Lifestyle Medicine and Its Implications for Patients with Cancer: Dr Leah Tonkin

Conference:

2024 West Oncology Virtual Conference for Advanced Patient Practicioners (APP)

Presenter:

Leah Tonkin, MD, MBA, DipABLM, West Cancer Center

At the 2024 West Oncology Virtual Conference for Advanced Patient Practicioners (APP) Dr Leah Tonkin presented on the topic of Lifestyle Medicine, exploring the role of evidence-based lifestyle interventions in cancer care. She noted that, by addressing modifiable risk factors, lifestyle medicine can support patients in managing chronic diseases, improve quality of life, enhance treatment outcomes, and reduce cancer recurrence. Her presentation focused on the core pillars of lifestyle medicine, highlighting actionable strategies for clinical integration.

Introduction to Lifestyle Medicine

Lifestyle medicine focuses on preventing, treating, and reversing chronic illnesses by modifying behaviors associated with poor health outcomes. Chronic diseases, including heart disease, cancer, and diabetes, represent the leading causes of death and disability in the United States. Dr Tonkin highlighted that 6 in 10 adults have at least one chronic disease, and 4 in 10 have two or more, often driven by unhealthy behaviors such as poor diet, physical inactivity, smoking, and excessive alcohol consumption. For cancer patients, lifestyle medicine can be transformative, improving prognosis and quality of life while mitigating recurrence risks. Evidence suggests that 75–90% of chronic diseases, including many cancers, are preventable through lifestyle changes.

The Core Pillars of Lifestyle Medicine

1. Nutrition

Nutrition is the cornerstone of lifestyle medicine. Poor dietary habits are the leading contributors to early death in the U.S., and evidence supports a predominantly plant-forward diet, emphasizing whole, minimally processed foods rich in fiber, nutrients, and antioxidants. This dietary approach can reduce cancer risk, support treatment, and may even reverse some chronic conditions.

Dr Tonkin highlighted data from some especially impactful studies, including:

• A nine-year study of early-stage breast cancer patients which showed a 50% reduction in mortality with daily intake of five fruits and vegetables, combined with 30 minutes of exercise, five days per week.

• Regular consumption of lignans (found in flaxseeds, sesame seeds, and cruciferous vegetables) was associated with a 51% reduction in all-cause mortality and a 71% reduction in breast cancer-specific mortality.

As such, clinicians should be encouraged to incorporate dietary counseling into their practice, which can help patients to adopt sustainable, nutrient-rich eating habits.

2. Physical Activity

Regular exercise can combat the negative effects of sedentary behavior and improve cardiovascular health, metabolic function, and immune responses. Accordingly, the American College of Lifestyle Medicine (ACLM) and the World Health Organization (WHO) recommend:

• 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity weekly.

• Strength training exercises two to three times per week.

Dr Tonkin also presented some compelling data on exercise and cancer:

• A meta-analysis of some 12,000 breast cancer patients showed a 34% reduction in breast cancer mortality and a 24% reduction in recurrence among those engaging in regular physical activity.

Non-Exercise Activity Thermogenesis (NEAT)—Dr Tonkin noted that everyday movements like walking during breaks, taking the stairs, or parking farther from work—has been emphasized as an accessible way to increase daily energy expenditure. In addition, studies have linked NEAT to improved glucose control, lower rates of obesity, and better overall health outcomes.

3. Restorative Sleep

Restorative sleep is critical for both physical and mental well-being. Dr Tonkin explained that inadequate sleep has been linked to increased risk of obesity, diabetes, cardiovascular disease, and cancer. Among cancer patients, poor sleep can also impair treatment efficacy, worsen side effects, and negatively affect overall survival.

The ACLM and the American Academy of Sleep Medicine have recommended 7–9 hours of sleep per night, ideally aligned with the body’s natural circadian rhythms. She noted that modern tools like sleep trackers can help patients optimize their sleep habits. Strategies for improving sleep also include maintaining a consistent bedtime, minimizing screen time before sleep, and creating a relaxing pre-sleep routine.

4. Stress Management

Chronic stress can exacerbate many health conditions, including cardiovascular disease, depression, and obesity, and can impair overall adherence to healthy behaviors. While stress does not directly cause cancer, it can negatively influence both immune function and recovery.

Dr Tonkin highlighted some practical techniques for stress reduction, including:

• Box Breathing: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, and hold for 4 seconds.

• 4-7-8 Breathing: Inhale for 4 seconds, hold for 7 seconds, and exhale for 8 seconds.

These breathing exercises activate the parasympathetic nervous system, helping to reduce stress and foster relaxation. Other interventions include yoga, meditation, and gratitude practices, all of which can enhance emotional resilience and mental clarity.

5. Social Connection

Social connection is also essential for both physical and mental health. Studies have shown that social isolation is linked to poorer survival rates in breast, lung, and colorectal cancers. In contrast, strong social networks can help to reduce stress, bolster the immune system, and encourage healthy behaviors.  Dr. Tonkin suggested fostering meaningful daily interactions, whether through family, friends, or brief encounters with strangers. Even small gestures, like smiling, can trigger dopamine and serotonin release, promoting feelings of happiness and well-being.

6. Avoidance of Risky Substances

Substance use—including tobacco, alcohol, and recreational drugs—remains a significant contributor to cancer risk and chronic disease burden. Tobacco alone is the leading preventable cause of morbidity and mortality in the U.S., and alcohol is a known carcinogen associated with several cancers, including breast, colorectal, and liver. Encouraging patients to reduce or eliminate risky substances can significantly improve health outcomes. Dr Tonkin also noted the growing "sober curious" movement, where individuals reduce alcohol consumption for improved physical and mental health.

Practical Implementation in Clinical Practice

Dr. Tonkin emphasized the importance of patient-centered approaches as a means for implementing positive lifestyle changes. By listening to patients’ concerns and assessing their confidence in adopting new habits, clinicians can work collaboratively with patients to set achievable goals.

‘SMART’ Goals—Dr Tonkin emphasized SMART Goals which are Specific, Measurable, Achievable, Relevant, and Time-bound—help patients build positive momentum. For instance, a SMART goal could be: "I will walk with a friend for 10 minutes after dinner three times a week." She also encourages providers to connect patients with resources, including lifestyle medicine programs and community support groups. Collaborative follow-ups can reinforce accountability and foster long-term adherence to healthy behaviors.

Final Takeaways

Summarizing her presentation, Dr Tonkin emphasized several key lifestyle medicine recommendations, including:

• Nutrition: Promote a plant-forward eating pattern, emphasizing whole, minimally processed foods.

• Physical Activity: Aim for at least 150 minutes of moderate or 75 minutes of vigorous exercise weekly, plus strength training.

• Restorative Sleep: Encourage 7–9 hours of high-quality sleep per night.

• Stress Management: Teach simple, effective stress reduction techniques to enhance coping.

• Social Connection: Facilitate opportunities for meaningful interactions.

• Avoid Risky Substances: Support patients in reducing or eliminating tobacco, alcohol, and other harmful substances.

Dr Tonkin concluded by emphasizing the role of lifestyle medicine in empowering patients to take control of their health. By addressing modifiable risk factors, clinicians can deliver more compassionate, holistic cancer care.  She also provided valuable resources to support the implementation of lifestyle medicine, including educational toolkits, CME opportunities, and patient handouts, which can serve as practical guides for integrating lifestyle interventions into oncology practice.

Speaker Disclosure Information: Dr Tonkin reported no relevant disclosures for this presentation.

You can see the full presentation on lifestyle medicine by Dr Tonkin here.