Incorporating Weight Management
and Physical Activity Throughout
the Cancer Care Continuum
PROCEEDINGS OF A WORKSHOP
Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by Contract No. 200-2011-38807 (Task Order No. 0051) and Contract No. HHSN263201200074I (Task Order No. HHSN26300052) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Lifestyle Medicine, American College of Radiology, American College of Sports Medicine, American Council on Exercise, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Dana-Farber Cancer Institute, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Medical Fitness Association, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, Penn State Cancer Institute, Pfizer Inc., and The University of Texas MD Anderson Cancer Center. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-46694-3
International Standard Book Number-10: 0-309-46694-6
Digital Object Identifier: https://doi.org/10.17226/24925
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Incorporating weight management and physical activity throughout the cancer care continuum: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24925.
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WORKSHOP PLANNING COMMITTEE1
WENDY DEMARK-WAHNEFRIED (Chair), Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center
LUCILE L. ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center
CATHERINE ALFANO, Vice President, Survivorship, American Cancer Society
RACHEL BALLARD, Director, Prevention Research Coordination, Office of Disease Prevention, National Institutes of Health
KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor, Professor of Behavioral Science, and Director, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center
DON W. BRADLEY, Associate Consulting Professor, Department of Community and Family Medicine, Duke University
JOANNE BUZAGLO, Senior Vice President, Research & Training, Cancer Support Community
ANDREW J. DANNENBERG, Henry R. Erle, MD-Roberts Family Professor of Medicine, Associate Director, Cancer Prevention, Sandra and Edward Meyer Cancer Center, Weill Cornell Medical College
WILLIAM H. DIETZ, Director, Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University
PAMELA GOODWIN, Professor of Medicine, Senior Investigator, Lunenfeld-Tanenbaum Research Institute, and Director, Marvell Koffler Breast Centre, Mount Sinai Hospital, University of Toronto
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
JENNIFER LIGIBEL, Senior Physician and Director, Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, and Assistant Professor, Harvard Medical School
GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
CAMERON KRIER MASSEY, Director, Government Relations and Program Affairs, LIVESTRONG Foundation
LOYCE PACE, Executive Director, Global Health Council
KATHRYN H. SCHMITZ, Professor, Public Health Science, Associate Director, Population Sciences, Penn State University College of Medicine
Project Staff
ERIN BALOGH, Senior Program Officer
SYLARA MARIE CRUZ, Senior Program Assistant (until April 2017)
NATALIE LUBIN, Senior Program Assistant (from June 2017)
CYNDI TRANG, Research Assistant
SHARYL J. NASS, Director, National Cancer Policy Forum and Board on Health Care Services
NATIONAL CANCER POLICY FORUM1
EDWARD J. BENZ, JR. (Chair), President and Chief Executive Officer Emeritus, Dana-Farber Cancer Institute; Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School
AMY P. ABERNETHY, Chief Medical Officer, Chief Scientific Officer, and Senior Vice President, Oncology, Flatiron Health
LUCILE L. ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center
GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; Affiliate Professor, Department of Biostatistics, University of Washington
KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute
KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor, Professor of Behavioral Science, and Director, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center
CATHY J. BRADLEY, Associate Director, Cancer Prevention and Control, University of Colorado Cancer Center
OTIS W. BRAWLEY, Chief Medical Officer, American Cancer Society
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
CHRISTOPHER R. COGLE, Professor of Medicine, Pierre Chagnon Professor of Stem Cell Biology and Bone Marrow Transplant, University of Florida; Scholar in Clinical Research, Leukemia & Lymphoma Society
ROGER D. DANSEY, Senior Vice President, Clinical Research-Late Stage Development, Merck
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Senior Vice President, Director, and Full Member, Clinical Research Division, Fred Hutchinson Cancer Research Center; Head, Department of Medicine, Division of Medical Oncology, University of Washington
GEORGE D. DEMETRI, Professor of Medicine and Director, Ludwig Center, Harvard Medical School; Senior Vice President for Experimental Therapeutics, Dana-Farber Cancer Institute; Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center
JAMES H. DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute
KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine; Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania
STANTON L. GERSON, President, Association of American Cancer Institutes; Director, Case Comprehensive Cancer Center; Professor of Hematological Oncology, Case Western Reserve University; Director, University Hospitals Seidman Cancer Center
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs
LINDA HOUSE, President, Cancer Support Community
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
LISA KENNEDY SHELDON, Chief Clinical Officer, Oncology Nursing Society; Editor, Clinical Journal of Oncology Nursing
SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University
RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
LEE M. KRUG, Disease Area Head, Lung and Head & Neck Cancer, Immuno-Oncology, Bristol-Myers Squibb
FRANCOIS LAFLEUR, U.S. Head and Vice President, Medical Affairs, Helsinn Therapeutics (U.S.), Inc.
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine; Director, The University of Chicago Comprehensive Cancer Center
MIA LEVY, Director, Cancer Health Informatics and Strategy; Ingram Associate Professor of Cancer Research; Associate Professor of Biomedical Informatics and Medicine, Vanderbilt-Ingram Cancer Center
MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer
RICHARD PAZDUR, Director, Oncology Center of Excellence; Acting Director, Office of Hematology and Oncology Products, Food and Drug Administration
LISA C. RICHARDSON, Director, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
MACE L. ROTHENBERG, Chief Development Officer, Oncology, Pfizer Global Product Development, Pfizer Inc.
RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology
DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute
LAWRENCE N. SHULMAN, Professor of Medicine, Deputy Director for Clinical Services; Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania
DAN THEODORESCU, Paul A. Bunn, Jr. Endowed Chair in Cancer Research, Professor of Surgery and Pharmacology, and Director, University of Colorado Cancer Center
GEORGE J. WEINER, C.E. Block Chair of Cancer Research, Professor of Internal Medicine, and Director, Holden Comprehensive Cancer Center, The University of Iowa
ROBERT A. WINN, Associate Vice Chancellor, Community Based-Practice; Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Illinois at College of Medicine; Director, University of Illinois Health Cancer Center
RICHARD C. WOODMAN, Senior Vice President and Head, North America Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation
National Cancer Policy Forum Staff
ERIN BALOGH, Senior Program Officer
PATRICK BURKE, Financial Officer
SYLARA MARIE CRUZ, Senior Program Assistant (until April 2017)
NATALIE LUBIN, Senior Program Assistant (from June 2017)
CYNDI TRANG, Research Assistant
SHARYL J. NASS, Forum Director, and Director, Board on Health Care Services
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
CRYSTAL DENLINGER, Fox Chase Cancer Center
ZORA DJURIC, University of Michigan
ROBERT HARRISON, Patient Advocate
LEE JONES, Memorial Sloan Kettering Cancer Center
DARSHAK SANGHAVI, OptumLabs
MELINDA STOLLEY, Medical College of Wisconsin
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ELENA NIGHTINGALE, National Academy of Medicine. She was responsible for making certain that an inde-
pendent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Acknowledgments
Support from the many sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Nonfederal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Lifestyle Medicine, American College of Radiology, American College of Sports Medicine, American Council on Exercise, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Dana-Farber Cancer Institute, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Medical Fitness Association, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, Penn State Cancer Institute, Pfizer Inc., and The University of Texas MD Anderson Cancer Center.
The forum wishes to express its gratitude to the expert speakers whose presentations helped further the dialogue about weight management and physical activity interventions for cancer survivors. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Contents
Terminology and Concepts Discussed at the Workshop
EVIDENCE BASE FOR THE IMPACT OF BODY WEIGHT AND PHYSICAL ACTIVITY ON CANCER SURVIVORS
INTERVENTIONS FOR WEIGHT MANAGEMENT AND PHYSICAL ACTIVITY IN CANCER SURVIVORS
Morbidities Associated with Cancer and Cancer Treatment
Chronic Disease Prevention in Cancer Survivors
Effects on Cancer Treatment Tolerability and Adherence
Interventions for Weight Management and Physical Activity in Other Populations
APPLYING THE EVIDENCE BASE TO PATIENT CARE
Examples of Intervention Components
Optimal Timing of Diet and Exercise Interventions
Patient Screening, Assessment, Triage, and Referral
Promotion of Healthy Behaviors
Tailoring Interventions to Special Populations
Racially and Ethnically Diverse Populations
EXAMPLES OF CHALLENGES IN IMPLEMENTING LIFESTYLE INTERVENTIONS
Patient-Centered Terminology for People with Obesity
POTENTIAL OPPORTUNITIES TO IMPROVE LIFESTYLE INTERVENTIONS FOR CANCER SURVIVORS
Integrating Clinical and Community-Based Programs and Resources
Insurance Coverage for Lifestyle Interventions
Clinician Education, Resources, and Standards
Collaborations and Partnerships
National Research Networks and Resources
Improving Measures and Endpoints
Data on Economic Outcomes and Implementation
Boxes, Figures, and Tables
BOXES
2 Cancer Survivor Experiences with Weight Management and Physical Activity
3 Strength After Breast Cancer Program
4 LIVESTRONG at the YMCA and the YMCA’s Diabetes Prevention Program
5 Australia’s Healthy Living After Cancer and Get Healthy Service Programs
7 Provider Competencies for the Prevention and Management of Obesity
8 Examples of Cancer Survivorship, Weight Management, and Physical Activity Resources for Clinicians
FIGURES
Acronyms and Abbreviations
ACA |
Patient Protection and Affordable Care Act |
ACS |
American Cancer Society |
ACSM |
American College of Sports Medicine |
AHA |
American Heart Association |
AHEAD |
Action for Health in Diabetes |
AMBER |
Alberta Moving Beyond Breast CancER |
APTA |
American Physical Therapy Association |
ASCO |
American Society of Clinical Oncology |
BMI |
body mass index |
BPC |
Bipartisan Policy Center |
BRCA |
BReast CAncer susceptibility gene |
BWEL |
Breast Cancer WEight Loss |
CARE |
Combined Aerobic and Resistance Exercise |
CDC |
Centers for Disease Control and Prevention |
CHALLENGE |
Colon Health and Life-Long Exercise Change |
CMS |
Centers for Medicare & Medicaid Services |
CPT |
Current Procedural Terminology |
DPP |
Diabetes Prevention Program |
EHR |
electronic health record |
ENERGY |
Exercise and Nutrition to Enhance Recovery and Good Health for You |
FDA |
Food and Drug Administration |
HHS |
Department of Health and Human Services |
HIPAA |
Health Insurance Portability and Accountability Act of 1996 |
INTERVAL-MCRPC |
INTense Exercise foR surVivAL Among Men with Metastatic Castrate-Resistant Prostate Cancer |
LIVES |
Lifestyle Intervention for Ovarian Cancer Enhanced Survival |
mTOR |
mammalian target of rapamycin |
NCCN |
National Comprehensive Cancer Network |
NEW |
Nutrition and Exercise Study for Women |
NIH |
National Institutes of Health |
ONS |
Oncology Nursing Society |
POUNDS LOST |
Preventing Overweight Using Novel Dietary Strategies |
REHAB |
Rehabilitation Exercise for Health After Breast Cancer |
RENEW |
Reach out to ENhancE Wellness |
START |
Supervised Trial of Aerobic versus Resistance Training |
USPSTF |
U.S. Preventive Services Task Force |
VO2max |
maximal oxygen uptake during exercise |