Nutritional Factors during and after Cancer: Impacts on Survival and Quality of Life.

The French National Cancer Institute conducted a collective expertise study with researchers and clinical experts from the French Network for Nutrition And Cancer Research (NACRe Network). The objective was to update the state of knowledge on the impacts of nutritional factors on clinical endpoints during or after cancer. Data from 150 meta-analyses, pooled analyses or intervention trials and 93 cohort studies were examined; they concerned 8 nutritional factors, 6 clinical events and 20 cancer locations. This report shows that some nutritional factors have impacts on mortality and on the risks of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional conditions can be encountered for certain cancer sites: from the diagnosis and throughout the health care pathways, weight loss (lung and esophageal cancers), malnutrition (lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (colorectal, breast and kidney cancers) and alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, and even support or management by health care professionals, in the context of tertiary prevention. This report also highlights some limitations regarding the existing literature and some needs for future research.

[During and after cancer: identification of high-risk nutritional situations]. / Pendant et après un cancer : repérer les situations nutritionnelles à risque.

"During and after cancer: identification of high-risk nutritional situations At the end of 2020, the French National Cancer Institute published a report presenting the state of knowledge on the impact of nutritional factors on clinical endpoints during or after cancer. This report is the result of a collective expertise by an expert group from the French Network for Nutrition And Cancer Research (NACRe Network, www.inrae.fr/nacre). This report shows that some nutritional factors have an impact on the mortality, and the risk of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional situations can be encountered for certain cancer sites: from the diagnosis and throughout the healthcare circuit, weight loss (for lung and esophageal cancers), malnutrition (for lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (for colorectal, breast and kidney cancers), or alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, or even support or management by healthcare professionals, in the context of tertiary prevention."

Pendant et après un cancer : repérer les situations nutritionnelles à risque Fin 2020, l'Institut national du cancer a publié un rapport présentant l'état actuel des connaissances sur l'impact des facteurs nutritionnels sur des événements cliniques pendant et après un cancer. Ce rapport est issu d'une d'expertise collective ayant fait appel à des experts du Réseau national alimentation cancer recherche (Réseau NACRe, www.inrae.fr/nacre). Le rapport montre que certains facteurs nutritionnels ont un impact sur la mortalité, le risque de récidive et de second cancer primitif chez les patients atteints de cancer. Ainsi, des situations nutritionnelles à risque pourraient être rencontrées pour certaines localisations du cancer  : dès le diagnostic et tout au long du parcours de soins, il convient d'être vigilant face à une éventuelle perte de poids (cancers du poumon et de l'oesophage), la dénutrition (cancers du poumon, de l'oesophage, du côlon et du rectum, du pancréas, de l'estomac et du foie), une prise de poids (cancers colorectal, du sein et du rein) ou la consommation d'alcool (cancers des voies aérodigestives supérieures)   ; et, après les traitements, à un excès de poids (cancers colorectal, du sein et du rein). Ces situations nécessitent des évaluations nutritionnelles, voire un accompagnement ou une prise en charge par des professionnels de santé, dans le cadre de la prévention tertiaire.

[Impact of nutritional factors during and after cancer]. / Impact des facteurs nutritionnels pendant et après cancer.

Nutritional factors (diet, weight, alcohol, physical activity) are identified as factors having an impact on the onset of several cancer sites. Less abundant scientific data also underline their impact on the tumor progression. A review of the scientific literature was carried out by a group of experts established by the French National Cancer Institute (INCa) to better document the influence of nutritional factors during and after cancer on outcomes such as overall mortality, cancer specific mortality, recurrence, second primary cancers and quality of life. This analysis of the literature completes messages of reduction of alcohol consumption, prevention of undernutrition or excess weight and adherence to dietary recommendations, avoiding the use of dietary supplements, fasting or restrictive diets and strengthens messages promoting the practice of physical activity and the fight against sedentary lifestyle.

[Benefits of physical activity for cancer patients]. / Bénéfices de l'activité physique pour les patients atteints de cancer.

