Living Your Best After Cancer:
Healthy Diet Choices ”
Wendy Demark-Wahnefried, PhD, RD, LDN
• Professor, Duke University School of Nursing & Duke
University Medical Center’s Dept. of Surgery
• Nationally-recognized nutritionist with research focusing on the relationship between diet and cancer diagnosis and treatment
• 2003-2005—Director of the Cancer Prevention,
Detection & Control Research Program at Duke
Comprehensive Cancer Center
• 2003—Named Susan G. Komen Professor of
Survivorship

Wendy Demark-Wahnefried, PhD, RD, LDN
Professor: School of Nursing & Dept. of Surgery
Duke University Medical Center

Achieve or maintain a healthful weight. Choose foods that help maintain a healthful weight. Adopt a physically active lifestyle.
Eat a variety of healthful foods, with an emphasis on plant sources.
- eat 5 or more servings of a variety of vegetables & fruit each day.
- choose whole grains in preference to processed (refined) grains & sugars.
- limit consumption of red meats, especially those high in fat & processed.
If you drink alcoholic beverages, limit consumption.

BMI = _ (Weight in Pounds) X 703
(Height in inches) x (Height in inches)
If 25 or over: Overweight
If 30 or over: Obese

Trends in Overweight* Prevalence (%)
Adults 18 & Older, 1992-2004
1992 1995
1998 2004
Less than 50% 50 to 55% More than 55% State did not participate in survey
*Body mass index of 25.0 kg/m 2 or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995,
1998) and Public Use Data Tape (2004), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005.

Anorexia/Cachexia
• Patients with select respiratory, G.I. & childhood cancers
• Patients living with advanced cancer
• Increasing weight to desired range important for recovery, well-being, functional status
• Diet & exercise key roles +/pharmacotherapy
Overweight/Obesity
• Overweight a risk factor for cancers of endometrium, colon, esophagus, kidney,& breast(post-menopausal) – high proportion overweight
(71% of breast/prostate survivors)
• Overweight at dx poor prognostic indicator for cancer overall & cervical, esophageal, gastric, colorectal, uterine, pancreatic, hepatic, prostatic, biliary, renal, & breast cancers, & multiple myeloma & non-
Hodgkin’s lymphoma
• Weight gain common during & after treatment – linked with co-morbidity, functional decline & maybe recurrent/progressive CA

Weight Change After Diagnosis & Association with
Recurrence & Mortality
Data from Cohort of 5204 Breast Cancer Survivors in Nurse’s Health Study recurrence breast cancer mortality all cause mortality
>0.5 loss maintain 0.5-2.0
gain
>2.0 gain
Change in BMI
0
0.8
0.6
0.4
0.2
1.8
1.6
1.4
1.2
1
Kroenke et al. JCO 23: 1370-8, 2005

• Balance caloric intake with physical activity
• Lose weight if currently overweight or obese

How are we doing???
On any given day in the United States...
815 billion calories are consumed (200 billion more than needed)
47 million hot dogs
4 million pounds of bacon
60 million pounds of red meat
170 million eggs

On any given day in the United States...
3 million gallons of ice cream
10 million pounds of candy
16 million gallons of beer and ale
1.5 million gallons of hard liquor
(enough to make 26 million people drunk!)

Bagel
1980 vs. 2000
210 Calorie
Difference
140 Calories
3” diam.
350 Calories
6” diam.
French Fries
1980 vs. 2000
400 Calorie
Difference
210 Calories
2.4 oz.
http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm
and http://hin.nhlbi.nih.gov/oei_ss/menu.htm#sl2
610 Calories
6.9 oz.

…6 potato chips or
3 cups of popcorn

To date there are limited data showing a benefit of a healthful diet on cancer-related survival, however data show that cancer survivors who eat a plant-based diet have lower death rates from other diseases
Compared with those who eat a Western diet
Kroenke et al JCO 23:9295-303, 2005

Choose whole grains in preference to processed (refined) grains and sugars.
Include grain products such as breads, cereals rice, pasta, or beans in every meal.
Eat other foods from plant sources several times each day.
Limit consumption of refined carbohydrates, including pastries, sweetened cereals, soft drinks, and sugars.

Eat AT LEAST 5 or more servings of vegetables and fruits each day
Include vegetables or fruits in every meal and for snacks.
Limit french fries, snack chips, and other fried vegetable products.
Choose 100% juice if you drink fruit or vegetable juices.

Alcohol among Cancer Survivor
Alcohol linked to cancers of the kidney, head & neck and breast.
Head & neck survivors who continue to drink have more complications, higher recurrence, other diseases and death
Alcohol protects against heart disease, so survivors need to weigh risks. If do drink alcohol, do so in moderation (ACS)

Miracle
60-89% of survivors take supplements
40-50% begin additional supplements after diagnosis
• No supplements have proven benefit on cancer-related outcomes, though some may reduce anxiety, etc.
• Refer to responsible sources of information, i.e., National Center for
Complementary & Alternative Medicine
( http://nccam.nih.gov
)
• Rely on food as a source of nutrients

• Achieve/maintain a healthful weight
• Consume a plant-based, nutrient-dense diet
• Moderate alcohol intake
• Seek local, regional or national programs that can provide support (i.e., ACS, NCCAM, clinical trials, hospital-based or community initiatives.

Reach Out to ENhancE Wellness in Older Survivors
(R01 CA106919)
• Test the impact of a diet-exercise mailed material/telephone counseling program on weight loss & physical functioning in 640 prostate, colorectal & breast cancer survivors
• 65+ years of age
• 5+ years out from diagnosis
• No progressive disease