American Cancer Society nutrition and physical activity guideline for cancer survivors

Cheryl L. Rock, Department of Family Medicine, School of Medicine, University of California at San Diego, La Jolla, California.
Cynthia A. Thomson, Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
Kristen R. Sullivan, Department of Population Sciences, American Cancer Society, Atlanta, Georgia.
Carol L. Howe, Department of Medicine, University of Arizona Health Sciences Library, Tucson, Arizona.
Lawrence H. Kushi, Division of Research, Kaiser Permanente Northern California, Oakland, California.
Bette J. Caan, Division of Research, Kaiser Permanente Northern California, Oakland, California.
Marian L. Neuhouser, Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Elisa V. Bandera, Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Ying Wang, Department of Population Sciences, American Cancer Society, Atlanta, Georgia.
Kimberly Robien, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
Karen M. Basen-Engquist, Division of Cancer Prevention and Population Sciences, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Justin C. Brown, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana.
Kerry S. Courneya, Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
Tracy E. Crane, Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
David O. Garcia, Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
Barbara L. Grant, Cancer Care Center, St Alphonsus Regional Medical Center, Boise, Idaho.
Kathryn K. Hamilton, Carol G. Simon Cancer Center, Morristown Medical Center, Morristown, New Jersey.
Sheri J. Hartman, Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California.
Stacey A. Kenfield, Department of Urology, University of California at San Francisco, San Francisco, California.
Maria Elena Martinez, Herbert Wertheim School of Public Health and Human Longevity Science, University of California at San Diego, La Jolla, California.
Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Larissa Nekhlyudov, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Linda Overholser, School of Medicine, University of Colorado, Denver, Colorado.
Alpa V. Patel, Department of Population Sciences, American Cancer Society, Atlanta, Georgia.
Bernardine M. Pinto, College of Nursing, University of South Carolina, Columbia, South Carolina.
Mary E. Platek, School of Health Professions, D'Youville College, Buffalo, New York.
Erika Rees-Punia, Department of Population Sciences, American Cancer Society, Atlanta, Georgia.
Colleen K. Spees, College of Medicine, The Ohio State University, Columbus, Ohio.
Susan M. Gapstur, Epidemiology Consultant, Tiffin, Iowa.
Marjorie L. McCullough, Department of Population Sciences, American Cancer Society, Atlanta, Georgia.

Abstract

The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.