A new study shows that although oncologists are very aware of the link between obesity and cancer, they often do not refer patients to weight management interventions. These findings result from a survey on the perceptions and practice behaviors of oncologists with regard to diet, physical activity, and weight management in people with cancer – during and after active treatment. The results of the 2018 American Society of Clinical Oncology (ASCO) Oncology Workforce survey are published in the Journal of Oncology Practice (JOP) and were first presented at the recent American Institute for Cancer Research (AICR) 2019 Research Conference.
“Addressing obesity and weight management is a key component of cancer care – from prevention through survivorship. It is critical that we understand providers’ knowledge of the link between obesity and cancer, current practices, and where more support is needed,” said lead author and chair-elect of ASCO’s Cancer Prevention Committee, Dr. Jennifer A. Ligibel. “This survey helps to identify the barriers oncologists face in providing weight management interventions for their patients, and will help guide future work by ASCO and others in the oncology field.”
The survey of nearly 1,000 oncology providers show that their knowledge of the link between cancer and obesity – and their attention to weight management, physical activity, and diet in patients during and after cancer treatment – was high. However, that often does not result in patient referrals to weight management, physical activity, or diet programs, and the survey identified several barriers to providing weight management interventions to patients with overweight and obesity.
The vast majority of survey respondents agreed that there is strong evidence that having overweight or obesity affects cancer treatment outcomes (93%) and that addressing a patient’s weight if they have overweight or obesity should be a standard part of cancer treatment (89%). While 79% felt it was the responsibility of the treating physician to make recommendations related to nutrition and weight management, 83% also felt that clinicians needed more training to adequately address these issues in cancer patients, and 84% believed that weight, diet or physical activity interventions should be conducted by other clinical staff with relevant expertise.
The survey also found that during active treatment, most respondents assessed a patient’s body mass index (BMI) (72%) and physical activity level (78%) always or most of the time, but they were less likely to always or usually assess a patient’s diet (58%). The majority of respondents also reported that they always or most of the time advise patients to maintain a healthy weight or lose weight if overweight (67% during active treatment; 83% after treatment), increase physical activity levels (73% during active treatment; 83%; after treatment), and eat a healthy, balanced diet (77% during active treatment; 79% after treatment).
However, few respondents referred patients for weight management interventions always or most of the time (24% during active treatment; 33% after treatment), and made referrals to a dietitian always or most of the time (43% during active treatment). Most respondents agreed that a lack of time for counseling or to set up a referral (66%), perceived patient resistance to behavioral interventions (73%), and lack of available resources for referrals to interventions (63%) were barriers to providing these interventions.
Dr. Ligibel stressed the importance of understanding the impact of messaging between oncology providers and patients. She said, “I think we need to figure out how do we get to that next step, how do we go from thinking these things are important to actually helping your patients make a change after they have been diagnosed with cancer and are looking for positive things that they can do to impact their quality of life and their cancer outcomes.”