Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine.

It's estimated that there are currently more than 18 million cancer survivors in the U.S. Cancer survivorship is no longer just about treatment, follow-up scans, and lab work. It's also about rebuilding a life that offers long-term protection for your heart, mind, and immune system — essentially, the whole person.

Often, cancer survivors are left with an overwhelming number of questions about what they can do to navigate this experience and reduce the chance of future cancer recurrence. Questions like: Is there a way I can change my diet to help protect me from a future cancer recurrence? How much and what type of exercise is safe during my cancer treatment or afterward if I'm on hormone therapy? Can improving my sleep or managing stress actually impact recurrence or fatigue during treatment?

In today's episode, we'll take a step-by-step approach to cancer survivorship and lifestyle medicine to address those questions — and so many more. We'll explore what the emerging field of lifestyle medicine tells us about nutrition, movement, restorative sleep, stress management, weight control, and the power of community support for cancer survivors. We'll also discuss how evidence-based lifestyle changes aren't a substitute for surgery, chemotherapy, or radiation, but a potent companion to these traditional treatments.

Most importantly, we'll answer that lingering question every survivor carries: What daily habits will give me the best shot at a long life beyond cancer? Whether you're newly diagnosed, years into remission, or supporting a loved one, this episode will give you science-backed answers and realistic steps to transform survivorship into vibrant, proactive living.

But first, let me introduce my guest, Dr Amy Comander. Dr Comander specializes in the care of women with breast cancer. She's the Medical Director of the Mass General Cancer Center, where she also serves as Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center at Newton-Wellesley Hospital. She's Director of the Lifestyle Medicine Program at the Mass General Cancer Center and is an Instructor in Medicine at Harvard Medical School. Dr Comander is a return guest on this podcast, so make sure to check out our show notes to find a link to her previous episode titled Thriving Beyond Diagnosis: Exploring Cancer Survivorship and Wellness.

Welcome back to the WebMD Health Discovered Podcast.

Amy Comander, MD: Thank you so much. It's great to be here.

Pathak: Well, it is, again, so great to have you because we're looking forward to learning even more from you this time. But before we jump into our topic for today, I'd love to just ask about your own health discovery — in your research or your work with patients — that brought together these two worlds of lifestyle medicine and cancer care for you.

Comander: I love kicking off this discussion with this topic — so important. When I first started practicing as a breast oncologist, I was not even aware of the field of lifestyle medicine. And how did I come across it? Really just seeing a pamphlet about a conference that was being hosted here in Boston focused on lifestyle medicine topics: the role of exercise, plant-based nutrition, restorative sleep. I attended the conference and was so fascinated and realized how important these tools were to apply to the field of cancer survivorship and to my own patients in breast oncology clinic, just based on the questions they would ask me every day.

"Dr Comander, how do I start an exercise regimen? How can I improve my sleep habits? What is the best diet to follow after a cancer diagnosis?" We know our patients are asking these questions, and they do want evidence-based answers. So that's how I got into this field and continue to do work in this important area — certainly for my patients, but also patients with other cancer diagnoses.

Pathak: So let's take a step back. You helped us understand a little bit about it, but what is lifestyle medicine? How do we define it for ourselves as practitioners? And then how do we share what that is with the rest of the world?

Comander: Well, happy to define it. I think it's so important, since some are not familiar with the term "lifestyle medicine." I like to use the description shared by the American College of Lifestyle Medicine, which defines lifestyle medicine as the therapeutic use of evidence-based lifestyle interventions to treat and prevent lifestyle-related diseases in a clinical setting.

What I really like about this definition is that lifestyle medicine empowers the individual with the knowledge and skills to make effective behavior changes that address the underlying causes of disease — or in my case, when I'm treating individuals with cancer, how to optimize their health, well-being, and ultimately, outcome from their cancer using these evidence-based tools.

Pathak: I wanna thank you so much for that because I think you really helped us understand each component and then think about how they come together. So how do you think about it as prevention? And then how do you sort of integrate it into treatment once someone is diagnosed?

Comander: Thank you for asking that, because in my clinic I'm seeing people who already have cancer, right? For the most part. So these individuals already say, "I have cancer, so unfortunately whatever I was doing did not prevent it."

And I, first of all, start by saying: No individual should ever blame herself or feel badly about getting breast cancer or any other diagnosis. We know the causes of these diseases are multifactorial, and we can't just pinpoint one thing. So I think that's really important for people to understand and reflect upon.

