New healthy living guidelines for cancer survivors

By Colleen Doyle, MS, RD

In my work at the American Cancer Society, when I talk with people who’ve been diagnosed with cancer, they tend to ask me 3 things: what can I do to reduce the chance that my cancer will come back? What can I do to help me not develop some other kind of cancer? How can I help my family members reduce their own risk for developing cancer?

For many years, answering questions 2 and 3 was a cinch.

We’ve known for years that for people who don’t smoke, the most important ways to reduce their risk of cancer are to strive to be at a healthy weight, live a physically active lifestyle, eat a diet made up mostly of fruits, vegetables and whole grains, and watch how much alcohol is consumed (if any, at all).  As a matter of fact, a recent study published by ACS researchers showed that non-smokers who most closely followed those recommendations had a significantly lower risk of premature death from cancer, cardiovascular disease, and all causes when compared to people who followed the guidelines least closely.

So giving advice about how to reduce their risk of developing another type of cancer and providing information to pass on to their own family members was pretty easy, because that data has been around for many years.

Answers about how to reduce the risk of recurrence were not as clear. But they’ve recently gotten clearer. [more]

Over the last several years, evidence has accumulated for a number of cancers that achieving and maintaining a healthy weight, getting enough physical activity, and eating a healthy diet can reduce the chance of recurrence and increase the likelihood of disease-free survival after a diagnosis of cancer. Big news.


Achieve and Maintain a Healthy Weight

Extra weight is linked to increased risk of the cancer coming back and decreased survival rates among breast, prostate, and colorectal (colon) cancer survivors, and possibly others.  Being overweight is a risk factor for these 3 cancers (and others), and many people with cancer are over­weight at the time of diagnosis. For these survivors, setting lifelong goals to achieve and maintain a healthy weight are among the most important health-related goals that can be set. Healthy ways to control weight include:

  • Limiting high-calorie foods
  • Drinking fewer beverages high in fat and/or added sugar
  • Eating more low-calorie foods like vegetables and fruits
  • Adding more physical activity throughout the day

Be Active on a Regular Basis

Many studies have shown that being physically active has a tremendous impact on quality of life of cancer survivors. Now, studies have demonstrated that physical activity after cancer diagnosis is also associated with a lower  risk of the cancer coming back and improved overall survival among multiple cancer survivor groups, including breast, colon, prostate, and ovarian cancer. 

Among breast cancer survivors, a recent analysis showed that getting exercise after diagnosis was associated with a 34% lower risk of breast cancer deaths, a 41% lower risk of dying from all causes, and a 24% lower risk of breast cancer recurrence. Among colon cancer survivors, studies suggest exercise cuts deaths from colon cancer and all causes, and cuts the risk of the cancer coming back by up to 50%.

Our recommendations, and those of the American College of Sports Medicine, encourage survivors to aim to exercise for at least 150 minutes per week, and to include strength training exercises at least 2 days per week.  For survivors who have not been previously active, gradually working up to these recommendations is the way to go.  

Fill your plate with vegetables, fruits, and whole grains

Recent reviews suggest that food choices may affect risk for recurrence and overall survival among survivors. The majority of these studies have focused on breast cancer, but more evidence has also emerged for colon and prostate cancer survivors.  

Similar to what we’ve seen for cancer prevention, it looks like it’s the overall dietary pattern that is important for cancer survivorship -it’s not one food, or even one food group, that makes the difference.  It’s likely the combination of many different nutrients coming from many different foods –working together — that offers the best protection.  Studies suggest that the best protection comes from a diet that:

  • Is high in fruits, vegetables and, whole grains
  • Includes more fish and poultry instead of red and processed meats
  • Includes low fat instead of full-fat dairy products,
  • Includes nuts and olive oil instead of less healthy sources of fat, such as butter or trans fats found in many processed snack foods.


The bottom line

Do we have all the answers related to nutrition, physical activity, and cancer survivorship? No. But do we have enough information and evidence to recommend that anyone who’s been diagnosed with cancer should strive to be at a healthy weight, live a physically active lifestyle, and add more fruits, vegetables and whole grains to their meals and snacks?  Absolutely.  It’s an important message that I’m sharing with everyone I know who has been diagnosed with any kind of cancer.  


Doyle is director of nutrition and physical activity for the American Cancer Society.

8 thoughts on “New healthy living guidelines for cancer survivors

  1. With all the mounting scientific evidence and studies against grains and the damage they can can cause our bodies, why are they still so highly recommended?
    Why is low fat milk recommended over full fat? Full fat has all the beneficial ingredients. Low fat strips out the healthy fat and leaves the lactose which, most people should learn be aware of, converts to sugar in our bodies.
    Yes, I'm simplifying my comments here but there is ample evidence out there to correspond to this. A reduction on grains and dairy has shown, in many studies, to be far more healthy and beneficial to a persons health.
    Also, I am a survivor myself.

  2. Hi, Lieven, Colleen has this to say re: your comment. Hope this is helpful information. Thanks for reading Expert Voices!

    "Thanks for your note, and congratulations on being a cancer survivor!

    I agree with your comment about grains in general, but it's refined grains that we all should be trying to limit, not whole grains. Absolutely we encourage people to cut back on white pasta, bread and rice; crackers and other snack foods that aren't whole grain; packaged and processed grain-based products like cakes, cookies, etc; cereals that are mostly refined flour (and sugar). In general, we all are eating too much of these kinds of grains, rather than the nutrient-rich, higher fiber whole grains. It's whole grains that we promote increasing consumption of, because the majority of people do not meet recommended levels.

