Introduction
Healthcare system practice guidelines represent systematically-developed statements intended to assist practitioners and patients in making decisions about relevant health care for a specific case or circumstance. Such guidelines provide a definition of relevant diagnostic and treatment aspects in the management of a health condition. These recommendations are based on evidence gathered from systematic reviews and the synthesis of up-to-date literature on a given topic.
It is notable that practice guidelines are not step-by-step protocols that must be followed. Rather, the information provided in them is there for practitioners to consider. For the purpose of the current evaluation, it was chosen to focus on the American Cancer Society (ACS) guidelines on nutrition and physical activity for Cancer Prevention. The aim of the guideline is to reduce the risks of cancer development in a population through the promotion of physical activity and healthy food choices.
Guidelines Overview
The ACS nutrition and physical activity guidelines are intended to serve as a foundation to communicate strategies and policies aimed at enhancing dietary and physical activity choices among Americans. The guidelines are updated approximately every five years on the basis of studies conducted by scholars in the areas of cancer research, prevention, public health, policy development, and epidemiology. Evidence gathered by the researcher is necessary to make suggestions on the relevant physical activity and dietary procedures. It is notable that within the guidelines, a special importance is placed on fostering a positive physical and social environment that will help all individuals, regardless of social status, to have great opportunities of choosing healthy behaviors.
For many problems that are concerned with cancer and dietary choices, the evidence is ambiguous as the published results remain inconsistent while the methods of studying nutrition are changing. For example, uncertainties arise because of the oversimplification of such aspects as the complexity of foods, with great importance placed on timing, dose, and duration of exposure to foods.
Research on physical activity is also challenging, especially since cancer endpoints require many years of follow up while rates at which individuals undertake exercises are inconsistent. Thus, “inferences about the many complex interrelationships between body weight, physical activity, diet, and cancer risk are therefore based […] on a combination of shorter-term clinical trials and observational studies” (p. 31). The totality of evidence from such sources represents the main basis for the guidelines.
Holding Professionals Accountable
For different professionals in the healthcare system, the guideline represents a framework for guiding their operations. For nurses who deal with patients diagnosed with different types of cancer, it is essential to develop a cohesive diet and physical activity plans to sustain their treatment. Nurses should pay attention to the aspect of affordability of healthy foods for their patients as well as identify any barriers that prevent their patients from sustaining a healthy diet. In many ways, avoiding unhealthy weight gain goes beyond the personal responsibility of patients and is also associated with the roles that nurses play.
While the guidelines do not specifically mention the part pharmacists play in the prevention of cancer through diet and exercise, inferences from the recommendations can be made. ACS calls for the implementation of multidisciplinary collaboration at local, state, and national levels to implement necessary changes. The shifts in policies and practices are concerned with increasing access to affordable and healthy foods, as well as providing safe and enjoyable environments for physical activities. Pharmacists are also expected to participate in the initiative through offering affordable dietary supplements and vitamins to support healthy diet choices.
The role of health policymakers is especially relevant to the current guidelines as they are the ones that have the most influence on the shaping of the relevant behaviors associated with healthy life choices. According to the authors of the guidelines, “although Americans would like to adopt healthy lifestyles, many of them encounter barriers that make it difficult to follow diet and activity guidelines” (p. 32).
Because of this, policymakers should be the ones to implement systematic changes to enhance the social environment and make it easier for people to make healthy life choices. The forces such as physical environments, cultural choices, social norms, and others form a framework that limits change for the improved health of the population. This is possible through creating accessible environments for physical activity at worksites and schools as well as offer effective transportation and recreation in communities.
References and Evidence
Research and reference used for developing the guidelines are credible and reliable resources. Most of the references are peer-reviewed articles published in reputable journals or periodicals. Some of them include, JAMA, International Journal of Cancer, American Journal of Clinical Nutrition, Cancer Epidemiology, Biomarkers & Prevention, American Journal of Preventative Medicine, American Journal of Public Health, Nutrition and Cancer, and more.
In addition, the authors of the guidelines used resources developed from other national and international organizations such as World Health Organization, Joint Food and Agriculture Organization of the United Nations/International Atomic Energy Agency, American Dietetic Association, International Agency for Research on Cancer, USDA’s National Agricultural Statistics Service, Economic Research Service, Centers for Disease Control and Prevention, and many more. The combination of literature (376 references) from the mentioned sources gave the authors of the guidelines a framework upon which the recommendations on healthy lifestyle choices were made.
If to define the evidence used for developing the guidelines, a large section was taken from clinical and non-clinical trials. Also, some sources represented systematic literature reviews that combined evidence from other references to make conclusions about the effectiveness of some interventions. Systematic reviews use well-defined and reproducible search strategies for identifying evidence that would support the solving of clinical problems.
Resources that were published by organizations are also guidelines or reports on the state on the population in regards to the dietary choices and lifestyle practices. Besides, evidence gathered from both journal articles and organization-based sources were developed by professionals in their field. In terms of the nature of evidence used in the guidelines, both quantitative and qualitative data was used. On the one hand, qualitative evidence offers a look at the perspectives of the population on dietary choices and exercise patterns. On the other hand, quantitative evidence is necessary for providing relevant statistical data on dietary lifestyle and food choices of the population. In addition, quantitative data is especially relevant to the discussion about cancer.
