Survivor's Guide
Living Well after Cancer

Staying Healthy after Treatment

Many cancer survivors adopt a healthier lifestyle after their cancer experience.

Studies on people who have survived cancer are limited compared with studies about preventing cancer. The evidence varies for different cancers, but research does suggest that a healthy lifestyle can stop or slow the development of many cancers (in combination with conventional treatment). It also shows that some people who have had cancer may be at an increased risk of other health problems, such as heart disease, lung problems or diabetes.

While more research needs to be done, the lifestyle changes recommended for cancer prevention may also help reduce the chance of the cancer coming back or a new cancer developing. They can also prevent other health problems.


Maintain a healthy body weight
A healthy body weight is important for reducing the risk of cancer recurrence and improving survival. The health risk associated with your body weight can be estimated using different techniques including the Body Mass Index and waist circumference. 

If you have lost a lot of weight during treatment, you may have to regain some weight to return to a healthy weight.

Waist circumference and health risk
Having fat around the abdomen or a potbelly, regardless of your body size, means you are more likely to develop certain obesity-related health conditions. Fat predominantly deposited around the hips and buttocks doesn't appear to have the same risk. Men, in particular, often put on weight around their waist.

Waist circumference can be used to indicate health risk.
Men 94 cm or more = increased risk
102 cm or more = substantially increased risk
Women 80 cm or more = increased risk
88 cm or more = substantially increased risk

Dietitians can help
Dietitians can help you with any nutrition concerns. They are available in all public hospitals and some private hospitals. Community health centres often have a dietitian. NCSM offers nutrition consultations by dietitians, call 03-26987300 to make an appointment.

The Malaysian Dietitians’ Association can direct you to an accredited practising dietitian in your area or to one who has experience in particular problems. 

Tips
  • Make fruit and vegetables, wholegrain breads, cereals, pasta and rice and other low-fat foods the basis of your diet.
  • Choose lean cuts of meat and trim as much fat as possible before cooking.
  • Remove the skin from chicken.
  • Limit your intake of red meat and processed meat, such as sausages.
  • Cook food in ways that use less fat - grill, steam, poach or bake.
  • Use a non-stick frypan or a spray of oil when pan-frying.
  • Try low-fat varieties of milk, yoghurt and cheese.
  • Don't use butter or margarine, or use only a scrape.
  • Limit the number of high-fat takeaways. For instance, avoid Asian foods with a lot of coconut milk.
  • Avoid high-fat snacks such as crisps and biscuits.
  • Reduce portion sizes.
  • Eat slowly and listen to your body - only eat when you're hungry and stop eating when you're full.

Eat more vegetables and fruit
Vegetables and fruit contain vitamins, minerals and phytochemicals, which are natural substances such as antioxidants that may destroy cancer-causing agents (carcinogens). Vegetables and fruit are also high in fibre and low in fat, which helps to control your weight.
Aim to eat a variety of different coloured vegetables and fruits to ensure you get enough of the substances in plant foods that may protect against certain types of cancer. The Malaysian Dietary Guidelines 2010 recommend two serves of fruit and three serves of vegetables a day. 

One serve is equal to:
  • 1 medium-sized piece of fruit
  • 2 smaller fruits, e.g. plums, apricots or kiwi
  • 1 cup of fruit pieces
  • 1 glass of fruit juice
  • 1½ tablespoons of sultanas
  • ½ cup of cooked vegetables
  • 1 cup of salad vegetables
How to eat more vegetables and fruit everyday
  • Enjoy fruit as a snack or for dessert.
  • Add fresh or canned fruit as a topping on breakfast cereal.
  • Fill half your dinner plate with vegetables.
  • Include at least three different coloured vegetables with your main meal.
  • Keep it interesting — cook vegetables in different ways, e.g. oven roasted, grilled, barbecued, stir fried.
  • Include salad with lunch.
  • Eat raw or cooked vegetables as a snack.
  • Keep fresh fruit on the table.
  • Shop for fresh vegetables and fruit regularly to ensure you have a fresh supply available.
  • Use frozen, dried or canned vegetables and fruit if fresh varieties are not available.
  • Adapt your recipes to include more vegetables (e.g. add carrot, celery and peas to bolognaise sauce).

Handle and prepare food safely
Food safety is particularly important for many people who have survived cancer.

Some cancer treatments, such as chemotherapy, may weaken the immune system. People who have a weakened immune system are at increased risk of food-borne illness (food poisoning). You may need to take extra precautions with food preparation and storage.

