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The September/October 2003 issue of CA: A Cancer Journal for Clinicians features newly revised guidelines for nutrition and exercise for cancer survivors.


An expert panel was convened with the goal of providing specific recommendations for the approximately 9.5 million cancer survivors in the U.S., two thirds of who survive more than 5 years after diagnosis. Recommendations include:


* Physical activity to increase appetite and reduce constipation and fatigue.


* Losing excess weight to decrease the risk of cancer recurrence and improve overall survival.


* Taking a standard multivitamin and mineral supplement equivalent to 100% of the recommended daily value when survivors cannot maintain healthy diets.



The recommendations include a caveat:Supplements containing high levels of folic acid or antioxidants may be harmful during cancer treatment. There is no direct evidence that a vegetarian diet can prevent cancer recurrence. Survivors following a vegetarian diet should ensure adequate nutrient intake.


Advise patients to balance the benefits of alcohol in moderation in reducing cardiovascular risk against the negative effect of increasing the risk of new cancers.


Because obesity is a risk factor for breast cancer and colorectal cancer, weight maintenance at desired body weight should be encouraged provided the treating oncologist approves.


A nonexhaustive list of site-specific cancer recommendations for survivors follows:


* Breast cancer: Obesity should be avoided; diets should include low amounts of saturated fats, but high amounts of vegetables and fruits, soy foods in moderation, and moderate to no alcohol.


* Colorectal cancer: Modifications in diet should be made to accommodate any interruption in normal nutrient absorption caused by chronic bowel problems or surgery.


* Lung cancer: Multivitamin/mineral supplement is advisable. Small, frequent meals that are concentrated in calories and easy to swallow are most beneficial.


* Prostate cancer: Patients should follow the diet and physical activity recommendations established by ACS to decrease cardiovascular disease risk. Multiple trials are underway to assess the effects of soy, flaxseed, vitamin E, and selenium supplements on prostate cancer.


* Esophageal cancer: Eat a high-protein, low-fat, high-carbohydrate diet. Avoid chocolate, fat, alcohol, coffee, spearmint, peppermint, garlic, and onion.


* Gastric cancer: Nutritional management depends upon which part of the stomach in involved.


* Head and neck cancer: Survivors should use sugar-free gum and mints; the use of oral rinses and gels may provide relief of symptoms and enhance appetite. Liquid, pureed, or juiced foods may be preferred.



After reviewing many well-known dietary regimens and supplements suggested as alternatives to standard care, the panel concluded that many have little or no evidence to support their use. The authors also noted that the guidelines do not imply that nutrition and physical activity are more important than other factors, and that medical interventions may be more important in controlling nausea or fatigue than dietary or exercise intervention.


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