[LifeSyle] Lifestyle modifications after the diagnosis of gynecological cancer

[Love Pulse]

 

Background
The influence of lifestyle factors on the quality of life, incidence and tumor recurrence has been evaluated in several studies and is gaining increasing importance in cancer research. However, the extent of the influence of such lifestyle factors on the quality of life of cancer patients remains largely unclear, as does the number of patients actually pursuing these lifestyle changes. The purpose of this study was to examine the prevalence and predictors of lifestyle changes in patients with gynecological cancer.

Methods
The survey consisted of a pseudonymous questionnaire that was conducted from January to May 2014 via a telephone interview with 141 patients with a gynaecological malignancy who had undergone surgery at our Department of Gynaecology and Obstetrics. Lifestyle factors (diet, physical activity, stress level, alcohol and nicotine consumption) prior to and after the diagnosis of cancer were evaluated.

 

Results
89% (n = 125) of the reported lifestyle changes after being diagnosed with cancer. There was a significant association between the implementation of lifestyle changes and age as well as the use of complementary medicine. Nutrition: 66% of the patients (n = 93) consumed more fruit and vegetables and 65% ate less meat (n = 92). Physical activity: 37% (n = 52) reported no change in their exercise routine, 36% (n = 51) described a decrease, 27% (n = 38) an increase in their physical activity. Subjective feeling of stress: 77% of the patients (n = 108) described a reduction in their perceived level of str

ess. Nicotine consumption: 63% (n = 12) of the 19 patients who were smokers at the time of the diagnosis quit or reduced smoking thereafter. Alcohol consumption: 47% (n = 61/129) of the patients reduced their alcohol consumption.

 

 

Conclusions
Most of the patients from our study group implemented lifestyle changes after being diagnosed with cancer. Prospective randomized trials are needed in order to determine the benefit of lifestyle changes (physical activity, dietary habits and stress reduction) for cancer survivors. The potential impact of lifestyle on the quality of life and the trajectory of the disease should be discussed with all oncological patients.

background
There is a growing body of literature regarding the influence of lifestyle factors such as nutrition, nicotine and alcohol consumption, as well as exercise on the development of various types of tumors, and lifestyle plays an increasing role in the prevention of malignancy.

 

The impact of these lifestyle factors on long-term survival and quality of life of cancer patients remains largely unclear, as does the question of how many cancer patients actually implement lifestyle changes after a diagnosis of malignancy. Some data indicates that 58% of long-term cancer survivors are overweight, 25% continue to smoke, 50% exercise and less than 20% report adequate consumption of fruits and vegetables [1]. In the United States, only 20% of cancer patients do the recommended 2.5 hours of physical activity per week, and only 35% are not overweight [2].

Based on the existing body of evidence, lifestyle modifications that affect diet, body weight, and physical activity may improve the prognosis of malignancy.

 

Nagle et al. and Dolecek et al. reported long-term survival in patients with ovarian cancer with increased intake of fruits and vegetables while increased consumption of meat and dairy products had a negative impact on survival of the same patients [3, 4]. In contrast to findings published by Dolecek et al., the Women's Health Initiative Monitoring Study did not show an association between consumption of certain food groups and improved survival. This long-term national health study evaluated 161,808 postmenopausal women between 1995 and 2012 with the goal of developing strategies to help prevent cardiovascular disease, breast and colorectal cancer as well as osteoporotic fractures. The questionnaire ("Healthy Eating Index") was used to assess dietary routine during the trial period and to assess potential association with the human race. Within the questionnaire the consumption of 12 food items (total fruit including juice, whole fruits excluding juice, total vegetables, dark green and orange vegetables and legumes, whole grains, whole grains, milk, meat and beans, oils, saturated fats, and sodium, were evaluated). Calories from solid fats/alcoholic beverages/added sugar).

 

636 participants of the trial were diagnosed with ovarian cancer during the period of observation. There was no statistically significant impact of the consumption of different food groups prior to the diagnosis of ovarian cancer and the overall mortality in this subset of patients. However, a higher dietary quality according to Healthy Eating Index (2005) was associated with a significantly lower mortality, suggesting an influence of the overall nutrition on the course of the disease rather than different dietary components [5].

