Nutrition and physical activity guidelines for cancer survivors

Cancer survivors often ask questions about food choices, physical activity, and dietary supplements. They want to learn whether nutrition and physical activity can help them to live longer or feel better. These guidelines are meant to answer some of those questions. Developed by an American Cancer Society (ACS) panel of experts, they will give you as a cancer survivor and your family the information you need to make informed decisions about your food and physical activity choices.

Nutrition and physical activity needs for cancer survivors may differ for a number of reasons, including where you are in your cancer experience. Three phases are used below as we discuss nutrition and physical activity. They are: active treatment and recovery, disease-free living or living with stable disease, and living with advanced cancer.

Nutrition During Cancer Treatment and Recovery

During cancer treatment, surgery, radiation therapy, and chemotherapy can affect your body's need for nutrients. These treatments can also affect your eating habits and how your body digests, absorbs, and uses food. Your main nutritional goals during this time are:

  • To make certain your body's nutrient and calorie needs are met.

  • To maintain a healthy weight.

  • To avoid losing muscle mass.

  • To ensure that any nutrition-related side effects (such as decreased appetite, mouth sores, difficulty swallowing, etc) are being prevented or managed as best they can.

  • To improve the quality of your life as you go through treatment.

To help you meet these goals, your health care team will look at your current nutritional status. If you are likely to have nutrition-related problems during treatment, your team will do one of 2 things: they will have the registered dietitian on the team see you, or they will help you find a qualified nutrition professional for dietary counseling. Getting help from a registered dietitian during cancer treatment can help to reduce treatment-related symptoms, improve your quality of life, and improve your eating.

Vitamin and Mineral Supplements

You may be thinking about using dietary supplements such as vitamins and minerals during your cancer treatment or you may already be taking some supplements. You should know that physicians do not agree on their use. Therefore, if you are taking any supplements, discuss this with your physician. Many dietary supplements contain levels that are higher than the amount found in food, and some may also be higher than what is recommended for good health. Some contain substances that may affect some chemotherapy drugs.

Many cancer experts advise their patients not to take supplements during treatment, or they may suggest using a dietary supplement only when it is needed to treat a deficiency or promote another aspect of health.

There currently is no evidence to support taking supplements after a cancer diagnosis to reduce the risk of recurrence. If you are thinking about taking a vitamin or mineral supplement after treatment, check first with your health care team. You will want to know about possible risks and benefits.

Some supplements can be useful in correcting specific deficiencies, but most studies have found that the risks of high-dose supplements usually outweigh the benefits. Unless your health care team recommends a supplement for a specific reason, do not take any that contain higher amounts than 100% of the daily value. Your first line of defense should be to strive to get the nutrients you need from nutrient-rich foods and beverages.

Exercise During Cancer Treatment

Exercise is safe during cancer treatment, and it has many benefits. It improves bone health, muscle strength, erectile dysfunction, and other quality-of-life measures. Before starting your exercise program, talk with your doctor or health care team. Ask them about when you can start to exercise and how you can be physically active during treatment. Your health care team will consider your condition and your personal preferences as they help you work out a plan.

If you are receiving chemotherapy and/or radiation therapy and already have an exercise program, you may need to exercise at a lower intensity and/or for a shorter period of time for a while. The goal should be to be active as much as possible. Some doctors may suggest that you wait to see what side effects you have with chemotherapy before starting physical activity.

If you did not exercise before your diagnosis, you might start with low-intensity activities such as stretching and brief, slow walks and progress slowly.

Older adults and those with bone metastases, osteoporosis, arthritis, or peripheral neuropathies should pay careful attention to their balance and safety to reduce the risk of falls and injuries. Having a caregiver or exercise professional present during exercise sessions can be helpful.

If you are unable to exercise, you might ask about physical therapy. Physical therapy during bed rest will help to maintain strength and range of motion and can reduce fatigue and depression.

Recovery After Treatment

After you have finished your treatment, you may still have symptoms or side effects that affect your nutrition and physical well-being. It will take some time for them to go away. If you lost weight during treatment, nutrition counseling will help you regain a normal, healthy weight. If you are overweight or obese, counseling can help you achieve a healthy weight. You may also need treatment for other symptoms or side effects that have not gone away. After treatment, a program of regular physical activity will help you recover from treatment and will improve your fitness.

Disease-Free Living or Living With Stable Disease

During this phase, setting and achieving goals for weight management, a physically active lifestyle, and a healthy diet will benefit your overall health and quality of life. To help you with these goals, the ACS has developed guidelines in 3 areas: weight management, physical activity, and dietary patterns. These guidelines appear below. Following these guidelines may help to reduce the risk of cancer recurrence and of developing another cancer. They are also important for your heart health.

ACS Guidelines on Nutrition and Physical Activity for Cancer Survivors

Get to and stay at a healthy weight.

  • If you are overweight or obese, limit how much you eat of high-calorie foods and beverages and increase physical activity to promote weight loss.

Be active.

  • Avoid inactivity and return to normal daily activities as soon as possible after diagnosis.

  • Aim to exercise at least 150 minutes per week.

  • Include strength training exercises at least 2 days per week.

Eat a variety of healthy foods from plant sources.

  • Limit the amount of processed meat and red meat you eat.

  • Eat 2½ cups or more of vegetables and fruits each day.

  • Choose whole grains rather than refined grain products.

Living With Advanced Cancer

If you are living with advanced cancer, a healthy diet and physical activity are still important for helping you maintain a sense of well-being and an improved quality of life. Many people with advanced cancer need to change their diet to meet their nutritional needs. They may also change it to help with symptoms or side effects such as fatigue, bowel changes, and a decreased sense of taste or appetite. For those with poor appetite, weight loss, or difficulty in gaining weight, some medicines can help to increase appetite.

Nutritional supplements such as high-protein/high-calorie beverages and foods can be helpful to those who cannot eat or drink enough to keep up with their body's needs. Some people think that tube feedings or intravenous feedings will help them. If you are thinking about these, talk with your doctor about whether these types of feedings will help you. Ask about the benefits and the risks or harms of these feedings, keeping in mind your goals for your cancer treatment.

If you are living with advanced cancer and wonder about physical activity, please ask your doctor for advice. There is not enough research on the benefits of exercise for survivors with advanced cancer for the ACS to make general recommendations. Talk to your physician about your personal physical abilities to see if exercise is right for you.

For more information on the ACS's Nutrition and Physical Activity Guidelines for cancer prevention or for cancer survivors, please call us at 1-800-227-2345.