Category Archives: Quality Of LIfe

Exercise, Reducing Your Likelihood of Cancer, and Life After Treatment

Diet, Habits, & Other Behaviors, Quality Of LIfe, Treatment & Management

Farmin Shahabuddin, MPH, Cancer Prevention and Treatment Fund

Most people know that exercise is good for your heart and overall health. What many people do not know is that exercise may also reduce the likelihood of developing cancer and help cancer survivors live longer after treatment ends. Whether you have never had cancer or finished treatment and want to lower your chances of it coming back, physical activity is one of the most important things you can do.

Can Exercise Reduce Your Likelihood of Getting Cancer?

Research shows that people who are physically active are less likely to develop many types of cancer. A study of 1.4 million people found that those who exercised regularly were less likely to develop 13 types of cancer, including breast, colon, liver, kidney, stomach, and bladder cancer.1

A 2025 study tracked activity of more than 85,000 adults using wearable devices. The most active people were about 26% less likely to develop cancer than the least active.2 Even light activities such as errands and household chores made a difference. Taking more steps each day also helped. For example, people who took 9,000 steps a day were about 16% less likely to develop cancer than those who took 5,000.

Cancer usually is growing before it is diagnosed, and being active in the year before a diagnosis is also beneficial according to a 2025 study of more than 28,000 people with stage 1 cancers who had activity records for the year before their diagnosis.3 Those who exercised as little as 60 minutes per week were 27% less likely to have their cancer progress to a more advanced stage  and were 47% less likely to die, compared to those who were not active.3 Five years after diagnosis, about 91% of the most active people were still alive, compared to about 84% of those who had not been active.3

Why Does Exercise Lower the Likelihood of Cancer?

Exercise may lower the likelihood of cancer in several ways. It lowers hormones such as estrogen and insulin that can encourage cancer cells to grow.4,5,6 It helps the immune system spot and destroy abnormal cells.6 It also helps people maintain a healthy weight, which matters because being overweight contributes to an estimated 14% to 20% of cancer deaths in the U.S.6 Exercise also helps move food through the digestive system faster, which reduces the time that the lining of the intestines is exposed to potentially harmful substances.

Scientists are still learning more about why exercise can prevent cancer. A 2026 lab study found that even 10 minutes of exercise changed the blood in ways that helped colon cancer cells repair damaged DNA.7 While more research is needed, this adds to the evidence that exercise sends signals throughout the body that may help fight cancer.

How Much Exercise Do You Need?

The U.S Department of Health and Human Services physical activity guidelines recommend that all adults get 150 to 300 minutes per week of moderate activity such as brisk walking, or 75 to 150 minutes of vigorous activity such as running. Adults should also do muscle strengthening exercises at least 2 days per week.6 These guidelines are not specific to cancer prevention. Of course, any amount of physical activity is better than none. The key is to start where you are and gradually build up.

Exercise for Cancer Survivors After Treatment

Exercise does not just matter before a cancer diagnosis. It can also be helpful during cancer treatment (see this link for our article on that). Regular exercise after you have finished cancer treatment, can also help you live longer and feel better, with fewer side effects from treatment, including less fatigue.8,9 Survivors who exercise regularly are less likely to die from cancer and are more likely to live longer than those who do not exercise.[10-14] It does not matter if you were fit before you got diagnosed. What matters is that you start exercising now.

Since exercise improves the immune system, cancer survivors who exercise regularly lower their chances of the cancer returning. A large 2026 study followed more than 17,000 cancer survivors for an average of about 11 years. 15 The survivors had bladder, endometrial, lung, oral cavity, ovarian, or rectal cancer. The activities studied included brisk walking, cycling, and swimming.      The study compared survivors at different activity levels to those who did no physical activity at all. It found that even small amounts of exercise that were considerably less than the recommended physical activity guidelines, were linked to longer survival. Bladder cancer survivors who did relatively low levels of exercise were 33% less likely to die from their cancer, endometrial cancer survivors were 38% less likely, and lung cancer survivors were 44% less likely, compared to those who did no physical activity.

Survivors who met or exceeded the recommended guidelines saw even greater benefits. Endometrial cancer survivors who met the guidelines were 60% less likely to die from their cancer, and lung cancer survivors were 62% less likely, compared to those who did no exercise. Oral and rectal cancer survivors who doubled the recommended amount of activity were 61% less likely to die of oral cancer and 43% less likely to die of rectal cancer.

Sitting Less Matters Too

Along with exercising more, sitting less can also make a difference. A 2022 study followed over 1,500 cancer survivors ages 40 and over for an average of 4.5 years. Survivors who exercised at least 150 minutes per week were less likely to die than those who did not exercise. 16  Survivors who sat for more than 8 hours a day were also more likely to die than those who sat less than 4 hours per day. Those who both did not exercise and sat more than 8 hours per day had the worst outcomes of all.”

A 2020 study followed 8,000 adults aged 45 and older for about 5 years. People who sat the most were more likely to die from cancer than those who sat the least.17 Replacing just 30 minutes of sitting per day with moderate to vigorous activity was linked to a 31% lower chance of dying from cancer. Even replacing that sitting time with light activity like standing or gentle walking was linked to an 8% lower chance of dying.

What Kind of Exercise Should I Do?

Aerobic activity of light to moderate intensity was the most common type of exercise studied in cancer patients. Combining aerobic exercise with walking and resistance training, such as lifting weights or resistance bands, led to greater health benefits than aerobic activity alone.11,13 Lifting weights refers to any weights, even just a few pounds. Do not assume you need barbells and large muscles.

Walking is the easiest way to start. The greatest benefit comes from walking at an average speed, about a 20-minute mile, for 3 to 5 hours per week.8 Even walking just 1 hour per week showed improvements over no physical activity at all.

