Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline

Abstract

PURPOSE To provide guidance on exercise, diet, and weight management during active cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials evaluating the impact of aerobic and resistance exercise, specific diets and foods, and intentional weight loss and avoidance of weight gain in adults during cancer treatment, on quality of life, treatment toxicity, and cancer control. PubMed and the Cochrane Library were searched from January 2000 to May 2021. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 52 systematic reviews (42 for exercise, nine for diet, and one for weight management), and an additional 23 randomized controlled trials. The most commonly studied types of cancer were breast, prostate, lung, and colorectal. Exercise during cancer treatment led to improvements in cardiorespiratory fitness, strength, fatigue, and other patient-reported outcomes. Preoperative exercise in patients with lung cancer led to a reduction in postoperative length of hospital stay and complications. Neutropenic diets did not decrease risk of infection during cancer treatment. RECOMMENDATIONS Oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent and may recommend preoperative exercise for patients undergoing surgery for lung cancer. Neutropenic diets are not recommended to prevent infection in patients with cancer during active treatment. Evidence for other dietary and weight loss interventions during cancer treatment was very limited. The guideline discusses special considerations, such as exercise in individuals with advanced cancer, and highlights the critical need for more research in this area, particularly regarding diet and weight loss interventions during cancer treatment. Additional information is available at www.asco.org/supportive-care-guidelines .

Adherence to the American Cancer Society Guidelines on nutrition and physical activity for cancer prevention and obesity‐related cancer risk and mortality in Black and Latina Women's Health Initiative participants

“…Based on other WHI research, guideline components may have changed in variable and opposing directions over the follow-up period. [33][34][35][36] The present study operationalized the 2012 guidelines to allow for direct comparisons with a limited body of literature that included minority cancer survivors 7,9,37 future studies should examine the new 2020 ACS guidelines 38 as well as the newly released guidelines for lifestyle management during cancer treatment, 39 not just in Black and Latina cohorts, but among all adults.…”

Is There a Role for Exercise When Treating Patients with Cancer with Immune Checkpoint Inhibitors? A Scoping Review

“…Numerous benefits of exercise for patients with cancer have been documented, including mitigation of cancer- and treatment-related symptoms and improved health-related quality of life (HRQoL) [ 10 , 11 , 12 , 13 ]. Studies have also shown a positive effect of exercise on tumour control, with preclinical studies reporting that exercise suppressed tumour growth and rate of recurrence when delivered as a sole intervention [ 14 , 15 , 16 , 17 , 18 ].…”

“…Exercise also enhanced the response to chemotherapy in the preclinical setting [ 21 ], and appeared to associate with improved disease-free survival in breast cancer patients undergoing adjuvant chemotherapy [ 22 ]. However, although ICIs comprise an important element of systemic therapy for cancer, the effect of combining ICIs with an exercise intervention is not well understood [ 13 ].…”

The experiences and perceptions of female breast cancer patients regarding weight management during and after treatment for oestrogen-receptor positive disease: a qualitative study

“…However, recent survey evidence showed that while a high proportion of breast cancer patients reported at least one positive nutrition or physical activity behaviour after diagnosis or treatment, several treatment-related barriers (fatigue, stress, changes in appetite/taste disturbances, pain and discomfort) impeded the adoption of these health behaviours [ 28 ]. Furthermore, a recently published American College of Clinical Oncology Guideline paper emphasised the need for more research into diet and weight management strategies for people undergoing cancer treatments [ 29 ]. Thus, the aim of this qualitative study was to investigate the experiences and perceptions of overweight ER + BCPs regarding weight management (healthy dietary behaviours and physical activity) during and after primary treatment and ongoing hormone therapy.…”