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Life after treatment

Taking control of your health

Cancer survivors will benefit from maintaining or adopting a healthier lifestyle after their cancer treatment. This could include achieving a healthy body weight, eating a healthy diet, being physically active, protecting yourself from the sun, stopping smoking or cutting down on alcohol.

Research suggests that a healthy lifestyle (in combination with conventional treatment) can stop or slow the development of many cancers. Research also shows that some people who have had cancer may be at an increased risk of other health problems, such as heart disease or type 2 diabetes.

While more research needs to be done in this area, the lifestyle changes recommended for cancer prevention may also help reduce the risk of the cancer coming back or a new cancer developing. Such lifestyle changes can also help prevent other health problems. Make sure you see your GP for regular lifestyle health checks. Find out more at cutyourcancerrisk.org.au and see information about healthy living programs run by Cancer Council.

Maintain a healthy body weight

Obesity is a risk factor for a number of different cancers. A healthy body weight is important for reducing the risk of cancer recurrence and improving survival. The health risk associated with your body weight can be estimated using different techniques including waist circumference (see below) and body mass index (BMI). To calculate your BMI, go to healthdirect.gov.au and search for BMI calculator.

Keep in mind that some cancer treatments can affect your weight and waist circumference. Some people expect to lose weight during cancer treatment, but for many people it can have the opposite effect. Weight gained during cancer treatment can be difficult to lose because of fatigue and other challenges after cancer treatment. Whether you have lost or gained weight, it is important to work towards getting back to a healthy weight.

Treatment for some cancers can affect your ability to eat, digest food and absorb essential nutrients. You will need to try different foods and ways of eating to find out what works for you. You may need to change your eating habits, such as eating smaller meals more often throughout the day.

Waist circumference and health risk

Having fat around the abdomen or waist, regardless of your body size, means you are more likely to develop certain obesity-related health conditions, including cancer. Some cancer types are also associated with increased fat around the hips and buttocks.

Waist circumference can be used to indicate health risk. Place a measuring tape around your waist at the narrowest point between the lower rib and the top of the hips at the end of a normal breath.

Health risk – Women

  • Increased: 80 cm or more
  • Substantially increased: 88 cm or more

Health risk – Men

  • Increased: 94 cm or more
  • Substantially increased: 102 cm or more

Seeing a dietitian

Dietitians can help you with nutritional concerns, any ongoing problems with food and eating, or supervised weight loss. They are available in all public hospitals, and some private hospitals and community health centres. Ask at your local centre or see your GP for a referral. To find an Accredited Practising Dietitian in your area or with experience in particular problems, call the Dietitians Association of Australia on 1800 812 942 or visit daa.asn.au. Ask about Medicare rebates.

Have a healthy, well-balanced diet

Eat more fruit, vegetables, wholegrains and fibre

Fruit and vegetables are essential for a healthy, balanced diet. They are a great source of fibre, vitamins and minerals. Fruit and vegetables also contain natural protective substances, such as antioxidants, that can prevent damage to DNA and other cells, and destroy cancer-causing agents (carcinogens) and cancer cells. Fruit and vegetables are low in kilojoules – eating them can help you maintain a healthy body weight.

Dietary fibre can help to ensure a healthy digestive system and reduce the risk of bowel cancer. Eating a diet high in fibre, including fruit, vegetables and wholegrain cereals, can also lower your risk of developing type 2 diabetes and heart disease, and help you maintain a healthy body weight. Some people experience ongoing bowel problems after cancer treatment (e.g. surgery or radiation therapy to the pelvis). If you find that dietary fibre makes any bowel problems worse, you may need to eat low-fibre foods.

The Australian Dietary Guidelines (eatforhealth.gov.au) recommend eating at least two serves of fruit and five serves of vegetables daily. Aim to eat a variety of different-coloured fresh fruit and vegetables. They are best eaten whole (i.e. not in a juice or supplement form), and a combination of cooked and raw vegetables is recommended. Frozen and tinned vegetables are still nutritious and are a good alternative. Look for varieties without added sugars, salt or fats.

The Australian Dietary Guidelines recommend that most adults eat at least four serves of cereal or grain foods each day, with at least two-thirds of these being wholemeal or wholegrain varieties.

How much is a serve?

