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What Is the Role of Lifestyle Medicine in Cancer Care?

Contributor Amy Comander, MD
A man and woman walking briskly outdoors.

If you have a serious health condition, you seek the most effective medical and surgical treatments for the best possible outcomes. But increasing evidence shows that focusing on specific lifestyle factors can also help you heal.

The American College of Lifestyle Medicine (ACLM) defines the field as “therapeutic use of evidence-based lifestyle interventions to treat and prevent lifestyle-related diseases in a clinical setting. It empowers individuals with the knowledge and life skills to make effective behavior changes that address the underlying causes of disease.”

Doctors encourage lifestyle strategies for people with various health conditions, including those affecting the heart, nervous system, and joints. These changes typically revolve around six pillars:

  • Nutrition

  • Physical activity

  • Stress management

  • Restorative sleep

  • Social connection

  • Avoidance of risky substances

“Treating the whole person, not just the cancer, is essential in oncology care,” says Amy Comander, MD, an oncologist and director of the Lifestyle Medicine Program at Mass General Cancer Center. “Increasing evidence has demonstrated that, in some cases, focusing on these key lifestyle factors can improve outcomes in cancer and other serious health conditions.”

Six areas to focus cancer lifestyle changes

Dr. Comander and colleagues have launched the Lifestyle Medicine Program to help people with cancer reap the benefits of a holistic approach to care.

“The oncology team wants to ensure that each patient has the tools in place to achieve the best possible outcome,” she explains. “But at the same time, we want to make sure we’re attentive to every aspect of a patient’s health. We ask our patients: How are you sleeping? How are you eating? How are you doing in terms of physical activity and stress management? What kind of social support do you have?”

The program offers individualized consultations about the important role of lifestyle medicine in cancer care. It also offers group visits focused on key topics in lifestyle medicine.

For patients with a diagnosis of breast cancer, the program offers the PAVING the Path to Wellness Program. This is a 12-week introduction to the important role of lifestyle medicine for breast cancer survivors. The goal is to apply evidence-based lifestyle medicine strategies to improve overall health, well-being, and even treatment outcomes.

The Lifestyle Medicine Program consists of a team of experts from across medical specialties. They work together to provide these clinic offerings, as well as in-depth education on specific topics and referrals to specialists.

The team helps patients set “SMART” goals: specific, measurable, attainable, relevant, and timely. “We focus on how we can break a patient’s goals down into components, which makes it a little bit less overwhelming and helps an individual achieve success,” Dr. Comander explains.

Managing nutritional concerns with cancer

Having good nutrition and maintaining a healthy weight are essential to maximizing wellness whether you have cancer or not. But if you have cancer, good nutrition also can help you maintain energy, prevent infection, and heal.

Your nutritional needs and priorities are very personal and individualized. A registered dietitian — especially one with extra training or experience in nutrition for people with cancer — can teach you how to use nutrition to achieve or maintain a healthy weight, minimize side effects, and optimize your overall health.

“Increasing research is demonstrating the benefits of a plant-predominant diet, certainly for cancer risk reduction, but also to potentially improve outcomes in certain types of cancer. This diet includes lots of fruits and vegetables and lots of fiber. Recent research has shown that the gut microbiome may play an important role in how a patient’s cancer responds to specific therapies. I think we’ll learn more about this in the next few years,” Dr. Comander says.

The Lifestyle Medicine Program refers patients to individual sessions with registered dietitians through Mass General’s Cancer Center Nutrition Services. Patients also can attend group Lifestyle Medicine appointments to learn more about nutrition for people with cancer.

Cancer and exercise

There is increasing evidence that exercise has many benefits in people with cancer. Studies show that physical activity during and after cancer treatment can:

  • Increase chances of survival from certain types of cancer

  • Improve sleep and lessen feelings of fatigue

  • Improve quality of life and ability to complete daily activities

  • Reduce anxiety and depressive symptoms

  • Reduce symptoms of lymphedema (swelling)

Exercise has many health benefits for cancer patients and survivors.

Dr. Comander recommends at least 150 minutes of moderate aerobic activity each week, plus strength training twice a week, based on guidance from the American Cancer Society and the American College of Sports Medicine. For people who need help starting or sticking with an exercise routine, referrals to physical therapists and community programs can help.

Mass General Cancer Center offers tips and demonstrates simple exercises on YouTube videos:

Stress management for cancer survivors

Practicing mindfulness and meditating can help cancer patients and survivors manage stress.

“Stress, anxiety, mood changes, and depressive symptoms are prevalent among cancer patients and their family members. It’s important for patients to talk to their oncology team about managing stress. There are some healthy, effective approaches and techniques we can use,” Dr. Comander says.

The other pillars of lifestyle medicine — good nutrition, regular exercise, social activities, and restorative sleep — are excellent ways to manage stress. For people who require more support, the Lifestyle Medicine Program can refer patients to the Mind Body Program for Cancer Survivors to help manage stress and build resilience.

Oncologists also offer referrals to therapists and share stress-management techniques. Examples include:

  • Go outside.

  • Practice mindfulness and meditate.

  • Prioritize daily tasks rather than trying to do it all.

  • Schedule time to do things you enjoy.

  • Set limits with yourself and others.

  • Use a calendar and reminders to keep appointments organized.

  • Write in a journal.

Cancer and sleep

Sleep disorders are common among people with cancer, Dr. Comander notes. Sleep may be affected by anxiety over the diagnosis, cancer pain, other symptoms such as gastrointestinal problems or trouble breathing, and treatment side effects.

Poor sleep during the cancer journey is also associated with higher levels of pain, longer hospital stays, and a greater risk of complications. Therefore, it’s important to address sleep issues and achieve restorative sleep.

“We help our patients optimize their sleep. If we’re concerned about sleep apnea, we may refer you for a sleep study. We provide counseling about good sleep hygiene. Some patients have hot flashes at night because of breast cancer treatment, or pain or neuropathy that’s keeping them up. We really try to take a deep dive into what’s affecting your sleep, and then we make appropriate referrals to address those issues,” Dr. Comander says.

Social connections during cancer

It’s natural for a cancer diagnosis to affect your relationships, but Dr. Comander says it’s essential to maintain social connections. “Many research studies show that healthy relationships and social connections are among the most important factors that predict long-term health and well-being.”

An oncologist can refer you to a counselor or social worker if you need help navigating relationships during your cancer journey. They can help you set expectations and communicate openly with family members, friends, sexual partners, and coworkers. They can also help you access community services for help or support groups with other people who understand your situation.

Substance abuse and cancer

Substance use disorders are more common among cancer patients and survivors. The Lifestyle Medicine Program helps patients understand and avoid these risky behaviors to improve health. For example, the team helps people quit using tobacco and vaping products, alcohol, and cannabis.

Amy Comander, MD