Originally published as JCO Early Release 10.1200/JCO.2008.20.1871 on November 17 2008

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Mediterranean Lifestyle Should Affect Health-Related Quality of Life Among Cancer Survivors

Tommaso Cai, Nicola Mondaini, Riccardo Bartoletti

Department of Urology, University of Florence, Florence, Italy

To the Editor:

We read with great interest the article by Blanchard et al¹ concerning the correlation between the American Cancer Society's recommendations and health-related quality of life (HRQoL) among patients who were survivors of six major cancers. In this well-designed and well-performed study, the authors show important associations between physical activity, fruit and vegetable consumption, smoking, and HRQoL, which should be taken into account in everyday clinical oncology practice. Therefore, in their study, the authors demonstrate clearly that interventions to increase physical activity and fruit and vegetable consumption and to reduce smoking had additive effects on the HRQoL of all evaluated patients who were cancer survivors. Nevertheless, we would like to present some additional considerations regarding their study. First, among all the cancer survivors, the patients who were survivors of bladder cancer made up the lowest percentage of patients to meet the recommendations for smoking (82.6%). Why? Do the authors think this was related to the fact that the patient with bladder cancer is, more frequently, a strenuous smoker? Do the authors think this was because of incorrect or unclear information from physicians about the risk of developing new bladder cancer or a bladder cancer recurrence? Second, was the percentage of cancer survivors who met the American Cancer Society's recommendations low because this study was carried out in the United States? In other words, we would like to emphasize that the reported low percentages, particularly in fruit and vegetable consumption, could also have been because of the lifestyle and dietary habits in the United States, even if higher percentages of adults in the healthy US population met the correct lifestyle recommendations.² Third, red wine is a fundamental component of the Mediterranean diet, and regular and moderate consumption is linked to reduced risk of coronary heart disease and lower overall mortality.^3,4 Consequently, the question is, what do the authors think about the role of regular and moderate consumption of red wine in modifying the cancer survivors’ HRQoL? The last consideration is related to the correlation between smoking habits and sex among bladder cancer survivors. Recent studies have demonstrated that controlling exposure to smoking has made an important contribution to the reduction in bladder cancer mortality, particularly among men.⁵ The question is, among bladder cancer survivors, what correlation was found between sex of patients, when patients began smoking, and length of smoking exposure?

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

NOTES

published online ahead of print at www.jco.org on November 17, 2008.

REFERENCES

1. Blanchard CM, Courneya KS, Stein K: Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: Results from the American Cancer Society's SCS-II. J Clin Oncol 26:2198-2204, 2008[Abstract/Free Full Text]

2. Centers for Disease Control and Prevention: Behavioral risk factor surveillance system survey data. Atlanta, GA, Centers for Disease Control and Prevention, US Department of Health and Human Services, 2005

3. Corder R, Mullen W, Khan NQ, et al: Oenology: Red wine procyanidins and vascular health. Nature 444:566, 2006[CrossRef][Medline]

4. Das S, Santani DD, Dhalla NS: Experimental evidence for the cardioprotective effects of red wine. Exp Clin Cardol 12:5-10, 2007

5. Pelucchi C, Bosetti C, Negri E, et al: Mechanisms of disease: The epidemiology of bladder cancer. Nat Clin Pract Urol 3:327-340, 2006[CrossRef][Medline]

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Related Reply

• In Reply:
  Kevin Stein, Chris M. Blanchard, Kerry S. Courneya, and Colleen Doyle
  JCO 2008 26: 6015-6016 [Full Text]

Related Article

• Cancer Survivors’ Adherence to Lifestyle Behavior Recommendations and Associations With Health-Related Quality of Life: Results From the American Cancer Society's SCS-II
  Christopher M. Blanchard, Kerry S. Courneya, and Kevin Stein
  JCO 2008 26: 2198-2204 [Abstract] [Full Text]

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