Fruit & vegetables

  • 1 medium-sized piece of fruit
  • 2 smaller fruits, e.g. plum, apricot
  • 1 cup diced fruit 1/2 cup cooked vegetables
  • 1 cup raw salad vegetables

Cereal & grains

  • 1 slice of wholegrain bread
  • 1/2 cup cooked brown rice or wholemeal pasta
  • 2/3 cup wholegrain breakfast cereal

Meat (uncooked)

  • 100 g lamb loin chop
  • 100 g steak 1/2 cup diced red meat
  • 1/2 cup mince

Limit your intake of red meat and avoid processed meats

It is important to eat a balanced diet that is high in plant foods, such as fruit, vegetables and wholegrain cereals, but there is no need to give up meat. Lean red meat is an important contributor to dietary iron, zinc, vitamin B12 and protein.

Eating too much red meat increases your risk of bowel cancer. To reduce your cancer risk, Cancer Council recommends people eat no more than one serve of lean red meat per day or two serves 3–4 days a week (see above).

There is strong evidence that eating processed meats, such as ham, bacon and deli meats, is associated with an increased risk of bowel and stomach cancers.

There is no conclusive evidence that being a vegetarian has a positive impact on survival after cancer treatment. However, increasing your consumption of fruit, vegetables and wholegrain foods will probably improve the quality of your diet. If you are considering reducing the amount of meat in your diet, it is important to include a variety of other proteins. These include eggs, legumes, pulses, nuts, wholegrains, soya and dairy products.

Nutrition and Cancer has more information about eating well after cancer treatment.

How to improve your diet

  • Eat a variety of nutritious foods every day.
  • Eat plenty of fruit, vegetables, legumes, wholegrain and high-fibre foods.
  • Try reduced-fat milk, yoghurt and cheese, that are also low in added sugars or salt.
  • Limit your intake of red meat (see below).
  • Choose lean cuts of meat and trim as much fat as possible before cooking.
  • Cut out processed meats like ham, bacon and deli meats altogether or eat only rarely.
  • For breakfast, add fruit and yoghurt to wholegrain cereal or serve some vegetables with your eggs and toast.
  • Limit the portion size of your meals and snacks.
  • Adapt your recipes to include more vegetables, beans and legumes, e.g. add grated carrot and zucchini, celery, capsicum, beans or peas to pasta sauces.
  • Fill half your dinner plate with vegetables.
  • Swap sugary drinks for water.
  • Avoid snacks that are high in added fats, sugars and salt, such as chips, biscuits and chocolate. Replace them with nuts, fruit, yoghurt or cheese.
  • Limit takeaway foods that are high in fat, sugar and salt.
  • Don't add salt to food during cooking or before eating. Add flavour with herbs and spices.
  • Grill, poach and bake rather than fry.
  • Steam or microwave vegetables to maintain their nutritional goodness.
  • Use a non-stick frying pan or a small amount of polyunsaturated oil (e.g. olive oil) when pan-frying.

Be physically active

Being physically active and limiting sedentary behaviour is essential for health and wellbeing. Research shows that physical activity can both reduce the risk of some cancers and help prevent some types of cancer coming back. Physical activity also helps to prevent weight gain and obesity, which are risk factors for a number of cancers.

Physical activity has a range of other benefits for cancer survivors. It can boost energy levels, increase muscle strength, improve mobility and balance, relieve stress, reduce the risk of heart disease, improve sleep, and decrease fatigue, anxiety and depression.

For maximum cancer prevention benefits, Cancer Council recommends aiming for at least 60 minutes of moderate activity or 30 minutes of vigorous activity every day. This can be broken up into smaller episodes of at least 10 minutes each. Moderate activity includes brisk walking, swimming and even household chores. Vigorous activity includes football, netball, running and aerobics.

Doing any physical activity is better than doing none. Start physical activity slowly and build up gradually. Many people lose muscle strength during cancer treatment and find it harder to complete tasks of normal daily living. Strength-training (resistance) activities can be very useful to reverse losses in muscle strength.

If you are unsure if you are well enough to exercise or worried about disrupting your recovery, talk to your doctor about the type and amount of activity suitable for you. They may refer you to an exercise physiologist or physiotherapist. Ask about Medicare rebates.

