Lifestyle Medicine Program Offers Care for the Whole Patient
In This Article
- A growing body of research shows that whole-person cancer care not only makes patients feel better but also can improve outcomes
- Lifestyle medicine is an approach that focuses on attention to nutrition, physical activity, stress management, restorative sleep, social connections, and avoidance of risky substances to improve health and well-being, and prevent chronic diseases
- The Lifestyle Medicine Program at Mass General Cancer Center offers individual consultations and group education to help patients apply these evidence-based approaches to improve health and well-being during cancer survivorship
Mass General Cancer Center has established a dedicated program for educating people with cancer about the importance of evidence-based lifestyle interventions that can improve quality of life, alleviate symptoms post-treatment, and promote adoption of healthy lifestyle behaviors that are associated with a reduced risk of cancer recurrence and improved prognosis. The program provides in-depth education, consultations, and referrals for evidence-based, comprehensive cancer treatments.
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"Given recent research findings, organizations including the American Cancer Society, National Comprehensive Cancer Network, and the American Society of Clinical Oncology have established guidelines which state that health promotion should be a key component of cancer survivorship care," says Amy Comander, MD, DipABLM, an oncologist and director of Lifestyle Medicine at Mass General Cancer Center.
"Promotion of healthy behaviors is therefore an important component of our visits with our patients. During a follow-up visit with one of my patients, I'm often focused on how my patient is feeling overall, how she is tolerating her treatment, and I ensure that she is up to date with her screening tests. I always ask each patient about her exercise and dietary habits, but I acknowledge that there is limited time during a standard follow-up visit to discuss the role of lifestyle factors in detail," she adds.
The Lifestyle Medicine Program at Mass General Cancer Center helps fill that gap by offering individual consultations, shared medical visits, and referrals to other Mass General programs.
Program Focuses on Research Advances in Lifestyle Interventions in Oncology Care
The American College of Lifestyle Medicine focuses on the "therapeutic use of evidence-based lifestyle interventions to treat and prevent lifestyle-related diseases in a clinical setting. Lifestyle medicine empowers individuals with the knowledge and life skills to make effective behavior changes that address the underlying causes of disease."
Lifestyle medicine focuses on six pillars that can help patients feel better during treatment and beyond. Each of these domains is relevant to oncology care:
- Nutrition
- Physical activity
- Stress management
- Restorative sleep
- Social connections
- Avoidance of risky substances
"Researchers from the American Cancer Society have reported that lifestyle factors play a role in 42% of cancers diagnosed in the United States. Increasing evidence now suggests that, in some cases, focusing on these lifestyle factors can also improve cancer outcomes," Dr. Comander adds.
The Lifestyle Medicine Program at Mass General Cancer Center hosts a clinic that offers one-on-one consultations with the lifestyle medicine team—an oncologist, oncology registered dietitian, and behavioral medicine specialist. The experts make personalized recommendations on lifestyle changes and help patients set "SMART" goals: specific, measurable, attainable, relevant, and timely.
The program also hosts a six-week group program that offers a virtual, in-depth education on specific topics from various experts. The sessions teach patients how to use healthy lifestyle behaviors to improve health, well-being, and recovery. Patients with a diagnosis of breast cancer may enroll in a 12-week lifestyle medicine program called PAVING the Path to Wellness.
Along the way, clinicians can refer specialists to help patients in the program pursue specific goals or address individual needs.
"The goal of the Lifestyle Medicine Program is to help bring attention to these issues and to refer our patients to get proper help to address those concerns," Dr. Comander says.
Evidence-based Nutrition Guidelines and Exercise Prescriptions for Cancer Patients
Cancer survivors are at increased risk for heart disease. Studies have also shown that this population tends to have high rates of prolonged sitting and lack of physical activity. Guidelines from the American Society of Clinical Oncology state that "oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent."
A 2019 survey of members of the American Society of Clinical Oncology indicated that 89% of respondents believe that cancer care should address obesity. However, 66% did not feel they had adequate training to discuss weight loss and lifestyle modifications, and 64% said they lacked places to refer patients for these services.
Similarly, a survey of patients found that only about half received counseling on diet and exercise during oncology visits.
"In that study, individuals who received counseling from their oncology team were more motivated to make positive lifestyle changes," Dr. Comander says. "What we say to our patients can really make a positive impact."
The Lifestyle Medicine Program can provide several interventions to help people with cancer tailor their diet and exercise:
- Education about clinical exercise physiology for cancer
- How nutrition and exercise can improve health, well-being, and recovery
- Individualized one-on-one consultation with a physician or nurse practitioner
- Coaching on how to set meaningful, achievable goals
- Detailed, personalized, advanced nutritional plans
- Referral to free or affordable community exercise programs that address exercise physiology and cancer, such as Livestrong
- Referral to physical therapy or rehabilitation for comprehensive evaluation of any limitations and strategies to restore physical functioning
- Strategies to be active and resume exercise based on current fitness level and treatments
Other Supportive Care to Patients with Cancer
The stresses of cancer survivorship can negatively impact sleep, affect personal relationships, and prompt misuse of drugs and alcohol. Healthcare professionals can help people with cancer address these issues for better health.
The Lifestyle Medicine Program offers the following interventions:
- Assessment of symptoms that might be affecting sleep, such as pain, neuropathy, or sleep apnea
- Counseling on how to set expectations and communicate openly with family members, friends, sexual partners, and coworkers
- Discussion of stress-management strategies, such as mindfulness, meditation and exercise
- Connection with helpful community services and support groups
- Programs to help people quit smoking or using other risky substances
- Tips on sleep hygiene
- Referral to the Mind Body Program for Cancer Survivors for additional help with stress and resilience
"Our goal at the Mass General Cancer Center—and what makes us so special—is that we care for the whole patient. We want to cure their cancer and ensure they achieve the best possible outcome. But at the same time, we want to make sure we're attentive to every aspect of their health," Dr. Comander says. "How are they sleeping? How are they eating? How are they doing in terms of physical activity? How are they doing in terms of stress management? What kind of social support do they have? All of these things are so intertwined with one another, and each of those pillars is so integral."
Referring Patients to the Oncology Lifestyle Medicine Program
Patients who have completed primary cancer treatment at Mass General Cancer Center can self-refer to the Lifestyle Medicine Program. Mass General providers can also refer people through the Epic electronic medical record.
"Mass General is a world leader in providing cutting-edge cancer treatment, and lifestyle medicine is absolutely a key component of providing comprehensive care to our patients with cancer," Dr. Comander says.
She hopes that more people receive these interventions. "It's important as healthcare professionals that we take the time to educate ourselves about how to discuss key lifestyle factors with our patients in clinic," she says. "It does make a powerful impact if a doctor, nurse practitioner, or another member of the healthcare team mentions these particular topics in clinic. As a community, it is important that we address these issues."
Learn more about the Lifestyle Medicine Program
Learn more about Mass General Cancer Center