Review ArticleReview
Open Access

The Impact of Exercise and Diet on Ovarian Cancer Mortality

JOHN P. MICHA, RANDY BOHART and BRAM H. GOLDSTEIN
Anticancer Research April 2026, 46 (4) 1763-1768; DOI: https://doi.org/10.21873/anticanres.18072

Abstract

Ovarian cancer is the most aggressive gynecologic malignancy, with reported 5-year survival rates approaching 32%. Despite the incremental benefits associated with novel therapies, lifestyle improvements (e.g., nutrition, exercise) potentially further bolster ovarian cancer patient outcomes and address an unmet clinical need. In the current review, we evaluated several available studies involving the impact of nutritional enhancement and exercise adoption on ovarian cancer survival. There is purported evidence to support the inclusion of exercise and improved nutrition in bolstering ovarian cancer survival outcomes. However, there are also countervailing data that confound the precise, independent value of these lifestyle changes on ovarian cancer survival, not to mention the specific circumstances under which ovarian cancer patients may derive a benefit. Additional research should evaluate the presumed ovarian cancer survival benefits from nutrition and exercise via randomized controlled trials.

Keywords:

Introduction

There were approximately 20,890 cases of ovarian cancer diagnosed in the United States during 2024, to which 12,740 patient deaths were attributed (1). Despite the benefits from surgery and platinum-taxane chemotherapy with targeted agents, the 5-year survival rate in advanced-stage ovarian cancer remains unfavorable (2). Accordingly, researchers have studied the impact of modifiable risk factors (e.g., exercise, nutrition) in endeavoring to reduce cancer risk and enhance overall survival (3-5).

Lifestyle improvements, namely adherence to nutritional and exercise regimens, reportedly benefit patient outcomes, especially in ovarian cancer (6-9). In a Women’s Health Initiative study (6), investigators recounted that increased consumption of fruit, vegetables and fiber coincided with a 37% lower incidence of all-cause mortality from ovarian cancer. The results were also borne out with increased exercise, wherein ovarian cancer patients who were physically active exhibited improved cancer-specific mortality (10). Despite these promising results, additional research has indicated these potential benefits (11).

Methods

The purpose of this study was to evaluate the impact of enhanced nutrition and improved exercise on ovarian cancer risk and survival. We conducted an extensive PubMed search primarily comprising several review articles and randomized controlled trials (RCTs) on the topics of exercise and ovarian cancer outcomes, nutrition and ovarian cancer survival from 2018-2025. The primary objective of this review was to analyze the impact of nutrition and exercise on ovarian cancer outcomes.

Inflammation and Immunity in Ovarian Cancer

Oncology patients are often nutritionally compromised, and thus, quite susceptible to malnutrition, sarcopenia, and cachexia (12, 13). These secondary conditions may be further exacerbated by inflammation and poor immunity, two distinct mechanisms implicated in the development and progression of cancer (14-16). For example, exercise-induced epinephrine activates NK cells, actuating cellular infiltration, bolstering the immune response, and inducing tumor suppression (17). Morrison et al. chronicled their experience with a murine model, indicating that exercise impacts C-C motif chemokine ligand 2 (CCL2) and Interleukin-15 (IL-15), thereby impeding peritoneal cancer cell viability (5).

In two, prospective Nurses Health studies (18), researchers measured the impact of nutritional quality (i.e., a pro-inflammatory diet) on survival in 1003 ovarian cancer patients via the empirical dietary inflammatory pattern and Alternative Healthy Eating Index. They reported that a high pre-post-diagnosis inflammatory score was associated with an increased risk for ovarian cancer-specific mortality [hazard ratio (HR)=1.58, 95% confidence interval (CI)=1.09-2.30] and all-cause mortality (HR=1.55, 95%CI=1.10-2.19).

Nutritional Benefits in Ovarian Cancer

Cao et al. conducted a prospective study that included 1107 ovarian cancer patients who were evaluated with the Healthy Eating Index, the Mediterranean diet score, and Dietary Approaches to Stop Hypertension score, while endeavoring to discern the impact of nutritional quality on ovarian cancer risk and survival (3). The researchers documented that an enhanced pre-diagnosis diet was associated with improved all-cause mortality according to the Healthy Eating Index (HR=0.75, 95%CI=0.60-0.93) and alternate Mediterranean diet score (HR=0.68, 95%CI=0.53-0.87).

