It's time to make the standard of lifestyle intervention in oncology

“I survived leukemia, but no one told me how to live again.”

That's what one of my patients said after completing chemotherapy. The treatment saved her life but made her weak, anxious, and wondered what would happen next. Her story is not unique. Despite significant advances in oncology in survival, too many patients emerged due to treatment of abused bodies, guiding reduced to faded survival pamphlets.

However, there is growing evidence that structured lifestyle interventions such as physical exercise, nutrition and stress management are not only helpful. They also reduce cancer recurrence, improve quality of life, reduce mortality, and even reduce health care costs.

It is time to see these interventions as additional, but rather as necessities.

The evidence is strong and growing

Cancer care is entering a new phase – evidence-based lifestyle interventions are a key component of comprehensive tumor treatment. A growing number of clinical studies have shown that changes in targeting diet, physical exercise, and stress management can significantly reduce cancer recurrence and mortality.

2023 New England Journal of Medicine The study followed 962 patients with colorectal cancer for three years. Those who were supervised, moderate-intensity exercise programs reduced mortality rates by 37%. This is more beneficial than many chemotherapy agents offer and fewer side effects.

Among breast cancer patients, regular physical exercise is associated with a 30-50% reduction in death and a 40% reduction in recurrence risk.

Aside from survival, structured lifestyle planning can improve the patient’s feelings. A meta-analysis of 110 randomized trials found that cancer survivors in lifestyle programs experienced significantly better physical, emotional, and social well-being. Exercise alone always reduces cancer-related fatigue, which is one of the most debilitating effects of treatment.

Strengthen the patient before treatment

Lifestyle medicine is not only crucial to recovery. Even before treatment begins, it is becoming more and more important.

Systematic review and meta-analysis for 2022 Supportive care for cancer Preparations were found to reduce the incidence of postoperative complications and reduce the average length of hospital stay in patients with fragile cancer. In 2023, comment Critical Comments on Tumor/Hematology Related pre-treatment courses with better treatment tolerance and post-treatment complications.

We will not send patients to the surgery without preparation. Without it, we shouldn't send them into radiation therapy, chemotherapy or immunotherapy.

However, none of these facts are secrets for oncologists. We already know that when used in conjunction with standard oncology care, “exercise is medicine.” In fact, the 2024 American Society of Oncology (ASCO) Integrated Society of Oncology (SIO) Guidelines clearly recommend exercise, mindfulness, cognitive behavioral therapy, yoga, relaxation and other practices in cancer patients to alleviate anxiety, depression, and fatigue.

Why are lifestyle interventions not standard?

Despite compelling evidence, most cancer patients still have the least changes to lifestyle changes. Handout. Some words of encouragement. Maybe a recommendation, even exists.

There are well-known obstacles:

• Low compliance with general or one-time recommendations. One study showed that only 5% of patients were fully adhered without structured support.
• The payer's non-pharmaceutical services have limited coverage.
• Debris care, especially after discharge or treatment is completed.

But the problem is not the patient. They participate when they are supported consistently and individually.

Cancer patients who receive diet, exercise and stress relief target coaches are more likely to adhere to lifestyle modified courses, which in turn leads to a decrease in total medical expenses, which is due to fewer hospitalizations and complications. These are the real savings for the provider and bring better results for the patients.

Embed lifestyle care in oncology

The evidence is too strong to ignore now. Exercise, nutrition, and mental health support are not “very good” extra features. They are evidence-based therapies and should stand with chemotherapy, immunotherapy, radiation and surgery.

What needs to be changed?

• Cancer centers must embed lifestyle services into standard pathways of care without bolting as they did afterwards.
• Payers must recognize that value by covering results-driven lifestyle plans.
• We must track lifestyle intervention metrics just like chemotherapy compliance or surgical outcomes. Are we helping patients move, eat and cope? If not, we lack the critical care section.

Beyond Survival: Helping Patients Prosper

Patients like my leukemia survivor are not only looking for survival. They are seeking strength, goals and paths toward. They want to thrive, not just endure.

Through a lifestyle program that improves adherence and reduces complications and costs, we have an effective model. What is missing is the willingness to expand it.

Lifestyle interventions not only improve quality of life. They prolong life, prevent pain, and relieve the financial burden on patients and systems. It’s time to make them the standard in oncology care, not the exception.

Image source: Saimon Sailent, Getty Images

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