Written and reviewed by Melissa Jacobs, MS, RD, CSO, LDN, CNSC, Advanced Practice Dietitian specializing in nutrition support and oncology at the Johns Hopkins Hospital
Cancer is the second leading cause of death in the United States affecting racial, ethnic, socioeconomic, and geographic subgroups differently. There has been a decline in the overall cancer death rate over the past thirty years of thirty-two percent. Furthermore, cancer survivorship has increased over this same time period with 16.9 million survivors in the United States as of January 2019. Increased survivorship numbers are largely due to the increasing aging population, different behavioral patterns, and changes in screening practices resulting in earlier detection and treatment. The overall five-year survival rate for all cancers combined is now approximately sixty-eight percent.
This is the third American Cancer Society Nutrition and Physical Activity Guideline to be released with a focus on evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake.
The study involved investigating breast cancer, cancers of the upper digestive system (oral cavity, pharyngeal) and lower digestive system (esophagus, stomach, small bowel, colon, rectum, anus, liver, gallbladder, biliary tract, and pancreas), bladder cancer, kidney cancer, prostate cancer, testicular cancer, endometrial cancer, ovarian cancer, and lung cancer. Hematological cancers such as leukemia, lymphoma, and multiple myeloma were evaluated. More investigations of the link between modifiable risk factors and recurrence risk and survival have been conducted for the more common cancers with higher survival rates while evidence is limited for cancers that are less common and often may have lower survival rates.
General guidelines on diet and activity for cancer survivors are as follows:
- Nutrition assessment and counseling should begin as soon as able after diagnosis with the goal of preserving muscle mass, preventing nutrient deficiencies, and managing side effects of treatment which often can affect nutritional status. A comprehensive nutritional assessment should be done with a registered dietitian or registered dietitian nutritionist who has received specialized education and training and takes a board exam. Furthermore, many registered dietitians have specialized training in oncology with obtaining a certified specialist in oncology credential.
- Physical activity and assessment counseling should also begin soon after diagnosis with the goal of helping prepare patients for treatment as well as managing cancer-related symptoms and treatment-related side effects.
Recommendations to improve long-term health and increase survivor likelihood:
- Maintain or increase muscle mass through diet and physical activity to avoid obesity.
- With consideration for the type of cancer, the health status of patient, treatment modality, and symptoms and side effects, engage in routine physical activity.
- Follow a healthy eating pattern that meets nutrient needs and is consistent with chronic disease prevention recommendations.
More specific guidelines have been able to be determined for breast cancer:
- A healthful diet after diagnosis can improve overall survival, but there is not enough evidence to show that healthy eating reduces cancer recurrence.
- A diet that’s high in red meat, processed meats (bologna, hot dogs, bacon, and others), and sweets increase the risk of death.
- Limited data show eating soy foods after a diagnosis may lower the risk of cancer recurrence.
- Drinking alcohol after a diagnosis of breast cancer does not seem to be associated with an increased death risk from all causes, according to the existing evidence.
- Being physically active is strongly and consistently linked to a lower death risk from breast cancer and other causes and conversely decreasing physical activity after diagnosis is linked with a higher death risk from any cause.
- Having obesity (BMI of 30 or higher) after a diagnosis is associated with a higher chance of the cancer returning, as well as a higher risk of dying from this cancer and other causes.
- It is not known how intentionally losing weight versus losing weight due to cancer affects survival after a diagnosis.
Other evidence exists and is recommended for other cancers regarding diet, physical activity, and obesity:
- Consuming a Western diet is associated with worse survival for people diagnosed with colorectal cancer and prostate cancer.
- Alcohol consumption is associated with a higher death risk from all causes after a diagnosis of head and neck cancer, laryngeal and pharyngeal cancer, and liver cancer; It’s not known how drinking alcohol affects survival after a diagnosis of most cancer.
- Being overweight or obese is associated with worse survival after a diagnosis of bladder cancer. A higher BMI (BMI of 25 or higher) in the “overweight” range is associated with a higher chance of cancer recurring and progressing in non-muscle invasive disease. The risk of dying from bladder cancer is inconclusive in regard to higher BMIs. For endometrial cancer, most evidence suggests that a BMI of 30 or higher (the “obesity” range) at diagnosis is associated with a higher death risk from all causes. A higher BMI has not been linked with the return of cancer or progression or a higher risk of dying from endometrial cancer.
Being physically active after a diagnosis improves survival after a diagnosis of colorectal cancer, female gynecological cancers (cervical, endometrial, and ovarian), and lastly prostate cancer.
For cancer prevention for individuals, the American Cancer Society recommendations are as follows:
- Achieve and maintain a healthy body weight throughout life by keeping weight within the healthy range and avoiding weight gain in adult life.
- Be physically active with adults by engaging in 150-300 minutes of moderate-intensity physical activity per week or 75-150 minutes of vigorous-intensity physical activity. Children and adolescents should engage in at least 1 hour of moderate- or vigorous-intensity physical activity per day.
- Move more and sit less.
- Follow a healthy eating pattern with nutrient-dense foods that help achieve and maintain weight. This includes colorful vegetables – dark, leafy greens, red and orange vegetables, and peas and beans that have higher fiber. Colorful fruit and whole fruits and whole grains are important while limiting more red meats, processed meats, sugary foods and beverages, processed foods, and refined grains.
- It is best to limit or avoid alcohol with no more than one drink per day for women and two drinks for men.
Lastly and most importantly to note, reductions in health disparities and improvements in health equity are prudent for more cancer survivors to be informed and apply these recommendations to their health to reduce recurrence risk and increase survival. Nutrition, physical activity, and living a healthy lifestyle are vital to our health. As more studies are conducted, the future of cancer will continue to evolve and provide more evidence-based guidelines across the continuum of care.
Rock et al. American Cancer Society Nutrition and Physical Activity Guideline for Cancer Survivors. (2022). A Cancer Journal for Clinicians. 0: 2-33.
For your best life after cancer – eat well and be physically active. American Cancer Society. March 16, 2022. Accessed: April 30, 2022. https://www.cancer.org/latest-news/new-nutrition-and-physical-activity-guidelines-for-cancer-survivors.html