American Society of Clinical Oncology (ASCO): Initiatives to Reduce the Impact of Obesity on Cancer
Obesity and Cancer: ASCO Position Statement Summary
The American Society of Clinical Oncology (ASCO) released a policy statement on initiatives to limit the harmful effects of obesity on cancer, and to prevent obesity-related cancers. Here, part 2 of this series summarizes ASCO’s 4-pronged approach to reduce the impact of obesity on cancer. Part 1 is an introduction to the topic and an overview of the position statement.
Education and Awareness
A majority of Americans are unaware of the link between obesity and the risk of cancer. While many oncologists and other health care professionals are aware of this link, they may lack training in initiating conversations with patients about this topic and on weight management strategies.
To address these gaps in knowledge, ASCO is working to educate oncologists and oncology fellows on the role of obesity in cancer risk and the adverse effects of obesity on cancer-related outcomes, including mortality. Past initiatives aimed at practicing oncologists have included obesity-related education at ASCO clinical meetings and in publications.
The American Society of Clinical Oncology also is working to educate the public on this topic and has already developed resources for patients on nutrition, physical activity, and weight management.
Clinical Guidance, Tools, and Resources
To ensure that oncologists are better equipped to integrate obesity prevention and management into the care of their patients, and that patients have access to needed services, ASCO is working to develop weight management guidelines for cancer survivors, tools for initiating conversations about weight loss with patients, and resources to help patients manage their weight. In 2014, ASCO issued a toolkit for oncology providers to support conversations with patients about the effects of obesity on cancer risk and cancer-related mortality. The toolkit includes information on assessing body mass index (BMI), strategies to initiate weight loss and weight management in cancer survivors, a guide to selecting treatment, clinical practice guidelines on obesity, and information on insurance coverage for weight management services. A companion guide for patients also is available.
While research has linked obesity with an increased risk of cancer and mortality in patients with cancer, many critical areas of research are needed to translate current knowledge into effective treatment and prevention strategies. ASCO's policy statement calls for the development of a comprehensive, coordinated research agenda to address key questions, including:
- Do weight loss and other lifestyle changes reduce the risk of developing cancer or cancer-related mortality?
- Should obesity be treated differently in cancer survivors versus people without a history of cancer?
- Should weight management interventions be initiated in patients undergoing cancer treatment or after completion of initial therapy?
- What is the best method for disseminating weight management programs to all cancer survivors who need them, especially among patients in underserved populations?
To encourage research in this field, ASCO hosted a multidisciplinary summit in November 2014 to discuss elements of successful lifestyle interventions for cancer survivors and potential opportunities to conduct large-scale interventional studies in cancer survivors. The summit was open to investigators who specialize in medical oncology, nutrition, physical activity, and behavioral medicine.
“Research has clearly established that there is a critical relationship between cancer and obesity, but more work is needed to determine whether weight loss, increased physical activity and improved dietary quality can lower cancer rates and improve outcomes,” said ASCO Energy Balance Working Group Chair Jennifer A. Ligibel, MD, who also is on ASCO’s Cancer Survivorship and Cancer Prevention Committees. “No single organization or medical specialty can address obesity alone, and we will collaborate with other groups to find evidence-based solutions for our patients,” Dr. Ligibel said.
Obtaining funding for these research endeavors is challenging and ASCO will advocate for increased funding for key gaps in knowledge from both public sources and nontraditional funding sources. Other strategies include promoting research on obesity through the Conquer Cancer Foundation and other philanthropic groups. ASCO noted that the National Cancer Institute currently has ongoing research initiatives in this area.
Policy and Advocacy
ASCO is committed to advocating for policy and systems changes to improve access to nutrition and exercise counseling services for patients with cancer. This includes advocating support for healthy community and workplace environments at the national level, and encouraging oncologists to advocate for institutional (eg, school, worksite), community, and state-level strategies to improve access to nutrition and physical activity resources for their patients.
The American Society of Clinical Oncology statement highlights the need to close gaps in private and public insurance coverage of weight management services and encourages the Department of Health and Human Services to define access to obesity treatment services in the new state health insurance exchange plans under the Affordable Care Act.
ASCO also described the role of the oncologist and cancer care team in implementing weight loss programs for patients. ASCO noted that it is essential to have a partnership between oncologists, primary care providers, and specialists in behavioral change (eg, dietitians, physical therapists, exercise specialists) to successfully implement weight loss programs.
Initiating conversations about weight management is the first step to helping patients lose weight and ASCO outlined an approach that includes the following:
- Calculate the patient’s BMI.
- Inform the patient of their weight status and whether there is a need to lose or gain weight.
- Encourage regular physical activity and a healthy eating from the time of cancer diagnosis through long-term follow up in all patients, regardless of their BMI.
- Refer patients to specialty care if needed, including oncology nutrition, rehabilitation medicine, and exercise physiology.
Oncologists and the oncology care team can support their patients by leading through example. Sharing personal experiences about trying to lose weight and physical activity can help motivate patients, as can taking part in community events that promote physical activity and healthy living.
June 26, 2015