Diet and Exercise Can Play an Important Role in Breast Cancer Survivors

A diet that is high in vegetables, fruits, whole grains and legumes is crucial for patients with breast cancer, according to Dr. Amy Comander.

Comander, director of breast oncology and survivorship at Mass General Cancer Center in Waltham and Newton, Massachusetts, also noted that combining nutrition with 150 minutes of moderate- or 75 minutes of rigorous aerobic exercise per week can play a major role in improving survival at CURE®’s Educated Patient® Breast Cancer Summit.

READ MORE: Early Evidence Shows Fasting, Keto Diet May Make Chemo and Some Other Cancer Treatments More Effective and Easier to Tolerate

After her presentation, Comander spoke with CURE® to go into more detail about nutrition, why patients should research supplements with their physician and how to implement physical activity during the pandemic.

CURE®: What do you suggest to patients who are getting used to a healthy eating routine?

Comander: We have so many amazing guidelines from the American Cancer Society, American Society of Clinical Oncology and other resources that I can give that to my patients, but actually helping our patients make those behavioral changes to adopt these healthier habits is a big challenge. I'm very fortunate to have a team of wonderful nutritionists at both of the cancer centers where I see patients, so that's a great first step: referring my patients to a nutritionist for that individualized counseling.

In terms of specific strategies, as you saw in my talk, I showed the image of the Harvard Healthy Eating Plate from the Harvard School of Public Health, and I feel like that's such a great way to teach about nutrition. Basically, you see a plate and what should be on (it). Fruits and vegetables (should be) half of the plate — not French fries or potatoes — but green vegetables, red peppers, squash, broccoli … the more colors the better. And then a quarter of the plate really should be whole grains. We're talking brown rice, whole wheat pasta, quinoa as opposed to white rice and other processed grains. (The other) quarter of the plate should reflect some type of protein source. I certainly counsel my patients about the importance of limiting red meat; we know that that's very important for prevention of certain cancers and in cancer survivorship.

Do you ever recommend vegan or vegetarian diets?

This is a really interesting area of research; we have a lot of data actually looking at a predominantly plant-based diet as regard to cardiovascular disease, type two diabetes and other chronic conditions. I think we're just now hopefully going to get farther in this field when it comes to cancer prevention and cancer survivorship. But I certainly counsel my patients on the importance of a plant-predominant diet. I don't tell people they need to be vegan or vegetarian, but certainly, red meat, chicken, poultry … those things really should be thought of as almost like a condiment and not the main part of the meal.

What is your advice for keeping a healthy mindset during treatment?

I really liked the concept of self-compassion, especially for my patients going through cancer treatment, who may be experiencing weight gain and many challenges. I remind them what they've been through, what their body is going through and to be kind to themselves and recognize that the middle of chemotherapy may not be the time that you're going to focus on the healthiest diet ever.

But (when patients ask), “What can I do to kind of get back to my healthy body weight?”, which is an important goal for our patients, I do really try to think of strategies to help them get there. And again, this approach is mindful eating. One comment I've heard from one of my cardiology colleagues that I really like is, every time you eat something, it really is an opportunity to provide fuel and nutrition for your body. So be mindful of what you're putting in your mouth.

How should patients navigate supplements during treatment?

We know from surveys of individuals going through cancer treatment or in survivorship that many of our patients are using some form of dietary supplement. And I think what's important to note is a lot of these supplements, they're not necessarily regulated by the FDA (Food and Drug Administration); what the bottle says on it may not actually be what's in there. And unfortunately, many of the components can potentially interact in a negative way with our treatments. That was demonstrated in a study looking at a population of breast cancer patients going through chemo and assessing supplement use. Unfortunately, it found that those who were using the supplements had a worse outcome. So, I think my message to my patients, as always, is if there's a supplement you really want to take, please bring it into your visit. Let's go over it together, let's research it together and figure out if there's truly an indication. There certainly are situations where a supplement is advised. For example, vitamin D is so important for our calcium metabolism and bone health. And many of our women do need to take vitamin D. But there are other supplements that, unfortunately, are not as beneficial and potentially could be harmful

READ MORE: Herb and Supplement Use During Cancer Treatment May Cause Drug Interactions That Could Be Harmful for Patients

How important is physical activity for patients with breast cancer or those in survivorship?

Exercise has been shown to have so many benefits for all of us, but in particular for breast cancer survivors. There is data that exercise improves cancer-related fatigue, physical functioning, quality of life, and lowers depression and anxiety. It can augment our immune system, and actually can lower risk of breast cancer recurrence and improve overall outcome.

I share this data with my patients, but then, how do you enact that behavioral change? So that is tricky, especially during the pandemic when trying (because) you can't just go to the gym and work with a trainer. There are lots of ways to help engage our patients with maybe virtual offerings with a trainer or online yoga classes. There's really a lot we can do right now, or there's a lot they can do just at home with maybe using one of those stretchy bands or some hand weights. It's baby steps one day at a time. Just getting outside to walk 10 minutes, five times a week as a start, and then gradually working up to that recommended 150 minutes a week of moderate aerobic exercise. So it’s certainly a work in progress, and you just have to kind of meet the patient where she's at and help work with (her) each step of the way.

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