Table 1.

Types of programs addressing physical activity, diet, or weight management for cancer survivors.

Program type	Description/examples	Cost coverage	Advantages	Limitations
Medically-based programs
Cancer rehabilitation	Services provided by a therapist, physiatrist, or interdisciplinary team with the goal of maintaining or restoring function, reducing symptom burden, maximizing independence, and improving quality of life	Covered as an essential health benefit under the Affordable Care Act, out-of-pocket cost sharing (i.e., co-pays) and other medical management often apply (65)	Highly personalized, matched to survivors’ needs and adapted to their health conditions	Availability and accessibility may be limited by costs, location, insurance plan, and time; likely not reimbursable for survivors without diagnosable impairments (e.g., those interested in health promotion); insufficient workforce of providers with cancer-specific training
Oncology dietitian services	Nutrition assessment and counseling from a registered dietitian nutritionist (RDN), including certified specialists in oncology (CSO)	Outpatient oncology dietitian services not routinely covered by insurance, may be offered at no charge to the patient in some cancer treatment settings	Highly personalized, matched to survivors’ needs and adapted to their health conditions	Limited accessibility, referral-based model requires health care provider to recognize a need (84), insufficient workforce of RDNs with cancer-specific training, outside of major cancer centers survivors may be required to pay for services
Weight loss, lifestyle change in non-oncology settings	Primary care provider obesity screening, weight loss counseling, reduction of behavioral cardiovascular risk factors; medical weight loss programs (which can include counseling, meal replacements, medication); bariatric surgery	Primary care obesity screening and counseling covered at no cost to the patient in most marketplace and employer-based plans and in Medicare for those with BMI ≥30, dietary and physical activity counseling covered at no cost to the patient in most marketplace and employer-based plans and in Medicare for patients with cardiovascular disease risk factors; some but not all costs of medical weight loss programs may be covered by insurance; Medicare and many Medicaid and private insurance plans cover bariatric surgery for patients with severe obesity or obesity-related co-morbidities	Primary care counseling is convenient and accessible to patients, integrated into health care. Bariatric surgery can produce large weight losses.	Services are not cancer-specific; few primary care providers have sufficient time and training and thus do not adequately implement evidence-based guidelines for weight loss counseling (34, 85)
Community-based programs
Not-for-profit programs	Group or individual programming with exercise specialist, RDN, or health educator; Example: LIVESTRONG at the YMCA, 12-week lifestyle change program, shown to increase physical activity and improve quality of life and fitness (86)	Historically offered free of charge or at low cost to survivors	Cancer-specific focus, community-based locations may be more convenient for survivors, provide in-person assistance for survivors who may need in-person guidance in how to do exercises, change diet, etc.	Not available in all communities, lack of sustainable funding model for operational expenses, and lack of program standards/accreditation process, which may make it difficult for survivors and their providers to judge program quality, safety, and appropriateness
Worksite programs	Employers may include programs for cancer survivors as part of their health and wellness programs; Example: the World Bank’s global headquarters provided a 6-week lifestyle program “Back to Life”, which included consultation with an exercise specialist, and individual exercise plan, group sessions twice a week focusing on lifestyle change strategies, strength training and balance, and stress relief. Half of participants reported a decline in fatigue and 65% demonstrated reduction in waist circumference (87), cancer survivors may also participate in health and wellness programs provided for the general employee population in their worksite	May be offered at no cost or with cost sharing	Convenient for participants, participating with co-workers may provide built-in social support (88), cancer-specific programs responsive to the needs of survivors	Cancer-specific worksite programs are not widely available, worksite wellness programs may be less available/accessible to low-income workers and small business, large proportion of cancer survivors are retired so unable to access worksite programs
Commercial programs	Examples include Weight Watchers, Curves	Survivor generally pays for the program or membership; some insurance or Medicare Advantage plans may cover the cost of gym memberships	Convenient for participants, studies with survivors have shown that both Weight Watchers and Curves were effective for cancer survivors when combined with some cancer-specific content (41, 89)	Not known if they are effective without cancer-specific content, costly for participants, some programs are reputable, but there are many commercial weight loss programs that do not use evidence-based methods
Home-based programs
Cancer-specific programs	Provides information, resources and guidance through print materials, web-based or mobile apps, telephone coaching peer support and equipment/devices to support behavior change, e.g., activity monitors, food scales. Example: RENEW, a program for older cancer survivors to increase physical activity, improve diet quality, and promote modest weight loss, shown in research to benefit physical functioning and quality of life (21, 90)	To date such programs have been available only through research studies, at no cost to participants. No current insurance coverage for this type of program	Strong research support for effectiveness of these programs on lifestyle behavior, functioning, and quality of life (72, 73, 91–94), convenient for participants, fewer geographic, time, and physical barriers to participation than with in-person programs	Dissemination of these programs has been limited, no sustainable model for intervention delivery has been identified, may not be appropriate for survivors with more serious impairments/comorbidities
Non-cancer specific	Websites, mobile apps, print information available to the general public; Example: ChooseMyPlate.gov, My Fitness Pal	Some sources are free, while other have fees that are not reimbursed by insurance	Convenient for participants, fewer geographic, time, and physical barriers to participation than with in-person programs	Minimal cancer specific information, not all products use evidence-based methods (95), survivors must be motivated to seek out and use these resources