Looking after yourself

Smoking is the biggest preventable cause of cancer. It increases the risk of developing many types of cancer, including lung, bowel, ovarian, bladder, kidney, liver, oesophageal, pancreatic and stomach cancers.

If you smoke, Cancer Council strongly recommends that you quit. Stopping smoking has been shown to increase your expected survival time and reduce your risk of developing another type of cancer.

Choosing to quit smoking at any age will benefit your health. It can also improve your ability to be more physically active and help reduce alcohol consumption, both of which can help you maintain a healthy weight. Many people who smoke find it hard to stop. Seek support and don’t be put off if it takes several attempts before you’re able to quit for good.

How to quit smoking

• Call Quitline on 13 7848 to talk to an advisor and request a free Quit Kit.
• Ask your doctor for advice about nicotine replacement therapy or prescription medicines to help you quit.
• Set a date to quit. Tell your family and friends so they can support you.
• Think of other attempts to quit as practice. Learn from what did and didn’t help.
• Make your home and car a smoke-free zone.
• Keep a list of all the reasons you want to quit.
• Do something else if you feel tempted to smoke (e.g. go for a walk, listen to music).
• Download an app such as My QuitBuddy from the App Store or Google Play. This can help you track your progress.

What about electronic cigarettes (vaping)?

E-cigarettes are battery-operated devices that heat a flavoured liquid to produce a vapour that users inhale into their lungs. The liquid can contain a wide variety of substances, including cancer-causing chemicals. In Australia, it is illegal to sell or buy e-cigarettes containing nicotine without a prescription.

Research is continuing into the health effects of e-cigarettes. However, there is growing evidence that it is not safe to use them as they contain a range of substances that have been shown to be harmful to people’s health. For up-to-date information regarding nicotine e-cigarettes, visit
tga.gov.au/nicotine-vaping-products.

Skin cancer is the most common cancer in Australia and one of the most preventable. Most skin cancers are caused by exposure to the sun’s  ultraviolet (UV) radiation. Using sun protection will reduce your risk of skin cancer. It’s also important to check your skin regularly and to ask your doctor how often you need a full skin check.

UV radiation from the sun causes skin cancer, but it is also the best source of vitamin D, which is needed for healthy bones. The body can absorb only a limited amount of vitamin D at a time. Getting more sun than recommended does not increase your vitamin D levels, but it does increase your skin cancer risk. Most people get enough vitamin D from incidental exposure to the sun, while using sun protection. When the UV Index is 3 or above, this may mean spending just a few minutes outdoors on most days of the week.

People who’ve had skin cancer have a higher risk of developing more skin cancers. Talk to your doctor about how to protect your skin from the sun, check for new skin cancers, and maintain your vitamin D levels.

How to protect your skin

The UV Index shows the intensity of the sun’s UV radiation. An index of 3 or above means that UV levels are high enough to damage unprotected skin, so sun protection is recommended. Use a combination of the following measures to protect your skin. Make sun protection a part of your everyday routine.

Slip on clothing – Wear clothing that covers your shoulders, neck, arms, legs and body. Choose fabric with a tight weave or with a high ultraviolet
protection factor (UPF) rating and darker fabrics where possible.

Slop on sunscreen – Use an SPF 30 or higher broadspectrum water-resistant sunscreen. Apply 20 minutes before going out and reapply every two hours, or after swimming, sweating or any activity that causes you to rub it off. For an adult, the recommended amount is 1 teaspoon for each arm, each leg, front of body, back of body, and the face, neck and ears – a total of 7 teaspoons of sunscreen for one full body application.

Slap on a hat – Wear a hat that shades your face, neck and ears. This includes legionnaire, broad-brimmed and bucket hats. Check to make sure the hat meets the Australian Standard. Choose fabric with a close weave that doesn’t let the light through. Baseball caps and sun visors do not offer enough protection.

Seek shade – Use shade from trees, umbrellas, buildings or any type of canopy. UV radiation is reflective and can bounce off surfaces, such as  concrete, water, sand and snow, so shade should never be the only form of sun protection used. If you can see the sky through the shade, even if
the direct sun is blocked, the shade will not completely protect you from UV.

