How to integrate a lifestyle medicine conversation into a 20-minute oncology consultation
By Dr Zahra Kassam and Dr Shireen Kassam
Oncology consultations are focused on treatments and symptom management. However, lifestyle factors such as nutrition, physical activity, sleep, and stress management, can significantly impact treatment tolerance, recovery, quality of life, survival outcomes, and in some cases improve response to treatments.
While time constraints may make it challenging to discuss lifestyle medicine, a structured approach can help healthcare providers incorporate it into a 20-minute consultation in a way that is practical and meaningful for patients. Small, achievable adjustments in diet, movement, and stress management can make a significant difference in how patients feel during treatment.
For the oncologist, this requires modification of the usual consultation style from an ‘expert approach’ to a ‘coach approach’, in which the patient-doctor relationship is used to identify a patient’s motivation, values, challenges and strengths in order to support behaviour change. In addition to sharing information, the oncologist will need to use skills such as mindful listening, asking open ended questions and promoting self-efficacy. The key is to make these conversations simple, patient-centred, and focused on manageable changes.
A Structured Approach: The 5-Step Model for a 20-Minute Consultation
Using a 5-step framework, lifestyle medicine can be addressed efficiently without overwhelming the patient.
- Connect and Assess (First 5 Minutes)
Start by understanding where the patient is in their journey:
- “How have you been feeling physically and emotionally?”
- “Are there any daily habits, such as diet, movement, or sleep, that are helping or making things harder?”
This approach builds rapport and helps identify areas where small improvements may be possible.
- Nutrition: Focus on Small, Simple Changes (5 Minutes)
Patients often ask what they should eat during treatment. Instead of overwhelming them with a complete diet overhaul, review the cancer guidelines from the American Institute of Cancer Research and focus on achievable steps:
- Encourage more plant-based, whole foods:
- Tailor suggestions to symptoms: For nausea, bland but nutrient-dense options such as oatmeal or smoothies work well. For low appetite, small, frequent meals can help.
- Offer some simple action: “Would you be open to adding one extra serving of vegetables each day?” “would you be open to reducing your processed meat and red meat consumption?”
- Physical Activity: Moving in Any Way Possible (3-5 Minutes)
Many patients assume they should avoid exercise during treatment, but gentle movement can boost energy and improve mental well-being, and in some cancers such as colon, breast and prostate improve survival outcomes.
- Adapt to energy levels: If they feel weak, suggest chair exercises or deep breathing. If stronger, a short daily walk is beneficial.
- Keep it achievable: “Would you feel comfortable trying a 5-10 minute walk or some gentle stretching?”
- Discuss the goal of 150 minutes of moderate physical activity weekly
- Stress and Emotional Well-being (3-5 Minutes)
Cancer treatment is emotionally challenging, yet stress management is often overlooked. Acknowledge their experience and offer simple tools:
- “It’s normal to feel overwhelmed. Are there any activities that help you relax?”
- Introduce mindfulness techniques: “Some patients find deep breathing or journalling helpful. Would you like a short guide on this?”
- Encourage social support: “Talking with loved ones or joining a support group can help. Do you have someone to lean on?”
- Closing: One Personalised Takeaway (Final 2 Minutes)
Wrap up the conversation by identifying one small, realistic step the patient can take:
- “It sounds like adding one serving of vegetables and taking a short walk daily could be good starting points. Does that feel manageable?”
- Provide a simple resource: A handout or website can reinforce key messages.
- Reassure and encourage progress: “We’ll check in on this next time, and we can adjust as needed.”
Final Thoughts
Incorporating lifestyle medicine into a cancer consultation doesn’t require lengthy discussions, it’s about offering small, practical steps that patients can integrate into their daily lives. By using a structured, patient-centred approach, healthcare providers can seamlessly introduce these conversations, helping patients feel more empowered in their treatment journey, and building a deeper sense of connection and trust between the patient and healthcare provider. Even in a short consultation, these discussions can make a meaningful impact on a patient’s well-being, treatment tolerance, and overall outcomes.
References
- Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116. PMID: 31626055; PMCID: PMC8576825.
- Frates EP, Bonnet J. Collaboration and Negotiation: The Key to Therapeutic Lifestyle Change. Am J Lifestyle Med. 2016 Jul 8;10(5):302-312. doi: 10.1177/1559827616638013. PMID: 30202286; PMCID: PMC6125074.
- Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. J Clin Oncol. 2022;40(22):2491-2507. doi:10.1200/JCO.22.00687
- Rock CL, Thomson C, Gansler T, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin. 2020;70(4):245-271. doi:10.3322/caac.21591
- Sharman R, Harris Z, Ernst B, Mussallem D, Larsen A, Gowin K. Lifestyle Factors and Cancer: A Narrative Review. Mayo Clin Proc Innov Qual Outcomes. 2024 Mar 4;8(2):166-183. doi: 10.1016/j.mayocpiqo.2024.01.004. PMID: 38468817; PMCID: PMC10925935.
- World Cancer Research Fund International, Dietary and lifestyle patterns for cancer prevention.
- World Cancer Research Fund International, After a cancer diagnosis, follow our recommendations, if you can.
Resources to share with patients:
A Community Guide to Cancer Nutrition