A new guideline published by the American Society of Clinical Oncology (ASCO) has recommended that patients actively receiving cancer treatment should engage in aerobic and resistance exercises. This is likely to benefit patients in terms of increased quality of life and alleviated treatment-related toxicities. This recommendation is made following an analysis of 52 systematic reviews and a further 23 randomized controlled trials. It is particularly noteworthy as the recommendation is the first of its kind to focus on patients who are actively receiving treatment. The guidance is focussed on oncology professionals and designed to provide evidence-based recommendations for optimized treatment tolerance, quality of life, and cancer control outcomes.
This large study evaluated 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. As a result of this study ASCO has made a number of recommendations which are laid out below
- Aerobic and Resistance Exercises Oncology providers should encourage patients on active treatment to incorporate aerobic and resistance exercises to mitigate treatment-related adverse events. Aerobic and resistance exercises have the potential to reduce fatigue, preserve cardiorespiratory fitness, physical functioning, and strength. In some populations, the benefits reach further; they may maintain or improve quality of life as well as help reduce anxiety and depression. The authors also noted that, although prehabilitation is an emerging field, oncology providers may consider encouraging patients about to undergo lung surgery to initiate preoperative exercises.
- Dietary Patterns – The review concluded that there is insufficient evidence to either recommend or condone specific diets such as ketogenic, low-carbohydrate, or low-fat diets. Functional foods and fasting were also not sufficiently linked to improved outcomes in quality of life, treatment toxicity, or disease control. Interestingly neutropenic diets are not recommended. Diets specifically excluding raw fruits and vegetables have not been shown to prevent infection in patients undergoing active treatment.
- Weight Loss and Weight Gain – The study found there is currently insufficient evidence tying intentional weight loss or weight gain interventions to quality of life, treatment toxicity, or cancer control outcomes but further research should be centred on this. The authors did note that dietary change and weight management strategies may still be valuable during or after cancer treatment and were keen to point out that this lack of clear guidance does not equate to support of a diet filled with red meats and processed foods or carbohydrates. Oncology providers were still encouraged to discuss healthy diet and weight with their patients.
The expert panel suggested that there are numerous areas where research should be expanded to provide more concise information to guide oncology professionals and one such area is for individuals with advanced cancer as these individuals are often excluded from trials on diet and exercise because of concerns regarding the safety of such interventions‚ especially in patients with bone metastases.
The full paper can be accessed here https://ascopubs.org/doi/pdf/10.1200/JCO.22.00687 and is of particular interest to oncology nurses who are frequently asked to guide patients receiving treatment on diet and exercise.