A new national survey identifies major gaps in oncology nutrition care, and offers an important blueprint for organizing comprehensive Exercise Oncology Programs
Exercise oncology is increasingly recognized as an essential component of comprehensive cancer care. But exercise cannot operate in isolation. Maintaining muscle mass, supporting treatment tolerance, managing weight, combating fatigue, and restoring physical function all depend, to varying degrees, on adequate nutrition.
A 2026 study published in the Journal of the Academy of Nutrition and Dietetics, “Nutrition Services in Oncology: A Cross-Sectional Survey of Patient Experiences, Needs, and Gaps in Care,” provides compelling evidence that nutrition services remain inconsistently integrated into cancer care. The study is particularly important for organizations developing Exercise Oncology Programs because it demonstrates why exercise and nutrition services should be deliberately connected within a multidisciplinary model of care.
What Did the Researchers Study?
Researchers analyzed survey responses from 1,427 U.S. cancer survivors participating in the Cancer Experience Registry. The study examined whether survivors had received professional nutrition care, whether their needs were met, when they wanted nutrition support, and what types of assistance they wanted. The population was predominantly female and non-Hispanic White, with breast, blood, and gastrointestinal cancers being the most common diagnoses.
The results expose an important gap.
Only 53.6% of participants reported receiving any professional nutrition care following their cancer diagnosis, and only 39.3% had received care from a registered dietitian nutritionist (RDN). Nearly half (46.4%) reported receiving nutrition services from none of the provider categories examined.
Among all participants:
- 41.0% said their nutrition needs had been met.
- 13.4% reported wanting nutrition care but not receiving it.
- 33.2% perceived no need for nutrition services.
- 12.5% were unsure whether they needed nutrition assistance.
That last finding deserves attention. Almost half of survivors either did not perceive a need for nutrition care or were uncertain about it. This suggests that simply making nutrition services available may not be enough. Patient education and proactive assessment may also be necessary.
The Need Doesn’t End When Treatment Ends
One of the most important findings for survivorship programs concerns when patients want help.
Among survivors who desired nutrition care, demand was greatest during active treatment. However, nutrition needs remained substantial after treatment, and unmet need was actually more commonly reported in the post-treatment period. Among those whose needs were unmet, 52.9% wanted nutrition support after treatment, compared with 41.2% among patients whose needs had been met.
This is highly relevant to Exercise Oncology Programs, many of which engage patients during the transition from active treatment into long-term survivorship.
Cancer rehabilitation does not end with the last chemotherapy infusion or radiation treatment. Survivors may be trying to rebuild muscle, improve cardiovascular fitness, regain energy, manage changes in body composition, establish healthier eating patterns, and address the long-term physical consequences of treatment.
Nutrition and exercise therefore represent complementary components of recovery.
Patients Want More Than Advice About Food
Another revealing finding is the breadth of concerns associated with nutrition.
Survivors with unmet needs were significantly more likely to want help with increasing energy, emotional health, concerns about cancer recurrence or progression, and weight loss.
These issues overlap substantially with the goals addressed by Exercise Oncology Programs.
A patient experiencing fatigue, loss of strength, unwanted changes in body composition, or difficulty maintaining adequate nutrition cannot always be managed effectively through an exercise prescription alone. Conversely, nutrition counseling without attention to physical activity, muscle function, and conditioning may address only part of the problem.
The lesson is straightforward: exercise and nutrition should be coordinated rather than delivered as separate supportive-care silos.
The Patients With the Greatest Needs May Have the Greatest Barriers
The study also uncovered disparities. Unmet nutrition needs were more common among younger patients, women, people experiencing very low food security, those without caregiver support, patients with greater symptom burden, and individuals treated in private oncology practices.
The authors further note that RDN engagement was lower among patients without caregiver support and those receiving care in community or private-practice settings. They suggest that expanding access through approaches such as telehealth could help address disparities, particularly for community-based and rural populations.
This is an organizational issue, not simply a patient responsibility.
