Cancer.Net Q&A Forum, September 1-30, 2006:
"Taking Care of Yourself During and After Cancer Treatment" with
David Alberts, MD, Arizona Cancer Center and Cyndi Thomson, PhD, RD, Arizona Cancer Center

Cancer.Net Q&A forums are month-long events on a specific topic. During the month, guests may submit questions to leading cancer experts by emailing them to contactus@cancer.net . Each week, answers are posted on Cancer.Net (www.cancer.net). Cancer.Net Q&A forums are free of charge, anonymous, and preregistration is not required.

Please keep in mind that Drs. Alberts and Thomson are unable to give individual medical advice in this setting, nor are they able to address questions that include information specific to one person's medical profile. The information presented here is for informational and educational purposes only and is not intended to substitute the professional medical advice or treatment recommendations provided by your doctor.

This forum is neither intended nor appropriate to serve as a means of obtaining a second opinion on cancer diagnosis or treatment. In response to questions about specific drugs, comments will focus only on the state of current research and clinical trials. It is advised that you do not delay seeking professional medical advice based on any information contained in this Q&A forum.

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David S. Alberts, MD, is the Director of the Arizona Cancer Center and Regents Professor of Medicine, Pharmacology, Nutritional Sciences, and Public Health at the University of Arizona's College of Medicine.

He is a pioneer of translational cancer prevention research, advancing cancer prevention from the earliest preclinical and clinical stages of drug development to definitive randomized controlled trials. Dr. Alberts has authored or co-authored more than 450 peer-reviewed publications and more than 140 book chapters and invited articles. He has served on the editorial boards of several peer-reviewed scientific journals, and he is currently co-editor-in-chief of Cancer Epidemiology, Biomarkers & Prevention. During his career, Dr. Alberts has been an advisor to numerous cancer prevention foundations and committees and is a member of the National Cancer Institute's Board of Scientific Advisors.

Dr. Alberts continues to coordinate studies for molecularly targeted nutrient and chemical chemopreventive agents. His laboratory research is concentrated on the in vitro screening of new chemicals and nutrients for cancer prevention and treatment activity, as well as the evaluation of new surrogate endpoint biomarkers for cancer prevention trials.

Cyndi Thomson, PhD, RD, is an Assistant Professor at the College of Medicine at the University of Arizona, and a member of the Cancer Prevention & Control Steering Committee at the Arizona Cancer Center. Dr. Thomson is a Registered Dietitian (RD) with more than 20 years of experience in clinical nutrition.

She is principal investigator on several diet-cancer grants, including the Susan G. Komen Green Tea Study, the Atkins Research Foundation weight loss intervention study among breast cancer survivors, and the Cancer Prevention and Control Career Development Award. She is the Arizona principle investigator for the multi-center Women's Healthy Eating and Living Study and the Women's Health Initiative Study.

Her current research includes possible dietary influences on breast and ovarian cancers and improving self-reported dietary measures in research.

Question 1: I start chemotherapy next month for breast cancer. Is there anything I can do now, or foods I can eat, to help my body prepare for these drugs?

Drs. Alberts and Thomson: Depending on the drugs used in treatment, your side effects can vary. We do know that it is important to eat healthy and try to not gain weight during treatment. Therefore, you ought to select lower fat foods, such as more vegetables, fruit, and lean protein sources, such as lowfat/nonfat dairy or lean chicken/turkey and fish. It is important to get adequate protein in your diet to promote healing after surgery and keep your immune system strong throughout treatment.

Question 2: My mother-in-law received multiple courses of radiation to treat oral cancer, and she's been having problems with a sore throat, thick saliva, and occasionally, problems swallowing. Eating has been understandably difficult. Do you have any recommendations to get her the nutrition she needs?

Drs. Alberts and Thomson: This can certainly be challenging. Try fruit/vegetable smoothies – sometimes colder or hotter foods go down better; try each to see what works best. It is important that every swallow counts, in terms of being nutrient-dense. Thus, select foods that are high in protein and other nutrients, rather than coffee, sodas, and similar things. She can also try the concentrated beverage drinks, such as Ensure, Boost, and ProSure, that are rich in nutrients and sometimes ease the strain of selecting meals. There are other ideas on the Arizona Cancer Center website, and the American Cancer Society has an excellent book entitled "Eating well, Staying well" that you may want to review.

If the swallowing difficulty persists, your mother-in-law ought to undergo an upper gastrointestinal (GI) endoscopy and widening of her esophagus. Additionally, she should ask her radiation oncologist about using pilocarpine hydrochloride (Salagen) tablets, which can increase saliva formation. The usual dose is one five-milligram tablet three times daily, up to two tablets three times daily.

Question 3: My husband is receiving chemotherapy for myeloma, and his blood counts are still really low. Are there any foods he should avoid? Are there vitamins or nutritional supplements he can take to increase the counts?

Drs. Alberts and Thomson:  Your husband should continue to eat a healthy diet with a high protein content. He can take one tablet of a high-potency multiple vitamin, but not megavitamins.

Question 4: I've been reading that exercise can help reduce fatigue, but what if you are too tired to exercise? I'm receiving adjuvant chemotherapy for stage IIb colorectal cancer.

Drs. Alberts and Thomson: Start slow but get started! For instance, take short walks (such as a quarter of a block at a time, increasing by a quarter of a block each day), get a pedometer and try to increase your number of steps slowly (up to 4,000-5,000 steps per day), lift light weights during TV watching, stand more instead of sitting, swing on a backyard swing, and/or do light yard work or gardening -- any activity that you enjoy and can build on. Don't feel you need to start with a 60-minute cardiovascular workout in the gym. Also, a little caffeine -- such as coffee or better yet, green tea -- may give you a little more energy to get you going.

