The American Society of Clinical Oncology (ASCO) has released a new guideline on exercise, diet, and weight management during active cancer treatment in adults.

The main endorsement was for oncology providers to recommend aerobic and resistance exercise to patients undergoing active treatment with curative intent, in order to lessen the side effects associated with the therapy.

Clinicians may also recommend preoperative exercises for patients who are scheduled for surgery for lung cancer.

A second key point applies to dietary changes. The guideline says there is not enough evidence to support a recommendation for or against specific diets. There is also insufficient evidence to support intentional interventions aimed at preventing weight loss or weight gain during active cancer treatment.

“During the treatment period, many cancer patients seek to make lifestyle changes recommended by their physicians,” said Jennifer A. Ligibel, MD, of the Dana-Farber Cancer Institute in Boston, Massachusetts, and directive co-chair. group of experts, commented in the ASCO Daily News. “What we really hope is that this guideline helps stimulate that discussion and action in the oncology clinic.”

The guidelines were published online May 16 in the Journal of Clinical Oncology.

The guidelines focus specifically on cancer patients who are currently undergoing active treatment, and they were developed by a multidisciplinary expert panel after a systematic review of the published literature. Only data from randomized controlled trials were considered.

The document “represents an important step in providing guidance to adult patients regarding exercise, diet and weight management during cancer treatment,” concludes the ASCO group. “Although the lack of evidence, particularly for diet and weight management, limited the number of recommendations ultimately made, the panel recommended the incorporation of exercise into cancer treatment for patients receiving systemic therapy and radiotherapy, as well as potentially in the preoperative setting for patients with lung cancer.”

Physical activity

In support of the physical activity recommendation, evidence shows that exercise interventions during active treatment reduce fatigue, preserve cardiorespiratory fitness, physical functioning and strength, the authors note. In some patient groups, exercise during active treatment may also improve quality of life and reduce anxiety and depression.

There is a low risk of exercise-associated adverse effects during treatment, the authors add. But there was not enough information to recommend or advise against exercise during treatment to improve cancer outcomes or treatment completion rates.

Sufficient evidence supports the recommendation of preoperative exercises for patients undergoing surgery for lung cancer, to reduce the length of hospital stay as well as postoperative complications. But these same benefits were not evident for those undergoing abdominal surgery for gastrointestinal or genitourinary cancers, the authors comment.

Non-specific dietary evidence

For diet, there is currently insufficient evidence to recommend or against specific types of diets to improve outcomes related to quality of life, treatment toxicity or cancer control, the ASCO group comments. This includes interventions such as ketogenic or low-carb diets, low-fat diets, functional foods, or fasting.

Additionally, the ASCO group notes that it does not recommend neutropenic diets (especially diets that exclude raw fruits and vegetables) to prevent infection in cancer patients during active treatment.

While in the general population, obesity has been associated with an increased risk of a number of types of cancer, the committee notes that there have been few randomized controlled trials that have assessed interventions for the management of weight during cancer treatment. Most studies to date have small cohorts, had weight loss as the primary endpoint, or assessed feasibility, but it remains unclear what effect weight loss might have on patient-reported outcomes. or other outcomes among those on active treatment.

Overall, the evidence suggests that intentional weight loss is achievable during cancer treatment (at least in patients with breast cancer and possibly prostate cancer), but there are limited evidence that it provides significant benefit.

Ligibel did not disclose any relevant financial relationship. Several co-authors disclosed industry connections, as noted in the paper.

J Clin Oncol. Published online May 16, 2022. Full text

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