But certainly, if someone’s had cancer, they are unfortunately at risk for another cancer or other chronic diseases that we're all at risk for living in this country — type 2 diabetes, cardiovascular disease, infections — I could go on and on. So we know that learning about the tools of lifestyle medicine is helpful to reduce the risk of other chronic diseases. That’s how I think about prevention. And also, we know these tools are very important as a component of treatment for the cancer.

And I'm not saying a replacement for standard treatment — such as, as a breast oncologist, endocrine therapies or chemotherapy or radiation or surgery — but as a complement to those standard therapies. Increasing data demonstrates the importance of attention to these lifestyle factors along with standard therapies.

Pathak: So let's start with one of the most foundational pillars — the diet or nutrition pillar. What role does nutrition play in cancer management?

Comander: I love starting with nutrition as well. We all love to discuss the importance of a healthy diet in terms of overall health and well-being. And when we think about cancer, certainly thinking about the role of diet and outcome from cancer. It can be a very overwhelming topic for many of my patients.

We know that in this day and age, we're all bombarded by so much information on TikTok and Instagram and Facebook — you name it, right? And sometimes it's hard to discern fact from fiction when it comes to nutrition information. So I like to go with guidelines from large organizations that have evidence-based approaches to tackling a topic like nutrition.

We know organizations such as the American College of Lifestyle Medicine really promote the importance of a whole-food, plant-predominant diet. And when it comes to oncology, we have great information from organizations such as the World Cancer Research Fund, American Institute for Cancer Research, and American Cancer Society, which have given us some nice guidelines to follow when it comes to diet. I'm happy to review these broadly.

I try to keep it simple, because we know this can be such an overwhelming topic. The first bullet point is thinking about diet quality — not really the specific aspects of everything on your plate, but the overall quality. Avoiding sugary drinks, limiting alcohol, limiting red meats, avoiding processed meats, limiting consumption of ultra-processed foods, and eating more fruits and vegetables and whole grains. So that’s what I mean by quality — think of the overall quality of your diet, of what food is actually on your plate.

Then, of course, we could take a deeper dive into that, but that’s just a general theme. Secondly, we know that weight management is important. This is a challenging topic for so many reasons, but unfortunately, for over 20 years now, we've known that obesity is associated with an increased risk of at least 13 different types of cancer. And individuals who are obese at the time of a cancer diagnosis, in many cases, have a worse prognosis. So helping individuals achieve a healthy body weight is also very important.

Another important point is supplements. All these organizations really have come to the same conclusion: supplements cannot prevent cancer, and they cannot cure cancer. They may be indicated in certain situations — for example, if someone has vitamin D deficiency or needs vitamin D to optimize their bone health, or maybe they’re iron deficient. So there are situations where a supplement is beneficial. But in general, when you see that ad come across your Instagram telling you to drink this juice every day to prevent your cancer from coming back — unfortunately, there is not solid data to support that.

The final bullet point is a really great one: community support is key. In order to incorporate these healthy behaviors into our diet, we need the support of our family, friends, and community. I love that that piece is incorporated into these guidelines as well.

Pathak: Thank you for starting us off with that piece of lifestyle medicine. Now I want to move us on to physical activity. You just shared with us before we started recording for this podcast that you just ran the Boston Marathon — so congratulations again!

So tell us how we can incorporate physical activity from the most basic level, because I can tell you I'm probably not in any kind of shape to do something like a marathon. How do you talk to your patients about incorporating physical activity?

Comander: We do know that exercise is such an important component of cancer treatment. In fact, there's an emerging field called exercise oncology, where researchers and clinicians are really dedicated to advancing this idea that exercise is key — along with standard cancer treatments.

In fact, the American Society of Clinical Oncology, my major organization, did come out with a guideline a few years ago specifically focused on the importance of physical activity. The guideline states that oncology providers should recommend aerobic and resistance exercise during active treatment with curative intent to mitigate side effects of cancer treatment.

So there it is in a guideline that we should be following. And why is this important? We know that exercise interventions reduce fatigue, preserve cardiorespiratory fitness as individuals proceed with treatment, improve quality of life, and also reduce anxiety and depression in some populations. Finally, exercise is safe and carries a low risk of adverse events. So exercise is really important.

Then the question is: what are the guidelines? How do we actually implement this?