Tips
  • Wash your hands with warm water and soap before preparing and cooking food.
  • Keep kitchen counters, chopping boards and utensils clean.
  • Avoid cross-contamination by using separate chopping boards and knives for preparing raw meat, fish or chicken.
  • Thaw frozen foods in the refrigerator or microwave. Do not thaw frozen food on the kitchen bench.
  • Keep hot food steaming hot and cold food cold.
  • Read expiry dates on food products and check for signs of food spoilage. If in doubt, throw it out.
  • Keep cooked food on a higher shelf in the fridge above raw food to lower the chance of uncooked meat juices falling into cooked food.
  • Avoid pre-prepared or precooked cold food that will not be reheated (e.g. deli salads, pâté, quiches and cold meats like ham and salami).

Dietary supplements
People who have survived cancer often consider taking dietary supplements such as vitamins and herbal tablets to optimise their health.

Some believe that high-dose vitamin supplements strengthen the body's immune system. However, there is little scientific evidence to support these claims, and some studies have suggested that vitamin supplements may be harmful at high dosages.

The general rule is that dietary supplements should never replace whole foods like fruit and vegetables, which are the best source of vitamins and minerals. Discuss plans to take vitamin supplements with your doctor or dietitian.


Frequently asked questions about food
There is no conclusive evidence that vegetarians or those who become vegetarians do better after cancer treatment. However, eating too much red meat, especially processed meats such as sausages, bacon and ‘Frankfurts’, is associated with a slightly increased risk of bowel cancer.

It's important to eat a diet that is high in plant foods, such as fruits, vegetables and cereal foods, but there is no need to give up meat.
The term ‘organic' is used to describe foods grown without pesticides or herbicides. Organic fruit and vegetables tend to be higher in vitamin C compared with conventionally grown varieties.

However, all types of fruits and vegetables are good for your health, whether organic or conventionally grown. There is no current evidence that organic fruit and vegetables are more effective in reducing cancer risk than conventionally grown fruit and vegetables. It is a good idea to thoroughly wash fruits and vegetables to remove any traces of pesticides.
Try to eat both raw (e.g. salad) and cooked vegetables. Boiling vegetables for a long time can reduce the amount of vitamins. Steaming and microwaving vegetables are good cooking methods to maintain their nutritional goodness.
It's best to mostly eat whole vegetables and fruit rather than as juices because they contain fibre, which is protective against bowel cancer. Juices are much higher in calories than fresh vegetables and fruit, which is an issue if you're watching your weight.
News stories about certain foods or diets can be confusing. They sometimes present evidence relating to studies done in laboratories, rather than on humans.

Certain types of fruit and vegetables are sometimes called ‘superfoods'. Although all fruit and vegetables are healthy and should be eaten regularly, there is no single superfood. This word may be used as a marketing term rather than as scientific fact. It's wise to consider whether an advertiser is promoting the superfood label.

There is also no single food that has been shown to cause cancer. Evidence supports eating plenty of fruit and vegetables and moderate serves of red meat and energy-dense foods. Call NCSM’s dietitians at 03-2698 7300 more information.


Quit smoking
If you are a smoker, NCSM strongly recommends that you quit. There's no safe level of tobacco use. Tobacco smoke contains more than 7,000 chemicals, including 69 known cancer-causing agents (carcinogens). Research shows that by continuing to smoke, you're more likely to develop another type of cancer.

Many smokers find quitting difficult. Don't be discouraged if it takes several attempts before you are able to quit successfully.

Tips
  • Ask your doctor for advice. 
  • NCSM offer smoking cessation service. Please call 03-26987300 to make an appointment.
  • Make a decision not to 'just have one'.
  • Make your home and car smoke-free zones.
  • Think of previous attempts to quit as practice, and learn what worked and what didn't.
  • Keep a list of all the reasons you want to quit.
  • Think of yourself as an ex-smoker.
  • Avoid tempting situations.

Be physically active
Physical activity helps to protect against some types of cancer coming back. There are many other benefits to being active besides this possible protection. Exercise can also boost energy levels, decrease fatigue, increase strength, relieve stress, reduce heart disease and lower anxiety and depression.

If you're unsure about whether you're well enough to exercise or if it will interfere with your recovery, talk to your doctor first.

Start physical activity slowly and increase gradually. Every person is different and the amount and type of activities will vary. Doctors usually recommend about 20 to 30 minutes a day of moderate physical activity.

Tips
  • Walking is great exercise. Walk with a friend or join a walking group, walk to the corner shop instead of driving, or try walking in the water instead of swimming.
  • Do some gardening.
  • Do some simple stretching exercises while watching television.
  • Take the stairs instead of the lift or escalators.
  • Do vigorous housework such as vacuuming or mowing the lawn.
  • Get off the bus or train one stop earlier or park further away from your destination and walk the rest of the way.
  • Take your children or grandchildren to the park or kick a ball around the backyard.
  • Take a dance class.

