By Linda Carroll
(Reuters Health) - Cancer specialists only rarely advisepatients on lifestyle changes that could improve overall healthand possibly also reduce the risk of recurrence, a new surveysuggests.
The survey of doctors from a Midwestern health system foundthat oncologists were far less likely than primary carephysicians to offer advice on health promotion strategies, suchas weight loss and smoking cessation, researchers reported inthe journal Cancer.
With oncologists reticent to offer advice on lifestylechanges, the onus may fall upon patients to bring the topic upand to find ways on their own to address changes, said studycoauthor Bonnie Spring, a professor of preventive medicine,psychiatry, psychology and public health and director of theInstitute for Public Health and Medicine at NorthwesternUniversity's Feinberg School of Medicine in Chicago.
Patients need to realize their lifestyle, their weight,their physical activity, their smoking all have a big influenceon the likelihood their cancer will recur, Spring said.
"They also impact the likelihood you will develop heartdisease," she tells patients. "Very likely, the drugs you weregiven to address the cancer may have had a toxic effect on yourheart. This is one of the things you can do to help control therisk."
To investigate oncologist attitudes towards lifestylecounseling, Spring and her colleagues surveyed 91 Northwesterndoctors, including 30 primary care physicians, 30 oncologistsand 31 physicians in other specialties (urologists,gynecologists and dermatologists) who treat survivors ofprostate cancer, breast cancer and melanoma.
Ninety percent of primary care physicians said theyrecommend lifestyle changes such as weight loss and smokingcessation to at least some cancer survivors. That was true forjust 26.7% of oncologists and 9.7% of specialists.
The researchers conducted in-depth interviews with 12 of theoncologists, who cited a number of concerns that drove theirdecision not to offer lifestyle counseling. Chief among them:they feared patients wouldn't be able to make lifestyle changesand continue to take their medications properly.
Many believed that cancer control was their primary concern.One stated "We're so focused on the life-or-death aspect ofcancer, everything (else) falls through the cracks."
Some weren't convinced by studies showing that lifestylefactors could impact cancer risk. One said "You know, I don'teven know what the impact is . . . I'm skeptical sometimes aboutsome of the data. For many of us, the interpretation oflifestyle data is more nebulous and oftentimes difficult orperceived as very difficult to adhere to the recommendation."
When oncologists did address lifestyle factors, it wasusually because the patient brought the subject up.
While the new study reports on data gathered at oneinstitution, Spring believes similar results would be foundacross the nation. "I think it's widespread," she said.
The new findings are "intriguing," said Dr. Charles L.Shapiro, director of the Survivorship Program at the TischCancer Institute at Mount Sinai in New York City. "But it's avery small study. I'd like to see a nationwide study."
As for the idea that patients won't take their medicationsif they are also trying to make lifestyle changes, Shapiro said,"that doesn't jive with my own experience. My group is wellversed in these kinds of things that patients can do forthemselves and how successful they are."
The new study covers "an important topic," said Elizabeth A.Platz, a professor at the Johns Hopkins School of Public Healthand the Sidney Kimmel Comprehensive Cancer Center at JohnsHopkins in Baltimore, Maryland.
"The study is telling us that not all physicians are in theposition to educate patients about lifestyle changes andoncologists often don't have time to do referrals," Platz said."That means that oncologists may need other clinical staff to beengaged in those activities."
Part of the problem, Platz said, is that research linkingcertain lifestyle factors, such as obesity, to cancer risk maynot have been absorbed by oncologists. "We need to make aneffort to deal with that," she said.
SOURCE: http://bit.ly/2Nyqrgx Cancer, online August 26,2019.
