Are you a health professional?

This section does not replicate the other information on this page but provides additional details or context most relevant to professionals.

Counseling patients

Do you have concerns about introducing lifestyle changes to your patients? 

  • I don’t know if there’s evidence that this really will make a difference.
  • Will I make my patients feel guilty for eating poorly, being overweight, and so on?
  • If I bring this up, I won’t have time to adequately counsel them.
  • I don’t have the knowledge and resources to support them through making lifestyle changes.

You’re not alone in these concerns,1Stump TK, Robinson JK et al. Physicians’ perspectives on medication adherence and health promotion among cancer survivors. Cancer. 2019 Dec 1;125(23):4319-4328. and you don’t have to do this alone. Of greatest importance is that you assess your patient’s lifestyle, sensitively introduce the topic of making lifestyle changes and why it’s important, then refer them to resources to support them in making lifestyle changes.

Even a short, focused conversation can lead to changes. Nutritional and dietary advice can help your patients, especially regarding quality of life.2Zhang F, Jin Y, Qiang W. The effects of dietary advice on malnutrition in Cancer patients: a systematic review and meta-analysis. Supportive Care in Cancer. 2020 Apr;28(4):1579-1585. Many practitioners have found that patients who feel better tend to tolerate and complete difficult treatments and may be more compliant with other therapies.

Evidence 

Patient recommendations and resources: Making changes › You may want to expand on that with a list of good local resources to refer your patients to.

We’ve gathered the evidence for you in How can Eating Well help me? What the research says › And we’ve started a list of recommendations and resources for you to share with your patients in Making changes › You may want to expand on that with a list of good local resources to refer your patients to.

We provide some resources to help you get started engaging your patients in conversations about lifestyle changes in general and specifically Eating Well.

Guidance on engaging your patients in lifestyle conversations

Print materials to display or share with patients

American College of Lifestyle Medicine

Colorful, engaging handouts and flyers

Free accounts give access to materials

Print Resources

Counseling for safety

In general, a plant-based whole foods diet can be individually tailored to the patient to be optimally nutritious and safe. Refer patients to a clinician such as a registered dietician certified in oncology nutrition or a naturopathic oncologist for diet individualization and monitoring, especially if patients are interested in or prescribed metabolic diets such as ketogenic or intermittent fasting. Patients are advised not to try specialized diets without expert guidance. See reviews in which we discuss cautions, contraindications and monitoring for various diets and approaches: Diets and Metabolic Therapies: Introduction ›

Intervention support and success

American College of Lifestyle Medicine

Stories of transformation and healing, of patients, physicians and organizations using evidence based Lifestyle Medicine

Lifestyle Medicine Story Project

Evidence of successful dietary-change interventions:

  • Behavior changes among people with cancer with an online diet intervention, and the mode of delivery did not influence the amount of dietary behavior change in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects3Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
  • Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) that behavioral incentives may encourage healthier eating behaviors in adolescents in a meta-analysis of controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial4Corepal R, Tully MA, Kee F, Miller SJ, Hunter RF. Behavioural incentive interventions for health behaviour change in young people (5-18 years old): a systematic review and meta-analysis. Preventive Medicine. 2018 May;110:55-66. 
  • Better adherence to a more Mediterranean-style, anti-inflammatory dietary pattern among breast cancer survivors with overweight or obesity who participated in an education and culinary-based dietary intervention including monthly nutrition and cooking workshops, motivational interviewing telephone calls and individualized newsletters compared to monthly informational brochures in a mid-sized RCT5Zuniga KE, Parma DL et al. Dietary intervention among breast cancer survivors increased adherence to a Mediterranean-style, anti-inflammatory dietary pattern: the Rx for Better Breast Health Randomized Controlled Trial. Breast Cancer Research and Treatment. 2019 Jan;173(1):145-154.
  • Participation in lifestyle interventions is valued by palliative cancer patients and may strengthen their coping abilities. However, some of the participants also expressed feelings of guilt and inadequacy.6Mikkelsen HE, Brovold KV, Berntsen S, Kersten C, Fegran L. Palliative cancer patients’ experiences of participating in a lifestyle intervention study while receiving chemotherapy. Cancer Nursing. 2015 Nov-Dec;38(6):E52-8.

One study found no consistent trends in physical activity and/or nutrition behavior change related to social cognitive theory-based interventions among cancer survivors as to delivery method or whether the intervention targeted single or multiple behaviors in a meta-analysis of interventions7Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. Journal of Cancer Survivorship. 2015 Jun;9(2):305-38.