Really, the goal is to get an individual to 150 minutes of moderate aerobic activity each week. That could be 30 minutes five times a week, and it can be broken up throughout the day — maybe 10 minutes three times a day, five days per week. Whatever works for an individual.

There are so many different ways to approach this. Of course, we always meet each patient where he or she is in terms of their exercise ability. Maybe that means walking some laps around the dining room a few times a day. Maybe that means walking down the driveway to get the mail. Every person’s starting in a different place.

But we definitely work with our patients to encourage them to be active as they're able to, because we know this can improve how they tolerate their treatment — and all the benefits I just discussed. So exercise is really, really important as a component of standard cancer treatment.

Pathak: That's really great to sort of outline the way that you can slowly incorporate it in whatever way matches your current activity level. You know, I think that sometimes there's two sides to this coin. There's the piece where you want to potentially push yourself because you know it's beneficial, but then there's also the piece that you want to respect your own sort of need for rest and recovery. So how do you talk about that with your patients?

Comander: I love that you asked that question because here I am spelling off the guidelines about exercise, but we know that depending on where a patient is and her exact treatment, this may or may not be possible. So, for example, when I have a patient who's going through chemotherapy in the adjuvant setting—you know, curative intent—some of these regimens are pretty intense.
And the last thing a person really wants to do is embark on a new exercise regimen. So I really encourage them to be active as their body will allow them—listen to their body, as you just stated so beautifully. So, you know, in those first few days after treatment, when someone's really feeling kind of run down, that's when I might say, just getting up and walking to the kitchen to get yourself that glass of water—just being a little bit active in those first few days when you're feeling awful—is going to help you. And then, as the chemo kind of gets outta your system, that's an opportunity to, you know, do a little bit more. But this is not the time to embark on some crazy fitness routine. You joked about a marathon earlier—this is not the time to train for something like that or to take on some new challenge. It's really a time to kind of maintain where you are and maybe get a little bit better.
But again, just being active to some degree has been shown to be helpful. I think in the past, we used to tell patients: just rest, stay in bed for three weeks, and then come back and see me again. But we do know that that's not the ideal recommendation either. So it really is a fine balance.
Another thing I didn’t really talk about—I mentioned the aerobic exercise—strength training or resistance training is also so important. And people get intimidated when they hear that. They think, oh, I have to go to the gym and go into the weight area, and it's very, you know, I don’t feel comfortable there. But there are so many things that people could do at home—bodyweight exercises, doing some squats—even in, you know, again, in your living room, just do 10 squats. If you don’t know what I mean by that, there are so many great YouTube videos and other resources to help people figure out what to do at home.
But, you know, keeping your strength up, which means keeping up your muscle mass, avoiding sarcopenia—these are things people can do at home during treatment as well, which can be very helpful. But one step at a time. I definitely am very thoughtful about that with my patients too.

Pathak: So can you talk a little bit about that third piece of the lifestyle medicine therapeutic sort of regimen, which involves really considering and thinking about the whole person—so the emotional well-being of the patient in front of you as well?
How do you incorporate that pillar into your treatment regimen?

Comander: So stress, anxiety, depression—unfortunately, these moods are very prevalent amongst my patient population. Individuals facing a diagnosis of cancer, fear of recurrence—you name it, we can go on and on. And so there is good research, though, that being active to some degree is actually beneficial in terms of addressing these symptoms that many people experience.
So, you know, we've all heard the term “runner’s high.” There's actually a biological basis to that, based on what’s happening in our brain in terms of the secretion of neurotransmitters—or I think the latest term is endogenous endocannabinoids or endorphins, whatever term you love to research. But there is actually a biological basis to that feeling that after you do some type of physical activity, you feel better. You feel less anxious, less depressed, less scared. So, we know that this has been shown in the cancer populations as well. So I do really encourage my patients to find some form of physical activity that they enjoy since this can really help address that pillar of lifestyle medicine that you're referring to—management of stress and anxiety.

Pathak: That's great. And how do you pull in things like yoga, tai chi, mindfulness meditation to support that pillar as well?

