Questioning human nature to fight cancer

A program of physical activity, an adapted diet, psychological support and meditation.... A simple recipe that heralds a revolution in cancer treatment. In twenty years of research into what are known as non-drug interventions, theInstitut de recherche en cancérologie de Montpellier (IRCM) has acquired a leading position.

"We're entering an incredible era, " comments Gregory Ninot, professor at the University of Montpellier and researcher at the Epsylon laboratory. Enthusiasm is rife following the announcement by the French Minister of Health that supportive care will be reimbursed for people who have been treated for cancer.

Supportive care refers to a set of physical, dietary, educational and psychological methods that set the framework for personalized, science-based support for cancer patients undergoing chemotherapy, radiotherapy or surgery.

Complementary therapy

These non-medication interventions (NMIs) are not alternative medicines or occupational activities. They treat specific symptoms associated with the disease and the side effects of treatment, such as fatigue, stress or nausea. Based on precise specifications tailored to each patient, these treatments constitute "a truly targeted and personalized complementary therapy that accompanies and enhances the efficacy of anti-cancer treatments", insists the researcher.

The research of Gregory Ninot and his team was given a real boost when they were awarded the prestigious label of Site de Recherche Intégrée sur le Cancer (SIRIC). Research funds were obtained to carry out the first clinical trials on NMIs. This synergy between the hospital and the university has made us pioneers and enabled us to go beyond the purely mechanistic prism of cancer research," notes the researcher. Today, we understand that our mission is to question the human element and put human methods back at the heart of cancer care, such as NMIs".

Oncology care in its own right?

Clinical trials have clearly demonstrated the effectiveness of non-drug interventions in limiting resistance to anti-cancer treatments, for example. They have also validated the positive psychological impact of an approach that enables patients to play an active role in their own recovery. What's more, sufficiently-dosed physical activity programs could have an effect on the risk of recurrence of certain cancers. A study carried out on a cohort of patients following treatment for colon cancer revealed that their prescription reduced the risk of recurrence by 38%. " If clinical trials confirm the results of these observational studies, NMIs will become fully-fledged oncology treatments to be systematically prescribed for certain patients", explains Gregory Ninot.

Non-invasive, less costly care for the patient, which should therefore be reimbursed by Social Security. This should be the case by 2020. Today, research is continuing to "structure all these NMIs so that tomorrow, every patient can benefit from adapted solutions and appropriate support", concludes the researcher.

Physical activity, instructions for use

Long considered an accessory, physical activity is now recognized as a therapeutic solution in its own right during and after cancer treatment. And a proven one at that. A study published in 2016 compiling cohorts of 35,622 patients concludes that sufficiently intense and regular physical activity (3 hours per week) is associated with a 38% reduction in the risk of cancer mortality in breast, colorectal and prostate cancer.

And while it's never too late to do the right thing, patients should be offered an adapted physical activity program as soon as possible. " Not after treatment, as was the case 10 years ago, but as soon as the diagnosis is announced," recommends Grégory Ninot. "The spontaneous reflex when you're ill is to rest, which is relevant when you're suffering from the flu. But with cancer, this becomes counter-productive. The more you rest, the more fragile and tired you become. Specialists refer to this as the vicious circle of deconditioning. An inactive patient will lose muscle mass, making him or her less able to withstand treatment. " It's counter-intuitive, but effort will help combat fatigue.

"The more you rest, the more tired you get.

The question is how much effort, and at what dose? "We recommend a minimum of 2 hours of endurance and 1 hour of muscle strengthening per week", answers Grégory Ninot.

Adapted physical activity programs could even help slow the progression of certain cancers and prevent recurrence. " The basic idea is to slow tumor progression and help prevent recurrence by providing personalized physical activity that targets the patient's immune, metabolic, inflammatory and neuropsychological functions", says the specialist.

While studies are currently being conducted to validate these hopes, it has already been proven that sufficient, well-dosed physical activity can improve patients' quality of life and general condition, and reduce the side effects of treatment while reinforcing certain beneficial effects. "This is already a great deal, and encourages specialized oncology establishments to integrate adapted physical activity professionals into their care teams".

Eat better for less cancer

How can we eat better to limit the risk of cancer? " You need to follow the recommendations of the World Cancer Research Fund (WCRF), which are scientifically validated," answers Grégory Ninot. In practice:

• Limit consumption of red meat and charcuterie. "Red meat less than 4 times a week, and ham one slice a week".
• Eat a diet rich in fruit, vegetables, wholegrain cereals and pulses. " You need to eat more than 5 portions of fruit and vegetables a day, raw, cooked or in compote," explains Grégory Ninot.
• Limit consumption of fast food, industrial cooking and processed foods rich in fat, starch or sugar to "once a week maximum".
• Drink less than 7 glasses of alcohol for women and 14 glasses for men, no added salt, less sugar, "especially sugary drinks".

"These recommendations should also be followed after cancer treatment," explains Grégory Ninot. A patient who is too thin or has too much abdominal fat is less likely to respond well to treatment", adds the researcher, who advises people to adapt their diet to stay within a body mass index range (BMI = weight/height squared) of between 18.5 and 25.

Are there dietary supplements for cancer patients? Specific diets to adopt? Intermittent fasting to try? For the time being, the WCRF has not identified any solid scientific evidence of their efficacy," replies Grégory Ninot. " Food supplements may even interact with certain chemotherapies and reduce their efficacy, so we might as well avoid them.

Playing an active role in your own recovery

"The announcement of a cancer diagnosis is a shock that can generate difficult family, professional and social situations. Social isolation, job loss, the departure of a partner - in all cases, the consequences handicap the healing and resilienceprocess ," reports Gregory Ninot. Many symptoms, such as stress, chronic fatigue, sleep disorders, lack of motivation and smoking, are psychological in origin and can be resolved by targeted NMIs.

To help patients, supportive care departments such as the one at the ICM surround themselves with psychologists, hypnotherapists, therapeutic education specialists, serious game specialists, social workers and socio-aestheticians. Psychologists, for example, offer a meditation practice. "Mindfulness-based meditation (MSBR ) produces convincing results. People focus their attention on solving the problem, and there is greater adherence to treatment." This psychotherapeutic intervention enables participants to look at their illness differently, by listening to themselves more and better.