Although the diet of the average cancer survivor was slightly better than that of the general population, the mean HEI score was close to the ‘needs improvement’ margin. The American Cancer Society’s guidelines for cancer survivors are to implement informed lifestyle decisions that assure the long-term success of their cancer therapy.2 These lifestyle decisions include weight management, physical activity, and a healthful diet high in vegetables and fruits. These survivors, however, reported eating half the daily recommended portion of fruits and vegetables.

Dr Cheskin, coauthor of this study, stated that he and his colleagues were surprised by these findings, adding that “awareness of this is important.”

Objective self-assessment is often difficult, biased by the engrained generational, socioeconomic, gender, and ethnic perceptions that likely alter personal optimums. A person’s perspective plays a vital role in correcting any behavior, if they believed they were already consuming a healthy diet, there is nothing to correct. More than half (56%) of these cancer survivors thought their diet was healthier than it actually was.

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Together, these findings indicated there remains a need for reevaluating current guidelines for which methods are effective for conveying the specific dietary requirements of a cancer survivor, targeted at addressing the high penetrance of diet quality overestimation and the inherent demographic biases that influenced preexisting dietary habits. These communication methods should be incorporated into routine clinical care such that all cancer survivors are adequately counseled.

By maintaining a high-quality diet, perhaps more patients may sustain their cancer survivor status, because, as Dr Cheskin asserted “there is no health without proper diet, and that may be particularly important for cancer survivors.”


1. Xue H, Liu J, Cheskin LJ, Sheppard VB. Discrepancy between perceived diet quality and actual diet quality among US adult cancer survivors. Eur J Clin Nutr. 2020;74(10):1457-1464. doi:10.1038/s41430-020-0619-2

2. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA A Cancer J Clin. 2012;62(4):243-74. doi:10.3322/caac.21142