Lifestyle medicine in the prevention and management of cancer: a state-of-the-art narrative review

Lifestyle medicine provides a unifying, evidence-based framework that may assist in reducing cancer incidence, improving treatment tolerance and survivorship across the cancer journey.

This article is a narrative, state-of-the-art review synthesising contemporary evidence on lifestyle medicine across the cancer continuum. The review was organised around the six pillars of lifestyle medicine: nutrition, physical activity, sleep, stress, social connection, risky substances associated with cancer risk, treatments and outcomes.

The literature showed many strong associations, though there was considerable variation in study populations, strength and consistency across studies and among the six pillars. Plant-predominant, Mediterranean-style dietary patterns, coupled with reduced ultra-processed foods, red and processed meats, are consistently associated in observational studies with 24%–60% relative reductions in the incidence of breast, colorectal and other cancers, with emerging microbiome-mediated mechanisms supporting nutrition strategies. Physical activity prescriptions are associated with reduced risk of multiple cancers, improved treatment completion, reduced sarcopenia and cachexia, and cancer recurrence and mortality among survivors. The evidence linking obesity, body composition, tobacco and alcohol to cancer emphasises muscle preservation, metabolic health, cessation interventions before and after diagnosis. A growing body of evidence associates sleep disruption, circadian misalignment, chronic stress, depression, loneliness and social isolation as clinically relevant modifiable determinants. Yet fewer than one in four survivors are recommended lifestyle strategies to complement the management strategy.

Although the strength, consistency of evidence and study populations vary across the six lifestyle pillars, the available literature suggests that lifestyle-related interventions across the six domains are associated with meaningful benefits.