Abstract
There is an ongoing need for solid evidence about the effects of healthy behaviors, and particularly diet, on the quality of life (QoL) among breast cancer survivors. We first conducted a cross-sectional study on 68 Italian stage I-III breast cancer survivors, to investigate the association of adherence to the Mediterranean diet (MD), physical activity and weight status with QoL. Adherence to MD and physical activity was assessed using structured questionnaires. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality-of-Life tools. We showed that low consumption of red meat and carbonated beverages, daily consumption of wine and high consumption of dishes seasoned with sofrito had beneficial effects on several QoL subscales. By contrast, using olive oil as the main culinary fat, low consumption of commercial sweets and high consumption of nuts were associated with negative effects. Overall, these findings resulted in a null effect of adherence to MD on QoL. Furthermore, we observed better QoL sub-scores among women who performed moderate physical activity (i.e., diarrhea) and those who were underweight/normal weight (i.e., physical functioning and dyspnea) if compared with their counterparts (p-values ≤ 0.003 after correction for multiple comparison). Next, we performed a systematic review of nine experimental studies to summarize whether dietary interventions might improve QoL among breast cancer patients. All the studies demonstrated significant improvements in overall QoL and/or its subscales after the interventions. However, differences in study design, interventions and tools used for QoL assessment did not allow us to provide an overall estimate. Moreover, only a single-arm trial evaluated the effect of an exclusive dietary-based intervention, while others combined dietary recommendations with physical activity and weight loss programs. For these reasons, our study encourages more efforts to improve the robustness of current evidence, through more homogenous tools, larger population-based studies and further randomized controlled trials.
Highlights
Breast cancer is the most common cancer among women worldwide [1], with an incidence that increased over the past decades, accounting for 2.09 million cases and 627.000 deaths in 2018 [2].Recent strides in breast cancer diagnosis and treatment ameliorated patients’ care [3], which resulted in a growing number of survivors in developed countries [4]
We conducted a cross-sectional analysis showing that low consumption of red meat and carbonated beverages, daily consumption of wine and high consumption of dishes seasoned with sofrito were associated with better scores for several quality of life (QoL) subscales
Mediterranean diet (MD) is characterized by some typical products—for example, olive oil, fish and nuts—that seemed to have a negative effect on several QoL subscales
Summary
Breast cancer is the most common cancer among women worldwide [1], with an incidence that increased over the past decades, accounting for 2.09 million cases and 627.000 deaths in 2018 [2].Recent strides in breast cancer diagnosis and treatment ameliorated patients’ care [3], which resulted in a growing number of survivors in developed countries [4]. Breast cancer survivors exhibit an increased risk for secondary tumors, cardiovascular disease, diabetes [5,6,7] and reduced quality of life (QoL) [8,9]. Considering that breast cancer and its treatments are associated with adverse effects [10,11], the survivors represent an important target population for promoting prevention strategies [12]. The American Cancer Society (ACS) guidelines for cancer survivors recommend to consume vegetables, fruits and whole grains regularly [13], and previous evidence showed that the promotion of a healthy diet might reduce the risk of recurrence [14], stress and breast/arm symptoms [15]. Tangney and colleagues reported a negative correlation with depression, assessed by the Center for Epidemiologic Studies Depression scale (CES-D)
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