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Do Cancer Doctors Focus on Lifestyle Risks?

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Cancer specialists only rarely advise patients on lifestyle changes that could improve overall health and possibly also reduce the risk of recurrence, a new survey suggests.

The survey of doctors from a Midwestern health system found that oncologists were far less likely than primary care physicians to offer advice on health promotion strategies, such as weight loss and smoking cessation, researchers reported in the journal Cancer.

With oncologists reticent to offer advice on lifestyle changes, the onus may fall upon patients to bring the topic up and to find ways on their own to address changes, said study coauthor Bonnie Spring, a professor of preventive medicine, psychiatry, psychology and public health and director of the Institute for Public Health and Medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Patients need to realize their lifestyle, their weight, their physical activity, their smoking all have a big influence on the likelihood their cancer will recur, Spring said.

“They also impact the likelihood you will develop heart disease,” she tells patients. “Very likely, the drugs you were given to address the cancer may have had a toxic effect on your heart. This is one of the things you can do to help control the risk.”

To investigate oncologist attitudes towards lifestyle counseling, Spring and her colleagues surveyed 91 Northwestern doctors, including 30 primary care physicians, 30 oncologists and 31 physicians in other specialties (urologists, gynecologists and dermatologists) who treat survivors of prostate cancer, breast cancer and melanoma.

Ninety percent of primary care physicians said they recommend lifestyle changes such as weight loss and smoking cessation to at least some cancer survivors. That was true for just 26.7% of oncologists and 9.7% of specialists.

The researchers conducted in-depth interviews with 12 of the oncologists, who cited a number of concerns that drove their decision not to offer lifestyle counseling. Chief among them: they feared patients wouldn’t be able to make lifestyle changes and continue to take their medications properly.

Many believed that cancer control was their primary concern. One stated “We’re so focused on the life-or-death aspect of cancer, everything (else) falls through the cracks.”

Some weren’t convinced by studies showing that lifestyle factors could impact cancer risk. One said “You know, I don’t even know what the impact is . . . I’m skeptical sometimes about some of the data. For many of us, the interpretation of lifestyle data is more nebulous and oftentimes difficult or perceived as very difficult to adhere to the recommendation.”

When oncologists did address lifestyle factors, it was usually because the patient brought the subject up.

While the new study reports on data gathered at one institution, Spring believes similar results would be found across the nation. “I think it’s widespread,” she said.

The new findings are “intriguing,” said Dr. Charles L. Shapiro, director of the Survivorship Program at the Tisch Cancer Institute at Mount Sinai in New York City. “But it’s a very small study. I’d like to see a nationwide study.”

As for the idea that patients won’t take their medications if they are also trying to make lifestyle changes, Shapiro said, “that doesn’t jive with my own experience. My group is well versed in these kinds of things that patients can do for themselves and how successful they are.”

The new study covers “an important topic,” said Elizabeth A. Platz, a professor at the Johns Hopkins School of Public Health and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Maryland.

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Schedule3 Oct 2023