The most important thing is to make it a habit. Start small by taking the stairs instead of the elevator or walking after dinner each evening. It is better to start small and keep it up than to try to do too much and give up. Do not miss the chance to get at least some benefit from this easy, free way to fight cancer.

The Bottom Line

Exercise is a powerful, free tool. For people who have never had cancer, regular physical activity is linked to a lower likelihood of developing many types of cancer. For survivors who have finished treatment, exercise lowers the chances of cancer coming back and helps people live longer. Being active before a diagnosis also improves outcomes if cancer does occur. Even if you were not active before, starting to exercise afterward still helps. Try to walk 3 to 5 hours a week at an average pace, about 1 mile per 20 minutes. Try to sit less and move more throughout the day. Even a little exercise is better than none. It is never too late to begin.

To read about the benefits of exercise during cancer treatment, click here: https://stopcancerfund.org/pz-diet-habits-behaviors/exercise-cancer-treatment-benefits/

References

  1. Moore, S. C., Lee, I. M., Weiderpass, E., Campbell, P. T., Sampson, J. N., Kitahara, C. M., Keadle, S. K., Arem, H., Berrington de Gonzalez, A., Hartge, P., Adami, H. O., Blair, C. K., Borch, K. B., Boyd, E., Check, D. P., Fournier, A., Freedman, N. D., Gunter, M., Johansson, M., & Patel, A. V. (2016). Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine, 176(6), 816–825. https://doi.org/10.1001/jamainternmed.2016.1548
  2. National Cancer Institute. (2025, March 26). Cancer risk decreases with more physical activity [Press release]. https://www.cancer.gov/news-events/press-releases/2025/light-intensity-physical-activity-cancer-risk
  3. Patricios, J., Constantinou, D., Goff, P., Kolbe-Alexander, T., Capostagno, B., Gossage, S., & van Rensburg, D. C. J. (2025). Regular physical activity before cancer diagnosis may lower progression and death risks. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2024-108699
  4. Key, T., Appleby, P., Barnes, I., & Reeves, G. (2002). Endogenous sex hormones and breast cancer in postmenopausal women: Reanalysis of nine prospective studies. Journal of the National Cancer Institute, 94(8), 606–616. https://doi.org/10.1093/jnci/94.8.606
  5. McTiernan, A., Tworoger, S. S., Ulrich, C. M., Yasui, Y., Irwin, M. L., Rajan, K. B., Sorensen, B., Rudolph, R. E., Bowen, D., Stanczyk, F. Z., Potter, J. D., & Schwartz, R. S. (2004). Effect of exercise on serum estrogens in postmenopausal women: A 12-month randomized clinical trial. Cancer Research, 64(8), 2923–2928. https://doi.org/10.1158/0008-5472.CAN-03-3393
  6. National Cancer Institute. (n.d.). Physical activity and cancer fact sheet. U.S. Department of Health and Human Services. https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet
  7. Orange, S. T., Dodd, E., Nath, S., Bowden, H., Jordan, A. R., Tweddle, H., Hedley, A., Chukwuma, I., Hickson, I., & Sharma Saha, S. (2025). Exercise serum promotes DNA damage repair and remodels gene expression in colon cancer cells. International Journal of Cancer. https://doi.org/10.1002/ijc.70271
  8. Holmes, M. D., Chen, W. Y., Feskanich, D., Kroenke, C. H., & Colditz, G. A. (2005). Physical activity and survival after breast cancer diagnosis. JAMA, 293(20), 2479–2486. https://doi.org/10.1001/jama.293.20.2479
  9. McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175(1), 34–41. https://doi.org/10.1503/cmaj.051073
  10. Meyerhardt, J. A., Heseltine, D., Niedzwiecki, D., Hollis, D., Saltz, L. B., Mayer, R. J., Thomas, J., Nelson, H., Whittom, R., Hantel, A., Schilsky, R. L., & Fuchs, C. S. (2006). Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: Findings from CALGB 89803. Journal of Clinical Oncology, 24(22), 3535–3541. https://doi.org/10.1200/JCO.2006.06.0863
  11. Fong, D. Y. T., Ho, J. W. C., Hui, B. P. H., Lee, A. M., Macfarlane, D. J., Leung, S. S. K., Cerin, E., Chan, W. Y. Y., Leung, I. P. F., Lam, S. H. S., Taylor, A. J., & Cheng, K. K. (2012). Physical activity for cancer survivors: Meta-analysis of randomized controlled trials. BMJ, 344, e70. https://doi.org/10.1136/bmj.e70
  12. Meyerhardt, J. A., Giovannucci, E. L., Holmes, M. D., Chan, A. T., Chan, J. A., Colditz, G. A., & Fuchs, C. S. (2006). Physical activity and survival after colorectal cancer diagnosis. Journal of Clinical Oncology, 24(22), 3527–3534. https://doi.org/10.1200/JCO.2006.06.0855
  13. Spence, R. R., Heesch, K. C., & Brown, W. J. (2010). Exercise and cancer rehabilitation: A systematic review. Cancer Treatment Reviews, 36(2), 185–194. https://doi.org/10.1016/j.ctrv.2009.11.003
  14. Sternfeld, B., Weltzien, E., Quesenberry, C. P., Jr., Castillo, A. L., Kwan, M., Slattery, M. L., & Caan, B. J. (2009). Physical activity and risk of recurrence and mortality in breast cancer survivors: Findings from the LACE study. Cancer Epidemiology, Biomarkers & Prevention, 18(1), 87–95. https://doi.org/10.1158/1055-9965.EPI-08-0595
  15. Rees-Punia, E., Teras, L. R., Newton, C. C., Gapstur, S. M., Patel, A. V., Gaudet, M. M., Islami, F., Campbell, P. T., & McCullough, M. L. (2026). Leisure-time physical activity and cancer mortality among cancer survivors. JAMA Network Open, 9(2), e2556971. https://doi.org/10.1001/jamanetworkopen.2025.56971
  16. Cao, C., Friedenreich, C. M., & Yang, L. (2022). Association of daily sitting time and leisure-time physical activity with survival among US cancer survivors. JAMA Oncology, 8(3), 395–403. https://doi.org/10.1001/jamaoncol.2021.6590
  17. Gilchrist, S. C., Howard, V. J., Akinyemiju, T., Judd, S. E., Cushman, M., Hooker, S. P., & Diaz, K. M. (2020). Association of sedentary behavior with cancer mortality in middle-aged and older US adults. JAMA Oncology, 6(8), 1210–1217. https://doi.org/10.1001/jamaoncol.2020.2045

