Optimizing Breast Cancer Survivorship: Addressing Lifestyle, Weight Management, and Psychological Health

With more than 4 million breast cancer (BC) survivors in the United States, oncologic care has expanded to encompass the long-term health, physical function, and quality of life of this growing population. Cancer survivorship is an active, longitudinal phase demanding ongoing adaptation to persistent physical symptoms, metabolic sequelae, and the psychological burden of uncertainty. This chapter examines three critical pillars of BC survivorship care: lifestyle interventions, weight management, and psychological well-being. Lifestyle medicine is an evidence-based field grounded in six core pillars: nutrition, physical activity, stress management, sleep, avoidance of risky behaviors, and positive social connection. Higher physical activity levels are associated with reductions in BC-specific and all-cause mortality, while adherence to a plant-forward, minimally processed dietary pattern is associated with lower overall mortality. Despite this evidence, implementation remains inconsistent, with key barriers including insufficient time, training, and referral resources. Elevated BMI at diagnosis and weight gain after treatment are associated with poorer BC outcomes and increased all-cause mortality. Although lifestyle modifications produce modest weight loss with mixed effects on survival outcomes, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a promising alternative, with emerging retrospective data suggesting improvements in overall survival and cardiovascular outcomes. Fear of cancer recurrence (FCR) is an unmet need among cancer survivors, affecting up to 59%, and does not decrease over time without intervention. Routine screening, honest information delivery, and a stepped-care referral model are recommended. Addressing these pillars will empower BC survivors to flourish during treatment and beyond.