Comander: Right. So, you know, organizations I mentioned—ASCO, American Society of Clinical Oncology—have also partnered with an organization called the Society of Integrative Oncology, which does explore the role of these integrative therapies that you're mentioning. Mindfulness-based stress reduction, other relaxation techniques, tai chi, acupuncture—all of these really interesting integrative techniques—and actually, many of these have been shown to help cancer survivors improve symptoms related to depression and anxiety.
So these are all part of guidelines now. Some of these interventions, particularly the role of exercise and mindfulness-based stress reduction—these programs and initiatives can help cancer patients feel less anxious, less depressed. Perhaps also, you know, cancer-related fatigue is another common symptom our patients experience. And so these interventions are now part of guidelines to address these symptoms that my patients may experience. So, I'm so glad that you asked about this too.

Pathak: As you're talking, what really strikes me is, oftentimes when a loved one has been diagnosed with cancer or someone we really care about, we're always thinking like, what can I do to help? How can I help in your journey? And it feels like being that social connection—that maybe moving with the person, that maybe helping with changes in their diet that you mentioned earlier, that maybe participating in like a walking circle or something like that—might be a great way to bring in that other pillar of social connection.
So you do a lot of work with group visits. Can you talk a little bit about that pillar and the social piece in helping yourself and potentially a loved one that you're trying to support through the journey?

Comander: That's such a great way to introduce this topic. So, you know, social connection, social support is a key pillar of lifestyle medicine. And when I first started doing this work in oncology, I’ll acknowledge I might have underestimated the importance of that pillar of lifestyle medicine. But then I saw—through, as you mentioned, some of the group visit work I've done with breast cancer survivors—seeing the benefits of that community support. Like another person who says, let me meet you tomorrow and let's go for a walk together. Or text me when you're going to the gym, and I'll get myself there too. You know, just having an individual that you're accountable to, who also gets what you're going through, is so beneficial.
So, in many ways, patients who have participated in my programs, where they've learned about the nutrition recommendations and the exercise recommendations and the stress management techniques—if you could ask them what was the number one benefit you gained from being part of this type of educational program?
I think many of them would say the social support from other people who really get what I'm going through. And so I think we really need to highlight the importance of social connection—social support—for individuals facing cancer diagnoses and many other chronic illnesses that we face here in this country.

Pathak: So beautifully said. And then that leads me to our sixth pillar of lifestyle medicine, which is the sleep piece. What does the evidence tell us about how sleep affects cancer progression? And is there anything that we know about sleep and treatment outcomes?

Comander: Such a great question. And again, I think in general, we're all learning so much more about the importance of sleep for our health—whether it's related to cancer or other diagnoses. But we know that sleep is so important. And I would say that, unfortunately, sleep disturbance or insomnia is quite prevalent among cancer survivors.
If you look at some of the data, depending on what study you look at, up to 30 to 70% of individuals with a cancer diagnosis do experience some degree of sleep disturbance. So obviously that's really unfortunate, and I hear this all day long in my own clinic about the sleep issues that my own patients are facing.
You know, why is sleep important for cancer survivors? I think, similar to the general population, getting adequate sleep is so important for our quality of life, for thinking about how our immune system's functioning, inflammation in our body, hormone levels, and certainly for our patients going through treatment, how they tolerate their treatment.
So I think this is kind of an emerging area—learning more about the biological basis of sleep as it relates to cancer treatment and outcome. But I will say that some of the therapies that have been found to be very helpful for management of insomnia, such as cognitive behavioral therapy—I've been fortunate, one of my colleagues at MGH, Dr Daniel Hall, is actually embarking on a study adapting a cognitive behavioral therapy program for insomnia for cancer survivors, specifically for this population. And I’ve been fortunate to collaborate with him. And that's just one example of taking the science of how we can help people with sleep disturbance and insomnia and improve that behavior.
And I've heard from some of my own patients, you know, great responses to those interventions so far. So I think this is an area that we all need to work on and learn more about. But I think we can all agree that sleep is important, and finding strategies to improve sleep in our cancer patient population is absolutely key.

Pathak: Yeah. As I've been listening to you talk about all of the different pillars and how they fit into cancer care, I can't help but reflect back on something you said at the very beginning, which is these interventions are sort of upstream even of the diagnosis. So you may have a particular cancer diagnosis, but these interventions are going to be helpful in the setting of treating that diagnosis, but also in managing so many other conditions that I would be taking care of as a primary care doctor—your high blood pressure, your diabetes, so many other chronic conditions. If you're integrating these pieces, you're going to find benefit in a lot of different pieces of the puzzle that you're dealing with on your health journey.