Sleep Better Tonight: A Guide for Cancer Patients and Survivors

Diet, Habits, & Other Behaviors, Quality Of LIfe

Farmin Shahabuddin, MPH, National Center for Health Research

Many cancer patients (and their loved ones) experience insomnia, which is defined as having trouble falling and/or staying asleep.1 If this is a problem for you, you are not alone. Lack of sleep can make us tired, make it difficult to concentrate, and make it difficult to deal with any issues that arise, and can increase our chances of developing other health problems.2 Most cancer patients with insomnia are prescribed sleep-aid medications, which can have unpleasant side effects, such as memory problems and other health risks.1 Before reaching for the medicine cabinet, there are natural strategies that can help you get the rest you need. This guide combines the latest research and expert recommendations to help cancer patients and survivors sleep without the need for pills.

Your Plate Is Your Sleep Aid: How Diet Affects Rest

One of the simplest and most overlooked ways to improve sleep is already in your kitchen. Research shows that foods and dietary patterns that improve sleep tend to be lower in sugar and saturated fat and higher in fiber.3

The Sleep-Friendly Menu

A Mediterranean-style diet, which is rich in fruits and vegetables, lean meat, olive oil, vegetable fats, and whole grains, has shown promising results for sleep. A 2020 study followed more than 400 women based on a sleep questionnaire that measured overall sleep quality and found that those who followed this eating pattern most closely had 30% fewer sleep problems as measured by a sleep questionnaire than those who did not.3

Foods that promote better sleep:3,4

  • Fruits and vegetables (promote relaxation)
  • Beans and lentils (the more servings, the better the sleep quality)
  • Whole grains
  • Nuts, seeds, and leafy greens
  • Lean meat, olive oil, and vegetable fats

Your gut and your brain work as a team. When you eat more fruits, vegetables, nuts, and other plant-based foods that are high in fiber, the good bacteria in your gut stay balanced and healthy. This helps your body relax and know when it is time to sleep, which may help you sleep better.3

Sleep Disruptors: What to Skip

Research found that eating more sugar, refined carbs, and saturated fat made people take longer to fall asleep and spend less time in deep, restorative sleep.4

Foods and drinks that disrupt sleep:3,4

  • Sugary snacks and drinks
  • Highly processed packaged foods
  • Chocolate (contains caffeine)
  • Alcohol (it makes you drowsy initially but disrupts sleep later)
  • Acidic foods like citrus, which can cause heartburn
  • Spicy foods

A study of almost 500 women found that those who took more than an hour to fall asleep consumed over 400 calories more per day and consumed more sugar, more saturated fat, and less fiber compared to those who fell asleep within 15 minutes.3

Creating the Perfect Sleep Environment

Cool, Dark, and Quiet

Your bedroom directly affects your sleep quality. Ideally, you want a quiet, dark, cool environment, all of which help you fall asleep more quickly.4 Temperatures between 65-70 are usually ideal, but keep in mind that biological differences mean that men tend to like cooler temperatures than women.

Wear Socks To Bed?

This may seem like a strange idea, but it works. As our body makes more melatonin near the end of the day to prepare us for sleep, our body temperature starts to drop. Wearing socks can help a natural process that increases the flow of blood to your hands and feet, warming them. The nonprofit Sleep Foundation points out that socks can help you fall asleep more quickly and even help you stay asleep.5 Of course, your socks should not be tight (you don’t want to cut off circulation!), and to prevent sweating feet, we recommend sleeping in cotton socks (100% cotton if possible) that are relatively lightweight.

The Light Fight: Winning the Battle Against Blue Glow

Melatonin is a hormone that is naturally released in the brain a few hours before we feel a sense of sleepiness. Light from phones, laptops, and TVs prevents melatonin from being released, making it hard to fall asleep.4 If you use your computer, smartphone, or tablet before bedtime, the blue and green light from these devices can neutralize melatonin’s effects. If you watch television, be sure you are at least six feet away from the screen.6 Even going to the bathroom in the middle of the night can make it harder to go back to sleep, so try using a flashlight to reduce the impact of the light. Unfortunately, if you wake up for a bathroom break, it is completely normal to take up to 30 minutes to drift back to sleep.6

Clock Work: Timing Your Way to Better Sleep

Harness the Power of Daylight

You can help program your body to produce melatonin for sleep at the right time of day by getting exposure to daylight during the morning and afternoon. Take a walk outside or sit beside a sunny window.4 Morning activity that exposes you to bright daylight will help your natural circadian rhythm.6

The Goldilocks Rule for Eating

Going to sleep hungry can keep you awake, but so can eating before bedtime. Avoid eating a big meal within two to three hours of bedtime. If you are hungry right before bed, eat a small, healthy snack (such as an apple with a slice of cheese or a few whole-wheat crackers) to satisfy you until breakfast.4

Rituals That Rock You to Sleep

When you were a child, and your mother read you a story and tucked you into bed every night, this comforting ritual helped lull you to sleep. Even in adulthood, a set of bedtime rituals can have a similar effect. Rituals help signal to the body and mind that it is time for sleep. Drink a glass of warm milk. Take a bath. Or listen to calming music to unwind before bed.4

Move It to Snooze It: Exercise and Sleep

Physical activity, even gentle movement like a short walk, can help you sleep better at night. Exercise boosts the effect of natural sleep hormones such as melatonin.4 However, timing matters: aerobic exercise releases endorphins, which are chemicals that keep people awake. If you are having trouble sleeping, try to avoid vigorous activity within two hours of bedtime.6 Of course, check with your doctor about what level of physical activity is right for you during treatment or recovery.

