“Every couple of years, we do a cancer risk factor awareness survey and about half of the people are unaware of most of these strong risk factors like alcohol, obesity, low physical activity, and diet.” – Nigel Brockton, PhD
“The immune system is important because then you’re using a system against a system, rather than one tool against one target.” – Nigel Brockton, PhD
“There is a huge difference between what can be recommended at the population level (the predominant role of AICR) versus what can be assessed to be potentially beneficial at the individual level (clinical guidance and patient choice).” – Nigel Brockton, PhD
Meeting Summary
Advanced cancer patients are looking for every edge they can find to enhance their immune system and general health to fight their disease. In a diagnosis that can arrive “out of the blue”, it is important to have agency and make a difference in things they can do, such as follow a healthy diet, reduce stress, get sleep, and exercise.
But what is the science that shows the potential impact of these and other lifestyle factors on patient outcomes?
A patient’s medical team is usually focused on testing and treatment options with surgery, radiation, or drugs. Where should patients look to get advice on these other lifestyle factors?
How should a patient (and caregivers) think about the potential impact?
What should an active and engaged patient do?
As a cancer survivor (Ewing sarcoma) and Vice President of Research at the American Institute for Cancer Research’s (AICR), Nigel Brockton, PhD, is uniquely positioned to share the scientific evidence regarding diet, nutrition, body weight and physical activity as they relate to cancer risk and survivorship. The AICR was formed to try and distinguish evidence from opinion because patients were fatigued and confused by the changing messages about what was healthy. Dr. Brockton outlined the evidence about cancer risk generally and about prostate cancer specifically, and he explained the future direction of research on a global scale with AICR’s international colleagues.
What does the science show about the potential impact of lifestyle factors on cancer outcomes?
The AICR recommends in general that you should be at a healthy weight, be physically active, eat a diet rich in whole grains, vegetables, fruits and beans, limit consumption of fast and processed foods, limit consumption of red and processed meats, limit consumption of sugar sweetened drinks, limit alcohol consumption, and don’t take supplements for cancer prevention. There are reasons to take supplements, but cancer prevention isn’t one of them. In some cancers, some of these supplements can interfere with the action of treatments. They can cut both ways.
If exercise were a pill, we’d give it to everyone. As long as you are capable of doing it, that is probably one of the strongest medicines, and it’s based on evidence. Immune benefits seem to come more from high intensity workouts.
Specific cancers have specific recommendations. For example, in colorectal cancer there is strong evidence for five factors that decrease your risk: whole grains, foods containing fiber, dairy products, calcium supplements, and physical activity, and five that increase your risk: red meat, processed meat, alcoholic drinks, adult body fatness, and attained height.
In prostate cancer the only strong evidence is increased risk from adult body fatness, specifically for advanced prostate cancer. There is limited, suggestive evidence that dairy products, diets high in calcium, low plasma alpha-tocopherol concentrations (Vitamin E), and low plasma selenium concentrations increase cancer risk.
What should an active and engaged patient do?
You can substantially reduce your cancer risk by changing your behavior. About half of people are unaware of strong risk factors like alcohol, obesity, low physical activity, and diet, or that coffee is beneficial. People often think that it’s genetics and pesticides and things, but they account for a fairly low proportion of cancers.
The cancer treatments that you receive could be bad for your cancer, but they are also bad for the rest of your body. The more you can do to maintain your resilience, the better off you are.
The call is for action, not perfection. The more of these recommendations you follow, the lower your cancer risk, and the better your outcomes. But any of these you address will be beneficial.
How should advanced cancer patients think about adopting lifestyle, nutrition, and exercise guidelines?
You can think about cancer like a bathtub which fills up with water (cancer risk). We’re all born with a certain amount of water in our cancer bathtub. There’s a leaky tap that adds water (cancer risk) over our lifetimes. Although we can never stop that leaky tap, we can reduce the flow by adopting healthy behaviors and avoiding unhealthy behaviors.
How do we know when our bathtub is getting full? We know through diagnostic tests.
It’s never too late to adopt healthy behaviors and slow the flow, and it’s also never too early. It’s pretty difficult to remove the water. We don’t have evidence yet for the reversibility of cancer risk.
What is the evidence for future cancer treatments, especially immunotherapies?
The future of cancer treatment, although it’s been very disappointing so far in prostate cancer, is immunotherapy. The immune system is important because then you’re using a system against a system, rather than one tool against one target. Prostate cancer tends to be a very immune cold tumor. The immune system doesn’t respond to them. Males, particularly older males, tend to have poor immune systems. A lot of lifestyle factors have an impact on the immune system. If the immune system is already compromised, then immunotherapy is not going to be able to function. If you’re giving immunotherapy as a last-ditch attempt, after you’ve wrecked somebody’s immune system with chemotherapy, the immunotherapy has less of a chance. This is not sci-fi anymore because with melanoma they’ve shown some really good results with mRNA vaccines.
How should advanced cancer patients make decisions between treatments based on solid, evidence-based research and those that are based on solid scientific theories, but for which there is no randomized clinical trial evidence (and may not be for many years)?
There is a huge difference between what can be recommended at the population level (the predominant role of AICR) versus what can be assessed to be potentially beneficial at the individual level (clinical guidance and patient choice). Given the complexity of cancer treatment options and the unique context of each case, particularly in advanced disease, being your own advocate and engaging in collective advocacy is hugely valuable. Oncologists are well trained, but it is impossible for one person to assimilate the entire ever-expanding field. Tumor boards seek to exploit a group to optimize treatment approaches for individual cases, but you are the best advocate for optimal approaches for YOU
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