Thomson et al. evaluated dietary quality via the Healthy Eating Index on all-cause mortality in 636 patients with ovarian cancer (6). Ultimately, the researchers indicated that improved diet quality coincided with reduced all-cause ovarian cancer mortality (HR=0.73; 95%CI=0.55-0.97, p trend=0.03). Qin et al. reported the outcomes of 60 women with ovarian cancer undergoing chemotherapy in an RCT. The patients who received a 15-week intervention comprising oral nutritional supplements and education exhibited a significant improvement in their Patient Generated-Subjective Global Assessment (PG-SGA) score (HR=2.77, 95%CI=2.28-3.25, p<0.001) compared to the control group (i.e., nutritional education only) (19).

Playdon et al. (20) reported similar outcomes with 811 patients with ovarian cancer, who demonstrated improved survival with higher consumption of fiber (HR=0.69, 95%CI=0.53-0.90, p-trend=0.002), vegetables (HR=0.79, 95% CI=0.62-0.99), and fish (HR=0.74, 95%CI=0.57-0.95), whereas survival was compromised in patients who adopted a high-glycemic diet (HR=1.28, 95%CI=1.01-1.65, p-trend=0.03). Johnston et al. investigated the inclusion of protein intake and the subsequent impact on ovarian cancer survival (21). In the 591 patients evaluated, higher protein consumption (e.g., 20% compared with ≤20% total protein) was associated with improved progression-free survival (adjusted HR=0.77, 95%CI=0.61-0.96) outcomes.

Exercise and Improved Ovarian Cancer Outcomes

Exercise reportedly improves cardiorespiratory fitness, health-related quality of life, and even survival in breast and colon cancers (22). Additionally, exercise theoretically mitigates chemotherapy-induced toxicity, thereby improving response rates and survival outcomes (23, 24). Clinically, studies have also reported that participating in an exercise regimen following a cancer diagnosis improves patient quality of life, thereby increasing the proclivity for individuals to successfully complete their chemotherapy regimen (25).

Ross et al. described their experience with the Ovarian cancer Prognosis And Lifestyle (OPAL) Study, wherein 503 patients with ovarian cancer reported their degree of sedentarism, exercise and treatment-associated side effects (26). High-intensity exercise (≥30 min of moderate-vigorous exercise/week) during chemotherapy coincided with greater survival rates (HR=0.68; 95%CI=0.47-1.01). Similarly, Zhou et al. (10) chronicled that patients with ovarian cancer (n=600) who engaged in physical activity (e.g., walking) following their diagnosis demonstrated a 26% lower risk of cancer-specific mortality ((HR=0.74; 95%CI=0.56-0.98) and a 24% lower risk of all-cause mortality (HR=0.76; 95% CI=0.58-0.98) compared to non-physically active patients.

Equivocal Ovarian Cancer Outcomes With Exercise

Cartmel et al. studied the impact of a 6-month exercise routine on ovarian cancer biomarkers [e.g., cancer antigen 125 (CA-125), C-reactive protein (CRP), insulin-like growth factor-1 (IGF-1, leptin) at baseline and at six months via an RCT (27)]. Once the exercise intervention was completed, IGF-1 [group difference in change: −14.2 (−26.1 to −2.3) ng/ml] and leptin [−8.9 (−16.5 to −1.4) ng/ml] values were dramatically reduced in the exercise cohort, although CA-125 (p=0.54), CRP (p=0.95), and insulin (p=0.37) levels were similar for the experimental and control groups; additionally, survival was equivalent with 70 months of follow-up (p=0.99).

