“Can I run if I’m on chemotherapy?”. “Can I go back to the gym if I haven’t finished radiotherapy?”, “Would it be better to follow the ketogenic diet while I am on treatment?”, “Or should I do intermittent fasting?”. There are many doubts that can arise when dealing with breast cancer, and often they are not answered. Also because if you look in the news you will find contradictory information: studies that today say one thing, tomorrow another. And it is normal that this is the case.
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Over the past twenty years, a great deal of research has been conducted on exercise and nutrition in women with breast cancer, as well as in other cancer patients. It should be noted that few of these studies have investigated whether increased physical activity, or changes in diet or weight affect relapse rate or mortality. Most focused on other aspects: improving the quality of life and reducing the adverse effects of therapies, which are no small thing anyway.
In any case, taken individually, they cannot decree what really works and what doesn’t: it is necessary to analyze and compare the researches and evaluate their quality, in order to then arrive at providing indications supported by solid data. This is what scientific societies do which, at the end of a great work of analysis, publish their guidelines. And so did the American Society of Clinical Oncology (Asco), which made its recommendations on “Exercise, Diet and Weight Management During Cancer Treatments” (non-metastatic).
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What the Asco guidelines say
The experts considered studies on patients with different cancers, not only breast cancer, in active treatment especially with chemotherapy and / or radiotherapy (they excluded, however, studies on breast cancer patients treated with hormone therapy alone, for which ad hoc guidelines have already been published in the past). Overall, they analyzed 52 reviews (42 on exercise, 9 on nutrition and one on weight management) and a further 23 clinical trials published between 2000 and 2021, with the aim of drawing conclusions. The indications are addressed to doctors, of course, but also to patients and their caregivers. Here’s what emerged.
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Question 1: Is aerobic and resistance exercise performed during therapy safe and does it improve quality of life, control of drug toxicity or cancer?
Recommendation: “Oncologists should recommend aerobic and resistance exercises during therapies to mitigate side effects.”
The data indicates that physical activity reduces fatigue (fatigue), preserves strength, cardiorespiratory and physical fitness. In some patients, particularly those with breast cancer, it improves the quality of life and reduces anxiety and depression. It can also improve sleep. Regarding safety, there is a low risk of adverse events and the benefits outweigh the risks.
The data, however, do not allow to date to affirm that exercise also improves the control of cancer – that is, lowering the risk of recurrence or increasing survival rates – or adherence to therapy.
Finally, the guidelines do not address mind-body exercises used in disciplines such as yoga.
As for who has a metastatic tumor, few studies have been conducted and this is why the guidelines cannot also address this patient population. Preliminary results, however, suggest that physical exercise is generally safe (obviously conducted after medical consultation), even in the case of bone metastases.
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Question 2: Is following a particular diet or consuming certain foods during treatment safe and improves quality of life, control of drug toxicity or cancer?
To date, there is insufficient evidence to recommend or advise against specific dietary interventions, such as the ketogenic, low-carb or low-fat diet, or the consumption of functional foods or fasting. Several clinical trials are ongoing and further data will have to be awaited. Neutropenic diets (especially those that exclude raw fruit and vegetables) are not recommended in order to prevent infections, because – experts report – the risks may outweigh the benefits.
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Question 3: Do interventions to lose weight or avoid weight gain during therapies safely improve quality of life, control of drug toxicity or cancer?
Several studies have shown a positive effect of weight control in the response to breast cancer treatment, and we know that obesity and being overweight are related to an increased risk of developing the disease. However, the Asco group of experts refrained from formulating specific recommendations, due to gaps in scientific evidence. This is not to say that doctors should not discuss healthy eating and weight control with patients: these strategies are certainly beneficial to the general population, and may also be important for cancer patients in therapy, but there is. more research is needed to provide information that is valid for all.
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But who can the patient turn to?
The critical point for putting the recommendations into practice is doctor-patient communication, the authors point out. “Patients may not be aware of the impact of exercise during treatment, while others may be on diets that are not supported by scientific evidence. The physician’s job should be to talk about the importance of physical activity and promote behaviors. healthy “.
But sharing knowledge and data is not enough: motivational strategies and targeted interventions are needed. The oncologist, alone, probably will not be able to do it: according to a recent survey also conducted by Asco, 84% of oncologists interviewed, while recognizing the benefits of diet, exercise and weight management, think that other figures should take care of these aspects. If rightly or wrongly it is not up to us to say it, but looking at Italy, this is certainly another point that we should take into account in the reorganization of cancer care in the area. Who can the patient turn to outside the large centers that today are able to offer an “integrated” approach?
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