Breaking the Sleep Anxiety Cycle

One of the most effective ways to overcome sleep problems is cognitive behavioral therapy for insomnia. This type of therapy helps people understand how their thoughts, habits, and routines affect their sleep.7 It focuses on changing behaviors that interfere with sleep, such as spending too much time in bed awake with unhelpful thoughts, whether worrying about your health or the health of a loved one, or even worrying that not getting enough sleep will make you feel worse the next day.

A review of studies found that cognitive behavior therapy is effective for reducing insomnia in cancer survivors.8 In addition, a 2019 study from Memorial Sloan Kettering Cancer Center found that the therapy helped reduce insomnia in cancer survivors, and also helped patients reduce their use of sleep aids even 20 weeks after finishing treatment. About 25% of patients were using at least one prescription sleep aid at the beginning of the study, but only 17% used the medication 20 weeks after treatment.9 Twenty weeks after completing the therapy, participants fell asleep an average of 24 minutes faster. That may not seem like much, but it is comparable to the small benefit of sleeping pills.9

The study also evaluated acupuncture for insomnia and found it to be less effective than cognitive therapy at falling asleep but more effective at staying asleep. almost as effective as cognitive behavioral therapy. Acupuncture is a traditional Chinese treatment where a trained acupuncturist places special needles into the skin at specific points on the body, which are associated with different aspects of health, such as pain or insomnia. Those who received acupuncture fell asleep an average of 11 minutes faster than before treatment. Right after completing treatment, participants who had acupuncture slept for an average of 62 more minutes a night, which was 27 more minutes than those treated with cognitive behavioral therapy. That is much more additional sleep than is typical of sleeping pills.9

Most cognitive behavioral therapy programs for insomnia last about six to eight weeks. If it is difficult to find a trained CBT-I therapist where you live, online therapy options are becoming more available. Acupuncture is a good alternative, especially for those who also experience pain, since acupuncture can also provide short-term pain relief.9,10

For more information about cognitive behavioral therapy or acupuncture for cancer patients with insomnia, see link.

Quiet the Mind: Tackling Stress Before Bed

When you are dealing with cancer, it is natural for worries to bubble to the surface at night, concerns about your health, upcoming appointments, treatment side effects, costs, or what the future holds. Stress activates the fight-or-flight hormones that make it hard to sleep.4

Give yourself time to wind down before bed. To relax, try deep breathing exercises: The simple one is to inhale slowly and deeply, and then exhale. Or try the 4-7-8 breathing exercise, which, in addition to a breathing technique, helps you concentrate on something other than whatever is worrying you.11

In addition to relaxation techniques, small changes to your sleep environment can also help. A sleep mask can block out light from streetlights, electronics, or early morning sun, helping your body stay in sleep mode. White noise, such as a fan, sound machine, or app, creates a steady background sound that covers up sudden noises that can disrupt your sleep. This can help your brain relax and make it less likely that you will wake up during the night.

If you are curious about which sleep masks, white noise machines, and other sleep products work best, Consumer Reports has tested and reviewed many of them. You can check out their recommendations.12 In addition, there are free cell phone apps that provide a choice of soothing repetitive sounds, such as waves, babbling streams, and rain, such as the Soothing Sleep Sounds for iPhones.

The Melatonin Question: What You Need to Know

If you try melatonin supplements, experts recommend buying the same brand consistently since supplements are not tested by any unbiased government agencies, and dosages vary between manufacturers. For most people, it is safe to take melatonin nightly for one to two months. After that, you should stop and see how your sleep is.6

Important caution: Talk to your oncologist or health care provider before taking melatonin or any supplement, as it may interact with your cancer treatment. Do not use melatonin if you are pregnant or breastfeeding or have an autoimmune disorder, a seizure disorder, or depression. Also, talk to your provider if you have diabetes or high blood pressure.6

Red Flags: When to Talk to Your Doctor

Pain or discomfort, an urge to move your legs, snoring, and a burning pain in your stomach, chest, or throat are symptoms of common sleep disrupters, including restless legs syndrome, sleep apnea, and gastroesophageal reflux disease (GERD). If these symptoms are keeping you up at night or making you sleepy during the day, talk to your doctor.4 Many cancer patients experience sleep problems related to their treatment or medications, so do not hesitate to bring up sleep concerns with your care team.

The “Magic Food” Myth

You may have heard that specific foods like tart cherries or kiwifruit can ease you into slumber. While some small studies suggest benefits, there is no single “miracle” food that works for everyone.3

The Bottom Line

Better sleep does not come from any single trick; it comes from building healthy habits throughout your day. Start with one or two changes that feel manageable. Eat more fruits and vegetables, get some gentle movement when you can, dim the lights in the evening, find ways to quiet your mind through breathing exercises or therapy, and permit yourself to rest.

If sleep problems persist, talk to your care team about cognitive behavioral therapy or acupuncture; both have been shown to help cancer survivors sleep better without the side effects of sleeping pills. Small improvements add up over time, and better sleep can help you feel better each day.