    In terms of dairy products, skim and 1% milk still have all the nutrients found in 2% and whole milk but much less – or none – of the unhealthy saturated fat in those higher fat choices. Also, the lower fat products have fewer calories and since weight control is critically important, we recommend those, as well, in terms of reducing calories. Lactose is the natural sugar found in dairy products, and like everything we eat, gets converted to sugar (glucose) in our bodies.

    Important to keep in mind, as well, that it's the overall dietary pattern that appears to be protective – a foundation emphasizing fruits, vegetables and whole grains, coupled with lean protein sources, healthy sources of fat (nuts, fish, oils high in monounsaturated fats) – and less sugary foods and drinks!"

  3. The following are 2 concepts that may or may not contribute to this story. Perhaps, if not already discovered, find new clues why some cancers return and others do not. First of all, I guess this report is true that eating healthy foods seem to help. I had 6 treatments of CHOPP, 3 weeks apart. For a total of 6 treatments in 2000. I used to frequently visit one restaurant, soon after each chemo session, and ordered the following foods. It would include fish, baby carrots, collard greens, pinto beans and orange juice. I was lucky to afford these meals; however, many may not. It was also not during the cold and flu season. Perhaps it may be better to eat at home. If you frequent public places like restaurants and grocery stores, you are exposed to more germs; especially during the cold and flu season. For people to eat at home, too many times, cancer patients feel extreme fatigue to buy and serve these meals, as well. As a thought, many major grocery stores now have catering services. Can a new partnership between the health insurance/cancer center and these caterers, be created to serve healthy meals at patients homes? Second, have they also done research, on the affects of vitamin D levels, in post cancer patients? It has been almost 12 years since my last chemo. I thought I read, the best way to manage your weight, is to exercise outdoors. You absorb, lots of vitamin D, from the sun. I like to bike and walk outdoors; whenever the weather allows it. I have a good tan from April to October. I joke with my wife, that I am absorbing anti-Lymphoma medicine from the sun. Is it possible, high vitamin D levels, can reduce many cancers from returning? Is it true, that people can better manage their weight, if they exercise outdoors? Therefore, by exercising outdoors, people can absorb some sun; while better managing their weight. What are the experts thoughts on this? In conclusion, I am hoping to share my cancer experience that will lead to more people living cancer free for good. Perhaps these clues have already been studied. Or that these concepts may help.

  4. This sounds like it was written by a financially or politically focused organization. It said a whole lot of nothing, and not much right. To rebuild the immune system and not feed cancer cells one must avoid sugar and dairy. Wheat should also be avoided. Red meats just cause trouble, and try to find some fish that isn't polluted. Don't go too heavy on the fruits with all their sugar. Get tested for vitamin and mineral deficiencies. The cancer society and other such organizations should spend more time researching how to help the body heal itself as it is designed, instead of cutting, burning and poisoning it with drugs that cause more problems than the disease. I am amazed that they admit that they just discovered that diet and exercise are good disease prevention! How sad!

  5. Red meats just cause trouble, and try to find some fish that isn't polluted. Don't go too heavy on the fruits with all their sugar. Get tested for vitamin and mineral deficiencies. The cancer society and other such organizations should spend more time researching how to help the body heal itself as it is designed, instead of cutting, burning and poisoning it with drugs that cause more problems than the disease. I am amazed that they admit that they just discovered that diet and exercise are good disease prevention! How sad!

  6. After recovering from cancer or any illness it can be extremely easy to fall into old habits. Yet when it is something as serious as cancer then it is imperative to make lifestyle changes, to improve your changes of staying cancer free. These guidelines are really useful but I think doctors should also stress the importance of sticking to the dietary regime, otherwise people will start to eat the wrong foods again.

  7. Colleen Doyle

    Scott Baker
    Colleen, I just read about you in an article in our local newspaper in Albany, NY. I am very interested in your expertise in diet an exercise for cancer survivors and your work with the American Cancer Society. I am currently in treatment for my third cancer since 1999. I am 42 years old and have two young boys 5 and 7 which provide me with an extreme will to not only live, but to thrive. Here is a brief history:

    1999 – Original diagnosis of Non-Hodgkin's Lymphoma followed by small bowel resection, CHOP therapy, and radiation.
    2007 – Second diagnosis of NHL also in the abdomen followed by RICE therapy with Rituxan then an autologous stem cell transplant.

    All treatment regimens were well tolerated through, I believe, continued focus on diet and exercise.

    2012 – Diagnosed with Primary Central Nervous System Lymphoma. Currently receiving Methotrexate therapy with Rituxan and tolerating it very well, again with continued commitment to diet and exercise.

    This time around I am far more focused on the diet aspects in that I am consuming only whole, natural, organic, unprocessed foods. I am eating less meat as well. Despite being in treatment I am feeling better than I have in years with the exception of a necessary daily nap in the afternoon due to anemia cause by treatment.

    I notice that many of your articles and most others I read discuss benefits of diet and exercise for patients with breast, prostate, and colon cancer, but I almost never see a discussion pertaining to Lymphoma. Has any research been done for the benefits of diet and exercise for Lymphoma patients? PCNSL is a life threatening disease which almost inevitably returns. I am on a mission to not let that happen or, at least, extend my remission for as long as possible using two tools which I do have control over, diet an exercise. Any information you could provide me or direction you could point me in would be greatly appreciated. I'd love to share the experiences and successes I have had to help others and hopefully gain iformation from others as well. I feel that by sharing and working together we could all survive a lot longer and
    possibly avoid recurrences altogether. Thank you for doing the great work you have done for cancer patients everywhere and for your association with the American Cancer Society.

  8. Hi, Scott, Colleen will be contacting you directly. Look for an email from her soon. And thanks for reading and for your comment. Best wishes to you!

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