Decision-making Uncertainty/Nutritional Issues During Phases

Decision-Making in Uncertainty

One of the most devastating effects of cancer is a profound sense of loss of control. Behavioral research has clearly shown that those who have higher levels of self-efficacy generally feel better and function better than do those who feel they have lost control over their situation.3

Seeking one’s own course of treatment and disease management, as well as confidently choosing the best course of action for oneself, is extremely important for enhancing quality of life. With so many important questions related to the challenges of cancer survivorship, and with an inadequate scientific basis for many of even the simplest questions, cancer survivors and those who care for them desperately need a credible framework of accurate information. This article provides such a framework.

When there is ample scientific evidence on an issue, choices can be easy. In contrast, when scientific evidence is insufficient, choices are difficult. Currently, there are many gaps and inconsistencies in the scientific evidence on the effects of nutrition and physical activity after cancer diagnosis.

For many of the most important nutrition and physical activity questions faced by cancer survivors, the scientific evidence comes only from in vitro and laboratory animal data, or anecdotal reports from poorly designed clinical studies. Moreover, the findings from these studies are often contradictory.

Very few controlled clinical trials have been done to test the impact of diet, nutritional supplements, or nutritional complementary methods on cancer outcomes among cancer survivors. Only a few observational epidemiologic studies have examined the relationship between nutritional factors and cancer outcomes.

Properly controlled studies of the effects of nutritional and physical activity interventions on the prognosis and quality of life of cancer survivors are urgently needed, and should be a high priority for all academic and research funding agencies.

The state of the scientific evidence regarding the effects of nutritional factors on the clinical outcomes among cancer survivors is not sufficient at this time to support a set of firm guidelines for cancer survivors. There is sufficient information, however, to serve as a basis for a framework for reasonable informed choices.

Nutritional Issues During the Phases of Cancer Survival

The phases of cancer survival include an active treatment phase; a recovery phase in which the body needs to be restored; a health maintenance phase to prevent both cancer recurrence, second primary tumors, and other preventable diseases; and, for some, a phase of living with advanced cancer. Survivors in each phase have different needs and challenges with respect to nutrition and physical activity.

The primary site of the cancer and the therapeutic modalities applied may also influence these needs. Adequate dietary intake can improve the nutritional status of nearly all cancer survivors. During all the phases of cancer survival, even for cancer survivors with no apparent nutritional problems, the principles outlined in the ACS’ Guidelines on Diet, Nutrition, and Cancer Prevention2 should be regarded as the basis for a healthy diet.

The ACS dietary guidelines are quite similar to those recommended by several other organizations, agencies, and experts as a reasonable basis for the dietary prevention of other chronic diseases as well as cancer.4-7 There are many special nutritional issues and needs during the phases of cancer survival, however, not specifically addressed by the cancer prevention guidelines that are addressed in this report.

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