When the American Society of Clinical Oncology (ASCO®) conducted the National Cancer Opinion Survey in July 2017, the results revealed something rather surprising. The survey showed that while 78 percent and 66 percent of respondents correctly identified tobacco use and sun exposure, respectively, as risk factors for cancer, only 31 percent correctly identified obesity as a risk factor for cancer.
The rate of obesity has increased so tremendously over the past few decades that it has overtaken tobacco as the leading cause of preventable cancer. An estimated 84,000 cancer diagnoses annually are attributed to obesity  and researchers have now linked it to twelve types of cancer.
Being overweight or obese increases the risk of breast cancer by 20-40%, colorectal cancer by 30% and gallbladder by 20-60%. People who are overweight or obese are also nearly twice as likely to develop cancers of the esophagus, gastric cardia, liver and kidney. On top of that, obese patients are likely to have other comorbidities such as diabetes, joint pain and heart disease, which can make cancer treatment even more difficult.
Oncology providers are actively working to educate the public on the growing link between cancer and obesity, and are also facing the challenge of devising proper treatment plans for their patients that will both fight the cancer and help maintain a good quality of life. Although one would think that the simple solution to obesity is a healthy diet and exercise, the answer is that is not always the case. Urging Americans to “eat right and exercise” has been attempted by many, including public health experts, non-profits, schools and governments. Healthy living and healthy lifestyle programs and public health warnings about obesity have not worked, and the obesity rate only continues to increase.
An individual approach
If this single-pronged approach to helping patients, and the general public, has proven to be ineffective, what will work? Rather than generalize, the solution may be to think in a more focused manner, by working with each patient individually. Just like diagnosing any other medical condition, each patient is unique and has his or her own story, so it makes sense that different programs will work for different patients. In this case, the best approach is one that is multi-disciplinary, patient-centric and “one by one.”
Many cancer patients seek out nutritional advice, mental health support, spiritual support and other services on their own, working to build their own support system that extends beyond the cancer. Often, these personal efforts are not communicated to their oncologists, which can cause concerns around safety, interactions and efficacy. It takes an integrated team to help each patient, including the nutritionist, psychologist, oncologist, internist and many more.
Carolyn Lammersfeld, MBA, MS, RD, CSO, LD, Vice President of Integrative Medicine at Cancer Treatment Centers of America® (CTCA), highlights the importance of creating a team around each patient to support the oncologist and streamline access to resources in lock-step with the patient’s oncology care. By having all of the essential services coordinated and under one roof, everyone on the team not only knows the patient, but also knows the bigger picture around that patient’s medical story and treatment.
“The focus on nutrition and other supportive services at Cancer Treatment Centers of America is to help patients manage symptoms and maintain or improve quality of life so that they can complete their oncology treatment plan on time without interruptions,” Lammersfeld says. “In supportive services, the work we do with patients is definitely a partnership.”
Ideally, patients are learning about the risk factors of obesity – including cancer – well before a cancer diagnosis. For that to be a reality, clinical training on this topic must begin in medical school and continue through CME, as new research and treatment options become available. But, even more important than the clinical training is the unspoken truth that many oncologists, internists, primary care physicians, nurses and other clinicians simply are not trained in how to have a conversation about weight with their patients. Getting more comfortable with having “the talk” about weight may involve role playing and/or practice. However we get there, we need to find a way to develop and consistently share a simple but important message with our patients, something along the lines of, “if you can get control of your weight, we have a better chance of getting control over your cancer.” This message should never criticize, but rather empower patients and bring positivity.
Finally, more research needs to be done to assess which weight loss programs are the best and for which patients. A care team should always collaborate and evaluate if and when it is appropriate for cancer patients to undergo surgery, receive certain medications, or begin a specific diet, etc. This joint effort will create a more complete treatment approach that will not only help battle a patient’s cancer, but improve their overall well-being and quality of life.
People often experience a feeling of loss of control when they hear the words “you have cancer.” It can be motivating and empowering for them to know they still have some control over their weight, and that achieving a healthy weight contributes to overall health. Because when you are fighting cancer, you want to do everything in your power to ensure your treatment is successful. That’s why it is so important to empower patients through education on the risks of obesity, and surround them with a team of specialists who can support them on their journey.
 Bullen Love D, Connecting Obesity & Stomach Cancer Oncology Times: December 25, 2017 – Volume 39 – Issue 24 – p 1,8–8 |doi: 10.1097/01.COT.0000528025.42664.a2 [Article]
 Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, Fabian CJ, et al. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol. 2014 Nov 1;32(31):3568-74. doi: 10.1200/JCO.2014.58.4680. Epub 2014 Oct 1.[Article]
Last Editorial Review: November 19, 2018
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