Most cancer survivors are just as overweight and inactive as everyone else, a new study shows.
An analysis of data collected from more than 114,000 adults in Canada shows that overall, a cancer diagnosis doesn’t appear to prompt significant changes in eating habits or increase physical activity, according to a report in Cancer, the medical journal of the American Cancer Society. The big exception is men who survive prostate cancer, who appear to be far more active than similar men without cancer.
But the overall findings are troubling because studies have suggested that cancer patients have much to gain from a healthful lifestyle. Obesity and physical inactivity are linked with a lower quality of life among cancer survivors and may increase the risk of the cancer coming back or death from the disease.
“These findings tell us that we need to look at ways to better support cancer survivors to become more active and to maintain a healthy body weight,” said Kerry Courneya, professor at the University of Alberta in Edmonton, in a press release. “We know that physical inactivity and obesity are risk factors for developing cancer. These are also risk factors for the recurrence of cancer. Lifestyle is just as important after diagnosis.”
The researchers compared data on activity and weight to national averages among the Canadian population. There were surprisingly few differences, suggesting that a cancer diagnosis doesn’t necessarily encourage more healthful living. The main exception was among prostate cancer survivors, who were 27 percent more likely to be active and about 30 percent less likely to be obese than the general population. The study authors didn’t have an explanation for the difference except that men may have been influenced by recent studies suggesting a link between exercise and better quality of life for prostate cancer survivors.
However, it’s not clear if the lower body mass index among prostate cancer survivors is a good thing because some data suggest prostate cancer treatments can lead to loss of lean body mass.
Other findings of the study showed:
- About 21 percent of cancer survivors are physically active, compared to about 25 percent of Canadians in general.
- Among cancer survivors, about 18 percent are obese and 34 percent are overweight. By comparison, about 15 percent of Canadians overall are obese and 37 percent are overweight.
- Male cancer survivors were more likely to be overweight or obese than female cancer survivors (62 percent versus 47 percent).
- The lowest levels of physical activity were among colorectal cancer survivors, breast cancer survivors and female melanoma survivors.
- Male skin cancer survivors were more active than the rest of the population, but that difference may simply reflect the fact that active people who spend a lot of time outdoors are more likely to develop skin cancer.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
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From 1 to 25 of 149 Comments
How well did this study control for post-cancer health issues? In other words, what came first - chicken or egg?
Many, many cancer survivors struggle with long-term fatigue. It’s not necessarily debilitating but it can be a real barrier to engaging in a lot of physical activity.
Radiation therapy to the neck, and some types of chemotherapy, can damage the thyroid, and survivors can end up with even more sluggishness and weight gain.
Certain types of chemotherapy cause nerve damage to the extremities. Many chemotherapy regimens, at least in the United States, are accompanied by massive doses of steroids that lead to weight gain and can wreak havoc on one’s metabolism.
The assortment of post-treatment long-term and late effects also includes lung damage, cardiac damage, cognitive deficits, premature menopause, loss of muscle mass, and the list goes on and on.
I had aggressive non-Hodgkin’s lymphoma when I was in my 30s - nonsmoking, normal-weight vegetarian me. I’m actually doing very, very well, but some days it can be a real struggle.
I would welcome a better exploration of *why* many cancer survivors struggle with weight and exercise issues, and what can be done to help them. Because, as far as I can see, knowledge about survivorship issues is pretty much in its infancy yet and no one really has a lot of help to offer.
What I don’t need are judgments from the health nannies about what I should or should not be doing. Just because I had cancer doesn’t mean they get to dictate how I ought to live the rest of my life. So back off!
— Perrin J.I think it’s so interesting that there was ever a hypothesis that cancer survivors would be healthier. My gut instinct would be to say that surviving a killer illness is likely to seriously damage your health, and that cancer survivors have an ongoing health impact even after treatment is ended and they’re cleared (5 years is the usual standard).
