One of our research goals – and key work areas – in the Global Cancer Update Programme (CUP Global) is cancer survivors.
In October 2022, we published a major review of existing research into the links between weight, diet, physical activity and the risk of death after a breast cancer diagnosis.
The review found strong evidence that a higher body weight after a breast cancer diagnosis increases a woman’s risk of death. It found some limited evidence that doing more physical activity lowers her risk of death.
The cancer survivors work encompasses reviews of adult cancer survivors and childhood cancer survivors. Every 2–3 years a data prioritisation exercise will determine when evidence could be/needs to be updated in the area of cancer survivorship (both for medical outcomes such as mortality and quality of life outcomes, covering evidence around specific exposures, eg physical activity, body weight).
Aims: Determining the impact of diet, nutrition and physical activity on children from diagnosis and into adult life
Benefits of approach
This is a new area for WCRF and the Transition Panel identified it as having particular importance since the CUP Global process offers a unique and efficient approach to synthesising available evidence and establishing evidence based conclusions/ recommendations for survivors of childhood cancer.
Survival for those diagnosed with cancer in childhood (<21 years of age) has improved dramatically in recent decades, but survivors of childhood cancer are at risk of developing an array of adverse health-related complications from aggressive, yet increasingly successful, curative therapy.
There’s demand from clinicians, families, and patients for evidence-based advice on the role of diet, nutrition and physical activity to enhance the efficacy of therapy and reduce the severity of treatment-related toxicity, over both the short- and long-term.
A comprehensive analysis of the existing published literature on diet, nutrition, and physical activity in childhood cancer survivors, using rigorous methodology, has not yet been done. Such an analysis would provide a foundation for diet, nutrition and physical activity recommendations that can be integrated into current care.
It will also define critical gaps in research and knowledge, suggesting opportunities for research on these topics and incentivising incorporation of diet, nutrition and physical activity assessment into ongoing and future clinical therapeutic trials.
Developing a paediatric acute leukaemia systematic review protocol and criteria for judging the evidence for medical and quality of life outcomes for childhood cancer survivors will form part of future CUP Global work. Paediatric acute leukaemia has been prioritised as it is the most common childhood cancer, with the most evidence to date.
Aims: Identifying the impact of diet, nutrition and physical activity following a cancer diagnosis
Benefits of approach
The aspiration to build the knowledge base for cancer survivors started in the previous CUP, with breast cancer survivors the first cancer type reviewed. Despite the enormous demand for reliable estimates and advice from the lay, medical and research worlds, the availability and quality of evidence has so far been insufficient to support robust, evidence-based diet, nutrition and physical activity recommendations that are specific for cancer survivors overall, or for survivors of specific types of cancer.
In recent years there has been a substantial growth in the volume of research among survivors of breast and other common cancers, especially colorectal and prostate cancers. This provides an opportunity to augment the previous analyses for breast cancer survivors by applying a similar approach to prostate and colorectal cancer survivors.
The workstream developed detailed protocols to allow for systematic analysis of colorectal and prostate cancer studies in the first instance. These systematic reviews, being implemented as part of CUP Global, will provide our first evidence conclusions and recommendations based on comprehensive syntheses of evidence concerning the role of diet, nutrition and physical activity on medical outcomes in prostate and colorectal cancer survivorship.
Additionally, quality of life measures will be evaluated, building on the pilot work done in this area for breast cancer survivors and providing additional novel and important contributions to the field of survivorship research.