The importance of healthy nutrition also cannot be overemphasized. The WCRF/AICR 2008 Summary of Food, Nutrition, Physical activity and the Prevention of Cancer: a Global Perspective recommendations regarding diet and physical fitness stress the importance of increasing plant foods and decreasing animal foods in our diet [38
]. According to the WCRF data, approximately a third of the cancers in Western, high-income countries are attributable to factors relating to food, nutrition and physical activity [43
]. Changing the patterns of behavior through increasing education, as well as other means, will be of great benefit in cancer prevention [44
]. Diets that are rich in cured meat or smoked meat and fish have been associated with an increased risk for childhood leukemia, while consumption of increased vegetables and bean-curd were associated with a decreased risk [45
The benefits of increased adherence to a plant-based diet similar to the Mediterranean style diet have been shown in a number of studies and in one recent meta-analysis involving 1.5 million patients [46
]. Those people who had increased adherence to the Mediterranean diet had a 9% reduction in overall mortality, 9% reduction in cardiovascular mortality, 6% reduction in cancer mortality and 13% decreased incidence of Parkinson’s and Alzheimer’s disease. Unfortunately, most people do not comply with the Mediterranean diet recommendations [47
Children with acute lymphoblastic leukemia (ALL) are at increased risk for cardiovascular disease and obesity as complications of their cancer treatment [49
]. Increased adherence to dietary recommendations regarding the Mediterranean plant-based diet may decrease the risk for these complications [46
]. Unfortunately, many survivors do not follow these dietary recommendations. In a group of 72 adult survivors of childhood ALL surveyed regarding their dietary patterns, no study participant reported complete adherence to any of the guidelines set forth by the WCRF/AICR, the Dietary Approaches to Stop Hypertension (DASH) diet, or the 2005 USA Department of Agriculture food guide [49
]. Approximately half of the participants reported consuming at least five servings of fruits and vegetables per day, adhering to the AICR recommendations; however, the consumption of both sugar and sodium were above the AICR guidelines and consumption of whole grains was inadequate.
An analysis of dietary adequacy was undertaken in patients who received treatment for B-cell lymphoma at the MD Anderson Cancer Center [50
] and 94% of participants were found to have either excessive or inadequate intakes of nutrients, including folate, vitamin A, iron, selenium and calcium. Of particular concern is that high dietary vitamin A intake may increase the risk of lung cancer in smokers [39
], while selenium may increase the risk of prostate cancer in men [36
The decreased level of activity present in children who have leukemia has been studied extensively [51
]. Implementing physical fitness programs, both during the acute hospitalization phase [60
] and following the cancer treatment, may be beneficial for decreasing side effects, such as osteoporosis, decreased muscle tone and slowing the weight gain often associated with postcancer treatment [43
]. These programs will also assist in establishing healthy lifestyle habits for decreasing secondary cancer risks in this population.
A 3-week in-patient walking program intervention consisting of 12 min of daily walking significantly improved fatigue, and decreased symptoms of distress and depression in patients undergoing bone marrow transplantation [60
]. Another study evaluating the effects of increased fitness on decreasing osteoporosis for children undergoing treatment for ALL [61
] did not show any benefit; however, the exercise intervention group did regain their pretreatment weight through significantly faster weight loss compared with the control group. The authors postulated that the lack of improvement in bone mineral density was due to the low level of patient adherence to the fitness program and recommended that future studies find methods to increase patient participation.