How to be more active

  • Walk with a friend, join a walking group or walk to the corner shop instead of driving.
  • Break up long periods of sitting or screen time by standing up every half-hour.
  • Take the stairs instead of the lift or escalators.
  • Do vigorous housework and activities around the home, such as vacuuming, gardening or mowing the lawn.
  • Get off the bus or train one stop earlier or park further away from your destination and walk the rest of the way.
  • Join a dance or yoga class.
  • Take your children or grandchildren to the park or kick a ball around the backyard.
  • Join an exercise group or a local gym.
  • Try short periods of aerobic exercise (e.g. walking, cycling or swimming), stretching, strength training (resistance exercises), Pilates and tai chi.
  • Talk to your GP before starting a new exercise program. A physiotherapist or exercise physiologist can develop a program that is right for you.
  • If you are being physically active outdoors, remember to protect your skin.
  • See Exercise for People Living with Cancer for more information.
  • Call 13 11 20 to find out about survivorship programs in your area.
"I was not as active before cancer as I am now. I walk three or four times a week. It gives me extra energy and helps clear my mind." – Rima

Quit smoking

If you smoke, Cancer Council strongly recommends that you quit. There is no safe level of tobacco use. Research shows that continuing to smoke increases your risk of developing another type of cancer.

There are many benefits to quitting smoking. Research indicates that quitting after a cancer diagnosis can increase your expected survival time and reduce your risk of developing a new second cancer.

Quitting smoking can also improve your ability to be more physically active and help reduce alcohol consumption, both of which can help you maintain a healthy weight.

Many people who smoke find quitting difficult. Seek support and don't be discouraged if it takes several attempts before you are able to quit for good. See quitting tips below.

How to quit smoking

  • Call Quitline on 13 7848 to talk to an advisor and request a free Quit Pack.
  • Ask your doctor for advice about subsidised medicines to help you quit.
  • Set a date to quit. Tell your family and friends so they can support you.
  • Think of yourself as someone who doesn't smoke.
  • Make your home and car a smoke-free zone.
  • Buy a reward with the money you would spend on tobacco.
  • Keep a list of all the reasons you want to quit.
  • Consider previous quit attempts as practice. Learn from what did and didn't help.
  • Don't be tempted to "just have one".
  • Avoid tempting situations or plan how you'll react if you are tempted.
  • Distract yourself if you feel tempted, e.g. going for a walk, having a drink of water.
  • Get support online – visit quitcoach.org.au or icanquit.com.au.
  • Download a smartphone app such as My QuitBuddy to help you track your progress.
"Being diagnosed with stomach cancer gave me the incentive to give up smoking...I feel so much fitter." – Tim

Use sun protection

Skin cancer is the most common cancer in Australia. The main risk factor associated with all types of skin cancer is overexposure to ultraviolet (UV) radiation from the sun. When UV levels are 3 and above, Cancer Council recommends you use a combination of sun protection measures when outdoors for more than a few minutes to reduce your skin cancer risk (see below).

Some exposure to the sun is healthy. Vitamin D, which is needed to develop and maintain healthy bones, is produced in the body when skin is exposed to UV radiation in sunlight. UV levels vary across Australia, according to the location, the season and the time of day. This means the amount of time you need to be in the sun to make enough vitamin D will vary. Short incidental sun exposure, such as walking from the office to get lunch on most days of the week, can be a good way to maintain vitamin D levels.

Protecting your skin from the sun

When UV levels are 3 or above, be SunSmart. Find a way to make sun protection part of your everyday routine, e.g. by having sunscreen and a broad-brimmed hat within easy reach before going outside.

SLIP on clothing

Wear clothing that covers your shoulders, neck, arms, legs and body. Choose closely woven fabric or fabric with a high ultraviolet protection factor rating.

SLOP on sunscreen

Use an SPF 30+ or higher broad-spectrum sunscreen. Use a water-resistant product for sports and swimming. Apply a generous amount of sunscreen 20 minutes before going out and reapply every two hours, or after swimming or any activity that causes you to sweat or rub it off.

SLAP on a sun-safe hat

Wear a hat that shades your face, neck and ears. This could be a wide-brimmed, bucket or legionnaire-style hat. Adult hats should have at least a 7.5 cm brim. Hats for children aged under 8 years should have at least a 5 cm brim, and hats for children aged 8–12 should have at least a 6 cm brim.