References

  1. Savard, J., Ivers, H., Villa, J., Caplette-Gingras, A., & Morin, C. M. (2011). Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. Journal of Clinical Oncology, 29(26), 3580–3586.
  2. Harvard Health Publishing. (2023, November 20). 8 secrets to a good night’s sleep. Harvard Health. https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
  3. Wadyka, S. (2025, January 10). Foods to eat for better sleep. Consumer Reports. https://www.consumerreports.org/health/nutrition-healthy-eating/foods-to-eat-for-better-sleep-a7781483547/
  4. Johns Hopkins Medicine. (n.d.). Natural sleep aids: Home remedies to help you sleep. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/natural-sleep-aids-home-remedies-to-help-you-sleep
  5. Sleep Foundation. (n.d.). Sleeping with socks on. Sleep Foundation. https://www.sleepfoundation.org/sleep-hygiene/sleeping-with-socks-on
  6. Harvard Health Publishing. (2023, November 20). 8 secrets to a good night’s sleep. Harvard Health. https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
  7. Tagle, A. (2026, January 15). 4 ways to beat the anxiety of insomnia—and get back to sleep. NPR Life Kit. https://www.npr.org/2026/01/15/nx-s1-5611117/beat-anxiety-insomnia-get-back-to-sleep
  8. Johnson, J. A., Rash, J. A., Campbell, T. S., Savard, J., Gehrman, P. R., Perlis, M., Carlson, L. E., & Garland, S. N. (2016). A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Medicine Reviews, 27, 20–28.
  9. Garland, S. N., Xie, S. X., DuHamel, K., Bao, T., Li, Q., Barg, F. K., Song, S., Kantoff, P., Gehrman, P., & Mao, J. J. (2019). Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: A randomized clinical trial. Journal of the National Cancer Institute, 111(12), 1323–1331.
  10. Yin, X., Gou, M., Xu, J., Dong, B., Yin, P., Masquelin, F., Wu, J., Lao, L., & Xu, S. (2017). Efficacy and safety of acupuncture treatment on primary insomnia: A randomized controlled trial. Sleep Medicine, 37, 193–200.
  11. Young, M. (2022, September 6). How to do the 4-7-8 breathing exercise. Cleveland Clinic. https://health.clevelandclinic.org/4-7-8-breathing
  12. Consumer Reports. (2026, January 9). 12 products that help us get a good night’s sleep. Consumer Reports. https://www.consumerreports.org/health/sleeping/products-that-help-us-get-a-good-nights-sleep-a8894453489/

Comparison of Acupuncture and Therapy as Treatments for Cancer Survivors with Insomnia

Quality Of LIfe, ,

Meg Seymour, PhD and Nina Zeldes, PhD, National Center for Health Research

Most cancer patients experience insomnia,[1] which is defined as having trouble falling and/or staying asleep. Most cancer patients with insomnia are prescribed sleep-aid medications as treatment,[2] which can have unpleasant side effects, such as memory problems and health risks.[3]  In fact, studies show that people who take sleep medication more often are more likely to develop many types of cancer (You can read this article for more information). Fortunately, in 2019, cancer researchers at Memorial Sloan Kettering found that there are safer and possibly more effective treatments for cancer patients’ insomnia: acupuncture, as well as a type of  therapy specifically developed for treating insomnia, called Cognitive Behavioral Therapy for Insomnia (CBT-I).

Acupuncture is a traditional Chinese treatment where a trained acupuncturist places special needles into the skin at specific points at the body, which are associated with different aspects of health. There are certain places on the body that acupuncturists place needles in order to treat sleep problems, as well as pain.

CBT-I is a type of therapy that uses several different approaches to treat insomnia. It uses methods such as “cognitive restructuring,” which trains patients to reduce anxious thoughts in ways that make it easier to fall asleep. Another strategy is “sleep restriction,” in which patients primarily stay in bed for sleeping, not for watching TV, reading, or other activities. The goal is to associate being in bed with sleeping, not thinking about issues that can interfere with sleeping.

Comparing acupuncture and therapy as insomnia treatments

Acupuncture and cognitive behavioral therapy had previously been proven effective for insomnia. For example, CBT-I had previously been shown to reduce insomnia among cancer survivors,[5] and acupuncture has been found to be effective for insomnia patients without cancer.[6] The goal of the 2019 study was to compare these two treatments for insomnia among cancer survivors, to determine which was more effective. 

The study compared the two treatments in 160 cancer survivors whose insomnia was severe enough that they were diagnosed with insomnia. Participants were randomly assigned to receive either 10 sessions of acupuncture treatment over 8 weeks, or 7 sessions of CBT-I over the course of 8 weeks. The researchers measured the severity of the participants’ insomnia, as well as other symptoms such as pain and anxiety. Participants’ symptoms were measured before they began treatment, right after completing the 8 weeks of treatment, and every four weeks up to 20 weeks after they finished the treatment. Measuring symptoms at these different times compared how effective the treatments were in both the short-term and the long-term.

Which treatment was most effective? 

The researchers found that both treatments were effective at reducing insomnia, and they also helped patients reduce their use of sleep aids, even at 20 weeks after finishing treatment. About 25% of patients were using at least one prescription sleep aid at the beginning of the study, but only 17% used the medication 20 weeks after treatment. CBT-I was slightly more effective than acupuncture at reducing insomnia symptoms and improving overall sleep quality, as well as reducing the amount of time it took to fall asleep and reducing the number of times participants woke up in the night. 