So I find the really fascinating part is that survivors of prostate cancer were the exception. I do wonder about the reasons for that. One possibility is that prostate risk increases with age, perhaps old people are more likely to change their lifestyle when they get “a sniff of the turf” than young people?
Interesting contribution to the increasing knowledge about cancer’s effects anyway. I know a woman who had breast cancer and a double mastectomy 15 years ago. Her employer was not very nice about her needing time off for her other unrelated health issues - her response (privately) was “where did it say that breast cancer made you into a triathlete? I was a short fat middle aged woman before the cancer, I’m lucky that I’m a short fat old woman now instead of dead.” I’m not saying she’s typical, but its an interesting counter-perspective.
— JillyFlowerSomebody will say that cancer survivors gave themselves cancer in the first place with their fatness, which they deliberately courted out of perversity, and that they are predestined to carcinogenic lifestylings then and now and isn’t it sad but what can you do, it’s America. Then somebody will respond that studies showing obesity leading to health problems are flawed. Then somebody will say that definitions of obesity are flawed in the first place. Then somebody will say something gratuitously insulting to fat people just to say something gratuitously insulting to fat people. Then somebody will mention that they are what is called by doctors overweight but that they nevertheless play racquet sports. Then somebody will post an anecdote about this one time when they were in the middle seat on an airplane and their seatmates in the window and aisle seats both needed seatbelt extenders. Then somebody will say that men get skin cancer because testosterone makes you too dumb to put on a hat when you go in the sun. Then about fifty actual cancer survivors will thank everyone to shut up about what they clearly know nothing about. Then there will be 75% comments completely supportive of the cancer survivors and 23% comments sympathetic to the cancer survivors but still critical of sedentary obesity as a lifestyle choice. 2% of comments will continue hooting at fat people. The sun will go down. The moon will come out. Owls and nightjars will make many off-topic remarks. Before it even seems possible, it will be a new day. The sun will come up and the flow of comments will slow and then stop. There will be a new topic. I hope it will be either: “Eating disorders are OCDs” or “OCDs are caused by staphylococcus infection destroying the basal ganglia in the brain,” or, best, BOTH! That staph causes anorexia nervosa is my very favorite of all theories, and I wish some scientist would write a grant already and prove it because I am tired of hearing that people starve themselves (or eat themselves elephantine) because they have a deathwish because they read fashion magazines or were teased as children.
— Nom, nom, nom!Do we know how activity levels were measured? Many studies / surveys only ask about leisure time activity, which discounts things like walking to work, walking at work, and so on.
Note that activity can be healthful regardless of body weight. At least one study found that overweight and obese women who exercise regularly were more likely to survive breast cancer than overweight / obese women who didn’t.
— JenKSurviving breast cancer was a gift. It was the impetus I needed to start taking getting healthy seriously. I dropped the requisite 50 pounds, started a fitness and diet program and stuck to it. Started training for the marathon.
My motivation–minimizing the recurrence of the disease.
Realistically, it was the advantages of having great medical insurance that allowed for the lifestyle changes.
I wonder why that aspect wasn’t raised.
S.R. Moritz
— S. R. MoritzIt seems counterintuitive, but only if we believe that the fear of death is a big motivator. A similar question exists in the field of criminology: does capital punishment deter other criminals from committing heinous crimes? This is still being debated in the field, but it likely does not deter other criminals.
One’s lifestyle is difficult to change permanently. This is seen in the ineffectiveness of dieting. The statistics are discouraging. Most people eventually gain back the weight they lost on a diet.
The same is true for physical activity levels. The stress-expert doctor, Hans Selye, once said that there are two sorts of people, “racehorses” and “turtles”. This may be an oversimplification of the range of human character types, but it serves our purpose here.
You aren’t going to get a “turtle” type to be running the Boston Marathon, nor should such a type. If I, er, I mean, they, are lucky, 45 minutes of walking 5 times a week is the best I, er, I mean they, can expect.