 

In the setting of an increasing number of overweight patients, an evaluation of a potential association between the body mass index (BMI) and the prognosis of gynecological malignancies is of great interest. The largest data collection on a potential influence of obesity on the survival of ovarian cancer patients was published by the Ovarian Cancer Association Consortium (OCAC) in 2015, including 21 trials and a total of 12,390 women. Women who had been obese (BMI ≥ 30) for one to five years prior to the diagnosis of ovarian cancer were shown to have a 12% increase in mortality [6]. Similarly, obesity (BMI > 25) was associated with a higher overall mortality in endometrial cancer patients [7, 8]. This difference in survival may be explained by different hormonal mechanisms as well as an insufficient dose of chemotherapy in overweight patients [9].

The American Cancer Society recommends regular physical activity (at least 150 min per week and including weight training on at least two days) and a quick resumption of regular daily activities to cancer survivors [10].

The first prospective trial evaluating the influence of physical activity in 600 ovarian cancer patients with a median follow-up of 10.9 years was published in 2014. It reported a reduction of the cancer-specific and overall mortality by 26% and 24% respectively in women who reported regular vigorous physical activity before the cancer diagnosis [11].

The lifestyle intervention study LIBRE-1 (Lifestyle Intervention Study in Women with Hereditary Breast and Ovarian Cancer), a randomized, prospective trial aiming to test the feasibility of lifestyle modifications in BRCA-1 and -2 mutation carriers, showed that there was a significantly lower prevalence of cancer in participants who had been physically active during their adolescence (p = 0.019). Patients who were smokers prior to the diagnosis of cancer also showed a significantly higher prevalence of malignancy than non-smokers (p < 0.001). In the 68 patients evaluated as part of this study, non-diseased mutation carriers revealed a significantly higher physical activity level than diseased mutation carriers (p = 0.046) and diseased mutation carriers (22.5 ± 5 kg/m2) had a lower BMI compared to non-diseased mutation carriers (25 ± 8 kg/m2), however this difference did not reach statistical significance (p = 0.079) [12].

 

Studies have shown the negative effect of stress on multiple female conditions such as infertility and endometriosis [13, 14]. Previous studies have described a higher level of stress and depression in cancer patients which can lead to a reduction of quality of life, thus having insight into the emotional status of the patients is critical [15,16,17].

Davis et al. [18] evaluated spiritual growth as a potential area of posttraumatic growth in 241 ovarian cancer patients prior to surgery and one year post-operatively. Spiritual growth was measured by examining the three following items: meaning (eg, “I have a reason for living”), peace (eg, “I feel a sense of harmony within myself”), and faith (eg, “I find comfort”). in my faith or feelings”). An increase in peace was associated with lower rates of depression (p ≤ 0.001) and anxiety (p = 0.004) at one year. There was no statistically significant association between the changes in meaning and faith and rates of depression and anxiety. Changes in peace helped neutralize the effect of stressful life events on depression (p = 0.027) and anxiety (p = 0.05), resulting in the worst psychological outcomes after one year in patients with a high number of life events and a decrease in peace. These findings suggest that the quality of peace may be the most adaptive parameter of spiritual growth in cancer patients. Furthermore, changes in peace appear to reduce the effect of life events on the psychological well-being.

 

Furthermore, it should also be highlighted that patients undergoing surgery for gynecological malignancies can strongly benefit from specialized pre-/intra and post-operative care. The ERAS-protocol (“Enhanced Recovery After Surgery”) includes over 20 items such as adequate nutrition, early post-operative mobilization and pain management. Through implementation of this protocol, it was possible to significantly reduce the time of hospitalization, post-operative complications and a reduction of the use of opioids for pain management [20].

While including lifestyle modification strategies into oncological patient care is becoming more and more common, there is limited evidence on it. The goal of the current study was to add further data on the important aspect of lifestyle modifications in this group of patients in order to integrate relevant aspects into oncological treatment plans in the future.

Edited June 29, 2021 by #Mr.Devil