Dietary changes among cancer survivors G. MASKARINEC, MD, PHD, S. MURPHY, PHD, RD, D.M. SHUMAY, MA & H. KAKAI, MA (CANCER RESEARCH), Center of Hawaii, Honolulu, HI, USA MASKARINEC G., MURPHY S., SHUMAY D.M. & KAKAI H. (2001) European Journal of Cancer Care 10, 12±20 Dietary changes among cancer survivors Given the limited scientific knowledge about dietary factors that affect cancer recurrence, dietary guidelines for cancer survivors are similar to general recommendations on healthy eating. This study explored the patterns of and motivation for, dietary changes among cancer patients. We conducted in- personinterviewswith143cancersurvivorswhowerechosenfromamailsurveyoncomplementaryand alternative medicine among cancer patients. We applied qualitative analysis using the software package NUD*IST to sort and code the transcribed interviews. The majority of dietary changes reported by 69 cancerpatientsagreedwithcurrentnutritionalrecommendations,suchasdecreasingmeatandfatintake and increasing the consumption of vegetables and fruits. However, many diet changers also reported the intake of herbal and vitamin supplements, many with unproven effects. The major themes for changing diet were hopes that nutrition would increase well-being, maintain health and prevent cancer recurrence and beliefs that foods that cause or prevent cancer should be avoided and increased, respectively. Many cancer patients use non-scientific reasons when deciding on dietary changes and supplement use. Increasing communication with health care providers may prevent the use of extreme diets, unproven and possibly harmful supplements and reduce exaggerated hopes related to the benefits of a particular dietary regimen. Keywords: cancer, complementary medicine, alternative medicine, nutrition, dietary supplements. Cancer survivors INTRODUCTION Scientific knowledge about nutritional factors that may prevent the recurrence of, or death from, cancer is limited. In addition to animal experiments that support a low-fat diet to prevent the recurrence of breast cancer (Cohen et al.1993),severalstudies±primarilywithbreast cancer patients±have shown that changing dietary behaviour after cancer diagnosis may affect life expec- tancy. Obesity (Hebert et al. 1998; Saxe et al. 1999) increased the risk of recurrence and death among breast cancer patients suggesting that energy intake per se may lower survival among cancer patients. Saturated fat intake (Hebert et al. 1998; Saxe et al. 1999) has also been associated with poorer outcomes. Whereas dietary fat intake was not associated with survival in the Nurses'Healthstudy(Holmes et al.1999),omega-3fatty acids, lutein and zeaxanthin, poultry, fish, vegetables, fibre and protein were associated with increased survi- val.Otherstudies(Ingram1994;Jain&Miller1997)have describedaprotectiveeffectoffruitandvegetableintake on breast cancer survival. Fat, selenium, vitamin E, and soy may have beneficial effects for prostate cancer patients (Lee & Fair 1999). Based on some case studies of pancreatic cancer (Carter et al. 1993), a possible role Correspondence address: Gertraud Maskarinec, MD PhD, Cancer Research of Hawaii, 1236 Lauhala Street, Honolulu, HI 96813, USA (e-mail: gertraud@crch.hawaii.edu). European Journal of Cancer Care, 2001, 10, 12±20 Paper 245 DISC # 2001 Blackwell Science Ltd Ahed Bhed Ched Dhed Ref marker Fig marker Tab marker Ref end Ref start