Beyond survival: How lifestyle medicine elevates cancer survivorship

Life after cancer often comes with a unique set of challenges but lifestyle medicine provides a core strategy for improving survivors’ quality of life, function, and long-term health.  

Each June, National Cancer Survivorship Month spotlights the more than 18 million cancer survivors in the U.S.—a number that continues to grow thanks to advances in early detection and treatment. Yet behind the rising survival rates lies a pressing question: How well are cancer survivors actually living after treatment ends? 

From persistent fatigue and anxiety to recurrence risk and chronic conditions, life after cancer often brings new—and sometimes invisible—burdens. This is where lifestyle medicine emerges not just as a supplement to care, but as a core strategy to improve quality of life, function, and long-term health.  

And the best part? We don’t have to start from scratch. We already have clear, evidence-based recommendations—like those from the American Institute for Cancer Research (AICR) and the American Cancer Society (ACS)—that provide a blueprint for healthier living after cancer.  

The American College of Lifestyle Medicine (ACLM) works tirelessly to translate evidence-based recommendations into real-world impact. Through its six foundational pillars—optimal nutrition, physical activity, restorative sleep, stress management, connectedness, and avoidance of risky substances—ACLM provides diverse resources designed to overcome common barriers such as time, cost, and accessibility. These include free patient-facing handouts, the “Food as Medicine for Cancer Risk Reduction” course, and a Risk Reduction and Survivorship Clinical Toolkit for clinicians. 

ACLM also supports board certification for physicians and health professionals and a Cancer Member Interest Group (MIG), which supports community building and collaboration for those focused on improving survivorship through lifestyle strategies. 

From risk reduction to survivorship strategy 

Most cancer survivors are surprised to learn that the same recommendations used for cancer prevention are also advised for survivorship. We follow the AICR’s guidelines, which emphasize a plant-predominant diet, regular physical activity, healthy body weight, and reduced alcohol intake—principles echoed by ACS in their 2022 Cancer Survivorship Guidelines. 

Yet despite this consensus, there’s a disconnect in implementation. Studies show that fewer than 25% of survivors meet basic lifestyle benchmarks, such as meeting general physical activity recommendations, even though up to 42% of cancers and 45% of cancer deaths are linked to modifiable factors like diet, weight, alcohol use, and inactivity.   

We have the knowledge. What’s missing is the actionable integration into oncology care—and a shift in perspective that views lifestyle as part of treatment, not a separate or secondary concern.  

Nutrition  

Food is not just nourishment—it’s a powerful modifier of cancer biology. Diets rich in minimally processed, plant-based foods not only support weight management and immunity, but play a role in survival.  

A pivotal study presented at the 2025 ASCO Annual Meeting (CALGB/SWOG 80702 cohort) found that, in stage III colorectal cancer survivors, those consuming antiinflammatory diets—characterized by high intake of leafy greens, vegetables, coffee, and tea—had an 87% lower risk of death compared to those consuming the most proinflammatory diets (high in red/processed meats, refined grains, sugary drinks) This powerful association held even after adjusting for treatment variables. 

Survivors practicing low-inflammatory eating and exercising (≥9 MET-hours/week) experienced a 63% greater survival advantage, highlighting the role of diet and movement in reducing inflammation and improving outcomes.  

Research shows that replacing 10% of ultra-processed foods—like packaged snacks and processed meats—with whole options (fruits, vegetables, legumes, whole grains) reduces colorectal cancer risk by 7%. This demonstrates how small changes, such as switching a deli meat sandwich for a colorful plant-based bowl, can make a significant impact.  

Preserving muscle mass through protein-rich meals (1.0–1.5 g/kg/day per European Society for Clinical Nutrition and Metabolism guidelines) is another cornerstone—vital for strength, treatment recovery, and metabolic health. Including sources like beans, lean fish, low-fat dairy, and poultry helps balance nutrition and supports muscle rebuilding. 

Fiber intake, found only in plant foods, fosters a diverse gut microbiome supporting immune function, mental well-being, and enhancing responses to treatments like CAR-T therapy. Foods like whole grains, legumes, cruciferous vegetables, and fermented options (e.g., yogurt, kefir) boost the microbiome.  

Exercise 

Exercise is a critical—yet still underprescribed—component of cancer care. It not only helps prevent cancer, but also improves survival, reduces treatment toxicity, and enhances every dimension of recovery. For survivors, movement is one of the most powerful tools available to reclaim energy, function, and control over their bodies. 

A landmark study presented at the 2025 ASCO Annual Meeting found that a structured exercise program initiated after surgery and chemotherapy in stage III/high-risk stage II colon cancer survivors reduced recurrence risk by 28% and lowered the risk of death by 37% at eight years—benefits comparable to leading adjuvant therapies This randomized controlled trial—the first of its kind—demonstrates that exercise should be part of the cancer plan.  

But beyond physical fitness, exercise has profound metabolic and immunologic effects. Muscle tissue acts as an endocrine organ, releasing anti-inflammatory myokines that may inhibit tumor growth and support immune surveillance.  Moreover, muscle mass—not weight—is increasingly recognized as a key predictor of survival, particularly in breast, colorectal, and lung cancers.  

Too often, survivors are advised to “rest” or avoid activity, when what their bodies need is targeted movement that supports healing. Resistance training, in particular, remains the only intervention proven to maintain or restore skeletal muscle—a vital factor for quality of life, treatment tolerance, and long-term survival. 

The American Cancer Society and American College of Sports Medicine recommend at least 150 minutes of moderate activity, including two days of strength training per week, for all cancer survivors. Yet fewer than 20% achieve these levels, often due to lack of guidance, support, or access. 

