Obesity has been shown to negatively affect the prognosis of someone with breast cancer, "so breast cancer survivors should be encouraged to maintain a healthy weight that is appropriate for their height," the authors write. According to new the new guidelines, any weight gained during therapy can be lost during the recovery period, but (loss) should not exceed more than one to two pounds per week.

Because some studies have suggested that low levels of fat might be associated with lower recurrence and better survival, the guide suggests a breast cancer survivor may want to limit fat to 20% of total calories. A diet low in fat can be started during therapy or afterward.

"Breast cancer survivors should obtain the majority of their added fat from monounsaturated sources such as olive or canola oil, avocado, and nuts," the guide states. "In addition, they should limit their intake of saturated fats from sources such as red meat, poultry, and fat-containing daily products." Foods rich in omega 3 fatty acids, such as salmon, also are recommended in the guide.

All breast cancer survivors should consume at least five servings a day of fruits and vegetables. Although the relationship between dietary fiber and breast cancer recurrence is not clear, a diet high in fiber may reduce estrogen levels, which may in turn reduce the risk of recurrence. The guide indicates that a diet high in whole grains, legumes, vegetables, and fruits would be a good choice for breast cancer survivors.

While soy products may be popular, there is conflicting scientific evidence about whether they might be beneficial or harmful. Until more is known, breast cancer survivors may consume "moderate" amounts of soy "as part of a healthy plant-based diet, avoiding very high levels of soy" including pills, powders, or supplements, the guide explains. Women with estrogen responsive breast cancer may want to completely abstain from consuming alcohol, as some researchers have suggested alcohol may increase the levels of estrogen in the blood.

Regular physical exercise may help prevent breast cancer, especially in premenopausal women. It also is useful for the management of osteoporosis and heart disease in all women.

"Older men with early-stage prostate cancer are actually at higher risk of death from heart disease than from prostate cancer," the authors maintain, "so it is especially wise for prostate cancer survivors to follow a heart-healthy diet that is low in saturated fat, high in fruits and vegetables, and accompanied by regular physical activity."

The authors note that many prostate cancer survivors may be told to consume lypocene, an antioxidant found in tomatoes. But they write that there is no evidence to suggest a beneficial effect and further study on the effects of lycopene is needed. Similarly, selenium may hold promise for reducing the risk of prostate cancer. Any supplement used should be no greater than 200 mg. per day. "The best source of selenium is in a selenium-enriched brewer’s yeast," rather than inorganic compounds that may cause brain and liver toxicity at high doses.

The effect of vitamin E on prostate cancer is uncertain; it may decrease the rate of conversion of latent to aggressive forms of prostate cancer, but more definitive studies are needed, the ACS experts write. For now, it would be "prudent" to limit supplements to a dose of 400 mg. to 800 mg. per day.

Studies are underway to evaluate the role of soy products on the growth of prostate cancer after a diagnosis of advanced disease, since soy contains phytoestrogens, a plant source for estrogen.

Treatments for lung cancer are "often aggressive," accompanied by a host of side effects, including fatigue, nausea, and vomiting that might interfere with eating. In addition, "many survivors exhibit low blood nutrient levels, even before diagnosis, due to inadequate diets and/or due to the adverse effects of smoking on micronutrients," the authors write.

As such, lung cancer survivors may need to make "special efforts to regain nutritional health during treatment and recovery," according to the guide. Making juices and homemade shakes, or using commercially prepared formulas, as well as taking a multivitamin-multimineral supplement, are advised.

Selenium is the one nutritional supplement that has been found to lower lung cancer incidence. Because this was found during research on the effect of selenium on skin cancers, it requires further studies which are underway to determine whether selenium might improve the prognosis of patients with lung cancer or forestall the development of second primary lung cancers. The nutritional committee is not yet ready to recommend supplements be consumed.

Nutritional assessment and support for people with these cancers is essential to improve overall health "before, during and after treatment," according to the committee. "Patients with head and neck cancers may experience poor nutrient intake because of biting, chewing, and swallowing difficulties, as well as reflux. This can be addressed through a high-protein, low-fat, high carbohydrate, regimen" and the avoidance of chocolate, fat, alcohol, and foods containing peppermint and garlic.

While people with oral leukoplakia, a pre-malignant lesion, benefit from beta carotene supplementation at appropriate doses (higher than recommended doses of beta carotene may result in more harm than benefit), survivors should attempt to eat fruits and vegetables that are orange and deep green to obtain this nutrient from natural sources.

Depending on what portion of the stomach has been removed, persons with gastric cancer may develop reflux and food may move rapidly through the stomach. To combat this, they may wish to eat small, frequent meals slowly, and avoid food and drinks that contain concentrated sugar, such as honey, jams, frosting, ice cream, and soft drinks.

In addition, some survivors may experience fat intolerance, addressed by lowering the amount of fat consumed. Those who have a milk intolerance can use lactose-free dairy products.

Survival after a colorectal cancer diagnosis is most determined by an adherence to the "full treatment regimen," according to the authors, especially if chemotherapy is suggested, as well as regular colonoscopies to find new lesions. Colorectal cancer survivors may be left with diarrhea or constipation, and may need to be referred to a nutritionist for dietary counseling. As with other cancers, selenium may be beneficial, but the benefits are uncertain. Until more research is done, the ACS recommends taking no more than 200 mcgs per day, found in a brewer’s yeast supplement.

"Survivors should be advised to maintain a reasonable weight, eat a well-balanced diet and participate in regular physical activity after treatment," the guidelines summarize.

The Guide for Informed Choices by Cancer Survivors appears in a recent issue of CA (Vol. 51, No. 3: 151-152, 153-181).