SEEK shade

Use shade from trees, umbrellas, buildings or any type of canopy. Shade is very effective at reducing UV exposure, however, UV radiation is reflective and can bounce off surfaces, such as concrete, water, sand and snow. It is wise to use other forms of UV protection as well, such as sunscreen and clothing.

Check sun protection times every day

Use the SunSmart UV Alert to check daily sun protection times in your local area. It is available as a free smartphone app, online (sunsmart.com.au or bom.gov.au/uv) or in the weather section of daily newspapers.

SLIDE on sunglasses

Protect your eyes with sunglasses that meet the Australian Standard AS1067. Wraparound styles are best. Sunglasses should be worn all year round.

Sensitive skin

Some cancer treatments may make your skin more sensitive to the sun, causing it to burn or be damaged by the sun more quickly or easily than before. Ask your treatment team if this applies to you.

Limit or avoid alcohol

Many people drink alcohol to relax and socialise. However, drinking too much may lead to weight gain. Drinking alcohol also increases the risk of cardiovascular disease, type 2 diabetes, and some cancers. Even low levels of alcohol consumption can increase cancer risk, and the risk increases with every drink you consume.

Cancer Council recommends that you limit your alcohol consumption to reduce your risk of cancer. If you choose to drink alcohol, stick to the National Health and Medical Research Council guidelines and limit your intake to two standard drinks a day. One standard drink contains 10 grams of alcohol, but remember that drinks served at home, restaurants and bars are usually more than a standard drink – see alcohol.gov.au for a guide to standard drinks.

How to reduce your alcohol intake

  • Use water to quench thirst and sip alcoholic drinks slowly.
  • Alternate alcoholic drinks with a glass of water.
  • Set yourself a limit and stop once you've reached it.
  • Switch to light beer, dilute spirits with extra mixer and ice, or have a spritzer or shandy (wine or beer mixed with soda or mineral water).
  • Wait until your glass is empty before topping it up to keep count of your drinks.
  • Have a few alcohol-free days each week.
  • Eat while you drink to slow your drinking pace and fill yourself up.
  • Offer to be the designated driver so that you limit your alcohol intake or don't drink.

Key points

  • You can reduce your cancer risk after treatment and improve survival through healthy lifestyle choices.
  • Whether you have lost or gained weight during treatment, it is important to return to a healthy weight.
  • Eating a variety of vegetables, fruit, wholegrain breads, cereals, pasta, rice and other foods low in fat, salt and sugar helps to maintain a healthy body weight.
  • Eating more dietary fibre can help lower the risk of bowel cancer and ensure a healthy digestive system.
  • Limiting your intake of red meat and cutting out processed meats can reduce your risk of bowel cancer.
  • Physical activity is important to reduce your cancer risk and help manage your weight. It also helps boost energy levels, decrease fatigue, relieve stress and improve overall wellbeing.
  • Quitting smoking can have a significantly positive impact on your survival. There is no safe level of smoking. Support is available to help you quit.
  • Being SunSmart every day and protecting your skin from the sun will lower your risk of skin cancer.
  • Alcohol is a known risk factor for cancer. Limiting or avoiding alcohol will reduce the risk of cancer and improve your general health and wellbeing.
  • Talk to your GP about the support they can provide to help you take control of your wellness.

R eviewed by: Dr Haryana Dhillon, Senior Research Fellow, Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, University of Sydney, NSW; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Jessica Barbon, Dietitian, Southern Adelaide Health Network, SA; Dr Anna Burger, Liaison Psychiatrist and Senior Staff Specialist, Psycho-oncology Clinic, Canberra Region Cancer Centre, ACT; Elizabeth Dillon, Social Worker, Peter MacCallum Cancer Centre, VIC; Prof Paul Glare, Chair in Pain Medicine and Director, Pain Management Research Institute, University of Sydney, NSW; Nicole Kinnane, Nurse Coordinator, Gynaecology Services, Peter MacCallum Cancer Centre, VIC; Amanda Piper, Manager, Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, VIC; Kyle Smith, Exercise Medicine Research Institute, Edith Cowan University, WA; Aaron Tan, Consumer; Dr Kate Webber, Medical Oncologist and Research Director, National Centre for Cancer Survivorship, NSW.


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