In the discussed guidelines, levels of evidence vary depending on the points of reference in the list. A large section of evidence is of Level II, which means that it was collected from relevant randomized controlled trials (RCTs). Information collected from well-designed cohort and case-control studies is Level IV while evidence obtained from non-randomized quasi-experimental studies is Level III (Burns, Rohrich, & Chung, 2011). Since there are more than three hundred sources used for the development of guidelines, defining the level of evidence is insufficient. Nevertheless, it is essential to note that Kushi et al. (2012) sought out high-quality resources due to the complexity and great importance of the topic.
How Well the Guidelines are Followed
In order to assess whether the professionals in the healthcare system adhere to the guidelines, it is essential to note the set of basic recommendations for practitioners and patients. First, it is suggested that the population achieves and maintains a healthy weight throughout life. Healthcare practitioners in all settings instruct their patients on the need to lose weight if needed and ensure that the treatment goes to plan. Body weight and cancer have been directly associated according to the authors, which is why the majority of healthcare specialists pay increased attention to the weight of their patients.
Second, the guidelines recommend adopting a physically active lifestyle for both children and adolescents. While it is the responsibility of individuals themselves to maintain a healthy weight is the focus, it is essential to understand that socially, physical activities are not promoted to the needed extent (Teixeira, Silva, Mata, Palmeira, & Markland, 2012). This means that the role of policymakers and social advocates should be considered.
Also, corporations make large profits by selling unhealthy foods and drinks, alcohol, tobacco, as well as technologies that promote sedentary lifestyles. In many ways, companies make money through encouraging consumers to make unhealthy choices and spend more (Weber, 2019). Therefore, there is some ambiguity in regards to important social and political players contributing to limited physical activity among society, and their lack of involvement is supported financially.
The emphasis on plant-based products as recommendations for maintaining a healthy body type and thus decrease the risk of cancer development is evident in the guidelines. It is indefinite as to whether the relevant professionals in the field adhere to this recommendation since their suggestions on healthy diets may differ. Moreover, the problem of access is especially relevant in this case as low-income individuals cannot afford such food options as well as may have limited access to them.
Because of this, the role of non-profit organizations that support families with low income should be discussed. While some efforts are undertaken, there is still much remaining to be done when it comes to ensuring that all individuals, regardless of financial status, can pursue healthy food choices.
Discussion
ASC’s guidelines on nutrition and physical activity for cancer prevention are of great value for the clinical practice as well as the healthcare industry overall. The guidelines provide a comprehensive overview of the most pressing dietary and lifestyle problems that contribute to the increased risks of cancer and provide suggestions targeted at their management and elimination. Four specific recommendations are made for patients as well as given for consideration to healthcare providers.
The first recommendation is concerned with maintaining a healthy weight, the second is linked to adopting a physically active lifestyle, the third deals with a healthy diet with a focus on plant foods, and the fourth is focused on eliminating or at least reducing the consumption of alcohol.
The list of recommendations is based on evidence from multiple professional sources. For example, in suggesting to increase the consumption of fresh, unprocessed vegetables and fruit, the authors of the guidelines provide evidence from a statement from the American Heart Association Nutrition Committee. In addition to the advice given to the population as to how people can limit the risk of cancer development, the guidelines discuss relevant nutrition and physical activity issues that may concern the general public.
For instance, the authors evaluate the role of processed meats in contributing to the stomach and colorectal cancer (Oostindjer et al., 2014). Another example is the discussion of whether sugar substitutes and nonnutritive sweeteners can be harmful and therefore cause cancer. The guidelines are notable for the exploration of each problem in detail to offer the most comprehensive look on the issue possible.
Lastly, apart from discussing various dietary choices and their influence on cancer occurrence, the guidelines mention food choices and lifestyle factors that have been proven to increase the occurrence of cancer. For instance, “breast cancer has been associated with the increased weight gain in postmenopausal (but not premenopausal women)” (Radimer et al., 2004, p. 7). Poor dietary choices have been linked to kidney, pancreatic, stomach, and upper aerodigestive tract cancers. Having a large bulk of information on the links between cancer and dietary and lifestyle choices is a valuable contribution to practice.
The guidelines can be used by both patients and healthcare professionals to assess the current state of wellbeing and physical integrity and use the list of recommendations to their benefit. However, it is essential to note that the last version of the guidelines was published in 2012 and needs to be updated shortly. Gaps in previous research should be eliminated to provide a cohesive look at how diet and lifestyle can be changed to reduce cancer occurrence.
References
Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and Reconstructive Surgery, 128(1), 305-310.
Kushi, L., Doyle, K., McCullough, M., Rock. C.L., Demark-Wahnefried, W., Bandera, E.V., … American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee. (2012). American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. CA: A Cancer Journal for Clinicians, 62(1), 30-67.
Oostindjer, M., Alexander, J., Amdam, G., Andersen, G., Bryan, N., Chef, D., … Egelandsdal, B. (2014). The role of red and processed meat in colorectal cancer development: A perspective. Meat Science, 97(4),583-596.
Radimer, K., Ballard-Barbash, R., Miller, J., Fay, M., Schatzkin, A., Troiano, R., … Splansky, G. (2004). Weight change and the risk of late-onset breast cancer in the original Framingham cohort. Nutrition Cancer, 49(1). 7-13.
Teixeira, P. J., Silva, M. N., Mata, J., Palmeira, A. L., & Markland, D. (2012). Motivation, self-determination, and long-term weight control. The International Journal of Behavioral Nutrition and Physical Activity, 9, 22.
Weber, L. (2019). Junk food companies spend billions of dollars on ads targeting black children. HuffPost. Web.