Question 5: How long should one wait after surgery to exercise? I had a hysterectomy about three weeks ago.

Drs. Alberts and Thomson: Get active right away even if it's light activity, as long as you don't lift too much weight or strain yourself too much. More frequent, smaller "doses" of activity may work best. We recommend that people get up and move even on the day of their surgery! Walking is the key activity. Increase the distance each day and try to walk at least two times daily, even around the house.

Question 1: I am about to finish treatment for kidney cancer. Should I follow a special diet after my treatment? I ate whatever I wanted before my diagnosis - can I just go back to doing that now?

Drs. Alberts and Thomson: This really depends on your particular circumstance. Many people lose weight unintentionally during treatment for kidney cancer. Carrying less weight is a good thing generally, but not at the expense of poor nutrition. Focus on higher protein foods, such as lowfat/nonfat dairy, lean chicken/fish, and beans (as tolerated), to promote healing and a strong immune system. If you can, locate a dietitian near you that works with cancer patients, and spend an hour growing in your understanding of your unique nutritional needs.

Question 2: Both my father and uncle have had prostate cancer. Does lycopene really help prevent prostate cancer? I am considering adding it to my supplements.

Drs. Alberts and Thomson: There is some evidence that lycopene is somewhat protective against prostate cancer. Being active and keeping a healthy body weight are also important. A lowfat diet that contains a lot of vegetables and fruit is not only healthy, but will help you keep your weight down and could prove protective. We strongly suggest you get lycopene from foods rather than supplements, as foods rich in lycopene are what appears to be protective. This includes tomatoes and tomato products (tomato paste, ketchup, spaghetti sauce, etc.). Other foods rich in lycopene include guava and watermelon. Eating lycopene-containing foods during meals that also have some source of fat (such as olive oil) will promote absorption.

Question 3: I am taking tamoxifen after breast cancer, but I have bad hot flashes. Is there anything you can recommend that might provide relief?

Drs. Alberts and Thomson: This is a decision you need to make with your oncologist. While soy products and some botanical (herb) supplements have been used by some women, there remains concern that these foods/supplements may be problematic for women who have been diagnosed with breast cancer. Talk to your physician. Increasing your physical activity through brisk walking twice daily and light weight lifting may be of some help.

Question 4: After breast cancer treatment caused premature menopause, I was advised by my nurse practitioner to guard my bone health. I recently read online something about soda harming bones because of the phosphorus. Is that true?

Drs. Alberts and Thomson: There is mixed evidence on this, but why drink soda anyway? Soda is nutrient-poor and replaces other, healthier beverage choices, such as vegetable and fruit juice, water, or even tea. In order to improve your bone health, be sure to get adequate calcium in your diet – through lowfat/nonfat dairy products, fish with bones, and dark green leafy vegetables – as well as taking a calcium supplement with added vitamin D. If you get constipated by calcium supplements, try taking one that has added magnesium as well.

Question 5: I have severe nausea and vomiting episodes after chemotherapy for lung cancer. I take medication for that, but it causes constipation. Are there dietary approaches to try to solve this?

Drs. Alberts and Thomson: First, talk with your doctor to see if there are alternative medications. Second, drink fluids such as water or more importantly (given you may be losing weight with the vomiting) prune juice, which is calorie-rich. Fiber can also help (high-fiber cereals, nuts/seeds, etc.) but you will still need to drink a lot of fluids. Keep something to drink with you at all times and sip all day!

Question 1: I just learned that my breast cancer treatment puts me at risk for lymphedema (arm swelling). Are there certain types of exercises or activities I should avoid?

Drs. Alberts and Thomson: This is a challenge, as we don't know much about why certain women get lymphedema and not others, and why it can occur even years after treatment. Most clinicians agree that women should avoid having their blood pressure checked or blood drawn from the arm where the lymph nodes were resected to stage their cancer. One risk factor that has been identified is obesity – so staying active and eating healthy so as to achieve and maintain a healthy weight is an important step you can take now. There is VERY preliminary evidence that compounds found in citrus may help because they reduce inflammation and promote a healthy circulatory system, so increasing citrus intake may be worth your while as well. Ask your doctor to refer you to a lymphedema specialist for a thorough discussion of what you can do now to reduce your risks. The National Lymphedema Network website is www.lymphnet.org.

Question 2:  I received a forwarded email, warning people that drinking cold water after eating causes cancer. According to the message, "cold water will solidify oily content in the food and this solidified content of fat will line the intestines and ultimately lead to cancer." Is this true, or is it an email urban myth?

Drs. Alberts and Thomson: There is no evidence of this at all!

Question 3: My doctor is giving me an option on whether I want an arm port or a chest port implanted for my chemotherapy. Is one better than the other in terms of being active? I would like to exercise during treatment if possible.

Drs. Alberts and Thomson:  We would recommend a chest port for an extremely active person.

Question 4: I get extremely anxious at times and often have problems sleeping at night. That makes me feel even worse the next day. My oncologist has offered a sleep aid medication, but I'm hoping you have other suggestions to help me combat my insomnia?

Drs. Alberts and Thomson: Increasing your physical activity may be of real help to you. We recommend walking at least 30 to 60 minutes twice daily. Adding light weight lifting could also help reduce your anxiety and improve sleep patterns. But, be sure to follow your doctor's instructions.