The prescription of physical activity for patients living with a long-term condition has been enshrined in legislation since 2016. The French National Cancer Institute published a literature review on the expected effects of physical activity in patients living with cancer. The benefits are prevention or correction of physical deconditioning, a preservation and/or a normalization of body composition, a reduction of cancerrelated fatigue, an overall quality-of-life improvement, the improvement of treatments tolerance and their medium and long-term effects, an increased life expectancy and a lower risk of cancer recurrence. These effects can be observed for a mixed physical activity program -cardio respiratory fitness and muscular strength-, with moderate to vigorous intensity activity, 30 minutes a day at least 5 days a week. The benefits are all the more important as physical activity starts early. Health professionals have an important part to play in helping patients engage in physical activity, with a regular even moderate practice which is always beneficial as compared with sedentary behaviors.

BÉNÉFICES DE L'ACTIVITÉ PHYSIQUE POUR LES PATIENTS ATTEINTS DE CANCER La prescription d'une activité physique adaptée pour les patients atteints d'une affection longue durée est inscrite dans la loi depuis 2016. L'Institut national du cancer a publié une synthèse de la littérature sur les effets à attendre de l'activité physique pour les patients atteints de cancer. Les bénéfices sont la prévention ou la correction d'un déconditionnement physique, un maintien et/ou une normalisation de la composition corporelle, une réduction de la fatigue liée aux cancers, une amélioration globale de la qualité de vie, une amélioration de la tolérance des traitements et de leurs effets à moyen et long terme, un allongement de l'espérance de vie et une réduction du risque de récidive. Ces effets sont observés pour une pratique d'activité physique mixte -cardiorespiratoires et renforcement musculaire-, comportant des exercices d'intensité modérée à élevée, 30 minutes par jour au moins 5 jours par semaine. Les bénéfices sont d'autant plus importants que l'activité physique est débutée précocement. Les professionnels de santé ont un rôle important à jouer dans l'engagement des patients dans la mise en pratique de l'activité physique, sans programmation trop rigide, avec une pratique régulière même de faible niveau constituant toujours un acquis par rapport à l'état sédentaire.

[Cancer prevention in France: Implication of health professionals]. / Prévention des cancers en France : quel rôle pour les professionnels de santé ?

Almost 40% of cancers are attributable to preventable cancer risk factors related to behavior. Health professionals must take into account the respective weight of the different causes of cancer to enforce effective cancer prevention. Their involvement is needed on several levels. In primary prevention, not only for vaccinations, detection and support the withdrawal of addiction, but also by a greater consideration in their patients of all cancer risk behavioral factors. This involvement is essential in the care and monitoring of patients with cancer. Thus, enhancing patient compliance with cancer prevention tips (stopping smoking, reducing alcohol consumption, practice physical activity, physical inactivity reduction, reduction of overweight, adopting a diversified and balanced diet) appears as a new challenge of personalized care in oncology that not only aims to reduce the incidence of cancer but also to reduce the risks of morbidity and long-term mortality.

Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: A review of the evidence.

PURPOSE: Prevention is a priority in the fight against cancers, especially nutritional prevention. To update the levels of evidence of relationships between 10 nutritional factors and cancer risk, the scientific literature published from 2006 to 2014 was reviewed by an expert group. METHODS: Data from 133 meta-analyses, pooled analyses or intervention trials were examined. Nearly 150 relationships between nutritional factors and cancer at various sites were evaluated. RESULTS: According to the evidence graded as convincing or probable, these factors were divided in two groups. Factors which increase the risk of cancer are alcoholic beverages, overweight and obesity, red meat and processed meat, salt and salted foods and beta-carotene supplements. Factors which decrease the risk of cancer are physical activity, fruits and vegetables, dietary fiber, dairy products and breastfeeding. CONCLUSION: Three main nutritional objectives should be attained to improve cancer prevention: to reduce alcoholic beverages consumption, to have a balanced and diversified diet and to be physically active.