Twenty weeks after completing treatment with CBT-I, participants fell asleep an average of 24 minutes faster, and those who received acupuncture fell asleep an average of 11 minutes faster than before they started treatment. That might not seem like much benefit, but it is comparable to the small benefit of sleeping pills.[7] After treatment, both groups stayed asleep for longer at night. However, those who received acupuncture stayed asleep even longer than those who received CBT-I. Right after completing treatment, participants who had acupuncture treatment slept for an average of 62 more minutes a night, 27 more minutes than those who were treated with CBT-I. After 20 weeks, those who received acupuncture still slept 51 minutes more than before treatment, which was 5 and a half minutes more than those treated with CBT-I. That is much more additional sleep than is typical of sleeping pills.[7]

However, this difference in the effectiveness of the two treatments was only true for men. The two treatments were equally effective at reducing overall insomnia severity in women. The researchers also found that CBT-I was only more effective among White participants, highly educated participants, and those with lower pain levels. Otherwise, the two treatments were equally effective. 

In addition to evaluating insomnia severity, the researchers also measured participants’ fatigue, anxiety, depression, and overall quality of life as measured by mental and physical health. The two treatments were equally effective at improving those symptoms.

The bottom line

Both acupuncture and CBT-I helped reduce insomnia symptoms in cancer survivors, but CBT-I was more effective for men, Whites, highly educated participants, and those with lower pain levels. The researchers concluded that CBT-I should be used as the first line of treatment for cancer-related insomnia, but pointed out that patients might find it difficult to find CBT-I treatment. Unfortunately, there are few trained CBT-I therapists, but acupuncture is a good alternative. In addition, acupuncture was more effective for the treatment of short-term pain than CBT-I. 

Despite the shortage of well-trained CBT-I therapists, the availability of online therapy can help those who are interested get access to this treatment. For more information on online therapy, you can read this article. 

 

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

 

References 

  1.     Savard J, Ivers H, Villa J, et al. Natural course of insomnia comorbid with cancer: an 18 month longitudinal study. Journal of Clinical Oncology. 2011; 29(26):3580–3586.
  2.     Berger AM, Matthews EE, Kenkel AM. Management of sleep-wake disturbances comorbid with cancer. Oncology. 2017 Aug 16;31(8).
  3.     Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: But lack of benefit. F1000Res. 2016;5:918.
  4.     Garland SN, Xie SX, DuHamel K, Bao T, Li Q, Barg FK, Song S, Kantoff P, Gehrman P, Mao JJ. Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: a randomized clinical trial. JNCI: Journal of the National Cancer Institute. 2019; 111(12):1323-31.
  5.     Johnson JA, Rash JA, Campbell TS, et al. A systematic review and metaanalysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Medicine Review. 2016;27:20–28.
  6.     Yin X, Gou M, Xu J, et al. Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep Medicine. 2017;37:193–200.
  7. Carr, T. The Problem With Sleeping Pills. Consumer Reports.com. https://www.consumerreports.org/drugs/the-problem-with-sleeping-pills/. Updated December 2018.

How to Report Problems With Medical Products to the FDA

General Treatment Issues, Quality Of LIfe, Treatment & Management

National Center for Health Research.

Every year, tens of thousands of consumers suspect that their medicines or medical devices might be causing unexpected side effects. Side effects – also called adverse reactions – can be quite minor, such as a rash or stomach upset, or very serious, such as mental confusion, heart damage or an autoimmune reaction. It is sometimes difficult to tell if the health problem is caused by the medical product or is merely a coincidence. That is why serious problems that are possibly related to a medical product should be reported to your physician and to the Food and Drug Administration (FDA). You do not have to be certain that the health problem is caused by the medical product – the purpose of a tracking program is to figure out if there is a problem by looking for a pattern in the reports. By tracking these reports, the FDA can determine if there is a pattern that may indicate the need to warn consumers or even to withdraw a product from the market.

The FDA has a program called MedWatch for reporting serious reactions and problems with medical products, including drugs and implanted devices.

The process is relatively simple and is outlined on the MedWatch website. You may ask your doctor to fill out a MedWatch form detailing the problem you have been experiencing. The MedWatch form is available online or you or your doctor can request a copy of the form by calling the FDA toll free at 1-888-INFO-FDA (1-888-463-6332).

If for some reason you do not wish to have the form filled out by your doctor or your doctor refuses to fill out the form (doctors are not required by law to complete a report to the FDA), then you can complete the form yourself. MedWatch provides a set of instructions for completing the form on their website, as well as an online form that you can submit on the website.

If you prefer to report your problem over the telephone, you can do that by calling the at 1-800-FDA-1088.

If you have questions or comments about a specific drug or medical device, you can call the FDA toll free information number at 1-888-INFO-FDA (1-888-463-6332), press 2, followed by 1 for information, then:

  • for dietary supplements, press 2
  • for drug products, press 3
  • for medical devices, press 4
  • for biologics, including human cells, tissues and cellular and tissue-based products, press 6

Reporting problems helps fix them and ensure that other patients do not experience the same unexpected side effects or reactions.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

The Benefits of Exercise After Getting Cancer

Breast Cancer, Colon Cancer, Diet, Habits, & Other Behaviors, General Treatment Issues, Prevention, Quality Of LIfe, Treatment & Management

Farmin Shahabuddin, MPH, Morgan Wharton and Annika Schmid, Cancer Prevention and Treatment Fund

You may have heard that regular exercise can reduce your risk of developing cancer, but did you know it’s also good for cancer patients who are undergoing or have completed treatment?

Is Exercise Good for Everyone with Cancer?

Exercise has proven benefits for cancer patients, ranging from improved fitness and higher quality of life to reduced rates of recurrence and a longer life. What we know about exercise and cancer mostly comes from studying patients with breast or colon cancer, but there is now evidence that there are benefits of exercise for men and women suffering from almost all types of cancer, even cancer as advanced as Stage III. [1, 2]

The best news of all: It doesn’t matter if you were fit before you got diagnosed.[1, 3, 4] A 2026 study found the following finding: lung and rectal cancer survivors who were inactive before their diagnosis but became active enough to meet physical activity guidelines afterward were still 42% and 49% less likely to die from their cancer, respectively, compared to those who remained inactive both before and after diagnosis.[5] So, it’s never too late to start exercising to fight cancer. If you’re coping with cancer or its aftermath, now is the time.

