Exercise, mental health, nutrition — these are all areas that can affect how someone lives during and after cancer treatment.
The healing power of exercise
Before Gabriela Dow's cancer diagnosis, her schedule, which involved juggling professional commitments with motherhood, left little time for working out. But when her oncologist recommended that she exercise during treatment, she started walking. "I learned early on that moving made me feel so much better, especially before the tiredness really set in," says Dow.
Not only does exercise make people feel better, fitness is correlated with mortality, says Dr. Arash Asher, director of Cancer Survivorship and Rehabilitation at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center. "There have been oodles of studies that show exercise is good for breast cancer patients. It reduces fatigue, it's good for the bones and it decreases anxiety. But there also seems to be a much lower recurrence rate for people who get moderate amounts of exercise per week."
Research shows that exercise also reduces recurrence rates of other types of cancer, including colorectal, prostate and ovarian cancers. The protective benefit may be manifold: physical activity reduces inflammatory chemicals, body fat and insulin sensitivity, all of which may fuel cancer progression and recurrence.
The caveat, says Asher, is that while moderate exercise is beneficial, intense exercise may actually suppress immunity in the short term. "The answer is that it needs to be tailored for each person."
Cancer rehab may also include "prehabilitation": targeted exercises designed to optimize a treatment's outcome that patients can do before the treatment begins. For example, preoperative lung cancer patients may do breathing exercises, such as blowing up balloons, prostrate cancer patients may do pelvic floor exercises and neck cancer patients may do swallowing exercises.
Good nutrition bolsters the body
Numerous studies have shown that breast cancer survivors who eat abundant fruits and vegetables are less likely to have a relapse and to die of the breast cancer. A 2014 study found that breast cancer survivors with better post-diagnosis diets also had a lower risk of death from non-breast cancer causes including cardiovascular disease and other cancers — both of which pose a disproportionately high risk for survivors.
"We recommend a variety of different-colored fruits, vegetables and whole grains because different colors mean different phytochemicals," says Arlene Provisor, clinical nutrition coordinator at the Oschin institute. Phytochemicals are natural compounds in plants, such as allicin in onions and carotenoids in carrots, that may stimulate the immune system, slow the proliferation of cancer cells and protect against DNA damage.
The American Cancer Society recommends that people consume phytonutrients and vitamins in whole foods rather than trying to obtain them from dietary supplements. There is currently no evidence that supplements are effective, and they may even be harmful, for patients in cancer treatment (unless they are used under a doctor's recommendation to treat a known deficiency).
Not only can sound nutrition prevent cancer from coming back, but a healthful diet before treatment helps patients heal more quickly from surgery and bolsters the body against the nutritional detriments of chemotherapy and radiation.
"When we first meet with patients, we like to make sure they focus on high-protein foods, and we always stress lean sources such as chicken, fish, legumes and nuts," says Provisor. "Protein is the main building block for cells, and the modality for chemotherapy and radiation is breaking down cells. So it's important to get enough protein from the diet to make new cells."
She adds that many people struggle to keep weight on during cancer treatment due to food aversion or nausea. "If they are only able to eat small amounts, we encourage them to eat things high in calories and protein so they can have a high density of nutrients per bite." She suggests nutrient-rich foods such as eggs, Greek yogurt and nut butters.
"It's easy to get depressed when you have cancer. Your hair falls out, you look like a zombie and you're afraid you're going to die," says Dow, who participated in mindfulness training through UC San Diego Moores Cancer Center. A practice of meditation, gratitude and even mindful eating helped lift her spirits and get through treatments with a hopeful attitude.
Many survivors struggle with stress, anxiety and depression. Yet research shows that these mental states are detrimental to the body's ability to fight cancer. Both depression and chronic stress increase inflammatory chemicals that impair the immune system and may increase tumor development, while stress hormones can stimulate cancer proliferation by increasing blood supply to tumors.
Asher recommends that cancer survivors stay connected to loved ones throughout cancer treatment, both to mitigate the effects of loneliness and to have someone to help remember appointments, ask doctors questions and help with errands. Many survivors also make meaningful connections through cancer support groups.
In addition to regular exercise, mind-body exercises such as tai chi or yoga can help relieve stress and lift mood, says Asher. Another vital factor for mental health is rest, says Asher. "Really invest in your sleep; it can help your fatigue and mood. Plus, sleep is important for maximizing your immune system's function."