Lifestyle and Behavioral Factors and Cancer Survivorship in Women

A growing number of women in the United States are cancer survivors. Behavioral and lifestyle factors are important components of health during and after cancer treatment and are modifiable with sustained behavior change. In this review, we summarize published evidence on the associations of the American College of Lifestyle Medicine’s 6 lifestyle pillars—nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep, and social connection—with survival and cancer recurrence among female cancer survivors and on the effects of interventions to modify each pillar in this population. We found that most of the 6 pillars have been associated with mortality and recurrence in large observational studies. Physical activity interventions have been associated with the broadest range of health benefits among female cancer survivors, including improved quality of life, cardiorespiratory fitness, physical functioning, mental health, sleep, and survival. Cognitive behavioral therapy and mindfulness-based relaxation, including mind-body exercises such as yoga, have also consistently shown efficacy for improving sleep and mental health. More work is needed to identify effective interventions for diet, alcohol and tobacco use, and social support and for improving maintenance of lifestyle changes. Implications for integrating behavioral and lifestyle medicine into clinical oncology are discussed.