The following recommendations are from the latest lifestyle guidelines for Chinese breast cancer patients developed by the Breast Group of the Women’s Health Branch of the Chinese Society for Preventive Medicine, and are for reference only.
A growing body of evidence-based medical evidence suggests that the lifestyle of breast cancer patients affects prognosis. Personal lifestyle factors such as dietary and nutritional status, weight change, physical activity status, and smoking and alcohol consumption after diagnosis and treatment of breast cancer patients are associated with metastatic recurrence of tumor, disease-free survival, and morbidity and mortality.
After achieving long-term survival, breast cancer patients need not only long-term medical care and rehabilitation services, but also guidance on daily living to develop and adhere to a healthy lifestyle that improves treatment outcomes and quality of life.
For this reason, the Breast Group of the Women’s Health Branch of the Chinese Society for Preventive Medicine organized experts to develop a lifestyle guideline for Chinese breast cancer patients, taking into account the characteristics of Chinese breast cancer patients, to provide recommendations and suggestions for daily life regarding disease-free survival and long-term survival of breast cancer patients during stable disease.
This article excerpts the recommendations of the guidelines in order to provide guidance for breast cancer patients and their families on how to live.
Attaining and maintaining a healthy weight
Patients with breast cancer should try to achieve a normal weight range of a body mass index (BMI) of 18.5 to 23.9 kg/m (calculated as weight/height in kg for weight and m for height) after the end of treatment, or a normal weight standard according to the Chinese Guidelines for the Prevention and Control of Overweight and Obesity in Adults.
For breast cancer patients who are already overweight and obese, lowering dietary energy intake and receiving individualized exercise weight reduction instructions are recommended.
For patients who are malnourished or underweight after aggressive anticancer therapy, further weight loss can reduce quality of life, interfere with treatment delivery, slow recovery, or increase the risk of complications, and must be evaluated by a specialist physician and dietitian to develop and implement a nutrition improvement plan.
Some physical activity is recommended for such patients to help improve physical function and gain weight, but high-intensity strenuous exercise should be avoided.
Regular physical activity
After the end of a phase of antineoplastic therapy, consult a specialist for advice on physical activity and physical exercise, including when to start, how hard to exercise, and how to exercise. Consult a specialist physician or professional sports instructor every 3 to 6 months to assess current physical activity and sport status and obtain recommendations for improvement.
Patients with breast cancer should avoid a sedentary lifestyle and return to their pre-diagnosis physical activity routine as soon as possible after diagnosis.
Adults aged 18 to 64 years with breast cancer should maintain at least 150 minutes of moderate-intensity exercise (roughly 30 minutes five times per week) or 75 minutes of vigorous aerobic exercise, and strength training (large muscle group resistance) at least twice per week. Exercise in 10-minute increments, preferably every day.
Elderly breast cancer patients >65 years of age should try to exercise as much as possible according to these recommendations, but if they have a chronic disease that limits their mobility, adjust the duration and intensity of exercise as directed by their physician, but avoid prolonged periods of inactivity.
Rational nutrition and diet
Adjust the structure of your diet to be rich in vegetables and fruits, whole grains, and high-quality protein. Rationalize your diet according to the Dietary Guidelines for Chinese Residents 2016.
A considerable number of studies have focused on the relationship between dietary nutrition and tumor-related survival in breast cancer patients. The results suggest that dietary structure and food choices are indeed associated with disease progression, risk of recurrence, and overall survival in breast cancer patients.
A dietary structure rich in vegetables and fruits, whole grains, poultry, and fish is associated with a 43% reduction in mortality in breast cancer patients compared to a diet rich in refined grains, red and processed meats, desserts, high-fat dairy products, and fried potatoes.
Food intake was synergistic with lifestyle, with breast cancer patients who consumed 5 servings of fruits and vegetables per day (each equivalent to 150g) and walked 30 minutes or more 6 days per week having the highest survival rates, while none of these alone had a significant effect on improving survival.
Use health supplements with caution
Patients with breast cancer should try to get as many essential nutrients as possible from their diet; nutrient supplements should be considered only when clinical manifestations or biochemical indicators suggest a nutrient deficiency; they may be considered when they are unable to get enough nutrients from food and are consuming only 2/3 of the recommended amount; such diagnoses should be made by a dietitian.
Smoking and alcohol cessation
Patients with breast cancer who smoke at the time of diagnosis have a 2-fold higher risk of death from breast cancer and a 4-fold higher risk of death from non-breast cancer than nonsmokers. The risk of dying from breast cancer in smokers was also related to the intensity and duration of smoking.
Some studies have shown a weak association between passive smoking and breast cancer death and all-cause death in women, and passive smoking puts postmenopausal or obese breast cancer patients at higher risk of poor prognosis. Therefore, it is recommended that breast cancer patients should try to avoid smoking and passive smoking and that breast cancer patients who smoke should quit smoking early.
The available evidence has confirmed an association between ethanol intake and a number of cancers, including breast cancer. Patients who have been diagnosed with cancer have an increased risk of developing a second primary cancer.
Ethanol has the ability to increase peripheral blood estrogen concentrations, which theoretically increases the risk of breast cancer recurrence. Therefore, breast cancer patients should avoid ethanol intake as much as possible.