Comander: I would agree. And that's where, you know, we hear this term care for the whole patient, but I do think—just like you would say in your own practice—you think about that principle. I think in oncology it's really important as well. Of course, as a breast oncologist, I am very focused on treating the breast cancer and outlining all the different therapies that we would recommend to cure someone of her breast cancer, right? But we also need to think about all the other, perhaps, medical issues that she has or that she's at risk for, and all the other factors in her life—what type of social support she has, what type of environment she lives in, what kind of community support she might have. Does she have access to transportation to her appointments? I mean, we can go on and on. So I think this concept of caring for the whole patient is something that is very much ingrained in us, for those of us who get really interested in learning about lifestyle medicine—because we see how everything is interconnected.

Pathak: And you talked to us a little bit about some of the emerging areas of research when it comes to lifestyle medicine and cancer care. What else are you seeing on the horizon? What are you really excited about?

Comander: Well, I just love to see more of these tools integrated into standard oncology care. Certainly, I'm so fortunate—working at the Mass General Cancer Center, I work with such an incredible multidisciplinary team with expertise in so many areas, whether it's nutrition or physical activity or CBT-I. There are so many different things I could talk about, and I feel very fortunate. But thinking about how we can offer these evidence-based approaches to individuals with cancer all over is certainly a big challenge. And we know, thankfully, due to advances in early detection and treatment, that the number of cancer survivors in this country has gone up greatly. I think we're right around 18 and a half million now. So, thinking about how all of us can work together to provide these important interventions to our cancer survivor population is something very exciting to me.

And then, of course, the research in so many of these specific pillars that we've just been discussing—sleep research, learning more about nutrition and the gut microbiome, learning more about exercise oncology. All of these play such an important role, and I think we're going to see so many more advances in the next few years.

Pathak: I'm excited too, listening to you, so thank you. I'm going to give you the last few minutes. For someone who's listening right now—whether they themselves or a loved one is on their own cancer journey or their cancer survivorship journey—where can they go for more resources about the work that you are doing? Because, as you said, you have this great sort of team and structure where you are. But if they're looking for resources potentially in a place where they are, how can they find more information?

Comander: Great question. So I often refer patients to the American Institute of Cancer Research website, AICR. Lots of evidence-based information about nutrition and physical activity for cancer risk reduction and for survivors. Certainly, they're welcome to look at the MGH Cancer Center website and learn more about our lifestyle medicine program, which really outlines the six pillars of lifestyle medicine and how these are important for oncology care. We have lots of webinars available that anyone can watch for free.

The American College of Lifestyle Medicine—you and I are both involved—and certainly lots of great resources there. There is now a toolkit specifically for cancer survivorship that is available through ACLM that individuals may find to be very useful. And the American Cancer Society also now has some great tools for healthy living and optimizing lifestyle after a cancer diagnosis. So these are just a few that come to mind, but they're all evidence-based and great resources.

Pathak: That's great, thank you. And I'll add another one—I’ve been using your book, actually your PAVING book, with a friend. A couple of us bought it, and we're all sort of trying to work our way through the workbook together. And we'll add that information to our show notes as well.

Comander: Love it. Thank you.

Pathak: Well, thank you so, so much for this conversation. Really appreciate all of the learning.

Comander: Thank you so much for inviting me.

Neha Pathak: Today's conversation reframed cancer survivorship as more than follow-up scans. We heard solid evidence that a whole-food, plant-rich diet, 150 minutes of weekly movement, and resistance work can reduce fatigue, preserve muscle, and even improve breast cancer outcomes—all while also lowering the risk for diabetes, heart disease, and dozens of other chronic conditions.

We covered how small, sustainable steps—from walking to the mailbox, swapping sugary drinks for water, practicing a 10-minute mindfulness routine—pay big dividends in immunity, inflammation control, and protecting us from further chronic conditions.

We discussed how survivorship success is supported by behavior change plus community support. So recruiting a walking buddy, joining an online meal planning group, or asking your care team about exercise oncology and CBT for insomnia programs is a really good idea.

Finally, keep credible resources handy—another key takeaway from today. The American Institute for Cancer Research, American College of Lifestyle Medicine, and American College of Sports Medicine guidelines can steer you towards evidence-based nutrition, fitness, and sleep strategies. In short, everyday lifestyle choices are not a side note to cancer care—they're powerful extensions of treatment that can help you thrive long after the last infusion.

To find out more information about Dr Amy Comander, please make sure to check out our show notes.

Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered Podcast.