Many of my new patient visits end with a summary of what we, the healthcare team, are going to do for them and a discussion about next steps (e.g., when to get labs, the process and timing for starting treatment, and follow up). At the end of the conversation, some patients will ask, “What can I be doing for myself at home?” I was not totally prepared for the question the first time I was asked, but now, patients and caregivers often inquire about what else can be done. Beyond appointments and medical interventions, what advice can we offer to empower our patients to play a role in their own care? The following are 4 suggestions that I make to some of my patients. Of course, this will not apply to everyone, but for some, it might be helpful:
Pay Attention to Your Diet
For men starting androgen-deprivation therapy (ADT), calcium and vitamin D are important for long-term bone health. The National Comprehensive Cancer Network® guideline1 includes recommendations from the National Osteoporosis Foundation that recommend patients consume 1000 to 1200 mg of calcium and 400 to 1000 IU of vitamin D per day. Although some patients may be absorbing sufficient levels of these nutrients through diet alone, others may require supplements to reach these levels. In terms of dietary patterns to follow, I generally recommend “heart-healthy” diets-those that are primarily based on plants and whole foods, and low in saturated fats and processed meats.2,3 While there are some data to support the role of these diets for improved cancer outcomes, they have documented benefits for noncancer outcomes such as diabetes and cardiovascular disease (CVD). There are ongoing clinical trials of plant-based diet and ketogenic diets in prostate cancer which will add to the recommendations for diets in the future.
Try to Stay Physically Active
Physical activity can reduce or minimize some of the side effects of ADT, and it is generally safe even in men who have bone metastases from prostate cancer. Specific exercise programs can and should be tailored to each individual; a referral to a physician with a specialty in cancer rehabilitation is a good idea if one is available. The target is approximately 2.5 to 5 hours per week of at least moderate-intensity exercise that includes combinations of strength training and aerobic activity. Additionally, there are many trials recruiting participants to explore different types of physical activity to help develop an exercise prescription for men with prostate cancer.
Monitor Your Weight
Estimates are that 70% of men starting ADT gain weight from therapy. This can be associated with worsening of CVD risk factors. Additionally, obesity is linked to worse clinical outcomes in some men with advanced prostate cancer. For these reasons, I encourage men to maintain a healthy weight through the lifestyle interventions described above. At Johns Hopkins University School of Medicine, we have a “Healthful Eating, Activity and Weight Program” that provides multidisciplinary services to patients to help with weight management and is a place I refer patients to as well.
Continue to See Your Other Doctors
Healthcare is becoming increasingly complex, and while in some situations the oncologist is the only physician a patient needs to see, if they are regularly seeing their primary care provider, or specialists like cardiologists, I encourage them to continue. I will write short summaries for the patient to take back to his other doctors and ensure my clinical notes get back to the other providers in the care team as well, so the primary provider knows what is happening with the cancer care and therapies started or stopped for cancer treatment.
Do you have ideas to add to this list? Are there other things you advise your patients to do between visits? Reach out and let me know what you think: @cathyhand
- National Comprehensive Cancer Network®. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®: Prostate Cancer. Version 4.2022. Accessed July 24, 2022. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf
- Shah UA, Iyengar NM. Plant-based and ketogenic diets as diverging paths to address cancer: a review. JAMA Oncol. 2022. [Online ahead of print.] doi: 10.1001/jamaoncol.2022.1769.
- 3. Gupta N, Patel HD, Taylor J, et al. Systematic review of the impact of a plant-based diet on prostate cancer incidence and outcomes. Prostate Cancer Prostatic Dis. 2022. doi: 10.1038/s41391-022-00553-2 https://www.nature.com/articles/s41391-022-00553-2