rep 2014 Wolin KY et al. Oncologist 2010 De Pergola G & J Silvestris. J Obes 2013 Chan DSM & T Norat. Curr Treat Options Oncol 2015 SUBOPTIMAL TREATMENT q Surgery is more technically challenging and has higher rate complications and risk for unclean margins q Radiation (external beam) may not be as accurate in hitting the target organ with obesity Wolin KY et al. The Oncologist 2010 Chan DSM & T Norat. Curr Treat Options Oncol 2015 Rooney M & A Wald. Clin J Oncol Nurs 2007 OBESITY AND CANCER Cancer Risk Overweight Obesity Wt. GAIN -Disease Relapse -Secondary Cancer Overweight Obesity WCRF/AICR Report (2 nd. Edition 2007) WCRF/AICR CUP Chan DS et al. Ann Oncol 2014 Reeves GK et al. BMJ 2007 Calle EE et al. N Engl J Med 2003 Renehan AG et al. Lancet 2008 Rock CL et al. CA: Cancer J Clin (ACS)

5 WEIGHT GAIN POST-DIAGNOSIS Nurses Health Study Median gain 6 lbs. = 35% Median gain 17 lbs. = 64% risk for relapse risk for relapse Kroenke CH et al. J Clin Oncol 2005 North Central Oncology Group 5.9 kg (13 lb.) 50% relapse Camoriano JK et al. J Clin Oncol 1990 WEIGHT GAIN BREAST CANCER 5-14 lb > 20 lb 50-96% Rooney M & A Wald. Clin J Oncol Nurs 2007 Chan DSM & T Norata. Curr Treat Options Oncol 2015 BODY COMPOSITION Adipose Tissue Muscle Mass Initiation, Growth/ Progression, Metastasis Vance V et al. Obes Rev 2011 Harvie MN et al. Breast Cancer Res Treat 2004 Keun HC et al. Clin Cancer Res 2009 Demark-Wahnefried W et al. Cancer 2012 Sheean PM et al. Breast Cancer Res Treat

6 TREATMENT EFFECTS Chemotherapy - Dosage - Duration Radiation Hormones Multi-treatment Makari-Judson G. World J Clin Oncol 2014 Vance V et al. Obes Rev 2011 Rooney M & A Wald. Clin J Oncol Nurs 2007 Chlebowski et al. J Clin Oncol 2002 Sedjo et al. J Cancer Surviv 2014 Chan DSM & T Norata. Curr Treat Options Oncol 2015 PHYSICAL EFFECTS - Reduced Physical Activity - Poor Physical Function Neuropathy Pain Anemia Feeling Sick RECOMMENDATIONS PHYSICAL ACTIVITY WCRF/AICR, ACS, ASCO, ACSM: -Encourage activity at diagnosis and regular physical activity for life -Avoid inactivity even in patients undergoing difficult treatment (modify activity) 6

7 BENEFITS DURING TREATMENT Physical Function Body Composition Cramp F & Byron-Daniel J. Cochrane Database Syst Rev 2012 Van Vulpen JK et al. Maturitas 2016 Leach HJ et al. Support Cancer Care 2016 EXERCISE DURING CHEMO May Improve Efficiency of Chemo Exercise during chemotherapy improves breast cancer disease-free survival Courneya KS et al. Med Sci Sports Exerc 2014 EXERCISE AND CANCER PREVENTION Number of studies find physical activity before or after cancer diagnosis reduces cancer occurrence/recurrence (risk reduction 20 to 50%). 180 minutes per week 50% Reduction Recurrence Nurses Health Study Holmes MD et al. JAMA 2005 Lahart IM et al. Acta Oncol 2015 Loprinzi PD & HLee Oncol Nurs Forum 2014 Schmid D & MF Leitzmann. Ann Oncol 2014 Kruk J & U Czerniak. Asian Pac J Cancer Prev 2013 Behrens G et al. Eur J Epidemiol

8 SLEEP LOSS AND OBESITY Sleep Overweight, Obesity Systematic Review and/or Meta-analyses Chen X et al. Obesity 2008 Magee L & L Hale. Sleep Med Rev 2012 Cappuccio FP et al. Sleep 2008 Patel SR et al. Obesity 2008 Liu J et al. J Spec Pediatr Nurs 2012 < 7 hr SLEEP LOSS < 7 hr Hormone Changes that: Appetite Metabolic Rate Fat Accumulation Spaeth AM et al. Am J Clin Nutr 2014 Leger D et al. Mol Cell Endocrinol 2015 Chaput JP et al. Obesity 2014 Vargas PA. Curr Obes Rep 2016 SLEEP LOSS AND CANCER Sleep Loss Risk Breast Cancer Occurrence/Recurrence (Independent of Body Size) Malina et al. Gynecol Obstet Fertil 2013 Wang et al. Scand J Work Environ Health 2012 Thompson CL et al. Breast Cancer Res Treat

