Nutrition Before During and After Cancer

Information on nutritional needs for cancer patients

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Cancer Survivors Eating Less Healthy than General Population

Cancer Survivor

Population ages 1 year and older with intakes below the recommendation or above the limit for different food groups and dietary components.

  • Vegetables: 87% have intakes below the goal
  • Fruit: 75% have intakes below the goal
  • Total Grains: 44% have intakes below the goal
  • Dairy: 86% have intakes below the goal
  • Protein Foods: 42% have intakes below the goal
  • Oils: 72% have intakes below the goal
  • Added sugars: 70% have intakes above the limit
  • Saturated fats: 71% have intakes above the limit
  • Sodium: 89% have intakes above the limit.

Note: The center (0) line is the goal or limit. For most, those represented by the orange sections of the bars, shifting toward the center line will improve their eating pattern.

Data Sources: What We Eat in America, NHANES 2007-2010 for average intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary based on age, sex, and activity level, for recommended intakes and limits.

There are now an estimated 14 million US cancer survivors; many facing health issues and increased risk for chronic conditions that a healthy diet may mitigate or prevent. Yet overall, cancer survivors are eating less healthy than the general population, consuming empty calories while not eating the recommended amounts of vegetables and whole grains, finds a new study.

Compared to the non-cancer group, survivors had overall poor adherence to Dietary Guidelines. Survivors were eating more empty calories, taking in these calories from alcohol, solid fats and/or added sugars. The group diagnosed with cancer was also consuming less fiber, green vegetables and whole grains compared with individuals with no history of cancer. Cancer survivors had low dietary intakes of vitamin D, vitamin E, potassium, and calcium, but high intakes of saturated fat and sodium. Younger the survivors; the worse diet they have.

Please follow ACIR guidelines for survivors and join a survivorship group in the hospital were your treatment was done or one near you.


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Cancer and its reoccurrence

Optimizing survorship

According to the National Cancer Institute, individuals are considered cancer survivors from the time of diagnosis through the balance of their lives. 65.8% of cancer survivors today have passed the classic five-year survival marker, and 40% have survived 10 years or more. These survivors face myriad nutrition-related challenges, including those caused by an increased risk of cancer recurrence or the development of a second cancer. Many experience long-lasting side effects of the cancer or its treatment or they develop late effects that begin months or years after initial treatment.

Recommendations for Survivors


Research on how nutrition, physical activity, and body composition affect cancer recurrence, the development of second primary cancers, and overall survival for cancer survivors still is limited.

American Institute for Cancer Research (AICR) recommendations state that after treatment, if possible and unless otherwise advised, survivors should aim to follow the organization’s cancer prevention recommendations for diet, physical activity, and healthy weight maintenance.


Protective Eating Pattern Vegetables, fruits, whole grains, and legumes form the core of a diet that reduces the risk of cancer and heart disease. Plant foods that aren’t highly processed or refined provide a wide range of nutrients and phytochemicals that may act protectively throughout cancer development, influencing DNA repair, inflammation, cell proliferation, and cancer progression. Diets built around foods low in calorie density are recommended to avoid weight gain and support intentional weight loss.

Colorful fresh group of vegetables and fruits

However, neither observational nor interventional studies have demonstrated a strong link between vegetable and fruit consumption and reduced cancer recurrence or mortality. The effects of a diet high in vegetables and fruits likely are influenced by personal characteristics such as hormonal status, genetics, gut microbiota, and medical treatment as well as how the diet is implemented, including the choice and preparation of vegetables and fruits, total calorie intake, and overall diet and lifestyle quality.

Dietary recommendations from the AICR and the ACS don’t address fat consumption except to call for avoiding very high levels that contribute to obesity. The ACS recommends limiting saturated fat for heart health, noting limited data linking saturated fat with cancer risk or recurrence.

Weight and Body Composition Traditionally, nutritional care for cancer survivors has focused on preventing and treating malnutrition and on regaining lost weight, and that remains true for some of them. However, many survivors today are overweight or obese at the time of their diagnosis and remain so following treatment. This reflects both the increased prevalence of obesity and its association with cancer risk and improvements in treatment and early diagnosis reducing unplanned weight loss.

Obesity’s link to poor prognosis for cancer patients may relate to several mechanisms, including increased inflammation and elevated levels of insulin and growth factors such as IGF-1 that promote cancer cell growth. Excess body fat increases adipose production of estrogen in postmenopausal women, raising levels that promote the growth of estrogen-sensitive cancers. Obesity also is associated with the risk of developing CVD, the primary cause of death among many cancer survivors.

People at a healthy weight when they’re diagnosed with cancer may gain weight during treatment and in the years that follow. Fatigue, depression, and insomnia can lead to decreased physical activity or increased calorie intake from using food to cope with these problems, which can result in weight gain. Some chemotherapy, hormone, and steroid medications also can cause undesirable weight gain.


The ACS guidelines for cancer survivors encourage those who are overweight to achieve and maintain a healthy weight.

Physical Activity Survivorship care has changed dramatically in its emphasis on physical activity. The strongest evidence involves breast cancer survivors, including several observational studies that link greater post diagnosis physical activity with reduced all-cause mortality.

Physical activity also is associated with increased progression-free survival and reduced recurrence, cancer mortality, and all-cause mortality in colorectal and prostate cancer survivors.

Interventions promoting physical activity consistently have demonstrated improved fitness, strength, and quality of life and decreased fatigue and sleep disturbances among survivors of various cancer types.


An American College of Sports Medicine roundtable of experts developed exercise guidelines for cancer survivors, published in 2010. Based on these guidelines, survivors are encouraged to follow the federal physical activity guidelines for all Americans, though in some cases certain modifications are necessary. All survivors are advised to avoid inactivity.

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Optimizing Survivorship

Optimizing survorship

The Institute of Medicine identifies four essential components of cancer survivorship care and recommends that every cancer patient receive an individualized survivorship care plan for monitoring and maintaining health.
A growing number of cancer treatment centers and hospitals are establishing survivorship programs. Sometimes called cancer pre-habilitation (pretreatment care) and rehabilitation programs, these may include pain management, smoking cessation, exercise, and nutrition components. Programs often offer support groups and cognitive-behavioral therapy targeting stress management, relaxation training, and coping skills.


Cancer survivors stand to benefit in many ways from a healthful lifestyle. Unfortunately, for some, a cancer diagnosis doesn’t always lead to health-protective changes. In a cross-sectional study of adult cancer survivors, most did meet the recommendation to avoid smoking, but only 30% to 47% met the physical activity recommendation, and about 15% to 19% met the five-a-day minimum vegetable and fruit target.


Dietitians play a vital role in enhancing cancer survivors’ health and quality of life. Assessing survivors’ nutritional status and dietary intake can identify areas in which they’re nutritionally lacking and also areas of potential excess. Guidance can help survivors meet nutritional needs and improve outcomes relevant to cancer, cardiovascular, and bone health. Survivors have wide-ranging needs for help in evaluating information from many sources and making evidence-based behavior changes that support recovery and long-term health, and dietitians can assist them in addressing these needs.

Following a healthy life style can help cancer survivors to thrive by enhancing their immune system and avoiding inflammation.