Another way to look at this is the difference between avoiding something and working to gain something. If one avoids death through the intervention of cancer specialists, one feels grateful and lucky, but is not necessarily motivated any further. If one decides to save $50 a month in order to buy a big screen TV, I, er, I mean, they, have a goal and a tangible prize at the end of the process.
Now whether I will be able to take that TV with me to the Great Beyond, I’ll get back to you later with the answer, when advances in computer technology allow posting to blogs in that Greater Place. (-:
— Rob L; N Myrtle Beach SCThis an enlightening study,though it ignores many things. If you get cancer and a doctor tells you that you have 6months to live,you wouldnt wanna spend time eating healthy.I might end up living my life doing things which I enjoy rather than dealing with exercises and healthy food choices,which in many cases are not as appealing as junk food.
Secondly, we cannot overlook the experiences which cancer patients have,the fear,worry, chemo and fatique,uncertainity,and other emotions.I really do not think any one would spend time worrieng about diet,you have other important things to use your energy on.
— faisalIt wasn’t breast cancer that propelled me to being more active and eating better. In my case, it was turning 50. Two years later, I found the lump, had the mastectomy, the chemotherapy and came out the other side in pretty good shape. I think (and yes, it may be very simplistic) my relatively quick recovery from the surgery and the tolerance to the chemo can be attributed, at least in part, to exercise and improved diet.
I’m now 61 and more active that I’ve ever been, with regular weight-training and cardio workouts. I do it because I like it and it makes me feel good (and also keeps my weight down and brings me in contact with some neat people). The fact that I’m a cancer survivor is coincidental, not cause and effect. It’s about motivating self and cancer (or any illness or event) is not necessarily that motivation.
— DJI don’t think it’s that weird that cancer survivors are no more fit than the average person. The prostate cancer group’s exceptional findings are a bit strange, given that prostate cancer has historically been more of an “old man’s” disease, and that doesn’t seem like a group that would be that concerned about getting in good shape post-treatment. But overall, I would think that people who were into physical fitness before their diagnosis might make an effort to maintain or regain that, and while there might be some previously sedentary or overweight cancer survivors who would try harder to get fit, others would be unwilling to change their lifestyle or unable to because of the effects of their disease or treatment.
I just spent part of the last weekend at an American Cancer Society “Relay for Life” event, where there were several hundred survivors in their purple t-shirts, and they were a mixed bag. Quite a number, not counting those who were clearly still undergoing treatment, were obviously overweight and not fit, but there is no way to tell whether that is by choice or not. Most of those I know who have had cancer (of all different kinds) look pretty much the same way they did before they got ill.
I haven’t had cancer (yet), but several years ago I became quite ill with recurrent major depression. For a while, I walked obsessively, miles and hours at a time, hoping I could walk myself off the end of the world and into oblivion. But ultimately, after I got still worse, ended up in the hospital and so forth, I basically stopped exercising at all and became quite reclusive and very sedentary. I am somewhat more functional now, but have been unable to regain the motivation to work myself back to fitness. I’ve tried — I joined a gym and for a while was quite serious about going — but I fail to feel those “exercise endorphins” that I keep hearing will kick in and make me feel better, and since I’m so badly out of shape, everything is that much harder than it used to be (I’m also a bunch years older now and well into middle age with its assorted and increasing aches and pains). I would *like* to be in better shape, but after being knocked down so hard, I’m not sure to what extent I’m going to get there. At this point, I’m just glad to be alive, because that for a time was in doubt. I know that what I experienced is not necessarily comparable to what a cancer survivor does, but when I try to imagine how I’d feel if I *had* had cancer, I sort of doubt I’d feel much differently about things, especially if I’d suffered any of the after-effects of treatment (fatigue, neuropathy, lymph system dysregulation, etc.).
— SallyFrom the previous post: “I was a short fat middle aged woman before the cancer, I’m lucky that I’m a short fat old woman now instead of dead.”