How Does Exercise Help Cancer Patients?

Many studies have shown that exercise is beneficial to cancer patients, but no one is sure exactly why. Earlier studies suggested that exercise may help women avoid breast cancer or a recurrence of it by decreasing female hormones that feed cancer in the breast [6,7] or by lowering inflammation in the body [8] , a suspected contributor to many diseases.

Physical Benefits of Exercise for Cancer Patients

Studies have shown that in cancer patients, exercise during or after treatment reduces fat and improves body mass index (BMI). [9, 10] Exercise lowers blood pressure, boosts the immune system, and increases bone mineral density. [10, 11] Denser bones mean fewer fractures.

Not surprisingly, cancer patients who exercise regularly during and after treatment reported increases in strength, walking ability, aerobic capacity, and flexibility. [9, 10]

Cancer patients who had completed treatment reported fewer negative side effects from treatment once they began to exercise regularly.[2] Patients who exercised during treatment reported less nausea and less difficulty sleeping.[10] The most reported improvement was reduced fatigue. [4, 10, 11]

A study published in 2021 indicates that exercise may also help relieve “chemo brain” (also known as chemo fog), which is a common side effect for cancer patients undergoing chemotherapy.[12] Common symptoms of chemo brain are having trouble with learning new tasks, remembering names, paying attention, and concentrating. The study found that patients who did either 2.5–5 hours of moderate intensity exercise (like brisk walking) per week or who did 1.5–2.5 hours of high intensity exercise (such as running) per week in the week before starting chemotherapy, within 1 month of completing chemotherapy, and 6 months after completing chemotherapy were less likely to report “chemo brain” symptoms than patients who did not exercise. Chemo brain can be upsetting and debilitating, affecting more than 75% of breast cancer patients undergoing chemotherapy, for example.

Mental and Emotional Benefits

In addition to the physical health benefits of exercise, cancer patients who exercised also reported improved mental and emotional well-being.[9] Patients who exercised during treatment and those who began to exercise afterwards frequently reported an increase in quality of life, less anxiety, and a renewed “fighting spirit.”[10] Cancer patients over the age of 80 who exercised regularly during their weeks or months of treatment reported less loss of memory.[13]

Long-Term Survival and Reducing Cancer Recurrence

Because exercise improves the immune system, cancer patients who exercise regularly lower their risk of the cancer returning. [1, 9, 11, 14] Patients who exercise are less likely to die from cancer and are more likely to live longer than patients who don’t exercise.

A large 2026 study combining data from six major long-term research projects followed more than 17,000 cancer survivors for an average of nearly 11 years after diagnosis to examine the survival benefits of moderate to vigorous physical activity. The activities included brisk walking, cycling, or swimming, and the patients had been diagnosed with bladder, endometrial, lung, oral cavity, ovarian, or rectal cancer. Current guidelines suggest that people with a history of cancer should aim for 150 to 300 minutes of moderate intensity or 75 to 150 minutes of vigorous intensity aerobic physical activity per week.[5]

The study found that even less than the standard recommended guidelines of physical activity seemed beneficial. For example, bladder cancer survivors who exercised were 33% less likely to die from their cancer, endometrial cancer survivors were 38% less likely, and lung cancer survivors were 44% less likely, compared to those who did no physical activity. Oral and rectal cancer survivors who doubled the amount of activity that was in the recommended guidelines were 61% less likely to die of oral cancer and 43% less likely to die of rectal cancer.[5]

A 2022 study found that cancer survivors who exercise and do not sit 8 or more hours a day live longer than less active cancer survivors.[15] The study followed over 1,500 cancer survivors ages 40 and over for an average of 4.5 years. The researchers found that those who exercised at least 150 minutes per week were less likely to die (of cancer or anything else) than people who did not report exercising. Survivors who reported sitting for more than 8 hours a day were also more likely to die than those who reported sitting less than 4 hours per day, and survivors who reported both a lack of exercise and sitting more than 8 hours per day were the most likely to die of all the survivors studied.

A 2020 study of 8,002 Black and white adults aged 45 and older in the U.S. examined whether sitting for long periods of time increases the chances of dying from cancer.[16] Each participant wore a hip-mounted device, like a fitness tracker, for 7 consecutive days to measure how much time they spent sitting versus being physically active. Over an average follow-up of about 5 years, 268 participants died of cancer. People who spent the most time sitting were more likely to die from cancer compared to those who sat the least. People who replaced just 30 minutes of sitting per day with moderate to vigorous physical activity had a 31% lower chance of cancer death. In fact, people who swapped that sitting time for light activity like standing or gentle walking were 8% less likely to die. This shows that the total amount of time spent sitting matters in addition to the time spent exercising, so cancer survivors should try to sit less and move more throughout the day.

What Kind of Exercise Should I Do?

Aerobic activity of light to moderate intensity was the most common type of exercise in the studies of cancer patients. [1, 9] Combining aerobic exercise with walking and resistance training (such as weightlifting or using resistance bands) led to greater health benefits than aerobic activity alone. [9, 11]

Walking can improve the health of cancer patients. Studies estimate that the greatest benefit from walking is seen in patients who walk at an average speed (a 20-minute mile) for 3–5 hours weekly.[2] Patients who walked just 1 hour per week, regardless of walking speed, showed improvements over the group of patients who reported no physical activity in a week.