Moorman et al. compared 638 patients with ovarian cancer to a control population while striving to discern if exercise impacted ovarian cancer survival (9). Physical activity before diagnosis did not affect overall ovarian cancer survival, although non-obese women who reported >2 h of exercise vs. <1 h/week of exercise derived a survival benefit (HR=0.69, 95%CI=0.47-1.00). Similarly, Abbott et al. conducted a case-control study involving 264 ovarian cancer survivors who reported on their recreational physical activity at diagnosis and at 12 months post baseline (28). The investigators remarked that neither exercise prior to diagnosis nor post-diagnosis influenced ovarian cancer mortality (HR <1.0 following covariate adjustment).

Equivocal Ovarian Cancer Outcomes With Nutrition

Crane et al. conducted a systematic review and reported no associations between ovarian cancer risk and the consumption of red meat, fiber, vitamin A, vitamin E, β-carotene, or folate (8). These results coincided with Cao et al. (3), who also did not report a relationship between pre-diagnosis diet status and ovarian cancer risk. While Thomson reported that overall diet quality was associated with improved mortality, this benefit precluded diabetic patients (6).

Johnston et al. evaluated the impact of increased protein and protein-related consumption on ovarian cancer outcomes but ultimately an association between protein consumption and patient disease recurrence or overall survival was not observed (21). Similarly, Al Ramadhani et al. assessed the survival of 503 patients with ovarian cancer who underwent dietary changes in a prospective study (29). After 4.4 years of follow-up, dietary modifications did not confer a survival benefit, irrespective of pre- or post-diagnosis diet quality.

Conclusion

The prognosis for advanced-stage ovarian cancer survival is inauspicious, with reported 5-year survival rates approaching 35% (1). Moreover, since many patients with ovarian cancer suffer from cachexia and reduced physical functioning, researchers have further suggested that the inclusion of exercise and enhanced nutrition potentially improves patient outcomes (6, 20, 26, 27, 30-32).

Nutrition reportedly improves ovarian cancer survival, but the presumed benefits may also be patient or disease-specific (6, 33). Thomson et al. reported that an improved dietary regimen benefitted ovarian survival outcomes, but not for patients with concurrent diabetes. Additionally, Nagle et al. reported that while nutrition substantively benefitted ovarian cancer mortality, these improvements were restricted to subjects with early-stage disease (33).

Exercise has also reportedly correlated with lower mortality rates in ovarian cancer, but the benefits may be circumstantial or case-dependent. Studies have further indicated that challenging or intensive exercise improves chemotherapy tolerability and surgical morbidity, but cumulative cytotoxic chemotherapy may preclude select patients with ovarian cancer from adhering to a vigorous, physical activity regimen (23, 24, 26).

There are compelling data to corroborate the adoption of a healthy, nutritional regimen (e.g., increased protein, fiber) and partake in moderate-vigorous exercise following an ovarian cancer diagnosis, especially while endeavoring to increase survival rates (20, 21, 26). While it remains uncertain as to whether nutrition or exercise uptake is more impactful in engendering improved ovarian cancer survival, perhaps the two lifestyle modifications confer a synergistic benefit. However, to further elucidate the precise contributions from nutrition and exercise in actuating favorable ovarian cancer outcomes, additional investigation with a randomized controlled trial is warranted.

Footnotes

  • Authors’ Contributions

    John Micha: conceptualization, supervision, original draft preparation- final manuscript review. Randy Bohart: content review, draft preparation- final manuscript review. Bram Goldstein: study supervision, original draft preparation, draft preparation- final review and editing of the manuscript.

  • Conflicts of Interest

    The Authors declare no potential conflicts of interest relevant to this article.

  • Artificial Intelligence (AI) Disclosure

    No sections involving the generation, analysis, or interpretation of research data were produced by generative AI. All scientific content was created and verified by the authors. Furthermore, no figures or visual data were generated or modified using generative AI or machine learning–based image enhancement tools.

  • Received November 4, 2025.
  • Revision received January 23, 2026.
  • Accepted February 3, 2026.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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The Impact of Exercise and Diet on Ovarian Cancer Mortality
JOHN P. MICHA, RANDY BOHART, BRAM H. GOLDSTEIN
Anticancer Research Apr 2026, 46 (4) 1763-1768; DOI: 10.21873/anticanres.18072
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