Last week we discussed some survivorship strategies to consider after oral, head and neck cancer treatment is complete. This blog will address how to go about developing a specific plan for health and wellness. Ideas will be presented on how to adopt a healthy lifestyle with good nutrition, regular physical activity, and survivorship care and follow-up. The following list is a list of health-related actions I encourage my patients to consider after completing their treatment. It is not a list that is “authorized” by any national cancer organization, but rather a collection of strategies for improving health after treatment:
- changing cancer-risk behaviors
- eating more nutritiously—swallow by swallow
- becoming more physically active—step by step
- and receiving continuing survivorship care and follow-up.
Use of tobacco products (e.g. smoking cigarettes or using smokeless tobacco) increases your risk of cancer recurrence. Also, reduce your exposure to second-hand smoke—stay away from people smoking cigarettes, cigars, or pipes. Seek help for quitting for good! Check out the National Cancer Institute’s Fact Sheet on “Where to Get Help When You Decide to Quit Smoking”. The NCI also has a Smoking Quitline available at 1-877-44U-Quit. The free hotline offers a wide range of services including one-on-one counseling, printed information, and referrals to other quit smoking resources.
Limit alcohol consumption
Quite simply, continuing to drink alcoholic beverages increases your risk for cancer coming back and decreases your survival. If you do drink, pay attention to portion size! There is truly portion distortion when it comes to purchasing and consuming alcoholic beverages. A drink of alcohol is defined as:
- 12 ounces of beer
- 5 ounces of wine
- 1.5 ounces of 80-proof distilled spirits
Again, the ACS’s guidelines for cancer prevention are:
- Drink no more than 1 drink per day if you are woman
- Drink no more than 2 drinks per day if you are a man
However, I encourage head and neck cancer survivors to not drink alcoholic beverages!
Obtain and maintain a healthy body weight
A healthy weight depends upon a person’s height. A recommendation for a healthy weight is often reported in terms of body mass index or BMI. A healthy BMI for most adults is within a range of 18.5. to 25. To calculate your own BMI refer to the National Health Institute’s BMI Calculator available at: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. Overweight and obesity are clearly linked with an increased risk for cancer and cancer recurrence.
However, being underweight and having a BMI lower than 18.5 can be a sign of malnutrition or undernutrition. Being underweight can also increase your risk of bone disease (osteoporosis), decreased immune function, and cardiac problems.
A common side effect of head neck cancer treatment is weight loss and for many people, that means being underweight. To help the majority of my patients to maintain their weight through treatment, they are encouraged to have a feeding tube placed. For many of my patients, it can take weeks and even months to slowly transition from using their feeding tube to be able to chew and swallow their food again. If you are having a hard time regaining weight lost or transitioning from tube feeding to eating after finishing your cancer treatment, seek help from your provider (e.g. doctor, nurse practitioner, or physician’s assistant) or ask for a referral to meet with a registered dietitian.
Visit your dentist regularly
As discussed in an earlier post, radiation therapy to the head and neck area can cause lasting eating challenges because of treatment-related loss of saliva, taste changes, and possible loss of chewing and swallowing function. Having regular dental check-ups is vital to your oral health. Be sure to use fluoride-containing toothpaste or other oral care products as directed by your dental team. If you have dentures or other oral prostheses, be sure that they fit properly.
Seek help if needed
If you are having challenges with chewing and swallowing, and range of movement, ask your provider for a referral to work with a specially trained oncology rehabilitation expert. Speech-language pathologists can help with treatment related changes and challenges with speaking, and chewing and swallowing. If you are experiencing coughing or wheezing after swallowing (a condition known as aspiration) or having difficulty with food becoming stuck with swallowing (a condition known as esophageal stricture or stenosis)—it is an important safety consideration to have your swallowing function evaluated.
Other members of the oncology rehabilitation team are physical therapists (PT). PTs can help with lingering medical conditions such as post treatment loss of movement, neck pain. To find a cancer rehabilitation program or specially trained clinicians visit the Oncology Rehab Partner’s STAR Program® (Survivorship Training and Rehabilitation) website at: http://www.oncologyrehabpartners.com/. If there is not a STAR Program in your area, ask your healthcare professional for a referral to your hospital’s rehabilitation program near you.
To help improve your physical well-being and function, consider consistent exercise. Follow the American Cancer Society’s guidelines above for engaging in regular physical activity. Be sure to discuss your plans about physical activity with your provider before beginning any exercise program. Also consider seeking out a LIVESTRONG program in your area. The LIVESTRONG Foundation and 270 YMCAs across America have partnered together to offer free, 12-week YMCA-managed programs for adult cancer survivors and their caregivers. To learn more about the LIVESTRONG at the YMCA program and where you can find one, visit: http://livestrong.org/ymca
Always remember that good nutrition is one of the cornerstone strategies to staying healthy and strong while living with cancer. Our Oncology Nutritionists can create a customized meal plan to make sure you’re receiving all the nutrients your body needs!