Maybe she is typical. My own mother is a two-time cancer survivor, yet she still the same overweight, workaholic she was before either bout. Even after my family attempted to help her start a better diet/exercise plan. Even after her doctor told her losing 20 pounds would work far better than any drug he could prescribe.
This study begs 2 questions in my mind — 1. Are less active and healthy people more prone to certain types of cancer and 2. Of those who get cancer because of their lower activity and health, how many have the will power to change their lives after the cancer. For my mother, she was not very active before cancer, a factor that contributed to her cancer, and now she still has not made any changes in her diet and exercise regime.
— NatalieAs a breast cancer survivor with one year of remission under my belt I have to add that lost of us are trying to do everything we can just to hold things together some days. Chemotherapy can cause some permanent damage and while I’m thrilled than aromatase drugs are here and are effective they often cause significant joint and muscle pain. Cheer us on, don’t put us down. http://www.aftercancernowwhat.wordpress.com
— kate www.aftercancernowwhat.wordpress.comFROM TPP — I’m surprised how many people have viewed this as being put down. Breast cancer survivors, in particular, have much more to gain from exercise and weight loss and the issue here is finding ways to help women improve their fitness post-cancer. I personally think this study is without judgment, and simply addresses an important public health issue.
Most breast cancer survivors are on estrogen blockers for years after diagnosis. These meds have lots of side effects, like increased appetite, sluggishness, hot flashes and aches and pains. All of which contribute to a non-atheletic life style.
— Christine ElizOnce again, this shows the “blame the victim” mentality of many researchers and writers. Instead of blaming “sin”, as in former times, we now blame the lifestyle of the victim. Even though it was the “cure” that caused the physical changes that contribute to the lifestyle.
@Nom, nom, nom!: Thank you! I haven’t laughed that hard while sitting in front of the computer in a long time.
TPP: How long after patients were declared cancer survivors was the information about their activity levels and physical fitness collected? This seems to be an important piece of information. Was it included in the study article?
FROM TPP — It’s a good question but the study data wasn’t broken down that way. I agree a more detailed analysis looking at cancer status and years since diagnosis etc would be interesting, but that would be a different and much more expensive study.
— Heron“I might end up living my life doing things which I enjoy rather than dealing with exercises and healthy food choices,which in many cases are not as appealing as junk food.
Secondly, we cannot overlook the experiences which cancer patients have,the fear,worry, chemo and fatique,uncertainity,and other emotions.I really do not think any one would spend time worrieng about diet,you have other important things to use your energy on.”
— Posted by faisal
I make no judgement about cancer survivors, but I disagree with every word Faisal says.
First, junk food does NOT taste better than healthy food. A great piece of fresh wild salmon, grilled with freshly made pesto and served with avocado salad dressed with garlic and top quality olive oil, followed by a small piece of freshly baked apple pie with good Trailhead cheese melted on top, is far more delicious than a whopper, particularly if accompanied with a glass of great red wine. Homemade duck confit served with white beans and herbs, and Savoy cabbage sauteed in butter and garlic - ditto. And don’t tell me these dishes are beyond the average American’s means; I ate that salmon this evening, and my husband makes duck confit every autumn. There is no need to eat the artificial tasting glop called junk “food.” You will enjoy your food more, not less, if you learn to cook and start paying attention to quality rather than quantity.
Second, exercise has been shown to make cancer survivors, especially breast cancer survivors who have had to deal with chemo, feel less tired and more energetic. Under these circumstances, exercise reduces fatigue; it does not worsen fatigue.
Third, regular exercise has been proved to reduce mild to moderate depression and anxiety, both of which can be problems for cancer survivors. It often helps a survivor regain some sense of control over his or her body, and lessens the fear.
In other words, eating healthy food and exercising make life more pleasurable. We have got to stop thinking of them as some kind of grim penance.
— kalebergDear Kaleberg:
— pinkladyJust out of curiosity, have you actually had cancer yourself? You say that exercise and healthy eating can make generally make survivors feel better, which I can’t dispute, but if you’re so tired you can hardly drag your own butt out of bed in the morning without constantly wishing you were still asleep, how can you expect someone to exercise? Or more importantly, why?