9 PSYCHOLOGICAL DISTRESS Stress and Stress Hormones Initiation, Growth/ Progression, Metastasis (Independent of Body Size) Bryla CM. Oncol Nurs Forum 1996 Shin KJ et al. Curr Pharm Des 2016 Powell ND et al. Brain Behav Immun 2013 STRESS/DISTRESS AND OBESITY Appetite Food Cravings (Sugar) Fat Accumulation Up to 24 pound weight gain 3 y post-diagnosis Befort CA et al. Psychooncology, 2010 COMFORT FOODS 9

10 DIET Avoid/Reduce: Sugar Processed Grains Added Salt Processed Meat Red Meat Saturated Fat Alcohol WCRF CUP 2016 wrcf.org AICR 2016 Bail J et al. Semin Oncol Nurs 2016 Consume: Plant Foods Cruciferous Veg Allium Veg Dark Green Leafy Colorful Fruits/Veg Berries, Grapes, Whole Grains Nuts/Seeds Legumes Fish, Quality Protein Lifestyle and Cancer Risk Obesity/Overweight increase cancer risk before and after cancer diagnosis Lifestyle issues that increase obesity and CANCER risk include: Poor physical function and low activity Insufficient Sleep (<7 hr) Psychological Distress Poor Diet and Dietary Choices BRCA Gene Mutations 50-80% Breast Cancer 40-60% Second Primary Breast Cancer 15-45% Ovarian Cancer 10

11 OBJECTIVES To study the anthropometrics (body size and composition) and lifestyles of BRCA mutation carriers STUDY POPULATION Study Population: FORCE 2012 Attendees National Meetings BRCA mutation carriers Survivors 44% Previvors 52% Controls Matched for age, body size No family history breast/ ovarian cancer THE STUDY POPULATION BRCA Mutations 44% 48% 56% 48% BRCA 1 BRCA 2 BRCA 1,2 Previvors 2% Survivors 11

12 Anthropometrics Weight, Height Body Mass Index (BMI; kg/ m2) Body Composition (Fat, Lean Tissue) MEASUREMENTS Levels of Physical Activity Anxiety Quality of Life (emotional, physical) Demographics, Cancer Information, Personal Issues, Sleep Diet (3-day food records) What Were the Findings? 12

13 Group RESULTS: Anthropometrics Wt. (lbs) BMI (kg/m 2 ) Fat (%) Lean: Fat Controls Previvors Survivors a 1.81 a a p<0.05 = NS Survivors vs. Previvors or Controls 3 Lean-to- Fat Mass *γ * γ.5 0 CONTROLS PREVIVORS SURVIVORS p<0.02 Controls vs. Survivors p<0.003 Previvors vs. Survivors Lean/Fat Lean/Fat 2.5 p< Possible Effectors: TREATMENT Survivors CHEMOTHERAPY No Yes HORMONES p=0.08 Lean/Fat RADIATION p=ns No Yes 0 No Yes 13

14 Physical Effectors: Physical Activity Lean-to-Fat Mass ACTIVE INACTIVE *p<0.01 Active vs. Inactive Poor body composition associated with inactive lifestyle % Physically Active 68% 77% 45% Survivors Controls Previvors Physical Effectors: Physical QoL Physical Function Lean:Fat Mass (-) Physical Limitations Pain *p<0.05 Lean:Fat Mass vs. Measures of Physical QoL Found: Body composition associated with poor physical function 14

15 Psychosocial Stress Anxiety Emotional Quality of Life PSYCHOLOGICAL DISTRESS Anxiety a a BAI Score Controls Previvors Survivors Emotional QoL a a Score a p=0.01 Control Values 30 Controls Previvors Survivors Psychological Distress 15

16 % Quality Sleep 65% 42% 25% Controls Previvors Survivors Poor Sleep Quality DIET Measure Controls Previvors Survivors Tot Kcal % Fat % Carbs % Protein Fiber g Sugar g Alcohol/wk No Significant Differences 16

17 SUMMARY: Anthropometrics Most BRCA mutation carriers in this study were not obese. However, lean tissue mass was lower and body fat was higher for survivors than previvors or controls which may predispose this population to weight gain and increased cancer risk. INTERVENTION Improve Lifestyle. SUMMARY: Physical Activity -Poor body composition was associated with reduced physical activity and function. -Less than 50% of survivors engage in physical activity and the majority scored low for physical function. INTERVENTION -Engage in regular physical activity. -See a specialist for chronic pain and other physical limitations. SUMMARY: Psychological Distress Psychological distress was high for ALL BRCA mutation carriers and associated with: -Sugar cravings -Weight gain -Poor sleep quality INTERVENTION Learn/practice anti-stress techniques. See a behavioral therapist for counseling. Join a support group. 17

18 SUMMARY: SLEEP Sleep quality was poor for previvors and even worse for survivors. Poor sleep quality was associated with higher % body fat, poor physical quality of life, and psychological distress. INTERVENTION Sleep 7-9 hrs daily. Learn/practice GOOD sleep hygiene. See a sleep specialist if suspect a disorder. SUMMARY: DIET Macronutrient intake looked good but no information concerning type of foods consumed. INTERVENTION Follow AICR (WCRF) guidelines for cancer- fighting vs. cancer-promoting foods. CONCLUSION PRACTICE HEALTHY LIFESTYLE AND WEIGHT MANAGEMENT FOR CANCER PREVENTION. 18