Today's Practice: Changing the Business of Medicine | Page 20

P R A CT I CE M A NA GE M E NT

Cancer Survivorship
sleep disturbance in patients with breast and prostate cancer. Caffeine intake and review of medications including supplements should be done.
Coping strategies including relaxation techniques
and meditation have been helpful. Patient with
chronic symptoms should be referred to sleep
specialist for sleep studies.

There is no current evidence to support the use of
weight loss supplements and cancer survival.
Patient should be screened for vitamin deficiencies
based on their cancer treatment and these deficiencies should be corrected interpreted as needed.
Vitamin D replacement for adequate bone health is
consider it in many cancer survivors.

Healthy Lifestyles
Cancer survivors should be encouraged to achieve
and maintain healthy weight to improve overall
health and quality of life. In some cancers, this has
been associated with reduced risk of cancer related
death and risk of recurrence. Patient should be
encouraged to engage in physical activity regularly
and to maintain a healthy body weight throughout
life. At least 150 minutes of moderate or 75 minutes of vigorous activity per week should be done
spread out over the course of the week. Two to three
sessions per week of strength training including
major muscle group should be done. Stretching of
major muscle groups on a regular basis is helpful as
well.

Immunizations
Use of inactivated vaccines is considered safe in
most cancer survivors. Vaccination schedules can
be reviewed at CDC website. Certain cancer
vaccine such as live attenuated viruses are
contraindicated in actively immunosuppressed
individuals specifically in survivors with lymphoma and other malignant neoplasm affecting bone
marrow or lymphatic system or history of
immune deficiency. Vaccine should ideally be
administered approximately two or more weeks
before cancer treatment and three or more
months after cancer chemotherapy. Inactivated
influenza vaccine can be administered during
cancer treatment. Live virus vaccines can be
administered for two more weeks before cancer
treatment or three or more months after chemotherapy is completed. In patients who receive
anti-B cell antibody therapy, vaccination should
be delayed for at least six months after therapy.
Patients with hematopoietic stem cell transplants
need special guidance from their transplant physicians on timing and safety of vaccinations.

Nutrition habits should be discussed and reviewed
regularly. Calorie intake is helpful in maintaining a
healthy BMI. “Prudent diet “has been associated
with reduced risk of cancer recurrence.” Limited
intake of red or processed meat, and it is recommended to use lean proteins like poultry, fish,
legume, low-fat dairy and nuts. Fat sources such as
olive or canola oil, avocados, nuts and fatty fishes
are encouraged. Fruits, vegetables, whole grains and
legumes should be the main source of carbohydrates. Fat should be no more than 20 to 35% of
total intake, with saturated fat being less than 10%
and trans fat less than 3%. Carbohydrate should be
45 to 65% of dietary intake with high intakes of
fruit, vegetables and whole grains. Protein should
contribute 10 to 35% of total intake with the goal
of 0.8 grams per kilogram.

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Manpreet Chadha, MD

Screening for other cancers
Routine surveillance for cancer recurrence is
typically done per US preventive task force guidelines for all cancer survivors. However second
cancers can be noted in cancer survivors at higher
rate than in general population because of genetic
susceptibility like cancer syndromes, common
predisposing factors like smoking, obesity and
carcinogen exposures and/or mutagenic effects of
cancer treatment (like secondary leukemia).

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