I’m not even going to talk about food, partly because the topic doesn’t appeal to me and partly because I don’t know anything about it, so I’ll just talk about exercise.
Cancer survivors have been through a lot. That’s an understatement, really, but I’m not going to change it. Chemo is horrible, I’m sure you know that, but do you realize how much? While some people bounce back to their regular lives quickly after finishing treatment, most don’t. The side effects linger long afterwards, and one of the biggest ones is fatigue. It’s terrible to sleep all night and wake up still as tired as you were the night before, and then realize that there’s nothing you can do about it. Do you think a person would even dream about exercising then?
Having had cancer myself and being in remission for almost a year, I speak from experience. Before cancer, I was heavily involved in competitive swimming and martial arts. Those are not easy sports and involve many hours of training each week. When I finished treatment, the first thing I wanted to do was start back up immediately, but I didn’t realize how long the side effects can stay with you…fatigue, I’m told by my doctor, can stick with you for ten years.
So really, I think about getting active again almost every day. Maybe it will happen someday, and maybe it won’t. But at the moment, I don’t really care, and I’m sure many other survivors would agree with me. Worrying about the “quality” of my food and weight, etc. is not at the top of my to-do list. I care more about the quality of my life…my family and friends…you know, that kind of stuff. I don’t think food and exercise can make that much of a difference. I’m glad to just be ALIVE! That’s all that matters to me, and thats all that SHOULD matter to everyone else.
Many good comments here. To follow up on faisal - my great-aunt was diagnosed with diabetes at 65. She wasn’t a big junk food addict at all, I think she ate healthier in most meals than I do. But she liked a tipple once a week (she used to say she’d never tasted win until she was 25 so she had some catching up to do). And she used to like baking. And she was a football fan of the first order. I remember her at 80, a lemonade in 1 hand, glass of wine in the other and a few chocolate biscuits on a saucer beside her.
She used to say what’s the fun of living at all if all you do is deny yourself pleasure?
She probably didn’t control her illness as well as someone who fanatically followed the diet prescribed, but she had regular breakouts, she used to be especially disciplined so she could have her weekend treats and after she had a stroke at 80 she was hardly going to be exercising much.
I think this focus on self-denial is not very appealng to people who have battled an illness already. I also think the focus on self-denial as our responsibility to health is not very healthy.
And I have to concur with KAte #11, it does sound like a put down. I realize it is just the way Tara expresses it and she probably doesn’t mean it but it runs through several posts - being inactive and enjoying food with more salt or sugar than is ideal might well be a sign of sin or bad indulgence in most of us. For cancer sufferers I’d call it a well deserved treat!
— JillyFlower@Kaleberg, re:
“First, junk food does NOT taste better than healthy food.”
De gustibus non disputandem est.
I am a very good cook. I cook a killer wine-braised short ribs with garlic and cheese soft polenta and asparagus. I cook an amazing tenderloin with a red wine sauce and garlic mashed. Scallops sauteed with pancetta in a dijon and dill sauce. Supreme of chicken in citrus-ancho chile sauce.
But if you wave a “Sack of 10″ from White Castle in front of my face, I’ll beat you senseless to get to it.
So can the “healthy food tastes better” sanctimony. It tastes better to *you* but the last time I checked, I am actually a different person than you. And that salmon recipe actually sounds pretty gross. Salmon with pesto and avocado? Are you high?
— KateI was one of those males that was already active and got skin cancer. In other words..my time outdoors contributed to my getting cancer (I was one of the ones too stupid to put on sunscreen). I’m still outdoors all the time, but now sunscreen is part of my daily wardrobe. Nevertheless.. even though I got skin cancer my advice is the same…get outside and get some excercise no matter your cancer status(but wear sunscreen!)
— SteveTo Sally in comment #9: been there, done that. I should say that I have been very depressed, and NOT done any exercise.
