Following a healthy lifestyle can help cancer survivors return to normal life, improve their quality of life and potentially reduce the risks of their cancer recurring
Cancer survivors should receive information about nutrition and lifestyle to help them recover and to potentially reduce the risk of the same cancer recurring or a new one developing. Frontline nursing staff are in a prime position to deliver information and advice to support cancer survivors. Our position paper addresses this issue (Murphy and Girot, 2013). It examines current guidelines and the evidence for the provision of diet and lifestyle advice to support people who have survived cancer, and to help them integrate back into normal life, improve their quality of life and potentially increase their chances of long-term survival. It discusses the importance of interprofessional working for nurses and the need for sound knowledge and education for those offering dietary advice.
Citation: Murphy J, Girot E (2013) Improving cancer survival with lifestyle advice. Nursing Times; 109: 29, 22-23.
Author: Jane Murphy is framework lead (health sciences); Elizabeth Girot is professor of nursing and deputy dean (education); both at Bournemouth University.
- This article has been double-blind peer reviewed
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It is becoming increasingly evident from current literature that lifestyle interventions, including a healthy diet, weight management and increased physical activity, can influence the rate of cancer progression and improve overall survival (Davies et al, 2010).
After completing treatment, patients invariably turn to nurses for help and advice on eating patterns and lifestyle behaviour and on how to follow diet and lifestyle recommendations. Frontline nursing staff are therefore in a prime position to provide this type of advice.
It is important that patients also know when and where to access more specialist help on diet and nutritional aspects of care from a registered dietitian or registered nutritionist. Health professionals need to promote public health, as identified in the National Cancer Survivorship Initiative (Department of Health, 2010), as an integral part of their role.
Evidence on nutrition and lifestyle
While more research is needed on specific nutrition recommendations for cancer survivors, there is growing evidence to show the benefits of following healthy lifestyles.
It is recommended that cancer survivors (those not undergoing active treatment) should be encouraged to follow current guidelines for diet, healthy weight and physical activity for cancer prevention (World Cancer Research Fund/American Institute for Cancer Research, 2007). Cancer survivors - before, during and after active treatment - should receive nutritional care from an appropriately trained professional. Since the publication of the policy document (WCRF/AICR, 2007), there have been a number of studies exploring aspects of food and nutrition on cancer recurrence and survival.
Attitudes of cancer survivors towards dietary change
A cancer diagnosis is increasingly being recognised as a “teachable” moment for undertaking health behaviour change (Demark-Wahnefried et al, 2000), although the ideal approach and timing for interventions remains unclear. Studies have shown that cancer survivors may become strongly motivated to modify their diet and behaviour to increase wellbeing, maintain health and prevent recurrence (Demark-Wahnefried and Jones, 2008).
Cancer survivors may also explore complementary and alternative medicine, including nutritional therapies, in the belief that these will enhance the effects of treatment, protect against treatment-related side-effects or improve quality of life. The absence of scientific evidence from controlled clinical trials to support alternative medicine claims presents health professionals with the challenge of how to encourage cancer survivors to respond to evidence-based advice rather than resorting to complementary and alternative therapies.
Knowledge of nutrition, diet and lifestyle changes in frontline care
Frontline nursing staff are in the best position to confidently provide accurate information on nutritional issues, physical activity and weight management at a time when cancer survivors are motivated to make lifestyle changes. However, a number of UK surveys of nurses and other health professionals in primary and secondary care showed weaknesses in nutrition education and knowledge (Rodman and Murphy, 2011). Some health professionals have been found to have notably serious knowledge gaps about aspects of diet and activity in cancer care and for secondary prevention (Anderson et al, 2010). It is also important that staff do not give conflicting messages about diet and exercise, as this could hinder positive engagement and affect cancer survival.
Nutrition education for nurses
Poor levels of nutrition knowledge among health professionals are due, at least in part, to education on this topic not being considered an important component of pre-registration preparation of health professionals for the past 50 years (Richards, 2009).
Recent developments in education recommended by the Nursing and Midwifery Council identified that pre-registration nurses needed to achieve a number of essential skills clusters. This has been reinforced by the new NMC standards for pre-registration nursing for the all-graduate intake nationally from 2013 (NMC, 2010). One of the five essential skills clusters focuses on nutrition and fluid management.
Increasing levels of malnutrition across all care settings, and concerns raised by the Care Quality Commission, have reinforced the need for interprofessional working.
Student nurses at pre-registration and specialist levels need to be taught to understand the evidence base underpinning a healthy balanced diet, along with the principles of effective, timely nutritional assessments by specialists within the multidisciplinary team. Creating time to reconnect with nutritional care would help support institutional change.
There is a clear need to promote healthy weight in cancer survivors as weight gain and a sedentary lifestyle are common after a cancer diagnosis.
Evidence shows that for the general public and cancer survivors, advice regarding nutrition benefits has not been consistent and, at times, even contradictory (Anderson et al, 2010).
Attention should also be directed towards collaborative working with non-NHS settings such as lifestyle intervention programmes to support people surviving cancer (Stull et al, 2007).
Interventions using evidence-based information to emphasise the importance of nutrition, exercise and lifestyle change should be formally introduced into routine clinical practice early in the treatment pathway and reinforced at regular intervals thereafter.
Frontline nurses should be able to provide appropriate and consistent advice on nutritional issues, physical activity and weight management.
Although it is evident that more training in this area is required, more research is needed to identify what form this should take. Additionally, interprofessional working needs to be improved to enable staff to motivate and encourage cancer survivors.
- Following a healthy lifestyle has been shown to benefit recovery, as well as reduce the likelihood of relapse
- Staff in all sectors should to be able to provide accurate information on nutrition, physical activity and weight management
- High-quality nutrition education and training is required for nurses in acute and primary care
- Frontline nurses should be able to refer patients for specialist nutritional advice within robust referral structures
- Inter-professional collaborative working is key to providing effective care and support for cancer survivors
Anderson AS et al (2010) It makes you feel so full of life: LiveWell, a feasibility study of a personalised lifestyle programme for colorectal cancer survivors. Supportive Care in Cancer; 18: 409-415.
Davies N et al (2010) Advising Cancer Survivors About Lifestyle: a Selective Review of the Evidence. Macmillan Cancer Support.
Demark-Wahnefried W et al (2000) Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer; 88: 674-684.
Demark-Wahnefried W, Jones LW (2008) Promoting a healthy lifestyle among cancer survivors. Hematology-Oncology Clinics of North America; 22: 319-342.
Department of Health (2010) National Cancer Survivorship Initiative: Vision. London: Department of Health.
Nursing and Midwifery Council (2010) Standards for Pre-Registration Nursing Education – annexe 3: Essential Skills Clusters and Guidance for Their Use (Guidance G7.1.5b). London: NMC.
Richards S (2009) The building blocks of a healthy diet. Practice Nurse; 38, 12-17.
Rodman S, Murphy JL (2011) Nutrition knowledge and attitudes of pre-registered and registered nurses in relation to cancer survivorship. Proceedings of the Nutrition Society; 70, E307.
Stull VB et al (2007) Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. Journal of Nutrition; 137, 243S-248S.
World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. AICR, Washington DC.