Lifestyle Medicine for High-Risk Cancer Patients

Woman in exercise gear looking at her smart watch
Article Summary
  • Sylvester Comprehensive Cancer Center’s High-Risk Lifestyle Medicine, Prevention and Digital Health program offers lifestyle modification medicine for high-risk cancer patients.
  • Current research says behavior modifications like a healthy diet and regular exercise can reduce cancer risk.
  • As a National Cancer Institute cancer center, Sylvester has access to the latest clinical trials that they can match to a patient’s specific needs.

A new initiative at Sylvester Comprehensive Cancer Center, a part of UHealth – University of Miami Health System, offers people at high risk for cancer personalized lifestyle modifications and support programs aimed at reducing their risk.

The High-Risk Lifestyle Medicine, Prevention and Digital Health program is part of the Diamond Hereditary Cancer Prevention Initiative.

“The latest evidence suggests modifiable behaviors within each person’s control, like regular exercise and following a healthy diet pattern, can attenuate overall cancer risk even in the presence of genetic mutations that increase a person’s risk for cancer, such as with BRCA or Lynch syndrome,” said Tracy E. Crane, Ph.D., RDN, director of lifestyle medicine, prevention and digital health and co-lead of the Cancer Control Program at Sylvester. “We also know that individuals who have a history of cancer are at elevated risk for a second cancer. The new program focuses on helping survivors and their support persons to reduce cancer risk with healthy lifestyle behaviors.”

Sylvester Comprehensive Cancer Center researcher Dr. Tracy Crane
Dr. Tracy Crane leads a number of lifestyle-based clinical trials for Sylvester.

The program incorporates traditional risk assessment derived from family history and genetics with patient-generated exercise, diet, activity and sleep data recorded by digital tools like Fitbits and Apple watches. The data is then analyzed using Sylvester’s My Wellness Check and My Wellness Research data platforms. Tobacco and alcohol use are also factored into individualized assessments and treatment plans, according to Dr. Crane.

The work requires multiple disciplines striving for a shared goal.

Nicholas A. Borja, M.D., Sylvester researcher and assistant professor of clinical and translational genetics at the University of Miami Miller School of Medicine, evaluates patients suspected of having a germline variant that predisposes them to cancer.

Dr. Nicholas Borja
Dr. Nicholas Borja says that positive lifestyle changes are particularly important for people who are genetically predisposed to cancer.

BRCA1 and BRCA2 gene mutations are among the most common disease-causing variants. They’re associated with increased breast, ovarian and prostate cancer risks. Lynch syndrome genes — also within Dr. Borja’s purview — increase colorectal cancer risk.

“Even for cancer that is driven by significant genetic predisposition, there is some element of randomness or chance,” Dr. Borja said. “Having genetic risk does not mean that there’s nothing you can do. In fact, it may mean there is even more at stake for taking your health into your own hands.”

Fifty percent of all cancers are related to modifiable factors, according to Paola Rossi, M.D., M.S.Ed., clinical program director for lifestyle medicine at Sylvester, who orchestrates the work of Sylvester’s health coaches.

Sylvester Comprehensive Cancer Center researcher Dr. Paola Rossi
Dr. Paola Rossi orchestrates the work of Sylvester’s health coaches.

“We’ve hired a new health coach for the high-risk clinic to evaluate and provide care for proven lifestyle medicine pillars in cancer prevention, focusing on healthy eating, physical activity, tobacco cessation and weight management,” Dr. Rossi said. “The health coach will meet with patients and identify weak spots in their behaviors that, if targeted, could reduce cancer risk.”

Sylvester’s National Cancer Institute cancer center designation empowers the organization to tap into prevention and supportive care programs and clinical trials to create comprehensive, evidence-based patient care.

“As a National Cancer Institute-designated cancer center, we are uniquely positioned to integrate innovative and transformative research opportunities in our cancer prevention and care operations,” said Frank J. Penedo, Ph.D., associate director for population sciences and director of Cancer Survivorship and Supportive Care at Sylvester.

Dr. Frank Penedo
Dr. Frank Penedo says Sylvester’s NCI cancer center designation gives patients access to valuable resources.

Precision Oncology Interventions in Nutrition and Training (OnPOINT) explores the impact of tailored diet and physical activity interventions on colorectal cancer patient recommendation adherence, quality-of-life, physical function, nutrition and body composition. The VITALITY study compares the effectiveness of virtually supervised and remotely monitored diet and exercise intervention in cancer survivors older than 65 years and their caregivers.

Programs like Believe in You, an 18-week training program that teaches cancer survivors how to live a healthier lifestyle, sprang from Sylvester’s lifestyle research.

Jessica MacIntyre, D.N.P., ARNP, NP-C, AOCNP, executive director for Sylvester’s clinical operations, says the High-Risk Lifestyle Medicine, Prevention and Digital Health program’s effectiveness stems from its ability to accurately assess individual risk.

“If a person has a genetic mutation, for example, we have a clinic called the Genetic Predisposition Syndrome Clinic,” she said, “which follows those patients and helps them to understand their risk from a specific mutation and provides them with screening recommendations and lifestyle modifications.”

Sylvester oncology nurse Jessica MacIntyre
Jessica MacIntyre points to Sylvester’s ability to personalize patient prevention and treatment plans as a key element of its success.

MacIntyre said her patients often ask her questions like, “If my mother had breast cancer when she was 30, am I at risk? Who can I talk to? And what can I do about it?”

“People want to advocate for themselves early on, especially now that we’re seeing more young patients diagnosed with cancer than we did in the past,” MacIntyre said.

“In the big picture, Sylvester’s new program will help to establish lifestyle medicine best practices and protocols for implementing screening along with lifestyle modifications and other recommendations to personalize cancer prevention in high-risk patients,” said Dr. Penedo.

Tags: Dr. Frank Penedo, Dr. Paola Rossi, Dr. Tracy Crane, Jessica MacIntyre, lifestyle medicine, Sylvester Comprehensive Cancer Center