Figure out what motivates you. It does not matter what it is, short of criminal behavior. It is probably the same things that motivated you prior to your depression, but you won’t feel as excited (or excited at all) when you contemplate these things. This is because your brain isn’t functioning the way it used to.
If it is gardening, do just a little of it, then try a little more later. If it is yard and garage sales and you are able to walk to where some of them are, do that. If it is going to a mall, do that. You can do some serious walking at a mall. Park far away.
Find some reason, any at all, to be in contact with people, and to keep moving forward physically at first, then via your desire mechanisms. Recapturing your desires is the key.
Keep after your depression. Ask your doctor to change your meds if they aren’t doing you much good. If you suspect you are over-medicated, which can make a person sluggish, insist to your doctor that he or she reduce the doses.
If none of this works, consider getting ECT (electro-convulsive treatment). It is much better than it was 40 years ago. The memory loss is minimal. But you must get ‘maintenance’ doses every few months for it to continue working.
As a last resort, if at all possible, get the deep-brain electrode implantations that have worked wonders for the few who needed them and had them available. This is a rare and expensive treatment option, available to only a few.
To kaleberg in comment #14: You are a foodie. Duck confit? What the… We should all be so lucky to live that way. And I dare you to come up with some “junky” food you like and sometimes crave, then be honest enough to post it here. I don’t know one person who grew up in America who doesn’t have some favorite commercial, pre-packaged snack food that has way too much of something “bad” in it.
— Rob L; N Myrtle Beach SCAnyone who has had cancer must cringe at the words “…gain from a healthy lifestyle…” Of course we would all want to do that. Dearly love to do that. But cancer does not focus one on health. It focuses one on death. Sorry to be so blunt, but that is the experience of most of us when cancer touches our lives. Enjoyment of life with loved ones becomes paramount. Counting calories or striving for an optimum weight or pressing 100 lbs? Sorry, that’s astoundingly delusional.
FROM TPP — all very well stated.
— JonThere is no definitive study that proves obesity as a causal element for cancer. 0. None.
There is, however, a correlation between BMIs of 25 - 27 and longer, healthier lives. And BMIs of 15 - 19 for shorter life spans.
Go figure. So much for research. And so much for this column’s simplistic research.
— LagomorphPost #3 by nom nom nom is dead on!! excellent prediction - you are quite familiar with the pattern of posting on this site! thanks for a good smile!
— rlsIt’s probably easier to be active if you were active before cancer but very difficult to start only after (surviving) cancer. Lesson: get moving while you’re healthy! I was lucky to have gotten started on regular exercise 2 years before my diagnosis (stage 4 breast cancer), INCREASED my activities during chemo, slacked off a bit after surgery and am dancing and walking daily now while on radiation therapy. I hope to see the benefits for some time to come!!!
— bhuddist nunLay off the personal attacks on Kaleberg #14 and anyone else who posts here whose opinion you don’t happen to agree with.
Faisal, #7, commented that:
“I might end up living my life doing things which I enjoy rather than dealing with exercises and healthy food choices, which in many cases are not as appealing as junk food”.
In response, Kaleberg made clear she thought junk food was less appealing than healthy food and that exercise had been shown in studies to benefit cancer survivors by making them less tired. Other posters might well disagree. Fine. Just because you disagree with someone, it does not warrant a personal attack on them.
Argue your case; support it with evidence; it’s unacceptable behaviour to resort to ad hominem attacks on posters with whom you happen to disagree.
TPP, please enforce NYTimes policy of not posting abusive comments on this blog.
FROM TPP — You’ll need to direct me to a specific comment you find abusive.
— Chris Colenso-DunneThe turm “survivor” is so relative. It takes decades to be sure that one is ‘cured’ rather than just in remission. My guess is that some folks have a new awareness of the fragility of life and that eating what they enjoy and not working out unless they really enjoy it makes sense to them.
— Anne–Marie Hislop