Oncology Care Providers Do Discuss Lifestyle With Patients

Roxanne Nelson, RN, BSN

May 23, 2019

Oncology care providers are aware of the link between obesity and cancer, and report that they do give attention to weight management, physical activity, and diet when seeing their patients, both during and after cancer treatment. Some, but not many, also refer patients to other specialists to support lifestyle change.

The findings come from a survey of nearly 1000 oncology care providers conducted by the American Society of Clinical Oncology, which was published online May 16 in the Journal of Oncology Practice.

"This survey was conducted as part of ASCO's Obesity Initiative," said lead author Jennifer A. Ligibel, MD, chair-elect of ASCO's Cancer Prevention Committee.

"The Obesity Initiative began in 2014, with goals of building awareness within the oncology community of the relationship between obesity and cancer risk and outcomes, as well as providing oncology providers with tools and resources to help facilitate conversations with their patients about weight management, exercise, and a healthy diet," she explained.

Ligibel, a senior physician and director of the Leonard P. Zakim Center for Integrative Therapies and Healthy Living at the Dana Farber Cancer Center in Boston, Massachusetts, told Medscape Medical News that the survey was conducted in part to help guide future ASCO educational initiatives aimed at increasing discussion around these topics as a part of oncology visits.

"We also wanted to help facilitate effective referrals to help patients make healthy lifestyle choices after cancer diagnosis," she said.

Attention Given, Few Referrals

Ligibel and colleagues developed an online questionnaire to evaluate oncology provider practice patterns and perceptions with regard to obesity and weight management during and after active cancer treatment.

The target audience included physicians, nurses, physician assistants, and other members of the clinical care team both in the US and abroad.

A total of 971 providers who were actively treating patients with cancer completed the survey. Most had a doctoral degree (82%), were located in the United States (69%), and practiced in a hospital or health system (including academic medical centers and state-funded institutions; 80%). More than three quarters (76%) cited medical oncology as their primary specialty category.

Almost all respondents (93%) either strongly agreed or agreed that strong evidence shows that being overweight or obese affects cancer treatment outcomes, and 89% felt that addressing a patient's weight (if overweight or obese) should be a standard part of the therapeutic regimen.

Most (70%) also believed that the treating physician is responsible for recommending weight loss, increased physical activity, and improved nutrition, but the majority (83%) also felt that clinicians needed more training to adequately address these issues. Similarly, 84% also believed that interventions to implement changes in weight, diet, or activity should be conducted by other clinical staff who had more relevant expertise.

A large proportion of respondents also reported that they always or most of the time advise patients to maintain a healthy weight or lose weight if overweight (67% during active treatment; 83% after treatment); increase their level of physical activity (73% during active treatment; 83%; after treatment); and eat a healthy, balanced diet (77% during active treatment; 79% after treatment).

Conversely, a much smaller percentage said that they referred patients for weight management interventions always or most of the time (24% during active treatment; 33% after treatment), and made referrals to a dietitian always or most of the time (43% during active treatment).

Respondents also offered their opinions on what they perceived to be barriers/challenges to providing weight management interventions to overweight and obese patients. Two thirds (66%) agreed that there was a lack of time for counseling or to set up a referral, while 73% cited a perceived patient resistance to behavioral interventions. Lack of available resources for referrals to interventions was also reported as a barrier by 63% of providers.

"Recommendations for what these strategies should be is a bit beyond the scope of the current effort, but we would envision the gaps in knowledge and practice illustrated in this survey to inform the development of practice guidelines and educational offerings by ASCO and other organizations focused on this topic," said Ligibel.

"I will say that ASCO has a number of resources that are currently available to help inform oncologists about these topics, as well as materials that can be given to patients to begin a conversation about healthy lifestyle after cancer diagnosis," she commented.

In particular, she highlighted the ASCO Provider and Patient Weight Management Toolkits, which can be accessed on ASCO's educational website.

Ligibel has disclosed no relevant financial relationships. Potential conflicts of interest were reported by some of the coauthors, as noted in the paper.

J Oncol Pract. Published online May 16, 2019. Abstract

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