Guideline: Guidelines on exercise, diet, and weight during cancer treatment

Contents

GUIDELINES AT A GLANCE

What are these guidelines about?

ASCO has published evidence-based guidelines on exercise, diet and weight for adults receiving treatment for cancer.

Why are these guidelines important?

There are many health benefits to diet, exercise and maintaining an ideal weight. For people in treatment, this can include improvement of unwelcome side effects. While some guidelines focus on people at risk for cancer or cancer survivors, few guidelines focus on recommendations for those who are currently undergoing cancer treatment.

ASCO Guidelines

ASCO assembled an expert panel to review scientific publications and clinical trial reports on the impact of exercise, diet and weight on people who are actively undergoing cancer treatment. The most commonly studied types of cancer were breast, prostate, lung and colorectal. This review allowed ASCO to provide clarity on lifestyle changes that can improve treatment-related side effects and cancer outcomes. 

The ASCO recommendations answer three primary questions:

1. Does exercise during cancer treatment safely improve quality of life, treatment side effects or cancer outcomes?

• ASCO strongly recommends that healthcare providers recommend aerobic and resistance exercise during active treatment to help reduce the common side effects of cancer treatment.
  • Aerobic exercise is any type of movement that gets your heart pumping. Some examples include brisk walking, swimming, running or cycling.
  • Resistance exercise increases muscle strength and endurance.  Some examples include Pilates and classic strength training using dumbbells, barbells and kettlebells.
• Exercise during cancer treatment can reduce fatigue, maintain cardiac (heart) fitness, physical functioning and strength. It can also improve quality of life and reduce anxiety and depression for some individuals. In addition, exercise during treatment has a low risk of adverse effects.
• There was not sufficient evidence to recommend for or against exercise during treatment to improve cancer outcomes.

2. Does eating a particular diet during cancer treatment safely improve quality of life, treatment side effects or cancer outcomes?

• There was not enough evidence to recommend for or against a particular diet, for example, a low-carb or low-fat diet or fasting, to improve quality of life, treatment side effects or cancer outcomes.
• Diets that specifically exclude raw fruits and vegetables (sometimes called neutropenic diets) are not recommended to prevent infections in people undergoing cancer treatment.

3. Do interventions to promote weight loss or avoid weight gain during cancer treatment safely improve quality of life, treatment toxicity or cancer control?

• There is not enough evidence to recommend for or against weight loss or avoiding weight gain during cancer treatment.

Strengths and limitations

Strengths

• The ASCO committee reviewed 52 studies (42 for exercise, 9 for diet, 1 for weight management) and an additional 23 randomized controlled trials that were specific to those undergoing cancer treatment.

Limitations

• Because there was limited research regarding the long-term impact of diet and weight during active treatment, it was challenging for ASCO to come up with comprehensive guidelines for patients undergoing cancer treatment. This underscores the gaps in research regarding whether dietary changes or weight loss among people undergoing treatment can impact outcomes.
  • Only 1 of 171 reviews for weight management met the inclusion criteria and was included, compared to 42 of 652 systematic reviews for exercise.  For diet, only 9 of 742 reviews met the eligibility criteria to be included in the update. 
• Because these guidelines are the results of a review of different types of data, ASCO could not recommend how long, when or how intense an exercise program should be during cancer treatment.

Context

Many people undergoing cancer treatment have questions about whether they should modify their lifestyle to improve treatment outcomes. Often, people undergoing cancer treatment turn to the lay press and social media for information about exercise, diet and weight. Scientific data is limited on the benefits related to modification of lifestyle while undergoing cancer treatment. ASCO has summed up available evidence to provide recommendations to help healthcare providers and their patients navigate online information that may contradict scientific research.

Conclusions

Exercise, specifically anaerobic exercise and resistance training, should be recommended by healthcare providers for patients undergoing cancer treatment. Currently, there is not enough evidence for ASCO to recommend other lifestyle changes, such as eating a specific diet or losing weight to improve treatment outcomes.

What does this mean for me?

If you are a cancer patient undergoing treatment, including chemotherapy, radiotherapy or surgery, talk with your healthcare team about including aerobic exercise and resistance training to help improve your quality of life and your overall cancer outcomes. 

Reference

Ligibel JA, Bohlke K, A M May et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. Journal of Clinical Oncology 2022; 40:22:2491-2507.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 11/29/22