Cancer survivors have an increased risk of developing second tumors compared to the general population because more than 35% of cancer survivors have lifestyles such as smoking and alcohol consumption. Other lifestyle risk factors such as excess weight and low physical activity also increase the risk of developing second tumors. It is an accepted fact worldwide that unhealthy lifestyle habits can lead to tumors. But can cancer patients gain survival benefits by living a healthy life, and what does it mean to live a healthy life? In a recent article in J. Pers. Med, Dr. Vijayvergia of the United States describes the impact of lifestyle on the quality of life and prognosis of cancer survivors, making it clear that a healthy lifestyle is an important component of treatment for cancer survivors and has a profound impact on the long-term health of patients. There are four essential elements of survivorship treatment: monitoring for cancer recurrence and second tumors, monitoring for the late medical and psychological effects of cancer and its treatment; prevention of cancer recurrence and second tumors and the late effects of cancer treatment; interventions for outcomes resulting from cancer and its treatment; and increased therapeutic collaboration between primary care physicians and oncologists. Each element is important to ensure that cancer survivors receive comprehensive care. Lifestyle interventions As long-term survivors continue to increase, a large body of literature describes the impact of lifestyle on survivors. Evidence from epidemiological studies and interventional studies suggests that lifestyle has an ameliorative effect on the side effects of certain cancer treatments, as well as an ameliorative effect on disease recurrence and an improvement in overall health outcomes. Lifestyle interventions are a very important aspect of survival treatment, and cohort studies have shown that for certain types of tumors, physical activity or a healthy diet can affect quality of life, disease-specific outcomes, and overall health outcomes in survivors. 1. Weight loss Being overweight is a risk factor for a variety of cancers and is most closely associated with breast, colorectal, prostate, esophageal and pancreatic cancers. Obesity also increases the risk of liver cancer, cervical cancer, ovarian cancer, non-Hodgkin’s lymphoma, multiple myeloma and aggressive prostate cancer. There are multiple molecular mechanisms underlying the association between body weight and cancer risk, including the effects of low-grade chronic inflammation, increased leptin and lipocalin, altered hormone and growth factor levels, insulin antagonism, and altered PI3K-AKT-mTOR signaling pathways, among others. The ENERGY trial is currently investigating whether weight loss can improve outcomes in certain types of cancer, with the ENERGY trial looking at the impact of weight loss on quality of life in patients with early-stage breast cancer; studies are also evaluating the impact of weight loss interventions on survivors after a diagnosis of colorectal cancer; and weight loss interventions are being studied in prostate cancer, endometrial cancer, and pediatric cancer survivors. Although there are conflicting data regarding weight, weight loss, and cancer-specific outcomes, the most important goal for survivors is to achieve and maintain a healthy weight (BMI 18.5C25 kg/m2) to maximize the ultimate overall health outcome. the ACS guidelines recommend achieving and maintaining a healthy weight through balanced living. For most survivors, weight loss should not begin until cancer-related treatment is completed. If a cancer survivor is overweight, a weight loss of 2 pounds per week is acceptable and is not affected by treatment. After cancer treatment is completed, weight loss needs to be achieved through a combination of diet, physical activity and behavioral approaches. Limiting the intake of high-calorie foods and beverages and increasing physical activity are necessary. Weight loss of 5-10% is beneficial to the health and cardiovascular aspects of the patient. Diets and dietary supplements for cancer survivors Many studies have examined the dietary habits of cancer survivors and the effect of diet on cancer-related outcomes and overall mortality, and similar to the general population, reductions in fat and energy intake are associated with a lower risk of recurrence and death. However, the WHEL study showed no significant effect of a low-fat diet and high levels of vegetable, fruit, and fiber intake on recurrence-free survival in breast cancer. It is important to note that there was no change in weight among cancer survivors in this study, suggesting that dietary structure changes alone are not sufficient to affect cancer-specific outcomes. Some studies have also addressed the effect of dietary structure on colon cancer outcomes. higher risk of recurrence and mortality in those consuming a more westernized diet in the CALGB 89803 study; Meyerhardt et al. also found that glycemic load affected disease-free survival and overall survival, with high glycemic load associated with shorter disease-free survival in overweight or obese (BMI ≥ 25 kg/m2) colon cancer survivors; prostate cancer patients satiated fat intake was associated with poorer survival, while monounsaturated fat intake improved clinical outcomes. The ACS-SCS II study showed that less than 20% of cancer survivors met the 5A dietary recommendations. Lack of information is the biggest barrier to healthy eating, primarily because physicians rarely discuss the impact of eating habits on quality of life and cancer outcomes with cancer survivors, and only 10% of cancer survivors report having received advice on diet and exercise from a physician. Lack of time for physicians is a major barrier