For some people, surviving cancer can be a teachable moment, a chance to correct unhealthy habits. “The wake-up call can be answered with improved dietary and other behaviors, or with denial and self-delusion, or, a little of both,” noted Lawrence J. Cheskin, MD, chair of the Department of Nutrition and Food Studies at the George Mason University [email communication, November 2020].

It appears, from an analysis of food consumption, that most Americans who survived cancer did not answer the wake-up call by implementing healthy changes to their eating behaviors, but they believed they had. These findings, and their potential for clinical effects on the health of the 15.5 million cancer survivors in the United States, were published in the European Journal of Clinical Nutrition.1


To assess the quality and perception of diets among cancer survivors, data from the National Health and Nutritional Examination Survey (NHANES) collected between 2005 and 2014 were analyzed. The NHANES assessed nutrition and health information from approximately 10,000 Americans every 2 years.

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The Healthy Eating Index (HEI)-2010 score was used to quantify diet quality on the basis of 24-hour consumption recall, in which scores between 100 and 80 indicated an excellent diet and lower than 50, a diet that needed improvement. This study concentrated on the HEI subcategories of fruits (maximum 5 points), vegetables (maximum 5 points), whole grains (maximum 10 points), and empty calories (maximum 20 points). Participants were asked to self-assess the quality of their diet by rating it between 5 (excellent) and 1 (poor).


Among the 25,475 participants surveyed, 2361 were cancer survivors. Compared with the general population, those who had survived cancer were significantly older (P <.0001), more likely to be women (P <.0001), to be White (P <.0001), and to have a higher level of education (P <.0001) and income (P <.0001).

The average HEI score among cancer survivors was 52.63 (95% CI, 50.37-54.89) in 2005 and increased to 55.26 (95% CI, 52.71-57.8) in 2014. Despite this temporal increase of 0.729 (P =.0193) points per year, the diets of cancer survivors were on the whole not particularly healthful. The investigators observed that survivors were consuming more whole grains (temporal trend, 0.19; P =.0319) and empty calories (temporal trend, 0.356; P =.0179) and fewer fruits (temporal trend, –0.91; P =.1909) and vegetables (temporal trend, –0.013; P =.7958) over time.

These survivors reported their diet was excellent (11.66%), very good (29.67%), good (38.02%), fair (16.96%), and poor (3.69%). The agreement between a person’s self-assessment and quantified HEI score was poor (k, 0.06; 95% CI, 0.02-0.09), and was lowest among men (k, 0.04; 95% CI, –0.02 to 0.08) and survivors of Hispanic ethnicity (k, 0.04; 95% CI, –0.06 to 0.15).

Survivors who were more likely to over-rate their diet were older (odds ratio [OR], 11.4; 95% CI, 10.01-10.2), with a higher educational attainment (OR, 1.32; 95% CI, 1.005-1.732), and of Hispanic ethnicity (OR, 1.792; 95% CI, 1.062-3.024).