Oncology Clinicians Must Prioritize Survivorship Lifestyle Discussions

During the 5 to 10 years of survivorship following initial active breast cancer treatment, oncology clinicians have a unique window to influence long-term patient health. Jenni Sheng, M.D., an Assistant Professor in the Department of Oncology at the Johns Hopkins University School of Medicine, emphasized in a recent interview that because patients form strong, trusting bonds with their oncology teams during this phase, a provider's guidance on lifestyle modification carries immense weight. Clinicians must proactively initiate conversations about physical activity and weight management, elevating these interventions to the same level of clinical priority as standard oncology therapies.

"I think patients need to hear us say that it is just as important as taking their endocrine therapy or getting their surveillance imaging," Sheng noted, pointing out that two-thirds of patients walking through the door already present with excess weight. Excess weight acts as a major risk factor for breast cancer recurrence, and survivorship visits offer a rare opportunity to address it directly. Rather than focusing solely on active cancer surveillance, clinicians have a professional duty to ask patients simple, direct questions such as: "What type of exercise are you doing? Are you exercising?" or "Have you thought about strategies to lose that extra weight?"

Sheng highlights that these conversations are critical for addressing interrelated chronic comorbidities, such as pre-diabetes or high blood pressure, which frequently complicate long-term survivorship. To systematically guide these discussions, she urges oncology nurses and physicians to review and promote the National Comprehensive Cancer Network (NCCN) guidelines for cancer survivors. Under these established benchmarks, clinicians should advise patients to stay active for at least 150 minutes per week, perform strength training at least twice a week, consume a 50% plant-based diet, and strictly limit red meat and alcohol consumption.

While implementing lifestyle modifications is the cornerstone of comprehensive survivorship care, behavioral weight loss (BWL) strategies alone often yield limited long-term success. To address this clinical gap, Sheng led the Adaptive Nutrition and Exercise Weight Loss (A-NEW) phase II study (NCT04499950), which evaluated an adaptive approach to weight management in stage 0 to III breast cancer survivors with a body mass index of 27 kg/m² or higher.

The trial initiated all participants on a remote, intensive BWL program consisting of phone coaching and dietary self-monitoring. At the 2-month mark, those who achieved less than a 5% weight loss (classified as SLOW-BWL) received oral FDA-approved weight-management medication Contrave (naltrexone/bupropion) in addition to continuing their BWL coaching.

Among the SLOW-BWL cohort, 42.1% successfully achieved a clinically meaningful weight loss of 5% or more by the 6-month endpoint. Furthermore, participants who reached this 5% weight loss threshold reported significant improvements in physical function and pain interference. The adaptive cohort also demonstrated beneficial clinical reductions in HbA1c and triglycerides between baseline and 6 months.

Sheng's clinical findings demonstrate that early weight loss trajectories can guide personalized, multimodal obesity treatments. By actively discussing NCCN lifestyle guidelines and utilizing adaptive pharmacological support when behavioral changes plateau, oncology clinicians can help breast cancer survivors overcome chronic barriers, manage comorbidities, and significantly optimize their long-term health outcomes.

Reference

1. Sheng JY, Zahurak ML, Too F, et al. Weight loss responses to pharmacotherapy in breast cancer survivors: results from the Adaptive Nutrition and Exercise Weight Loss (A-NEW) Study. Clin Cancer Res. Published online August 4, 2026. doi:10.1158/1078-0432.CCR-26-0270