to advice. Physical activity in cancer survivors Physical activity and exercise have a positive impact on quality of life in cancer survivors, affecting patients’ fear of recurrence, self-esteem, good mood, sexual desire, sleep disturbance, social functioning, anxiety, frailty, and pain. Studies have shown that physical activity and exercise reduce cancer-specific and all-cause mortality in early-stage breast, prostate and colorectal cancers, but up to 66% of cancer survivors do not meet physical activity standards, and those who do have a better quality of life. Moderate to vigorous activity, such as three hours of walking, bicycling or swimming per week, reduces all-cause and cancer-specific mortality in postmenopausal breast cancer patients. Additional meta-analyses have shown that physical activity also reduces breast cancer recurrence. Regular physical activity may also help with chronic fatigue during and after treatment. Studies have shown that moderate physical activity reduces the incidence of fatigue during and after chemotherapy in breast cancer patients, and this also applies to colorectal cancer survivors if physical activity requirements are met. In addition, meta-analyses have confirmed the effect of regular physical activity on the reduction of fatigue associated with various cancers, chemotherapy and radiotherapy. The mechanisms underlying the protective effects of physical activity and exercise in cancer patients are conflicting. Regular physical activity may alter immune function, oxidative damage, and alter the insulin axis, which has an impact on cancer metabolism. Exercise training reduces the production of COX-2, iNOS and TNF-α, which promote tumorigenesis, and thus exercise training has anti-inflammatory and anti-proliferative effects. However, for cancer survivors certain factors can affect physical activity, partly related to previous cancer treatment. Colon cancer survivors report persistent oxaliplatin-induced neurotoxic effects in 15% to 40% of the population, even up to 6 years after the end of adjuvant therapy. Lung cancer treatment often affects lung function and therefore affects the patient’s tolerance to exercise. Nearly 90% of cancer patients experience pain, and about 20%C30 of patients have chronic pain caused by cancer or treatment. In addition, physicians are less likely to recommend exercise to cancer survivors, possibly because there is no clear evidence to recommend the appropriate type, intensity, frequency, and duration of physical activity to improve cancer or treatment-related outcomes. In addition to the lack of appropriate guidelines, physicians have little time to discuss the benefits of a healthy lifestyle and exercise with survivors. These hinder cancer survivors’ awareness and acceptance of exercise and physical activity. Cancer survivors whose physical activity is less limited should be guided by standard guidelines. Formal rehab instruction should be considered for cancer survivors undertaking new physical activity programs or for survivors who are themselves at moderate to high risk for side events while exercising. Smoking cessation The general population can benefit from smoking cessation, with particular benefits for cancer survivors, as smoking has an adverse effect on cancer outcomes. One study showed that continued smoking after diagnosis of lung cancer increased all-cause mortality and recurrence, with 5-year survival rates of 33% and 70% for smokers and nonsmokers, respectively, in early-stage lung cancer. Previous smoking history also has an effect on colon cancer (patient survival), (xx) significantly shortening disease-free survival, and similar findings have been found in head and neck cancer and bladder cancer. Although most cancer survivors stop smoking after treatment, approximately 15% of survivors continue to smoke. Health care worker recommendations have a strong impact on patient behavior, and many cancer survivors benefit from smoking cessation recommendations and cessation interventions from their health care providers. Cancer survivors should be evaluated for smoking at every visit and should quit whenever possible. There are many ways to quit, with the 5A approach (Ask, Advise, Assess, Support, Arrange) recommended in the U.S. Public Health Service Clinical Practice Guidelines for Tobacco Cessation, and treatment recommendations include behavioral therapy and pharmacologic co-interventions, with FDA-approved medications including nicotine replacement therapy. National quitlines and community-based cessation programs are also important places for cancer survivors to go for help in quitting. The NCCN Survivorship Guidelines recommend that all cancer survivors should quit smoking as a routine treatment, and have published guidelines for cessation.ASCO also publishes guidelines for cessation, and the ACS guidelines for cessation can be read on their website. Conclusion There is substantial evidence that lifestyle can influence cancer-related outcomes, both in terms of quality of life and prognosis. Obesity, poor diet, low activity, and continued smoking have adverse effects on cancer survivors, and lifestyle interventions can ameliorate these effects. However, specific patterns of physical activity require further study, in addition to assessing the biological mechanisms by which lifestyle modifications and health behaviors affect cancer outcomes. Patients are more receptive to lifestyle changes when they realize that cancer can be modified to some extent and also have relevant recommendations from their physicians. Therefore, lifestyle recommendations are a very important part of treatment for cancer survivors and should be incorporated into the overall treatment plan. This will have a profound impact on long-term patient health outcomes.