The needs of a cancer survivor who is fighting the disease and a cancer survivor that has been given the ‘all-clear’ are not the same.

If you are still undergoing treatment (chemotherapy, radiotherapy or surgery) it is important to support and fuel your body in order to better tolerate cancer treatments. For some, this may mean eating a nourishing diet, rich in energy and protein. If you are undergoing treatment and have recently lost weight without trying, or have any difficulties with your appetite, food intake, or if you have problems swallowing, please ask your doctor or dietitian about our other books: ‘Good nutrition for Cancer Recovery’ or ‘Eating well with swallowing difficulties in cancer’. Both of these books are professionally endorsed are available free of change from your local hospital or from us. They have both received Irish Healthcare Awards for best patient education initiatives.

For cancer survivors who do not have problems with weight loss or with their appetite or food intake, a healthy eating diet might be the most appropriate plan. If you have completed your cancer treatment and been told that you are in remission, it is best to eat a healthy diet, keep physically active and try to maintain a healthy body weight. The information in this book is for cancer survivors who have recovered from their disease and have been advised by their medical team to follow a healthy eating diet.

It is recommended that all patients diagnosed with cancer receive advice from a registered health care professional (preferably from a registered dietitian with experience in oncology, or to talk to their oncologist or cancer specialist nurse) on what diet best suits their diagnosis and personal needs.

The number of cancer survivors worldwide is increasing dramatically. In 2018, there were 18.1 million new cases of cancer diagnosed and 43.8 million people living with cancer within 5 years of diagnosis. It is estimated that the number of new cases of cancer diagnosed annually will increase to 23.6 million by 2030. Also, it is predicted that the number of cancer survivors will reach 70 million by 2050.

The rise in cancer survivorship can be attributed to two main things. Firstly, the rates of many cancers are increasing every year. People are living longer, which means there is a higher chance of cancer developing, and there has been an increase in lifestyle factors/behaviours that increase cancer risk. Secondly, people are surviving longer after a cancer diagnosis because of better screening, diagnosis and treatments for the disease. This means for some people diagnosed with the disease, depending on their diagnosis and cancer type, cancer becomes a chronic, ongoing illness that requires long-term management. As a result, in recent years research has started to look at the importance of a healthy lifestyle after cancer treatment.

Yes, there is scientific evidence that certain lifestyle factors can help to reduce the risk of developing a new cancer and the risk of a cancer coming back. Unfortunately no change can reduce your risk totally or guarantee a cancer-free life. There are people who do everything ‘right’ and still develop cancer. There are people who make all of the recommended changes after a cancer diagnosis and unfortunately their disease may still return despite this. However, there are things you can do to help you be as healthy as possible.

Research into the role of diet and lifestyle on cancer survivorship is in relatively early stages compared to research into cancer prevention. In short, there is no evidence to advise a diet different to that of cancer prevention as it is thought that the same mechanisms that promote cancer prevention also promote the prevention of recurrence.

There are thousands of websites, books, blogs, articles and experts giving advice on how to eat both during cancer treatment and afterwards. This makes it very difficult for cancer survivors to decide what is fact and what is fiction. The most reliable information from all of the scientific studies that have been performed are the expert reports published by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR). These reports are endorsed by the World Health Organisation (WHO) and many other international organisations. Panels of expert scientists review the scientific evidence from hundreds and thousands of scientific papers.

The latest cancer prevention recommendations come from the WCRFs latest Expert Report (2018) and from the conclusions of an independent panel of experts. The recommendations represent a ‘package’ of healthy lifestyle choices, which together, can make an enormous impact on people’s likelihood of developing cancer and other non-communicable diseases over their lifetimes. The WCRF recommends that:

• All cancer survivors to receive nutritional care from an appropriately trained professional*.
• If able to do so, and unless otherwise advised, aim to follow the recommendations for diet, healthy weight, and physical activity as listed below.