Clinical practice guidelines

Recommends a nutrition consultation for treating cancer-related fatigue

Mode of action: diet and hormones

Lower risk of breast cancer recurrence among people following a reduced-fat diet may be due to metabolic hormones and factors associated with decreased fat tissue.8Dieli-Conwright CM, Lee K, Kiwata JL Reducing the risk of breast cancer recurrence: an evaluation of the effects and mechanisms of diet and exercise. Current Breast Cancer Reports. 2016;8(3):139-150.

Further evidence

Clinical evidence is summarized in How can Eating Well help me? What the research says ›

Optimizing your body terrain: preclinical evidence

Inflammation

Immune function

  • Edible mushrooms may regulate the immune system.10Jayachandran M, Xiao J, Xu B. A critical review on health promoting benefits of edible mushrooms through gut microbiota. International Journal of Molecular Sciences. 2017 Sep 8;18(9).

Your microbiome

  • Shifting from a Mediterranean diet to a standard Western diet high in heavily processed foods and meats negatively altered the microbiota in 1 day, and a diet high in sugar decreased necessary microbial diversity within 1 week in animal studies11Turnbaugh PJ, Ridaura VK et al. The effect of diet on the human gut microbiome: a metagenomic analysis in humanized gnotobiotic mice. Science Translational Medicine. 2009 Nov 11; 1(6):6ra14; Sen T, Cawthon CR et al. Diet-driven microbiota dysbiosis is associated with vagal remodeling and obesity. Physiology and Behavior. 2017 May 1;173:305-317.
  • A high-sugar diet, irrespective of the amount of fat, led to increases in body weight and body fat and gut microbiota dysbiosis characterized by an overall decrease in bacterial diversity and an increase in Firmicutes/Bacteriodetes ratio in mice.12Sen T, Cawthon CR et al. Diet-driven microbiota dysbiosis is associated with vagal remodeling and obesity. Physiology & Behavior. 2017 May 1;173:305-317.
  • Altered gut bacteria and fewer colon tumors among mice eating walnuts13Nakanishi M, Chen Y et al. Effects of walnut consumption on colon carcinogenesis and microbial community structure. Cancer Prevention Research (Philadelphia). 2016 Aug;9(8):692-703.

Commentary

Dysbiosis and chronic systemic inflammation may contribute to the development of neuropathies associated with prediabetes, diabetes, and metabolic syndrome. An anti-inflammatory elimination diet―foods to support an anti-inflammatory, neuroprotective milieu, utilizing whole foods with a high phytonutrient density, low glycemic load, protective antioxidants, and high-quality dietary fats along―and void of common inflammatory foods (gluten, diary, sugar, corn, and soy) is used by some to manage neuropathy not related to cancer.14Rowin J. Integrative neuromuscular medicine: neuropathy and neuropathic pain: consider the alternatives. Muscle & Nerve. 2019 Aug;60(2):124-136.

Professional resources

National Heart, Lung, and Blood Institute

DASH (Dietary Approaches to Stop Hypertension) is a flexible and balanced eating plan that helps create a heart-healthy eating style for life.

DASH Eating Plan

Today’s Dietitian

“The magazine for nutrition professionals”

Today’s Dietitian

Ligabel J, Meyerhardt JA. The roles of diet, physical activity, and body weight in cancer survivorship. UpToDate.

Fortmann SP, Burda BU et al., editors. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: a systematic evidence review for the US Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Nov. Report No.: 14-05199-EF-1.

The second of of a four-part lecture series on Integrative Cancer Care for clinicians, this segment discusses the role of nutrition in integrative cancer care.

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Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewers

Rebecca Katz

Expert on the role of food in supporting health for the chronically ill and CancerChoices advisor
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Rebecca Katz, MS, is a nationally recognized expert on the role of food in supporting health for the chronically ill. With a master of science in health and nutrition education, Ms. Katz is founder of the Healing Kitchens Institute and has been a visiting chef and nutrition educator at the Commonweal Cancer Help Program for more than a decade.

Rebecca Katz Expert on the role of food in supporting health for the chronically ill and CancerChoices advisor

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Miki Scheidel

Co-Founder and Creative Director
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Miki Scheidel is Co-founder and creative director of CancerChoices. She led the effort to transform Beyond Conventional Cancer Therapies, the prior version of CancerChoices, to its current form. Miki and her family were deeply affected by her father’s transformative experience with integrative approaches to metastatic kidney cancer. That experience inspires her work as president of the Scheidel Foundation and as volunteer staff at CancerChoices. She previously worked with the US Agency for International Development and Family Health International among other roles. She received her graduate degree in international development from Georgetown University, a graduate certificate in nonprofit management from George Mason University, and a Bachelor of Arts from Gettysburg College.

Miki Scheidel Co-Founder and Creative Director

Last update: December 1, 2022

Last full literature review: June 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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