Pilot Project Aids Cancer Survivors in Achieving Healthy Weight and Reducing Recurrent Risk

Based on the strong evidence of an association between cancer and obesity, Cleveland Clinic Cancer Institute is launching an initiative to help survivors of prostate and breast cancer reduce recurrence risk through healthy living.

Led by exercise physiologists and an obesity medicine specialist, the Next Steps Fitness for Cancer Survivors program will include:

• An initial virtual group session raising awareness about the connection between obesity, physical inactivity and cancer
• A second virtual group session designed to help participants prioritize regular physical activity alongside healthy eating, quality sleep and stress management
• Optional body composition, strength and cardiovascular assessments and individualized exercise prescriptions
• Follow-up surveys to determine program feasibility, program acceptance and approaches for program improvement

Initiating discussions with patients

“We often hear that patients have gained weight during or after cancer treatment and now they are looking towards their next step in improving their health and quality of life,” says David Creel, PhD RD ACSM-CEP, a psychologist in Cleveland Clinic’s Department of Endocrinology. “Other times, providers may raise the issue to a patient when they’ve noticed their weight trending up. Simply asking the patient if this is something they’d like support with can be a welcome invitation to achieving a healthier lifestyle.”

“Patients often appreciate having something they can have control over. They may not have control over genetic predispositions for cancer or how well their treatment works but they can optimize aspects like eating right, doing physical activity, keeping their weight under control and managing stress.”

Getting a good night’s sleep

Sleep is an important part of managing weight, as hunger hormones shift when you don’t get adequate sleep. Leptin hormones decrease when you’re tired, interfering with your ability to feel satiated. Also, when you're chronically fatigued, it's harder to pursue healthy lifestyle behaviors like exercising or making a homecooked meal.

Sleep apnea is also connected with worsening obesity. “Sleep and stress go together,” explains Dr. Creel. “When we manage our stress better, we tend to sleep better. And when we exercise, it helps with sleep, so it’s all connected.”

Patients struggling to get to sleep or stay asleep may be referred to a physician in Sleep Medicine to diagnose a sleep disorder. In addition, psychologists specializing in behavioral sleep medicine can provide personal guidance on better sleep hygiene and stress management. The providers often ask patients to keep a sleep diary to help identify sleep challenges and individualize treatment recommendations.

Understanding the emotions of eating

Psychologists in the program team engage multiple modalities to support healthy eating:

• Cognitive behavior therapy is a common approach to support patients in goal setting and finding productive ways to manage stress and emotions.
• Mindfulness-based treatment helps patients make a connection between their mind and body. These methods can help people tolerate distress without overreacting or overeating as a soothing mechanism.
• Value-based treatment helps providers uncover what’s important to the individual to motivate them and keep them engaged in making healthy decisions.

Addressing weight stigma

Many patients who are overweight have faced stigma and body image concerns throughout their lives. “It’s common for people to report negative experiences with family members, at school or even from medical providers amid struggles with their weight,” says Dr. Creel. “We’re working to build an environment where they can trust us and see that we’re here to help them.”