Restorative sleep  

Sleep isn’t just about rest—it’s a biological necessity for healing, hormone regulation, emotional balance, and immune function. Unfortunately, sleep disturbances are common among cancer survivors, often triggered by treatment side effects, medication interactions, anxiety, or nighttime pain. 

Poor sleep can disrupt cortisol and melatonin, two key hormones that regulate immune surveillance and inflammation. Cortisol dysregulation is associated with increased cancer progression and reduced immune response. While low melatonin levels have been linked to higher tumor activity and poor outcomes in certain cancers.  

Moreover, sleep loss impacts mood, cognition, and treatment adherence—critical elements of long-term recovery. Survivors who get fewer hours of quality sleep report higher levels of depression, anxiety, and fatigue, and face challenges in returning to work or re-engaging in social life.  

Simple strategies—like sleep hygiene education, cognitive behavioral therapy for insomnia (CBT-I), and structured daily routines—can help restore this vital pillar of health. Clinicians can play a key role by routinely assessing sleep quality and encouraging targeted interventions. 

Stress management 

Cancer is a life-altering diagnosis, and for many survivors, stress doesn’t end when treatment does. Whether it’s fear of recurrence, financial concerns, or navigating a new identity post-cancer, chronic stress can linger—and harm recovery. 

Persistent psychological stress elevates pro-inflammatory cytokines and impairs immune defenses, creating a biological environment that may fuel cancer progression.  

Importantly, survivors with better stress coping mechanisms report higher quality of life, better treatment adherence, and even longer survival in some cancer types. Just as physical therapy is a tool for restoring function, mind-body practices are essential tools for restoring emotional regulation. 

Connectedness is essential for mental health and a biological necessity. For cancer survivors, meaningful relationships significantly influence physical recovery, immune function, and survival rates.  

Yet, many survivors face increased loneliness and isolation after treatment, especially if they lose touch with care teams or struggle to restore previous social roles. A 2024 analysis in the Journal of the National Comprehensive Cancer Network found lonely cancer survivors had a 33% higher mortality risk than those with strong social networks, even after adjusting for lifestyle choices and disease severity.   

Kroenke et al. (2013) also noted that breast cancer patients with solid social support had a 40% lower death risk and improved quality of life than isolated individuals. Strong social ties buffer stress, enhance treatment adherence, and motivate healthy behaviors.  

Avoiding risky habits 

While lifestyle medicine often focuses on what to add (e.g., more movement, better food), it’s equally important to address what to reduce or remove. In cancer survivorship, avoiding risky habits—like tobacco use, excessive alcohol consumption, and prolonged sedentary behavior—is a critical part of reducing recurrence and improving overall health. 

Tobacco 

Tobacco remains the leading preventable cause of cancer worldwide, contributing to nearly 20% of all cancer deaths (WHO, 2024). Even among survivors, smoking increases the risk of recurrence, second primary cancers, and cardiovascular complications. Cessation is one of the most effective interventions clinicians can promote—every conversation matters. 

Alcohol 

Though culturally normalized, alcohol is a Group 1 carcinogen, meaning there is no safe level of use. A global analysis published in The Lancet Oncology reported that alcohol contributed to over 6.3 million cancer cases and 3.3 million deaths in 2020 (Rumgay et al., 2021). For colorectal, breast, liver, and head and neck cancers, even moderate intake increases risk. 

Talking about alcohol use in survivorship care should be standard practice—especially since many survivors are unaware of its impact. Offering supportive, nonjudgmental guidance, along with access to behavioral tools or low-risk drinking strategies, can make a lasting difference. 

Sedentary behavior 

Sitting for prolonged periods—independent of exercise levels—has been linked to increased mortality risk in cancer survivors. A 2020 study in JAMA Oncology found that those with the highest sedentary time had an 82% higher risk of cancer death, even after adjusting for physical activity levels. Encouraging survivors to break up sitting time with brief walks, stretches, or standing tasks is a simple yet powerful behavior shift. 

Why aren’t we doing more? 

The gap between evidence and implementation is wide. According to surveys, many oncology providers lack training in lifestyle counseling or believe patients won’t change their behavior. But these are myths we must challenge. 

Survivors often crave actionable strategies—but they need support, not vague encouragement. When clinicians provide specific, culturally sensitive, and achievable recommendations, behavior change becomes not only possible but empowering. 

From theory to practice: action steps for clinicians 

Lifestyle strategies don’t require a new clinic or a 90-minute visit. They start with small, consistent integrations: 

• Ask about movement, sleep, and nutrition in routine follow-ups. 
• Refer to lifestyle-trained professionals (health coaches, dietitians, exercise physiologists). 
• Make it visible—display handouts or posters featuring the six pillars. 
• Leverage survivor groups and community programs to reduce isolation and build support and accountability. Model the message—clinicians who live these principles are more likely to inspire change.

Redefining success in cancer care 

For decades, cancer care has centered around five-year survival rates. But survival alone is no longer enough. We must also consider healthspan—how well someone lives during and beyond treatment. 

That means targeting fatigue, restoring strength, preventing secondary conditions, and fostering emotional resilience. Lifestyle medicine isn’t a replacement for cancer treatment—it’s the foundation for thriving after treatment ends. 

Cancer survivors deserve more than a pat on the back for finishing treatment. They deserve a roadmap to reclaim their health—one rooted in evidence-based lifestyle strategies that promote healing, empowerment, and true recovery. 

Let’s redefine what success looks like in cancer care. Let’s move beyond survival, towards true survivorship—one step, one meal, one night, one connection at a time.