Childhood Cancer Survivors Cut Risk With Healthy Lifestyle

Jenni Laidman

July 30, 2014

Adherence to a healthy lifestyle lowers the risk for metabolic syndrome in childhood cancer survivors, according to a study published online July 28 in Cancer.

The study also showed that nearly three-quarters of the childhood cancer survivors failed to adhere to healthy lifestyle guidelines, and were thus doubling their risk for metabolic syndrome. In fact, metabolic syndrome rates in the study cohort were similar to those in a much older population, report Kirsten Ness, PhD, from the Department of Epidemiology and Cancer Control at St. Jude Children's Research Hospital in Memphis, Tennessee, and colleagues.

The study involved 1598 childhood cancer survivors who were at least 18 years of age and who had been free from cancer for 10 years or more. The investigators assessed adherence to the lifestyle habits recommended by the World Cancer Research Fund/American Institute for Cancer Research (WCRFR/AICR).

"This study is unique because of the large, well-characterized population of survivors with various diagnoses, which we studied many years from their original cancer diagnosis," said Dr. Ness.

Just over one-quarter of the study cohort followed the healthy lifestyle guidelines, and almost one-third had developed metabolic syndrome.

"These findings are important because they indicate that adults who were treated for cancer as children have the opportunity to influence their own health outcomes," Dr. Ness said in a statement.

She emphasized that "cancer survivors should not smoke. In addition, adopting a lifestyle that includes maintaining a healthy body weight, regular physical activity, and a diet that includes fruits and vegetables and that limits refined sugars, excessive alcohol, red meat, and salt has potential to prevent development of the metabolic syndrome."

Details of the Study

Metabolic syndrome is a constellation of health factors that increase the risk for heart disease, stroke, and diabetes. For a diagnosis of metabolic syndrome, people must have at least 3 of the following conditions: excess abdominal obesity, elevated triglyceride levels, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and high fasting blood sugar levels.

The WCRFR/AICR guidelines recommend at least 150 minutes/week of moderate physical activity, at least 5 servings/day of fruits and vegetables, at least 400 g/day of complex carbohydrates, less than 14 g/day of alcohol for women and less than 28 g/day for men, less than 80 g/day of red meat, less than 2400 mg/day of sodium, and a body mass index no higher than 25 kg/m².

If study participants met at least 4 of the criteria, they were classified as being adherent to the lifestyle guidelines.

The women who did not adhere to the guidelines were 2.4 times more likely to develop metabolic syndrome than those who followed the guidelines, and the smen who did not follow the guidelines were 2.2 times more likely.

"Importantly, the association between an unhealthy lifestyle and metabolic syndrome was even stronger than the association between cranial radiotherapy and metabolic syndrome in females, suggesting that individuals predisposed to adverse cardiovascular outcomes after treatment for childhood cancer may be able to modify this risk through behavioral changes," the investigators explain.

For the cancer survivors in this study, the overall prevalence of metabolic syndrome was 31.5%; for those older than 40 years, the prevalence was 22.0%. In the general population, the overall prevalence of metabolic syndrome is around 34%, and for those older than 40 years, it is about 68%, Dr. Ness and colleagues report.

Considerable Challenge

Despite guidelines issued by the American Society of Clinical Oncology in 2013 for the continuing care of the more than 13 million cancer survivors in the United States, there is still a considerable challenge in making sure childhood cancer survivors get the kind of care they need, said study investigator Kerri Nottage, MD, also from St. Jude Children's Research Hospital.

"The main problem for disseminating information or even training physicians is that primary care physicians may only have 1 childhood cancer survivor," Dr. Nottage told Medscape Medical News. "They're not going to spend a lot of time reading the guidelines.

"A lot of centers deal with follow-up care differently," she said. At St. Jude, patients who complete cancer therapy go for annual visits to a clinic that focuses on the late affects of cancer treatment. "They're given a written summary of their medical history, as well as an update of current evaluations, that they can bring to any other physicians they see."

Patients should be encouraged to follow-up with an oncologist, Dr. Nottage said.

Survivorship care plans are essential in the treatment of childhood cancer survivors, but are not as common as they should be, said Lisa Diller, MD, clinical director of pediatric oncology at Dana-Farber/Children's Hospital Care Center in Boston, who was not involved in the study.

"It's very helpful if survivors continue to be seen in survivorship-focused clinics, which most cancer centers now have," Dr. Diller told Medscape Medical News in an email. "The continuation of care in that setting allows the patient to get new information (such as was described in this study) and for the patient and the oncologist to communicate with the [primary care physician]."

Dr. Diller noted that, given the prevalence of obesity, primary care physicians should be prepared to help all patients, not just cancer survivors, approach a change in diet effectively.

For female cancer survivors, the investigators found that advanced age, lower educational attainment, and treatment with cranial radiotherapy were all associated with an increased risk for metabolic syndrome. For male survivors, white race, advanced age, and lower educational attainment were associated with an increased risk.

In the study cohort, 32.5% of the males and 31.0% of the females had developed metabolic syndrome. Only 25.2% of the men and 28.8% of the women were considered to be adherent to the WCRF/AICR guidelines.

In men, the most prevalent component of metabolic syndrome was high blood pressure (53.0%), followed by elevated fasting glucose levels (38.2%) and low HDL cholesterol (38.2%). In women, the most prevalent component was low HDL cholesterol (42.6%), followed by increased waist circumference (42.6%) and high blood pressure (40.6%).

Obesity, excessive consumption of red meat and sodium, and inadequate intake of fruits and vegetables were common in the study cohort. In men and women, mean daily consumption was 1 serving of fruit and 2.5 servings of vegetables. Sodium intake was higher in men than in women.

For study participants with metabolic syndrome, 87.8% of men and 87.2% of women did not adhere to the WCRF/AICR guidelines.

Of the 53.0% of men with hypertension, 78.9% did not follow guidelines. Of the nearly 40% of men who had elevated levels of fasting glucose, 80.8% did not adhere to the guidelines.

Of the 42.6% of women with low HDL cholesterol, 81.6% did not adhere to the guidelines. Of the more than 40% of women had an elevated waist circumference, 87.0% did not adhere to the guidelines

The study was financed by grants from the National Cancer Institute and the American Lebanese Syrian Associated Charities. Coauthor Leslie Robison, PhD, from St. Jude, reports receiving personal fees for acting as a scientific advisor for Novo Nordisk.

Cancer. Published online July 28, 2014. Abstract

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