1. Be a healthy weight – keep your weight within the healthy range and avoid weight gain
2. Be physically active every day – walk more and sit less
3. Eat wholegrains, vegetables, fruit and beans – make these part of your usual diet
4. Limit ‘fast foods’ and other processed foods high in fat, starches or sugars
5. Limit red meat and eat little, if any, processed meat
6. Limit sugar sweetened drinks – drink mostly water and unsweetened drinks
7. Limit alcohol consumption – for cancer prevention, it’s best not to drink alcohol
8. Do not use supplements for cancer prevention – aim to meet needs through diet alone

While following each individual recommendation is expected to offer cancer protection, the most benefit is to be gained by treating them as a ‘package’ or way of life.

PERSONAL RECOMMENDATIONS

• All cancer survivors to receive nutritional care from an appropriately trained professional.
• Unless otherwise advised, and if they can, all cancer survivors are advised to follow the Cancer Prevention Guidelines. Our Recipe Book contains recipes which meet these guidelines.
• Recommendations as far as possible after the acute stage of treatment.

The term ‘cancer survivor’ describes anyone who has been given a diagnosis of cancer at any stage, including those who have recovered from the disease.

When it comes to taking responsibility for their health, cancer survivors are a motivated group. They tend to be very receptive to advice from their medical and surgical teams. So what should people living with cancer do? Are the circumstances of people who have recovered from cancer any different from those of people free from cancer? When it comes to family shopping and meal preparation, should the person with cancer be treated differently? Or should the whole family follow the same recommendations and advice?

Ultimately, research into how to prevent cancers recurring is in its early days. The World Cancer Research Fund (WCRF) has pledged that research into how best to improve the health of cancer survivors will take priority in the scientific work it funds into the future. For now, however, it has examined all available evidence to come up with the following recommendation:

If able to do so, and unless otherwise advised, cancer survivors should aim to follow the WCRF recommendations for diet, healthy weight, and physical activity.

The evidence shows that eating a mainly plant-based diet, staying at a healthy weight and keeping physically active will help lower the chances of cancers recurring. Following these recommendations will also improve the chances of longer-term survival after a cancer, particularly breast cancer.

It is also recommended that cancer survivors receive nutritional care from an appropriately qualified professional, like a registered dietitian. There is an abundance of information out there on diet for cancer survivors, and unfortunately it comes from many different sources and is often conflicting or incorrect. A healthcare professional who can evaluate the scientific evidence around a specific diet or dietary supplement, and then advise the cancer survivor based on their own unique medical situation, would be ideal.

SHOULD ALL CANCER SURVIVORS FOLLOW THESE RECOMMENDATIONS?

Not quite – there are exceptions. These recommendations do not apply to anybody going through cancer treatments at present. If you have recently been diagnosed with cancer, or are currently undergoing treatment for cancer, your nutritional needs are likely to be unique right now. In this case, it is more important to follow your doctor’s advice. You may be referred to the book ‘Good Nutrition for Cancer Recovery’, (which is a free resource available in your local hospital or from www.breakthroughcancerresearch.ie) which contains recipes with a higher protein and calorie content, suitable for most people with a new diagnosis of cancer.

If you are a cancer survivor whose treatments have affected your ability to eat or digest certain foods, then you may also have specific dietary requirements to consider. Patients who have undergone removal of part of the stomach (gastrectomy) or colon (colectomy), for example, may have particular digestive issues that call for a more specialised type of diet. A registered dietitian with experience in oncology would be ideally placed to advise on this.

NOTHING TO LOSE…

While there can never be a guarantee against cancer returning, the best evidence we have at the moment is simply to try follow the recommendations by the World Cancer Research Fund which are discussed within this book. The good news is that aiming for a healthy weight, staying physically active and eating a mainly plant-based diet is likely to reduce our risk of other chronic diseases – like heart disease or Type 2 diabetes – as well as cancer. And regular physical activity is one of the most effective ways we have of relieving stress, reducing anxiety and bringing a sense of control over our circumstances. So, in following this recommendation, there really is nothing to lose, and only good things to gain.