Slide on sunglasses – Protect your eyes with sunglasses that meet the Australian Standard. Wraparound styles are best. Sunglasses should be worn all year round to protect both the eyes and the delicate skin around the eyes.

Check daily sun protection times – Each day, use the free SunSmart app to check the recommended sun protection times in your local area. The times will vary according to where you live and the time of year. Visit sunsmart.com.au for more information. You can also find sun protection times at the Bureau of Meteorology  or in the weather section of daily newspapers.

Sensitive skin after treatment – Some cancer treatments may make your skin more sensitive to the sun, causing it to burn or be damaged by the sun more quickly or easily than before. Ask your treatment team if this applies to you, and if there are any extra things you should do to protect your skin or you need more frequent skin checks.

Some cancer treatments can affect your weight. People often expect to lose weight during cancer treatment, but for many people it can have the opposite effect. Weight gained during cancer treatment can be difficult to lose because of fatigue and other challenges. Whether you have lost or gained weight, it is important to work towards a healthy weight.

Being overweight or obese is a risk factor for many types of cancer (including cancer of the bowel, kidney, pancreas, oesophagus, uterus, liver and breast), heart disease and diabetes. Keeping your weight within the healthy range can help reduce the risk of cancer recurrence and improve survival. The health risk associated with your body weight can be estimated using your waist measurement and body mass index (BMI). To calculate your BMI, go to Health Direct’s BMI calculator.

Waist measurement and health risk

Having fat around the abdomen or waist, regardless of your body size, can increase your risk of developing cancer, heart disease and diabetes. Some cancer types are also associated with increased fat around the hips and buttocks. Knowing your waist measurement can help you work out your risk. Place a measuring tape around your waist at the narrowest point between the lower rib and the top of the hips. Make sure to breathe normally. Use the measurements below to determine your health risk.

Increased health risk

• Female waist – 80 cm or more
• Male waist – 94 cm or more

Greatly increased health risk

• Female waist – 88 cm or more
• Male waist – 102 cm or more

Physical activity is a broad term that covers any activity that moves your body and increases your breathing and heart rate. Physical activity has a range of benefits for cancer survivors. It can:

• reduce the risk of some cancers (but not all) coming back, including breast, bowel and endometrial (uterine) cancers
• help prevent weight gain – being overweight or obese is a risk factor for many cancers
• help with recovery from treatment (rehabilitation) by increasing energy levels, improving sleep, increasing muscle strength, improving mobility and balance, relieving stress, and decreasing fatigue, anxiety and depression
• reduce the risk of developing other health problems, such as heart disease, osteoporosis and type 2 diabetes.

Recommended amounts of activity

Once cancer treatment is finished and you return to your usual day-to-day activities, aim to be as physically active as your abilities allow. The Clinical Oncology Society of Australia recommends that people with cancer do:

• at least 150 minutes (2½ hours) of moderate intensity aerobic exercise or 75 minutes (1¼ hours) of vigorous intensity aerobic exercise every week
• 2–3 strength-training (resistance exercise) sessions a week to build muscle strength.

Moderate intensity aerobic exercise includes brisk walking, swimming, jogging, cycling and golf. Vigorous intensity aerobic exercise includes fast jogging, running, swimming or cycling and playing team sport such as football or netball.

Australia’s Physical Activity and Sedentary Behaviour Guidelines encourage adults to aim to do 300 minutes (5 hours) of moderate activity or 150 minutes (2½ hours) of vigorous activity every week. For maximum cancer prevention benefits, aim to gradually increase your activity to 60 minutes of moderate physical activity or 30 minutes of vigorous activity every day.

Many people lose muscle mass and strength during cancer treatment and find it harder to complete tasks of normal daily living. Strength-training (resistance exercise) can help you regain physical strength and get back to your daily activities. It can be done at home, an exercise clinic or gym. Resistance-based exercises can be done using your own body weight or equipment such as resistance bands, hand and ankle weights, or gym-based machines.

Taking care when exercising

Before taking part in any exercise program, it is important to talk to your specialist or GP about any precautions you should take. Ask about the   amount and type of exercise that is right for you.