Protect your skin from sun
Your skin from the sun and avoid other sources of UV radiation (such as solariums) as skin cancer is almost totally preventable.
  • Wear clothing that covers as much of your skin as possible, including the back of your neck. Shirts with sleeves and a collar, trousers, and long skirts or long shorts that cover a large part of your legs are ideal. The best protection comes from closely woven fabric, as UV radiation can go through thin material.
  • Protect your face, neck and ears with a hat. Broad brim, bucket style and legionnaire style hats provide good protection. Baseball caps aren't recommended. Adult hats should have at least an 8cm to 10cm brim.
  • Wear SPF30+ broad-spectrum water-resistant sunscreen when you go into the sunlight for periods longer than 15 minutes and reapply every two hours.
  • Protect your eyes with sunglasses. Wrap-around styles are best.
  • Never allow your skin to burn. Avoid being in the sun when UV radiation is high, between 10am and 3pm. 

Limit or avoid alcohol
Alcohol is a risk factor for some cancers, particularly cancer of the mouth, throat, oesophagus, bowel, liver, bowel, liver and breast. Limiting alcohol may also decrease the risk of cancer recurrence.

To reduce the risk of cancer, you should limit or avoid alcohol.

A guide to standard drinks
For men and women who choose to drink alcohol, the recommended amount is an average of no more than two standard drinks a day for man and one standard drinks a day for woman. One standard drink contains 10 grams of alcohol. However, different drinks have different alcohol volumes, so it is best to drink in moderation and know what you are consuming.
  • 100 mL (small glass) of red wine = 1 standard drink
  • 100 mL (small glass) of white wine = 0.9 standard drinks
  • 30 mL (one nip or shot) of spirits = 1 standard drink
  • 60 mL (two nips or shots) of port = 0.8 standard drinks
  • 285 mL (one middy, half pint or pot) of normal strength beer = 1.1 standard drinks
  • 375 mL of mid-strength beer = 1 standard drink
  • 425 mL (one schooner) of low-alcohol (light) beer = 0.9 standard drinks. 
A balanced approach
The risks and benefits of drinking alcohol vary for different diseases. A small amount of alcohol taken regularly may provide some protection against heart disease, but usually only for middle-aged people. This possible benefit needs to be balanced against the increased risk of liver cirrhosis, stroke, high blood pressure and cancer.
There are many other healthy habits that can reduce both the risk of cancer recurrence and heart disease, such as healthy eating, regular physical activity and not smoking.

Tips
  • Use water to quench thirst.
  • Start with a non-alcoholic drink.
  • Sip alcoholic drinks slowly.
  • Switch to light beer. Alternate alcoholic drinks with water or soft drinks.
  • Order half nips of spirits.
  • Don't fill wine glasses to the top.
  • Have a spritzer or shandy (wine or beer mixed with non-alcoholic soda or mineral water).
  • Wait until your glass is empty before topping it up to help keep count of your drinks.
  • Have a few alcohol-free days during the week, especially if you are a regular drinker.
  • Eat while you drink to slow your drinking pace and to fill you up.
  • Avoid salty snacks, which make you thirsty so you drink more.
  • Offer to be the designated driver so that you don't drink or limit your alcohol intake.
Information reviewed by:
Dr Kate Webber, Cancer Survivorship Research Fellow and Medical Oncologist, NSW Cancer Survivors Centre; Kathy Chapman, Director, Health Strategies, Cancer Council NSW; Janine Deevy, Adolescent and Young Adult Cancer Care Coordinator, Royal Brisbane and Women's Hospital, QLD; Dr Louisa Gianacas, Clinical Psychologist, Psycho-oncology Service, Calvary Mater Newcastle, NSW; Tina Gibson, Education and Support Officer, Cancer Council SA; A/Prof Michael Jefford, Senior Clinical Consultant at Cancer Council VIC, Consultant Medical Oncologist, Peter MacCallum Cancer Centre and Clinical Director, Australian Cancer Survivorship Centre, VIC; Annie Miller, Project Coordinator, Community Education Programs, Cancer Council NSW; Micah Peters, Project Officer, Education and Information, Cancer Council SA; Janine Porter-Steele, Clinical Nurse Manager, Kim Walters Choices, The Wesley Hospital, QLD; Ann Tocker, Cancer Voices; and A/Prof Jane Turner, Department of Psychiatry, University of Queensland.