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CancerLynx - we prowl the net
June 17, 2007

2007 Concepts For Reducing Toxicity and Improving Survival
Ernest H. Rosenbaum, MD

Hematologic Cancers, Bone Marrow Transplant and Stem Cell Transplant
Lung Cancer

Prostate Cancer
Head and Neck, Upper Gastrointestinal Cancers and Pancreatic Cancer

Hematologic Cancers, Bone Marrow Transplant and Stem Cell Transplant
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1. Fact: There are only a few studies on the role of diet and hematologic malignancies.
2. Fact: Obesity may have an adverse affect on treatment toxicities, mortality, overall survival and disease-free survival. Exercise has some beneficial value on functional capacity, muscle strength, fatigue, aerobic fitness, psychological function and quality of life.
3. Fact: Intensive chemotherapy and total body radiation therapy is related to adverse side effects with nausea, vomiting, diarrhea, mucositis and esophagitis.
4. Fact: Because of major food restrictions due to toxicity and possible malnutrition, diet needs to be monitored carefully. Use of energy-rich foods post transplant and supportive parenteral nutritional support are very valuable. Enteral nutrition support helps reduce medical complications.

Lung Cancer
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1. Fact: Largely due to cigarettes, and diets low in vegetables and fruits are associated with increased lung cancer risk. Clinical trials with selenium and skin cancer have noted a reduced risk of lung cancer.
2. Fact: Aggressive lung cancer treatment has many side effects, and often survivors begin with low nutrition levels due to smoking and poor diets; thus, frequent meals, which are smaller, can be very helpful. Use of energy-dense dietary supplements or enteral nutrition is also helpful.
3. Fact: Physical activity to improve lung cancer survival has not been demonstrated.

Prostate Cancer
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1. Fact: PC is common in older men - related to a high intake of animal food sources. High saturated fats have been associated with increased risk for prostate cancer and a worse survival.
2. Fact: Monosaturated fat intake is associated with a better survival.
3. Fact: Decreasing saturated fats is likely to be beneficial in prostate cancer.
4. Fact: There is an association between vegetable and fruit intake and prostate cancer. Lycopenes found in tomato and tomato products, watermelon, and pink grapefruit are currently popular, and intakes of fish and tomato sauce are associated with reduced risk.
5. Fact: A high vegetable and fruit diet has been found to reduce risk for cardiovascular disease, but benefits for prostate cancer are still uncertain.
6. Fact: Supplements and dairy products are associated with increased risk for aggressive forms of prostate cancer.
7. Fact: The role of calcium and vitamin D supplements are still under study; although, 600 IU of vitamin D, 1200 mg of calcium daily, and pursuing active lifestyles, including weight bearing exercises, can be helpful in the prevention of prostate cancer recurrence. This merits further study and confirmation.
8. Fact: Vitamin E had no effect on survival, and selenium supplements are believed to reduce prostate cancer incidence.
9. Studies on selenium and vitamin E are in progress.10. Fact: Thus far, there is no association between obesity and physical activity on the risk of prostate cancer; although, obese survivors have a higher mortality rate.
10. Fact: A relationship between obesity and risk of recurrence and survival has not yet been established.
11. Fact: PC survivors receiving androgen-deprivation therapy had improvements in muscular fitness, quality of life, and therapy with exercise training three times a week.
12. Fact: Recommended diets are rich in vegetables and fruits, low in saturated fats, and increased physical activity. Moderation with low-fat dairy intake, prudent diet, and exercise will decrease cardiovascular disease risk, which is the major cause of death in prostate cancer survivors.

Head and Neck, Upper Gastrointestinal Cancers and Pancreatic Cancer
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1. Fact: Studies show the importance of a diet with fruits and vegetables, and in pancreatic cancer, obesity is a risk factor.
2. Fact: Thus far, studies are inconclusive for dietary factors and physical activity.
3. Fact: The symptoms present in esophageal and gastric cancer can compromise nutritional intake and absorption with nutritional complications.
4. Fact: A high-protein, low-fat, high-carbohydrate diet helps increase lower esophageal sphincter pressure.
5. Fact: Foods to avoid include chocolate, fat, alcohol, coffee, caffeine, spearmint, peppermint, garlic, and onions, as they decrease lower esophageal sphincter pressure.
6. Fact: Acidic foods, such as tomato-based products and orange juice, may cause head and neck mucosa irritation.
7. Fact: Rapid transit is often noted, which can decrease food absorption.
8. Fact: Supplementation with Omega-3 fatty acids has a favorable effect on short-term weight gain and performance status.
9. Fact: A trial with 200 mg of thalidomide a day was associated with slower loss of weight among persons with advanced pancreatic cancer.
10. Fact: Side effects can cause a poor nutritional status from difficulties in head and neck of biting, chewing and swallowing post surgery, as well as dry mouth, mucositis and taste changes.
11. Fact: Acidic, salty, spicy and hot/cold foods are often not well tolerated. Oral rinses and sugar-free gum and mints can provide some relief. Often, a liquid diet is better tolerated.
12. Fact: Following chemoradiation, eating abilities are compromised, and improvement can take up to twelve months post therapy.
13. Fact: Tube feeding immediately after surgery for esophageal and gastric cancers with physical activity can help reduce pain and disability, as well as improve quality of life.
14. Fact: Mucositis is common post head and neck therapy.

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