Your doctor may refer you to an exercise physiologist or physiotherapist to develop an exercise program to meet your specific needs. You may be able to attend one-to-one or group-based sessions, or your exercise professional may develop a program for you to follow at home. They will also show you how to exercise safely and monitor the intensity of your exercise (e.g. by measuring your heart rate).

How to be more active

• Doing any physical activity is better than doing none. To avoid overexerting yourself, start physical activity slowly and build up gradually.
• Walk with a friend or pet, join a walking group or walk to the corner shop instead of driving. If you are exercising outdoors, remember to protect your skin.
• Break up long periods of sitting or screen time by standing up and moving every half-hour.
• Take the stairs instead of the lift or escalators.
• Do some vigorous housework and activities around the home each day, such as vacuuming, gardening or mowing the lawn.
• Get off the bus or train one stop earlier or park further away from your destination and walk the rest of the way.
• Record your activity or steps completed each day. This can help keep you motivated.
• Join a group class such as dancing, Pilates, yoga or tai chi.
• Take your children or grandchildren to the park or kick a ball around the backyard.
• Try short periods of aerobic-based exercise (e.g. walking, cycling or swimming), stretching, or resistance-based exercises (e.g. using hand weights,
  resistance bands or your own body weight).
• Join a cancer survivorship exercise program or a local gym. Call 13 11 20 to find out about survivorship programs in your area.

Drinking alcohol increases the risk of developing some cancers, including cancer of the mouth and throat, oesophagus, bowel, stomach, liver and breast. Even drinking small amounts of alcohol can increase cancer risk, and the risk increases with every drink. Alcohol contains a lot of energy (kilojoules or calories), so it can contribute to weight gain. Drinking alcohol also increases the risk of other diseases, such as heart disease and type 2 diabetes.

Cancer Council recommends you limit how much you drink to reduce your cancer risk. If you choose to drink alcohol, stick to the National Health and Medical Research Council guidelines and have no more than 10 standard drinks a week and no more than 4 standard drinks in one day. One standard drink has 10 grams of alcohol, but remember that drinks served at home and bars are often more than a standard drink.

Ways to reduce your alcohol intake

• Choose a non-alcoholic drink such as sparkling mineral water with fresh lemon or lime slices.
• Alternate alcoholic drinks with a glass of water.
• Set yourself a limit and stop once you’ve reached it.
• Wait until your glass is empty before topping it up to keep count of your drinks.
• Explore no alcohol beers, wines, spirits and mocktails.
• Have some alcohol-free days each week.
• Eat while you drink to slow your drinking pace.
• Catch up with friends over coffee or go for a walk.
• Download the Drinks Meter or the Daybreak app to help monitor your drinking.

For information and support, call the National Alcohol and Other Drug Hotline on 1800 250 015.

It is important to eat a balanced diet from the five food groups – fruit, vegetables and legumes, wholegrains, meat (or alternatives) and dairy (or alternatives). Limit foods containing saturated fat, added salt and added sugars, and avoid sugary drinks.

Fruit, vegetables and legumes

Eating fruit, vegetables and legumes (e.g. beans, lentils, peas) is important for your health. They are a great source of fibre, vitamins and minerals. Fruit and vegetables also contain natural substances, such as antioxidants and phytochemicals, which can protect cells in the body from damage that may lead to cancer. Eating fruit, vegetables and legumes can help you achieve and maintain a healthy weight because they are low in kilojoules and high in fibre.

The Australian Dietary Guidelines recommend eating at least two serves of fruit and five serves of vegetables or legumes daily. Aim to eat a variety of different-coloured fresh fruit and vegetables. They are best eaten whole (not juiced), and it’s good to eat both cooked and raw vegetables. Frozen and tinned vegetables are just as nutritious and are a good alternative to fresh produce – look for varieties without added sugars, salt or fats.

Wholegrain, wholemeal and high-fibre foods

Dietary fibre can help to ensure a healthy digestive system and reduce the risk of bowel cancer. Eating a diet high in fibre and wholegrain foods can also lower your risk of developing type 2 diabetes and heart disease, and help you maintain a healthy body weight.