What This Means for Exercise Oncology Programs
This publication provides an important framework for how Exercise Oncology Programs should be designed.
A comprehensive program should not simply place an exercise professional in a fitness facility and wait for oncology referrals. Instead, it should develop a coordinated pathway that connects oncology, exercise professionals, registered dietitian nutritionists, rehabilitation specialists, behavioral health resources, and survivorship care.
Several organizational principles emerge from this research:
- Nutrition screening should be systematic. Patients entering an Exercise Oncology Program should be assessed for nutrition-related risk rather than referred only when malnutrition becomes obvious.
- RDN referral pathways should be built into the program. The researchers specifically call for standardized screening and clear referral mechanisms to improve timely access to specialized nutrition care.
- Screening should continue across the cancer continuum. Needs change from diagnosis to treatment, recovery, recurrence, advanced disease, and long-term survivorship.
- Exercise and nutrition assessments should inform one another. Loss of muscle, fatigue, weight changes, inadequate caloric or protein intake, and treatment-related symptoms can directly affect an individual’s ability to participate safely and effectively in exercise.
- Programs need hybrid delivery models. Telehealth and shared-care approaches may extend RDN expertise into community oncology practices and other resource-constrained environments. The authors specifically identify these models as priorities for future implementation research.
- Programs should address social determinants of health. Food insecurity, caregiver availability, education, geography, and treatment setting can influence whether patients receive supportive care. Exercise Oncology Programs should therefore consider screening and referral pathways for community resources, not merely exercise prescriptions.
From Exercise Program to Integrated Cancer Care
Perhaps the most important organizational message from this study is that the future of exercise oncology should be multidisciplinary.
Exercise professionals can identify declining strength, endurance, mobility, and functional capacity. Dietitians can identify inadequate intake, malnutrition risk, weight and body-composition concerns, and nutrition-impact symptoms. Oncology clinicians provide the medical context. Behavioral and psychosocial professionals can address the emotional and motivational barriers that influence both eating and physical activity.
Connecting these disciplines creates something more powerful than any single intervention.
Importantly, the authors themselves conclude that RDNs should be integrated into care teams throughout the cancer continuum and that patient awareness of available nutrition services needs to improve. They also emphasize disparities related to socioeconomic resources, caregiving support, food security, symptom burden, and care setting.
The study has limitations: it was cross-sectional and relied on self-reported information, and its participants were disproportionately female, non-Hispanic White, and breast cancer survivors. The researchers therefore caution against assuming that the prevalence estimates precisely represent the entire U.S. cancer population.
Nevertheless, its message for program development is powerful.
Exercise Oncology Programs should not be organized as exercise-only programs. They should become gateways to coordinated supportive cancer care, with exercise and nutrition functioning as closely integrated components from treatment through long-term survivorship.
Call to Action
At CancerFitness.org, we believe the next generation of Exercise Oncology Programs should move beyond simply telling people with cancer to “exercise more.”
Cancer centers, community oncology practices, healthcare systems, fitness organizations, and survivorship programs should develop structured multidisciplinary pathways that combine individualized exercise assessment and prescription with nutrition screening, access to oncology-trained registered dietitian nutritionists, symptom management, behavioral support, and long-term follow-up.
For patients and survivors, ask your cancer care team not only “How should I exercise?” but also “Should I meet with an oncology dietitian?”
For healthcare organizations developing Exercise Oncology Programs, the challenge is larger: build nutrition into the program from the beginning rather than adding it later.
Exercise and nutrition are not competing supportive therapies. Together, they can form two foundational pillars of comprehensive cancer rehabilitation and survivorship care.
CancerFitness.org : Making personalized exercise and comprehensive supportive care part of the cancer treatment journey.
Reference: Nutrition Services in Oncology: A Cross-Sectional Survey of Patient Experiences, Needs, and Gaps in Care. Bailey M. Foster, MS, RD; Melissa F. Miller, PhD, MPH; Colleen K. Spees, PhD, RD; Cynthia A. Thomson, PhD, RD; et al. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS October 2026 Volume 126 Number 10