To get the most out of exercise, you need to make it a habit—something you commit to for the long-term. That’s why it is better to start small, with easily achievable changes like using the stairs regularly instead of the elevator or walking each evening after dinner. Remember to set realistic goals, because it is better to start small and keep it up than to try to do too much and give up. Don’t miss the chance to get at least some benefit from this easy, free strategy to fight cancer.

The Bottom Line

Exercise helps individuals who are undergoing cancer treatment and those who have completed cancer treatment. Cancer patients who exercise regularly during and after treatment can expect fewer side effects from treatment, including less fatigue, fewer problems with concentration and memory, and better overall fitness and health. Patients who exercise are less likely to experience a return of cancer in the future and are more likely to live longer, healthier lives.

You should try to walk at least 3 to 5 hours a week at an average pace (about 1 mile per 20 minutes). Even minimum exercise, like walking one hour per week, can improve the health of cancer patients who have completed treatment, compared to cancer patients who do not exercise at all. The benefits from exercise can be seen in all cancer patients regardless of whether they exercised regularly before they were diagnosed with cancer. It’s never too late to begin to exercise and improve your health!

References

  1. Jeffrey A. Meyerhardt, D.H., Donna Niedzwiecki, Donna Hollis, Leonard B. Satz, Robert J. Mayer, James Thomas, Heidi Nelson, Renaud Whittom, Alexander Hantel, Richard L. Schilsky, and Charles S. Fuchs, Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: Findings from CALGB 89803. Journal of Clinical Oncology, 2006. 24(22): p. 3635-3541.
  2. Michelle D. Holmes, W.Y.C., Diane Fesknich, Candyce H. Kroenke, Graham A. Colditz, Physical activity and survival after breast cancer diagnosis. Journal of the American Medical Association, 2005. 293(20): p. 2479-2486.
  3. Jeffrey A. Meyerhardt, E.L.G., Michelle D. Holmes, Andrew T. Chan, Jennifer A. Chan, Graham A. Colditz, and Charles S. Fuchs, Physical activity and survival after colorectal cancer diagnosis. Journal of Clinical Oncology, 2006. 24(22): p. 3527-3534.
  4. Margaret L. McNeely, K.L.C., Brian H. Rowe, Terry P. Klassen, John R. Mackey, Kerry S. Courneya, Effects of exercise on breast cancer patients and survivors: A systematic review and meta analysis. Canadian Medical Association Journal, 2006. 175(1): p. 34-41.
  5. Rees-Punia E, Teras LR, Newton CC, et al. Leisure-Time Physical Activity and Cancer Mortality Among Cancer Survivors. JAMA Netw Open. 2026;9(2):e2556971. doi:10.1001/jamanetworkopen.2025.56971
  6. Key T, Appleby P, Barnes I, Reeves G. Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst. Apr 17 2002;94(8):606-616.
  7. McTiernan A, Tworoger SS, Ulrich CM, et al. Effect of exercise on serum estrogens in postmenopausal women: a 12-month randomized clinical trial. Cancer Res. Apr 15 2004;64(8):2923-2928.
  8. Friedenreich CM, Neilson HK, Woolcott CG, et al. Inflammatory Marker Changes in a Yearlong Randomized Exercise Intervention Trial among Postmenopausal Women. Cancer Prevention Research. January 1, 2012 2012;5(1):98-108.
  9. Daniel Y T Fong, J.W.C.H., Bryant P H Hui, Antoinette M Lee, Duncan J Macfarlane, Sharron S K Leung, Ester Cerin, Wynnie Y Y Chan, Ivy P F Leung, Sharon H S Lam, Aliki J Taylor, Kar-keung Cheng, Physical activity for cancer survivors: Meta analysis of randomised controlled trials. British Medical Journal, 2012. 344(70).
  10. Ruud Knols, N.K.A., Daniel Uebelhart, Jaap Fransen, and Geert Aufdemkampe, Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 2005. 23(16): p. 3830-3842.
  11. Rosalind R. Spence, K.C.H., Wendy J. Brown, Exercise and cancer rehabilitation: A systematic review. Cancer Treatment Reviews, 2009. 36: p. 185-194.
  12. Elizabeth A. Salerno, Eva Culakova, Amber S. Kleckner, Charles E. Heckler, Po-Ju Lin, Charles E Matthews, Alison Conlin, Lora Weiselberg, Jerry Mitchell, Karen M. Mustian, Michelle C. Janelsins. Physical Activity Patterns and Relationships With Cognitive Function in Patients With Breast Cancer Before, During, and After Chemotherapy in a Prospective, Nationwide Study. Journal of Clinical Oncology. 2021. https://ascopubs.org/doi/full/10.1200/JCO.20.03514.
  13. LK Sprod, S.M., W Demark-Wahnefried, MC Janelsins, LJ Peppone, GR Morrow, R Lord, H Gross, KM Mustian, Exercise and cancer treatment symptoms in 408 newly diagnosed older cancer patients. Journal of Geriatric Oncology, 2012. 3(2): p. 90-97.
  14. Barbara Sternfeld, E.W., Charles P. Quesenberry, Jr., Adrienne L. Castillo, Marilyn Kwan, Martha L. Slattery, and Bette J. Caan, Physical activity and risk of recurrence and mortality in breast cancer survivors: Findings from the LACE study. Cancer Epidemiology, Biomarkers & Prevention, 2009. 18(1): p. 87-95.
  15. Cao, C, Friedenreich, CM and Yang L. Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors. JAMA Oncology, January 6, 2022 online, https://jamanetwork.com/journals/jamaoncology/article-abstract/2787951.
  16. Gilchrist SC, Howard VJ, Akinyemiju T, Judd SE, Cushman M, Hooker SP, Diaz KM. Association of Sedentary Behavior With Cancer Mortality in Middle-aged and Older US Adults. JAMA Oncology. 2020;6(8):1210–1217.