The Australian Dietary Guidelines recommend that most adults eat at least four serves of cereal or grain foods each day, with at least two-thirds of these being wholegrain or wholemeal varieties. Wholegrain foods include wholemeal breads, rolled oats, wholemeal pasta, brown rice, barley, popping corn, cracked wheat (burghul) and quinoa. Wholegrain foods contain the outer layer of the grain, which contains fibre, vitamins, minerals and phytochemicals. Wholemeal foods are made from wholegrains that have been crushed to a finer texture. Nutritionally, wholemeal and wholegrain foods are very similar.

Some people continue to have bowel problems after cancer treatment. If you find that dietary fibre makes any bowel problems worse, you may need to eat low-fibre foods. A dietitian can recommend suitable foods for your situation.

How much is a serve?

Fruit, vegetables, legumes

• 1 medium-sized piece of fruit
• 2 smaller fruits (e.g. plum, apricot)
• 1 cup diced fruit
• ½ cup cooked vegetables
• ½ cup legumes
• 1 cup raw salad vegetables

Wholegrain foods 

• 1 slice of wholegrain bread
• ½ cup cooked brown rice or wholemeal pasta
• 2/3 cup wholegrain breakfast cereal
• ½ cup cooked porridge

Meat (raw) 

• 100 g lamb loin chop
• 100 g steak
• 1/2 cup diced red meat
• 1/2 cup mince

Red meat and processed meat

Red meat includes beef, lamb, pork, veal, goat, venison and kangaroo. Lean red meat is an important source of dietary iron, zinc, vitamin B12 and protein. But eating too much red meat increases your risk of bowel cancer. To reduce your cancer risk, Cancer Council recommends people eat no more than one serve of lean red meat a day or two serves on 3–4 days a week.

There is strong evidence that eating processed meats, such as ham, bacon and prosciutto, is associated with an increased risk of bowel cancer. Cancer Council recommends you limit eating processed meats.

There is no conclusive evidence that eating a vegetarian diet has a positive impact on survival after cancer treatment. However, eating more fruit, vegetables, legumes and wholegrain foods will probably improve the quality of your diet.

Ways to eat well after cancer

• Eat a variety of nutritious foods every day.
• Add vegetables, legumes, fruit, wholegrain and high fibre foods to your meals.
• Limit your intake of red meat.
• Choose lean cuts of meat and trim as much fat as possible before cooking.
• Swap a serve of red meat for another variety of protein. Sources of protein include fish, chicken, eggs, legumes, tofu, nuts, wholegrains, soya and
  dairy products.
• Avoid processed meats like ham, bacon and deli meats or eat only occasionally.
• Try reduced-fat milk, yoghurt and cheese. Choose varieties that are also low in added sugars or salt.
• Eat fish a couple of times a week.
• Add fruit and yoghurt to wholegrain cereal or serve some vegetables such as mushrooms with your eggs and wholegrain toast.
• Adapt your recipes to include more vegetables and legumes (e.g. add grated carrot and zucchini, celery, capsicum, beans or lentils to pasta sauces).
• Limit the portion size of your meals and snacks.
• Fill half your dinner plate with vegetables.
• Swap sugary drinks for water.
• Avoid snacks that are high in added fats, sugars and salt, such as chips, biscuits and chocolate. Replace them with nuts, fruit, yoghurt or cheese.
• Limit takeaway foods that are high in fat, sugar, salt and kilojoules.
• Don’t add salt to food during cooking or before eating. Add flavour with herbs and spices.
• Grill, poach, slow roast and stir-fry rather than deep fry.
• Steam or microwave vegetables to maintain their nutritional goodness.

Managing dietary changes

Treatment for some cancers can affect how you eat, swallow, digest food and absorb essential nutrients. You may need to try different foods and ways of eating to find out what works for you.

A dietitian can help tailor an eating plan to manage any ongoing issues. They can also provide advice about suitable nutritional supplements to help maintain your strength.

It may take time and support to adapt to your new way of eating. You may feel self-conscious or worry about eating in public or with friends. These
reactions are natural. It may help to talk about how you feel with your family and friends, your GP, a counsellor or someone who has been through a similar experience.

Download our booklet ‘Nutrition for People Living with Cancer’