A major new study published in JAMA Network Open has delivered a sobering message: the United States continues to experience dramatically higher death rates than other high-income countries, despite enormous healthcare spending and access to advanced medical technology.
The study analyzed more than 63.5 million deaths in the United States between 1999 and 2022 and found that the US experienced more than 12.6 million “excess deaths” compared with peer nations. The leading contributors were circulatory diseases, metabolic diseases, obesity-related illnesses, diabetes, and conditions associated with poor lifestyle health.
For the exercise oncology community, this publication should serve as a wake-up call.
While this paper was not specifically focused on cancer survivors, its findings strongly reinforce why Exercise Oncology Programs may represent one of the most important opportunities to reduce long-term mortality among cancer patients and survivors.
Cancer survivors are particularly vulnerable to the exact diseases driving America’s mortality crisis.
The Overlooked Problem in Cancer Survivorship
Modern oncology has made tremendous progress in improving cancer survival. Millions of patients are now living years and decades after treatment. However, many survivors do not ultimately die from recurrent cancer alone. Instead, they frequently develop:
- Cardiovascular disease
- Diabetes and metabolic dysfunction
- Obesity and sarcopenia
- Frailty and functional decline
- Depression and social isolation
- Physical inactivity–related chronic disease
This new JAMA analysis found that circulatory disease alone accounted for 40% of all excess deaths in the US in 2022. Diabetes, kidney disease, and metabolic disorders accounted for another 13%.
These are precisely the conditions that structured exercise programs are known to improve.
Exercise is no longer simply a “wellness recommendation.” It is increasingly becoming a medically important intervention capable of improving survival, reducing complications, and improving quality of life.
Why Exercise Oncology Matters
Cancer treatments themselves can accelerate many of the chronic diseases identified in this report.
Chemotherapy, hormonal therapy, immunotherapy, radiation, and prolonged inactivity may contribute to:
- Loss of muscle mass (sarcopenia)
- Weight gain and adverse body composition
- Insulin resistance
- Cardiovascular dysfunction
- Reduced mobility and endurance
- Chronic fatigue
- Anxiety and depression
Exercise Oncology Programs directly target many of these risks.
Research over the past decade has shown that structured exercise can:
- Improve cardiovascular fitness
- Reduce cancer-related fatigue
- Improve insulin sensitivity and metabolic health
- Preserve muscle mass and strength
- Improve treatment tolerance
- Reduce frailty
- Improve emotional health
- Potentially reduce cancer recurrence and improve survival in some cancers
Importantly, exercise may also help address the “years of life lost” problem emphasized in this study. The investigators reported that excess US deaths accounted for nearly 22 million excess years of life lost in 2022 alone.
Exercise programs that preserve physical function, mobility, and cardiometabolic health could potentially have a major effect on these outcomes for cancer survivors.
Exercise Oncology Is Also a Public Health Strategy
One of the most striking conclusions of the paper was that many excess deaths in the United States may be preventable through better health and social policies.
Exercise Oncology Programs should now be viewed through this larger public health lens.
These programs are not simply supportive care services. They may represent scalable interventions capable of reducing:
- Cardiovascular mortality
- Obesity-related disease
- Metabolic disease
- Physical disability
- Healthcare utilization
- Long-term survivorship complications
Cancer centers that integrate structured exercise into standard cancer care could potentially improve outcomes far beyond cancer itself.
The Future of Cancer Care Must Include Exercise
The evidence supporting exercise in oncology continues to grow rapidly. Yet many cancer patients still finish treatment without:
- A physical activity assessment
- A referral to an exercise program
- Body composition monitoring
- Strength testing
- Cardiometabolic risk evaluation
- Long-term survivorship fitness planning
That must change.
The healthcare system can no longer afford to separate cancer treatment from long-term health optimization.
If the United States hopes to reduce the chronic disease burden driving excess mortality, Exercise Oncology Programs should become a routine part of comprehensive cancer care.
Call to Action
Cancer survivors deserve more than simply surviving cancer.
They deserve programs that help them remain physically strong, metabolically healthy, independent, and alive for as long as possible.
Exercise Oncology Programs may become one of the most important tools available to reduce not only cancer-related complications, but also the cardiovascular and metabolic diseases now driving America’s excess death rates.
The future of cancer care should not only focus on destroying tumors.
It must also focus on rebuilding health. Reference: Causes of Excess Deaths in the US Compared With Other High-Income Countries. Jacob Bor, PhD; Rafeya V. Raquib, MS; David Himmelstein, MD; Steffie Woolhandler, MD; Andrew C. Stokes, PhD, JAMA Network Open. 2026;9(5):e266147. doi:10.1001/jamanetworkopen.2026.6147
